Is late-preterm birth a risk factor for hypertension in childhood?

Late-preterm birth is associated with higher rates of neonatal morbidity and mortality and higher health care utilization, but its impact on later life is not well known. In this study, we aimed to evaluate whether late-preterm birth affects blood pressure, renal function, and urinary protein excretion in children later in life. Sixty-five children aged 4 to 13 years born as late-preterm and 65 age- and sex-matched children born full term were evaluated with 24-h ambulatory blood pressure monitoring (ABPM), urinary microalbumin excretion (UAE), and glomerular filtration rate (GFR). All subjects underwent ABPM prospectively. For each gender, daytime, nighttime, and 24-h systolic and diastolic and mean blood pressures (SBP, DBP, and MAP) were transformed to standard deviation scores (SDS). Blood pressure profiles (SBP DBP, and MAP) were considered abnormal when the corresponding SDS values exceeded 1.63. Urinary microalbumin excretion was expressed as milligrams per day, and the value between 30 and 300 mg/day was defined as microalbuminuria (MA). There was no significant difference in the mean GFR and MA levels between late-preterm and term children. 24-h systolic BP SDS, daytime systolic BP SDS, nighttime systolic BP SDS, 24-h diastolic BP SDS, nighttime diastolic BP SDS, 24-h MAP BP SDS, daytime MAP BP SDS, and nighttime MAP BP SDS were found to be significantly higher in late-preterm children compared to term children. Conclusion: We conclude that late-preterm children have higher BP levels, so those children should be followed up carefully by the pediatrician regarding probable hypertension in their future life.     

Abnormal circadian blood pressure regulation in liver transplanted children

HT is a frequent cardiovascular risk factor in liver transplant recipients. However, there are only few studies in the literature regarding the risk of HT in liver transplanted children. The aim of this study was to assess the 24 h BP profiles of liver transplanted patients and to compare the results with healthy children. ABPM was performed on 20 liver transplanted patients and 27 healthy children aged 7.1 ± 4.8 and 8.5 ± 2.9 yr, respectively. HT was defined as SDS > 1.64 (i.e., >95th percentile) adjusted for gender and height. The mean duration of post-transplant follow-up was 32 ± 19 months. Six (30%) patients were found to be hypertensive. The physiological nocturnal BP fall was attenuated significantly in the study group for diastolic BP (11.5 ± 6.1 mmHg vs. 17.7 ± 7.1 mmHg, p = 0.006). Specifically, the number of patients with high nighttime systolic and diastolic BP SDS (p = 0.02 and p = 0.004, respectively) as well as elevated nighttime systolic (p = 0.03) and diastolic (p = 0.003) BPLs was found to be significantly higher than those in the controls. Alteration of the "normal" circadian rhythm is very frequent in liver transplant recipients. Thus, it is recommended to perform ABPM on all liver transplanted children not to underdiagnose HT.     

Ambulatory blood pressure monitoring in children with unilateral multicystic dysplastic kidney

Multicystic dysplastic kidney (MCDK) is one of the most common congenital renal anomalies. Arterial hypertension is a potential complication of MCDK. Blood pressure (BP) has so far been measured only casually and the frequency of hypertension has been estimated to be between 0%–8%. Ambulatory blood pressure monitoring (ABPM) provides more precise information on BP than the casual BP measurement. The aim of this study was to investigate the BP profile in children with MCDK using ABPM. A group of 25 children (16 girls), with a mean age of 7.8 years (range 3.8–17.7 years) were investigated. ABPM was performed using the oscillometric SpaceLabs 90207 device. Hypertension was defined as mean systolic and/or diastolic BP during the day and/or in the night exceeding 95th percentile for ABPM. Five (20%) children showed hypertension, two of them had combined daytime and night-time hypertension and three had isolated nocturnal hypertension, although daytime BP was between the 90th–95th percentile in two of them. Children with ultrasonographical and/or laboratory signs of contralateral kidney abnormalities showed a higher incidence of hypertension than those without abnormalities (two of four versus 3 of 21). The mean night-time systolic and diastolic BP of children with MCDK was significantly higher than in healthy children (+0.50 and +0.54 SDS, respectively, P=0.012 and 0.03, respectively). Three of the hypertensive children were already nephrectomised. All five hypertensive children showed ultrasonographical and/or laboratory signs of contralateral kidney abnormalities. Hypertensive children had significantly higher microalbuminuria than normotensive children (6.9 ± 3.2 mg/mmol creatinine versus 1.8 ± 0.7, P=0.03). The nocturnal BP fall (dip) was attenuated in five children, only one of whom was hypertensive. Conclusion Arterial hypertension in children with multicystic dysplastic kidney is seen more often if based on ambulatory blood pressure monitoring than on casual blood pressure recordings. The main risk factor for developing hypertension is contralateral kidney damage. Ambulatory blood pressure monitoring should be performed in children with multicystic dysplastic kidney, especially in those with contralateral kidney abnormalities. Received: 20 July 1999 and in revised form: 27 November 1999, 24 March 2000, 3 May 2000 Accepted: 3 May 2000     

