Prevalence of Pediatric Masked Hypertension and Risk of Subclinical Cardiovascular Outcomes: A Systematic Review and Meta-Analysis

Jason Chung; Cal Robinson; Lauren Sheffield; Prathayini Paramanathan; Andrew Yu; Joycelyne Ewusie; Stephanie Sanger; Mark Mitsnefes; Rulan S Parekh; Manish D Sinha; Myanca Rodrigues; Lehana Thabane; Janis Dionne; Rahul Chanchlani

doi:10.1161/HYPERTENSIONAHA.123.20967

Prevalence of Pediatric Masked Hypertension and Risk of Subclinical Cardiovascular Outcomes: A Systematic Review and Meta-Analysis

Hypertension. 2023 Nov;80(11):2280-2292. doi: 10.1161/HYPERTENSIONAHA.123.20967. Epub 2023 Sep 22.

Authors

Jason Chung¹, Cal Robinson², Lauren Sheffield³, Prathayini Paramanathan⁴, Andrew Yu⁵, Joycelyne Ewusie⁶, Stephanie Sanger⁷, Mark Mitsnefes⁸, Rulan S Parekh⁹, Manish D Sinha¹⁰, Myanca Rodrigues¹¹, Lehana Thabane^{6

12}, Janis Dionne¹³, Rahul Chanchlani¹⁴

Affiliations

¹ Temerty Faculty of Medicine, University of Toronto, Ontario, Canada (J.C.).
² Department of Pediatrics, Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada (C.R.).
³ Faculty of Sciences, McMaster University, Hamilton, Ontario, Canada (L.S.).
⁴ All Saints University College of Medicine, Kingstown, Saint Vincent and the Grenadines (P.P.).
⁵ Faculty of Science, University of Alberta, Edmonton, Canada (A.Y.).
⁶ Department of Health Research Methods, Evidence, and Impact, Research Institute - St Joseph's Healthcare Hamilton, McMaster University, Ontario, Canada (J.E., L.T.).
⁷ Department of Health Sciences: Health Science Library, McMaster University, Hamilton, Ontario, Canada (S.S.).
⁸ Department of Pediatrics, Division of Nephrology, Cincinnati Children's Hospital Medical Center, OH (M.M.).
⁹ Department of Pediatrics and Medicine, Division of Nephrology, The Hospital for Sick Children, University Health Network and University of Toronto, Ontario, Canada (R.S.P.).
¹⁰ Department of Paediatric Nephrology, King's College London, Evelina London Childrens Hospital, United Kingdom (M.D.S.).
¹¹ Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada (M.R.).
¹² University of Johannesburg Faculty of Health Sciences, South Africa (L.T.).
¹³ Department of Pediatrics, Division of Nephrology, University of British Columbia, Vancouver, Canada (J.D.).
¹⁴ Department of Pediatrics, Division of Pediatric Nephrology, McMaster Children's Hospital, McMaster University, Hamilton, Canada (R.C.).

PMID: 37737026
DOI: 10.1161/HYPERTENSIONAHA.123.20967

Abstract

Masked hypertension (MH) occurs when office blood pressure is normal, but hypertension is confirmed using out-of-office blood pressure measures. Hypertension is a risk factor for subclinical cardiovascular outcomes, including left ventricular hypertrophy, increased left ventricular mass index, carotid intima media thickness, and pulse wave velocity. However, the risk factors for ambulatory blood pressure monitoring defined MH and its association with subclinical cardiovascular outcomes are unclear. A systematic literature search on 9 databases included English publications from 1974 to 2023. Pediatric MH prevalence was stratified by disease comorbidities and compared with the general pediatric population. We also compared the prevalence of left ventricular hypertrophy, and mean differences in left ventricular mass index, carotid intima media thickness, and pulse wave velocity between MH versus normotensive pediatric patients. Of 2199 screened studies, 136 studies (n=28 612; ages 4-25 years) were included. The prevalence of MH in the general pediatric population was 10.4% (95% CI, 8.00-12.80). Compared with the general pediatric population, the risk ratio (RR) of MH was significantly greater in children with coarctation of the aorta (RR, 1.91), solid-organ or stem-cell transplant (RR, 2.34), chronic kidney disease (RR, 2.44), and sickle cell disease (RR, 1.33). MH patients had increased risk of subclinical cardiovascular outcomes compared with normotensive patients, including higher left ventricular mass index (mean difference, 3.86 g/m^2.7 [95% CI, 2.51-5.22]), left ventricular hypertrophy (odds ratio, 2.44 [95% CI, 1.50-3.96]), and higher pulse wave velocity (mean difference, 0.30 m/s [95% CI, 0.14-0.45]). The prevalence of MH is significantly elevated among children with various comorbidities. Children with MH have evidence of subclinical cardiovascular outcomes, which increases their risk of long-term cardiovascular disease.

Keywords: ambulatory blood pressure monitoring; cardiovascular diseases; carotid intima-media thickness; left ventricular hypertrophy; masked hypertension.

Publication types

Meta-Analysis
Systematic Review
Review

MeSH terms

Blood Pressure / physiology
Blood Pressure Monitoring, Ambulatory
Carotid Intima-Media Thickness
Child
Humans
Hypertension* / complications
Hypertension* / epidemiology
Hypertrophy, Left Ventricular
Masked Hypertension* / diagnosis
Masked Hypertension* / epidemiology
Prevalence
Pulse Wave Analysis / adverse effects