Current etiology of hypertension in European children – role of serum uric acid

Abstract

Background: While hypertension (HT) in pediatric patients is often secondary (SH), recent trends show a rise in primary hypertension (PH), which is associated with an increasing global prevalence of obesity. Our study aimed to assess the etiology of HT and predictors of PH in a large European cohort of children referred for HT based on office blood pressure (BP) measurements. Methods: We performed retrospective analysis of 2008 children aged 0–18 years (12.3 ± 4.9 years) diagnosed with HT. Patients were classified into white coat hypertension (WCH), PH, or SH groups based on office BP and 24-hour ambulatory BP monitoring (ABPM). Clinical, anthropometric, and biochemical data were collected to differentiate PH and SH and to identify predictors of PH. Results: Out of 2008 patients included in the analysis, HT was confirmed in 1452 patients (556 were classified as WCH). Of 1452 patients with HT: 42.8% had PH, while 57.2% had SH, mainly secondary to renal parenchymal disease (33.2% of SH patients), post-kidney transplant HT (23.1%), aortic coarctation (15.9%) and renovascular HT (13.8%). However, PH started to be the dominant cause of HT after 13 years of age and was diagnosed in 59.1% of 13–18-year-old patients with confirmed HT. Age ≥ 13 years, obesity (BMI-SDS ≥1.65), and serum uric acid ≥ 5.5 mg/dL were identified as significant PH predictors. Conclusions: Our study provides valuable insights into the current etiology of pediatric HT and highlights the role of uric acid level assessment in the diagnosis of PH in children.