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Masked Hypertension in Pediatric Heart Transplant Recipients
Neha Bansal1, Waheed A Raedi2, Shivanand S Medar2,3
1Division of Pediatric Cardiology, Children's Hospital at Montefiore, Albert Einstein College of Medicine, 3415 Bainbridge Ave- R1, Bronx, NY, 10467, USA. nbansalmd@gmail.com.
Insights
Masked hypertension, particularly isolated nocturnal hypertension, is common in pediatric heart transplant patients. Ambulatory blood pressure monitoring is crucial for early detection and management in this population.
Area of Science:
- Cardiology
- Pediatric Nephrology
- Transplantation Medicine
Background:
- Masked hypertension (HTN), especially isolated nocturnal HTN (INH), is a known cardiovascular disease (CVD) risk factor.
- Its prevalence and impact in pediatric heart transplant (PHT) patients remain understudied.
- Ambulatory blood pressure monitoring (ABPM) can detect HTN but is not routinely used in PHT care.
Purpose of the Study:
- To determine the incidence of masked HTN in PHT recipients.
- To assess the utility of 24-hour ABPM in identifying HTN in this population.
- To explore correlations between ABPM parameters and clinical variables.
Main Methods:
- A prospective, cross-sectional study involving 34 PHT recipients.
- Utilized 24-hour ABPM to assess blood pressure patterns.
- Employed Spearman correlation coefficient to analyze relationships between ABPM parameters and clinical data.
Main Results:
- Masked HTN was diagnosed in 18 of 30 patients (60%) without prior known HTN, with 14 cases of INH.
- Abnormal diurnal blood pressure variation was observed in 82% of patients.
- A significant correlation was found between 24-hour diastolic blood pressure index and glomerular filtration rate (GFR).
Conclusions:
- Masked HTN, predominantly INH, is frequently under-recognized in PHT recipients.
- ABPM is essential for identifying HTN and abnormal circadian blood pressure patterns in PHT patients.
- ABPM plays a vital role in the long-term management and cardiovascular risk assessment of PHT survivors.
Background:
Masked hypertension (HTN), especially, isolated nocturnal HTN (INH) has been shown to be a risk factor for cardiovascular disease (CVD) but is not studied well in pediatric heart transplant (PHT) patients. Ambulatory blood pressure monitoring (ABPM) is known to identify patients with HTN but is not used routinely in PHT.
Methods:
A single-center, prospective, cross-sectional study of PHT recipients was performed to observe the incidence of masked HTN using 24-h ABPM. The relationship between ABPM parameters and clinical variables was assessed using Spearman correlation coefficient. p value < 0.05 was considered significant.
Results:
ABPM was performed in 34 patients, mean age 14 ± 5 years, median 5.5 years post-PHT. All patients had normal cardiac function, left ventricular mass index and blood pressure measurements in the clinic. Four patients had known prior HTN and on medications, one of them was uncontrolled. Of the remaining 30 patients, 18 new patients were diagnosed with masked HTN, of which 14 had INH. Diurnal variation was abnormal in 82% (28/34) patients. 24-h diastolic blood pressure (DBP) index correlated with glomerular filtration rate (GFR) (r = - 0.44, p = 0.01). There was no correlation between other ABPM parameters with tacrolimus trough levels.
Conclusions:
ABPM identified masked HTN in 60% of patients, with majority being INH. Abnormal circadian BP patterns were present in 82% and an association was found between GFR and DBP parameters. HTN, especially INH, is under-recognized in PHT recipients and ABPM has a role in their long-term care.
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