title: Masked hypertension associates with left ventricular hypertrophy in children with CKD.
abstract: Left ventricular hypertrophy (LVH) associates with increased risk for cardiovascular disease. Hypertension leads to LVH in adults, but its role in the pathogenesis of LVH in children is not as well established. To examine left ventricular mass and evaluate factors associated with LVH in children with stages 2 through 4 chronic kidney disease (CKD), we analyzed cross-sectional data from children who had baseline echocardiography (n = 366) and underwent ambulatory BP monitoring (n = 226) as a part of the observational Chronic Kidney Disease in Children (CKiD) cohort study. At baseline, 17% of children had LVH (11% eccentric and 6% concentric) and 9% had concentric remodeling of the left ventricle. On the basis of a combination of ambulatory and casual BP assessment (n = 198), 38% of children had masked hypertension (normal casual but elevated ambulatory BP) and 18% had confirmed hypertension (both elevated casual and ambulatory BP). There was no significant association between LVH and kidney function. LVH was more common in children with either confirmed (34%) or masked (20%) hypertension compared with children with normal casual and ambulatory BP (8%). In multivariable analysis, masked (odds ratio 4.1) and confirmed (odds ratio 4.3) hypertension were the strongest independent predictors of LVH. In conclusion, casual BP measurements alone are insufficient to predict the presence of LVH 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 risk in children with CKD.
authors.affiliation: Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA. mark.mitsnefes@cchmc.org
authors.forename: Mark
authors.initials: M
authors.lastname: Mitsnefes
authors.forename: Joseph
authors.initials: J
authors.lastname: Flynn
authors.forename: Silvia
authors.initials: S
authors.lastname: Cohn
authors.forename: Joshua
authors.initials: J
authors.lastname: Samuels
authors.forename: Tom
authors.initials: T
authors.lastname: Blydt-Hansen
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Saland
authors.forename: Thomas
authors.initials: T
authors.lastname: Kimball
authors.forename: Susan
authors.initials: S
authors.lastname: Furth
authors.forename: Bradley
authors.initials: B
authors.lastname: Warady
mesh_terms: D000293:Adolescent; D001794:Blood Pressure / Q000502:physiology; D002648:Child; D002908:Chronic Disease; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004452:Echocardiography; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology* / Q000503:physiopathology; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology; D007674:Kidney Diseases / Q000150:complications* / Q000503:physiopathology; D008297:Male; D015999:Multivariate Analysis; D009316:National Institutes of Health (U.S.); D015995:Prevalence; D012307:Risk Factors; D012720:Severity of Illness Index; D014481:United States