Kids With Hypertension May Have Twice the Risk of Cardiac Events

Children diagnosed with hypertension had a higher associated long-term risk of major adverse cardiac events (MACE) compared with matched controls without the condition, according to a Canadian population-based, retrospective cohort study.

Over a median follow-up of 13.6 years, incidence of MACE was 4.6 per 1,000 person-years in children with hypertension compared with 2.2 per 1,000 person-years in controls (HR 2.1, 95% CI 1.9-2.2), reported Rahul Chanchlani, MBBS, MD, MSc, of McMaster Children’s Hospital in Hamilton, Ontario, and colleagues in JAMA Pediatrics. The findings were also presented at the Pediatric Academic Societies meeting in Toronto.

Specifically, kids with hypertension compared with those without had a higher associated risk of stroke (HR 2.7, 95% CI 2.4-2.9), hospitalization for myocardial infarction or unstable angina (HR 1.8, 95% CI 1.7-2.0), and coronary intervention (HR 4.1, 95% CI 3.2-5.3).

They also had a higher associated risk of developing congestive heart failure (HR 2.6, 95% CI 2.4-2.9), other cardiovascular diagnoses (HR 1.7, 95% CI 1.6-1.8), and undergoing cardiovascular procedures (HR 2.6, 95% CI 2.3-2.8) versus controls.

However, there was no difference in the risk of cardiovascular death between the two groups.

“Hypertension in children is not a benign condition,” Chanchlani told MedPage Today.

In fact, there has been a five-fold increase in the prevalence of pediatric hypertension over the last 3 decades, the authors noted. Globally, 6% of kids have the condition.

“Increasing pediatric hypertension has been associated with more obesity, less physical activity, higher dietary sodium intake, and urbanization,” they wrote. “However, most children (up to 90%) do not undergo regular BP [blood pressure] screening, more than three-quarters with hypertension are undiagnosed, and very few with hypertension are adequately treated.”

“The association we found between pediatric hypertension and MACE may have substantial health and financial implications,” they continued. “Policies and initiatives to improve the uptake of pediatric BP screening, increase clinician and family awareness of pediatric hypertension, and optimize pediatric hypertension care may help prevent future CVD [cardiovascular disease].”

The study included all children ages 3 to 18 years who were alive in Ontario from 1996 to 2021, identified using provincial administrative health databases. Children with prior kidney replacement therapy were excluded.

A total of 25,605 children (median age 15, 57.6% boys) with hypertension and 128,025 controls without hypertension were included. Each case was matched with five controls by age, sex, birth weight, maternal gestational hypertension, prior comorbidities (chronic kidney disease, diabetes, cardiovascular surgery), and a propensity score for hypertension.

Chanchlani and team said that baseline covariates were balanced after propensity score matching, and prior comorbidities were uncommon (hypertension vs control cohort: malignancy, 5.7% vs 6.2%; congenital heart disease, 4.3% vs 4.2%; diabetes, 1.9% vs 1.9%).

The median age of participants at last follow-up was 27 in both cohorts. Chanchlani acknowledged the relatively young ages of participants in comparison to the age range for which people typically think about events like strokes or heart attacks occurring.

Complete follow-up (until March 2022) occurred in 89.3% of participants; 1.5% were censored for death, and 9.2% were censored for provincial emigration.

Limitations to the study included that the researchers did not have access to data on additional effect modifiers or confounders, such as hypertension detection method, BP values to determine hypertension stage, subclinical cardiovascular disease presence, body mass index, hypertension duration, and antihypertensive treatment, Chanchlani and colleagues said.

They also noted that detection bias was possible if kids with hypertension had more healthcare visits and cardiovascular disease screening.

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