Proteinuria and nocturnal blood pressure dipping in hypertensive children and adolescents.
Proteinuria and nocturnal blood pressure dipping in hypertensive children and adolescents.
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DOI：
10.1038/s41390-020-01315-3
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发表时间：
2021-10
影响因子：
3.6
通讯作者：
Garimella PS
中科院分区：
文献类型：
--
作者：
Bakhoum CY;Vuong KT;Carter CE;Gabbai FB;Ix JH;Garimella PS
成人无夜间血压下降与心血管不良结局有关，而蛋白尿是该人群中无夜间血压下降的危险因素。儿童不浸泡的风险因素在很大程度上是未知的。我们回顾了2018年8月至2019年1月接受24小时动态血压监测(ABPM)并在ABPM后一年内有尿蛋白与肌酐比值(PCR)的5至19岁患者。血压下降被定义为从白天到晚上≥收缩压和舒张压下降10%。多变量Logistic和线性回归模型评估了蛋白尿与非浸泡的相关性。在确认的77名儿童中，27名(35.1%)为非勺型。在调整了体重指数(BMI)后，尿液PCR值每高两倍，不沾尿的几率就高出38%。在调整了体重指数、年龄和估计的肾小球滤过率后，尿PCR值较高还与舒张期降低1.33%(95%可信区间0.31至2.34)相关。这项研究的局限性包括它的回溯性设计和尿PCR与ABPM之间的时间间隔。蛋白尿似乎与儿童血压不下降有关。这一发现需要在前瞻性研究中得到证实。
Absence of nocturnal blood pressure dipping is associated with adverse cardiovascular outcomes in adults, and proteinuria is a risk factor for non-dipping in this population. Risk factors for non-dipping in children are largely unknown. We retrospectively identified patients aged 5 to 19 years who underwent 24-hour ambulatory blood pressure monitoring (ABPM) from August 2018 to January 2019 and had a spot urine protein to creatinine ratio (PCR) within one year of their ABPM. Dipping was defined as ≥10% reduction in systolic and diastolic blood pressure from day to night. Multivariable logistic and linear regression models evaluated the association of proteinuria with non-dipping. Among 77 children identified, 27 (35.1%) were non-dippers. Each two-fold higher urine PCR was associated with 38% higher odds of non-dipping, after adjusting for body mass index (BMI). Higher urine PCR was also associated with a lower diastolic dipping percentage by 1.33 (95% CI 0.31 to 2.34), after adjusting for BMI, age, and estimated glomerular filtration rate. Limitations of this study include its retrospective design and the time lapse between urine PCR and ABPM. Proteinuria appears to be associated with blood pressure non-dipping in children. This finding needs to be confirmed in prospective studies.
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