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BP Load No Aid to Prognosis in Pediatric Chronic Kidney Disease

But high average blood pressure on 24-hour test strongly predicts child's cardiac, kidney disease risk

FRIDAY, March 27, 2020 (HealthDay News) -- Blood pressure (BP) load does not provide additive value in predicting outcomes in children with chronic kidney disease (CKD), according to a study published online March 11 in the Clinical Journal of the American Society of Nephrology.

Jason Lee, M.D., from University of California in San Francisco, and colleagues used data from 533 children participating in the Chronic Kidney Disease in Children Study to determine the prevalence of normotension, isolated BP load elevation (≥25 percent of all readings elevated, but mean BP normal), and ambulatory hypertension.

The researchers found that 23 percent of the cohort had isolated BP load elevation, but isolated BP load elevation was not significantly associated with left ventricular hypertrophy (LVH; odds ratio, 1.8; 95 percent confidence interval [CI], 0.8 to 4.2) or end-stage kidney disease (ESKD; hazard ratio, 1.2; 95 percent CI, 0.7 to 2.0). Every 10 percent increase in systolic BP load was associated with higher odds of LVH (odds ratio, 1.1; 95 percent CI, 1.0 to 1.3), but discrimination for LVH was poor. Every 10 percent increase in systolic BP load was associated with a 1.2-fold higher risk for ESKD (95 percent CI, 1.1 to 1.2), but discrimination for ESKD was also poor. Systolic BP load was not statistically significantly associated with either LVH or ESKD when adjusting for mean systolic BP. For diastolic BP load, findings were similar.

"Our data suggest that the proportion of readings on a 24-hour blood pressure test that are high may not provide additional insight beyond the average blood pressure values surrounding a child's risk for developing cardiac disease or worsening kidney disease," Lee said in a statement. "However, having a high average blood pressure on a 24-hour blood pressure test does strongly predict a child's cardiac and kidney disease risk."

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