Ambulatory blood pressure characteristics and left ventricular hypertrophy in untreated children with primary hypertension.

Abstract

To identify clinical and ambulatory blood pressure monitoring (ABPM)-derived factors associated with left ventricular hypertrophy (LVH) in untreated children and adolescents with primary hypertension. This retrospective study included 306 untreated patients aged 9-17 years with newly diagnosed primary hypertension. LVH was defined as a left ventricular mass index ≥ 45 g/m^2.16. Propensity score-based overlap weighting was used to balance demographic and obesity-related characteristics between patients with and without LVH. Weighted logistic regression was performed to evaluate clinical, laboratory, and ABPM-derived factors associated with LVH. LVH was present in 89 patients (29.1%). Grade 2 office hypertension was the strongest factor associated with LVH (OR 4.22, 95% CI 2.29-7.77; P < 0.001). Selected metabolic and inflammatory markers showed exploratory associations with LVH. Among continuous ABPM parameters, nighttime mean diastolic blood pressure was associated with LVH (OR 1.54 per 10-mmHg increase, 95% CI 1.02-2.31), although this association was lost after adjustment for hypertension grade. In contrast, a systolic non-dipper pattern remained associated with LVH after adjustment for hypertension grade (OR 2.83, 95% CI 1.18-6.80; P = 0.020).

Conclusion:  LVH was common among untreated children with primary hypertension, with office HTN severity being the predominant associated factor. Abnormal circadian BP patterns may provide complementary information for identifying children with LVH.

What is known: • Left ventricular hypertrophy is a common form of cardiac target-organ damage in children with primary hypertension. • Ambulatory blood pressure monitoring provides information on nocturnal blood pressure and circadian patterns beyond office blood pressure.

What is new: • In untreated children, grade 2 office hypertension was the factor most strongly associated with left ventricular hypertrophy. • A systolic non-dipping pattern remained associated with left ventricular hypertrophy after adjustment for hypertension severity, suggesting additional value of circadian blood pressure assessment.