CLINICAL QUESTION

Are children with hypertension at increased risk of major adverse cardiovascular events compared with children without hypertension?

BOTTOM LINE

After nearly 14 years of follow-up, children with hypertension are twice as likely to experience major adverse cardiovascular events as children without hypertension. (Level of Evidence = 2b)

SYNOPSIS

The researchers used Ontario's provincial administrative health databases to compare the cardiovascular outcomes of children with newly diagnosed hypertension vs the outcomes of children without hypertension. The authors matched five control patients for every child with hypertension based on several factors, such as age, sex, birth weight, maternal gestational hypertension, comorbid conditions, and propensity scores. Socioeconomic marginalization and rurality were also considered. The authors defined their outcome—major adverse cardiovascular events— as the composite of cardiovascular death, stroke, hospitalization for acute myocardial infarction or unstable angina, or coronary intervention. From the database of several million children, they were able to match 25,605 children with hypertension to 128,025 children without hypertension. The average age of participants entering the study was 15 years and 58% were male. Over a median follow-up of 13.6 years, major adverse cardiovascular events occurred in 1,557 children (6.1%) with hypertension vs 3,901 control patients (3.1%). The overall incidence of major adverse cardiovascular events was 4.6 per 1,000 person-years (95% CI, 4.4–4.9 events) among children with hypertension vs 2.2 per 1,000 person-years (95% CI, 2.2–2.3) among control patients. After further analysis, children with hypertension were twice as likely to have a major adverse cardiovascular event as those without (hazard ratio = 2.1; 95% CI, 1.9–2.2). Finally, children with hypertension were at a higher risk of stroke, hospitalization for myocardial infarction or unstable angina, coronary intervention, and congestive heart failure, but not cardiovascular death.