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Masked hypertension associates with left ventricular hypertrophy in children with CKD

Mark Mitsnefes1, Joseph Flynn, Silvia Cohn

  • 1Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA. mark.mitsnefes@cchmc.org

Journal of the American Society of Nephrology : JASN
|November 18, 2009
PubMed

Insights

Hypertension, including masked hypertension, significantly increases the risk of left ventricular hypertrophy (LVH) in children with chronic kidney disease (CKD). Standard blood pressure checks are insufficient; early screening with echocardiography and ambulatory BP monitoring is crucial for assessing cardiovascular risk.

Area of Science:

  • Pediatric Nephrology
  • Cardiovascular Research
  • Hypertension Studies

Background:

  • Left ventricular hypertrophy (LVH) is a known cardiovascular risk factor in adults, often linked to hypertension.
  • The role of hypertension in the development of LVH in pediatric chronic kidney disease (CKD) populations is not well-established.

Purpose of the Study:

  • To assess left ventricular mass and identify factors associated with LVH in children stages 2-4 CKD.
  • To evaluate the prevalence of masked and confirmed hypertension in this cohort.

Main Methods:

  • Cross-sectional analysis of 366 children from the CKiD study with baseline echocardiography.
  • Ambulatory blood pressure (BP) monitoring was performed on 226 children.
  • BP data combined with casual BP measurements for hypertension classification.

Main Results:

  • 17% of children exhibited LVH; 38% had masked hypertension, and 18% had confirmed hypertension.
  • LVH was significantly more prevalent in children with masked (20%) or confirmed (34%) hypertension compared to normotensive children (8%).
  • Masked and confirmed hypertension were the strongest independent predictors of LVH (OR 4.1 and 4.3, respectively).

Conclusions:

  • Casual BP measurements are inadequate for predicting LVH in pediatric CKD.
  • The high prevalence of masked hypertension underscores the need for ambulatory BP monitoring.
  • Early echocardiography and ambulatory BP monitoring are recommended for cardiovascular risk assessment in children with CKD.

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