Blood Pressure Profile in Pediatric Moyamoya: Longitudinal Analysis and Revascularization Impact

Moyamoya is a progressive cerebral arteriopathy and an important cause of recurrent stroke. We examined the prevalence of high blood pressure (BP) in patients with pediatric onset moyamoya and its clinical and neuroimaging associations.

BP was documented retrospectively at diagnosis and was measured prospectively during follow-up visits. BP > 90^th percentile was referred to as high BP and was further categorized to elevated BP, Stage 1, and Stage 2 hypertension according to the 2017 American Academy of Pediatrics Clinical Practice Guidelines. All patients were evaluated for end-organ dysfunction and possible etiology for high BP.

Of 44 patients (54.4% female, mean age 14.6 ± 6.2 years), 16 (36.3%) developed high BP (elevated BP-4 [25%], Stage 1 and Stage 2 hypertension-six patients each [37.5%]), at a mean age of 9.95 ± 5.26 years and median of 1.65 years (interquartile range: 0.3, 6.4) postdiagnosis. One patient was diagnosed with midaortic syndrome; the remainder had no extracranial medium-large vessel vasculopathy. High BP was significantly associated with bilateral disease (P = 0.006), clinical stroke (P = 0.038), higher composite cerebrovascular stenosis scores at last follow-up (P = 0.003), and higher number of revascularization surgeries (P = 0.012). At study conclusion, BP improved in 8/16 patients (50%), including complete normalization in 4 (25%), all of whom had undergone revascularization (8/13, 61.5%).

Over one third of pediatric moyamoya patients develop high BP, which is associated with more severe disease. Revascularization appears to improve BP control. Further research is needed to explore underlying mechanisms and define optimal management strategies for hypertension in this population.