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Masked Hypertension Associates with Left Ventricular Hypertrophy in Children with CKD

Mark Mitsnefes^*, Joseph Flynn, Silvia Cohn, Joshua Samuels, Tom Blydt-Hansen^||, Jeffrey Saland^¶, Thomas Kimball^*, Susan Furth^**, Bradley Warady and for the CKiD Study Group

*Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio;
Division of Nephrology, Seattle Children's Hospital, Seattle, Washington;
Johns Hopkins University School of Public Health, Baltimore, Maryland;
Department of Pediatrics, University of Texas, Houston, Texas;
^||Department of Pediatrics, Health Sciences Center, Winnipeg, Manitoba, Canada,
^¶Department of Pediatrics, Mount Sinai School of Medicine, New York, New York;
**Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
Division of Nephrology, Children's Mercy Hospital, Kansas City, Missouri

Correspondence: Dr. Mark Mitsnefes, Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, MLC: 7022, 3333 Burnet Avenue, Cincinnati, OH 45229-3039. Phone: 513-636-4531; Fax: 513-636-7407; E-mail: mark.mitsnefes{at}cchmc.org

Received for publication June 11, 2009. Accepted for publication August 25, 2009.

Left ventricular hypertrophy (LVH) associates with increased risk for cardiovascular disease. Hypertension leads to LVH in adults, but its role in the pathogenesis of LVH in children is not as well established. To examine left ventricular mass and evaluate factors associated with LVH in children with stages 2 through 4 chronic kidney disease (CKD), we analyzed cross-sectional data from children who had baseline echocardiography (n = 366) and underwent ambulatory BP monitoring (n = 226) as a part of the observational Chronic Kidney Disease in Children (CKiD) cohort study. At baseline, 17% of children had LVH (11% eccentric and 6% concentric) and 9% had concentric remodeling of the left ventricle. On the basis of a combination of ambulatory and casual BP assessment (n = 198), 38% of children had masked hypertension (normal casual but elevated ambulatory BP) and 18% had confirmed hypertension (both elevated casual and ambulatory BP). There was no significant association between LVH and kidney function. LVH was more common in children with either confirmed (34%) or masked (20%) hypertension compared with children with normal casual and ambulatory BP (8%). In multivariable analysis, masked (odds ratio 4.1) and confirmed (odds ratio 4.3) hypertension were the strongest independent predictors of LVH. In conclusion, casual BP measurements alone are insufficient to predict the presence of LVH in children with CKD. The high prevalence of masked hypertension and its association with LVH supports early echocardiography and ambulatory BP monitoring to evaluate cardiovascular risk in children with CKD.

Copyright © 2009 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673