Blood pressure monitoring and management in young girls with turner syndrome

Mohammed Ibrar Murtaza; Lindsey McVey; Alexander Fletcher; Ellen Anderson; Emma Leighton; Jarod Wong; Avril Mason

doi:10.1530/endoabs.51.P020

Background: Hypertension (HT) is common in adults with Turner Syndrome (TS) but less is known about HT in children with TS.

Aim: To determine the frequency of HT in girls with TS in West of Scotland and to assess its association with clinical characteristics. Patients and methods Retrospective cross-sectional analysis of 126 girls with TS in the West of Scotland, with at least 2 clinic blood pressure (BP) measurements in the preceding 12 months. HT was defined by systolic or diastolic BP measurement ≥95th percentile for gender and height on 2 consecutive visits in one year. Stage 1 HT (95th−99th centile) and stage 2 HT (>99th centile).

Results: Median age was 16 years (range 3, 20) and duration of follow-up was 9.25 years (1.2, 17.5). Median height SDS was −2.0 (−4.92, 0.16) and Body Mass Index (BMI) SDS 1.0 (−3.15, 4.14). 71/126 had karyotype of 45X, 0. 8/126 had history of coarctation of aorta of whom 1 was hypertensive. 39/126 (31%) were hypertensive: 14/39 were defined as stage I HT and 25/39 as stage II HT.

Multivariate logistic regression analysis for factors associated with HT using age (95% CI 0.96 to 1.42), BMI SDS (95% CI 1.01 to 2.21), karyotype (95% CI 0.57 to 2.86) and tanner stage (95% CI 0.57 to 1.19) as independent factors found only BMI to be associated with HT in girls with TS.

Further dissecting the association between BMI and HT:

(24/99) with BMI SDS <+2.0 were hypertensive

(11/22) with BMI SDS between +2 to +3 were hypertensive

(4/5) with BMI SDS >+3.0 were hypertensive

Off the 27/126 patients with BMI SDS >+2.0, 15/27 have 2 measurements of BP >+2.0 SD in a year.


	Normotensive (n, 87)	Hypertensive (n, 39)	P value
Age (years)	16.38 (3, 20)	17.15 (8, 20)	0.88
Height SDS	−1.96 (−4.92, 0.16)	−1.76 (−4.24, −0.33)	0.21
BMI SDS	1 (−3.15, 3.78)	1.42 (−1.08, 4.14)	0.003
Bicuspid Aortic Valve	15/87 (17%)	4/39 (10%)	0.28
Growth Hormone*	57/87 (66%)	21/39 (54%)	0.14
Oestrogen+	53/87 (61%)	29/39 (74%)	0.22
45X	47/87 (54%)	24/39 (62%)	0.66
Tanner stage (B)			0.71
*Current and previous use; +Current use.

Discussion: Our current study demonstrated that 31% of TS girls were hypertensive based on most recent clinic measurements over a 12 month period. BMI was a strong a predictor of hypertension in our study. Therefore, intensive weight control may help with prevention and management of HT in these girls. Optimal monitoring and management of BP in paediatric TS is unclear and merits future research.

Endocrine Abstracts

P020