Kids With Hypertension Face Long-Term Cardiovascular Risk

The prevention of cardiovascular diseases is a significant public health problem. Systemic arterial hypertension is a well-recognized risk factor for cardiovascular diseases worldwide. At birth, most of the pediatric population has ideal cardiovascular health. As they progress through life, however, they often develop habits that expose them to modifiable cardiovascular risk factors.

Arterial hypertension plays a significant role in cardiovascular morbidity, and its incidence in infants is rising along with the global increase in obesity. There has been an almost fivefold increase in the prevalence of hypertension among youth in the past three decades, from 1.3% (1990-1999) to 6.0% (2010-2014).

Despite the increasing prevalence of pediatric hypertension and its association with subclinical cardiovascular disease, this condition remains underrecognized and inadequately treated. There is a lack of consensus on the importance of its diagnosis and monitoring. Only between 11% and 35% of infants undergo regular blood pressure checks (at least once per year), and few youngsters with hypertension receive proper follow-up, diagnosis, or treatment.

In May 2024, JAMA Pediatrics published a paired retrospective cohort study conducted in Canada titled “Long-Term Cardiovascular Outcomes in Children and Adolescents With Hypertension.” The study included 27,651 eligible infants diagnosed with hypertension and 4,465,559 eligible control infants without hypertension.

After propensity-score matching, infants diagnosed with hypertension were found to have higher rates of obesity, chronic kidney disease, cancer, and congenital heart diseases. They also had previously used healthcare services more frequently. The final cohort included 25,605 infants diagnosed with hypertension and 128,025 control infants without hypertension.

The median follow-up was 13.6 years (interquartile range [IQR], 7.8-19.5), with a median age at the last check-up of 27 years (IQR, 21-34). Complete follow-up was achieved in 89.3% of youth until March 2022. Major adverse cardiovascular events occurred in 6.1% of patients with hypertension and 3.1% of controls during the follow-up period.

The incidence of major adverse cardiovascular events was 4.6 events per 1000 person-years among infants with hypertension and 2.2 events per 1000 person-years among controls. Patients with hypertension had a higher associated risk for major adverse cardiovascular events during follow-up compared with controls (hazard ratio [HR], 2.1).

Infants diagnosed with hypertension had a higher associated risk for stroke (HR, 2.7), hospitalization resulting from heart attack or unstable angina (HR, 1.8), and coronary intervention (HR, 4.1) compared with control infants without hypertension. There were no differences in the risk for mortality from cardiovascular disease, however. Infants with hypertension also had a higher risk for heart failure (HR, 2.6), other cardiovascular diagnoses (HR, 1.7), and undergoing cardiovascular procedures (HR, 2.6) compared with controls.

This extensive study concluded that the pediatric population diagnosed with arterial hypertension had twice the associated risk for major adverse cardiovascular events compared with infants without arterial hypertension.

The study provides crucial information about the risk that children with hypertension face into adulthood. Hence, it is essential to implement public health strategies targeted at modifiable behaviors related to cardiovascular risk factors, which could lead to significant improvements. Early detection of arterial hypertension in the pediatric population and its appropriate treatment, including specific lifestyle changes, can help reduce the prevalence of these factors and potentially decrease the burden of cardiovascular diseases in the future.

This story was translated from the Medscape Spanish edition using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.