ACMJ
Anatolian Current Medical Journal

Anatolian Current Medical Journal (ACMJ) is an unbiased, peer-reviewed, and open access international medical journal. The Journal publishes interesting clinical and experimental research conducted in all fields of medicine, interesting case reports, and clinical images, invited reviews, editorials, letters, comments, and related knowledge.

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Original Article
Clinical and laboratory characteristics of pediatric orthostatic hypertension: a retrospective study
Abstract
Aims: Orthostatic hypertension (OHT) is an underrecognized condition in the pediatric population, characterized by an abnormal rise in blood pressure upon standing. Given its potential long-term implications, including cardiovascular remodeling and end-organ damage, early identification and management of OHT are crucial. This study aims to evaluate the clinical and laboratory characteristics of children diagnosed with OHT, providing insights into potential risk factors and associated conditions.
Methods: A retrospective, cross-sectional study was conducted at Ankara Training and Research Hospital between September 2022 and August 2024. A total of 111 pediatric patients diagnosed with OHT based on an active standing test were included. Demographic data, presenting symptoms, laboratory parameters (including vitamin B12, ferritin, and vitamin D levels) were analyzed.
Results: The median age of the cohort was 15.3 years (range: 6.8–17.9), with a female predominance (63%). Nearly half of the patients (46%) were overweight or obese, and 22% had a family history of hypertension. Cardiovascular symptoms were the most common (36%), followed by cerebral hypoperfusion symptoms (35%) and other symptoms, including fatigue and concentration issues (27%). A significant proportion of the patients exhibited vitamin D deficiency (41%), vitamin B12 borderline levels (45%), and iron deficiency anemia (15%). Additionally, postural orthostatic tachycardia syndrome (POTS) was present in 24% of patients, with a notable association between POTS and low body weight (p=0.037).
Conclusion: The descriptive findings of this study illustrate a range of clinical and laboratory characteristics in children with OHT, hinting at potential areas for future investigation. Although associations with pubertal status, obesity, and vitamin deficiencies were observed, the study's design limits causal inference. Future research, including control groups and prospective approaches, is crucial to understand the clinical importance of these observations.

Keywords : Orthostatic hypertension, autonomic dysfunction, pediatric population, active standing test

