Ambulatory isolated diastolic hypertension and risk of left ventricular hypertrophy in children with primary and secondary hypertension

Abstract

Background: Pediatric blood pressure (BP) assessment and management is increasingly important. Uncontrolled systolic and combined hypertension leads to hypertension-mediated organ damage. The impact of isolated diastolic hypertension is less clearly understood.

Methods: We analyzed the prevalence of ambulatory isolated diastolic hypertension (IDH) in primary (PH) and secondary (SH) hypertension, and associations with BMI Z-score (BMIz) and left ventricular mass index adjusted to the 95th percentile (aLVMI) in a large, multicenter cohort of hypertensive children. Hypertensive children were divided and analyzed in three ambulatory hypertension subgroups: 24-h, daytime, and nighttime. Specifically, we sought to determine the prevalence of ambulatory 24-h, daytime, or nighttime IDH.

Results: Prevalence of IDH varied based on ambulatory phenotypes, ranging from 6 to 12%, and was highest in children with SH. Children with IDH tended to be more likely female and, in some cases, were leaner than those with isolated systolic hypertension (ISH). Despite previous pediatric studies suggesting no strong association between diastolic blood pressure and left ventricular hypertrophy (LVH), we observed that children with IDH were equally likely to have LVH and had comparable aLVMI to those with ISH and combined systolic-diastolic hypertension.

Conclusions: In summary, ambulatory IDH appears to be a unique phenotype with a female sex, and younger age predilection, but equal risk for LVH in children with either PH or SH.

Keywords: Ambulatory blood pressure monitoring; Children; Diastolic blood pressure; Hypertension.

A higher-resolution version of the Graphical abstract is available as Supplementary information

Fig. 1

A Evaluation statistics with mean difference and 95% confidence intervals of the difference shown for females with primary hypertension (PH) across the ambulatory phenotypes. Isolated diastolic hypertension was higher in females with PH and 24-h hypertension. ISOSBP24, isolated 24-h systolic hypertension; ISODBP24, isolated 24-h diastolic hypertension; SBPDBP24, combined 24-h hypertension. B Evaluation statistics with mean difference and 95% confidence intervals of the difference shown for females with secondary hypertension (SH) across the ambulatory phenotypes. Isolated diastolic hypertension was higher in females with SH and 24-h hypertension. ISOSBP24, isolated 24-h systolic hypertension; ISODBP24, isolated 24-h diastolic hypertension; SBPDBP24, combined 24-h hypertension

Fig. 2

A Evaluation statistics with mean difference and 95% confidence intervals of the difference shown for LVH prevalence in those with primary hypertension (PH) and 24-h hypertension. This reveals that children with PH and 24-h IDH had non-significantly different, and possibly higher, chance of LVH. ISOSBP24, isolated 24-h systolic hypertension; ISODBP24, isolated 24-h diastolic hypertension; SBPDBP24, combined 24-h hypertension. B Evaluation statistics with mean difference and 95% confidence intervals of the difference shown for LVH prevalence in those with secondary hypertension (SH) and 24-h hypertension. This reveals that children with SH and 24-h IDH had non-significantly different, and possibly higher, chance of LVH. ISOSBP24, isolated 24-h systolic hypertension; ISODBP24, isolated 24-h diastolic hypertension; SBPDBP24, combined 24-h hypertension