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Role of 24-h ambulatory blood pressure monitoring in children with chronic kidney disease.

Gupta D, Chaturvedi S, Chandy S, Agarwal I - Indian J Nephrol (2015 Nov-Dec)

Bottom Line: While 39.1% children had stage 3 and 4 CKD each, 21.7% had stage 5 CKD.In these, CBP was elevated in 23.5% and ABP in 47%.We found that higher the number of abnormal ABPM indices (assessed by BP Index, nocturnal dipping and BP Load) higher the likelihood of LVH (P = 0.046).

View Article: PubMed Central - PubMed

Affiliation: Department of Community Medicine, Christian Medical College and Hospital, Vellore, India.

ABSTRACT
Hypertension is common in children with chronic kidney disease (CKD) and is a major determinant of CKD progression. Ambulatory blood pressure monitoring (ABPM) has been proposed to be better in detecting hypertension as compared to casual blood pressure (CBP). This study aims to study the usefulness of ABPM in detecting masked hypertension, evaluating the adequacy of blood pressure (BP) control and predicting left ventricular hypertrophy (LVH) amongst children with CKD. A prospective cross-sectional study of 46 children with stage 3-5 CKD was conducted at the Pediatric Nephrology department of a tertiary hospital in South India. All children underwent CBP, ABPM and an echocardiography. Results were categorized as normal BP; confirmed hypertension; masked hypertension and white coat hypertension. Out of 46 children studied, 11 were undergoing dialysis. While 39.1% children had stage 3 and 4 CKD each, 21.7% had stage 5 CKD. Masked hypertension was detected in 19.6% and 21.7% had confirmed hypertension. Thirty-four (73.9%) children were already receiving antihypertensive medication. In these, CBP was elevated in 23.5% and ABP in 47%. Among children with hypertension as defined by ABPM, LVH was detected in 32.2%. We found that higher the number of abnormal ABPM indices (assessed by BP Index, nocturnal dipping and BP Load) higher the likelihood of LVH (P = 0.046). ABPM is better in detecting hypertension and monitoring adequacy of treatment in children with CKD. The high prevalence of masked hypertension and its association with LVH supports early echocardiography and ambulatory BP monitoring to evaluate cardiovascular risks in this population.

No MeSH data available.


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Left ventricular hypertrophy was noted in all categories of ABPM in varying proportions
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Figure 2: Left ventricular hypertrophy was noted in all categories of ABPM in varying proportions

Mentions: Left ventricular hypertrophy was defined as the LVM >95th centile for age, sex and height.[23] Using the above definition, 13 children were found to have LVH. Only 6 (46.1%) of these children were identified to have hypertension by CBP, whereas one (7.6%) had normal BP; 3 (23%) had severe ambulatory hypertension, 4 (30.7%) had masked hypertension, 2 (15.3%) had WCH and 3 (23%) had unclassified hypertension as classified by ABPM [Figure 2]. Hence we would have missed many children with LVH if ABPM had not been used. LV hypertrophy was further classified into concentric hypertrophy (elevated LVMI and relative wall thickness >0.41) and eccentric hypertrophy (elevated LVMI and relative wall thickness <0.41).[2425] Eleven children had concentric hypertrophy (suggestive of pressure overload), whereas 4 children had eccentric hypertrophy (suggestive of volume overload).


Role of 24-h ambulatory blood pressure monitoring in children with chronic kidney disease.

Gupta D, Chaturvedi S, Chandy S, Agarwal I - Indian J Nephrol (2015 Nov-Dec)

Left ventricular hypertrophy was noted in all categories of ABPM in varying proportions
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4663773&req=5

Figure 2: Left ventricular hypertrophy was noted in all categories of ABPM in varying proportions
Mentions: Left ventricular hypertrophy was defined as the LVM >95th centile for age, sex and height.[23] Using the above definition, 13 children were found to have LVH. Only 6 (46.1%) of these children were identified to have hypertension by CBP, whereas one (7.6%) had normal BP; 3 (23%) had severe ambulatory hypertension, 4 (30.7%) had masked hypertension, 2 (15.3%) had WCH and 3 (23%) had unclassified hypertension as classified by ABPM [Figure 2]. Hence we would have missed many children with LVH if ABPM had not been used. LV hypertrophy was further classified into concentric hypertrophy (elevated LVMI and relative wall thickness >0.41) and eccentric hypertrophy (elevated LVMI and relative wall thickness <0.41).[2425] Eleven children had concentric hypertrophy (suggestive of pressure overload), whereas 4 children had eccentric hypertrophy (suggestive of volume overload).

Bottom Line: While 39.1% children had stage 3 and 4 CKD each, 21.7% had stage 5 CKD.In these, CBP was elevated in 23.5% and ABP in 47%.We found that higher the number of abnormal ABPM indices (assessed by BP Index, nocturnal dipping and BP Load) higher the likelihood of LVH (P = 0.046).

View Article: PubMed Central - PubMed

Affiliation: Department of Community Medicine, Christian Medical College and Hospital, Vellore, India.

ABSTRACT
Hypertension is common in children with chronic kidney disease (CKD) and is a major determinant of CKD progression. Ambulatory blood pressure monitoring (ABPM) has been proposed to be better in detecting hypertension as compared to casual blood pressure (CBP). This study aims to study the usefulness of ABPM in detecting masked hypertension, evaluating the adequacy of blood pressure (BP) control and predicting left ventricular hypertrophy (LVH) amongst children with CKD. A prospective cross-sectional study of 46 children with stage 3-5 CKD was conducted at the Pediatric Nephrology department of a tertiary hospital in South India. All children underwent CBP, ABPM and an echocardiography. Results were categorized as normal BP; confirmed hypertension; masked hypertension and white coat hypertension. Out of 46 children studied, 11 were undergoing dialysis. While 39.1% children had stage 3 and 4 CKD each, 21.7% had stage 5 CKD. Masked hypertension was detected in 19.6% and 21.7% had confirmed hypertension. Thirty-four (73.9%) children were already receiving antihypertensive medication. In these, CBP was elevated in 23.5% and ABP in 47%. Among children with hypertension as defined by ABPM, LVH was detected in 32.2%. We found that higher the number of abnormal ABPM indices (assessed by BP Index, nocturnal dipping and BP Load) higher the likelihood of LVH (P = 0.046). ABPM is better in detecting hypertension and monitoring adequacy of treatment in children with CKD. The high prevalence of masked hypertension and its association with LVH supports early echocardiography and ambulatory BP monitoring to evaluate cardiovascular risks in this population.

No MeSH data available.


Related in: MedlinePlus