Metabolic syndrome and serum uric acid level in children and adolescents with hypertension

Background: Metabolic syndrome (MS) in children with arterial hypertension (HT) contributes to early cardiovascular organ damage, yet MS definitions vary and overlook abnormalities such as elevated serum uric acid (UA). Our study assessed the prevalence, clinical characteristics, and prognostic value of classical and UA-modified MS definitions in hypertensive children at the Children's Memorial Health Institute in Warsaw, Poland. Methods: We included 420 patients aged 10–18 years with HT confirmed by ambulatory blood pressure monitoring (ABPM). All underwent anthropometric evaluation, office BP and ABPM measurements, biochemical testing including UA, and assessment of hypertension-mediated organ damage (HMOD): left ventricular mass index (LVMi), carotid intima-media thickness (cIMT), and pulse wave velocity (PWV). Results: MS prevalence by IDF criteria was 14.5%, including 18.3% in children aged 10–15 and 9.4% in those aged 16–18. MS occurred more often in primary than secondary hypertension (17.7% vs. 5.5%; P = 0.003). Compared with non-MS patients, those with MS had higher triglycerides and LDL, slightly higher fasting plasma glucose ( P = 0.061), and lower HDL ( P < 0.001). UA levels were higher in primary vs. secondary HT (5.8 vs. 5.2 mg/dl; P < 0.001) and in MS vs. non-MS (6.3 vs. 5.5 mg/dl; P < 0.001). MS was associated with greater cIMT-SDS (1.26 vs. 0.92; P = 0.012) and more frequent left ventricular hypertrophy (42% vs. 29%; P = 0.08). Results were consistent across primary and secondary HT subgroups. Adding UA to the MS definition improved prediction of LVH, increasing agreement from κ = 0.086 to 0.190. Conclusions: MS is common in hypertensive children, particularly those with primary HT. Including UA in MS criteria may enhance prediction of HMOD, especially LVH.