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1. Magkas N, Tsioufis C, Thomopoulos C, et al. Orthostatic hypotension: from pathophysiology to clinical applications and therapeutic considerations. J Clin Hypertens (Greenwich). 2019;21(5):546-554. doi: 10.1111/jch.13521
2. Zhang Q, Li J, Xie Y, Zhao J, Du J. Orthostatic hypertension in children and adolescents with postural tachycardia syndrome. J Trop Pediatr. 2014;60(6):461-466. doi:10.1093/tropej/fmu055
3. Duan H, Zhou K, Hua Y. Clinical progress of orthostatic hypertension in children. Chin Med J (Engl). 2014;127(21):3825-3828. doi:10.3760/cma.j.issn.0366-6999.20132969
4. Zhao J, Han Z, Zhang X, et al. A cross-sectional study on upright heart rate and BP changing characteristics: basic data for establishing diagnosis of postural orthostatic tachycardia syndrome and orthostatic hypertension. BMJ Open. 2015;5(6):e007356. doi:10.1136/bmjopen-2014-007356
5. Flynn JT, Kaelber DC, Baker-Smith CM, et al. Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics. 2017;140(3):e20171904. doi:10.1542/peds.2017-1904
6. Wang C, Li Y, Liao Y, et al. 2018 Chinese Pediatric Cardiology Society (CPCS) guideline for diagnosis and treatment of syncope in children and adolescents. Sci Bull (Beijing). 2018;63(23):1558-1564. doi:10.1016/j.scib.2018.09.019
7. Misra M, Pacaud D, Petryk A, et al. Vitamin D deficiency in children and its management: review of current knowledge and recommendations. Pediatrics. 2008;122(2):398-417. doi:10.1542/peds.2007-1894
8. Aksu T, Ünal Ş. Iron deficiency anemia in infancy, childhood, and adolescence. Turk Arch Pediatr. 2023;58(4):358-362. doi:10.5152/TurkArchPediatr.2023.23049
9. Hu Y, Jin H, Du J. Orthostatic hypertension in children: an update. Front Pediatr. 2020;8:425. doi:10.3389/fped.2020.00425
10. Hu Y, Wang Y, He B, et al. Sympathetic overactivation from supine to upright is associated with orthostatic hypertension in children and adolescents. Front Pediatr. 2020;8:54. doi: 10.3389/fped.2020.00054
11. Khalaji A, Behnoush AH, Tajdini M. Association between vitamin D deficiency and vasovagal syncope: a systematic review and meta-analysis. Clin Cardiol. 2023;46(7):721-728. doi:10.1002/clc.24035
12. Kovalchuk T, Boyarchuk O. Serum vitamin D levels in children and adolescents with vasovagal syncope, syncope due to orthostatic hypotension, and cardiac syncope. Turk Arch Pediatr. 2023;58(1):42-48. doi:10.5152/TurkArchPediatr.2022.22141
13. Xiao Y, Wu J, Min L, Dong X. The correlation between serum 25-hydroxyvitamin D and parathyroid hormone levels and orthostatic intolerance in children. Progress Pediatr Cardiol. 2022;66:101550. doi:10. 1016/j.ppedcard.2022.101550
14. Zhang Q, Sun Y, Zhang C, Qi J, Du J. Vitamin D deficiency and vasovagal syncope in children and adolescents. Front Pediatr. 2021;9:575923. doi: 10.3389/fped.2021.575923
15. Oden Akman A, Tumer L, Hasanoglu A, Ilhan M, Caycı B. Frequency of vitamin D insufficiency in healthy children between 1 and 16 years of age in Turkey. Pediatr Int. 2011;53(6):968-973. doi:10.1111/j.1442-200X. 2011.03486.x
16. Beitzke M, Pfister P, Fortin J, Skrabal F. Autonomic dysfunction and hemodynamics in vitamin B12 deficiency. Auton Neurosci. 2002;97(1): 45-54. doi:10.1016/s1566-0702(01)00393-9
17. Gröber U, Kisters K, Schmidt J. Neuroenhancement with vitamin B12—underestimated neurological significance. Nutrients. 2013;5(12):5031-5045. doi:10.3390/nu5125031
18. Aytemir K, Aksöyek S, Büyükasik Y, et al. Assessment of autonomic nervous system functions in patients with vitamin B12 deficiency by power spectral analysis of heart rate variability. Pacing Clin Electrophysiol. 2000;23(6):975-978. doi:10.1111/j.1540-8159.2000.tb00883.x
19. Öner T, Guven B, Tavli V, Mese T, Yılmazer MM, Demirpence S. Postural orthostatic tachycardia syndrome (POTS) and vitamin B12 deficiency in adolescents. Pediatrics. 2014;133(1):e138-e142. doi:10.1542/peds.2012-3427
20. Pektas A, Koken R, Koca HB. Serum vitamin B-12 in children presenting with vasovagal syncope. Asia Pac J Clin Nutr. 2018;27(1):176-181. doi:10.6133/apjcn.022017.17
21. Zhao J, Yang JY, Jin HF, Du JB. Clinical analysis of orthostatic hypertension in children. Zhonghua Er Ke Za Zhi. 2012;50(11):839-842.
22. Fedorowski A. Postural orthostatic tachycardia syndrome: clinical presentation, aetiology and management. J Intern Med. 2019;285(4):352-366. doi:10.1111/joim.12852
23. Sebastian SA, Co EL, Panthangi V, et al. Postural orthostatic tachycardia syndrome (POTS): an update for clinical practice. Curr Probl Cardiol. 2022;47(12):101384. doi:10.1016/j.cpcardiol.2022.101384
Article available in :
Volume 7, Issue 3, 2025
Page : 338-342
https://doi.org/10.38053/acmj.1659477
Article Information
Received : 18 Mar 2025
Accepted : 12 May 2025
Published : 30 May 2025
Corresponding Author :

Yasemin Nuran Dönmez: Department of Paediatric Cardiology, Ankara Training and Research Hospital, University of Health Sciences, Ankara, Turkiye

[email protected]
Citation : Dönmez YN, Celep B, Baltu D, Şener YZ. Clinical and laboratory characteristics of pediatric orthostatic hypertension: a retrospective study. Anatolian Curr Med J. 2025;7(3):338-342.

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