[Office and 24-Hour Ambulatory Blood Pressure Measurements in Hypertension Assessment in Children with Chronic Kidney Disease].

Introduction:Hypertension (HT) isone of the major risk factors of chronickidney disease (CKD) progression andcardiovascular complications.The aim of the study was to analyzeblood pressure (BP) values and assessthe usefulness of clinical measurementsin BP monitoring in childrenwith chronic kidney disease.Material and methods:The studywas conducted in 62 children (40boys and 22 girls) aged 4,2-18,6 years(median age 12.4 (9.1; 16.0) with CKDstages 1 + 2 (n = 9), 3 (n = 17), 4 (n = 15)and 5. Creatinine concentration wasmeasured and glomerular filtration ratewas calculated using the Schwartz formula.Each of the patients underwentclinical BP measurements and 24-hourambulatory blood pressure monitoring(ABPM).Results:Based on clinical meaurementselevated BP values were foundin 25 patients (40.3%): in stages 1 + 2in 33.3%, in stage 3 in 41.2%, in stage4 in 46.6% and in stage 5 in 38.1% patients.Hypertension was diagnosedwith ABPM in 30 patients (48.4% of thestudied population): in stages 1 + 2 - 3patients (33.3%), in stage 3 - 8 patients(47, 1%), in stage 4 - 7 patients (46.7%)and stage 5 - 12 patients (57.1%). Only12 patients (19.4%) had hypertensiondiagnosed in both clinical and ABPMmeasurements. White coat effectwas found in 13 children (21.0%) andmasked HT in 18 children (29.0%). In24-hour BP monitoring the highestvalues of systolic, diastolic and meanBP values were found in children withmasked HT. In children with maskedHT higher values of 24-hour systolic(120 vs. 105.5 mmHg, p<0.001) anddiastolic (75 vs. 65 mmHg, p<0.001)BP compared with clinical values weredetected. Children with masked HT hadsignificantly higher nighttime diastolicBP compared with children with HT(1.43 vs. 0.74 z-score, p<0.001).Conclusions:The large percentageof children with masked hypertensionis an indication for frequent ABPMmeasurements in children with chronickidney diseses. Office measurements are not sufficient todetect HT in children with CKD. The best diagnostic methodto confirm and monitor hypertension in patients with CKDis 24-hour ambulatory blood pressure monitoring.