title: Ambulatory blood pressure patterns in children with chronic kidney disease.
abstract: Ambulatory blood pressure (BP) monitoring (ABPM) is the best method of detecting abnormal BP in patients with chronic kidney disease (CKD), whose hypertension may be missed with casual BP measurements. We report ABPM findings in 332 children 1 year after entry in the Chronic Kidney Disease in Children cohort study. All of the subjects underwent casual and ambulatory BP measurement. BP was categorized based on casual and ABPM results into normal (42%), white-coat (4%), masked (35%), and ambulatory (14%) hypertension. Only half of the subjects had a normal ABPM. BP load was elevated (>25%) in 52% (n = 172), whereas mean BP was elevated in 32% (n = 105). In multivariate analysis, those using an angiotensin-converting enzyme inhibitor were 89% more likely to have a normal ABPM than those who did not report using an angiotensin-converting enzyme inhibitor (odds ratio, 1.89 [95% CI, 1.17-3.04]). For every 20% faster decline in annualized glomerular filtration rate change, the odds of an abnormal ABPM increased 26% (odds ratio, 1.26 [95% CI, 0.97-1.64]). A 2.25-fold increase in urine protein:creatinine ratio annualized change was associated with a 39% higher odds of an abnormal ABPM (odds ratio, 1.39 [95% CI, 1.06-1.82]). Abnormalities on ABPM are common in children with chronic kidney disease and are strongly associated with known risk factors for end-stage renal disease. Individuals on angiotensin-converting enzyme inhibitors were less likely to have abnormal ABPM, suggesting a possible therapeutic intervention. ABPM should be used to monitor risk and guide therapy in children with chronic kidney disease.
authors.affiliation: University of Texas Health Science Center at Houston, Houston, TX 77030, USA. Joshua.A.Samuels@uth.tmc.edu
authors.forename: Joshua
authors.initials: J
authors.lastname: Samuels
authors.forename: Derek
authors.initials: D
authors.lastname: Ng
authors.forename: Joseph T
authors.initials: JT
authors.lastname: Flynn
authors.forename: Mark
authors.initials: M
authors.lastname: Mitsnefes
authors.forename: Tim
authors.initials: T
authors.lastname: Poffenbarger
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Warady
authors.forename: Susan
authors.initials: S
authors.lastname: Furth
mesh_terms: D000293:Adolescent; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology*; D007676:Kidney Failure, Chronic / Q000150:complications / Q000503:physiopathology*; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D059466:White Coat Hypertension / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents