Longitudinal Trends in 24-hour Ambulatory Blood Pressure Monitoring in Pediatric Patients with Chronic Kidney Disease
2023
Hochschulschrift
Zugriff:
Background: Ambulatory blood pressure monitoring (ABPM) is the gold standard for diagnosis and monitoring of hypertension (HTN) in children and young adults with chronic kidney disease (CKD). Data on longitudinal ambulatory blood pressure (ABP) trends in this population are limited. Methods: Retrospective review of the children and young adults who received CKD care at Cincinnati Children’s Hospital Medical Center (CCHMC) from 1/2014 to 12/2021 to evaluate longitudinal trends in use of and assessment of blood pressure control by ABPM. Univariate analysis was performed to describe the population at time of each ABPM procedure and to identify interval change in pertinent patient and clinical characteristics. Generalized linear mixed modeling (GLMM) assuming binomial distribution and logit link was performed to identify factors associated with worsening ABP control. Results: Over the study period, 302 ABPM studies were completed among 122 unique CKD patients (59% male; mean age 12.7 years at first ABPM; 85.2% non-black; 17% glomerular disease, 54% non-glomerular disease, 29% secondary/other cause of CKD; mean CKID U25 eGFR 69.2mL/min/1.73m2). Half of the population was prescribed antihypertensive medications at the time of the first ABPM. Median time between studies was 23.9 months. More CKD patients had normal blood pressure classification by ABPM over time (46.7%, 61.5%, and 61.7% at first, second, and third ABP study, respectively; p = 0.043). A univariate analysis revealed a significant increase in the number of patients prescribed an antihypertensive agent (50.8%, 66.4, and 78.7% at the time of the first, second, and third ABP study, respectively; p = 0.001), with more patients being prescribed ACEi/ARB therapy (41%, 54.9%, and 63.8% at the time of the first, second, and third ABP study; p = 0.013) and beta blockers (4.1%, 7.3%, and 17% prescribed beta blockers at the first, second, and third ABP study; p = 0.017). GLMM identified increasing number of prescribed antihypertensive agents (estimate = 0.335, p = 0.047) as a risk factor for uncontrolled blood pressure whereas non-black race (estimate = -0.997, p = 0.009) and ACEi or ARB therapy (estimate = -1.067, p = 0.0007) were found to be associated with improved blood pressure control at the time of the repeat ABPM. This GLMM provided acceptable discriminatory ability with an AUC of 0.734.Conclusions: Use of ABPM results in improved blood pressure control over time in pediatric CKD patients. Factors associated with improved ABP status include non-black race and the use of ACEi/ARB therapy.
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Longitudinal Trends in 24-hour Ambulatory Blood Pressure Monitoring in Pediatric Patients with Chronic Kidney Disease
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Autor/in / Beteiligte Person: | Besser, Victoria |
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Veröffentlichung: | 2023 |
Medientyp: | Hochschulschrift |
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