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Isolated nocturnal hypertension is associated with increased left ventricular mass index in children

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Abstract

Background

Isolated nocturnal hypertension (INH) is associated with increased prevalence of left ventricular hypertrophy (LVH) and cardiovascular morbidity and mortality in adult patients. Unlike in adults, data illustrating the possible association between INH and cardiac target organ damage is lacking in children. This study aimed to investigate whether INH is associated with increased left ventricular mass index (LVMI) and LVH in children.

Methods

Retrospective data from all untreated children with confirmed ambulatory hypertension (HT) in our center was reviewed. Ambulatory blood pressure monitoring (ABPM) and echocardiography were performed concurrently. Ambulatory normotensive children served as controls. LVH was defined as LVMI ≥ 95th percentile.

Results

There were 102 ABPM studies; of these, 79 children had renal HT, and 23 had primary HT. Median age of children was 13.2 years (3.8–18.9). Nineteen children had INH, 9 children had isolated daytime HT, 54 had daytime and nighttime HT, and 20 were normotensive. The LVMI adjusted for age (patient’s LVMI/95th percentile of the LVMI) was significantly higher in children with INH than in normotensive children (0.83 ± 0.03 vs. 0.74 ± 0.03, p = 0.03). Left ventricular hypertrophy was present in 11% of children with INH; this was not significantly higher than in normotensive children (0%, p = 0.23).

Conclusions

This study investigated the association between INH and cardiac structure in children with primary and renal HT and showed children with INH had higher LVMI adjusted for age than normotensive children and children with INH had similar LVMI adjusted for age to children with isolated daytime HT.

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References

  1. Li Y, Staessen JA, Lu L, Li LH, Wang GL, Wang JG (2007) Is isolated nocturnal hypertension a novel clinical entity? Findings from a Chinese population study. Hypertension 50:333–339

    CAS  PubMed  Google Scholar 

  2. Li Y, Wang JG (2013) Isolated nocturnal hypertension: a disease masked in the dark. Hypertension 61:278–283

    CAS  PubMed  Google Scholar 

  3. Wang C, Deng WJ, Gong WY, Zhang J, Tang H, Peng H, Zhang QZ, Ye ZC, Lou T (2015) High prevalence of isolated nocturnal hypertension in Chinese patients with chronic kidney disease. J Am Heart Assoc 4:e002025

    PubMed  PubMed Central  Google Scholar 

  4. Seeman T, Pohl M, Palyzova D, John U (2012) Microalbuminuria in children with primary and white-coat hypertension. Pediatr Nephrol 27:461–467

    PubMed  Google Scholar 

  5. Suláková T, Janda J (2008) Ambulatory blood pressure in children with diabetes 1. Pediatr Nephrol 23:2285–2286

    PubMed  Google Scholar 

  6. Lee SH, Kim JH, Kang MJ, Lee YA, Won Yang S, Shin CH (2011) Implications of nocturnal hypertension in children and adolescents with type 1 diabetes. Diabetes Care 34:2180–2185

    PubMed  PubMed Central  Google Scholar 

  7. Patzer L, Seeman T, Luck C, Wühl E, Janda J, Misselwitz J (2003) Day- and night-time blood pressure elevation in children with higher grades of renal scarring. J Pediatr 142:117–122

    PubMed  Google Scholar 

  8. Seeman T, John U, Bláhová K, Vondrichová H, Janda J, Misselwitz J (2001) Ambulatory blood pressure monitoring in children with unilateral multicystic dysplastic kidney. Eur J Pediatr 160:78–83

    CAS  PubMed  Google Scholar 

  9. Campbell JF, Swartz SJ, Wenderfer SE (2015) Nocturnal hypertension and attenuated nocturnal blood pressure dipping is common in pediatric lupus. F1000Res 4:164. https://doi.org/10.12688/f1000research.6532.2

    Article  PubMed  PubMed Central  Google Scholar 

  10. Macumber IR, Weiss NS, Halbach SM, Hanevold CD, Flynn JT (2016) The association of pediatric obesity with nocturnal non-dipping on 24-hour ambulatory blood pressure monitoring. Am J Hypertens 29:647–652

    PubMed  Google Scholar 

  11. Peppard PE, Young T, Palta M, Skatrud J (2000) Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med 342:1378–1384

    CAS  PubMed  Google Scholar 

  12. Leung LC, Ng DK, Lau MW, Chan CH, Kwok KL, Chow PY, Cheung JM (2006) Twenty-four-hour ambulatory BP in snoring children with obstructive sleep apnea syndrome. Chest 130:1009–1017

