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.

Department of Nephrology Kidney Transplantation and Hypertension Children's Memorial Health Institute Warsaw Poland

Department of Pediatrics Charles University Prague 2nd Faculty of Medicine Prague Czech Republic

Department of Pediatrics University Hospital Ostrava Ostrava Czech Republic

Division of Nephrology Department of Pediatrics Children's Hospital of Eastern Ontario University of Ottawa Ottawa Canada

Kidney Research Center Department of Cellular and Molecular Medicine The Ottawa Hospital Research Institute University of Ottawa Ottawa Canada

Medical Faculty University of Ostrava Ostrava Czech Republic

Zobrazit více v PubMed

Song P, Zhang Y, Yu J et al (2019) Global prevalence of hypertension in children. JAMA Pediatr 173:1154. 10.1001/jamapediatrics.2019.3310 PubMed PMC

Myette RL, Flynn JT (2024) The ongoing impact of obesity on childhood hypertension. Pediatr Nephrol. 10.1007/s00467-023-06263-8 PubMed

Sarnecki J, Obrycki Ł, Feber J et al (2022) Isolated systolic hypertension is associated with increased left ventricular mass index and aortic stiffness in adolescents: a cardiac magnetic resonance study. J Hypertens 40:985–995. 10.1097/HJH.0000000000003101 PubMed

Obrycki Ł, Feber J, Derezinski T et al (2020) Hemodynamic patterns and target organ damage in adolescents with ambulatory prehypertension. Hypertension 75:826–834. 10.1161/HYPERTENSIONAHA.119.14149 PubMed

Alsaeed H, Metzger DL, Blydt-Hansen TD et al (2021) Isolated diastolic high blood pressure: a distinct clinical phenotype in US children. Pediatr Res 90:903–909. 10.1038/s41390-021-01369-x PubMed

Rasała J, Marschollek P, Marschollek K et al (2020) New methods of differentiation between primary and secondary hypertension in a pediatric population: a single-center experience. Adv Clin Exp Med 29:1299–1304. 10.17219/ACEM/127425 PubMed

Wühl E, Witte K, Soergel M et al (2002) Distribution of 24-h ambulatory blood pressure in children: normalized reference values and role of body dimensions. J Hypertens 20:1995–2007. 10.1097/00004872-200210000-00019 PubMed

Flynn JT, Urbina EM, Brady TM et al (2022) Ambulatory blood pressure monitoring in children and adolescents: 2022 update: a scientific statement from the American Heart Association. Hypertension 79:114–124. 10.1161/HYP.0000000000000215 PubMed

Lopez L, Colan SD, Frommelt PC et al (2010) Recommendations for quantification methods during the performance of a pediatric echocardiogram: a report from the Pediatric Measurements Writing Group of the American Society of Echocardiography Pediatric and Congenital Heart Disease Council. J Am Soc Echocardiogr 23:465–495. 10.1016/j.echo.2010.03.019 PubMed

Devereux RB, Alonso DR, Lutas EM et al (1986) Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol 57:450–458. 10.1016/0002-9149(86)90771-X PubMed

Khoury PR, Mitsnefes M, Daniels SR, Kimball TR (2009) Age-specific reference intervals for indexed left ventricular mass in children. J Am Soc Echo 22:709–714. 10.1016/j.echo.2009.03.003 PubMed

de Simone G, Devereux RB, Daniels SR et al (1995) Effect of growth on variability of left ventricular mass: assessment of allometric signals in adults and children and their capacity to predict cardiovascular risk. J Am Coll Cardiol 25:1056–1062. 10.1016/0735-1097(94)00540-7 PubMed

Vallat R (2018) Pingouin: statistics in Python. J Open Source Softw 3:1026. 10.21105/joss.01026

Ali US, Patil HA, Prakash RG et al (2022) Prevalence and subtypes of hypertension in normal-weight and obese Indian adolescents: a cross-sectional study. J Hum Hypertens 36:1003–1010. 10.1038/s41371-021-00605-5 PubMed

Mahajan S, Zhang D, He S et al (2019) Prevalence, awareness, and treatment of isolated diastolic hypertension: insights from the China PEACE million persons project. J Am Heart Assoc 8:e012954. 10.1161/JAHA.119.012954 PubMed PMC

Hamdani G, Mitsnefes MM, Flynn JT et al (2021) Pediatric and adult ambulatory blood pressure thresholds and blood pressure load as predictors of left ventricular hypertrophy in adolescents. Hypertension 78:30–37. 10.1161/HYPERTENSIONAHA.120.16896 PubMed

Urbina EM, Mendizábal B, Becker RC et al (2019) Association of blood pressure level with left ventricular mass in adolescents: SHIP AHOY. Hypertension 74:590–596. 10.1161/HYPERTENSIONAHA.119.13027 PubMed

Jacobsen AP, McKittrick M, Daya N et al (2022) Isolated diastolic hypertension and risk of cardiovascular disease: controversies in hypertension-con side of the argument. Hypertension 79:1571–1578. 10.1161/HYPERTENSIONAHA.122.18458 PubMed PMC

Yano Y, Kim HC, Lee H et al (2022) Isolated diastolic hypertension and risk of cardiovascular disease - pro side of the argument. Hypertension 79:1563–1570. 10.1161/HYPERTENSIONAHA.122.18459 PubMed

Lee H, Yano Y, Cho SMJ et al (2020) Cardiovascular risk of isolated systolic or diastolic hypertension in young adults. Circulation 141:1778–1786. 10.1161/CIRCULATIONAHA.119.044838 PubMed

Jacobsen AP, Al Rifai M, Arps K et al (2021) A cohort study and meta-analysis of isolated diastolic hypertension: searching for a threshold to guide treatment. Eur Heart J 42:2119–2129. 10.1093/eurheartj/ehab111 PubMed PMC