Sinha MD, Simpson J, Qureshi SA, et al.
Ambulatory Blood Pressure Management in the Management of Hypertension
in Patients with CKD 3-5.
ASN Annual Meeting -- San Francisco
J Am Soc Nephrol
(Nov) 18:627A 2007

Aim: To study the predictive value of an abnormal 24-hour ABP profile for end
organ damage in patients with CKD stage 3-5.
Methods: Patients
underwent simultaneous casual blood pressure (CBP), ABPM, 2D-guided m-mode
echocardiograph (LVH if LVMI >38g/m2.7) and ECG assessment, measurement of
several biochemical cardiovascular risk markers. CBP data for 18-months prior
to study date was analysed as time averaged z-score.
Results: We
present initial results of a 5-year prospective study. 20 patients (14 male)
aged 12.4y +/-2.9 (mean+/-sd) with cGFR 24.6+/-14.9 ml/min/1.73m2 were
studied. On the day of study all patients bar two (both with systolic
hypertension) had normal CBP. Time averaged BP z-scores over 18-months prior
to study was normal. Of 12 patients with abnormal ABPM 10 had LVH but so did
6 of 8 patients who had LVH but normal ABPM. Overall, 10 (50%) patients had
both abnormal ABPM and LVH. 10 (50%) had other findings: 2 (10%) abnormal
ABPM but no LVH; 2 (10%) normal ABPM and no LVH; 6 (30%) normal ABPM and LVH.
Data were analysed for differences between two groups of patients, with and
without LVH. BP z-scores on the day of study or time averaged BP z-scores,
MAP and pulse pressure over past 18-months were not significantly different
between two groups. There were no significant differences between groups for
ABPM criteria, Hb, Ca*P04 product, iPTH and cGFR.
Conclusions: There
is a high incidence of LVH in paediatric patients with CKD 3-5. This is
primarily but not exclusively secondary to hypertension. We report a new
group of CKD patients with normal CBP and ABPM but LVH. In CKD patients with
LVH causes other than hypertension should be
evaluated.
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