Increased prevalence of ambulatory and isolated nocturnal hypertension in children with idiopathic intracranial hypertension: a case-control study.

UNLABELLED: Idiopathic intracranial hypertension (IIH) has been associated with increased cardiovascular risk in adults; however, data regarding blood pressure abnormalities in children with IIH are limited. This study aimed to evaluate office and ambulatory blood pressure characteristics and cardiac findings in pediatric patients with IIH. In this cross-sectional case-control study, 42 children and adolescents with IIH who underwent 24-h ambulatory blood pressure monitoring (ABPM) were compared with 34 controls selected to be comparable in terms of age, sex, and body mass index (BMI). Office blood pressure measurements, ABPM parameters, blood pressure load, dipping status, left ventricular mass index (LVMI), relative wall thickness (RWT), and left ventricular hypertrophy (LVH) prevalence were assessed. Demographic characteristics, anthropometric measurements, and metabolic parameters were comparable between groups. Office blood pressure measurements and mean ambulatory systolic and diastolic blood pressure standard deviation scores (SDS) did not differ significantly. However, nighttime diastolic blood pressure load was significantly higher in children with IIH than in controls [15.4% (6.3-25.0) vs. 6.2% (0.0-18.8), p = 0.016], while nighttime systolic blood pressure load showed a non-significant trend toward elevation [11.8% (0.0-20.3) vs. 6.2% (0.0-13.0), p = 0.065]. Ambulatory hypertension was more prevalent in the IIH group than in controls (28.6% vs. 5.9%; OR 6.40, 95% CI 1.32-31.00; p = 0.011). Isolated nocturnal hypertension was also significantly more frequent among children with IIH (19.0% vs. 2.9%, p = 0.031) and accounted for two-thirds of all ambulatory hypertension cases. Systolic and diastolic dipping patterns were similar between groups. No significant differences were observed in LVMI, LVH prevalence, or RWT. CONCLUSIONS: Children with IIH demonstrated a higher prevalence of ambulatory hypertension, predominantly driven by isolated nocturnal hypertension, despite similar office blood pressure measurements and the absence of overt cardiac target organ damage. These findings suggest altered nocturnal blood pressure regulation and may represent early markers of the increased cardiovascular risk previously reported in adults with IIH. ABPM may provide additional value in the evaluation of children with IIH by identifying clinically relevant blood pressure abnormalities that are not detectable by routine office measurements. WHAT IS KNOWN: • Idiopathic intracranial hypertension (IIH) is associated with increased cardiovascular risk in adults, including a higher incidence of hypertension independent of obesity. • Blood pressure abnormalities in children with IIH have not been previously evaluated using ambulatory blood pressure monitoring (ABPM). WHAT IS NEW: • Children with IIH have a significantly higher prevalence of ambulatory hypertension and isolated nocturnal hypertension compared to controls, despite similar office blood pressure measurements. • Isolated nocturnal hypertension accounts for two-thirds of ambulatory hypertension cases, highlighting the value of ABPM in the routine evaluation of pediatric IIH.