Yapısal Böbrek Anomalisi olan Çocuklarda Ofis ve Ambulatuvar Kan Basıncı Arasındaki Farklılıkların Değerlendirilmesi

Yapısal böbrek anomalileri çocukluk döneminde görülen hipertansiyonun en sık nedenlerinden biridir. Bu çalışmada yapısal böbrek anomalisi olan çocuklarda ofis kan basıncı (OKB) ile ambulatuar kan basıncı izlemi (AKBİ) sonuçlarının karşılaştırılması amaçlanmıştır. Bu çalışmada AKBİ yapılan yapısal böbrek anomalili hastaların sonuçları değerlendirildi. Hastaların OKB ile AKBİ değerleri arasında anlamlı farklılık olup olmadığı araştırıldı. OKB ve AKBİ sonuçları arasındaki farklılıkların anlamlılığını belirlemek için t-testi (paired samples t-test) kullanıldı. Farklılıkları etkileyen faktörler lineer regresyon analizi ile araştırıldı.OKB değerleri gece sistolik kan basıncı (SKB) ve diastolik kan basıncı (DKB) değerlerinden anlamlı olarak daha yüksekti (p<0.01). OKB değerleri farklılıkların hepsi ile pozitif korele bulundu (p<0.05). Gece SKB ile OKB arasındaki farklılıklar yaş ve vücut kitle indeksi ile pozitif yönde koreleydi (sırası ile p = 0.001, p = 0.015). Kan üre azotu ile OKB - gece DKB ve OKB - 24 saat DKB farklılıkları arasında anlamlı ilişki olduğu belirlendi (sırası ile β = 0.220, p = 0.033, β = 0.205, p = 0.045). Glomerul filtrasyon hızı ve OKB-gece SKB farklılığı arasında anlamlı negatif ilişki olduğu saptandı (β = -0.05, p = 0.01). Yapısal böbrek anomalisi olan çocukların izlemi sırasında AKBİ yapılması ve ofis ile ambulatuvar kan basınçları arasındaki farklılıkların değerlendirilmesi hipertansiyonun erken dönemde tanınmasında oldukça önemlidir.

Anahtar Kelimeler:

Office blood pressure, ambulatory blood pressure, structural renal abnormalities

Evaluation of the Differences Between Office and Ambulatory Blood Pressure Values in Children with Structurel Renal Anomaly.

Structural renal abnormalities are one of the most common causes of hypertension in children. In this study, it was aimed to compare office blood pressure (OBP) and ambulatory blood pressure monitoring (ABPM) values in children with structural renal abnormalities. The data from patients with structural renal abnormalities who performed ABPM were evaluated in this study. It was investigated whether there were significant differences between OBP and ABPM values. The paired t-test was used to determine the significance of the differences between OBP and ABPM values. The factors affecting the differences between office and ambulatory blood pressure values were investigated using linear regression analysis. The OBP values were significantly higher than nighttime systolic blood pressure (SBP) and diastolic blood pressure (DBP) (p<0.01). The OBP values were positively correlated with all differences (p<0.05). Age and body mass index were positively associated with OBP–nighttime SBP difference (p = 0.001, p = 0.015, respectively). Serum blood urea nitrogen level was positively associated with OBP–nighttime DBP and OBP–24h DBP differences (β = 0.220, p = 0.033, β = 0.205, p = 0.045, respectively). There was a negative correlation between glomerul filtration rate and OBP–nighttime SBP difference (β = -0.05, p = 0.01). The performing of ABPM and the evaluation of the differences between office and ambulatory blood pressure is very important in the early recognition of the hypertension in children with structural renal anomaly.

Keywords:

Office blood pressure, ambulatory blood pressure, structural renal abnormalities,