Improved control of hypertension in children after renal transplantation: results of a two-yr interventional trial

Hypertension is a frequent complication in children after renal transplantation and the control of post-transplant hypertension is unsatisfactorily low. The aim of this prospective interventional study was to improve the control of hypertension in children after renal transplantation. Thirty-six children fulfilled the inclusion criteria (> or =6 months after transplantation and no acute rejection in the last three months). BP was measured using ABPM. Hypertension was defined as mean ambulatory BP > or =95th-centile for healthy children and/or using antihypertensive drugs. The study intervention consisted of using intensified antihypertensive drug therapy - in children with uncontrolled hypertension (i.e., mean ambulatory BP was > or =95th centile in treated children), antihypertensive therapy was intensified by adding new antihypertensive drugs to reach goal BP <95th centile. ABPM was repeated after 12 and 24 months. Daytime BP did not change significantly after 12 or 24 months. Night-time BP decreased from 1.57 +/- 1.33 to 0.88 +/- 0.84 SDS for systolic and from 1.10 +/- 1.51 to 0.35 +/- 1.18 SDS for diastolic BP after 24 months (p < 0.05). The number of antihypertensive drugs increased from 2.1 +/- 0.9 to 2.7 +/- 0.8 drugs per patient (p < 0.05), this was especially seen with the use of ACE-inhibitors (increase from 19% to 40% of children, p < 0.05). In conclusion, this interventional trial demonstrated that, in children after renal transplantation, the control of hypertension, especially at night-time, can be improved by increasing the number of antihypertensive drugs, especially ACE-inhibitors.     

Predominance of nocturnal hypertension in pediatric renal allograft recipients

Hypertension is common in children with end-stage renal disease who have undergone renal transplantation. We performed ambulatory blood pressure monitoring (ABPM) in renal allograft recipients who were on stable maintenance immunosuppressive medications and were more than six months post-transplant. Echocardiographic measurement of left ventricular mass index (LVMI) was obtained at the time of ABPM. Twenty-nine children with a mean age of 14.8 yr (8-18 yr) were evaluated 4.3 yr (0.6-12.8 yr) after deceased donor (n = 13) or living donor (n = 16) transplantation. BP levels were higher during sleep compared with when awake using the 95th percentile to standardize mean BP for each period: mean BP was expressed as a standard deviation score (SDS) for each time period, awake vs. sleep: systolic (s) BP SDS were 0.43 +/- 1.3 vs. 1.29 +/- 1.2 (p < 0.001) and diastolic (d) BP SDS were 0.04 +/- 1.3 vs. 1.34 +/- 1.2 (p < 0.001). Significant differences between awake and sleep BP were also confirmed using the mean BP for each period expressed as a BPI. Hypertension (HTN) during sleep was more common than awake HTN. Based upon BPI, 21% had sHTN when awake compared with 48% during sleep and 7% had dHTN when awake compared with 41% during sleep (p < 0.05). Based upon mean BP load, 38% had sHTN when awake compared with 55% during sleep and 21% demonstrated dHTN when awake compared with 52% during sleep (p < 0.05). Left ventricular mass (LVM) was abnormally increased in six of 17 children (35%); LVM was not correlated with BP. Children prescribed angiotensin converting enzyme inhibitors or angiotensin II receptor blockers (ACEi/ARB) had significantly lower systolic BP compared with those on calcium channel blocking agents (CCB). Mean sSDS was -0.11 +/- 1.1 in those children on ACEi/ARB compared with 1.6 +/- 1.2 in those on CCB (p = 0.02): sSDS during sleep was significantly lower in the ACEi/ARB group compared with CCB (0.70 +/- 1.1 vs. 2.0 +/- 1.1, p = 0.04). Isolated nocturnal HTN is more common than daytime HTN among clinically stable pediatric renal allograft recipients. Detection and treatment of nocturnal HTN in pediatric allograft recipients could potentially affect graft survival.     

