Hypertension in children with congenital adrenal hyperplasia.
OBJECTIVE
Estimates of high blood pressure (BP) incidence in children with congenital adrenal hyperplasia (CAH) vary widely; risk factors are poorly understood. We estimated incidence of hypertension by CAH subtype and sex, and assessed its association with body mass index, hydrocortisone and fludrocortisone.


METHODS
Longitudinal.


METHODS
Chart review of 180 paediatric CAH patients (120 salt wasting; 60 simple virilizing; 93 females) seen from 1970 to 2013.


METHODS
High BP was diagnosed by diastolic or systolic blood pressure measurement ≥95th percentile for age, sex and height; hypertension was diagnosed with high BP on at least three clinic visits.


RESULTS
Children with classic CAH who received fludrocortisone had a significantly higher rate of hypertension (55% vs 31%) than those who did not. Hypertension incidence was higher in salt-wasting CAH (58%) than in simple-virilizing CAH (35%). Hypertension first occurred before age 5 years in 91% of salt-wasting males and 50% of cases in salt-wasting females; most simple-virilizing cases occurred during ages 10-18 years. Rates of hypertension were higher in children who had three or more measurements with 17-OHP < 400 ng/dl (12·12 nmol/l), and this difference was significant in salt-wasting males. Children on fludrocortisone who had three or more readings of 17-OHP < 400 ng/dl (12·12 nmol/l) had a significantly higher rate of hypertension than those who did not. Hydrocortisone dose was not associated with hypertension.


CONCLUSIONS
Children with CAH are at higher risk for hypertension than the general paediatric population, and incidence differs by sex and CAH subtype. Hypertension was higher in children on fludrocortisone and who were oversuppressed.
University of Minnesota Masonic Children's Hospital, Minneapolis, MN, USA.
Nadia
N
Maccabee-Ryaboy
Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA.
William
W
Thomas
Children's Hospitals of Minnesota, Minneapolis, MN, USA.
Jennifer
J
Kyllo
The Mayo Clinic College of Medicine, Rochester, MN, USA.
Aida
A
Lteif
University of Minnesota Masonic Children's Hospital, Minneapolis, MN, USA.
Anna
A
Petryk
University of Minnesota Masonic Children's Hospital, Minneapolis, MN, USA.
Maria Teresa
MT
Gonzalez-Bolanos
Institute of Child Health, University College London, London, UK.
Peter C
PC
Hindmarsh
University of Minnesota Masonic Children's Hospital, Minneapolis, MN, USA. saraf010@umn.edu.
Kyriakie
K
Sarafoglou
D019326:17-alpha-Hydroxyprogesterone / Q000097:blood; D000293:Adolescent; D000312:Adrenal Hyperplasia, Congenital / Q000503:physiopathology*; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D005260:Female; D005438:Fludrocortisone / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D006973:Hypertension / Q000139:chemically induced / Q000209:etiology*; D007223:Infant; D007231:Infant, Newborn; D008137:Longitudinal Studies; D008297:Male; D012189:Retrospective Studies; D012737:Sex Factors
D019326:17-alpha-Hydroxyprogesterone; D005438:Fludrocortisone