Children who underwent surgery for congenital heart disease (CHD) were at a much higher risk of developing hypertension in the long run compared to healthy controls, a retrospective cohort study showed.
The incidence of hypertension was 141.3 per 10,000 person-years after CHD surgery and only 11.1 per 10,000 person-years in matching children without CHD, according to Chiragu Parih, et al. Med., From Johns Hopkins University in Baltimore and his colleagues.
Ultimately, 12.4% versus 1.1% of these groups developed high blood pressure (BP) during a median of 9.8 years of follow-up, the researchers reported in their online study in JAMA network open.
“The increased incidence of hypertension is particularly significant because hypertension may be a harbinger of adverse cardiovascular outcomes later in adulthood, as seen in previous research,” Parih’s group said. “The findings suggest that interventions are needed to reduce the long-term risk of hypertension after cardiac surgery in this population.”
“Our findings provide data that can improve recommendations for BP monitoring and follow-up of children after cardiac surgery,” the authors concluded.
Parikh and colleagues used seven linked administrative databases for their cohort survey of individuals in Ontario, Canada. In total, the team identified 3,600 children with operative CHD correction, which is 1:10 of the general pediatric population without CHD.
Those who had surgical repair had their first surgery with an average of 150 days of age. Boys made up 55.7% of the cohort.
Hypertension is more likely in children who underwent surgery 150 years ago than those who underwent more complex surgery (e.g., repair of hypoplastic left heart syndrome, right ventricular double exit, aortic coarctation, pulmonary artery atresia) and those who had dialysis during their cardiac surgery indexation. hospitalization.
“Age at surgery can be a surrogate for the severity of a congenital heart defect, because a newborn who urgently needs surgical repair of a serious illness cannot delay surgery into old age. In addition, hypertension is common in certain types of CHD that are more likely to be corrected at an early age. , such as aortic coarctation and hypoplastic left heart syndrome, ”Parih’s group explained.
“Also, immature kidney function and limited physiological reserve of newborns may contribute to their long-term risk of hypertension after cardiac surgery. However, the cumulative risk of hypertension is high even among those undergoing index surgery at 150 days or older,” they wrote. researchers.
They acknowledged that the study relied on hypertension identified from administrative laws rather than on individual BP measurements or prescribing antihypertensive drugs.
In addition, the analysis is subject to potential bias in the determination, the team noted. Children who have undergone cardiac surgery have multiple health encounters where BP would be checked, while most healthy children do not undergo BP monitoring.
Indeed, the 1.1% observed risk of hypertension for control was only 1.1% in the study, compared with an estimated prevalence of 3.5% in the general pediatric population.
The researchers suggested that future research use individual clinical measurements of BP, as well as outpatient BP monitoring and neurohormonal assessment to better characterize the burden and mechanisms of hypertension in children who have previously had CHD surgery.
Clinical trials are also needed to test interventions for hypertension and determine optimal BP goals, the team added.
The study was supported by grants from the NIH and the Institute for Clinical Evaluative Sciences.
Parikh reported receiving personal fees from the Data Monitoring and Security Committee and as well as from Renalytix AI as a member of the Advisory Board.