High Blood Pressure Often Undetected in Kidney Disease Children

According to a study, many children with chronic kidney disease (CKD) are not appropriately treated for high blood pressure (hypertension), which puts them at serious risk of developing heart disease. Researchers found that many children with CKD who show normal blood pressure readings at the doctor's office have high blood pressure when tested at home

High blood pressure increases the risk of developing an enlarged heart, or left ventricular hypertrophy (LVH), which frequently leads to progressive heart disease. Children with CKD who have high blood pressure often develop LVH, yet many children with CKD who have normal blood pressure when taken in the doctor's office also develop the condition. The researchers wondered if these children actually have elevated blood pressure not detected in the clinic.

They analyzed information from approximately 200 children in the Chronic Kidney Disease in Children study, a prospective observational study of children with mild to moderate CKD. Children were asked to wear devices that collect blood pressure readings periodically throughout the day and night. The researchers found that monitoring blood pressure in this way revealed that one third of children with CKD 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 LVH 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 LVH and high blood pressure in children with mild to moderate CKD, said study author Dr. Mark Mitsnefes. "We hope that by recognizing and treating masked hypertension we might reverse LVH and delay or prevent the development of more serious cardiac complications in these children."

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References:
1. Mark Mitsnefes, et al. Masked Hypertension Associates with Left Ventricular Hypertrophy in Children with CKD. Journal of the American Society Nephrology. November 12, 2009, doi 10.1681/ASN.2009060609.