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24-hour blood pressure monitoring in children with chronic renal insufficiency
202A
POSTERS: Pediatric Hypertension
P-468 RACIAL DIFFERENCES IN SODIUM INTAKE DURING THE EVALUATION OF BLOOD PRESSUE AND TARGET ORGAN CHANGES IN YOUTH Gregory A. Harshfield, Frank A. Treiber, Caroline Dekkers, Gaston Kapuku. Pediatrics, Medical College of Georgia, Augusta, Georgia, United States. Objective: Essential hypertension is becoming more prevalent in the pediatric population. Sodium intake has been related to blood pressure levels, particularly in African-Americans. The purpose of this study was to determine the relationship of sodium intake to resting blood pressure (BP) and BP’s during a series of medical evaluations in normotensive youths and relate these to target organ change to the heart as determined by left ventricular mass/height 2.7. Methods: The 108 subjects included 61 African-Americans and 47 European-Americans (mean age ⫽ 19 yrs) who are participants in an ongoing study of cardiovascular risk factors in youth. Pre-test sodium intake was estimated from sodium excretion (UNaV). Following the initial collection, the subjects underwent a series of evaluations, including resting BP measurements, an echocardiogram, dual x-ray absorptiometry, the assessment of endothelium dependent vasodilation to reactive hyperemia, and a psychosocial/lifestyle questionnaire battery. A post-test UNaV was then obtained. Results: African-Americans and European-Americans had similar levels of pre- and post-test UNaV, resting BP, and both average level and change in UNaV and BP’s across the series of evaluations. In AfricanAmericans, pre-test UNaV was related to resting systolic BP (r ⫽ 0.30; P⬍ 0.02) which was in turn related to left ventricular mass/ height2.7(r ⫽ 0.47; P⬍0.001). Pre-test UNaV was also related to resting diastolic (r⫽0.33; P⬍0.01) BP, the average level of diastolic BP across the series of evaluations (r⫽0.33; P⬍0.05), and the difference in diastolic BP from the initial reading to the final reading (r⫽0.418; P⬍0.008) in AfricanAmericans. Resting diastolic BP was inversely correlated with the change in UNaV across the testing period (r⫽-0.32; P⬍0.01). In contrast, measures of UNaV were not related to any measure of BP in EuropeanAmericans. Conclusion: Reducing sodium intake will have a beneficial impact on BP and BP related target organ changes in African-American youth. Key Words: Blood Pressure, Sodium Intake, Pediatric
P-469 CHILDHOOD BLOOD PRESSURE PREDICTS ADULT MICROALBUMINURIA IN BLACKS BUT NOT IN WHITES-THE BOGALUSA HEART STUDY Sheikh M. Hoq, Wei Chen, Sathanur R. Srinivasan, Gerald S. Berenson. Tulane Center for Cardiovascular Health, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States. Microalbuminuria is considered an important indicator for cardiovascular and renal disease and is related to cardiovascular mortality for both type 2 diabetes and essential hypertension. However, it remains uncertain whether childhood blood pressure levels predict microalbuminuria in adulthood . This study examined 2122 (32% black, 57% female) as children, aged 5 to 17 years, and as adults, aged 20 to 37 years, with an average follow-up period of 16 years. Microalbuminuria is defined as urinary albumin excretion between 30 and 300 mg/day and urinary albumin/ creatinine ratio of 3 to 30 mg/mmol. As noted earlier black boys had higher blood pressure levels than the white boys. As adults systolic and diastolic blood pressure, urine albumin excretion and the albumin/ creatinine ratio were significantly greater in blacks than in whites. In blacks, but not in whites, childhood blood pressure levels were signifi0895-7061/02/$22.00
AJH–April 2002–VOL. 15, NO. 4, PART 2
cantly higher in those with microalbuminuria. This association persisted into adulthood. Multivariate regression analysis, adjusting for childhood BMI, age and sex showed that childhood blood pressure and rate of change in blood pressure from childhood to adulthood are significant predictors of urine albumin excretion and a greater albumin/creatinine ratio in blacks, but not in whites. The finding that elevated blood pressure beginning in childhood is associated with microalbuminuria in adult life in blacks supports the notion that blacks may be more susceptible than whites to hemodynamics related renal damage. A better understanding of the relationship between childhood blood pressure and urine albumin excretion is critically important for primary prevention of hypertension and ultimate renal damage. Key Words: Microalbuminuria, Blood Pressure, Black-White
