Endocrine Abstracts

Background: Cardiovascular related deaths account for over 40% of the excess mortality in Turner Syndrome (TS). Hypertension, a modifiable risk factor for both aortic dilatation and dissection, is more commonly encountered in TS during childhood and adolescence. The objective of this systematic review and meta-analysis is to determine the prevalence of hypertension in paediatric patients with TS and in relation to the methodologies of blood pressure evaluation.

Methods: The systematic review of the literature was performed per PRISMA guidelines. Three online databases were searched (Medline, Embase and Web of Science) for literature which reported a prevalence, or allowed calculation of prevalence, of hypertension in patients with TS who were 18 years of age or younger. The primary outcome of this review was the pooled prevalence of hypertension in patients with TS, 18 years or younger. Meta-analysis was conducted using a random-effects model. The between-study variance heterogeneity of effect size estimates across the studies was assessed using the Q-test and the I² statistic.

Results: Seventeen studies met the primary eligibility criteria with a total of 1948 patients included. The estimated pooled prevalence of hypertension in children and adolescents TS was 16% (95% CI: 8.9%-24.6%). There was significant heterogeneity detected between the studies. Funnel plot demonstrated no asymmetry and P-value for Egger’s test was not significant (P=0.3123), suggesting no obvious publication bias. The prevalence of hypertension in studies which utilised 24-hour ambulatory blood pressure monitoring was 21.1% (15.2-27.6). On the other hand, the prevalence of hypertension where blood pressure was obtained from a single measurement was 13.5% (5.2%-24.4%).

Conclusion: To our knowledge, this is the first systematic review and meta-analysis evaluating the prevalence of hypertension in a paediatric TS population. Given the impact of hypertension with long term health outcomes and the reversibility of the health risks by addressing abnormal blood pressure, prompt and early diagnosis of hypertension in young girls with TS should be prioritised. The role of 24-hour blood pressure monitoring in routine clinical assessment of girls with TS should be clarified in future clinical consensus guidance.