PDF

___

Referans1. WHO, World Health Organization. A global brief on hypertension, 2013. Geneva: World Health Organization; 2013.
Referans2. Verdecchia P, Carini G, Circo A, et al. Left ventricular mass and cardiovascular morbidity in essential hypertension: the MAVI study. J Am Coll Cardiol. 2001;38 (7):1829–1835.
Referans3. Gupta-Malhotra M, Banker A, Shete S, et al. Essential hypertension vs. secondary hypertension among children. Am J Hypertens. 2015;28 (1):73–80.
Referans4. Silverstein DM, Champoux E, Aviles DH, et al. Treatment of primary and secondary hypertension in children. Pediatr Nephrol. 2006;21(6):820–827.
Referans5. Shikha D, Singla M, Walia R, et al. Ambulatory blood pressure monitoring in lean, obese and diabetic children and adolescents. Cardiorenal Med. 2015;5(3):183–190.
Referans6. Li A-Q, Zhao Z-Y, Zhang L-L, et al. Overweight influence on circadian variations of ambulatory blood pressure in Chinese adolescents. Clin Exp Hypertens. 2005;27(2-3):195–201.
Referans7.Pickering TG, Shimbo D, Haas D. Ambulatory blood-pressure monitoring. N Engl J Med. 2006;354(22):2368–2374.
Referans8. Stabouli S, Kotsis V, Toumanidis S, et al. White-coat and masked hypertension in children: association with target-organ damage. Pediatr Nephrol. 2005;20(8):1151–1155.
Referans9.Flynn JT, Kaelber DC, Baker-Smith CM, et al. Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents. Pediatrics. 2017;140(3):e20171904.
Referans10.Soergel M, Kirschstein M, Busch C, et al. Oscillometric twenty-four-hour ambulatory blood pressure values in healthy children and adolescents: a multicenter trial including 1141 subjects. Pediatrics. 2017 Dec;140(6)
Referans11.Chobanian AV, Bakris GL, Black HR, et al. Seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension. 2003;42(6):1206–1252.
Referans12.National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics. 2004;114 (2 Suppl 4th Report):555–576.
Referans13.Schwartz GJ, Brion LP, Spitzer A. The use of plasma creatinine concentration for estimating glomerular filtration rate in infants, children, and adolescents. Pediatr Clin North Am. 1987;34(3):571-590.
Referans14.Fujita H, Matsuoka S, Awazu M. Masked Isolated Nocturnal Hypertension in Children and Young Adults. Pediatr Cardiol. 2018;39(1):66-70.
Referans15.Karpettas N, Kollias A, Vazeou A, et al. Office, ambulatory and home blood pressure measurement in children and adolescents. Expert Rev Cardiovasc Ther. 2010;8 (11):1567-1578.
Referans16.Seo HS, Kang TS, Park S, et al. Non-dippers are associated with adverse cardiac remodeling and dysfunction. In J Cardiol. 2006;112(2): 171–177.
Referans17.Stabouli S, Kotsis V, Zakopoulos N. Ambulatory blood pressure monitoring and target organ damage in pediatrics. J Hypertens. 2007;25(10):1979-1986.
Referans18.Salice P, Ardissino G, Barbier P, et al. Differences between office and ambulatory blood pressures in children and adolescents attending a hospital hypertension clinic. J Hypertens. 2013;31(11):2165–2175.
Referans19.Salgado CM, Jardim PC, Viana JK, et al. Home blood pressure in children and adolescents: a comparison with Office and ambulatory blood pressure measurements. Acta Paediatr. 2011;100(10):e163-168.
Referans 20.Stergiou GS, Alamara C, Kalkana C, et al. Out-of-office blood pressure in children and adolescents: disparate findings by using home or ambulatory monitoring. Am J Hypertens. 2004; 17(10): 869–875.
Referans 21.Babinska K, Kovacs L, Janko V, et al. Association between obesity and the severity of ambulatory hypertension in children and adolescents. J Am Soc Hypertens. 2012;6 (5):356–363.
Referans 22.Macumber IR, Weiss NS, Halbach SM, et al. The Association of Pediatric Obesity with nocturnal non-dipping on 24-hour ambulatory blood pressure monitoring. J Hypertens. 2016; 29(5):647–652.
Referans 23.Samuel JP, Bell CS, Hebert SA, et al. Office blood pressure measurement alone often misclassifies treatment status in children with primary hypertension. Blood Press Monit. 2017;22(6):328–332.
Referans 24.Mitsnefes M, Flynn J, Cohn S, et al. Masked hypertension associates with left ventricular hypertrophy in children with CKD. J Am Soc Nephrol. 2010;21(1):137–144.
Referans 25.McNiece KL, Gupta-Malhotra M, Samuels J, et al. Left ventricular hypertrophy in hypertensive adolescents: analysis of risk by 2004 National High Blood Pressure Education Program Working Group staging criteria. Hypertension. 2007;50(2):392–395.
Referans 26.Lurbe E, Torro I, Alvarez V, et al. Prevalence, persistence, and clinical significance of masked hypertension in youth. Hypertension. 2005;45(4):493-498.
Referans 27.Iimuro S, Imai E, Watanabe T, et al. Clinical correlates of ambulatory BP monitoring among patients with CKD. Clin J Am Soc Nephrol. 2013;8(5):721-730.
Referans 28.Seeman T, Patzer L, JohnU, et al. Blood pressure, renal function, and proteinuria in children with unilateral renal agenesis. Kidney Blood Press Res. 2006;29(4):210–215.
Referans 29.Harshfield GA, Pulliam DA, Alpert BS. Ambulatory blood pressure and renal function in healthy children and adolescents. Am J Hypertens. 1994;7(3):282-285.
Referans 30.Patzer L, Seeman T, Luck C, et al. Day- and night-time blood pressure elevation in children with higher grades of renal scarring. J Pediatr. 2003;142(2):117-122.