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Long-term risk of hypertension after surgical repair of congenital heart disease in children

Greenberg JH, McArthur E, Thiessen-Philbrook H, Zappitelli M, Wald R, Kaushal S, Ng DK, Everett AD, Chanchlani R, Garg AX, Parikh CR. JAMA Netw Open. 2021;4(4):e215237. Epub 2021 Apr 8. DOI: https://doi.org/10.1001/jamanetworkopen.2021.5237


Importance — The long-term risk of hypertension in children after surgery for congenital heart disease (CHD) is unclear.

Objective — To assess the incidence of hypertension after cardiac surgery in children with CHD.

Design, Setting, and Participants — A multicenter retrospective matched cohort study was conducted in Ontario, Canada, using administrative databases. A total of 3600 children with surgical repair of CHD were matched to 10 children (n = 36 000) from the general population without CHD on age, sex, index date, rurality, and neighborhood income.

Main Outcomes and Measures — Diagnosis of hypertension over a median follow-up time of 9.8 years (interquartile range, 6.8-12.9 years) after surgery. The last follow-up was March 31, 2019.

Results — Overall, in 3600 children with surgical repair of CHD, the median age at first surgery was 150 days (interquartile range, 40-252 days) and 2005 (55.7%) were boys. During follow-up, 445 (12.4%) children with surgical repair of CHD developed hypertension compared with 398 (1.1%) in the matched control group. The incidence rate of hypertension in children who received surgery for CHD was 141.3 (95% CI, 128.8-155.1) per 10 000 person-years compared with children in the matched control group, who had a rate of 11.1 (95% CI, 10.1-12.3) per 10 000 person-years. The risk of hypertension was higher in children with index surgical dates at an age of less 150 days compared with those who had surgical dates at an age of 150 days or older (P = .006 for interaction). The risk of hypertension was increased in children with more complex surgery, particularly children with hypoplastic left heart syndrome (49 of 140 [35.0%]), and in children who received dialysis (22 of 126 [17.5%]; hazard ratio, 1.67; 95% CI, 1.09-2.56) during the index cardiac surgery hospitalization.

Conclusions and Relevance — The incidence of long-term hypertension in this study was 12 times higher in children with surgical repair of CHD compared with children in the matched control group. The findings suggest that interventions aimed at reducing the long-term risk of hypertension after cardiac surgery in this population are needed.

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