Gupta D, Chaturvedi S, Chandy S, Agarwal I
Department of Community Medicine, Christian Medical College and Hospital, Vellore, India.
Department of Pediatric Nephrology, Christian Medical College and Hospital, Vellore, India.
Indian J Nephrol. 2015 Nov-Dec;25(6):355-61. doi: 10.4103/0971-4065.148305.
Hypertension is common in children with chronic kidney disease (CKD) and is a major determinant of CKD progression. Ambulatory blood pressure monitoring (ABPM) has been proposed to be better in detecting hypertension as compared to casual blood pressure (CBP). This study aims to study the usefulness of ABPM in detecting masked hypertension, evaluating the adequacy of blood pressure (BP) control and predicting left ventricular hypertrophy (LVH) amongst children with CKD. A prospective cross-sectional study of 46 children with stage 3-5 CKD was conducted at the Pediatric Nephrology department of a tertiary hospital in South India. All children underwent CBP, ABPM and an echocardiography. Results were categorized as normal BP; confirmed hypertension; masked hypertension and white coat hypertension. Out of 46 children studied, 11 were undergoing dialysis. While 39.1% children had stage 3 and 4 CKD each, 21.7% had stage 5 CKD. Masked hypertension was detected in 19.6% and 21.7% had confirmed hypertension. Thirty-four (73.9%) children were already receiving antihypertensive medication. In these, CBP was elevated in 23.5% and ABP in 47%. Among children with hypertension as defined by ABPM, LVH was detected in 32.2%. We found that higher the number of abnormal ABPM indices (assessed by BP Index, nocturnal dipping and BP Load) higher the likelihood of LVH (P = 0.046). ABPM is better in detecting hypertension and monitoring adequacy of treatment 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 risks in this population.
高血压在慢性肾脏病（CKD）患儿中很常见，并且是CKD进展的主要决定因素。与偶测血压（CBP）相比，动态血压监测（ABPM）被认为在检测高血压方面更具优势。本研究旨在探讨ABPM在检测CKD患儿隐匿性高血压、评估血压（BP）控制是否充分以及预测左心室肥厚（LVH）方面的作用。在印度南部一家三级医院的儿科肾脏病科，对46例3 - 5期CKD患儿进行了一项前瞻性横断面研究。所有患儿均接受了CBP、ABPM和超声心动图检查。结果分为血压正常；确诊高血压；隐匿性高血压和白大衣高血压。在研究的46例患儿中，11例正在接受透析。39.1%的患儿为3期CKD，39.1%为4期CKD，21.7%为第5期CKD。检测到19.6%的患儿有隐匿性高血压，21.7%确诊为高血压。34例（73.9%）患儿已经在接受抗高血压药物治疗。其中，CBP升高的占23.5%，ABP升高的占47%。在ABPM定义为高血压的患儿中，32.2%检测到LVH。我们发现ABPM异常指标（通过血压指数、夜间血压下降和血压负荷评估）数量越多，发生LVH的可能性越高（P = 0.046）。ABPM在检测CKD患儿高血压和监测治疗是否充分方面更具优势。隐匿性高血压的高患病率及其与LVH的关联支持早期进行超声心动图和动态血压监测，以评估该人群的心血管风险。
