Nocturnal hypertension predicts left ventricular hypertrophy in children with primary hypertension

Childhood hypertension is a significant global health concern, with left ventricular hypertrophy (LVH) being its most common target organ damage. Evidence from Chinese pediatric populations remains scarce. Therefore, this study aimed to investigate the risk factors of LVH in children with primary hypertension and to develop a prediction model.

In this cross-sectional study, 121 children diagnosed with primary hypertension (aged 3-17 years) admitted to Children's Hospital of Fudan University (January 1, 2019-December 31, 2024) were included. Clinical data (age, sex, height, weight, birth history, and family history of hypertension), laboratory parameters, 24-hour ambulatory blood pressure monitoring (ABPM), and echocardiography were collected. Participants were stratified into the LVH group and the non-LVH group based on left ventricular mass index (LVMI). Partial correlation analysis evaluated associations of variables with left ventricular mass and LVMI. Stepwise multivariable logistic regression was used to identify independent risk factors. Based on significant factors, a risk prediction model was constructed, with model performance assessed via receiver operating characteristic (ROC) curves [area under the curve (AUC)] and goodness-of-fit tests (Hosmer-Lemeshow χ²).

LVH was observed in 17.4% (21/121) of participants, predominantly concentric hypertrophy. Partial correlation analysis adjusted for age and sex revealed positive correlations of alanine aminotransferase (ALT), aspartate aminotransferase (AST), 24-hour mean systolic blood pressure (SBP), daytime mean SBP, and morning mean SBP (the average of ambulatory SBP readings taken within 2 hours of waking up) with LVMI (r=0.26, 0.37, 0.25, 0.25, and 0.23, all P<0.05), respectively. Nocturnal hypertension was identified as an independent risk factor of LVH [odds ratio (OR) =4.07; 95% confidence interval (CI): 1.47-13.24; P=0.01]. The combined prediction model incorporating age, sex, body mass index (BMI), and nocturnal hypertension demonstrated a moderate discrimination (AUC =0.710; 95% CI: 0.593-0.827) and good calibration (Hosmer-Lemeshow χ²=5.70; P=0.68).

This study identified nocturnal hypertension as a critical independent risk factor for LVH in pediatric primary hypertension. The prediction model may provide valuable insights for early identification of LVH.