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Hypertension: An Important But Reversible Cause of Systolic Dysfunction in a Cohort of Pediatric Patients

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Abstract

Cardiac dysfunction due to hypertension (CDHTN) in pediatrics is not well described. We aimed to describe the presentation and outcomes of pediatric CDHTN and identify clinical features associated with resolution of dysfunction. A single-center retrospective cohort study of patients ≤ 21 years with CDHTN from January 2005–September 2020 was performed. Patients with systolic dysfunction without another cause, blood pressure > 95th percentile, and physician judgment that dysfunction was secondary to hypertension were included. Demographics, clinical characteristics, echocardiographic findings, and outcomes were examined using Fisher’s exact and Mann–Whitney U tests. Multiple correspondence analysis was used to explore the relationship of resolution of dysfunction to clinical features. Thirty-four patients were analyzed at a median age of 10.9 (IQR 0.3–16.9) years. Patients were divided into groups < 1 year (n = 12) and ≥ 1 year (n = 22). Causes of hypertension were varied by age, with renovascular disease most common in infants (42%) and medical renal disease most common in older patients (77%). Echocardiography demonstrated mild LV dilation (median LV end-diastolic z-score 2.6) and mild LV hypertrophy (median LV mass z-score 2.4). Most patients (81%) had resolution of dysfunction, particularly infants (92%). One patient died and one patient was listed for heart transplant. None required mechanical circulatory support (MCS). No clinical features were statistically associated with resolution of dysfunction. Hypertension is an important but reversible cause of systolic dysfunction in children. Patients are likely to recover with low mortality and low utilization of MCS or transplantation. Further studies are needed to confirm features associated with resolution of dysfunction.

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Abbreviations

LVH:

Left ventricular hypertrophy

CDHTN:

Cardiac dysfunction secondary to hypertension

EF:

Ejection fraction

LV:

Left ventricular

SF:

Shortening fraction

BP:

Blood pressure

IQR:

Interquartile range

MCA:

Multiple correspondence analysis

MCS:

Mechanical circulatory support

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Acknowledgements

This work was supported in part by the Cardiac Center Clinical Research Core at the Children’s Hospital of Philadelphia.

Funding

Financial support for A.K. from National Institutes of Health 5T32 HL007915. Study sponsors were not involved in study design, data collection, analysis or interpretation, writing of the report or decision to submit the manuscript for publication.

Author information

Authors and Affiliations

  1. Division of Cardiology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Alicia M. Kamsheh, Robert A. Palermo, Jonathan B. Edelson, Kimberly Y. Lin, Joseph W. Rossano, Carol A. Wittlieb-Weber & Matthew J. O’Connor

  2. Division of Nephrology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Kevin E. Meyers

  3. Data Science and Biostatistics Unit, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Lezhou Wu

  4. Division of Pediatric Cardiology, Department of Pediatrics, The University of Vermont, Burlington, VT, USA

    Danielle S. Burstein

  5. Division of Cardiothoracic Surgery, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Katsuhide Maeda

  6. Division of Cardiology, St. Louis Children’s Hospital, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA

    Alicia M. Kamsheh

Authors
  1. Alicia M. Kamsheh
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  2. Kevin E. Meyers
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  3. Robert A. Palermo
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  4. Lezhou Wu
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  5. Danielle S. Burstein
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  6. Jonathan B. Edelson
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  7. Kimberly Y. Lin
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  8. Katsuhide Maeda
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  9. Joseph W. Rossano
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  10. Carol A. Wittlieb-Weber
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  11. Matthew J. O’Connor
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Contributions

All authors contributed to the study conception and design. Data collection was performed by AK. Analysis was performed by AK, LW, and MO’C. The first draft of the manuscript was written by AK and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Alicia M. Kamsheh.

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Competing interests

The authors have no relevant financial or non-financial interests to disclose.

Ethics Approval

This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was reviewed by the Children’s Hospital of Philadelphia Institutional Review Board and granted exemption.

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Kamsheh, A.M., Meyers, K.E., Palermo, R.A. et al. Hypertension: An Important But Reversible Cause of Systolic Dysfunction in a Cohort of Pediatric Patients. Pediatr Cardiol 45, 331–339 (2024). https://doi.org/10.1007/s00246-023-03313-8

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