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.
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.
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.
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: firstname.lastname@example.org
Received 7 July, 2018
Revised 11 April, 2019
Accepted 26 April, 2019
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