Document Type : original article

Authors

1 Pediatric Cardiology Department, Mofid Children’s Hospital, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

2 Pediatric Nephrology Research Center, Research Institute for Children's Health, Mofid Children Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Abstract

Background: It is now hypothesized that the Ambulatory Blood Pressure Measurement (ABPM) method in determining and controlling blood pressure and renal disease-related cardiac defects in children with renal impairment can be more applicable. We aimed to compare the mean blood pressure measured by the ABPM method with blood pressure measured by the auscultation method in determining cardiovascular complications by measuring left ventricular mass index (LVMI) in children with chronic kidney disease.
Methods: This cross-sectional study was performed on 40 children suffering from chronic kidney disease referred to Mofid Children Hospital in Tehran between 2019 and 2021. Each child was evaluated during the first 24 hours, every 20 minutes during the day, and every 30 minutes during the night, and blood pressure was assessed by the ABPM method and every 3 hours by the auscultation method. Patients also underwent echocardiography to determine LVMI.
Results: Based on the assessment by auscultation method, 47.0% of children suffered from systolic hypertension, and 40.0% had diastolic hypertension. In total, 50% were hypertensive. According to ABPM blood pressure data, 23 patients (57%) had systolic hypertension and 24 patients (60%) had diastolic hypertension. In total, 16 patients (40%) had normal blood pressure and 24 patients (60%) had hypertension by the ABPM method. Also, according to ABPM measurement, 10 patients (25%) suffered from masked hypertension, and 6 patients (15%) from white-coat hypertension. There was a significant association between LVMI and the blood pressures assessed by the ABPM method.
Conclusion: Auscultation blood pressure measurement alone may not be sufficient to diagnose hypertension in patients with chronic kidney disease. It should be used in conjunction with the ABPM method.

Keywords

  1. Seyed Mehrdad Hamrahian 1, Bonita Falkner 2. Hypertension in Chronic Kidney Disease. Adv Exp Med Biol. 2017; 956:307-325. doi: 10.1007/5584_2016_84.
  2. Tedla FM, Brar A, Browne R, Brown C. Hypertension in chronic kidney disease: navigating the evidence. Int J Hypertens. 2011; 2011:132405. doi: 10.4061/2011/132405. Epub 2011 May 24.
  3. Norris KC, Nicholas SB. Strategies for Controlling Blood Pressure and Reducing Cardiovascular Disease Risk in Patients with Chronic Kidney Disease. Ethn Dis. 2015 Nov 5; 25(4):515-20. doi: 10.18865/ed.25.4.515.
  4. Bethany Roehm 1, Daniel E Weiner. Blood pressure targets and kidney and cardiovascular disease: same data but discordant guidelines. Curr Opin Nephrol Hypertens. 2019 May; 28(3):245-250. doi: 10.1097/MNH.0000000000000492.
  5. Jarraya F. Treatment of Hypertension: Which Goal for Which Patient? Adv Exp Med Biol. 2017; 956:117-127. doi: 10.1007/5584_2016_97.
  6. Khouri Y, Steigerwalt SP, Alsamara M, McCullough PA. What is the ideal blood pressure goal for patients with stage III or higher chronic kidney disease? Curr Cardiol Rep. 2011 Dec; 13(6):492-501.
  7. Chang AR, Lóser M, Malhotra R, Appel LJ. Blood Pressure Goals in Patients with CKD: A Review of Evidence and Guidelines. Clin J Am Soc Nephrol. 2019 Jan 7; 14(1):161-169. doi: 10.2215/CJN.07440618. Epub 2018 Nov 19
  8. Velasquez MT, Beddhu S, Nobakht E, Rahman M, Raj DS. Ambulatory Blood Pressure in Chronic Kidney Disease: Ready for Prime Time? Kidney Int Rep. 2016 Jul; 1(2):94-104. doi: 10.1016/j.ekir.2016.05.001. Epub 2016 Jun 4.
  9. Mayeda L, Rivara MB. Nighttime Hypertension in Chronic Kidney Disease-Are We in the Dark Without Ambulatory Blood Pressure Monitoring? JAMA Netw Open. 2022 May 2; 5(5):e2214469
  10. Habas E Sr, Habas E, Khan FY, Rayani A, Habas A, Errayes M, Farfar KL, Elzouki AY. Blood Pressure and Chronic Kidney Disease Progression: An Updated Review. Cureus. 2022 Apr 18; 14(4):e24244. doi: 10.7759/cureus.24244.
  11. Nagaraju SP, Shenoy SV, Rao IR, Bhojaraja MV, Rangaswamy D, Prabhu RA. Measurement of Blood Pressure in Chronic Kidney Disease: Time to Change Our Clinical Practice - A Comprehensive Review. Int J Nephrol Renovasc Dis. 2022 Feb 9; 15:1-16.
  12. Coresh J, Wei GL, McQuillan G, Brancati FL, Levey AS, Jones C, Klag MJ. Prevalence of high blood pressure and elevated serum creatinine level in the United States: findings from the third National Health and Nutrition Examination Survey (1988-1994). Archives of internal medicine. 2001 May 14; 161(9):1207-16.
  13. Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. New England Journal of Medicine. 2004 Sep 23; 351(13):1296-305.
  14. Levy D, Garrison RJ, Savage DD, Kannel WB, Castelli WP. Left ventricular mass and incidence of coronary heart disease in an elderly cohort: the Framingham Heart Study. Annals of Internal Medicine. 1989 Jan 15; 110(2):101-7.
  15. Levy D, Garrison RJ, Savage DD, Kannel WB, Castelli WP. Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study. New England Journal of Medicine. 1990 May 31; 322(22):1561-6.
  16. Ramaswamy P, Chikkabyrappa S, Donda K, Osmolovsky M, Rojas M, Rafii D. Relationship of ambulatory blood pressure and body mass index to left ventricular mass index in pediatric patients with casual hypertension. Journal of the American Society of Hypertension. 2016 Feb 1; 10(2):108-14
  17. Mitsnefes M, Flynn J, Cohn S, Samuels J, Blydt-Hansen T, Saland J, Kimball T, Furth S, Warady B, CKiD Study Group. Masked hypertension associates with left ventricular hypertrophy in children with CKD. Journal of the American Society of Nephrology. 2010 Jan 1; 21(1):137-44
  18. Gupta D, Chaturvedi S, Chandy S, Agarwal I. Role of 24-h ambulatory blood pressure monitoring in children with chronic kidney disease. Indian journal of nephrology. 2015 Nov; 25(6):355