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[Office and 24-hour ambulatory blood pressure measurements in hypertension assessment in children with chronic kidney disease].

Introduction
Hypertension (HT) is
one of the major risk factors of chronic
kidney disease (CKD) progression and
cardiovascular complications.
The aim of the study was to analyze
blood pressure (BP) values and assess
the usefulness of clinical measurements
in BP monitoring in children
with chronic kidney disease.


Material and methods
The study
was conducted in 62 children (40
boys and 22 girls) aged 4,2-18,6 years
(median age 12.4 (9.1; 16.0) with CKD
stages 1 + 2 (n = 9), 3 (n = 17), 4 (n = 15)
and 5. Creatinine concentration was
measured and glomerular filtration rate
was calculated using the Schwartz formula.
Each of the patients underwent
clinical BP measurements and 24-hour
ambulatory blood pressure monitoring
(ABPM).


Results
Based on clinical meaurements
elevated BP values were found
in 25 patients (40.3%): in stages 1 + 2
in 33.3%, in stage 3 in 41.2%, in stage
4 in 46.6% and in stage 5 in 38.1% patients.
Hypertension was diagnosed
with ABPM in 30 patients (48.4% of the
studied population): in stages 1 + 2 - 3
patients (33.3%), in stage 3 - 8 patients
(47, 1%), in stage 4 - 7 patients (46.7%)
and stage 5 - 12 patients (57.1%). Only
12 patients (19.4%) had hypertension
diagnosed in both clinical and ABPM
measurements. White coat effect
was found in 13 children (21.0%) and
masked HT in 18 children (29.0%). In
24-hour BP monitoring the highest
values of systolic, diastolic and mean
BP values were found in children with
masked HT. In children with masked
HT higher values of 24-hour systolic
(120 vs. 105.5 mmHg, p<0.001) and
diastolic (75 vs. 65 mmHg, p<0.001)
BP compared with clinical values were
detected. Children with masked HT had
significantly higher nighttime diastolic
BP compared with children with HT
(1.43 vs. 0.74 z-score, p<0.001).


Conclusions
The large percentage
of children with masked hypertension
is an indication for frequent ABPM
measurements in children with chronic
kidney diseses. Office measurements are not sufficient to
detect HT in children with CKD. The best diagnostic method
to confirm and monitor hypertension in patients with CKD
is 24-hour ambulatory blood pressure monitoring.