    PubMed  Google Scholar 

  13. Bayrakci US, Schaefer F, Duzova A, Yigit S, Bakkaloglu A (2007) Abnormal circadian blood pressure regulation in children born preterm. J Pediatr 151:399–403

    PubMed  Google Scholar 

  14. McGlothan KR, Wyatt RJ, Ault BH, Hastings MC, Rogers T, DiSessa T, Jones DP (2006) Predominance of nocturnal hypertension in pediatric renal allograft recipients. Pediatr Transplant 10:558–564

    PubMed  Google Scholar 

  15. Seeman T, Simková E, Kreisinger J, Vondrák K, Dusek J, Gilík J, Feber J, Dvorák P, Janda J (2006) Control of hypertension in children after renal transplantation. Pediatr Transplant 10:316–322

    CAS  PubMed  Google Scholar 

  16. Seeman T, Simková E, Kreisinger J, Vondrák K, Dusek J, Gilík J, Dvorák P, Janda J (2007) Improved control of hypertension in children after renal transplantation: results of a two-yr interventional trial. Pediatr Transplant 11:491–497

    CAS  PubMed  Google Scholar 

  17. Massella L, Mekahli D, Paripović D, Prikhodina L, Godefroid N, Niemirska A, Ağbaş A, Kalicka K, Jankauskiene A, Mizerska-Wasiak M, Afonso AC, Salomon R, Deschênes G, Ariceta G, Özçakar ZB, Teixeira A, Duzova A, Harambat J, Seeman T, Hrčková G, Lungu AC, Papizh S, Peco-Antic A, De Rechter S, Giordano U, Kirchner M, Lutz T, Schaefer F, Devuyst O, Wühl E, Emma F (2018) Prevalence of hypertension in children with early-stage ADPKD. Clin J Am Soc Nephrol 13:874–883

    PubMed  PubMed Central  Google Scholar 

  18. Düzova A, Karabay Bayazit A, Canpolat N, Niemirska A, Kaplan Bulut I, Azukaitis K, Karagoz T, Oguz B, Erdem S, Anarat A, Ranchin B, Shroff R, Djukic M, Harambat J, Yilmaz A, Yildiz N, Ozcakar B, Büscher A, Lugani F, Wygoda S, Tschumi S, Zaloszyc A, Jankauskiene A, Laube G, Galiano M, Kirchner M, Querfeld U, Melk A, Schaefer F, Wühl E, 4C Study Consortium (2019) Isolated nocturnal and isolated daytime hypertension associate with altered cardiovascular morphology and function in children with chronic kidney disease: findings from the cardiovascular comorbidity in children with chronic kidney disease study. J Hypertens 37:2247–2255

    PubMed  Google Scholar 

  19. Fan HQ, Li Y, Thijs L, Hansen TW, Boggia J, Kikuya M, Björklund-Bodegård K, Richart T, Ohkubo T, Jeppesen J, Torp-Pedersen C, Dolan E, Kuznetsova T, Stolarz-Skrzypek K, Tikhonoff V, Malyutina S, Casiglia E, Nikitin Y, Lind L, Sandoya E, Kawecka-Jaszcz K, Imai Y, Ibsen H, O'Brien E, Wang J, Staessen JA (2010) International Database on Ambulatory Blood Pressure In Relation to Cardiovascular Outcomes Investigators. Prognostic value of isolated nocturnal hypertension on ambulatory measurement in 8711 individuals from 10 populations. J Hypertens 28:2036–2045

    CAS  PubMed  Google Scholar 

  20. McMullan CJ, Hickson DA, Taylor HA, Forman JP (2015) Prospective analysis of the association of ambulatory blood pressure characteristics with incident chronic kidney disease. J Hypertens 33:1939–1946

    CAS  PubMed  Google Scholar 

  21. Dost A, Bechtold-Dalla Pozza S, Bollow E, Kovacic R, Vogel P, Feldhahn L, Schwab KO, Holl RW, Initiative DPV (2017) Blood pressure regulation determined by ambulatory blood pressure profiles in children and adolescents with type 1 diabetes mellitus: impact on diabetic complications. Pediatr Diabetes 18:874–882

    CAS  PubMed  Google Scholar 

  22. Seeman T, Hradský O, Gilík J (2016) Nocturnal blood pressure non-dipping is not associated with increased left ventricular mass index in hypertensive children without end-stage renal failure. Eur J Pediatr 175:1091–1097

