scholarly journals Prognostic Value of Ambulatory Blood Pressure Load in Pediatric CKD

2020 ◽  
Vol 15 (4) ◽  
pp. 493-500
Author(s):  
Jason Lee ◽  
Charles E. McCulloch ◽  
Joseph T. Flynn ◽  
Joshua Samuels ◽  
Bradley A. Warady ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cross Section ◽  
Odds Ratio ◽  
Prognostic Value ◽  
Ventricular Hypertrophy ◽  
Left Ventricular ◽  
Adverse Outcomes ◽  
Cross Sectional ◽  
Pediatric Ckd ◽  
Sectional Analysis

Background and objectivesElevated BP load is part of the criteria for ambulatory hypertension in pediatric but not adult guidelines. Our objectives were to determine the prevalence of isolated BP load elevation and associated risk with adverse outcomes in children with CKD, and to ascertain whether BP load offers risk discrimination independently or in conjunction with mean ambulatory BPs.Design, setting, participants, & measurementsWe studied 533 children in the CKD in Children (CKiD) Study to determine the prevalence of normotension, isolated BP load elevation (≥25% of all readings elevated but mean BP normal), and ambulatory hypertension. We examined the association between these categories of BP control and adverse outcomes (left ventricular hypertrophy [LVH] or ESKD). We used c-statistics to determine risk discrimination for outcomes by BP load used either independently or in conjunction with other BP parameters.ResultsOverall, 23% of the cohort had isolated BP load elevation, but isolated BP load elevation was not statistically significantly associated with LVH in cross-section (odds ratio, 1.8; 95% CI, 0.8 to 4.2) or time to ESKD (hazard ratio, 1.2; 95% CI, 0.7 to 2.0). In unadjusted cross-sectional analysis, every 10% higher systolic BP load was associated with 1.1-times higher odds of LVH (95% CI, 1.0 to 1.3), but discrimination for LVH was poor (c=0.61). In unadjusted longitudinal analysis, every 10% higher systolic BP load was associated with a 1.2-times higher risk of ESKD (95% CI, 1.1 to 1.2), but discrimination for ESKD was also poor (c=0.60). After accounting for mean systolic BP, systolic BP load was not statistically significantly associated with either LVH or ESKD. Findings were similar with diastolic BP load.ConclusionsBP load does not provide additive value in discriminating outcomes when used independently or in conjunction with mean systolic BP in children with CKD.PodcastThis article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2020_03_11_CPOD10130819.mp3

scholarly journals Twenty-Four–Hour Ambulatory Blood Pressure versus Clinic Blood Pressure Measurements and Risk of Adverse Outcomes in Children with CKD

2018 ◽  
Vol 13 (3) ◽  
pp. 422-428 ◽  
Author(s):  
Elaine Ku ◽  
Charles E. McCulloch ◽  
Bradley A. Warady ◽  
Susan L. Furth ◽  
Barbara A. Grimes ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Left Ventricular Hypertrophy ◽  
Confidence Interval ◽  
Ventricular Hypertrophy ◽  
Left Ventricular ◽  
Hazard Ratio ◽  
Adverse Outcomes ◽  
Cross Sectional ◽  
Single Visit ◽  
Unadjusted Analysis

Backgroundand objectives Our objective was to determine whether clinic BPs (taken at either a single visit or two sequential visits) are inferior to ambulatory BPs in their ability to discriminate risk of adverse outcomes in children with CKD.Design, setting, participants, & measurementsWe included 513 participants of the CKD in Children Study who had clinic BPs and 24-hour ambulatory BP monitoring performed during similar timeframes. Predictors of interest were systolic BPs taken at a single visit or two repeated visits within a 1-year period compared with mean wake and sleep systolic ambulatory BPs. Outcomes were left ventricular hypertrophy and ESKD. We determined the ability for each BP parameter to provide risk discrimination using c statistics.ResultsDuring mean follow-up of 3.5 years, 123 participants developed ESKD. In cross-sectional unadjusted analysis, every 0.1 increase in systolic BP index was associated with a 2.0 times higher odds of left ventricular hypertrophy (95% confidence interval, 1.5 to 2.8) by clinic BPs versus 1.8 times higher odds (95% confidence interval, 1.3 to 2.4) by ambulatory wake BP. The c statistic was highest for clinic BP (c=0.65; 95% confidence interval, 0.58 to 0.73) but similar to ambulatory wake BP (c=0.64; 95% confidence interval, 0.57 to 0.71) for the discrimination of left ventricular hypertrophy. In longitudinal unadjusted analysis, every 0.1 increase in systolic BP index was associated with a higher risk of ESKD using repeated clinic (hazard ratio, 1.5; 95% confidence interval, 1.3 to 1.8) versus ambulatory wake BP (hazard ratio, 1.6; 95% confidence interval, 1.3 to 2.0). Unadjusted c statistics were the same for wake (c=0.61; 95% confidence interval, 0.56 to 0.67) and clinic systolic BPs (c=0.61; 95% confidence interval, 0.55 to 0.66) for discriminating risk of ESKD.ConclusionsClinic BPs taken in a protocol-driven setting are not consistently inferior to ambulatory BP in the discrimination of BP-related adverse outcomes in children with CKD.

