Pediatric Nephrology

, 24:823 | Cite as

Blood pressure load, proteinuria and renal function in pre-hypertensive children

  • Riccardo Lubrano
  • Elisabetta Travasso
  • Claudia Raggi
  • Giuliana Guido
  • Raffaele Masciangelo
  • Marco Elli
Original Article


It is as yet unclear whether blood pressure load (BPL) can affect renal function in pre-hypertensive children. We have studied 250 children, with a mean age of 9.12 ± 3.28 years, with the aim of assessing if pre-hypertension in children can indeed affect renal function. The study cohort consisted of 146 children with pre-hypertension (group P) and a control group of 104 children with normal blood pressure (group C). All children were tested for orthostatic proteinuria, an exclusion criterion, glomerular filtration rate (GFR), and proteinuria, and ambulatory blood pressure monitoring was performed. Based on the BPL, group P was further subdivided into group P1 (BPL ≤ 40%, low BPL) and group P2 (BPL > 40%, high BPL). We found that GFR was reduced in pre-hypertensive children (90.74 ± 48.69 vs. 110.32 ± 20.30 ml/min per 1.73 m2, p < 0.0001) and that proteinuria was increased (145.36 ± 110.91 vs. 66.84 ± 42.94 mg/m2 per 24 h; p < 0.0001). However, mean values were still within normal limits. A comparison of the group with high BPL and that with low BPL revealed that the former had relatively reduced GFR (79.15 ± 42.04 vs. 96.78 ± 51.20 ml/min per 1.73 m2; p < 0.006) and increased proteinuria (198.29 ± 142.17 vs. 118.31 ± 80.07 mg/m2 per 24 h; p < 0.036). In comparison to the reference values of the normal population, the GFR was reduced and proteinuria was increased in the group with high BPL. Based on our results, pre-hypertension in children with high BPL seems to be associated with reduced GFR and increased proteinuria. A reasonable doubt remains that the patients with higher proteinuria and larger reduction of GFR may harbor an as yet unknown subclinical renal condition responsible for the onset of pre-hypertension. Therefore, children with even mildly elevated BP are at risk of developing renal damage and should change their lifestyle to prevent further increases in BP.


Arterial blood pressure monitoring Child Glomerular filtration rate Hypertension Pre-hypertension Proteinuria 


