Doyon Anke, Bayazit Aysun Karabay, Duzova Ali, Thurn Daniela, Canpolat Nur, Kaplan Bulut Ipek, Azukaitis Karolis, Obrycki Lukasz, Ranchin Bruno, Shroff Rukshana, Candan Cengiz, Erdogan Hakan, Paripovic Dusan, Donmez Osman, Lugani Francesca, Arbeiter Klaus, Yilmaz Ebru, Zaloszyc Ariane, Wühl Elke, Melk Anette, Querfeld Uwe, Schaefer Franz
Heidelberg University, Medical Faculty Heidelberg, Center for Pediatrics and Adolescent Medicine, Division of Pediatric Nephrology, Germany (A. Doyon, E.W., F.S.).
Department of Pediatric Nephrology, Çukurova University, Faculty of Medicine, Adana, Turkey (A.K.B.).
Hypertension. 2025 Jun;82(6):1035-1045. doi: 10.1161/HYPERTENSIONAHA.124.24330. Epub 2025 Apr 8.
Office blood pressure (BP) trajectories may help assess hypertension progression and the effects of antihypertensive treatment in children with chronic kidney disease.
Analysis of antihypertensive treatment and BP slopes in 320 patients from the 4C study (Cardiovascular Comorbidity in Children with Chronic Kidney Disease) cohort with chronic kidney disease before renal replacement therapy, based on a minimum of 3 individual observations and 2 years of follow-up.
At enrollment, 70 (22%) patients had uncontrolled or untreated hypertension, 130 (41%) patients had controlled hypertension, and 120 (37%) patients had normotension without antihypertensive treatment. Antihypertensive treatment medication was prescribed for 53% of patients at baseline and initiated or added for 91 patients (AHT-I [group with intensification of antihypertensive treatment] group, 28%) during follow-up. Overall BP SD score remained stable over time in the cohort (β=-0.037±0.034, =0.34 and -0.029±0.348, =0.093 per year for systolic and diastolic BP SD score). In the AHT-I group, systolic and diastolic BP SD scores were higher at baseline and decreased significantly during follow-up (-0.22±0.07, <0.003 and -0.12±0.05 SD score per year, =0.01). Only 8 of 70 (11%) patients from the previously untreated/uncontrolled group remained untreated at the last observation, while 31 (44%) were controlled during follow-up. Of the 120 normotensive patients at baseline, 60% remained normotensive while 40% progressed to uncontrolled/untreated (n=23, 19%) or controlled (n=24, 20%) hypertension.
Although the overall BP of the population remained stable over time, individual patterns of BP management showed considerable variability. BP control improved significantly with intensified antihypertensive therapy; however, a significant number of previously normotensive individuals developed new-onset hypertension during the observation period.
诊室血压轨迹可能有助于评估慢性肾脏病患儿高血压的进展以及降压治疗的效果。
基于至少3次个体观察和2年随访，对4C研究（慢性肾脏病患儿心血管合并症）队列中320例接受肾脏替代治疗前的慢性肾脏病患者的降压治疗和血压斜率进行分析。
入组时，70例（22%）患者患有未控制或未治疗的高血压，130例（41%）患者患有控制良好的高血压，120例（37%）患者血压正常且未接受降压治疗。53%的患者在基线时开具了降压治疗药物，91例患者（AHT-I组[强化降压治疗组]，28%）在随访期间开始或加用了降压药物。队列中总体血压标准差评分随时间保持稳定（收缩压和舒张压标准差评分每年分别为β=-0.037±0.034，P=0.34和-0.029±0.348，P=0.093）。在AHT-I组中，收缩压和舒张压标准差评分在基线时较高，随访期间显著下降（每年分别为-0.22±0.07，P<0.003和-0.12±0.05标准差评分，P=0.01）。在之前未治疗/未控制组的70例患者中，仅8例（11%）在最后一次观察时仍未接受治疗，而31例（44%）在随访期间血压得到控制。在基线时血压正常的120例患者中，60%仍保持血压正常，而40%进展为未控制/未治疗（n=23，19%）或控制良好（n=24，20%）的高血压。
尽管总体人群血压随时间保持稳定，但个体血压管理模式存在显著差异。强化降压治疗可显著改善血压控制；然而，相当数量之前血压正常的个体在观察期内出现了新发高血压。
