Tags

Type your tag names separated by a space and hit enter

Clinical Course, Management, and Outcomes of Pediatric Takayasu Arteritis Initially Presenting with Hypertension: a 16-year overview.

Abstract

OBJECTIVE

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 2002/01 to 2016/12, with 5 additional patients being prospectively recruited from 2017/01 to 2017/12. 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 supra-diaphragmatic arterial involvement. Renovascular disease(p=0.001) and revascularization (p=0.006) were associated with hypertension. At the 3-year follow-up, 53% of hypertensive patients achieved BP control and 39% experienced events including vascular complications, flares, or death. The 1-year, 3-year, 5-year, 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 BMI <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 over 50%. Intervention particularly on renal artery is beneficial for BP control and decreased events.

Authors+Show Affiliations

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

Pub Type(s)

Journal Article

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, 2019.
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.
Fan, L., Zhang, H., Cai, J., Yang, L., Wei, D., Yu, J., ... Lou, Y. (2019). Clinical Course, Management, and Outcomes of Pediatric Takayasu Arteritis Initially Presenting with Hypertension: a 16-year overview. American Journal of Hypertension, doi: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 Jul 5; 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, Y1 - 2019/07/05/ PY - 2019/04/29/received PY - 2019/7/7/entrez PY - 2019/7/7/pubmed PY - 2019/7/7/medline KW - Takayasu arteritis KW - hypertension KW - intervention KW - outcome KW - pediatric vasculitis JF - American journal of hypertension JO - Am. J. Hypertens. N2 - OBJECTIVE: 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 2002/01 to 2016/12, with 5 additional patients being prospectively recruited from 2017/01 to 2017/12. 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 supra-diaphragmatic arterial involvement. Renovascular disease(p=0.001) and revascularization (p=0.006) were associated with hypertension. At the 3-year follow-up, 53% of hypertensive patients achieved BP control and 39% experienced events including vascular complications, flares, or death. The 1-year, 3-year, 5-year, 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 BMI <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 over 50%. Intervention particularly on renal artery is beneficial for BP control and decreased events. 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 -