Prevention of cardiovascular disease is a significant public health problem. Systemic arterial hypertension is a recognized risk factor for cardiovascular disease worldwide. At birth, the majority of children have optimal cardiovascular health. However, over the course of life, they often develop habits that expose them to modifiable cardiovascular risk factors.
Arterial hypertension plays a significant role in cardiovascular disease and its incidence in infants is increasing along with the global increase in obesity. Over the last three decades, the prevalence of hypertension in adolescents has increased almost fivefold, from 1.3% (1990–1999) to 6.0% (2010–2014).
Despite the increasing prevalence of childhood hypertension and its association with subclinical cardiovascular disease, this condition is still under-recognized and under-treated. There is no consensus on the importance of its diagnosis and monitoring. Only between 11% and 35% of infants have their blood pressure checked regularly (at least once a year), and few children with hypertension receive adequate follow-up, diagnosis, or treatment.
In May 2024 JAMA Pediatrics published a paired retrospective cohort study conducted in Canada entitled “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 children 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 disease, and to have used health services more frequently before. The final cohort included 25,605 infants diagnosed with hypertension and 128,025 control infants without hypertension.
The median follow-up time was 13.6 years (interquartile range (IQR), 7.8-19.5), with the median age at last follow-up being 27 years (IQR, 21-34). Complete follow-up was achieved in 89.3% of adolescents through March 2022. Major adverse cardiovascular events occurred during the follow-up period in 6.1% of patients with hypertension and 3.1% of controls.
The incidence of major cardiovascular events was 4.6 events per 1000 person-years in infants with hypertension and 2.2 events per 1000 person-years in controls. Patients with hypertension had a higher risk of major cardiovascular events during follow-up compared with controls (hazard ratio (HR) 2.1).
Infants diagnosed with hypertension had a higher risk of stroke (HR 2.7), hospitalization for heart attack or unstable angina (HR 1.8), and heart attack surgery (HR 4.1) compared with control infants without hypertension. However, there were no differences in the risk of death from cardiovascular disease. Infants with hypertension also had a higher risk of heart failure (HR 2.6), other cardiovascular diagnoses (HR 1.7), and cardiovascular surgery (HR 2.6) compared with control groups.
This comprehensive study concluded that children diagnosed with arterial hypertension had twice the risk of major cardiovascular events compared to infants without arterial hypertension.
The study provides important information on the risk faced by children with hypertension into adulthood. Therefore, it is important to implement public health strategies targeting 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 reduce the burden of cardiovascular disease in the future.
This story was translated from the Spanish edition of Medscape Several editorial tools, including AI, were used. Human editors reviewed this content before publication.
