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Abstract: TH-OR43

Risk of Subclinical-Cardiovascular Outcomes in Children with Ambulatory Hypertension: A Systematic Review and Meta-Analysis

Session Information

Category: Hypertension and CVD

  • 1401 Hypertension and CVD: Epidemiology, Risk Factors, and Prevention

Authors

  • Chung, Jason, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
  • Yu, Andrew, University of Alberta Faculty of Science, Edmonton, Alberta, Canada
  • Bamhraz, Abdulaziz Ahmed, McMaster Children's Hospital, Hamilton, Ontario, Canada
  • Ewusie, Joycelyne Efua, The Research Institute of St Josephs Healthcare Hamilton, Hamilton, Ontario, Canada
  • Pandey, Arjun K., McMaster University, Hamilton, Ontario, Canada
  • Mitsnefes, Mark, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Parekh, Rulan S., The Hospital for Sick Children, Toronto, Ontario, Canada
  • Dionne, Janis M., BC Children's Hospital, Vancouver, British Columbia, Canada
  • Chanchlani, Rahul, McMaster Children's Hospital, Hamilton, Ontario, Canada
Background

Several studies have shown associations between childhood hypertension (HTN) and subclinical-cardiovascular outcomes (SCOs) such as left ventricular hypertrophy (LVH), increased pulse wave velocity (PWV) and increased carotid intima media thickness (cIMT). These data support the effect of elevated blood pressure (BP) in children leading to cardiovascular risk in adults; however, the association is not consistent in all studies. In this review, we investigate the prevalence of SCOs in children with HTN, diagnosed by ambulatory blood pressure monitoring (ABPM).

Methods

A systematic literature search was conducted on four electronic databases to include relevant full-length publications in English language, published abstracts and conference proceedings from Jan 1974 to Mar 2020. Article screening, data extraction and quality assessment were independently completed and verified by two reviewers. Primary outcomes included SCOs such as LVH, left ventricular mass index (LVMI), PWV and cIMT as per standard definitions. Meta-regression was done to adjust for the effect of body mass index (BMI) on LVMI.

Results

Of 8996 studies, 38 were included for analysis. SCO indices were significantly greater in those with HTN than those with normotension (NTN). Mean difference between the HTN and NTN group was 0.03mm (95% CI: 0.01, 0.05) for cIMT, 0.42 m/sec (95% CI: 0.25-0.6) for PWV, and 5.02gm-2.7 (95% CI: 3.66-6.39) for LVMI. HTN group had 3-times higher odds of LVH (3.10 [95% CI: 1.65-5.82]). Meta regression showed that BMI had a significant influence on the mean differences in LVMI, with the mean difference in LVMI increasing by 0.81gm-2.7 (95% CI [0.42, 1.19], p < 0.001) per unit increase in BMI.

Conclusion

Children with ambulatory HTN have a greater risk of SCOs. These findings emphasize the importance for children to have their BP within normal values.