  1. 1.
    Urbina E, Alpert B, Flynn J, Hayman L, Harshfield GA, Jacobson M, Mahoney L, McCrindle B, Mietus-Snyder M, Steinberger J, Daniels S, American Heart Association Atherosclerosis, Hypertension, and Obesity in Youth Committee (2008) Ambulatory blood pressure monitoring in children and adolescents: recommendations for standard assessment: a scientific statement from the American Heart Association Atherosclerosis, Hypertension, and Obesity in Youth Committee of the council on cardiovascular disease in the young and the council for high blood pressure research. Hypertension 52:433–451PubMedCrossRefGoogle Scholar
  2. 2.
    Sorof JM, Portman RJ (2000) Ambulatory blood pressure monitoring in the pediatric patient. J Pediatr 136:578–586PubMedCrossRefGoogle Scholar
  3. 3.
    Sorof JM, Portman RJ (2002) Ambulatory blood pressure monitoring in children and adolescent. Clin Pediatr (Phila) 41:549–564CrossRefGoogle Scholar
  4. 4.
    Flynn J (2000) Impact of ambulatory blood pressure monitoring on the management of hypertension in children. Blood Press Monit 5:2111–2115CrossRefGoogle Scholar
  5. 5.
    Leenen FH, Coletta E, Davies RA (2007) Prevention of renal dysfunction and hypertension by amlodipine after heart transplant. Am J Cardiol 100:531–535PubMedCrossRefGoogle Scholar
  6. 6.
    Lurbe E, Sorof JM, Daniels SR (2004) Clinical and research aspects of ambulatory blood pressure monitoring in children. J Pediatr 144:7–16PubMedCrossRefGoogle Scholar
  7. 7.
    Koshy S, Macarthur C, Luthra S, Gajaria M, Geary D (2005) Ambulatory blood pressure monitoring: mean blood pressure and blood pressure load. Pediatr Nephrol 20:1484–1486PubMedCrossRefGoogle Scholar
  8. 8.
    Kennedy SE, Mackie FE, Rosenberg AR, Craig E, Kainer G (2005) Agreement on reporting of ambulatory blood pressure monitoring in children. Pediatr Nephrol 20:1766–1768PubMedCrossRefGoogle Scholar
  9. 9.
    Nehal US, Ingelfinger JR (2002) Pediatric hypertension: recent literature. Curr Opin Pediatr 14:186–189CrossRefGoogle Scholar
  10. 10.
    Khan IA, Gajaria M, Stephens D, Balfe JW (2000) Ambulatory blood pressure monitoring in children: a large center’s experience. Pediatr Nephrol 14:802–805PubMedCrossRefGoogle Scholar
  11. 11.
    Sorof JM, Portman RJ (2001) Ambulatory blood pressure measurements. Curr Opin Pediatr 13:133–137PubMedCrossRefGoogle Scholar
  12. 12.
    Flynn JT, Alderman MH (2005) Characteristics of children with primary hypertension seen at a referral center. Pediatr Nephrol 20:961–966PubMedCrossRefGoogle Scholar
  13. 13.
    Sorof JM (2000) White coat hypertension in children. Blood Press Monit 5:197–202PubMedCrossRefGoogle Scholar
  14. 14.
    National high blood pressure education program working group on high blood pressure in children and adolescent (2004) The fourth report on the diagnosis, evaluation and treatment of high blood pressure in children and adolescent. Pediatrics 114:555–576CrossRefGoogle Scholar
  15. 15.
    Sorof JM, Cardwell G, Franco K, Portman RJ (2002) Ambulatory blood pressure and left ventricular mass index in hypertensive children. Hypertension 39:903–908PubMedCrossRefGoogle Scholar
  16. 16.
    Grupo de trabajo para el trattamiento de la Hipertensiòn arterial de la sociedad Europea: Sociedad Europea de Cardiologia (2007) ESH/ESC 2007 guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 25:1105–1187CrossRefGoogle Scholar
  17. 17.
    Abrahamsson K, Hansson S, Larsson P, Jodal U (2002) Antibiotic treatment for five days is effective in children with acute cystitis. Acta Paediatr 91:55–58PubMedCrossRefGoogle Scholar
  18. 18.
    Hayman LL, Meininger JC, Daniels SR, McCrindle BW, Helden L, Ross J, Dennison BA, Steinberger J, Williams CL (2007) Primary prevention of cardiovascular disease in nursing practice: focus on children and youth: a scientific statement from the American Heart Association Committee on atherosclerosis, hypertension and obesity in youth cardiovascular nursing, council on epidemiology and prevention, and council on nutrition, physical activity and metabolism. Circulation 116:344–357PubMedCrossRefGoogle Scholar
  19. 19.
    Richey PA, DiSessa TG, Hastings MC, Somes GW, Alpert BS, Jones DP (2008) Ambulatory blood pressure and increased left ventricular mass in children at risk for hypertension. J Pediatr 152:343–348PubMedCrossRefGoogle Scholar
  20. 20.
    Hogg RJ, Portman RJ, Milliner D, Lemley KV, Eddy A, Ingelfinger J (2000) Evaluation and management of proteinuria and nephrotic syndrome in children: recommendations from a pediatric nephrology panel established at the national kidney foundation conference on proteinuria, albuminuria, risk, assessment, detection and elimination (PARADE). Pediatrics 105:1242–1249PubMedCrossRefGoogle Scholar
  21. 21.
    Wuhl E, Witte K, Soergel M, Mehls O, Schaefer F, for German working Group on Pediatric Hypertension (2002) Distribution of 24-h ambulatory blood pressure in children: normalized reference values and role of body dimensions. J Hypertens 20:1995–2007PubMedCrossRefGoogle Scholar