    PubMed  Google Scholar 

  23. Wühl E, Witte K, Soergel M, Mehls O, Schaefer F, 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 20:1995–2007

    PubMed  Google Scholar 

  24. Flynn JT, Daniels SR, Hayman LL, Maahs DM, BW MC, Mitsnefes M, Zachariah JP, Urbina EM, American Heart Association Atherosclerosis, Hypertension and Obesity in Youth Committee of the Council on Cardiovascular Disease in the Young (2014) Update: ambulatory blood pressure monitoring in children and adolescents: a scientific statement from the American Heart Association. Hypertension 63:1116–1135

    CAS  PubMed  PubMed Central  Google Scholar 

  25. Lurbe E, Agabiti-Rosei E, Cruickshank JK, Dominiczak A, Erdine S, Hirth A, Invitti C, Litwin M, Mancia G, Pall D, Rascher W, Redon J, Schaefer F, Seeman T, Sinha M, Stabouli S, Webb NJ, Wühl E, Zanchetti A (2016) 2016 European Society of Hypertension guidelines for the management of high blood pressure in children and adolescents. J Hypertens 34:1887–1920

    CAS  PubMed  Google Scholar 

  26. Lurbe E, Cifkova R, Cruickshank JK, Dillon MJ, Ferreira I, Invitti C, Kuznetsova T, Laurent S, Mancia G, Morales-Olivas F, Rascher W, Redon J, Schaefer F, Seeman T, Stergiou G, Wühl E, Zanchetti A, European Society of Hypertension (2009) Management of high blood pressure in children and adolescents: recommendations of the European Society of Hypertension. J Hypertens 27:1719–1742

    CAS  PubMed  Google Scholar 

  27. Sahn DJ, DeMaria A, Kisslo J, Weyman A (1978) Recommendations regarding quantitation in M-mode echocardiography: results of a survey of Echocardiographic measurements. Circulation 58:1072–1083

    CAS  PubMed  Google Scholar 

  28. Devereux RB, Alonso DR, Lutas EM, Gottlieb GJ, Campo E, Sachs I, Reichek N (1986) Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol 57:450–458

    CAS  PubMed  Google Scholar 

  29. Daniels SR, Kimball TR, Morrison JA, Khoury P, Meyer RA (1995) Indexing left ventricular mass to account for differences in body size in children and adolescents without cardiovascular disease. Am J Cardiol 76:699–701

    CAS  PubMed  Google Scholar 

  30. Khoury PR, Mitsnefes M, Daniels SR, Kimball TR (2009) Age-specific reference intervals for indexed left ventricular mass in children. J Am Soc Echocardiogr 22:709–714

    PubMed  Google Scholar 

  31. Flynn JT, Kaelber DC, Baker-Smith CM, Blowey D, Carroll AE, Daniels SR, de Ferranti SD, Dionne JM, Falkner B, Flinn SK, Gidding SS, Goodwin C, Leu MG, Powers ME, Rea C, Samuels J, Simasek M, Thaker VV, Urbina EM, Subcommittee on screening and management of high blood pressure in children (2017) Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics 140:e20171904

    PubMed  Google Scholar 

  32. Kobzova J, Vignerova J, Blaha P, Krejcovsky L, Riedlova J (2004) The 6th nationwide anthropological survey of children and adolescents in the Czech Republic in 2001. Cent Eur J Public Health 12:126–130

    CAS  PubMed  Google Scholar 

  33. Schwartz GJ, Muñoz A, Schneider MF, Mak RH, Kaskel F, Warady BA, Furth SL (2009) New equations to estimate GFR in children with CKD. J Am Soc Nephrol 20:629–637

    PubMed  PubMed Central  Google Scholar 

  34. O'Flynn AM, Madden JM, Russell AJ, Curtin RJ, Kearney PM (2015) Isolated nocturnal hypertension and subclinical target organ damage: a systematic review of the literature. Hypertens Res 38:570–575

    PubMed  Google Scholar 

  35. Fujita H, Matsuoka S, Awazu M (2018) Masked isolated nocturnal hypertension in children and young adults. Pediatr Cardiol 39:66–70

    PubMed  Google Scholar 

  36. Cuspidi C, Facchetti R, Bombelli M, Sala C, Tadic M, Grassi G, Mancia G (2017) Is night-time hypertension worse than daytime hypertension? A study on cardiac damage in a general population: the PAMELA study. J Hypertens 35:506–512

