ORIGINAL ARTICLE Comparison of echocardiographic changes in children with primary hypertension and hypertension due to mild to moderate chronic kidney disease Gabriel Paris 1 & Sudheer R. Gorla 1 & Aura J. Arenas-Morales 2 & Wacharee Seeherunvong 2 & Sethuraman Swaminathan 1 Received: 27 April 2018 /Revised: 18 September 2018 /Accepted: 21 September 2018 # IPNA 2018 Abstract Background Chronic systemic hypertension has a well-known association with increased cardiovascular morbidity and mortal- ity. One of the most important target organs affected in systemic hypertension is the heart. In addition, chronic kidney disease (CKD) further increases the mortality from cardiovascular disease. The aim of this study was to evaluate the differences in the cardiovascular changes in pediatric patients with primary hypertension (pHTN) vs. those with secondary hypertension from chronic kidney disease (CKD-HTN). Methods This was a retrospective chart review of patients with CKD-HTN and pHTN. The medical records were reviewed for anthropometric data, biochemical assessment of renal function, and for cardiovascular changes on echocardiogram. Results Twenty-three patients with pHTN and 29 patients with CKD-HTN were included in the study. There were no differences in age, gender, weight, height, body mass index, and blood pressure between the 2 groups. There was a high prevalence of left ventricular diastolic dysfunction among both the groups (CKD-HTN 25 vs. pHTN 26%). Reduced mitral valve inflow Doppler E/A ratio, a marker of left ventricular diastolic dysfunction in echocardiogram, was more pronounced in CKD-HTN patents, in comparison to those with pHTN (p = 0.042). Also, diastolic function worsened with declining glomerular filtration rate in patients with CKD-HTN. Similarly, patients with CKD-HTN had a larger aortic root dimension when compared to patients with pHTN (p= 0.049). Conclusions The prevalence of left ventricular diastolic dysfunction is similar in patients with pHTN and CKD-HTN. Patients with CKD-HTN appear to have more severe diastolic dysfunction and larger aortic root dimensions. Keywords Chronic kidney disease . Secondary hypertension . Primary hypertension . Echocardiogram . Children Introduction Systemic hypertension (HTN) is one of the major risk factors for cardiovascular morbidity and mortality. In adults, elevated blood pressure has been shown to be associated with stroke and coronary artery disease [1]. The severity and duration of HTN have an impact on target organ damage. Children diag- nosed with HTN at an early age are at higher risk for devel- oping adverse cardiovascular events in adulthood [2, 3]. Secondary hypertension is relatively more common in chil- dren when compared to adults. Chronic kidney disease (CKD) is one of the common causes of secondary hypertension in pediatric patients [4]. In children and adults with CKD, cardiovascular disease (CVD) is the leading cause of mortality. This is especially true in those with advanced CKD due to the higher prevalence of non-traditional risk factors, such as dysregulation of mineral metabolism, in addition to other traditional risk factors [5, 6]. However, there is evidence that CVD even occurs in early CKD which can progress with time [7, 8]. Thus, chil- dren with CKD and HTN (CKD-HTN) could have acceler- ated risk for CVD, when compared with subjects with pHTN. Understanding the early echocardiographic changes in these * Sethuraman Swaminathan sswami@miami.edu 1 Division of Pediatric Cardiology, Department of Pediatrics, Holtz Children’ s Hospital, Jackson Memorial Hospital, University of Miami/Miller School of Medicine, 1611 NW 12 Avenue, NW Room 109, Miami, FL 33136, USA 2 Division of Pediatric Nephrology, Department of Pediatrics, Holtz Children’ s Hospital, Jackson Memorial Hospital, University of Miami/Miller School of Medicine, Miami, FL, USA Pediatric Nephrology https://doi.org/10.1007/s00467-018-4096-y