BP Control and Left Ventricular Hypertrophy Regression in Children with CKD

Abstract

In adult patients with CKD, hypertension is linked to the development of left ventricular hypertrophy, but whether this association exists in children with CKD has not been determined conclusively. To assess the relationship between BP and left ventricular hypertrophy, we prospectively analyzed data from the Chronic Kidney Disease in Children cohort. In total, 478 subjects were enrolled, and 435, 321, and 142 subjects remained enrolled at years 1, 3, and 5, respectively. Echocardiograms were obtained 1 year after study entry and then every 2 years; BP was measured annually. A linear mixed model was used to assess the effect of BP on left ventricular mass index, which was measured at three different visits, and a mixed logistic model was used to assess left ventricular hypertrophy. These models were part of a joint longitudinal and survival model to adjust for informative dropout. Predictors of left ventricular mass index included systolic BP, anemia, and use of antihypertensive medications other than angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. Predictors of left ventricular hypertrophy included systolic BP, female sex, anemia, and use of other antihypertensive medications. Over 4 years, the adjusted prevalence of left ventricular hypertrophy decreased from 15.3% to 12.6% in a systolic BP model and from 15.1% to 12.6% in a diastolic BP model. These results indicate that a decline in BP may predict a decline in left ventricular hypertrophy in children with CKD and suggest additional factors that warrant additional investigation as predictors of left ventricular hypertrophy in these patients.

Cardiovascular risk factors and mortality in children with chronic kidney disease

“…Even though hypertension has been reported to be the single most important CVRF in CKD, [6,30,31] we found anaemia to be the most common CVRF overall in our study, and hypertension to be the second most common overall. The high rate of anaemia probably reflects the undernutrition reported in the dialysis group, in addition to other causes of anaemia in CKD such as declining production of erythropoietin, inflammation, severe secondary hyperparathyroidism …”

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

“…Nonetheless, there is pediatric evidence that effective antihypertensive treatment induces regression of LVH, ameliorates cardiac geometry and function (22,23,(174)(175)(176). In children with CKD receiving angiotensin converting enzyme inhibitors (ACEi), improved BP control resulted in LVH regression and improved systolic function within 12 months of treatment.…”

“…First-line therapy includes salt restriction and agents that target the renin-angiotensin-aldosterone-system combined with beta-blockers in low doses if necessary to achieve BP control. Addition of diuretics is recommended in patients with volume overload (175,176). Occasionally one may see patients with critical CoA presenting with heart failure and upper limb HTN.…”

Evidence-based guidelines for the management of hypertension in children with chronic kidney disease

“…Hypertension is a known independent risk factor for renal disease progression in children [1,3,4]. It is also a risk factor for left ventricular hypertrophy and increased carotid intima-media thickness in children with CKD [5][6][7][8]. There is even early evidence that treatment of hypertension can slow renal progression and reverse cardiovascular changes [4,6,9].…”

“…It is also a risk factor for left ventricular hypertrophy and increased carotid intima-media thickness in children with CKD [5][6][7][8]. There is even early evidence that treatment of hypertension can slow renal progression and reverse cardiovascular changes [4,6,9]. With mounting evidence that hypertension is a modifiable risk factor, it is important that we measure blood pressure, and diagnose and treat hypertension to prevent renal and cardiovascular consequences.…”