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Association of parental blood pressure with retinal microcirculatory abnormalities indicative of endothelial dysfunction in children

Islam, Muhammada; Jafar, Tazeen H.a,b,c; Bux, Rasoola; Hashmi, Shiraza; Chaturvedi, Nishd,*; Hughes, Alun D.d,*

doi: 10.1097/HJH.0000000000000063
ORIGINAL PAPERS: Children and adolescents

Objective: Microcirculatory abnormalities precede the onset of hypertension and may explain its familial nature. We examined the relationship between parental blood pressure (BP) and offspring retinal microvasculature in Pakistani trios [father, mother, and child (aged 9–14 years)].

Methods: This is a substudy of a population-based trial of BP reduction. Data were available on 358 normotensive, and 410 offspring of at least one hypertensive parent. Retinal vessel characteristics were measured from digital images. Multivariable linear regression models were built to assess the associations between maternal and paternal BP and offspring retinal microvasculature.

Results: Optimality deviation was greatest in offspring of two hypertensive parents, compared with those with one or no hypertensive parent (P = 0.030 for trend). Paternal SBP and DBP were each significantly associated with optimality deviation in offspring (P = 0.023 and P = 0.006, respectively). This relationship persisted after accounting for offspring cardiovascular risk factors [increase in optimality deviation (95% confidence interval, CI) 0.0053 (0.0001–0.0106, P = 0.047) and 0.0109 (0.0025–0.0193, P = 0.011), for each 10 mmHg increase in paternal SBP and DBP, respectively]. Maternal DBP was inversely associated with offspring arteriovenous ratio −0.0102 (−0.0198 to −0.0007, P = 0.035).

Conclusion: Microvascular endothelial dysfunction in children is associated with increasing levels of parental hypertension. The association with paternal BP is independent of other cardiovascular risk factors, including the child's BP. Higher maternal DBP is associated with evidence of arteriolar narrowing in offspring. These early microcirculatory changes may help explain familial predisposition to hypertension in people of Pakistani origin at an early age.

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aClinical Epidemiology Unit, Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan

bHealth Services & Systems Research, Duke-NUS Graduate Medical School, Singapore, Singapore

cDivision of Nephrology, Department of Medicine, Tufts Medical Center, Boston, Massachusetts, USA

dNational Heart and Lung Institute, Imperial College London, London, UK

*N.C. and A.D.H. contributed equally to the writing of the article.

Correspondence to Professor Tazeen H. Jafar, MD, MPH, Program in Health Services & Systems Research, Duke-NUS Graduate Medical School Singapore, 8 College Road Singapore 169857. Tel: +92 21 34864812; fax: +92 21 34934294; e-mail:

Abbreviation: AVR, arteriovenous ratio

Received 31 July, 2013

Accepted 28 October, 2013

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