Ability of Blood Pressure to Predict Left Ventricular Hypertrophy in Children with Primary Hypertension

Objective: To determine whether casual blood pressure (BP) or ambulatory BP monitoring (ABPM) measurements obtained at the initial visit of a child with confirmed hypertension (HTN) might predict left ventricular hypertrophy (LVH), possibly obviating the need for echocardiography. Study design: We conducted a cross-sectional study of 184 children aged 3 to 20 years who were referred for initial evaluation of elevated BP at 3 tertiary care centers. Casual BP and various ambulatory BP variables were analyzed to determine their association with LVH, defined after echocardiography by cardiologist diagnosis or a left ventricular mass index equal to or greater than the sex-specific 95th percentile. Results: A total of 41% of children who had echocardiograms had LVH. Children with LVH were significantly more likely to be non-white and have a higher body mass index z-score. There was no difference in casual systolic or diastolic BP index in children with hypertension who had LVH and children with hypertension without LVH. Children with systolic or diastolic BP loads ≥50% were no more likely to have LVH than children with loads <50%. Conclusion: LVH is common in children with newly diagnosed HTN. The initial examination of these children should include echocardiography, because neither the severity of casual BP elevation nor the presence of abnormal ambulatory BP results at initial diagnosis are predictive of LVH.