Altered Carnitine Profiles and Amino Acids in Obese Hypertensive Children: A Comparative Study with Healthy Controls

Objective Early detection of hypertension and characterization of metabolic alterations in obese children are critical for timely intervention. This study aimed to evaluate amino acid profiles and carnitine levels in pediatric patients with secondary hypertension due to exogenous obesity, compare these findings with healthy controls, and identify potential early biomarkers of hypertension. Materials and Methods Thirty hypertensive children (19 males; mean age 13.4 years; mean BMI 2.95 SDS) attending the Pediatric Nephrology Clinic of Bağcılar Training and Research Hospital between August 2024 and January 2025 were enrolled. Age-matched healthy children served as controls. Participants with chronic illnesses or regular medication use were excluded. All underwent anthropometric assessment, biochemical and hormonal testing, lipid profiling, vitamin evaluation, abdominal and renal ultrasonography, ambulatory blood pressure monitoring, cardiac assessment, and fundoscopic examination. Quantitative amino acid and acylcarnitine analyses were performed using tandem mass spectrometry. Results Antihypertensive therapy was initiated in 25 patients. Significant elevations in C3, C5-Iso, C5-DC, C16 (p < 0.005), C5:1 (p = 0.012), and C18 (p = 0.013) were observed in hypertensive children compared with controls. Branched-chain and aromatic amino acids were also elevated. C16 carnitine strongly correlated with BMI (p = 0.003), while C8:0 (octanoylcarnitine) was most strongly associated with HOMA-IR (r = 0.62; p < 0.001). Insulin resistance was identified in 60% of cases. Conclusion Systemic inflammation in obese children contribute to hypertension development. Early assessment of metabolic markers using tandem MS may enable detection of preclinical alterations and guide timely intervention. Elevated C16 and C8:0 carnitine levels may serve as early indicators of metabolic dysfunction in hypertensive obese children.