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Meta-Analysis
. 2025 May 15;38(6):370-379.
doi: 10.1093/ajh/hpaf026.

Elevated Blood Pressure and Cardiac Mechanics in Children and Adolescents: A Systematic Review and Meta-Analysis

Andrea Faggiano  1 , Elisa Gherbesi  1 , Carla Sala  1   2 , Stefano Carugo  1   2 , Guido Grassi  3 , Cesare Cuspidi  3 , Marijana Tadic  4
Affiliations
Meta-Analysis

Elevated Blood Pressure and Cardiac Mechanics in Children and Adolescents: A Systematic Review and Meta-Analysis

Andrea Faggiano et al. Am J Hypertens. .

Abstract

Introduction: Evidence on left ventricular (LV) mechanics, assessed by speckle tracking echocardiography (STE), in children and adolescents with elevated blood pressure (BP)/hypertension is scanty.

Aim: The aim of the present meta-analysis was to provide an updated information on LV systolic function phenotyped by global longitudinal strain (GLS) and LV ejection fraction (LVEF) in the setting of pediatric hypertension.

Methods: Systematic searches were conducted across bibliographic databases (Pub-Med, OVID, EMBASE, and Cochrane Library) to identify eligible studies from inception up to 30 November 2024. Studies reporting data on LV mechanics in pediatric hypertension and controls were included. The statistical difference of the echocardiographic variables of interest between groups such as LVEF and GLS was calculated by standardized mean difference (SMD) with 95% confidence interval (CI) using random-effects models.

Results: Eight studies including 719 individuals with elevated BP/hypertension and 1,653 age-matched healthy controls were considered for the analysis. Pooled average LVEF values were 72.4 ± 1.6% in the healthy control group and 72.5 ± 1.8% in the elevated BP/hypertensive group (SMD: 0.08 ± 0.15, CI: -0.21/0.36, P = 0.60); the corresponding values of GLS were -19.6 ± 1.1% and 18.5 ± 0.9% (SMD: -0.96 ± 0.25, CI: -1.46/-0.47, P < 0.0001). A parallel impairment of global circumferential strain emerged from pooled data of three studies (SMD: -0.96 ± 0.25, CI: -1.46/-0.47, P < 0.0001).

Conclusions: Our data suggest that LVEF is unable to detect early alterations in systolic function in pediatric hypertension, and the implementation of STE may be highly useful in unmasking systolic dysfunction in this setting.

Keywords: blood pressure; global longitudinal strain; hypertension; left ventricular ejection fraction; pediatric hypertension; systolic function.

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Conflict of interest statement

The authors declared no conflict of interest.

Figures

Figure 1.
Figure 1.
Schematic flowchart for the selection of studies.
Figure 2.
Figure 2.
Forest plot of left ventricular ejection fraction (LVEF) in healthy normotensive controls and elevated BP/hypertensive individuals. Standard mean difference (SMD) and 95% confidence interval (CI); random model (I2 > 75%). BP, blood pressure.
Figure 3.
Figure 3.
Forest plot of global longitudinal strain (GLS) in healthy normotensive controls and elevated BP/hypertensive individuals. Standard mean difference (SMD) and 95% confidence interval (CI); random model (I2 > 75%).
Figure 4.
Figure 4.
Forest plot of global circumferential strain (GCS) in healthy normotensive controls and elevated BP/hypertensive individuals. Standard mean difference (SMD) and 95% confidence interval (CI); random model (I2 > 75%). BP, blood pressure.
Figure 5.
Figure 5.
Forest plot of E/e′ ratio healthy normotensive controls and elevated BP/hypertensive individuals. Standard mean difference (SMD) and 95% confidence interval (CI); random model (I2 > 75%). BP, blood pressure.
Figure 6.
Figure 6.
Forest plot of left ventricular mass index (LVM g/m2.7) in healthy normotensive controls and elevated BP/hypertensive individuals. Standard mean difference (SMD) and 95% confidence interval (CI); Random model (I2 >75%).
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