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Curr Hypertens Rep (2014) 16:426
DOI 10.1007/s11906-014-0426-z
PEDIATRIC HYPERTENSION (JT FLYNN, SECTION EDITOR)
Autonomic Nervous System Dysregulation in Pediatric Hypertension
Janusz Feber & Marcel Ruzicka & Pavel Geier &
Mieczyslaw Litwin
Published online: 16 March 2014# Springer Science+Business Media New York 2014
Abstract Historically, primary hypertension (HTN) has been prevalent typically in adults. Recent data however, suggests an increasing number of children diagnosed with primary HTN, mainly in the setting of obesity. One of the factors considered in the etiology of HTN is the autonomous nervous system, namely its dysregulation. In the past, the sympathetic nervous system (SNS) was regarded as a system engaged mostly in buffering major acute changes in blood pressure (BP), in response to physical and emotional stressors. Recent evidence suggests that the SNS plays a much broader role in the regulation of BP, including the development and maintenance of sustained HTN by a chronically elevated central sympathetic tone in adults and children with central/visceral obesity. Consequently, attempts have been made to reduce the SNS hyperactivity, in order to intervene early in the course of the disease and prevent HTN-related complications later in life.
Keywords Arterial hypertension . Autonomous nervous system . Sympathetic nervous system . Children
Introduction
Pediatric hypertension seems to be changing, mainly because of the childhood obesity epidemic [1]. In the past, the diagnosis of hypertension (HTN) was quite rare in childhood, and most hypertensive children suffered from secondary HTN [2]. Recent reports indicate however, that up to 91 % of children evaluated for HTN have no underlying cause identified [3], which suggests that the prevalence of primary HTN (PH) is increasing.
This epidemiologic shift revives the discussion and research on etiology and pathogenesis of HTN. Whilst secondary HTN has clearly defined pathologic entities, if identified, the etiology of primary HTN is still not completely understood. There are multiple factors which may cause or contribute to arterial HTN in children, including obesity, poor sleep quality, smoking, insulin resistance, sympathetic nervous system (SNS) activation, alteration in sodium homeostasis, changes in renin-angiotensin system (RAS), changes in endothelial function, hyperuricemia, genetic background, low birth weight and prematurity [4]. This suggests that primary HTN is a polyfactorial disease with a complex interplay between various pathogenetic mechanisms. In this article, we will focus...