Hypertension Rates Higher in Children with Congenital Heart Disease

Jason H. Greenberg, MD

There is not much known about the long-term risk of hypertension in children following surgery for congenital heart disease.

A team, led by Jason H. Greenberg, MD, MHS, Division of Nephrology, Department of Pediatrics, Yale University School of Medicine, assessed the incidence of hypertension following cardiac surgery in pediatric patients with congenital heart disease.

In the multicenter, retrospective matched cohort study, the researchers examined administrative databases in Ontario to identify 3600 children with surgical repair of congenital heart disease. Each patient was matched with 10 children from the general population without congenital heart disease on age, sex, index date, rurality, and neighborhood income.

The researchers sought main outcomes of the diagnosis of hypertension over a median follow-up of 9.8 years following surgery.

The median age of the patient population at the first surgery was 150 days.

Hypertension Rates

The researchers identified 445 (12.4%) children during follow-up with surgical repair of congenital heart disease that developed hypertension, while just 398 (1.1%) children developed hypertension in the matched control group.

The incidence rate of hypertension in children who needed surgery for CHD was 141.3 (95% CI, 128.8-155.1) per 10,000 person-years. This was compared to children in the matched control group with a rate of 11.1 (95% CI, 10.1-12.3( per 10,000 person-years.

“The risk of hypertension was higher in children with index surgical dates at an age of less 150 days compared with those who had surgical dates at an age of 150 days or older (P = .006 for interaction),” the authors wrote.

Surgeries

In addition, the risk of hypertension increased in children with more complex surgery, especially children with hypoplastic left heart syndrome (n = 49; 35%) and in children who received dialysis (n = 22; 17.5%; HR, 1.67; 95% CI, 1.09-2.56) during the index cardiac surgery hospitalization.

“The incidence of long-term hypertension in this study was 12 times higher in children with surgical repair of CHD compared with children in the matched control group,” the authors wrote. “The findings suggest that interventions aimed at reducing the long-term risk of hypertension after cardiac surgery in this population are needed.”

Background Information

Congenital heart disease is currently the most common type of birth defect, affecting approximately 2.4 children in the US.

While children with congenital heart disease do not require surgical intervention, approximately 25% of children with the disorder require cardiac surgery.

However, advancements in both diagnosis and treatment of the disorder has increased survival rates and raised the quality of life for children after surgical repair of the cardiac defect.

“Because of this improved survival, there is now an intensified focus on assessment and prevention of long-term cardiovascular disease and hypertension,” the authors wrote. Previous research has documented the pathologic changes to the cardiovascular system and kidneys after cardiac surgery. Cardiopulmonary bypass can lead to injury and remodeling of the cardiovascular system and kidneys as well as subsequent complications, such as acute kidney injury, chronic kidney disease, and hypertension.”

The study, “Long-term Risk of Hypertension After Surgical Repair of Congenital Heart Disease in Children,” was published online in JAMA Network Open.