Hypertension and Blood Pressure Monitoring in Girls with Turner Syndrome

Background: Hypertension (HTN) is a common, modifiable risk factor for cardiovascular mortality in girls with Turner Syndrome (TS). Previous studies including those with use of ambulatory blood pressure monitoring (ABPM) have been conducted in small cohorts and have shown wide variability in prevalence. No studies of patients with TS are available using the American Heart Association (AHA) 2022 ABPM guidelines, nor have there been longitudinal ABPM studies to describe the evolution of BP phenotype in girls with TS. Objective: The primary objectives of this study are to provide an updated prevalence of HTN phenotypes in pediatric patients with TS based on the 2022 ABPM guidelines in a large cohort of TS patients, compare patterns on first ABPM between patients with TS and age- and sex-matched controls, and describe the evolution of BP phenotype in patients with TS and repeated ABPM studies. Methods: Retrospective review of screening ABPM in patients with TS between 2007-2024. All ABPM studies were interpreted using the 2022 AHA ABPM guidelines. Data were summarized using descriptive statistics with 95% confidence intervals calculated for the percentage of patients with HTN. Results: Sixty-seven girls with TS underwent at least one ABPM between 2007 and 2024. 42 girls had at least two ABPMs, and 21 girls had at least three ABPM. The incidence of hypertension in girls with TS was 0.75 per person-year. HTN was diagnosed in 33% of patients on first ABPM, with phenotypes on first ABPM listed in Table 1a. Additionally, on first ABPM, 33% of girls had blunted dipping and 33% had isolated nocturnal HTN. Figure 1 shows ABPM phenotype evolution on repeated ABPMs. Figure 2 shows an Alluvial plot describing transition of ABPM phenotype across repeated studies. Table 2a. shows the prevalence of each ABPM phenotype for all repeated ABPM. Conclusions: Masked HTN is more common than sustained or white coat HTN on both first ABPM and repeated studies in girls with TS. Nocturnal HTN and blunted nocturnal dipping are common in girls with TS. ABPM identifies BP patterns in girls with TS that are not evident on clinic BP measurements.