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 (LVMI-ht) with current guidelines using the adult cutoff of 51 g/ht; 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 were included. We defined LVH using the pediatric cutoff of LVMI-ht ≥ 38.6 g/ht. 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 ≥ 38.6 g/ht. 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 34.2±10.5 g/ht. 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. Age, male sex, and body mass index (BMI) percentile were significantly associated with increased LVMI-ht. 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.