Current etiology of hypertension in European children - factors associated with primary hypertension.

Background: While hypertension (HT) in pediatric patients is often secondary (SH), recent trends show a rise in primary hypertension (PH), which is associated with an increasing global prevalence of obesity. A relationship between serum uric acid and PH has also been suggested. Our study aimed to assess the etiology of HT and factors associated with PH in a large European cohort of children referred for HT based on office blood pressure (BP) measurements.

Methods: We performed a retrospective analysis of 2008 children aged 0-18 years (12.3 ± 4.9 years) diagnosed with HT. Patients were classified into white coat hypertension (WCH), PH, or SH groups based on office BP, 24-h ambulatory BP monitoring (ABPM) and clinical evaluation. Anthropometric, hemodynamic, and biochemical data were collected.

Results: Out of 2008 patients included in the analysis, 200 (10%) were excluded due to multifactorial HT diagnosis after kidney transplantation (KTx). Among the remaining patients HT was confirmed in 1260 (548 were classified as WCH). Of 1260 patients with HT: 49.3% had PH, while 50.7% SH, mainly secondary to renal parenchymal disease (43.5% of SH patients), aortic coarctation (20.7%), and renovascular HT (18%). Age > 12.5 years, obesity (BMI SDS (standard deviation score) ≥ 1.65), and serum uric acid > 4.8 mg/dL were identified as significant factors associated with PH.

Conclusions: Our study provides valuable insights into the current etiology of pediatric HT and highlights the role of age, obesity, and uric acid level in the diagnosis of PH in children.