From the Pediatric Kidney Disease and Hypertension Centers, Phoenix, AZ (G.-M.B.); Johns Hopkins University, Baltimore, MD (C.P.); Cincinnati Children's Hospital, OH (M.M.); McGovern Medical School UT Health, Houston, TX (J.S.); Children's Mercy Hospital, Kansas City, MO (B.A.W.); Children's Hospital of Philadelphia, PA (S.F.); and Seattle Children's Hospital, Seattle, WA (J.F.).
Hypertension. 2018 Mar;71(3):444-450. doi: 10.1161/HYPERTENSIONAHA.117.09649. Epub 2018 Jan 2.
Uncontrolled hypertension in children with chronic kidney disease (CKD) has been identified as one of the main factors contributing to progression of CKD and increased risk for cardiovascular disease. Recent efforts to achieve better blood pressure (BP) control have been recommended. The primary objective of this analysis was to compare BP control over 2 time periods among participants enrolled in the CKiD study (Chronic Kidney Disease in Children). Casual BP and 24-hour ambulatory BP monitor data were compared among 851 participants during 2 time periods: January 1, 2005, through July 1, 2008 (period 1, n=345), and July 1, 2010, through December 31, 2013 (period 2, n=506). Multivariable logistic regression to model the propensity of a visit record being in period 2 as a function of specific predictors was performed. After controlling for confounding variables (age, sex, race, socioeconomics, CKD duration, glomerular filtration rate, proteinuria, body mass index, growth failure, and antihypertensives), no significant differences were detected between time periods with respect to casual BP status (prehypertension: 15% versus 15%; uncontrolled hypertension: 18% versus 17%; =0.87). Analysis of ambulatory BP monitor data demonstrated higher ambulatory BP indices, most notably masked hypertension in period 2 (36% versus 49%; <0.001). Average sleep BP index (<0.05) and sleep BP loads (<0.05) were higher in period 2. Despite publication of hypertension recommendations and guidelines for BP control in patients with CKD, this study suggests that hypertension remains undertreated and under-recognized in children with CKD. This analysis also underscores the importance of routine ambulatory BP monitor assessment in children with CKD.
儿童慢性肾脏病（CKD）患者的未控制高血压已被确定为 CKD 进展和心血管疾病风险增加的主要因素之一。最近已建议采取措施以更好地控制血压。本分析的主要目的是比较参加 CKiD 研究（儿童慢性肾脏病）的患者在两个时间段内的血压控制情况。比较了 851 名参与者在两个时间段内的偶然血压和 24 小时动态血压监测数据：2005 年 1 月 1 日至 2008 年 7 月 1 日（第 1 期，n=345）和 2010 年 7 月 1 日至 2013 年 12 月 31 日（第 2 期，n=506）。使用多变量逻辑回归来建立一个模型，以记录特定预测因素的访问记录是否处于第 2 期。在控制混杂变量（年龄、性别、种族、社会经济状况、CKD 持续时间、肾小球滤过率、蛋白尿、体重指数、生长不良和抗高血压药）后，两个时间段之间在偶然血压状态方面无显著差异（前期高血压：15%对 15%；未控制的高血压：18%对 17%；=0.87）。动态血压监测数据的分析显示，动态血压指标更高，尤其是第 2 期的隐匿性高血压（36%对 49%；<0.001）。第 2 期的平均睡眠血压指数（<0.05）和睡眠血压负荷（<0.05）更高。尽管发表了高血压建议和 CKD 患者血压控制指南，但本研究表明，儿童 CKD 患者的高血压治疗仍不足，认识不足。该分析还强调了常规动态血压监测评估在儿童 CKD 中的重要性。
