ESPN 50th Annual Meeting

ESPN 2017


 
ACCURACY OF CASUAL CLINIC BLOOD PRESSURE MEASUREMENT AS A DIAGNOSTIC TEST FOR BLOOD HYPERTENSION IN CHILDREN WITH CHRONIC KIDNEY DISEASES
MARINA AKSENOVA 1 NATALYA KONKOVA 1 TATJANA LEPAEVA 1 TATJANA KYRGANOVA 1 VLADIMIR DLIN 1

1- SCIENTIFIC RESEARCH CLINICAL INSTITUTE OF PEDIATRICS, N.I.PIROGOV’ NATIONAL RUSSIAN MEDICAL UNIVERSITY OF MOSCOW
 
Introduction:

 The ambulatory blood pressure monitoring (ABPM) is not obligatory test for diagnosis of blood hypertension (BH) in children with chronic kidney diseases (CKD). But it know that about 1/3 of children with CKD has masked hypertension which associates with left ventricular hypertrophy. The aim was to determine the accuracy of casual clinic blood pressure measurement (CBPM) for diagnosis of blood pressure hypertension in children with CKD.

Material and methods:

 Demographic, clinical, laboratory date including CBPM and ABPM were obtained in 359 children with CKD (mean age 12,68±3,13 years; F/M=1,03; mean eGFR=84,18±29,6 ml/min/1,73m2). Normal casual blood pressure (BP) defined as systolic blood pressure (SBP) and diastolic blood pressure (DBP)<90th percentile for gender, age, height. Ambulatory BH was defiened as mean wake and/or sleep SBP and/or DBP levels   ≥ 95th percentile for gender, age, height. White coat hypertension (WCH) was defined as casual clinic SBP and/or DBP  ≥95th percentile for gender, age and height but mean wake and sleep SBP and DBP <95th percentile for gender, age and height. Masked hypertension (MH) was defined as normal casual clinic SBP and DBP and mean wake and/or sleep SBP and/or DBP≥ 95th percentile for gender, age and height. 

Results:

 BH was revealed in 100 pts (q=0,28) and in 199 pts (q=0,55) by CBPM and  ABMP,  respectively.  The 18 children (q=0,05) had WCH; 99 pts (q=0,27) had MH. The most pts with MH (n=56; q=0,57) had isolate sleep systolic and/or diastolic BH;  4 pts (q=0,04) had isolate wake systolic BH; whole day systolic and diastolic BH was diagnosed in 8 (q=0,08) and 10 (q=0,1) children, respectively; whole day systolic-diastolic BH was detected in 21 pts (q=0,21).  Ambulatory BH was revealed in about 1/5 of children with normal casual BP and  in more than 2/5 of pts with casual  BP=90-95‰ (tabl.1).  There was high incidence of overdiagnosis of BH by CBPM. The sensitivity/specificity of CBPM for the diagnosis of ambulatory systolic and diastolic BH were 0,6/0,82  and 0,5/0,78, respectively with positive predict value 0,5 for systolic BH and 0,42 for diastolic BH.

Table 1. Prevalence of systolic and diastolic ambulatory blood pressure hypertension by casual clinic blood pressure  (CBP) percentile

 

CBP<90

90≤CBP<95

CBP95

Systolic wake BH

0,10

0,25

0,5

Systolic sleep BH

0,26

0,45

0,6

Diastolic wake BH

0,11

0,55

0,44

Diastolic sleep BH

0,21

0,41

0,89

Conclusions:

 The sensitivity/specificity of CBPM for the diagnosis ambulatory BH is suboptimal. We believe that CBPM is not considered adequate for use as single diagnostic test for hypertension in children with CKD.