Longitudinal Analysis of Gastroesophageal Reflux Disease and Its Impact on Cardiovascular Function and Development of Hypertension in Pediatric Populations: A Multi-center Study

Background: Gastroesophageal reflux disease (GERD) is increasingly recognized as a condition with systemic effects extending beyond the gastrointestinal tract. Objective: To evaluate the long-term impact of GERD on cardiovascular function and the development of hypertension in pediatric populations through a multi-center, one-year longitudinal analysis. Methods: This longitudinal study was conducted at The Children's Hospital, Lahore, and Allied Hospital, Faisalabad, from June 2024 to May 2025. A total of 285 children aged 5-16 years with confirmed GERD were enrolled from multiple tertiary care hospitals. Participants underwent baseline assessments including clinical evaluation, anthropometry, blood pressure measurement, echocardiography, heart rate variability (HRV) analysis, and inflammatory biomarkers (CRP, IL-6, TNF-α). Results: Over the three-year period, 48 children (16.8%) developed hypertension, with the highest incidence in the severe GERD group (30.7%). Systolic blood pressure increased significantly from 106.8 ± 8.9 mmHg at baseline to 114.7 ± 10.1 mmHg at 36 months (p < 0.001). Children with moderate and severe GERD showed marked reductions in HRV and increased low frequency/high frequency (LF/HF) ratios, indicating sympathetic predominance. Inflammatory biomarkers rose progressively, with CRP correlating positively with systolic blood pressure (r = 0.38, p < 0.01). Echocardiography revealed significant increases in left ventricular mass index over time, particularly in severe GERD cases. Multivariate analysis identified severe GERD (β = 0.31, p < 0.001), elevated CRP (β = 0.27, p = 0.002), and higher BMI (β = 0.22, p = 0.008) as independent predictors of hypertension. Conclusion: GERD in pediatric populations is associated with progressive cardiovascular alterations, including rising blood pressure, autonomic dysregulation, systemic inflammation, and early cardiac remodeling.