高血压儿童和青少年的蛋白尿和夜间血压下降。

Proteinuria and nocturnal blood pressure dipping in hypertensive children and adolescents.

机构信息

Division of Pediatric Nephrology, Rady Children's Hospital, San Diego, CA, USA.

Department of Pediatrics, University of California San Diego, La Jolla, CA, USA.

出版信息

Pediatr Res. 2021 Oct;90(4):876-881. doi: 10.1038/s41390-020-01315-3. Epub 2021 Jan 27.

DOI:10.1038/s41390-020-01315-3

PMID:33504962

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8313642/

Abstract

BACKGROUND

The absence of nocturnal blood pressure dipping is associated with adverse cardiovascular outcomes in adults, and proteinuria is a risk factor for non-dipping in this population. Risk factors for non-dipping in children are largely unknown.

METHODS

We retrospectively identified patients aged 5-19 years who underwent 24-h ambulatory blood pressure monitoring (ABPM) from August 2018 to January 2019 and had a spot urine protein-to-creatinine ratio (PCR) within 1 year of their ABPM. Dipping was defined as ≥10% reduction in systolic and diastolic blood pressure from day to night. Multivariable logistic and linear regression models evaluated the association of proteinuria with non-dipping.

RESULTS

Among 77 children identified, 27 (35.1%) were non-dippers. Each two-fold higher urine PCR was associated with 38% higher odds of non-dipping, after adjusting for body mass index (BMI). Higher urine PCR was also associated with a lower diastolic dipping percentage by 1.33 (95% confidence interval 0.31-2.34), after adjusting for BMI, age, and estimated glomerular filtration rate.

CONCLUSIONS

Limitations of this study include its retrospective design and the time lapse between urine PCR and ABPM. Proteinuria appears to be associated with blood pressure non-dipping in children. This finding needs to be confirmed in prospective studies.

IMPACT

Our study demonstrates the association of proteinuria with non-dipping of blood pressure in children. This association has been explored in adults, but to our knowledge, this is the first time it is evaluated in children referred for evaluation of elevated blood pressure. Non-dipping is a modifiable risk factor for kidney function decline and cardiovascular disease in adulthood, and thus early identification in children is important. The association between proteinuria and non-dipping in children will allow us to more readily identify those at risk, with a future focus on interventions to modify blood pressure dipping patterns.

摘要

背景

夜间血压下降缺失与成年人不良心血管结局相关，蛋白尿是该人群非杓型血压的一个危险因素。儿童非杓型血压的危险因素在很大程度上尚不清楚。

方法

我们回顾性地确定了 2018 年 8 月至 2019 年 1 月期间接受 24 小时动态血压监测（ABPM）且 ABPM 后 1 年内有尿液蛋白/肌酐比值（PCR）点值的 5-19 岁患者。夜间血压下降定义为白天到夜间收缩压和舒张压下降≥10%。多变量逻辑回归和线性回归模型评估了蛋白尿与非杓型血压的相关性。

结果

在确定的 77 名儿童中，有 27 名（35.1%）是非杓型血压。在校正体重指数（BMI）后，尿 PCR 每增加两倍，非杓型血压的可能性就会增加 38%。在校正 BMI、年龄和估计肾小球滤过率后，尿 PCR 与舒张压下降百分比降低 1.33（95%置信区间为 0.31-2.34）也相关。

结论

本研究的局限性包括回顾性设计以及尿液 PCR 和 ABPM 之间的时间间隔。蛋白尿似乎与儿童血压非杓型有关。这一发现需要在前瞻性研究中得到证实。

影响

我们的研究表明蛋白尿与儿童血压非杓型有关。这一关联在成年人中已经得到了探索，但据我们所知，这是首次在因高血压就诊的儿童中评估这一关联。非杓型血压是成年后肾功能下降和心血管疾病的一个可改变的危险因素，因此在儿童中早期识别非常重要。蛋白尿与儿童非杓型血压的相关性将使我们能够更容易地识别出那些有风险的人，未来的重点将放在干预措施上，以改变血压下降模式。