Unmasking hypertension in children and adolescents with sickle/beta‐thalassemia

Abstract

Sickle cell disease (SCD) is associated with increased risk of cardiovascular disease, although blood pressure (BP) levels have been reported to be lower in SCD patients compared to general population. Aims of the present study were to investigate the prevalence of BP phenotypes and levels of arterial stiffness in pediatric patients with SCD and to assess the differences with children at risk for hypertension. We included in the study 16 pediatric SCD (HbS/β‐thalassemia, S/β‐thal) patients and 16 consecutive children at risk for hypertension referred to our hypertension clinic that served as high‐risk controls. All patients underwent ambulatory BP monitoring and measurement of carotid‐femoral pulse wave velocity (PWV). S/β‐thal patients had lower office systolic BP than the high‐risk control group (115.43 ± 10.03 vs 123.37 ± 11.92, P = .05) but presented similar levels of day and night ambulatory BP. Office hypertension was found in 12.5% of the S/β‐thal patients and in 43.8% of the high‐risk controls (P = .06), while 18.8% of the S/β‐thal patients and 25% of the high‐risk controls presented hypertension by ambulatory BP levels (P = .21). All of the S/β‐thal patients with ambulatory hypertension had night hypertension (one combined night and day hypertension) with office normotension (masked hypertension). S/β‐thal patients and high‐risk controls presented equal prevalence of masked hypertension (18.8%). Children and adolescents with S/β‐thal present similar prevalence of BP phenotypes and levels of PWV with children at risk for hypertension. A significant number of children and adolescents with S/β‐thal may have masked nighttime hypertension despite normal office BP levels.

Masked Hypertension in Healthy Children and Adolescents: Who Should Be Screened?

“…In children with SCD, masked hypertension is most likely secondary to renal or vascular consequences of SCD. Indeed similar prevalence of masked hypertension (18%) and elevated cfPWV (carotid-femoral pulse wave velocity) was found in children with SCD (all having HbS/β-thalassemia) and high-risk controls (children referred for evaluation to hypertension clinic) [ 45 ]. All of the children with SCD and MH had nocturnal hypertension (three of them isolated nocturnal).…”

“…Sickle cell disease (SCD) is associated with increased risk of cardiovascular disease, although office BP levels have been reported to be normal. On the contrary, masked hypertension has been consistently reported in prospective cohorts of children with SCD that underwent ABPM with prevalence ranging from 6 to 35% among studies [44][45][46][47]. In a cohort of 52 children with SCD, masked hypertension was found in 35% of the patiens [46].…”

“…In pediatric patients with heart disease or chronic conditions/ syndromes accompanied with cardiac or vascular abnormalities, a high prevalence of masked hypertension has been frequently reported [43][44][45][46][47][48][49][50].…”

Evaluation of Transfusion-Related Hemodynamic Parameters in Patients with Beta-Thalassemia Major by Ambulatory Blood Pressure Monitoring Method

“…Studies on masked hypertension in other than patients with thalassemia are available in the literature. In a study conducted with children and adolescents diagnosed with sickle cell anemia (heterozygous s/ß thalassemia), the rate of masked hypertension was found to be 18.8% [30]. In the study conducted by Moodalbail et al, with 56 patients with sickle cell anemia between the ages of 5-20, they followed the blood pressure of the patients for 24 hours with the ABPM method; and 30% of the patients were found to be hypertensive.…”

“…In the study conducted by Tabatabaie et al, with 30 pediatric patients with BTM using the ABPM method; white coat hypertension was found in 6.67% of the patients [20]. In the study conducted by Stabouli et al, in children and adolescents diagnosed with sickle cell anemia (heterozygous s/ß thalassemia) whose blood pressure was monitored with the ABPM method, the rate of white coat hypertension was found as 12.5% [30].…”