title: Blood pressure abnormalities in children with sickle cell anemia.
abstract: BACKGROUND
  Kidney disease is an important cause of morbidity and mortality in patients with sickle cell anemia (SCA). The factors that affect progression of renal disease are unknown, especially in children and adolescents. Alterations in blood pressure, including hypertension and lack of the normal nocturnal dip in blood pressure, are important determinants of diabetic nephropathy and other renal diseases and may play a role in sickle cell nephropathy. Our primary hypothesis was that children with SCA who have microalbuminuria will demonstrate less nocturnal dipping of blood pressure compared to patients without microalbuminuria. We also investigated other potential factors associated with microalbuminuria.
  
  
  METHODS
  This prospective study of 52 adolescents with SCA followed in the Children's Medical Center Dallas Comprehensive Sickle Cell Center characterized 24-hour ambulatory blood pressure profiles and presence of microalbuminuria. Stepwise logistic regression was performed to identify significant independent factors that are associated with microalbuminuria.
  
  
  RESULTS
  Thirty-five percent of patients were identified as having previously unrecognized hypertension, and 17% had pre-hypertension (blood pressure greater than the 90th percentile but less than the 95th percentile). Fifty-six percent of patients lacked the normal nocturnal dip in blood pressure. In addition, 21% had microalbuminuria, and their percent nocturnal dip was significantly less than those without microalbuminuria (P = 0.01).
  
  
  CONCLUSIONS
  Blood pressure abnormalities are common in adolescents with SCA and are a possible modifiable risk factor in the progression of sickle cell nephropathy.
authors.affiliation: Division of Nephrology, Dallas, Texas.
authors.forename: Amy M
authors.initials: AM
authors.lastname: Becker
authors.forename: Jordan H
authors.initials: JH
authors.lastname: Goldberg
authors.forename: Michael
authors.initials: M
authors.lastname: Henson
authors.forename: Chul
authors.initials: C
authors.lastname: Ahn
authors.forename: Liyue
authors.initials: L
authors.lastname: Tong
authors.forename: Michel
authors.initials: M
authors.lastname: Baum
authors.forename: George R
authors.initials: GR
authors.lastname: Buchanan
mesh_terms: D000293:Adolescent; D000419:Albuminuria / Q000453:epidemiology; D000755:Anemia, Sickle Cell / Q000150:complications* / Q000503:physiopathology; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D002648:Child; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D016015:Logistic Models; D008297:Male; D011446:Prospective Studies
keywords: hypertension; microalbuminuria; nocturnal dipping; sickle cell nephropathy