Masked Hypertension Associates with Left Ventricular Hypertrophy in Children with CKD
Masked Hypertension Associates with Left Ventricular Hypertrophy in Children with CKD
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DOI：
10.1681/asn.2009060609
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发表时间：
2010-01-01
影响因子：
13.6
通讯作者：
Warady, Bradley
中科院分区：
文献类型：
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作者：
Mitsnefes, Mark;Flynn, Joseph;Warady, Bradley
左心室肥大（LVH）与心血管疾病的风险增加。高血压导致成人LVH，但其在儿童LVH的发病机理中的作用尚未确定。为了检查患有第2至4个慢性肾脏疾病（CKD）儿童中LVH相关的左心室肿块，并评估与LVH相关的因素，我们分析了来自基线超声心动图（n = 366）的儿童的横截面数据，并接受了卧床BP监测（n = n = n = 226）作为儿童观察性慢性肾脏疾病（CKID）研究的一部分。在基线时，有17％的儿童患有LVH（11％偏心率和6％同心），而9％的儿童患有左心室的同心重塑。根据卧床和休闲BP评估的结合（n = 198），有38％的儿童患有掩盖的高血压（正常休闲但卧床BP升高），18％的儿童证实了高血压（均为休闲和卧床BP升高）。 LVH和肾功能之间没有显着关联。与正常休闲和卧床BP（8％）的儿童相比，LVH在确认（34％）或蒙面（20％）高血压的儿童中更为常见。在多变量分析中，掩盖（优势比4.1）和确认（优势比4.3）高血压是LVH的最强独立预测指标。总之，仅休闲BP测量不足以预测CKD儿童中LVH的存在。蒙面高血压的高流行及其与LVH的关联支持早期的超声心动图和卧床BP监测，以评估CKD儿童的心血管风险。
Left ventricular hypertrophy (LVH) associates with increased risk for cardiovascular disease. Hypertension leads to LVH in adults, but its role in the pathogenesis of LVH in children is not as well established. To examine left ventricular mass and evaluate factors associated with LVH in children with stages 2 through 4 chronic kidney disease (CKD), we analyzed cross-sectional data from children who had baseline echocardiography (n = 366) and underwent ambulatory BP monitoring (n = 226) as a part of the observational Chronic Kidney Disease in Children (CKiD) cohort study. At baseline, 17% of children had LVH (11% eccentric and 6% concentric) and 9% had concentric remodeling of the left ventricle. On the basis of a combination of ambulatory and casual BP assessment (n = 198), 38% of children had masked hypertension (normal casual but elevated ambulatory BP) and 18% had confirmed hypertension (both elevated casual and ambulatory BP). There was no significant association between LVH and kidney function. LVH was more common in children with either confirmed (34%) or masked (20%) hypertension compared with children with normal casual and ambulatory BP (8%). In multivariable analysis, masked (odds ratio 4.1) and confirmed (odds ratio 4.3) hypertension were the strongest independent predictors of LVH. In conclusion, casual BP measurements alone are insufficient to predict the presence of LVH in children with CKD. The high prevalence of masked hypertension and its association with LVH supports early echocardiography and ambulatory BP monitoring to evaluate cardiovascular risk in children with CKD.