Hypertension puts kids at risk of long-term cardiac events

Children who have hypertension are more likely to experience adverse cardiovascular outcomes in the future than those without high blood pressure (BP), according to a study presented at PAS 2024.

“These complications may be preventable with improved paediatric BP screening and control,” said lead researcher Cal H Robinson, MD, Pediatric Nephrology Fellow, The Hospital for Sick Children, Toronto, Ontario, Canada.

Robinson and colleagues performed a retrospective cohort study on 25,605 children (aged 3‒18 years) with a diagnosis of incident hypertension from 1996‒2021 in Ontario, Canada. Participants were identified using provincial administrative health databases with validated case definitions. Those with prior hypertension or kidney replacement therapy (dialysis or transplant) were excluded.

Children with hypertension were matched to five paediatric controls (n=128,025) without hypertension by age, sex, birthweight, maternal gestational hypertension, previous comorbidities (eg, chronic kidney disease, diabetes mellitus, and cardiovascular surgery), and a propensity score for hypertension. The researchers then followed participants until death, provincial emigration, or March 2022.

Cox proportional hazard models were used to examine the primary outcome of time to major adverse cardiac events (MACE; a composite of cardiovascular death, stroke, myocardial infarction, or unstable angina hospitalization, or coronary intervention). Secondary outcomes included individual cardiovascular events, cardiovascular procedures, and all-cause mortality.

Baseline characteristics after propensity score matching were similar between the children with and without hypertension. Their median age was 15 years, and less than half (42 percent) were female. Prior comorbidities were also not common (4 percent congenital heart disease, 6 percent malignancy, and 2 percent diabetes). [Robinson, C, et al, PAS 2024]

The incidence rate of MACE during a median follow-up of 12.9 years was 5.4 per 1,000 person-years (PY) in children with hypertension compared with 1.4 per 1,000 PY in control participants (adjusted hazard ratio [aHR], 2.1, 95 percent confidence interval [CI], 1.9‒2.2).

Children with hypertension had a higher risk of all-cause mortality (IR, 2.7 vs 0.5 per 1,000 PY; aHR, 1.9, 95 percent CI, 1.7‒2.0) than their nonhypertensive counterparts. In addition, hypertensive children were at greater risk of congestive heart failure (IR, 2.2 vs 0.3 per 1,000 PY; aHR, 2.6, 95 percent CI, 2.4‒2.9) and cardiovascular procedures (IR, 2.3 vs 0.4 per 1,000 PY; aHR, 2.6, 95 percent CI, 2.3‒2.8).

“Youth diagnosed with hypertension are at significantly higher (two to four times) risk of long-term cardiovascular events,” said Robinson, noting that those aged <13 years and those with CKD had the highest risk.

“These findings should be confirmed by large-scale, well-controlled prospective studies,” he said.

Hypertension is a major cause of adult cardiovascular disease and affects about 6 percent of children. In addition, paediatric hypertension has seen a fivefold increase from 1990 to 2010, according to the researchers. [Song, et al, 2019]

“Paediatric hypertension tracks into adulthood and is associated with subclinical cardiovascular disease,” Robinson said.