Ambulatory blood pressure measurement in young normotensive patients with autosomal dominant polycystic kidney disease.
BACKGROUND
Autosomal dominant polycystic kidney disease (ADPKD) is the most common genetic disorder causing chronic kidney disease in adults. Hypertension occurs early and frequently precedes the development of renal failure. It has been shown that clinically normotensive young adults with ADPKD exhibit increased left ventricular mass and left ventricular mass index (LVMI), which contributes to the increased cardiovascular risk in these patients. We set out to investigate whether normotensive patients have a prehypertensive state that could account for their increased LVMI.


METHODS
Patients with ADPKD followed as outpatients were selected if they were aged between 21-30 years, were normotensive (office and sporadic blood pressure < 140/90 without medication), and had normal renal function (GFR > 90 ml/min). Normotensive controls aged between 21-30 years were selected, all with normal renal ultrasound, serum creatinine, dipstick analysis and microalbuminuria /creatinine ratio. Patients and controls underwent 24-hour ambulatory blood pressure measurement (ABPM) according to the local protocol.


RESULTS
Systolic (124.7 +/- 7.6 vs. 115.2 +/- 6.9; p < 0.0001), diastolic (77.3 +/- 6.3 vs. 70.5 +/- 3.9; p < 0.0001) and mean (92.7 +/- 8.5 vs. 85.7 +/- < 0.001) 24-hour blood pressure was significantly higher in patients with ADPKD compared to controls. Statistically significant differences were also found when daytime and night-time periods were analyzed separately. Hypertension on ABPM was diagnosed in 6 patients but differences in the ABPM profile persisted even when these patients were excluded from the analysis.


CONCLUSIONS
In young adults with ADPKD there is a prehypertensive state that can be detected using ABPM.
de Almeida
Edgar A F
EA
Serviço de Nefrologia e Transplantação Renal, Serviço de Cardiologia, Hospital de Santa Maria, Lisboa, Portugal. edgar.almeida@hsm.min-saude.pt
de Oliveira
Eduardo I
EI
Lopes
José António
JA
Almeida
Ana G
AG
Lopes
Mário G
MG
Prata
M Martins
MM
D000328:Adult; D018660:Blood Pressure Monitoring, Ambulatory; D005260:Female; D006801:Humans; D008297:Male; D016891:Polycystic Kidney, Autosomal Dominant / Q000503:physiopathology*