  22. 22.
    Seeman T, Palyzova D, Dusek J, Janda J (2005) Reduced nocturnal blood pressure dip and sustained nighttime hypertension are specific markers of secondary hypertension. J Pediatr 147:366–371PubMedCrossRefGoogle Scholar
  23. 23.
    Hogg RJ, Furth S, Lemley KV, Portman R, Schwatz GJ, Balk E, Lau J, Levin A, Kausz AT, Eknoyan G, Levely AS (2003) National kidney foundation’s kidney disease outcomes quality initiative clinical practice guidelines for chronic kidney disease in children and adolescents: evaluation, classification, and stratification. Pediatrics 111:1416–1421PubMedCrossRefGoogle Scholar
  24. 24.
    World Medical Association Declaration of Helsinki (2000) Ethical principles for medical research involving human subjects. JAMA 284:3043–3045CrossRefGoogle Scholar
  25. 25.
    Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, Jones DW, Materson BJ, Oparil S, Wright JT (2003) Seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension 42:1206–1252PubMedCrossRefGoogle Scholar
  26. 26.
    Croix B, Feig DI (2006) Childhood hypertension is not a silent disease. Pediatr Nephrol 21:527–532PubMedCrossRefGoogle Scholar
  27. 27.
    Sorof JM, Alexandrov AV, Cardwell G, Portman RJ (2003) Carotid artery intimal-medial thickness and left ventricular hypertrophy in children with elevated blood pressure. Pediatrics 111:61–66PubMedCrossRefGoogle Scholar
  28. 28.
    Hanevold C, Waller J, Daniels S, Portman R, Sorof J (2004) The effects of obesity, gender, and ethnic group on left ventricular hypertrophy and geometry in hypertensive children: a collaborative study of the International Pediatric Hypertension Association. Pediatrics 113:328–333PubMedCrossRefGoogle Scholar
  29. 29.
    Litwin M, Nieemirska A, Sladowska J, Antoniewicz J, Daszkowska J, Wierzbicka A, Wawer ZT, Grenda R (2006) Left ventricular hypertrophy and wall thickening in children with essential hypertension. Pediatr Nephrol 21:811–819Google Scholar
  30. 30.
    Dursun H, Bayazit AK, Cengiz N, Seydaoglu G, Buyukcelik M, Soran M, Noyan A, Anarat A (2007) Ambulatory blood pressure monitoring and renal functions in children with a solitary kidney. Pediatr Nephrol 22:559–564PubMedCrossRefGoogle Scholar
  31. 31.
    Patzer L, Seeman T, Luck C, Wuhl E, Janda J, Misselwitz L (2003) Day and night time blood pressure elevation in children with higher grades of renal scarring. J Pediatr 142:117–122PubMedCrossRefGoogle Scholar
  32. 32.
    Cuspidi C, Lonati L, Sampieri L, Michev I, Macca G, Rocanova JI, Salerno M, Fusi V, Leonetti G (2000) Prevalence of target organ damage in treated hypertensive patients: different impact of clinic and ambulatory blood pressure control. J Hypertens 18:803–809PubMedCrossRefGoogle Scholar
  33. 33.
    Schärer K (1999) Clinical nephrology, dialysis and transplantation: a continuously update textbook. Dustri-Verlag, DeisenhofenGoogle Scholar
  34. 34.
    Mule G, Nardi F, Andonico G, Cottone S, Raspanti F, Piazza G, Volpe V, Ferrara D, Cerasola G (2001) Relationships between 24 h blood pressure load and target organ damage in patients with mild-to-moderate essential hypertension. Blood Press Monit 6:15–23Google Scholar
  35. 35.
    Han HC (2007) A biomechanical model of artery buckling. J Biomech 40:3672–3678PubMedCrossRefGoogle Scholar
  36. 36.
    Boulatov VA, Stenehjem A, Os I (2001) Association between albumin:creatinine ratio and 24-hour ambulatory blood pressure in essential hypertension. Am J Hypertens 14:338–344PubMedCrossRefGoogle Scholar
  37. 37.
    MacMahon S, Pet S, Cutler J, Collins R, Sorlie P, Neaton J, Abbott R, Godwin J, Dyer A, Stamler J (1990) Blood pressure, stroke and coronary heart disease. Part 1, prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias. Lancet 333:765–774CrossRefGoogle Scholar
  38. 38.
    Lewington S, Clarke R, Qizilbash N, Peto R, Collins R (2002) Age specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one millon adult in 61 prospective studies. Lancet 360:1903–1913PubMedCrossRefGoogle Scholar
  39. 39.
    Sorof JH (2001) Systolic hypertension in children: benign or beware? Pediatr Nephrol 16:517–525PubMedCrossRefGoogle Scholar

Copyright information

© IPNA 2008

Authors and Affiliations

  • Riccardo Lubrano
    • 1
  • Elisabetta Travasso
    • 1
  • Claudia Raggi
    • 1
  • Giuliana Guido
    • 1
  • Raffaele Masciangelo
    • 2
  • Marco Elli
    • 3
  1. 1.Dipartimento di Pediatria, Unità Operativa di Nefrologia Pediatrica, Azienda Policlinico “Umberto I”Università degli Studi di Roma “La Sapienza”RomeItaly
  2. 2.Dipartimento di Medicina Sperimentale e PatologiaUniversità degli Studi di Roma “La Sapienza”RomeItalia
  3. 3.Dipartimento di Scienze Cliniche “Osp. Luigi Sacco”Università degli Studi di MilanoMilanItalia

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