Many children with chronic kidney disease who show normal blood pressure readings at the doctor’s office have high blood pressure when tested at home, according to a study appearing in an upcoming issue of the Journal of the American Society Nephrology (JASN). The findings indicate that many chronic kidney disease children are not appropriately treated for hypertension, which puts them at serious risk of developing heart disease.
Hypertension increases the risk of developing an enlarged heart, or left ventricular hypertrophy, which frequently leads to progressive heart disease. Children with chronic kidney disease who have hypertension often develop left ventricular hypertrophy, yet many children with chronic kidney disease who have normal blood pressure when taken in the doctor’s office also develop the condition. Mark Mitsnefes, MD, Kidney Clinic, Cincinnati Children’s Hospital Medical Center, and his colleagues wondered if these children actually have elevated blood pressure not detected in the clinic.
The researchers analyzed information from approximately 200 children in the Chronic Kidney Disease in Children (CKiD) study, a prospective observational study of children with mild to moderate chronic kidney disease. Children were asked to wear devices that collect blood pressure readings periodically throughout the day and night. Mitsnefes and his team found that monitoring blood pressure in this way revealed that one third of children with chronic kidney disease who had normal blood pressure readings in the doctor’s office actually had elevated blood pressure (called masked hypertension). Some of these children were not taking any blood pressure medications, meaning they had unrecognized hypertension, while some were being treated with low doses of antihypertensive medications, meaning they had undertreated hypertension. More importantly, children with masked hypertension were four times as likely to have left ventricular hypertrophy as children with normal blood pressure.
These results support the case for early heart tests and ongoing blood pressure readings outside the clinic as a part of standard care to screen for left ventricular hypertrophy and hypertension in children with mild to moderate chronic kidney disease, said Mitsnefes. "We hope that by recognizing and treating masked hypertension we might reverse left ventricular hypertrophyand delay or prevent the development of more serious cardiac complications in these children.”
The authors report no financial disclosures. Joseph Flynn, MD at Seattle Children’s Hospital, Silvia Cohn, MS at Johns Hopkins University School of Public Health, Joshua Samuels, MD at The University of Texas, Thomas Blydt-Hansen, MD at the Health Sciences Center, Winnipeg, Canada, Jeffrey Saland, MD at The Mount Sinai School of Medicine), Thomas Kimball, MD at Cincinnati Children’s Hospital Medical Center, Susan Furth, MD, PhD at Johns Hopkins University School of Medicine, and Bradley Warady, MD at the University of Missouri-Kansas City School of Medicine, for the CKiD Study Group.
The article, entitled "Masked Hypertension and Associated Left Ventricular Hypertrophy in Children with CKD,” will appear online at http://jasn.asnjournals.org/ on November 12, 2009.
The American Society of Nephrology (ASN) does not offer medical advice. All content in ASN publications is for informational purposes only, and is not intended to cover all possible uses, directions, precautions, drug interactions, or adverse effects. This content should not be used during a medical emergency or for the diagnosis or treatment of any medical condition. Please consult your doctor or other qualified health care provider if you have any questions about a medical condition, or before taking any drug, changing your diet or commencing or discontinuing any course of treatment. Do not ignore or delay obtaining professional medical advice because of information accessed through ASN. Call 911 or your doctor for all medical emergencies.
Founded in 1966, the American Society of Nephrology (ASN) is the world’s largest professional society devoted to the study of kidney disease. Comprised of 11,000 physicians and scientists, ASN continues to promote expert patient care, to advance medical research, and to educate the renal community. ASN also informs policymakers about issues of importance to kidney doctors and their patients. ASN funds research, and through its world-renowned meetings and first-class publications, disseminates information and educational tools that empower physicians.