P-470 24-HOUR BLOOD PRESSURE MONITORING IN CHILDREN WITH CHRONIC RENAL INSUFFICIENCY Mark M. Mitsnefes, Stephen R. Daniels. Division of Nephrology and Hypertension; Division of Cardiology, Children’s Hospital Research Foundation, Cincinnati, OH, United States. Hypertension is a frequent complication in children with chronic renal insufficiency (CRI). To better assess hypertension in pediatric patients with CRI we performed 24-hour ambulatory blood pressure monitoring (ABPM) in 19 children, mean age 12.7⫾4.6 years. BP was measured every 20 minutes during the day and every 30 minutes at night. The median observation time was 24 hours, the mean number of reading was 54⫾15, and the mean percentage of successful reading was 82⫾16%. In addition, we evaluated the relationship between ABPM parameters and left ventricular hypertrophy (LVH), the marker of hypertensive endorgan injury. Hypertension was defined as 1) systolic BP (SBP) or diastolic BP (DBP) ⬎95% for age, sex and height and 2) 24-hour SBP load ⬎ 35% or 24-hour DBP load ⬎ 25%. LVH was defined as left ventricular mass (LVM) index ⬎ 95% for age and sex. Nine (47%) patients were taking angiotensin converting enzyme inhibitors (ACEI). SBP or DBP ⬎95% for age, sex and height were found in 5 (26%) patients by either casual BP or ABPM. Mean 24-hour SBP load was 36.1⫾28.2% and mean 24-hour DBP load was 26.8⫾22.8%. SBP mean 24-hour, daytime and nighttime load ⬎35% was demonstrated in 8 (42%), 11 (58%) and 9 (47%) patients respectively. DBP mean 24-hour, daytime and nighttime load ⬎25% was seen in 8 (42%), 9 (47%) and 6 (32%) patients respectively. Mean dipping was 7.9⫾7.8% for SBP and 12.3⫾9.4% for DBP. Nondipping pattern was found in 10 (53%) patients for SBP and in 5 (26%) patients for DBP. Three children had higher sleep SBP and DBP than awake BP. Lower SBP dipping was associated with lower glomerular filtration rate (r⫽0.44, p⫽0.05). LVH was found in 6 (32%) patients. There was no significant relationship between ABPM data and LVM but children with higher mean 24-hour SBP had a tendency to have higher LVM index (r⫽0.40, p⫽0.06). No significant difference in ABPM data and LV indexes were found between children on ACEI and without BP medications. These results confirm the high prevalence of hypertension using ABPM criteria in children with CRI. Worse CRI is associated with less of nighttime decline in blood pressure. A higher mean 24-hour SBP may be associated with increased LVM. Key Words: Ambulatory Blood Pressure Monitoring, Children, Chronic Renal Insufficiency © 2002 by the American Journal of Hypertension, Ltd. Published by Elsevier Science Inc.
POSTERS: Pediatric Hypertension
P-468 RACIAL DIFFERENCES IN SODIUM INTAKE DURING THE EVALUATION OF BLOOD PRESSUE AND TARGET ORGAN CHANGES IN YOUTH Gregory A. Harshfield, Frank A. Treiber, Caroline Dekkers, Gaston Kapuku. Pediatrics, Medical College of Georgia, Augusta, Georgia, United States. Objective: Essential hypertension is becoming more prevalent in the pediatric population. Sodium intake has been related to blood pressure levels, particularly in African-Americans. The purpose of this study was to determine the relationship of sodium intake to resting blood pressure (BP) and BP’s during a series of medical evaluations in normotensive youths and relate these to target organ change to the heart as determined by left ventricular mass/height 2.7. Methods: The 108 subjects included 61 African-Americans and 47 European-Americans (mean age ⫽ 19 yrs) who are participants in an ongoing study of cardiovascular risk factors in youth. Pre-test sodium intake was estimated from sodium excretion (UNaV). Following the initial collection, the subjects underwent a series of evaluations, including resting BP measurements, an echocardiogram, dual x-ray absorptiometry, the assessment of endothelium dependent vasodilation to reactive hyperemia, and a psychosocial/lifestyle questionnaire battery. A post-test UNaV was then obtained. Results: African-Americans and European-Americans had similar levels of pre- and post-test UNaV, resting BP, and both average level and change in UNaV and BP’s across the series of evaluations. In AfricanAmericans, pre-test UNaV was related to resting systolic BP (r ⫽ 0.30; P⬍ 0.02) which was in turn related to left ventricular mass/ height2.7(r ⫽ 0.47; P⬍0.001). Pre-test UNaV was also related to resting diastolic (r⫽0.33; P⬍0.01) BP, the average level of diastolic BP across the series of evaluations (r⫽0.33; P⬍0.05), and the difference in diastolic BP from the initial reading to the final reading (r⫽0.418; P⬍0.008) in AfricanAmericans. Resting diastolic BP was inversely correlated with the change in UNaV across the testing period (r⫽-0.32; P⬍0.01). In contrast, measures of UNaV were not related to any measure of BP in EuropeanAmericans. Conclusion: Reducing sodium intake will have a beneficial impact on BP and BP related target organ changes in African-American youth. Key Words: Blood Pressure, Sodium Intake, Pediatric
