By Lynda Williams, medwireNews Reporter
medwireNews: Paediatric hypertension is associated with a significantly increased long-term risk of major adverse kidney events (MAKEs), suggests research published in The Lancet Child & Adolescent Health.
“The study findings provide robust evidence of increased kidney-related risks even in the absence of pre-existing kidney disease, offering new insights into the long-term effects of paediatric hypertension”, say Rahul Chanchlani (McMaster University, Hamilton, Ontario, Canada) and co-authors.
The team identified 26,324 children and adolescents aged 3–18 years who were diagnosed with hypertension in Ontario between April 1996 and March 2023. These patients were aged a median 15 years at baseline, 58.7% were boys and 3.0% of patients had a mother with hypertension.
Each patient was propensity-score matched with up to five individuals without hypertension (n=126,834) by age, sex, birthweight, maternal gestational hypertension, pre-existing diabetes, history of cardiovascular surgery, obesity and history of acute kidney injury.
The most common comorbidities in the patients and controls were obesity (14.4 vs 14.3%), malignancy (6.8 vs 7.1%), congenital heart disease (4.4 vs 4.7%), chronic liver disease (2.5 vs 2.5%), and diabetes (1.6 vs 1.6%). Just 0.9% of each group had a history of acute kidney injury.
The patients and controls were followed up for a median 14.2 and 13.7 years, respectively, for the primary outcome of MAKEs – defined as all-cause mortality, chronic kidney disease, or kidney failure indicated by chronic dialysis or receipt of a kidney transplant.
Overall, 7.7% of children and adolescents with hypertension experienced MAKEs versus 2.4% of controls, giving a significant 3.03-fold increase in risk. The corresponding incidence rates were 5.52 and 1.66 cases per 1000 person–years.
Childhood hypertension was also significantly associated with higher risk of the secondary outcomes of all-cause mortality, incident chronic kidney disease, and kidney failure, with hazard ratios (HRs) of 1.90, 4.56 and 7.00, respectively.
And, in turn, these events led to a significantly higher risk of hospital admission for acute kidney injury (HR=3.18), albuminuria (HR=2.34), and of developing stage II or III chronic kidney disease based on respective estimated glomerular filtrate rates of less than 90 and less than 60 mL/min per 1.73 m2 (HR=2.17 and 5.57).
Prespecified subgroup analyses of the relationship between paediatric hypertension and MAKEs indicated that the association was stronger in girls than boys, in children with hypertension who were aged less than 13 years versus older children, and among those without versus with diabetes, as well as among children whose mothers had gestational hypertension, Chanchlani et al observe.
“These results support revisiting paediatric hypertension guidelines to prioritise kidney and cardiovascular health and advocate for cost-effective interventions to mitigate long-term complications”, the researchers conclude.
“Further research is needed to support these findings and explore prevention and management strategies in diverse populations.”
medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2025 Springer Healthcare Ltd, part of Springer NatureLancet Child Adolesc Health 2025; doi:10.1016/ S2352-4642(25)00127-0
Lancet Child Adolesc Health 2025; doi:10.1016/S2352-4642(25)00127-0
https://pubmed.ncbi.nlm.nih.gov/40578375
Keywords: paediatrics, cardiology, hypertension, kidneys, renal