Blood Pressure in Children With Chronic Kidney Disease

Abstract

To characterize the distribution of blood pressure (BP), prevalence and risk factors for hypertension in pediatric chronic kidney disease (CKD), we conducted a cross-sectional analysis of baseline BP's in 432 children (mean age 11y; 60% male; mean glomerular filtration rate [GFR] 44 ml/min/1.73m2) enrolled in the Chronic Kidney Disease in Children cohort study. BP's were obtained using an aneroid sphygmomanometer. GFR was measured by iohexol disappearance. Elevated BP was defined as BP≥90th percentile for age, gender and height. Hypertension was defined as BP≥95th percentile or as self-reported hypertension plus current treatment with antihypertensive medications. For systolic BP, 14% were hypertensive and 11% were pre-hypertensive (BP 90-95th percentile); 68% of subjects with elevated SBP were taking antihypertensive medications. For diastolic BP, 14% were hypertensive, and 9% were pre-hypertensive; 53% of subjects with elevated DBP were taking antihypertensive medications. 54% of subjects had either systolic or diastolic BP≥95th percentile or a history of hypertension plus current antihypertensive use. Characteristics associated with elevated BP included black race, shorter duration of CKD, absence of antihypertensive medication use, and elevated serum potassium. Among subjects receiving antihypertensive treatment, uncontrolled BP was associated with male sex, shorter CKD duration and absence of ACE inhibitor or ARB use. 37% of children with CKD had either elevated systolic or diastolic BP, and 39% of these were not receiving antihypertensives, indicating that hypertension in pediatric CKD may be frequently under- or even un-treated. Treatment with ACE inhibitors or ARB's may improve BP control in these patients.

BP Control and Left Ventricular Hypertrophy Regression in Children with CKD

“…[1][2][3][4]15 One of the important findings of our current longitudinal study is the confirmation of a strong association between casual BP and LVMI in the CKiD population. The multivariate model predicting LVMI with SBP also showed that, after adjusting for SBP and confounders (including age), LVMI had an average decrease of 40% over 4 years.…”

“…This effect could occur independently of any regression of LVH. [24][25][26] In a baseline cross-sectional analysis, 15 the use of antihypertensive medication other than ACEI or ARB was also associated with uncontrolled BP. It is possible that the association with the lower prevalence of LVH is related to a better control of hypertension with ACEI and ARB in our study.…”

“…[10][11][12] However, the link between elevated BP and LVH in children with CKD remains controversial. [1][2][3]15 To better understand the relationships between BP and LVH in children with CKD, we analyzed BP and echocardiographic data from children enrolled in the Chronic Kidney Disease in Children (CKiD) cohort, a prospective observational study of children with mild to moderate CKD. The objectives of this study were to (1) analyze the longitudinal effects of casual BP on left ventricular mass index (LVMI) and (2) determine whether casual BP is associated with the development and/or regression of LVH in children with CKD.…”

2016 European Society of Hypertension guidelines for the management of high blood pressure in children and adolescents

“…The prevalence of HTN in pediatric CKD ranges from 20 to 80% depending on the degree of renal dysfunction (154)(155)(156)(157). However, even children with CKD stage 2 (i.e.…”

Pharmacologic Management of Pediatric Hypertension

“…The Chronic Kidney Disease in Children study showed that even in children with CKD, who have a 37% prevalence of hypertension, 39% of patients with confirmed hypertension were not receiving antihypertensive drugs [32]. A study of 1.3 million children with military health insurance found that only 34% of children diagnosed with hypertension underwent echocardiography, and only 38.9% of children diagnosed with hypertension received an antihypertensive medication [29].…”