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Journal of Pediatric Endocrinology and Metabolism

Editor-in-Chief: Kiess, Wieland

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Volume 30, Issue 2


The association between obesity, hypertension and left ventricular mass in adolescents

Saime Ergen Dibeklioglu / Berna Şaylan Çevik / Banu Acar
  • Department of Pediatric Nephrology, Ankara Children’s Hematology and Oncology Hospital, Ankara, Turkey
  • Other articles by this author:
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/ Zeynep Birsin Özçakar / Nermin Uncu
  • Department of Pediatric Nephrology, Ankara Children’s Hematology and Oncology Hospital, Ankara, Turkey
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Nazlı Kara
  • Department of Pediatric Nephrology, Ankara Children’s Hematology and Oncology Hospital, Ankara, Turkey
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/ Şemsa Çaycı
  • Department of Pediatric Nephrology, Ankara Children’s Hematology and Oncology Hospital, Ankara, Turkey
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Nilgün Çakar
Published Online: 2017-01-18 | DOI: https://doi.org/10.1515/jpem-2016-0170



Obesity and hypertension (HT) are well known cardiac risk factors. Our goal was to show that even if arterial blood pressure (BP) measurements of obese adolescents are normal during clinical examination, ambulatory blood pressure monitoring (ABPM) can be high, may include cardiac involvement and can also detect left ventricular mass indices (LVMI) value for obese adolescents to diagnose left ventricular hypertrophy (LVH).


This study included 130 children (57 obese hypertensive, 36 obese normotensive, 14 normal weight hypertensive and 23 normal weight normotensive). Adolescents whose BP was measured during clinical examination, after 24-h BP was detected using ABPM, were examined with echocardiography for calculation of LVMI to determine cardiac risk factors for LVH.


There was a significant difference between the LVMI of obese-normotensive and obese-hypertensive adolescents, which showed the effect of obesity on LVMI independent of HT. Twenty (35.7%) of 56 obese adolescents with HT detected with ABPM had normal BP measurements during clinical examination. Dipper and nondipper features of obese adolescents were significantly higher in ABPM than those with normal body mass index. When the cutoff LVMI value for LVH was set at ≥38 g/m2.7, 38.9% of obese-normotensive and 50.9% of obese-hypertensive subjects had LVH; however, when the cutoff value was set at ≥51 g/m2.7, the rates were 2.8% and 19.3%, respectively.


Obesity is a risk factor for LVH independent of HT. To identify masked HT, 24-h ABPM and cardiac examination should be routinely performed in obese adolescents. Using a limit of LVMI ≥38 g/m2.7 in evaluating LVH secondary to HT in obese individuals may lead to an overestimated diagnosis rate of LVH.

Keywords: adolescence; hypertension; left ventricular hypertrophy; left ventricular mass index; obesity


  • 1.

    Sorof JM, Poffenbarger T, Franco K, Bernard L, Portman RJ. Isolated systolic hypertension, obesity, and hyperkinetic hemodynamic states in children. J Pediatr 2002;6:660–6.Google Scholar

  • 2.

    Pascual M, Pascual DA, Soria F, Vicente T, Hernandez AM, et al. Effects of isolated obesity on systolic and diastolic left ventricular function. Heart 2003;10:1152–66.Google Scholar

  • 3.

    Bostanci BK, Civilibal M, Elevli M, Duru NS. Ambulatory blood pressure monitoring and cardiac hypertrophy in children with metabolic syndrome. Pediatr Nephrol 2012;27:1929–35.Google Scholar

  • 4.

    Ramaswamy P, Chikkabyrappa S, Donda K, Osmolovsky M, Rojas M, et al. Relationship of ambulatory blood pressure and body mass index to left ventricular mass index in pediatric patients with casual hypertension. J Am Soc Hypertens 2016;10:108–14.Google Scholar

  • 5.

    Kharod AM, Ramlogan SR, Kumar S, Raghuveer T, Drake W, et al. Childhood obesity increases left-ventricular mass irrespective of blood pressure status. Pediatr Cardiol 2014;35:353–60.Google Scholar

  • 6.

    Hanevold C, Waller J, Daniels S, Portman R, Sorof J, et al. The effects of obesity, gender, and ethnic group on left ventricular hypertrophy and geometry in hypertensive children: a collaborative study of the International Pediatric Hypertension Association. Pediatrics 2004;113:328–33.Google Scholar

  • 7.

    Ozturk C, Aparci M, Karaduman M, Balta S, Çelik T, et al. Relationship of systolic blood pressure and body mass index with left ventricular mass and mass index in adolescents. Angiology 2016;67:58–65.Google Scholar

  • 8.

    Wühl E, Witte K, Soergel M, Mehls O, Schaefer F, et al. Distribution of 24-h ambulatory blood pressure in children: normalized reference values and role of body dimensions. J Hypertens 2002;10:1995–2007.Google Scholar

  • 9.