843 VARIABILITY OF BLOOD PRESSURE AND PROGNOSTIC VALUE OF LEFT VENTRICULAR HYPERTROPHY

2012 ◽  
Vol 30 ◽  
pp. e245-e246
Author(s):  
Carlos Calvo ◽  
Sergio Cinza ◽  
Alvaro Hermida ◽  
Jose Enrique Lopez ◽  
Marta Pena ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Left Ventricular Hypertrophy ◽  
Prognostic Value ◽  
Ventricular Hypertrophy ◽  
Left Ventricular

Abstract 214: Arterial Stiffness in Patients with Metabolic Syndrome: a Cross-Sectional Study in Guayaquil, Ecuador

2016 ◽  
Vol 36 (suppl_1) ◽  
Author(s):  
Carlos A Peñaherrera ◽  
Ruben E Peñaherrera ◽  
Maria C Duarte ◽  
Ernesto Peñaherrera
Keyword(s):  
Blood Pressure ◽  
Metabolic Syndrome ◽  
Arterial Stiffness ◽  
Ventricular Hypertrophy ◽  
Laboratory Data ◽  
Cross Sectional Study ◽  
Left Ventricular ◽  
Sectional Study ◽  
Abdominal Girth ◽  
Cross Sectional

Background: metabolic syndrome (MetS) can chronically affect blood vessels, leading to cardiovascular disease. Techniques that assess arterial rigidity and age such as Arteriograph® can provide insight on blood vessel function. We aimed to evaluate arterial stiffness in patients with MetS. Methodology: cross-sectional study at Luis Vernaza hospital between November and December 2015. We included patients from the Cardiology Department with a full blood panel. We obtained clinical data for age, gender, history of smoking, hypertension, diabetes, and left ventricular hypertrophy, and measured abdominal girth and blood pressure. Using the Arteriograph®, we measured brachial and central augmentation indexes, central blood pressure, pulse wave velocity (PWV) and arterial age. We retrieved values for triglycerides, HDL, and glycemia from laboratory data. We used IDF criteria to diagnose MetS, but ALAD criteria were used to detect increased abdominal girth. A p value of <0.05 accepted for significance. Results: 95 patients were selected for analysis. 42 (44.2%) were female and 53 (55.8%) were male, with mean age of 61.7 years (SD 13.1). 58 (61.1%) of our patients had hypertension, 29 (30.5%) had diabetes, and 33 (34.7%) had ventricular hypertrophy. 47 (49.5%) of our patients had MetS. We found significant differences in arterial measurements in MetS vs. non-MetS patients, with higher values in the former (Table 1). We obtained non-significant results for the relationship between arterial age and MetS (p=0.32), even after adjusting for smoking (p=0.28) or ventricular hypertrophy (p=0.71). We found non-significant correlation between age and PWV (p=0.32), and found MetS to be significantly more common in women (p<0.001). Conclusion: MetS patients have a higher grade of arterial stiffness. Arterial age was not related to MetS, and it was more prevalent in women. Arteriograph® measurements are helpful to improve diagnosis and management of cardiovascular patients.

PROGNOSTIC VALUE OF LEFT VENTRICULAR HYPERTROPHY AND BLOOD PRESSURE VARIABILITY

2011 ◽  
Vol 29 ◽  
pp. e490
Author(s):  
S. Cinza Sanjurgo ◽  
A. Hermida Ameijeiras ◽  
Je López Paz ◽  
M. Pena Seijo ◽  
G. Calvo González ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Left Ventricular Hypertrophy ◽  
Blood Pressure Variability ◽  
Prognostic Value ◽  
Ventricular Hypertrophy ◽  
Left Ventricular

scholarly journals Risk factors for electrocardiographic left ventricular hypertrophy in a young Chinese general population: the Hanzhong adolescent cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yue-Yuan Liao ◽  
Ke Gao ◽  
Bo-Wen Fu ◽  
Lei Yang ◽  
Wen-Jing Zhu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
General Population ◽  
Left Ventricular Hypertrophy ◽  
Ventricular Hypertrophy ◽  
Fasting Glucose ◽  
Left Ventricular ◽  
Cross Sectional ◽  
Female Sex ◽  
Sectional Analysis

