Change in cardiac geometry and function in CKD children during strict BP control: a randomized study

Area of Science:

• Pediatric Nephrology
• Cardiology
• Hypertension Management

Background:

• Children with chronic kidney disease (CKD) often exhibit left ventricular hypertrophy (LVH) and impaired systolic function.
• This study investigated cardiac changes in pediatric CKD patients as part of a larger trial on blood pressure control.

Purpose of the Study:

• To evaluate the impact of strict blood pressure control and ACE inhibition on left ventricular (LV) geometry and systolic function in children with mild to moderate CKD.
• To compare the effects of conventional versus intensified blood pressure control strategies.

Main Methods:

• Eighty-four children with CKD underwent echocardiograms and ambulatory BP monitoring at baseline and follow-up (1-2 years).
• Patients had elevated 24-hour mean BP or were on high-dose ACE inhibitors, randomized to conventional or intensified BP control.
• Data analyzed for changes in LV mass index (LVMI) and midwall fractional shortening.

Main Results:

• Prevalence of LVH decreased significantly from 38% to 25% (P<0.05).
• LVMI reduction occurred in patients with baseline LVH, independent of randomization or BP reduction.
• Midwall fractional shortening increased in the total cohort (P<0.05), with greater improvement in the intensified BP control group.

Conclusions:

• ACE inhibition, combined with improved BP control, led to LVH regression and improved systolic function in children with CKD within 12 months.
• Lowering BP to the low-normal range enhanced myocardial function more than LVMI.
• Intensified BP control yielded slightly greater improvements in cardiac function compared to conventional control.