    CAS  PubMed  Google Scholar 

  37. Mitsnefes MM (2012) Cardiovascular disease in children with chronic kidney disease. J Am Soc Nephrol 23:578–585

    CAS  PubMed  PubMed Central  Google Scholar 

  38. Hansen TW, Li Y, Boggia J, Thijs L, Richart T, Staessen JA (2011) Predictive role of the nighttime blood pressure. Hypertension 57:3–10

    CAS  PubMed  Google Scholar 

  39. Belsha CW, Wells TG, McNiece KL, Seib PM, Plummer JK, Berry PL (1998) Influence of diurnal blood pressure variations on target organ abnormalities in adolescents with mild essential hypertension. Am J Hypertens 11:410–417

    CAS  PubMed  Google Scholar 

  40. Sorof JM, Cardwell G, Franco K, Portman RJ (2002) Ambulatory blood pressure and left ventricular mass index in hypertensive children. Hypertension 39:903–908

    CAS  PubMed  Google Scholar 

  41. Mitsnefes MM, Kimball TR, Kartal J, Witt SA, Glascock BJ, Khoury PR, Daniels SR (2006) Progression of left ventricular hypertrophy in children with early chronic kidney disease: 2-year follow-up study. J Pediatr 149:671–675

    PubMed  Google Scholar 

  42. Sharma AP, Mohammed J, Thomas B, Lansdell N, Norozi K, Filler G (2013) Nighttime blood pressure, systolic blood pressure variability, and left ventricular mass index in children with hypertension. Pediatr Nephrol 28:1275–1282

    PubMed  Google Scholar 

  43. Lurbe E, Redon J, Kesani A, Pascual JM, Tacons J, Alvarez V, Batlle D (2002) Increase in nocturnal blood pressure and progression to microalbuminuria in type 1 diabetes. N Engl J Med 347:797–805

    CAS  PubMed  Google Scholar 

  44. Kollias A, Dafni M, Poulidakis E, Ntineri A, Stergiou GS (2014) Out-of-office blood pressure and target organ damage in children and adolescents: a systematic review and meta-analysis. J Hypertens 32:2315–2331

    CAS  PubMed  Google Scholar 

  45. Portaluppi F, Provini F, Cortelli P, Plazzi G, Bertozzi N, Manfredini R, Fersini C, Lugaresi E (1997) Undiagnosed sleep-disordered breathing among male nondippers with essential hypertension. J Hypertens 15:1227–1233

    CAS  PubMed  Google Scholar 

  46. Harshfield GA, Barbeau P, Richey PA, Alpert BS (2000) Racial differences in the influence of body size on ambulatory blood pressure in youths. Blood Press Monit 5:59–63

    CAS  PubMed  Google Scholar 

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Acknowledgments

We thank our colleagues for performing some of the ABPM studies and Redina Hasani and Mairead Pfaff for their contribution as the scientific English language editors.

Funding

This work was funded by the project of Ministry of Health, Czech Republic, for conceptual development of research organization 00064203 (University Hospital Motol, Prague, Czech Republic) and by the National Sustainability Program I (NPU I) Nr. LO1503 provided by the Ministry of Education Youth and Sports of the Czech Republic.

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Authors and Affiliations

  1. Department of Pediatrics, University Hospital Motol, Charles University Prague, Second Faculty of Medicine, V Úvalu 84, 15006, Prague, Czech Republic

    Tomáš Seeman & Ondřej Hradský

  2. Biomedical Center, Faculty of Medicine in Pilsen, Charles University Prague, Pilsen, Czech Republic

    Tomáš Seeman

  3. Kardiocentrum and Centre for Cardiovascular Research, University Hospital Motol, Prague, Czech Republic

    Jiří Gilík

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  1. Tomáš Seeman
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  2. Ondřej Hradský
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  3. Jiří Gilík
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Correspondence to Tomáš Seeman.

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The authors declare that they have no conflict of interest.

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Ethical approval was waived by local Ethics Committee of University Hospital Motol in view of the retrospective nature of the study, and all the procedures being performed were part of the routine care. The prospective blood pressure and echocardiography investigation of healthy children was approved by the local Ethics Committee and the parents signed their informed consent with the study.

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Seeman, T., Hradský, O. & Gilík, J. Isolated nocturnal hypertension is associated with increased left ventricular mass index in children. Pediatr Nephrol 36, 1543–1550 (2021). https://doi.org/10.1007/s00467-020-04861-4

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  • DOI: https://doi.org/10.1007/s00467-020-04861-4

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