Youth with high blood pressure are nearly four times more likely to be at long-term risk of serious heart conditions including stroke and heart attack, according to a new study. The research, led by McMaster University, will be presented at the Pediatric Academic Societies (PAS) 2024 Meeting, held May 3-6 in Toronto.
Hypertension affects one of every 15 children and adolescents worldwide and is a growing concern, according to researchers. Despite this, it is unclear what happens to these children in the long-term. Researchers compared 25,605 youth diagnosed with hypertension from 1996-2021 in Ontario to peers without the condition.
The study found that during average follow-up of 13 years, youth with hypertension were at two to four times higher risk of experiencing heart attack, stroke, heart failure, or cardiac surgery compared to youth without hypertension. Experts say that improved blood pressure screening and treatment during childhood may reduce the risk of serious cardiovascular disease as an adult.
“Devoting more resources to pediatric blood pressure screening and control could lower the risks of long-term heart conditions in children with hypertension,” said Cal H. Robinson, MD, pediatric nephrology fellow at The Hospital for Sick Children (SickKids) and presenting author. “More awareness about the importance of regular screening and follow-up for pediatric hypertension may prevent children from developing significant adverse heart outcomes later in life.”
Study authors recommend additional funding for long-term pediatric hypertension studies to provide greater insight into adult heart and kidney outcomes in children with hypertension.
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EDITOR:
Dr. Cal Robinson will present “Long-term Cardiovascular Outcomes in Children and Adolescents with Hypertension: A Population-based, Propensity-matched Cohort Study” on Monday, May 6 from 9:00-9:15 AM E.T.
Reporters interested in an interview with Dr. Robinson (presenting author) or Dr. Rahul Chanchlani, associate professor of pediatrics, McMaster University (senior author) should contact Amber Fraley at amber.fraley@pasmeeting.org.
SickKids contact: Sarah.warr@sickkids.ca
McMaster University contact: Adam Ward (warda17@mcmaster.ca)
The PAS Meeting connects thousands of pediatricians and other health care providers worldwide. For more information, please visit www.pas-meeting.org.
About the Pediatric Academic Societies Meeting
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Abstract: Long-term cardiovascular outcomes in children and adolescents with hypertension: A population-based, propensity-matched cohort study
Presenting Author: Cal H. Robinson, MD
Organization
The Hospital for Sick Children (SickKids)
Topic
Hypertension
Background
Hypertension affects 6% of all children and its prevalence is increasing. Pediatric hypertension tracks into adulthood and is associated with subclinical cardiovascular disease. However, there is limited direct evidence linking pediatric hypertension to cardiovascular outcomes in later adulthood, contributing to under-diagnosis and treatment.
Objective
To determine the long-term risk of cardiovascular outcomes among children with hypertension.
Design/Methods
Retrospective cohort study of all children (3-18 years) with an incident hypertension diagnosis from 1996-2021 in Ontario, identified using provincial administrative health databases with validated case definitions. Children with prior hypertension or kidney replacement therapy (dialysis/transplant) were excluded. Cases were matched with five pediatric controls without hypertension by age, sex, birthweight, maternal gestational hypertension, prior co-morbidities (chronic kidney disease, diabetes mellitus, and cardiovascular surgery), and a propensity score for hypertension. Children were followed until death, provincial emigration, or March 2022. The primary outcome was time-to-major adverse cardiac events (MACE; a composite of cardiovascular death, stroke, myocardial infarction or unstable angina hospitalization, or coronary intervention) using Cox proportional hazards models. Secondary outcomes were individual cardiovascular events, cardiovascular procedures, and all-cause mortality.
Results
A total of 25,605 children with hypertension were matched to 128,025 children without hypertension. Baseline covariates were well balanced after propensity score matching. Median age was 15 years (IQR 11-17), 42% were female, and prior co-morbidities were uncommon (4% congenital heart disease, 6% malignancy, and 2% diabetes). During median 12.9-year (IQR 6.8-19.8) follow-up, the incidence rate (IR) of MACE was 5.4/1000 person-years (py) in children with hypertension vs. 1.5/1000py in controls (adjusted hazard ratio (aHR) 2.1, 95%CI 1.9-2.2). Children with hypertension were at higher risk of all-cause mortality (IR 2.7 vs. 0.5/1000py; aHR 1.9, 95%CI 1.7-2.0), congestive heart failure (IR 2.2 vs. 0.3/1000py; aHR 2.6, 95%CI 2.4-2.9), and cardiovascular procedures (IR 2.3 vs. 0.4/1000py; aHR 2.6, 95%CI 2.3-2.8) vs. non-hypertensive controls.
Conclusion(s)
Children with hypertension are at higher long-term risk of adverse cardiovascular outcomes vs. non-hypertensive controls. These complications may be preventable with improved pediatric blood pressure screening and control. These findings should be confirmed by large-scale, well-controlled prospective studies.
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