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Circadian blood pressure changes in untreated children with kidney disease and conserved renal function
N Lingens1, M Freund, T Seeman
1Division of Paediatric Nephrology, University Children's Hospital, Heidelberg, Germany.
Insights
Ambulatory blood pressure monitoring (ABPM) is more reliable for diagnosing hypertension in children with kidney disease than standard methods. ABPM detects significant daytime and nocturnal hypertension, even with normal kidney function.
Area of Science:
- Pediatric Nephrology
- Cardiovascular Health in Children
- Hypertension Diagnostics
Background:
- Children with kidney disease are at risk for hypertension.
- Standard blood pressure measurements may underestimate hypertension prevalence.
- Early detection of hypertension is crucial for preventing renal deterioration.
Purpose of the Study:
- To evaluate the diagnostic utility of 24-hour ambulatory blood pressure monitoring (ABPM) in children with kidney disease.
- To compare ABPM findings with casual office and home blood pressure recordings.
- To identify the prevalence of daytime, nocturnal, and circadian rhythm abnormalities in blood pressure.
Main Methods:
- Twenty-four-hour ABPM was performed on 31 children (aged 3-19 years) with kidney disease and normal renal function.
- Patients were not receiving antihypertensive therapy.
- Creatinine clearance was assessed, with a median of 112 ml/min/1.73m².
Main Results:
- ABPM identified hypertension in 26% of children during the daytime, significantly higher than casual recordings (62% office, 38% home).
- Nocturnal hypertension was detected in 6 patients (19%), with 2 having normal daytime blood pressure.
- Distorted circadian blood pressure patterns were observed in 8 patients (26%).
Conclusions:
- ABPM provides a more reliable assessment of hypertension in children with kidney disease compared to casual measurements.
- Nocturnal hypertension, a significant risk factor for kidney disease progression, is prevalent in nearly 20% of these children.
- ABPM is essential for accurate hypertension diagnosis and management in pediatric kidney disease patients with preserved renal function.
Abstract:
Ambulatory blood pressure monitoring over 24 h was applied in 31 children with kidney disease, aged 3-19 (median 11) years, in the absence of renal insufficiency and without antihypertensive therapy. Median creatinine clearance was 112 ml/min/1.73m2. Ambulatory blood pressure monitoring revealed that eight patients (26%) were hypertensive during the daytime, compared to 62% through casual recordings obtained in the office and 38% when blood pressure was taken at home. Nocturnal hypertension was detected by ambulatory monitoring in six patients, two of whom had normal blood pressure in the daytime. Median nocturnal dipping was 13% for systolic and 21% for diastolic blood pressure, i.e. similar to healthy children. Rhythm analysis recognized a distorted circadian pattern for systolic and/or diastolic blood pressure in eight patients. In conclusion, ambulatory blood pressure monitoring allows the evaluation of hypertension more reliably than casual recordings in the office. Nocturnal hypertension, as a major risk factor for renal deterioration, is detected in a similar proportion as daytime hypertension in almost 20% of untreated children with kidney disease and normal renal function.