NEW YORK (Reuters Health) - Children with chronic kidney disease have a high prevalence of masked hypertension, often in association with left ventricular hypertrophy (LVH), research findings indicate.
Therefore, these children should have early echocardiography and ambulatory blood pressure monitoring to evaluate their cardiovascular risk, the investigators advise.
As they report online in the Journal of the American Society of Nephrology, Dr. Mark Mitsnefes, from Cincinnati Children's Hospital, Ohio, and co-authors analyzed 366 pediatric kidney disease patients with baseline echocardiography results, 266 of whom also underwent ambulatory blood pressure monitoring.
Overall, 38% had masked systolic or diastolic hypertension, and another 18% had confirmed hypertension. Nearly a third of those with masked hypertension, and 15% of children with confirmed hypertension, were not being treated for it.
Furthermore, "masked hypertension was found in treated children who had hypertension and in whom blood pressure was thought to be well controlled on the basis of office measurements," the authors report.
LVH was present in 8% of children with normal blood pressure, 34% of children with confirmed hypertension (p < 0.003), and 20% of children with masked hypertension (p = 0.039). Children treated with ACE inhibitors or angiotensin receptor blockers were less likely to have LVH than those treated with other classes of antihypertensive agents.
On multivariate analysis, odds ratios for LVH were 4.1 with masked hypertension and 4.3 with confirmed hypertension.
"Casual blood pressure measurements alone are insufficient to predict the presence of LVH in children with chronic kidney disease," the researchers conclude. "The high prevalence of masked hypertension...supports early echocardiography and ambulatory blood pressure monitoring...in children with chronic kidney disease."
Home BP monitoring, they add, could be "an intermediate step and a lower cost alternative" to ambulatory monitoring.
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