    Sorof JM, Cardwell G, Franco K, Portman RJ. Ambulatory blood pressure and left ventricular mass index in hypertensive children. Hypertension 2002;4:903–8.Google Scholar

  • 10.

    Zhang R, Reisin E. Obesity-hypertension: the effects on cardiovascular and renal systems. Am J Hypertens 2000;13:1308–14.Google Scholar

  • 11.

    Alpert MA. Obesity cardiomyopathy: pathophysiology and evolution of the clinical syndrome. Am J Med Sci 2001;4:225–6.Google Scholar

  • 12.

    Crisostomo LL, Araújo LM, Câmara E, Carvalho C, Silva FA, et al. Left ventricular mass and function in young obese women. Int J Obes Relat Metab Disord 2001;2:233–8.Google Scholar

  • 13.

    Harada K, Orino T, Takada G. Body mass index can predict left ventricular diastolic filling in asymptomatic obese children. Pediatr Cardiol 2001;4:273–8.Google Scholar

  • 14.

    Kliegman RM. Overweight and obesity, 18th ed. Nelson Textbook of Pediatrics, 2006.Google Scholar

  • 15.

    Strauss RS. Childhood obesity. Pediatr Clin North Am 2002;1:175–201.Google Scholar

  • 16.

    Urbina E, Alpert B, Flynn J, Hayman L, Harshfield GA, et al. American Heart Association Atherosclerosis, Hypertension, and Obesity in Youth Committee. Ambulatory blood pressure monitoring in children and adolescents: recommendations for standard assessment: a scientific statement from the American Heart Association Atherosclerosis, Hypertension, and Obesity in Youth Committee of the council on cardiovascular disease in the young and the council for high blood pressure research. Hypertension 2008;52:433–41.Google Scholar

  • 17.

    Devereux RB, Alonso DR, Lutas EM, Gottlieb GJ, Campo E, et al. Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol 1986;6:450–8.Google Scholar

  • 18.

    National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 2004;114:555–76.Google Scholar

  • 19.

    Lurbe E, Alvarez V, Liao Y, Tacons J, Cooper R, et al. The impact of obesity and body fat distribution on ambulatory blood pressure in children and adolescents. Am J Hypertens 1998;11(4 Pt 1):418–24.Google Scholar

  • 20.

    Mitsnefes MM, Kimball TR, Kartal J, Witt SA, Glascock BJ, et al. Progression of left ventricular hypertrophy in children with early chronic kidney disease: 2-year follow-up study. J Pediatr 2006;5:671–5.Google Scholar

  • 21.

    Brady TM, Fivush B, Flynn JT, Parekh R. Ability of blood pressure to predict left ventricular hypertrophy in children with primary hypertension. J Pediatr 2008;152:73–8.Google Scholar

  • 22.

    Sherwood A, Gullette EC, Hinderliter AL, Georgiades A, Babyak M, et al. Relationship of clinic, ambulatory, and laboratory stress blood pressure to left ventricular mass in overweight men and women with high blood pressure. Psychosom Med 2002;2:247–57.Google Scholar

  • 23.

    Armario P, del Rey RH, Sánchez P, Martín-Baranera M, Torres G, et al. Determinants of left ventricular mass in untreated mildly hypertensive subjects: hospital study in mild hypertension. Am J Hypertens 1999;11:1084–90.Google Scholar

  • 24.

    Maggio AB, Aggoun Y, Marchand LM, Martin XE, Herrmann F, et al. Associations among obesity, blood pressure, and left ventricular mass. J Pediatr 2008;4:489–93.Google Scholar

  • 25.

    Crowley DI, Khuory PR, Urbina EM, Ippisch HM, Kimball TR. Cardiovascular impact of the pediatric obesity epidemic: higher left ventricular mass is related to higher body mass index. J Pediatr 2011;158:709–14.Google Scholar

  • 26.

    Chinali M, de Simone G, Roman MJ, Lee ET, Best LG et al. Impact of obesity on cardiac geometry and function in a population of adolescents: the Strong Heart Study. J Am Coll Cardiol 2006; 11:2267–73.Google Scholar

  • 27.

    Khoury PR, Mitsnefes M, Daniels SR, Kimball TR. Age-specific reference intervals for indexed left ventricular mass in children. J Am Soc Echocardiogr 2009;22:709–14.Google Scholar

  • 28.

    Richey PA, Disessa TG, Hastings MC, Somes GW, Alpert BS, et al. Ambulatory blood pressure and increased left ventricular mass in children at risk for hypertension J Pediatr 2008;152:343.Google Scholar

About the article

Received: 2016-05-04

Accepted: 2016-11-03

Published Online: 2017-01-18

Published in Print: 2017-02-01

Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

Research funding: None declared.

Employment or leadership: None declared.

Honorarium: None declared.

Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

Citation Information: Journal of Pediatric Endocrinology and Metabolism, Volume 30, Issue 2, Pages 167–174, ISSN (Online) 2191-0251, ISSN (Print) 0334-018X, DOI: https://doi.org/10.1515/jpem-2016-0170.

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