Title

Nocturnal Hypertension in Children With Chronic Kidney Disease Is Common and Associated With Progression to Kidney Replacement Therapy.

Document Type

Article

Publication Date

10-2022

Identifier

DOI: 10.1161/HYPERTENSIONAHA.121.18101

Abstract

BACKGROUND: Nocturnal hypertension is a risk factor for chronic kidney disease (CKD) progression among adults. In children, effects of nocturnal hypertension on CKD progression is less studied.

METHODS: We investigated the relationships between nocturnal, daytime, or sustained hypertension and progression to kidney replacement therapy in children using Cox proportional hazards models. Nocturnal and diurnal hypertension respectively defined as: mean blood pressure >95th percentile and/or load >25% for either systolic or diastolic blood pressure within sleep or wake periods.

RESULTS: One thousand five hundred seventy-seven ambulatory blood pressure monitoring studies from 701 CKiD participants were reviewed. Nighttime, daytime, and both types of hypertension were 19%, 7%, and 33%, respectively. Participants with both daytime and nocturnal hypertension had the highest risk of kidney replacement therapy. Among children with CKD, compared with those who were normotensive, those with isolated nocturnal hypertension had a hazard ratio of 1.49 ([CI, 0.97-2.28];

CONCLUSIONS: The presence of both daytime and nocturnal hypertension is significantly associated with risk of kidney replacement therapy. Our study confirms the utility of ambulatory blood pressure monitoring in children with CKD. Identifying and controlling both daytime and nocturnal hypertension using ambulatory blood pressure monitoring may improve outcomes and delay CKD progression in this population.

Journal Title

Hypertension

Volume

79

Issue

10

First Page

2288

Last Page

2297

MeSH Keywords

Adult; Blood Pressure; Blood Pressure Monitoring, Ambulatory; Child; Humans; Hypertension; Renal Insufficiency, Chronic; Renal Replacement Therapy

Keywords

chronic kidney disease; circadian rhythm; hypertension; pediatrics

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