Children with high blood pressure face long-term risk for cardiovascular disease

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Key takeaways:

  • Pediatric hypertension is often unrecognized.
  • Children with high blood pressure were more likely to suffer cardiovascular ailments as adults.

TORONTO — Children with high blood pressure are more likely to be at risk for a stroke, heart attack or other major cardiac event later in life, according to research presented at the Pediatric Academic Societies Meeting.

High blood pressure affects 6% of children and is often unrecognized, according to Cal Robinson, MD, a pediatric nephrology fellow and PhD student at the Hospital for Sick Children in Toronto, and colleagues.

Robinson told Healio that the goal of the study was to better understand the long-term risks that children with high blood pressure will face.

“Previous research has shown that high blood pressure in childhood tracks into adulthood and is associated with changes to the heart and blood vessels, which may lead to cardiovascular disease,” Robinson said. “If we found that high blood pressure was associated with a greater risk of future heart disease, this may justify improved pediatric blood pressure screening, diagnosis and treatment.”

Using a provincial health database, Robinson and colleagues identified 25,605 children aged between 3 and 18 years living in the province of Ontario who were diagnosed with high blood pressure between 1996 to 2021, and matched them to 128,025 children who did not have hypertension. They followed the patients from the time they were diagnosed with high blood pressure until they died, emigrated from the province or completed follow-up in March 2022.

“Our main outcome was major adverse cardiac events, which is a combination of cardiovascular death, stroke, hospitalization for heart attack or angina, or a coronary procedure,” Robinson said.

“Over 13-year median follow-up, we found that children with high blood pressure were at two-times higher risk of experiencing major adverse cardiac events than children without high blood pressure,” Robinson said.

Specifically, the incidence of major adverse cardiac events was 5.4 per 1,000 person-years among children with high blood pressure vs. 1.5 per 1,000 person-years among the control group, with an adjusted HR of 2.1 (95% CI, 1.9-2.2).

Children with hypertension also faced approximately double the risk — or higher — for all-cause mortality (aHR = 1.9; 95% CI, 1.7-2.0), congestive heart failure (aHR = 2.6; 95% CI, 2.4-2.9) and cardiovascular procedures (aHR = 2.6; 95% CI, 2.3-2.8) vs. controls.

“This is one of the first studies to demonstrate that children with high blood pressure are at increased risk of cardiovascular disease,” Robinson said.

Robinson said improved screening may increase the recognition of high blood pressure in children and create opportunities for better treatment, and recommended that children with persistent high blood pressure be treated or referred to an appropriate specialist.

“Since the average age at the end of our study follow-up was 27 years, even longer-term research is needed to evaluate the risk of cardiovascular disease in middle age,” Robinson said. “Future studies should also evaluate the impact of different cardiovascular disease prevention strategies, including dietary changes, lifestyle modification and blood pressure medications.”


Robinson CH, et al. Long-term cardiovascular outcomes in children and adolescents with hypertension: A population-based, propensity-matched cohort study. Presented at: Pediatric Academic Societies Meeting; May 2-6, 2024; Toronto.

Study: Children with hypertension at higher long-term risk for serious heart conditions. Published May 3, 2024. Accessed May 3, 2024.

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