Blood pressure abnormalities in children with sickle cell anemia

Becker, Amy M.; Goldberg, Jordan; Henson, Michael; Ahn, Chul Woo; Tong, Liyue; Baum, Michel; Buchanan, George R.

doi:10.1002/pbc.24843

Cited by 44 publications

(43 citation statements)

References 50 publications

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“…While in-clinic BP is convenient and may portend clinical complications, the gold standard strategy for identifying risk for end-organ damage in other disease has been to perform 24 hour ABPM [20]. Our cohort confirms prior pediatric studies that demonstrate a lack of correlation between hypertension defined by in-clinic BP monitoring and 24 hour ABPM [21, 35]. In addition, our cohort mirrors the results of two prior studies which suggested that SCA patients have a higher prevalence of nocturnal hypertension and lack of nocturnal dipping in pediatric SCA [21, 22].…”

Section: Discussionsupporting

confidence: 76%

“…Ambulatory blood pressure monitoring (ABPM), which identifies nocturnal hypertension, is superior to casual in-clinic blood pressure monitoring for identifying children at high risk for end-organ damage [20]. Two prior studies have identified a high prevalence of nocturnal hypertension in SCA, yet no data are available to define the association between nocturnal hypertension and eGFR in SCA [21, 22]. Hyperuricemia has been associated with hypertension and cardiovascular events in other diseases but, despite the high prevalence of hyperuricemia in SCA, the association of hyperuricemia and sickle cell nephropathy has not been explored [18, 19].…”

Section: Introductionmentioning

confidence: 99%

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Evaluating risk factors for chronic kidney disease in pediatric patients with sickle cell anemia

et al. 2017

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Background Patients with Sickle Cell Anemia (SCA) have an increased prevalence of nephropathy and mortality from chronic kidney disease (CKD). Methods We evaluated the association of hyperuricemia and nocturnal hypertension with lower estimated glomerular filtration rate (eGFR) by cystatin-C among patients 10-21 years old with HbSS or SB0 thalassemia during a non-acute clinic visit. eGFR was obtained in 83 participants, uric acid in 81, and 24 hour ambulatory blood pressure monitoring (ABPM) was performed in 44 participants. Vital signs, CBC, CMP, LDH, medications, and urine microalbumin/creatinine were measured. Hyperuricemia was defined as a uric acid level ≥5.5 mg/dL. Nocturnal hypertension was defined as >25 % of nocturnal readings >95th percentile according to norms established by the American Heart Association Statement on ABPM in children and adolescents. Results The mean eGFR was statistically significantly lower among patients with hyperuricemia than with normal uric acid levels (143 vs 161 mL/min/1.73m2, respectively). Fourteen of 44 (32 %) participants had systolic nocturnal hypertension and 12 of 44 (27 %) had diastolic nocturnal hypertension. The mean eGFR was statistically significantly lower among participants with nocturnal systolic and diastolic hypertension than normal nocturnal blood pressure. In a regression model, nocturnal hypertension and hyperuricemia were associated with a lower eGFR. Conclusion Two risk factors for CKD, nocturnal hypertension and hyperuricemia, were associated with lower eGFR in older children and adolescent patients with SCA, and warrant long-term studies of their association with progression to CKD in this population.

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Section: Discussionsupporting

confidence: 76%

Section: Introductionmentioning

confidence: 99%

Evaluating risk factors for chronic kidney disease in pediatric patients with sickle cell anemia

et al. 2017

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“…Our prevalence is similar to that of 45% reported by Benneh-Akwasi Kuma et al in Ghana [20] as well as of 44% found by Makubi et al [21] and Gordeuk et al [6]. However, it is somewhat higher than that of 17% found by Becker et al [5] and Bodas et al [4], respectively. The observed disparity in relative hypertension prevalence could be explained by differences in methodology, patient's clinical characteristics and thresholds used to define relative hypertension.…”

Section: Discussioncontrasting

confidence: 46%

“…Although elevated PP is a marker of arterial stiffness in old people, the association of PP and relative hypertension might be related to increased stroke volume as a compensatory mechanism, similar to that seen in patients with clinical hemolytic anemia [1]. Using ambulatory blood pressure monitoring (ABPM) in SCD patients, Becker et al [5] reported a 35% and 56% prevalence of unrecognized hypertension and non-dipping blood pressure pattern, respectively. They concluded that BP abnormalities in SCD are more common than usually reported.…”

