In untreated children with primary hypertension, grade 2 office hypertension was the predominant factor associated with left ventricular hypertrophy, while a systolic non-dipping pattern remained independently associated with LVH after adjustment for hypertension severity.
Left ventricular hypertrophy was present in nearly one-third of untreated children with newly diagnosed primary hypertension.
Grade 2 office hypertension was the strongest clinical factor associated with LVH in untreated hypertensive children.
Nighttime mean diastolic blood pressure on ABPM was associated with LVH, but this association was lost after adjustment for hypertension grade.
A systolic non-dipping circadian blood pressure pattern remained independently associated with LVH after adjustment for hypertension grade.
Selected metabolic and inflammatory markers showed exploratory associations with LVH in untreated hypertensive children.
Abnormal circadian blood pressure patterns may provide complementary information beyond office blood pressure for identifying children with LVH.
This research examined 306 children and adolescents (ages 9–17) who were newly diagnosed with high blood pressure but had not yet received any treatment. The researchers used ambulatory blood pressure monitoring (ABPM), which tracks blood pressure over a full 24-hour period including during sleep, along with standard clinic blood pressure readings and heart ultrasound measurements. They found that nearly 30% of these children already had left ventricular hypertrophy (LVH) — an enlargement of the heart's main pumping chamber that is a sign of early organ damage from high blood pressure. The most important factor linked to LVH was having more severe high blood pressure (classified as grade 2) in the clinic, which was associated with more than four times the odds of having LVH compared to those with lower-grade hypertension. Interestingly, one pattern detected only by 24-hour blood pressure monitoring — called a 'systolic non-dipping pattern,' where blood pressure does not drop normally during nighttime sleep — was also associated with LVH even after accounting for how severe the high blood pressure was in the clinic. This suggests that around-the-clock blood pressure monitoring may reveal heart risk information that a single clinic measurement would miss. This research suggests that in children with high blood pressure, getting a 24-hour ambulatory blood pressure measurement may help identify those at greater risk for early heart damage, particularly those whose blood pressure fails to decrease appropriately at night. Early identification of LVH in children could be important for guiding how aggressively to treat hypertension in young patients before further heart damage develops.
Zhu K, Su R, Yang J, Liu G, Xu L, Li J, et al.. (2026). Ambulatory blood pressure characteristics and left ventricular hypertrophy in untreated children with primary hypertension.. European journal of pediatrics. https://doi.org/10.1007/s00431-026-07530-0