Paediatric hypertension linked to increased risk of major adverse kidney events

Hypertension in children and adolescents appears to be associated with heightened long-term risk of major adverse kidney events (MAKEs), according to a large retrospective study.

Researchers used health administrative databases and identified children and adolescents residing in Ontario, Canada. A total of 26,324 paediatric patients with hypertension were propensity score-matched with 126,834 youths without hypertension (control).

The primary outcome of MAKE included all-cause mortality, incident chronic kidney disease, or kidney failure (ie, start of chronic dialysis or receipt of kidney transplantation). This was evaluated in the hypertension and control groups using weighted Cox regression.

In the hypertension cohort, the median age at entry was 15 years, and 58.7 percent were male. There were few participants with comorbidities (4.4 percent had congenital heart disease, 6.8 percent had malignancy, 1.6 percent had diabetes, and 9.0 percent had complex chronic conditions) and were born to mothers with hypertension (3.0 percent).

The median follow-up was 14.2-years in the hypertension cohort and 13.7 years in the control cohort. MAKE occurred in 7.7 percent and 2.2 percent of participants in the respective cohorts, with the corresponding incidence rate of 5.52 and 1.66 per 1,000 person-years.

Hypertension in children and adolescents was associated with a threefold increased risk of MAKE (hazard ratio, 3.03, 95 percent confidence interval, 2.86–3.21).

The findings, which should be validated in prospective studies, point to the potential of improving recognition and control of paediatric hypertension as a strategy to prevent progressive kidney dysfunction.