P-469 CHILDHOOD BLOOD PRESSURE PREDICTS ADULT MICROALBUMINURIA IN BLACKS BUT NOT IN WHITES-THE BOGALUSA HEART STUDY Sheikh M. Hoq, Wei Chen, Sathanur R. Srinivasan, Gerald S. Berenson. Tulane Center for Cardiovascular Health, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States. Microalbuminuria is considered an important indicator for cardiovascular and renal disease and is related to cardiovascular mortality for both type 2 diabetes and essential hypertension. However, it remains uncertain whether childhood blood pressure levels predict microalbuminuria in adulthood . This study examined 2122 (32% black, 57% female) as children, aged 5 to 17 years, and as adults, aged 20 to 37 years, with an average follow-up period of 16 years. Microalbuminuria is defined as urinary albumin excretion between 30 and 300 mg/day and urinary albumin/ creatinine ratio of 3 to 30 mg/mmol. As noted earlier black boys had higher blood pressure levels than the white boys. As adults systolic and diastolic blood pressure, urine albumin excretion and the albumin/ creatinine ratio were significantly greater in blacks than in whites. In blacks, but not in whites, childhood blood pressure levels were signifi0895-7061/02/$22.00
AJH–April 2002–VOL. 15, NO. 4, PART 2
cantly higher in those with microalbuminuria. This association persisted into adulthood. Multivariate regression analysis, adjusting for childhood BMI, age and sex showed that childhood blood pressure and rate of change in blood pressure from childhood to adulthood are significant predictors of urine albumin excretion and a greater albumin/creatinine ratio in blacks, but not in whites. The finding that elevated blood pressure beginning in childhood is associated with microalbuminuria in adult life in blacks supports the notion that blacks may be more susceptible than whites to hemodynamics related renal damage. A better understanding of the relationship between childhood blood pressure and urine albumin excretion is critically important for primary prevention of hypertension and ultimate renal damage. Key Words: Microalbuminuria, Blood Pressure, Black-White
P-470 24-HOUR BLOOD PRESSURE MONITORING IN CHILDREN WITH CHRONIC RENAL INSUFFICIENCY Mark M. Mitsnefes, Stephen R. Daniels. Division of Nephrology and Hypertension; Division of Cardiology, Children’s Hospital Research Foundation, Cincinnati, OH, United States. Hypertension is a frequent complication in children with chronic renal insufficiency (CRI). To better assess hypertension in pediatric patients with CRI we performed 24-hour ambulatory blood pressure monitoring (ABPM) in 19 children, mean age 12.7⫾4.6 years. BP was measured every 20 minutes during the day and every 30 minutes at night. The median observation time was 24 hours, the mean number of reading was 54⫾15, and the mean percentage of successful reading was 82⫾16%. In addition, we evaluated the relationship between ABPM parameters and left ventricular hypertrophy (LVH), the marker of hypertensive endorgan injury. Hypertension was defined as 1) systolic BP (SBP) or diastolic BP (DBP) ⬎95% for age, sex and height and 2) 24-hour SBP load ⬎ 35% or 24-hour DBP load ⬎ 25%. LVH was defined as left ventricular mass (LVM) index ⬎ 95% for age and sex. Nine (47%) patients were taking angiotensin converting enzyme inhibitors (ACEI). SBP or DBP ⬎95% for age, sex and height were found in 5 (26%) patients by either casual BP or ABPM. Mean 24-hour SBP load was 36.1⫾28.2% and mean 24-hour DBP load was 26.8⫾22.8%. SBP mean 24-hour, daytime and nighttime load ⬎35% was demonstrated in 8 (42%), 11 (58%) and 9 (47%) patients respectively. DBP mean 24-hour, daytime and nighttime load ⬎25% was seen in 8 (42%), 9 (47%) and 6 (32%) patients respectively. Mean dipping was 7.9⫾7.8% for SBP and 12.3⫾9.4% for DBP. Nondipping pattern was found in 10 (53%) patients for SBP and in 5 (26%) patients for DBP. Three children had higher sleep SBP and DBP than awake BP. Lower SBP dipping was associated with lower glomerular filtration rate (r⫽0.44, p⫽0.05). LVH was found in 6 (32%) patients. There was no significant relationship between ABPM data and LVM but children with higher mean 24-hour SBP had a tendency to have higher LVM index (r⫽0.40, p⫽0.06). No significant difference in ABPM data and LV indexes were found between children on ACEI and without BP medications. These results confirm the high prevalence of hypertension using ABPM criteria in children with CRI. Worse CRI is associated with less of nighttime decline in blood pressure. A higher mean 24-hour SBP may be associated with increased LVM. Key Words: Ambulatory Blood Pressure Monitoring, Children, Chronic Renal Insufficiency © 2002 by the American Journal of Hypertension, Ltd. Published by Elsevier Science Inc.