SAN FRANCISCO, May 8 — Childhood hypertension, determined by ambulatory blood pressure monitoring, more than doubles the risk of left ventricular hypertrophy.

Risk rose progressively as hypertension increased — to a 2.58-fold risk for those having blood pressure above the 95th percentile, found Alisa A. Acosta, M.D., M.P.H., of the University of Texas Health Science Center at Houston, and colleagues.

• Explain to interested patients that blood pressure in children is based on percentiles reflecting the range of normal values for those of the same age and height.
• Note that this study was published as an abstract and presented orally at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.

However, a single casual blood pressure measurement in the office did not predict left ventricular hypertrophy, they reported here at the American Society of Hypertension meeting.

These findings add to growing evidence that childhood blood pressure not only tracks into adulthood but has immediate consequences as well. (See Kid’s BP Can Predict Adult Readings)

Hypertrophy is evidence that end-organ damage has already occurred in childhood, commented William B. White, M.D., of the University of Connecticut in Farmington, who moderated a press conference at which the findings were presented.

“In young adults and middle age adults, left ventricular hypertrophy is an independent risk factor for heart failure,” he said. “So if it continues and nothing is done about it, it does cause harm.”

Dr. Acosta added that it also acts as a surrogate marker for increased risk of stroke, heart attack, and other cardiovascular events in adulthood, although these events are rare in healthy children.

Although lifestyle measures and antihypertensive medication may halt this progression, opportunities for early intervention are often missed, she said. (See Childhood Hypertension Usually Goes Undiagnosed)

The American Heart Association recommends yearly blood pressure measurement for children older than 3, but blood pressure norms can be time consuming to determine for individual children, and measurement still, at times, goes overlooked in pediatric care, Dr. Acosta said.

Given recent publication of AHA ambulatory blood pressure classifications for children, Dr. Acosta’s group studied blood pressure in 241 children ages 6 to 17 and naive to blood pressure management.

About a third had left ventricular hypertrophy measured on echocardiography (greater than 38.6 gm/m^2.7 under pediatric criteria).

As blood pressure category rose from normal to severe ambulatory hypertension, the average left ventricular mass rose from 34.3 to 38.6 g/m^2.7 (P=0.018 for trend).

Prevalence of hypertrophy also rose with hypertension category (P<0.001).

After adjustment for age, gender, race or ethnicity, and body mass index, the risk compared with normal blood pressure tended to be:

• Lower for those with so-called white coat hypertension, defined as high blood pressure within 25% above the 95th percentile on in-office monitoring only (odds ratio 0.37, 95% confidence interval 0.12 to 1.17)
• Lower for masked hypertension, defined as high blood pressure on ambulatory but not in-office monitoring (OR 0.73, 95% CI 0.23 to 2.29)
• Elevated for prehypertension, defined by an in-clinic systolic pressure more than 25% to 50% above the 95th percentile blood pressure (OR 1.14, 95% CI 0.45 to 2.85)
• Elevated for ambulatory hypertension, defined by a systolic load 25% to 50% above the 95th percentile on both in-clinic and ambulatory monitoring (OR 1.33, 95% CI 0.36 to 4.94)

After adjustment, risk compared with normal blood pressure was significantly elevated for severe ambulatory hypertension, additionally defined by systolic load more than 50% above the 95th percentile on both measures (OR 2.58, 95% CI 1.05 to 6.33).

Because the ambulatory measurements predicted a child’s risk for left ventricular hypertrophy better than casual measurement in the clinic alone, the researchers recommended the AHA staging criteria as more accurate.

“Improved identification of patients at risk for target organ damage will allow for early treatment and delay the onset of overt cardiovascular events,” Dr. Acosta’s group concluded.

The researchers reported no conflicts of interest. Dr. White reported conflicts of interest with SunTech Medical, Takeda, NicOx, Teva, Boehringer Ingelheim, and Novartis Pharmaceuticals.

Primary source: American Society of Hypertension

Source reference:
Acosta AA, et al “Association of left ventricular hypertrophy (LVH) and hypertension (HTN) by ambulatory blood pressure (ABP) stages” ASH

Related Article(s):

• Kid’s BP Can Predict Adult Readings
• Childhood Hypertension Usually Goes Undiagnosed

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