The association between copeptin and hypertension in children and adolescents: a systematic review

Copeptin, a stable surrogate marker of arginine vasopressin, has been implicated in blood pressure regulation, but its role in pediatric hypertension remains unclear. This systematic review evaluates the association between copeptin levels and hypertension in children and adolescents. A comprehensive search was conducted in PubMed, Scopus, Web of Science, Embase, and Cochrane Library up to February 21, 2025. Additional sources, including Google Scholar and reference lists of relevant articles, were screened to ensure literature saturation. Observational studies (cohort, case-control, and cross-sectional) assessing copeptin levels in relation to blood pressure in pediatric populations (< 18 years) were included. Copeptin levels were assessed using validated biochemical methods, including enzyme-linked immunosorbent assay. The Newcastle-Ottawa Scale was used to assess the quality of included studies. Due to heterogeneity in study designs and outcome measurements, a narrative synthesis was performed. Twelve studies met the inclusion criteria, with sample sizes ranging from 25 to 351 participants. Some studies reported a significant association between higher copeptin levels and hypertension, particularly in children with obesity or metabolic disorders. However, other studies found no significant correlation. Differences in study design, sample characteristics, copeptin measurement methods, and confounding factors contributed to the heterogeneity of findings. The evidence on the association between copeptin and hypertension in children is inconclusive. While some studies support its potential role as a biomarker, inconsistencies highlight the need for standardized methodologies and longitudinal studies. Future research should explore copeptin's clinical utility in pediatric hypertension risk stratification.Systematic review registration number PROSPERO: CRD420251003190.