Diagnostic value of a single blood pressure reading for the detection of latent hypertension in children with chronic kidney diseases

Hypertension is a modifiable risk factor for cardiovascular diseases. The data of  24-hour ambulatory blood pressure monitoring (ABPM) largely correlate with target organ lesions; however, the availability of 24-hour ABPM remains low in clinical practice.

Objective. to determine the diagnostic value of a single office blood pressure measurement for the detection of latent hypertension in children with chronic kidney diseases

Subjects and methods. A single office blood pressure measurement and 24-hour ABPM were carried out in 359 children (boys/girls, 0,51/0,49; median age, 13 years (5; 17) with chronic kidney diseases (a glomerular filtration rate of 84,18±29,6 ml min/1,73m2 (median, 86 ml/min/1,73m2 estimated using the Schwartz equation). To rule out the impact of antihypertensive and/or immunosuppressive therapy on the results of the study, the investigators identified a group of 108 patients (boys/girls, 0,52/0,48; median age, 12 years (5; 16), estimated median glomerular filtration rate, 84 ml/min/1,73m2 ) who did not receive the above treatment.

Results. Office blood pressure measurements revealed prehypertension in 14,5% of cases, hypertension in 27,5%, which was consistent with white coat hypertension in 5% of cases. According to 24-hour ABPM, hypertension was present in 48,7% of the children, including those with latent hypertension (26%). Children with latent hypertension (56,4%) had more frequently elevated blood pressure only at night. The level of office blood pressure was weakly correlated with that of the mean diastolic blood pressure during the day, regardless of the presence/absence of antihypertensive and/or immunosuppressive therapy. Latent hypertension was detected in approximately one-fifth of children with different blood pressure levels in the normal range and its frequency significantly increased 1,5–2-fold in patients with higher-normal blood pressure (90‰ ≤ AP <95‰). The children who did not receive antihypertensive and/or immunosuppressive therapy showed a close correlation between the level of a single office blood pressure measurement and the parameters of 24-hour ABPM, as well as a lower frequency of latent hypertension. The risk of latent hypertension increases significantly when the level of a single office blood pressure is more than 75‰.

Conclusion. The normal level of a single office blood pressure reading does not allow latent hypertension to be ruled out in children with chronic kidney diseases. The risk of latent hypertension was significantly higher in patients with a single systolic/diastolic blood pressure measurement of more than 75‰ by gender, age, and height. Regardless of the level of a single office blood pressure measurement, 24-hour ABPM should be therefore carried out in all children with chronic kidney diseases. 

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