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Published on: October 12, 2017
Risk of hypertension in primary vesicoureteral reflux
Ana C Simoes e Silva1, Jose Maria P Silva, Jose Silverio S Diniz
1Pediatric Nephrourology Unit, Hospital das Clínicas, Federal University of Minas Gerais, Belo Horizonte, Brazil.
Insights
Children with primary vesicoureteral reflux (VUR) face an increased risk of developing hypertension, particularly with age and renal damage. Early detection and management are crucial for better outcomes in pediatric hypertension associated with VUR.
Area of Science:
- Pediatric Nephrology
- Cardiovascular Health in Children
- Urology
Background:
- Primary vesicoureteral reflux (VUR) is a common condition in children.
- Hypertension is a significant comorbidity that can arise in individuals with VUR.
- Long-term data on hypertension risk in pediatric VUR patients is limited.
Purpose of the Study:
- To estimate the cumulative risk of developing hypertension in children diagnosed with primary VUR.
- To analyze the association between age, renal damage, and hypertension incidence in this cohort.
- To provide long-term probability estimates for hypertension in pediatric VUR patients.
Main Methods:
- A retrospective cohort study of 735 patients diagnosed with primary VUR between 1970 and 2004.
- Systematic follow-up of 664 patients with serial blood pressure measurements.
- Kaplan-Meier survival analysis and age-stratified prevalence calculations were used.
Main Results:
- 20 out of 664 (3%) patients developed hypertension during follow-up.
- Estimated hypertension probability reached 15% by age 21.
- Hypertension prevalence increased significantly with age, reaching 35% in patients over 20.
- Renal damage at baseline was strongly associated with a higher risk of sustained hypertension.
Conclusions:
- Children with primary VUR have a notable risk of developing hypertension, increasing with age.
- The presence of renal damage at diagnosis significantly elevates the risk and lowers the age of hypertension onset.
- This study highlights the importance of long-term cardiovascular monitoring in children with VUR.
Abstract:
The aim of this report was to estimate the risk of hypertension in children with primary vesicoureteral reflux (VUR). Between 1970 and 2004, 735 patients were diagnosed with VUR at a single tertiary renal unit. Of 735 patients, 664 (90%) were systematically followed and had multiple measurements of blood pressure. Hypertension was defined as values persistently above 95th for age, sex, and height in three consecutive visits. Risk of hypertension was analyzed by the Kaplan-Meier method. Of 664 patients followed, 20 (3%) developed hypertension. The estimated probability of hypertension was 2% (95%CI, 0.5%-3%), 6% (95%CI, 2%-10%), 15% (95%CI, 11%-20%) at 10, 15, and 21 years of age, respectively. The prevalence of hypertension has increased with age: it was 1.7% for patients with 1 yr-9.9 yr, 1.8% for adolescents with 10 yr-14.9 yr, 4.7% for patients with 15-19.9 yr, and 35% for patients>20 years at the end of the follow-up (P<0.001). It was estimated by survival analysis that 50% of patients with unilateral and bilateral renal damage would have sustained hypertension at about 30 and 22 years of age, respectively. Hypertension increased with age and was strongly associated with renal damage at entry in an unselected population of primary VUR.
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