Hypertension not uncommon in adults with cerebral palsy

A recent systematic review and meta-analysis has revealed that about one in three adults with cerebral palsy are hypertensive, which stresses the importance of clinical screening for blood pressure (BP) in these individuals beginning in young adulthood.

“Our results suggest that in this young sample of adults with cerebral palsy, BP levels and the prevalence of hypertension are relatively high,” the researchers said.

Literature searches were conducted for studies published between January 2000 and November 2017 to identify potential datasets. The researchers included samples of adults with cerebral palsy (n≥10, age ≥18 years) if BP data, cerebral palsy-related factors (eg, subtype), and sociodemographic variables (eg, age, sex) were available.

Hypertension was defined as BP ≥140/90 mm Hg or use of any antihypertensive agents.

Data from 11 international cohorts representing 444 adults with cerebral palsy (median age 29.0 years, 51 percent men, 89 percent spastic type, Gross Motor Function Classification System levels I–V) were included in the meta-analysis. [J Hypertens 2021;39:1942-1955]

The overall prevalence of hypertension was 28.7 percent (95 percent confidence interval, 18.8–39.8), while the overall mean systolic (SBP) and diastolic (D)BP were 124.9 mm Hg (95 percent CI, 121.7–128.1) and 79.9 mm Hg (95 percent CI, 77.2–82.5), respectively.

In subgroup analysis, higher BP levels or higher prevalence of hypertension was observed in adults with cerebral palsy >40 years of age, men, those with spastic cerebral palsy, or those who lived in Africa. Risk factors associated with BP or hypertension included body mass index (BMI), resting heart rate, and alcohol intake.

“Age-related changes in BP are consistent with findings in the general population, where hypertension becomes progressively more common with advancing age,” the researchers said. “This could be related to the large increases in arterial stiffness, which seems to progress faster and at a younger age in adults with cerebral palsy compared with the general population.” [JAMA 2013;310:959-968; Rehabil Med 2019;51:525-531]

The findings on higher SBP levels in men than in women also supported those in the general population. [Adv Exp Med Biol 2018;1065:139-151]

While BMI, resting heart rate, and alcohol consumption contributed to SBP/DBP levels or hypertension, no significant associations were observed for muscle tone, family history of cardiovascular disease (CVD), and smoking.

“These data must be interpreted with caution because of missing data, large confidence intervals, and our limited ability to include all covariates in a single model,” the researchers said. “More research is needed to investigate the exact effect of potential risk factors on BP in adults with cerebral palsy.”

Notably, some of these risk factors are modifiable, which indicates the value of a healthy lifestyle with greater physical activity and a healthy diet. A behavioural intervention to regulate BP in adults with cerebral palsy may also be beneficial, according to the researchers.

“Early detection of hypertension in the general population can prevent end-organ damage, such as CVD. As a higher risk of CVD was seen in adults with cerebral palsy than in the general population, it is of importance to focus on modifiable risk factors, such as BP,” they said. [Dev Med Child Neurol 2019;61:477-483]

“We, therefore, recommend that regular clinical checks and monitoring of BP should be included in their standard care,” the researchers added.