Prevalence of Elevated Blood Pressure and Left Ventricular Hypertrophy in Adolescents with Congenital Heart Disease

Background Left ventricular hypertrophy (LVH) associated with hypertension (HTN) is a predictor of cardiovascular (CV) events in adulthood. LVH is defined using left ventricular mass indexed to height 2.7 (LVMI-ht 2.7 ) with current guidelines using the adult cutoff of 51 g/ht 2.7 ; however, the pediatric cutoff is lower. Adults with congenital heart disease (CHD) have higher rates of HTN compared to the general adult population. Data on the prevalence of elevated blood pressure (SBP) in youths with CHD is limited. The aim of our study was to determine the prevalence of elevated BP and LVH in adolescents with CHD. Methods We retrospectively analyzed echocardiograms from patients with CHD from 2012-2019. Patients with biventricular CHD aged 13-17 years with documented BP, height, weight, and measurement of LVMI-ht 2.7 were included. We defined LVH using the pediatric cutoff of LVMI-ht 2.7 ≥ 38.6 g/ht 2.7 . Patients were grouped by BP category into normotensive (NT, SBP < 120 mm Hg), Elevated BP (E-BP, 120 ≤ SBP < 130 mm Hg), Stage 1 HTN (HTN-1, 130 ≤ SBP < 140 mm Hg), and Stage 2 HTN (HTN-2, SBP ≥ 140 mm Hg). Prevalence of LVH was reported in each group defined as LVMI-HT 2.7 ≥ 38.6 g/ht 2.7 . Results 855 patients were included. Mean (± standard deviation, SD) age was 15.5±1.5 years with 485/855 (56.7%) male, SBP 117±13.5 mmHg, and LVMI-ht 2.7 34.2±10.5 g/ht 2.7 . 493/855 (57.7%) were in the NT group, 214/855 (25%) in E-BP, 99/855 (11.6%) in HTN-1, and 49/855 (5.7%) in HTN-2. Prevalence of LVH increased with higher SBP with 96/493 (19.5%) in NT, 80/214 (37.4%) in E-BP, 32/99 (32.3%) in HTN-1, and 20/49 (40.8%) in HTN-2. Of youths with LVH, 49/228 (21.5%) met adult criteria of ≥ 51 g/ht 2.7 . Age, male sex, and body mass index (BMI) percentile were significantly associated with increased LVMI-ht 2.7 . Conclusions Youths with CHD have a high prevalence of elevated BP, HTN, and LVH. BMI is a significant risk factor for the development of LVH in this population. These findings support early screening for HTN in this group because youths with CHD have baseline increased CV risk that may be compounded by obesity and long-term HTN. Clinical Perspective What is new? The prevalence of abnormal blood pressure and LVH in adolescents with CHD is understudied and our data show that HTN and LVH are common in this population. One-fifth of adolescents with biventricular congenital heart disease and left ventricular hypertrophy met adult criteria for left ventricular hypertrophy. What are the clinical implications? Left ventricular hypertrophy secondary to hypertension is linked to adverse cardiac events in adulthood. Early screening and detection for abnormal blood pressure in the adolescent congenital heart disease population may lead to earlier initiation of lifestyle interventions or pharmacotherapy and mitigate long-term adverse clinical and financial outcomes in an already vulnerable population.