title: Forty-four-hour interdialytic ambulatory blood pressure monitoring and cardiovascular risk in pediatric hemodialysis patients.
abstract: BACKGROUND
  Children undergoing chronic hemodialysis are at risk of cardiovascular disease and often develop left ventricular hypertrophy (LVH). Twenty-four-hour ambulatory blood pressure monitoring (ABPM) is known to better predict cardiovascular morbidity than casual blood pressure (BP) measurement. Given the BP variability attributed to interdialytic fluid overload, 44-h ABPM should better delineate cardiovascular morbidity in pediatric hemodialysis patients.
  
  
  METHODS
  In this cross-sectional study, 17 children (16.7 ± 2.9 years) on chronic hemodialysis underwent 44-h interdialytic ABPM and routine echocardiogram. Left ventricular mass index (LVMI) was calculated by height-based equation; LVH was defined as an LVMI in the ≥95th percentile for height-age and gender. Hypertension was defined by the recommendations of the Fourth Report of the National High Blood Pressure Education Program for casual measurements, and by those of the American Heart Association for ABPM.
  
  
  RESULTS
  Twenty-four percentage of patients were hypertensive by casual post-dialytic systolic BP, whereas 59% were hypertensive by ABPM. Eighty-eight percentage of patients had abnormal cardiac geometry: 53% had LVH. Thirty-five percentage (6 of 17) had masked hypertension, including four with abnormal cardiac geometry, of which, three had LVH. LVMI correlated with ABPM, but not with casual measurements. Strongest correlations with an increased LVMI were with 44-h diastolic BP: at night (r = 0.53, P = 0.03) and total load (r = 0.57, P = 0.02). LVH was similarly associated with 44-h nighttime BP: systolic (P = 0.02), diastolic (P = 0.01) and mean arterial (P = 0.01).
  
  
  CONCLUSIONS
  Casual BP measurement underestimates hypertension in pediatric hemodialysis patients and does not correlate well with indicators of cardiovascular morbidity. In contrast, 44-h interdialytic ABPM better characterizes hypertension, with nighttime parameters most strongly predicting increased LVMI and LVH.
authors: Division of Pediatric Nephrology, Department of Pediatrics , University of Miami , Miami, FL , USA.
authors: Chryso P
authors: CP
authors: Katsoufis
authors: Division of Pediatric Nephrology, Department of Pediatrics , University of Miami , Miami, FL , USA.
authors: Wacharee
authors: W
authors: Seeherunvong
authors: Division of Pediatric Cardiology, Department of Pediatrics , University of Miami , Miami, FL , USA.
authors: Nao
authors: N
authors: Sasaki
authors: Division of Pediatric Nephrology, Department of Pediatrics , University of Miami , Miami, FL , USA.
authors: Carolyn L
authors: CL
authors: Abitbol
authors: Division of Pediatric Nephrology, Department of Pediatrics , University of Miami , Miami, FL , USA.
authors: Jayanthi
authors: J
authors: Chandar
authors: Division of Pediatric Nephrology, Department of Pediatrics , University of Miami , Miami, FL , USA.
authors: Michael
authors: M
authors: Freundlich
authors: Division of Pediatric Nephrology, Department of Pediatrics , University of Miami , Miami, FL , USA.
authors: Gaston E
authors: GE
authors: Zilleruelo
keywords: blood pressure; children; hemodialysis; hypertension; left ventricular hypertrophy