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Visit-to-visit blood pressure variability in children and adolescents with renal disease

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Abstract

Background

Increase in blood pressure (BP) variability (BPV) is associated with cardiovascular events, target organ damage, and arterial stiffness in adults. We previously reported that 24-h BPV may be associated with arterial stiffness and underlie white-coat hypertension (WCH). In this study, we examined whether visit-to-visit variability (VVV) could predict WCH and whether VVV correlated with eGFR, eGFR slope, and albuminuria/proteinuria in children and adolescents with renal diseases.

Methods

VVV was determined as average real variability of office BP measurements between visits, and 24-h BPV as the standard deviation of 24-h ambulatory BP. In 35 renal patients (25 boys and 10 girls, 7–18 years of age), divided into normotension (NT), WCH, and hypertension (HTN), the relationships between VVV and 24-h BPV and VVV in each BP category were studied. In separate 48 renal patients (24 boys and 24 girls, 2–18 years of age), the correlation between VVV and eGFR, eGFR slope, urine albumin or protein excretion was examined.

Results

Systolic VVV was significantly correlated with systolic office BP index. There was no correlation between VVV and 24-h BPV or 24-h pulse pressure. In addition, VVV was not different among NT, WCH, and HTN. Systolic VVV was significantly negatively correlated with eGFR but not with eGFR slope, albuminuria, or proteinuria. A cut-off value of systolic VVV for detecting eGFR < 60 ml/min per 1.73 m2 was 8.5.

Conclusion

VVV could not predict WCH. Systolic VVV correlated with eGFR but not with eGFR slope, albuminuria/proteinuria. Increased VVV could be a marker of decreased eGFR.

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Abbreviations

ABP:

Ambulatory blood pressure

ARV:

Average real variability

ABPM:

Ambulatory blood pressure monitoring

BP:

Blood pressure

BPV:

Blood pressure variability

HTN:

Hypertension

NT:

Normotension

ROC:

Receiver operating characteristic

TOD:

Target organ damage

WCH:

White-coat hypertension

VVV:

Visit-to-visit variability

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Author information

Authors and Affiliations

  1. Department of Pediatrics, Tokyo Medical Center, Tokyo, Japan

    Hisayo Fujita

  2. Matsuoka Clinic, Yokohama, Kanagawa, Japan

    Seiji Matsuoka

  3. Department of Pediatrics, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan

    Midori Awazu

Authors
  1. Hisayo Fujita
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  2. Seiji Matsuoka
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  3. Midori Awazu
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Correspondence to Midori Awazu.

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All authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national ethical guidelines for medical and health research involving human subjects and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was not obtained but the option of opting out was provided as approved by the ethics committee at Keio University School of Medicine.

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Fujita, H., Matsuoka, S. & Awazu, M. Visit-to-visit blood pressure variability in children and adolescents with renal disease. Clin Exp Nephrol 22, 1150–1156 (2018). https://doi.org/10.1007/s10157-018-1557-3

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  • DOI: https://doi.org/10.1007/s10157-018-1557-3

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