Ambulatory blood pressure patterns in children with chronic kidney disease.
Ambulatory blood pressure patterns in children with chronic kidney disease.
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DOI：
10.1161/hypertensionaha.111.189266
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发表时间：
2012-07
期刊：
影响因子：
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通讯作者：
Chronic Kidney Disease in Children Study Group
中科院分区：
文献类型：
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作者：
Samuels J;Ng D;Flynn JT;Mitsnefes M;Poffenbarger T;Warady BA;Furth S;Chronic Kidney Disease in Children Study Group
动态血压监测(ABPM)是发现慢性肾脏病(CKD)患者血压异常的最佳方法，但办公室血压测量可能会漏掉这些患者的高血压。我们报告了332名儿童在参加儿童慢性肾脏疾病(CKiD)队列研究一年后的ABPM结果。所有受试者都进行了随机和动态血压测量。根据随机血压和动态血压监测结果，将血压分为正常高血压、白大衣高血压、隐匿性高血压和动态高血压。只有一半的受试者的动态血压正常。52%(n=172)的患者血压负荷升高(25%)，而平均血压升高32%(n=105)。在多变量分析中，使用血管紧张素转换酶抑制剂(ACEI)的患者ABPM正常的可能性比不使用ACEI的患者高89%(OR：1.89，95%CI：1.17，3.04)。年化肾小球滤过率每下降20%，发生动脉血压异常的几率增加26%(OR：1.26，95%CI：0.97，1.64；p=0.081)。尿蛋白：肌酐比值年化变化2.25倍与ABPM异常的几率增加39%相关(OR：1.39，95%CI：1.06，1.82；p=0.019)。ABPM异常在CKD儿童中很常见，并与已知的终末期肾脏疾病的危险因素密切相关。服用ACEI的个体发生ABPM异常的可能性较小，这表明可能的治疗干预。ABPM应用于CKD儿童的风险监测和指导治疗。
Ambulatory blood pressure monitoring (ABPM) is the best method of detecting abnormal blood pressure (BP) in patients with chronic kidney disease (CKD), whose hypertension may be missed with office BP measurements. We report ABPM findings in 332 children 1 year after entry in the Chronic Kidney Disease in Children (CKiD) cohort study. All subjects underwent casual and ambulatory BP measurement. BP was categorized based on casual and ABPM results into normal, white coat, masked, and ambulatory hypertension. Only half of the subjects had a normal ABPM. BP load was elevated (>25%) in 52% (n= 172) while mean BP was elevated in 32% (n= 105). In multivariate analysis, those using an ACE inhibitor (ACEi) were 89% more likely to have a normal ABPM than those who did not report using an ACEi (OR: 1.89, 95%CI: 1.17, 3.04). For every 20% faster decline in annualized GFR change, the odds of an abnormal ABPM increased 26% (OR: 1.26, 95%CI: 0.97, 1.64; p= 0.081). A 2.25 fold increase in urine protein:creatinine ratio annualized change was associated with a 39% higher odds of an abnormal ABPM (OR: 1.39, 95%CI: 1.06, 1.82; p= 0.019). Abnormalities on ABPM are common in children with CKD, and are strongly associated with known risk factors for end stage renal disease. Individuals on ACEi were less likely to have abnormal ABPM, suggesting a possible therapeutic intervention. ABPM should be used to monitor risk and guide therapy in children with CKD.