HDCN Abstract:  ASN Annual Meeting -- San Francisco  

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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