Prevalence and impact of abnormal blood pressure on left ventricular hypertrophy in adolescents with congenital heart disease

Background

Left ventricular hypertrophy (LVH) secondary to hypertension is associated with cardiovascular events in adulthood. Prevalence of abnormal blood pressure and LVH in youths with congenital heart disease (CHD) is understudied despite childhood hypertension predicting adult hypertension. This study aimed to describe the prevalence of hypertension and LVH in adolescents with CHD and factors associated with LVH in this population.

Methods

This was a retrospective analysis of echocardiogram reports from patients with CHD aged 13–17 years with documented systolic blood pressure (SBP), height, weight, and left ventricular mass (LVM) indexed to body size (LVMI-ht^2.7). Patients were stratified by SBP and CHD type. Hypertension and LVH prevalence were calculated; linear regression models assessed factors associated with LVH.

Results

Of 853 patients (mean age 15.5 ± 1.5 years, 57.1 % male), 25.1 % had elevated SBP, whereas 11.6 % and 5.7 % had stage 1 and stage 2 hypertension, respectively. LVH was more prevalent with higher SBP (37.4 % elevated, 32.3 % stage 1 hypertension, and 40.7 % stage 2 hypertension) versus 19.6 % normotensive. BMI percentile and SBP were significantly associated with LVMI-ht^2.7; for 10 % BMI percentile and 10 mmHg SBP increases, LVMI-ht^2.7 increased by 1.2 g/m^2.7 and 0.93 g/m^2.7, respectively, after adjustment for age, sex, race, SBP, BMI, and CHD lesion.

Conclusions

Adolescents with CHD have a high prevalence of abnormal SBP and LVH. BMI percentile and SBP were associated with LVMI-ht^2.7. Findings support screening for BMI and hypertension in youths with CHD as this population has increased baseline cardiovascular risk that may be compounded by obesity and chronic hypertension.