Section: Discussionmentioning

confidence: 99%

“…However, recent data indicate that blood pressure (BP) abnormalities such as relative systemic hypertension (BP ≥ 120 -139/70 -89 mmHg) and increased pulse pressure (PP ≥ 60 mmHg) or systolic hypertension are associated with an increased pulmonary, renal and cardiovascular disease (CVD) risk [1] [2] [4] [5] [6]. In addition, the lack of nocturnal BP dip using ambulatory BP monitoring (ABPM), a well-known risk factor for the development and progression of renal and cardiovascular disease, has been reported to play an important role in SCD-associated target organ involvement [5].…”

Section: Introductionmentioning

confidence: 99%

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Blood Pressure Patterns and Factors Associated with Relative Hypertension among Steady State Sickle Cell Disease Patients in Kinshasa, Democratic Republic of the Congo: A Cross-Sectional Study

Mboliasa¹,

Lepira²,

Makulo³

et al. 2018

WJCD

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Background: Although systemic hypertension is rarely seen in steady state sickle cell disease (SCD), relative hypertension has been reported to be associated with an increased risk of cardiovascular and renal complications. Objective: To determine the prevalence of BP patterns and assess factors associated with relative hypertension in sickle cell anemia (SCA) adult patients. Methods: Clinical data and office BP were obtained from 103 consecutive steady-state SCA adult patients (mean age 26 ± 7.9 years, 66% females, 22.3% on hydroxyurea) attending four healthcare centers providing SCD-specific care in Kinshasa. Seated BP was measured using an automated electronic device. Three consecutive blood pressure measurements were taken with 2 minutes interval between readings and the average of the 2 last readings was considered for the analyses. Normal BP, relative hypertension and systemic hypertension were defined as BP < 120/70 mmHg, 120 -139/70 -89 mmHg and ≥140/90 mmHg, respectively. Results: Normal BP, relative hypertension and systemic hypertension were observed in 56 (54%), 43 (42%) and 4 (4%) of SCA patients, respectively. In multivariate analysis, factors associated with relative hypertension were leg ulcer (aOR 2.05; 95%CI 1.77 -5.18; p = 0.016), central obesity (aOR 3.32; 95%CI 1.28 -6.24; p = 0.001), smoking (aOR 5.02; 95%CI 1.51 -9.50; p = 0.017), and microalbumiuria (aOR 3.44; 95%CI 1.44 -5.76; p = 0.035). Conclusion: Relative hypertension was a common finding in the present case series and associated with traditional cardiovascular risk factor as well as factors specific to SCD highlighting the need for measures to prevent its progression towards systemic hypertension and associated cardiovascular and renal disease.

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Factors associated with growth and blood pressure patterns in children with sickle cell anemia: Silent Cerebral Infarct Multi‐Center Clinical Trial cohort

et al. 2014

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Individuals with sickle cell anemia (SCA) exhibit delayed growth trajectories and lower blood pressure (BP) measurements than individuals without SCA. We evaluated factors associated with height, weight, and BP and established reference growth curves and BP tables using data from the Silent Cerebral Infarct MultiCenter Clinical (SIT) Trial (NCT00072761). Quantile regression models were used to determine the percentiles of growth and BP measurements. Multivariable quantile regression was used to test associations of baseline variables with height, weight, and BP measurements. Height and weight measurements were collected from a total of 949 participants with median age of 10.5 years [Interquartile range (IQR) 8.2-12.9] and median follow-up time of 3.2 years (IQR 1.8-4.7, range 0-12.9). Serial BP measurements were collected from a total of 944 and 943 participants, respectively, with median age of 10.6 years (IQR 5 8.3-12.9 years), and median follow-up time of 3.3 years (IQR 5 1.7-4.8). Multivariable quantile regression analysis revealed that higher hemoglobin measurements at baseline were associated with greater height (P < 0.001), weight (P 5 0.000), systolic BP (P < 0.001), and diastolic BP (P 5 0.003) measurements. We now provide new reference values for height, weight, and BP measurements that are now readily available for medical management.

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Blood pressure abnormalities in children with sickle cell anemia

Abstract: Blood pressure abnormalities are common in adolescents with SCA and are a possible modifiable risk factor in the progression of sickle cell nephropathy.

Cited by 44 publications

References 50 publications

Evaluating risk factors for chronic kidney disease in pediatric patients with sickle cell anemia

Evaluating risk factors for chronic kidney disease in pediatric patients with sickle cell anemia

Blood Pressure Patterns and Factors Associated with Relative Hypertension among Steady State Sickle Cell Disease Patients in Kinshasa, Democratic Republic of the Congo: A Cross-Sectional Study

Factors associated with growth and blood pressure patterns in children with sickle cell anemia: Silent Cerebral Infarct Multi‐Center Clinical Trial cohort

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