Gu Haotian, Simpson John M, Cansick Janette, Finlay Eric, Gilbert Rodney, Lunn Andrew, Maxwell Heather, Morgan Henry, Shenoy Mohan, Shroff Rukshana, Subramaniam Pushpa, Tizard Jane, Tse Yincent, Chowienczyk Phil, Sinha Manish D
King's College London British Heart Foundation Centre, London, UK.
King's College London British Heart Foundation Centre, London, UK; Department of Paediatric Cardiology, Evelina London Children's Hospital, Guy's & St Thomas NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK.
EBioMedicine. 2025 May;115:105691. doi: 10.1016/j.ebiom.2025.105691. Epub 2025 Apr 21.
Relationship between blood pressure (BP) control and left ventricular (LV) diastolic function in children with chronic kidney disease (CKD) is uncertain. The aim of this study is to investigate whether achieving lower BP yields a favourable impact on diastolic function.
We performed an exploratory analysis in the HOT-KID, a parallel group, open-label, multicentre, randomised, controlled trial (ISRCTN25006406). Children with CKD were randomised to standard (50th-75th percentile) or intensive (<40th percentile) standardised office systolic BP targets. Echocardiograms were performed at baseline and at follow-up visits. Diastolic function was assessed by early (E) and late mitral inflow (A) E/A ratio, mitral annular motion of myocardial relaxation (e') and atrial contraction (a') velocity, LV compliance of E/e' and e'/a' ratio, and left atrial volume index (LAVi) by a blinded observer.
There was a difference in the average annual rate of change in E/A ratio (difference in means -0·07 per year, 95% CI: -0·14 to -0·01), septal e' (difference in means -0·003 m/s per year, 95% CI: -0·005 to 0·001), and LAVi (difference in means 0·82 ml/m per year, 95% CI: 0·22-1·42) in the standard (n = 60) compared to the intensive treatment arm (n = 64). However, the average annual changes in all other diastolic function measures were similar between standard and intensive treatment groups. There was no difference for overall adverse events or serious adverse events between the two treatment groups.
Our exploratory analysis in a small, open label RCT suggests that achieving lower blood pressure may favourably impact some measures of LV diastolic function in children with CKD.
British Heart Foundation (PG/11/90/28,994); The authors MDS, PJC acknowledge financial support from the Department of Health via the National Institute for Health Research (NIHR) comprehensive Biomedical Research Centre and Clinical Research Facilities awards to Guy's and St Thomas' NHS Foundation Trust in partnership with King's College London and King's College Hospital NHS Foundation Trust. There are no relationships with industry.
慢性肾脏病（CKD）患儿的血压（BP）控制与左心室（LV）舒张功能之间的关系尚不确定。本研究的目的是调查实现更低的血压是否会对舒张功能产生有利影响。
我们在HOT-KID研究中进行了一项探索性分析，这是一项平行组、开放标签、多中心、随机对照试验（ISRCTN25006406）。CKD患儿被随机分配至标准（第50至75百分位数）或强化（<第40百分位数）标准化诊室收缩压目标组。在基线和随访时进行超声心动图检查。由一名盲法观察者通过二尖瓣早期（E）和晚期（A）流入E/A比值、心肌舒张时二尖瓣环运动（e'）和心房收缩（a'）速度、E/e'和e'/a'比值的左心室顺应性以及左心房容积指数（LAVi）来评估舒张功能。
与强化治疗组（n = 64）相比，标准治疗组（n = 60）的E/A比值平均年变化率（均值差异为每年-0·07，95%置信区间：-0·14至-0·01）、室间隔e'（均值差异为每年-0·003 m/s，95%置信区间：-0·005至0·001）和LAVi（均值差异为每年0·82 ml/m，95%置信区间：0·22 - 1·42）存在差异。然而，标准治疗组和强化治疗组之间所有其他舒张功能指标的平均年变化相似。两组治疗的总体不良事件或严重不良事件无差异。
我们在一项小型开放标签随机对照试验中的探索性分析表明，实现更低的血压可能会对CKD患儿的某些左心室舒张功能指标产生有利影响。
英国心脏基金会（PG/11/90/28,994）；作者MDS、PJC感谢卫生部通过国家卫生研究院（NIHR）综合生物医学研究中心以及临床研究设施奖向盖伊和圣托马斯国民保健服务基金会信托基金提供的资金支持，该信托基金与伦敦国王学院和国王学院医院国民保健服务基金会信托基金合作。与行业无关系。
