Hypertension Research (2018) 41:897–903 https://doi.org/10.1038/s41440-018-0087-4 ARTICLE Early myocardial changes in normotensive children of hypertensive parents: a tissue Doppler study Pelin Kosger 1 ● Gokmen Ozdemir 2 ● Ali Yildirim 3 ● Birsen Ucar 1 ● Zubeyir Kilic 1 Received: 29 January 2017 / Revised: 8 February 2018 / Accepted: 28 February 2018 / Published online: 31 August 2018 © The Japanese Society of Hypertension 2018 Abstract The aim of this study was to examine early left ventricular systolic and diastolic changes using tissue Doppler imaging (TDI) in normotensive children of hypertensive parents (NCHP), a risk group for cardiovascular diseases. Ninety-two children characterized as NCHP (age range: 6–18 years) and 90 age-, gender-, height-, weight-, and body mass index-matched children characterized as normotensive children of normotensive parents (NCNP) were included in the study. Left ventricular diastolic parameters were assessed using transmitral flow pulse wave Doppler echocardiography and mitral septal and lateral annular TDI. Left ventricular systolic and diastolic function was evaluated globally using the TDI-derived myocardial performance index (MPI′). Mean systolic, diastolic, and average blood pressure values were found to be higher in the NCHP group than in the NCNP group. Echocardiographic parameters in the NCHP group showed statistically significant differences, including increased interventricular septum end-diastolic wall thickness (p = 0.039), left ventricular end-diastolic posterior wall thickness (p = 0.011), relative wall thickness (p = 0.013), and transmitral flow A velocity (p = 0.003); parameters determined by TDI included a prolonged isovolumetric relaxation time (p < 0.001) and isovolumetric contraction time (p = 0.002), shortened ejection time (p = 0.001), and increased MPI′ (p < 0.001) in the NCHP group. Early alterations in myocardial function, indicated by increased MPI′ values, had a positive correlation with systolic blood pressure and myocardial thickness. Conversely, they were negatively correlated with the ejection fraction and E/A ratio, which decreases with diastolic dysfunction. The MPI′ is considered a repeatable, non-invasive, and low-cost assessment method that can surpass conventional methods in the detection of early left ventricular systolic and diastolic functional changes in the subclinical period of hypertension in children with familial risk. Introduction The prevalence of essential hypertension is gradually increasing in children. Although the development of hypertension is multifactorial, having a positive family history is thought to be a major risk factor [1, 2]. It has been shown that children of hypertensive parents have higher blood pressure profiles compared with children of normo- tensive parents [3, 4]. Being at risk for hypertension in adulthood, children with high blood pressure profiles represent an important group in the study of cardiovascular changes induced by subclinical hypertension [5]. Functional and morphological changes originating from uncontrolled hypertension have been shown previously in myocardial tissue [6]. An increase in left ventricular thick- ness and left ventricular hypertrophy are compensatory mechanisms that diminish stress on the wall resulting from high blood pressure. Previous studies have shown that sys- tolic function was preserved, but diastolic functional changes were initiated in children with primary hypertension [7–9]. Studies assessing the presence of morphological and func- tional changes suggest the utility of non-pharmacological interventions at early ages in normotensive children of hypertensive parents (NCHP) at risk for high blood pressure; however, due to variable demographics and echocardio- graphic methods, the results were inconsistent [10, 11]. The myocardial performance index (MPI) is a parameter that provides a global evaluation of left ventricular systolic * Pelin Kosger pelinkosger@mynet.com 1 Department of Pediatric Cardiology, Eskisehir Osmangazi University, Faculty of Medicine, Eskisehir, Turkey 2 Antalya Research Hospital, Clinic of Pediatric Cardiology, Antalya, Turkey 3 Eskisehir, Turkey 1234567890();,: 1234567890();,: