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Office and ambulatory blood pressure elevation in children with chronic renal failure
Mark M Mitsnefes1, Thomas R Kimball, Stephen R Daniels
1Division of Nephrology and Hypertension, Cincinnati Children's Hospital Research Foundation, Cincinnati, Ohio, USA. mark.mitsnefes@chmcc.org
Insights
Ambulatory blood pressure monitoring (ABPM) reveals frequent hypertension and abnormal dipping in children with chronic renal insufficiency (CRI). Higher 24-hour systolic blood pressure predicts left ventricular hypertrophy, unlike casual BP measurements.
Area of Science:
- Pediatric Nephrology
- Cardiovascular Research
- Hypertension Management
Background:
- Hypertension is a common complication in pediatric patients with chronic renal insufficiency (CRI).
- Hypertension in CRI is linked to target organ damage, notably left ventricular hypertrophy (LVH).
- Accurate blood pressure assessment is crucial for managing these risks.
Purpose of the Study:
- To evaluate hypertension prevalence using 24-hour ambulatory blood pressure monitoring (ABPM) in children with CRI.
- To assess the relationship between ABPM parameters and left ventricular hypertrophy (LVH).
- To compare ABPM findings with casual blood pressure measurements.
Main Methods:
- Conducted 24-hour ABPM in 29 pediatric patients with CRI (mean age 12.4 years).
- Assessed systolic and diastolic blood pressure, including dipping patterns.
- Correlated ABPM data with echocardiographic assessment of LVH (LVM index).
Main Results:
- ABPM identified hypertension more frequently, especially diastolic hypertension, than casual BP.
- Significant prevalence of abnormal dipping patterns for both systolic and diastolic blood pressure was observed.
- Higher 24-hour systolic blood pressure was the sole independent predictor of increased left ventricular mass index (LVMI).
- No significant correlation was found between LVMI and office blood pressure readings.
Conclusions:
- ABPM is superior to casual BP measurements for detecting hypertension in children with CRI.
- ABPM parameters, particularly 24-hour systolic blood pressure, are better predictors of LVH in this population.
- These findings underscore the importance of ABPM for risk stratification and management in pediatric CRI.
Abstract:
Hypertension is a frequent complication in patients with chronic renal insufficiency (CRI) and is associated with target organ damage, including left ventricular hypertrophy (LVH). To better assess hypertension in pediatric patients with CRI, we performed 24-h ambulatory blood pressure monitoring (ABPM) and evaluated the relationship between ABPM parameters and LVH in 29 children, mean age 12.4+/-3.8 years. There was no significant difference in the frequency of hypertension comparing casual systolic blood pressure (SBP) (21%) with the mean 24-h (21%) or daytime mean SBP (21%). However, diastolic hypertension was detected more frequently using ABPM: 24% for 24-h diastolic blood pressure (DBP), 14% for daytime DBP, and 7% for casual DBP. Nighttime systolic hypertension as well as diastolic hypertension was detected in 12 (41%) children. Seventeen (59%) patients had attenuated dipping for SBP and 9 (31%) had abnormal DBP dipping. Lower SBP dipping was associated with lower glomerular filtration rate (r=0.44, P<0.05). LVH was found in 6 (21%) patients. LVM index was significantly correlated with 24-h SBP (r=0.43, P<0.05). Multiple regression analysis confirmed that higher 24-h SBP was the only independent predictor for increased LVM index (P=0.001). No significant relationship was found between LVM index and office blood pressure. These results confirm a high prevalence of blood pressure abnormalities using ABPM criteria in children with CRI and suggest that ABP may better predict end-organ damage in these patients than casual BP.