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Clinical Course, Management, and Outcomes of Pediatric Takayasu Arteritis Initially Presenting With Hypertension: A 16-year overview.
Am J Hypertens. 2019 09 24; 32(10):1021-1029.AJ

Abstract

BACKGROUND

To investigate the clinical features, management, and outcomes of childhood Takayasu arteritis (c-TA) initially presenting with hypertension.

METHODS

This study retrospectively reviewed medical charts of 96 inpatient c-TA cases from January 2002 to December 2016, with 5 additional patients being prospectively recruited from January 2017 to December 2017. Data were compared between c-TA groups initially presenting with and without hypertension. Blood pressure (BP) control, event-free survival, and associated risk factors were assessed by logistic regression, Kaplan-Meier survival curve, and COX regression models.

RESULTS

The hypertensive cohort (N = 71, 28.2% males) as compared with non-hypertensive cohort had significantly fewer active diseases; fewer episodes of claudication, syncope, blurred vision, and myocardial ischemia; and fewer systemic symptoms (P < 0.05). The hypertensive group presented with more localized abdominal lesions (OR = 14.4, P = 0.001) and limited supradiaphragmatic arterial involvement. Renovascular disease (P = 0.001) and revascularization (P = 0.006) were associated with hypertension. At the median 3-year follow-up, 53% of hypertensive patients achieved BP control and 39% experienced events including vascular complications, flares, or death. The 1-, 3-, 5-, and 10-year event-free survival were 78.7% (95% CI: 65.7%-87.2%), 63.0% (95% CI: 48.1%-74.7%), 48.9% (95% CI: 32.0%-63.8%), and 31.6% (95% CI: 13.8%-51.2%), higher than in non-hypertensive group (P = 0.014). Heart failure, stroke, and body mass index <18.5 kg/m2 were prognostic factors for events. Intervention and baseline systolic BP were independent factors for BP control (P < 0.05).

CONCLUSIONS

Majority of c-TA has hypertension, presenting with a more quiescent disease without typical systemic and/or ischemia symptoms, more localized abdominal lesions, higher proportion of revascularizations and better event-free survival. Three-year BP control is more than 50%. Intervention particularly on renal artery is beneficial for BP control and decreased events.

CLINICAL TRIAL REGISTRATION

Trial Number: NCT03199183.

Authors+Show Affiliations

Department of Hypertension, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.Department of Hypertension, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.Department of Hypertension, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.Department of Hypertension, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.Department of Hypertension, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.Department of Hypertension, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.Department of Hypertension, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.Department of Hypertension, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.Department of Hypertension, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

31278892

Citation

Fan, Luyun, et al. "Clinical Course, Management, and Outcomes of Pediatric Takayasu Arteritis Initially Presenting With Hypertension: a 16-year Overview." American Journal of Hypertension, vol. 32, no. 10, 2019, pp. 1021-1029.
Fan L, Zhang H, Cai J, et al. Clinical Course, Management, and Outcomes of Pediatric Takayasu Arteritis Initially Presenting With Hypertension: A 16-year overview. Am J Hypertens. 2019;32(10):1021-1029.
Fan, L., Zhang, H., Cai, J., Yang, L., Wei, D., Yu, J., Fan, J., Song, L., Ma, W., & Lou, Y. (2019). Clinical Course, Management, and Outcomes of Pediatric Takayasu Arteritis Initially Presenting With Hypertension: A 16-year overview. American Journal of Hypertension, 32(10), 1021-1029. https://doi.org/10.1093/ajh/hpz103
Fan L, et al. Clinical Course, Management, and Outcomes of Pediatric Takayasu Arteritis Initially Presenting With Hypertension: a 16-year Overview. Am J Hypertens. 2019 09 24;32(10):1021-1029. PubMed PMID: 31278892.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical Course, Management, and Outcomes of Pediatric Takayasu Arteritis Initially Presenting With Hypertension: A 16-year overview. AU - Fan,Luyun, AU - Zhang,Huimin, AU - Cai,Jun, AU - Yang,Lirui, AU - Wei,Dongmei, AU - Yu,Jiachen, AU - Fan,Jiali, AU - Song,Lei, AU - Ma,Wenjun, AU - Lou,Ying, PY - 2019/7/7/pubmed PY - 2019/7/7/medline PY - 2019/7/7/entrez KW - Takayasu arteritis KW - blood pressure KW - hypertension KW - intervention KW - outcome KW - pediatric vasculitis SP - 1021 EP - 1029 JF - American journal of hypertension JO - Am. J. Hypertens. VL - 32 IS - 10 N2 - BACKGROUND: To investigate the clinical features, management, and outcomes of childhood Takayasu arteritis (c-TA) initially presenting with hypertension. METHODS: This study retrospectively reviewed medical charts of 96 inpatient c-TA cases from January 2002 to December 2016, with 5 additional patients being prospectively recruited from January 2017 to December 2017. Data were compared between c-TA groups initially presenting with and without hypertension. Blood pressure (BP) control, event-free survival, and associated risk factors were assessed by logistic regression, Kaplan-Meier survival curve, and COX regression models. RESULTS: The hypertensive cohort (N = 71, 28.2% males) as compared with non-hypertensive cohort had significantly fewer active diseases; fewer episodes of claudication, syncope, blurred vision, and myocardial ischemia; and fewer systemic symptoms (P < 0.05). The hypertensive group presented with more localized abdominal lesions (OR = 14.4, P = 0.001) and limited supradiaphragmatic arterial involvement. Renovascular disease (P = 0.001) and revascularization (P = 0.006) were associated with hypertension. At the median 3-year follow-up, 53% of hypertensive patients achieved BP control and 39% experienced events including vascular complications, flares, or death. The 1-, 3-, 5-, and 10-year event-free survival were 78.7% (95% CI: 65.7%-87.2%), 63.0% (95% CI: 48.1%-74.7%), 48.9% (95% CI: 32.0%-63.8%), and 31.6% (95% CI: 13.8%-51.2%), higher than in non-hypertensive group (P = 0.014). Heart failure, stroke, and body mass index <18.5 kg/m2 were prognostic factors for events. Intervention and baseline systolic BP were independent factors for BP control (P < 0.05). CONCLUSIONS: Majority of c-TA has hypertension, presenting with a more quiescent disease without typical systemic and/or ischemia symptoms, more localized abdominal lesions, higher proportion of revascularizations and better event-free survival. Three-year BP control is more than 50%. Intervention particularly on renal artery is beneficial for BP control and decreased events. CLINICAL TRIAL REGISTRATION: Trial Number: NCT03199183. SN - 1941-7225 UR - https://www.unboundmedicine.com/medline/citation/31278892/Clinical_Course,_Management,_and_Outcomes_of_Pediatric_Takayasu_Arteritis_Initially_Presenting_with_Hypertension:_a_16-year_overview L2 - https://academic.oup.com/ajh/article-lookup/doi/10.1093/ajh/hpz103 DB - PRIME DP - Unbound Medicine ER -
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