Children with hypertension at higher risk of associated major adverse cardiac events
Children with hypertension were at an increased risk of stroke, congestive heart failure, and other major adverse cardiac events compared to non-hypertensive individuals.
Children with hypertension at higher risk of associated major adverse cardiac events | Image Credit: © New Africa - © New Africa - stock.adobe.com.
A study published in JAMA Pediatrics revealed children that have been diagnosed with hypertension are at a higher risk of associated long-term cardiovascular disease, making blood pressure follow-up improvement strategies a priority in this patient population.1
According to the study abstract from Cal H. Robinson, MD, of The Hospital for Sick Children in Toronto, Ontario, Canada, and colleagues, hypertension affects 6% of all children with an increasing prevalence.1
The Centers for Disease Control and Prevention (CDC) stated, as of November 7, 2023, that 1 in every 25 individuals aged 12 to 19 years have hypertension, and that 1 in 10 have elevated blood pressure. The CDC acknowledged that high blood pressure in youth is associated with health issues later in life.2
The American Heart Association states a variety of factors can contribute to hypertension including excess weight or obesity, family history, race, diabetes, too many calories in the diet, low birth weight, kidney disorders, sleep apnea, among other factors.3
To assess if children and adolescents with hypertension were at a higher risk for associated major adverse cardiac events (MACE), the investigators conducted a population-based, retrospective matched cohort study from 1996 to 2022. Included were children aged 3 to 18 years alive in Ontario, Canada from 1996 to 2021. Participants were identified using provincial administrative health databases.1
Children with previous kidney replacement therapy were excluded. Those included had an incident hypertension diagnosis that was identified by validated case definitions using physician and diagnostic billing claims. In each case, 5 controls without hypertension matched it by age, sex, birth weight, maternal gestational hypertension, prior comorbidities, and a propensity score for hypertension.1
"The primary outcome was MACE (a composite of cardiovascular death, stroke, hospitalization for myocardial infarction or unstable angina, or coronary intervention)," the investigative team wrote. "Time to MACE was evaluated using the Kaplan-Meier method and Cox proportional hazards regression."1
In all, 25,605 children with hypertension (mean age [IQR] 15 [11-17] years, 57.6% male) were matched to 128,025 controls without hypertension. "Baseline covariates were balanced after propensity score matching, and prior comorbidities were uncommon, wrote the authors.1
Hypertension group vs control cohort1:
- Malignancy: 1451 (5.7%) vs 7908 (6.2%)
- Congenital heart disease: 1089 (4.3%) vs 5408 (4.2%)
- Diabetes: 482 (1.9%) vs 2410 (1.9%)
Incidence of MACE was 4.6 per 1000 person-years during a median 13.6 (7.8-19.5) years of follow-up in children with hypertension compared to 2.2 per 1000 person-years in the control group individuals (hazard ratio, 2.1; 95% CI, 1.9-2.2).1
Children with hypertension were at an increased risk of stroke, hospitalization for myocardial infarction or unstable angina, coronary intervention, and congestive heart failure compared to non-hypertensive individuals. An increased risk was not observed for cardiovascular death.1
In conclusion, the investigators found that hypertension had a higher associated long-term risk of MACE compared to the control group, "justifying the improvement of blood pressure follow-up and control strategies among youth with hypertension."1
Related: Did hypertension guidelines change practice patterns in primary care?
In a study that evaluated hypertension guidelines in Canada and subsequent change in practice associated with the guidelines, investigators found that guideline publication was met with increased blood pressure screenings and hypertension prevalence, though follow-up was suboptimal.4
Authors of this study, published in JAMA Network Open, suggested that the uptake of hypertension guidelines in the primary care setting could be improved through more consistent follow-up.4
For full details of this study, click here.
References:
- Robinson CH, Hussain J, Jeyakumar N, et al. Long-Term Cardiovascular Outcomes in Children and Adolescents With Hypertension. JAMA Pediatr. Published online May 06, 2024. doi:10.1001/jamapediatrics.2024.1543
- About high blood pressure in kids and teens. Centers for Disease Control and Prevention. November 7, 2023. Accessed May 16, 2024. https://www.cdc.gov/high-blood-pressure/about/about-high-blood-pressure-in-kids-and-teens.html?CDC_AAref_Val=https://www.cdc.gov/bloodpressure/youth.htm
- High blood pressure in children. The American Heart Association. Accessed May 16, 2024. https://www.heart.org/en/health-topics/high-blood-pressure/why-high-blood-pressure-is-a-silent-killer/high-blood-pressure-in-children
- Fitch, J. Did hypertension guidelines change practice patterns in primary care? Contemporary Pediatrics. May 14, 2024. Accessed May 16, 2024. https://www.contemporarypediatrics.com/view/did-hypertension-guidelines-change-practice-patterns-in-primary-care-
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