Abstract
Objective: The aim of this study was to investigate the clinical characteristics and factors associated with pediatric hypertension and target organ damage (TOD).Methods: We retrospectively reviewed clinical data from 205 children with hypertension treated in our hospital from 2007 to 2018. The patients were classified based on the type of hypertension (primary, secondary) and presence of TOD (heart, brain, retina). Logistic regression analysis was performed to identify the factors independently associated with hypertension and TOD.Results: There were 107 males, 97 females, and one intersex in this study, with an age range of 0.1–17.9 years. Majority of cases (177, 86.3%) had secondary hypertension, while 13.7% had primary hypertension. The most frequent cause of secondary hypertension was renal disease (59.32%). Elevated serum creatinine level (odds ratio [OR] = 7.22, 95% confidence interval [95% CI] = 1.6–32.62, P = 0.01), blood urea nitrogen (OR = 6.33, 95% CI = 1.81–22.19, P = 0.004), serum uric acid level (OR = 3.66, 95% CI = 1.20–11.22, P = 0.023), and albuminuria (OR = 3.72, 95% CI = 1.50–9.26, P = 0.005) were independently associated with secondary hypertension. Elevated serum uric acid and blood urea nitrogen levels were associated with left ventricular hypertrophy (OR = 6.638, 95% CI = 1.349–32.657, P = 0.02) and hypertensive encephalopathy (OR = 4.384, 95% CI = 1.148–16.746, P = 0.031), respectively. Triglyceride level correlated with hypertensive retinopathy (P = 0.001).Conclusion: Pediatric hypertension was most often secondary, with renal disease as the leading cause. Elevated levels of serum uric acid, blood urea nitrogen, serum creatinine, and albuminuria may indicate secondary hypertension in childhood. Elevated serum uric acid, blood urea nitrogen, and triglyceride levels were associated with left ventricular hypertrophy, hypertensive encephalopathy, and hypertensive retinopathy, respectively.
Highlights
Hypertension, an increase in systemic arterial pressure, is a major public health issue worldwide [1]
We recorded the results of laboratory examinations, including urinalysis, levels of blood urea nitrogen (BUN), serum uric acid (SUc), serum creatinine (SCr), low-density lipoprotein (LDL), triglycerides (TG), total cholesterol (TC), C-reactive protein (CRP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), aldosterone, rennin, and angiotensin
28 cases (13.7%) showed primary hypertension, while 177 (86.3%) children had secondary hypertension. In both the primary hypertension group and secondary hypertension group, the highest proportion of subjects belonged to the group aged ≥12 years
Summary
Hypertension, an increase in systemic arterial pressure, is a major public health issue worldwide [1]. Cardiovascular events rarely occur in children, pediatric hypertension has been identified as a predictor of adult hypertension and a potential risk factor for cardiovascular disease and mortality [3]. Data on blood pressure (BP) tracking from childhood to adulthood have demonstrated that elevated BP in childhood increases the risk of developing hypertension in adulthood [4, 5]. Early detection of childhood hypertension and timely intervention may reduce the risk of cardiovascular disease in adults. Pediatric hypertension used to be considered as a rare disease, epidemiological studies have shown its growing prevalence, with a relative increase rate of 75–79% from 2000 to 2015 globally [6]. Most studies have estimated the prevalence of pediatric hypertension in the range between 2 and 5% [7, 8], which likely increases with age
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