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Isolated nocturnal and isolated daytime hypertension associate with altered cardiovascular morphology and function in children with chronic kidney disease

findings from the Cardiovascular Comorbidity in Children with Chronic Kidney Disease study

Düzova, Alia; Karabay Bayazit, Aysunb; Canpolat, Nurc; Niemirska, Annad; Kaplan Bulut, Ipeke; Azukaitis, Karolisf; Karagoz, Tevfikg; Oguz, Bernah; Erdem, Sevcani; Anarat, Alib; Ranchin, Brunoj; Shroff, Rukshanak; Djukic, Milanl; Harambat, Jeromem; Yilmaz, Alevn; Yildiz, Nurdano; Ozcakar, Birsinp; Büscher, Anjaq; Lugani, Francescar; Wygoda, Simones; Tschumi, Sibyllet; Zaloszyc, Arianeu; Jankauskiene, Augustinav; Laube, Guidow; Galiano, Matthiasx; Kirchner, Mariettay; Querfeld, Uwez; Melk, Anetteaa; Schaefer, Franzbb; Wühl, Elkebb for the 4C Study Consortium

doi: 10.1097/HJH.0000000000002160
Original Article: PDF Only

Introduction: Prevalence of isolated nocturnal hypertension (INH) and isolated daytime hypertension (IDH) is around 10% in adults. Data in children, especially in chronic kidney disease (CKD), are lacking. The aim of this cross-sectional multicenter cohort study was to define the prevalence of INH and IDH and its association with cardiovascular morphology and function, that is, pulse wave velocity (PWV), carotid intima–media thickness (cIMT), or left ventricular mass index (LVMI) in children with CKD.

Methods: Ambulatory blood pressure (BP) monitoring profiles were analyzed in 456 children with CKD stages III–V participating in the Cardiovascular Comorbidity in Children with Chronic Kidney Disease Study (64.3% males, 71.3% congenital anomaly of the kidney and urinary tract, age 12.5 ± 3.2 years, estimated glomerular filtration rate 29 ± 12 ml/min per 1.73 m2). Baseline PWV, cIMT, and LVMI were compared in normotension, INH, IDH, or sustained 24-h hypertension.

Results: Prevalence of sustained hypertension was 18.4%, of INH 13.4%, and of IDH 3.7%. PWV SDS (SD score) and cIMT SDS were significantly higher in sustained hypertension and INH, and PWV SDS was significantly higher in IDH, compared with normotension. LVMI was significantly increased in sustained hypertension, but not in INH or IDH. Determinants of INH were smallness for gestational age, older age, higher height SDS and parathyroid hormone, and shorter duration of CKD. In logistic regression analysis, day/night-time hypertension or ambulatory BP monitoring pattern (normal, INH, IDH, sustained hypertension) were independently associated with cardiovascular outcome measures: elevated night-time BP was associated with increased cIMT, PWV, and left ventricular hypertrophy; INH was associated with cIMT.

Conclusion: INH is present in almost one out of seven children with predialysis CKD; INH and nocturnal hypertension in general are associated with alterations of arterial morphology and function.

aDivision of Pediatric Nephrology, Hacettepe University Faculty of Medicine, Ankara

bCukurova University Faculty of Medicine, Adana

cIstanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey

dThe Children‘s Memorial Health Institute, Warsaw, Poland

eEge University Faculty of Medicine, Izmir, Turkey

fClinic of Pediatrics, Faculty of Medicine, Vilnius, Lithuania

gDivision of Pediatric Cardiology

hDepartment of Radiology, Hacettepe University Faculty of Medicine, Ankara

iDivision of Pediatric Cardiology, Cukurova University Faculty of Medicine, Adana, Turkey

jHospices Civils de Lyon, Bron, France

kGreat Ormond Street Hospital for Children, London, UK

lSchool of Medicine, University of Belgrade, Belgrade, Serbia

mPediatric Nephrology Unit, Bordeaux University Hospital, Bordeaux, France

nIstanbul University Istanbul Medical Faculty

oMarmara University Faculty of Medicine, Istanbul

pDivision of Pediatric Nephrology and Rheumatology, Department of Pediatrics, Ankara University Medical School, Ankara, Turkey

qUniversity Children‘s Hospital, Pediatrics 2, Pediatric Nephrology, University of Duisburg-Essen, Essen, Germany

rDivision of Nephrology and Transplantation, G. Gaslini Institute, Genova, Italy

sKlinikum St. Georg, Leipzig, Germany

tPediatric Nephrology, Inselspital, Bern, Switzerland

uCHU Hautepierre, Strasbourg, France

vInstitute of Clinical Medicine, Vilnius University, Vilnius, Lithuania

wNephrology Unit, University Children's Hospital, Zürich, Switzerland

xDepartment of Pediatrics and Adolescent Medicine, University of Erlangen-Nuremberg, Erlangen

yInstitute of Medical Biometry and Informatics, Heidelberg

zCharité Universitätsmedizin Berlin, Berlin

aaHannover Medical School, Hannover

bbCenter for Pediatrics and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany

Correspondence to Ali Düzova, Division of Pediatric Nephrology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Sihhiye, 06100 Ankara, Turkey. E-mail:

Received 7 July, 2018

Revised 11 April, 2019

Accepted 26 April, 2019

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