Division of Pediatric Cardiology, Children's Hospital at Montefiore, Albert Einstein College of Medicine, 3415 Bainbridge Ave- R1, Bronx, NY, 10467, USA.
Division of Pediatric Critical Care Medicine, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA.
Pediatr Cardiol. 2023 Jun;44(5):1003-1008. doi: 10.1007/s00246-023-03096-y. Epub 2023 Jan 19.
Masked hypertension (HTN), especially, isolated nocturnal HTN (INH) has been shown to be a risk factor for cardiovascular disease (CVD) but is not studied well in pediatric heart transplant (PHT) patients. Ambulatory blood pressure monitoring (ABPM) is known to identify patients with HTN but is not used routinely in PHT.
A single-center, prospective, cross-sectional study of PHT recipients was performed to observe the incidence of masked HTN using 24-h ABPM. The relationship between ABPM parameters and clinical variables was assessed using Spearman correlation coefficient. p value < 0.05 was considered significant.
ABPM was performed in 34 patients, mean age 14 ± 5 years, median 5.5 years post-PHT. All patients had normal cardiac function, left ventricular mass index and blood pressure measurements in the clinic. Four patients had known prior HTN and on medications, one of them was uncontrolled. Of the remaining 30 patients, 18 new patients were diagnosed with masked HTN, of which 14 had INH. Diurnal variation was abnormal in 82% (28/34) patients. 24-h diastolic blood pressure (DBP) index correlated with glomerular filtration rate (GFR) (r = - 0.44, p = 0.01). There was no correlation between other ABPM parameters with tacrolimus trough levels.
ABPM identified masked HTN in 60% of patients, with majority being INH. Abnormal circadian BP patterns were present in 82% and an association was found between GFR and DBP parameters. HTN, especially INH, is under-recognized in PHT recipients and ABPM has a role in their long-term care.
已经证实，隐匿性高血压（HTN），尤其是孤立性夜间 HTN（INH）是心血管疾病（CVD）的一个危险因素，但在儿科心脏移植（PHT）患者中研究得并不充分。动态血压监测（ABPM）已被证实可识别高血压患者，但在 PHT 患者中并未常规使用。
对接受心脏移植的患者进行了一项单中心、前瞻性、横断面研究，使用 24 小时 ABPM 观察隐匿性 HTN 的发生率。使用 Spearman 相关系数评估 ABPM 参数与临床变量之间的关系。p 值<0.05 被认为具有统计学意义。
对 34 例患者进行了 ABPM 检查，平均年龄 14±5 岁，中位数为心脏移植后 5.5 年。所有患者均具有正常的心功能、左心室质量指数和诊室血压测量值。有 4 例患者有已知的高血压病史且正在服用药物，其中 1 例血压控制不佳。在其余 30 例患者中，有 18 例新诊断为隐匿性 HTN，其中 14 例为 INH。82%（28/34）的患者昼夜血压变化异常。24 小时舒张压（DBP）指数与肾小球滤过率（GFR）呈负相关（r=-0.44，p=0.01）。其他 ABPM 参数与他克莫司谷浓度之间无相关性。
ABPM 发现 60%的患者存在隐匿性高血压，其中大多数为 INH。82%的患者存在昼夜血压模式异常，并且在 GFR 和 DBP 参数之间发现了相关性。HTN，尤其是 INH，在 PHT 受者中被低估，ABPM 在其长期治疗中具有重要作用。
