Ambulatory blood pressure monitoring useful for pediatric kidney disease
MedWire News: Ambulatory blood pressure monitoring (ABPM) can be used to aid clinicians in detecting increased cardiovascular risk among children with chronic kidney disease (CKD), say researchers.
"This analysis demonstrates the feasibility of measuring ABPM in a multicenter trial, highlights the significant burden of hypertension in patients with CKD, and reveals an important association between CKD progression and the presence of ambulatory hypertension," report Joshua Samuels (University of Texas Health Science Center at Houston, USA) and team.
They reported ABPM findings in 332 children aged between 1 and 16 years with an estimated glomerular filtration rate (eGFR) of 30‑90 mL/min per 1.73 m2.
The BP of each child was categorized according to casual BP and ABPM results. Normotensive BP was defined as a casual BP less than the 95th percentile, wake and sleep mean ABPM less than the 95th percentile, and wake and sleep load less than 25%.
Ambulatory hypertension was defined as a casual BP in the 95th percentile or higher, wake or sleep mean ABPM in the 95th percentile or higher, or wake or sleep load of at least 25%.
White-coat hypertension was defined as a casual BP in the 95th percentile or higher, wake and sleep mean ABPM greater than the 95th percentile, and wake and sleep load greater than 25%.
Masked hypertension was defined as a casual BP greater than the 95th percentile, wake or sleep mean ABPM in the 95th percentile or higher, or wake or sleep load of at least 25%.
Overall, 42% of children had normal ABPM, 4% had white-coat hypertension, 35% had masked hypertension, and 14% had ambulatory hypertension.
Multivariate analysis adjusted for age, gender, CKD diagnosis, eGFR, and urine protein to creatinine ratio, showed that patients who received treatment with antihypertensive medications had a 13% higher chance of having a normal ABPM than those who did not.
Specifically, patients who used angiotensin-converting enzyme (ACE) inhibitors were 89% more likely to have a normal ABPM compared with those who did not.
The average annual decline in eGFR for all children was 0.96 mL/min per 1.73 m2, corresponding to a decrease of 4% per year. For each 20% faster decline in this annualized eGFR change, the risk for an abnormal ABPM increased by 26%.
Further analysis revealed that a 2.25-fold increase in the annualized rate of change in the urine protein to creatinine ratio (decline of 8% per year) was associated with a 39% higher risk for an abnormal ABPM.
"Individuals on ACE inhibitors were less likely to have abnormal ABPM, suggesting a possible therapeutic intervention," remark the authors.
"Given these important findings, ABPM should be used to monitor risk and trigger therapeutic interventions in children with CKD," they conclude.
By Piriya Mahendra