Abstract Background Electrocardiographic left ventricular hypertrophy (ECG-LVH) is a common manifestation of preclinical cardiovascular disease. The present study aimed to investigate risk factors for ECG-LVH and its prevalence in a cohort of young Chinese individuals. Methods (1) A total of 1515 participants aged 36–45 years old from our previously established cohort who were followed up in 2017 were included. Cross-sectional analysis was used to examine risk factors for ECG-LVH and its prevalence. (2) A total of 235 participants were recruited from the same cohort in 2013 and were followed up in 2017. Longitudinal analysis was used to determine the predictors of LVH occurrence over the 4-year period. We used multivariable logistic regression models to calculate OR and 95% CIs and to analyze risk factors for ECG-LVH. Results In the cross-sectional analysis, the prevalence of LVH diagnosed by the Cornell voltage-duration product in the overall population and the hypertensive population was 4.6% and 8.8%, respectively. The logistic regression results shown that female sex [2.611 (1.591–4.583)], hypertension [2.638 (1.449–4.803)], systolic blood pressure (SBP) [1.021 (1.007–1.035)], serum uric acid (SUA) [1.004 (1.001–1.006)] and carotid intima-media thickness (CIMT) [67.670 (13.352–342.976)] were significantly associated with the risk of LVH (all P < 0.05). In the longitudinal analysis, fasting glucose [1.377 (1.087–1.754)], SBP [1.046 (1.013–1.080)] and female sex [1.242 (1.069–1.853)] were independent predictors for the occurrence of LVH in the fourth year of follow-up. Conclusions Our study suggested that female sex, hypertension, SBP, SUA and CIMT were significantly associated with the risk of LVH in young people. In addition, fasting glucose, SBP and female sex are independent predictors of the occurrence of LVH in a young Chinese general population.

scholarly journals Cross-sectional association of blood pressure variability and night-time dipping with cardiac structure in adolescents

2020 ◽  
Author(s):  
LJ Goudswaard ◽  
S Harrison ◽  
D Van De Klee ◽  
N Chaturvedi ◽  
DA Lawlor ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Variability ◽  
Left Ventricular ◽  
Internal Diameter ◽  
Cardiac Structure ◽  
Night Time ◽  
Cross Sectional ◽  
The Mean ◽  
Average Real Variability ◽  
Sectional Analysis

AbstractGreater blood pressure variability (BP) and reduced night-time BP dipping are associated with cardiovascular disease independently of mean BP in adults. This study examines whether these associations are apparent in adolescents. A cross-sectional analysis was undertaken in 587 UK adolescents. We examined associations between measures of blood pressure dipping and variability (including standard deviation weighted for day/night (SDdn), average real variability (ARV) and variability independent of the mean (VIM)) with cardiac structure measures assessed by echocardiography: (1) left ventricular mass indexed to height2.7 (LVMi2.7), (2) relative wall thickness (RWT), (3) left atrial diameter indexed to height (LADi), and (4) left ventricular internal diameter in diastole (LVIDD)). Greater BP variability was associated with cardiac structures including higher RWT, which persisted after adjustment for mean BP. There was no evidence for an association between night-time dipping and cardiac structures. Measurement of BP variability might benefit cardiovascular risk assessment in adolescents.

scholarly journals Blood pressure variability and night-time dipping assessed by 24-hour ambulatory monitoring: Cross-sectional association with cardiac structure in adolescents

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0253196
Author(s):  
Lucy J. Goudswaard ◽  
Sean Harrison ◽  
Daniel Van De Klee ◽  
Nishi Chaturvedi ◽  
Debbie A. Lawlor ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ambulatory Monitoring ◽  
Left Ventricular ◽  
Internal Diameter ◽  
Cardiac Structure ◽  
Night Time ◽  
Cross Sectional ◽  
Average Real Variability ◽  
Sectional Analysis ◽  
Structure Measurement

Greater blood pressure (BP) is associated with greater left ventricular mass indexed to height2.7 (LVMi2.7) in adolescents. This study examined whether greater BP variability and reduced night-time dipping are associated with cardiac remodeling in a general population of adolescents. A cross-sectional analysis was undertaken in 587 UK adolescents (mean age 17.7 years; 43.1% male). BP was measured in a research clinic and using 24-hour ambulatory monitoring. We examined associations (for both systolic and diastolic BP) of: 1) clinic and 24-hour mean BP; 2) measures of 24-hour BP variability: standard deviation weighted for day/night (SDdn), variability independent of the mean (VIM) and average real variability (ARV); and 3) night-time dipping with cardiac structures. Cardiac structures were assessed by echocardiography: 1) LVMi2.7; 2) relative wall thickness (RWT); 3) left atrial diameter indexed to height (LADi) and 4) left ventricular internal diameter in diastole (LVIDD). Higher systolic BP was associated with greater LVMi2.7. Systolic and diastolic BP were associated with greater RWT. Associations were inconsistent for LADi and LVIDD. There was evidence for associations between both greater SDdn and ARV and higher RWT (per 1 SD higher diastolic ARV, mean difference in RWT was 0.13 SDs, 95% CI 0.045 to 0.21); these associations with RWT remained after adjustment for mean BP. There was no consistent evidence of associations between night-time dipping and cardiac structure. Measurement of BP variability, even in adolescents with blood pressure in the physiologic range, might benefit risk of cardiovascular remodeling assessment.

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