• Assisted Reproduction Tied to Vascular Aging, HTN in Adolescents

    — Hypertension was 6 times more prevalent in ART-born adolescents

    Children conceived with assisted reproductive technology (ART) may be at increased risk for premature vascular aging and hypertension, researchers reported.

    Compared with age- and sex-matched controls, a group of adolescents conceived via ART had a 25% reduction in the flow-mediated dilation of the brachial artery (P<0.01) and a significant thickening of the carotid-femoral artery (463.7 µm versus 435 µm, P<0.01), said Emrush Rexhaj, MD, of the University of Bern, Switzerland, and colleagues.

    Furthermore, the prevalence of arterial hypertension (defined as >130/80 mmHg) was 6-fold higher in the ART group (15% versus 2.5%, P=0.041), Rexhaj's group reported in the Journal of the American College of Cardiology.

    According to 24-hour ambulatory blood pressure monitoring (ABPM), both mean systolic and diastolic blood pressure were significantly higher in the ART group than the control group (systolic, 119.8 ± 9.1 mmHg versus 115.7 ± 7.0 mmHg, P=0.03; diastolic, 71.4 ± 6.1 mmHg versus 69.1 ± 4.2 mmHg, P=0.02), the study found.

    Rexhaj and colleagues had studied the same ART cohort 5 years earlier and found reduced flow-mediated dilation and increased carotid intima-media thickness compared with controls, but no evidence of increased hypertension. The hypertension likely took time to develop, they said.

    "The increased prevalence of arterial hypertension in ART participants is what is most concerning," Rexhaj said in a statement. "There is growing evidence that ART alters the blood vessels in children, but the long-term consequences were not known. We now know that this places ART children at a six times higher rate of hypertension than children conceived naturally."

    The use of ART has been growing exponentially over the past 2 decades, the study authors said. Children born with the help of ART now make up 2% to 5% of children in developed countries. Worldwide, more than 6 million people have been conceived by ART.

    "ART has allowed millions of infertile couples to have children," the study authors wrote. "However, this success may have come at a price because evidence is accumulating indicating that ART alters the cardiovascular and metabolic phenotype in mice and humans."

    Rexhaj's group measured 24-hour ambulatory blood pressure and assessed vascular function in 54 apparently healthy adolescents (mean age 16.5) conceived by ART. They compared these measurements with a group of 43 age- and sex-matched controls. Potential cardiovascular risk factors were comparable in the two groups, including body-mass index, lipids, creatinine, high-sensitivity C-reactive protein, maternal smoking status, and maternal cardiovascular risk profiles.

    In an accompanying editorial, Larry Weinrauch, MD, of Harvard Medical School in Boston, and colleagues pointed out some limitations of the study. The cohort was small, they said, and it excluded ART-born children at higher risk for developing hypertension due to factors such as preeclampsia during pregnancy or maternal diabetes.

    "This observation, derived from a relatively small cohort, may actually understate the importance of this problem for ART populations because higher risk populations for development of hypertension ... were excluded from the study," Weinrauch and colleagues said.

    "Although a 6-fold higher prevalence of hypertension in the ART-conceived group compared with the control group is striking, it was defined only by a single 24-hour ABPM without office blood pressure or repeat measurement," they said. "Whether these elevated ABPM values represent masked hypertension or would regress to the mean with a repeat assessment is unknown. In addition, no evidence of target end-organ damage, such as left ventricular hypertrophy, was reported."

    Nevertheless, "it seems reasonable to be more vigilant for development of elevated blood pressure among children and adolescents conceived with ART to implement early lifestyle-based modifications and, if necessary, pharmacotherapy," Weinrauch and colleagues said. "In addition, a suspicion of longstanding changes should be maintained for adults conceived with ART and found to be hypertensive to lead to assessment for left ventricular hypertrophy or dysfunction."


    The study was funded by the Swiss National Science Foundation, the Placide Nicod Foundation, and other organizations. No study authors reported relevant financial relationships.

    Weinrauch and colleagues reported no relevant financial relationships.

    Reviewed by Henry A. Solomon, MD, FACP, FACCClinical Associate Professor, Weill Cornell Medical College and Dorothy Caputo, MA, BSN, RN, Nurse Planner


    Read the original article on Medpage Today: Assisted Reproduction Tied to Vascular Aging, HTN in Adolescents

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