24 hour blood pressure monitoring in healthy and hypertensive children

24 Hour ambulatory blood pressure monitoring (ABPM) was performed to provide data on the normal daily blood pressure of healthy schoolchildren and on patients with hypertension. The subjects studied were 123 healthy schoolchildren with a mean (SD) age of 12.5 (1.6) years (range 9.5-14.5 years), 24 children with borderline or mild hypertension, 17 with renal hypertension and normal renal function, 10 with chronic renal failure, and six with a renal allograft. In eight children with definite renal disease a second measurement was performed after treatment modification. The monitor used for ABPM was validated with a mercury column manometer. The mean (SD) of the signed differences of the blood pressure measured by the two methods was -0.19 (1.75) mmHg for the systolic and -0.21 (2.11) mmHg for the diastolic blood pressure (n = 60). Normal values for daytime and night time blood pressure were determined for those aged 10-14 years. The mean (SD) blood pressure of the 123 children was 109 (7)/66 (8) mmHg (systolic/diastolic) for the daytime and 96 (8)/52 (7) mmHg at night time. Of the 24 children with borderline or mild hypertension 14 had a raised blood pressure on ABPM. The circadian rhythm was disturbed in three children of this group. Even children with normal daytime blood pressure had significantly higher systolic blood pressure in the night when compared with the controls. The incidence of disturbed circadian rhythm was higher in the groups with renal hypertension (4/17 in the subgroup with normal renal function, 5/16 in the group with renal failure and/or transplantation). All children undergoing a second ABPM measurement had a lower average blood pressure after treatment adjustment. ABPM measurements were reproducible and accurate. The method provided new data on the physiological circadian variation of blood pressure in healthy children. It proved to be a helpful tool in the diagnosis of hypertension, particularly in the detection of cases of disturbance of the circadian rhythm of blood pressure pattern and individual adjustment of treatment.     

24 hour blood pressure monitoring in healthy and hypertensive children.

24 Hour ambulatory blood pressure monitoring (ABPM) was performed to provide data on the normal daily blood pressure of healthy schoolchildren and on patients with hypertension. The subjects studied were 123 healthy schoolchildren with a mean (SD) age of 12.5 (1.6) years (range 9.5-14.5 years), 24 children with borderline or mild hypertension, 17 with renal hypertension and normal renal function, 10 with chronic renal failure, and six with a renal allograft. In eight children with definite renal disease a second measurement was performed after treatment modification. The monitor used for ABPM was validated with a mercury column manometer. The mean (SD) of the signed differences of the blood pressure measured by the two methods was -0.19 (1.75) mmHg for the systolic and -0.21 (2.11) mmHg for the diastolic blood pressure (n = 60). Normal values for daytime and night time blood pressure were determined for those aged 10-14 years. The mean (SD) blood pressure of the 123 children was 109 (7)/66 (8) mmHg (systolic/diastolic) for the daytime and 96 (8)/52 (7) mmHg at night time. Of the 24 children with borderline or mild hypertension 14 had a raised blood pressure on ABPM. The circadian rhythm was disturbed in three children of this group. Even children with normal daytime blood pressure had significantly higher systolic blood pressure in the night when compared with the controls. The incidence of disturbed circadian rhythm was higher in the groups with renal hypertension (4/17 in the subgroup with normal renal function, 5/16 in the group with renal failure and/or transplantation). All children undergoing a second ABPM measurement had a lower average blood pressure after treatment adjustment. ABPM measurements were reproducible and accurate. The method provided new data on the physiological circadian variation of blood pressure in healthy children. It proved to be a helpful tool in the diagnosis of hypertension, particularly in the detection of cases of disturbance of the circadian rhythm of blood pressure pattern and individual adjustment of treatment.     

动态血压监测在儿童肾脏疾病中的临床研究

目的 研究儿童肾脏疾病中的动态血压(ABP)的特点.方法 以33例肾脏疾病患儿为研究对象,采用ABPM6100仪进行动态血压测量(ABPM),受试对象均未服用降压药物.以1997年德国1141名健康儿童的ABP值作为正常参考值.结果 夜间高血压发生率高于日间高血压发生率;夜间收缩/舒张压负荷(29.1±34.5)%/(24.9±34.3)%和指数(0.95±0.11)/(0.90±0.18)明显大于日间收缩/舒张压负荷(12.9±23.6)%/(9.3±19.1)%和指数(0.88±0.09)/(0.77±0.12);肾脏疾病患儿夜间收缩/舒张压下降率为(6.6±6.0)%/(8.8±10.2)%,明显低于正常值(13±6)%/(23±9)%;高达24例(72.7%)患儿夜间收缩压和(或)舒张压下降率为"非杓型",即使在正常血压者中也有72.7%的"非杓性"发生率.在33例患儿中随机血压(CBP)升高者5例,均有ABP升高;CBP正常者28例,但其中6例ABP升高.结论 ABPM能发现儿童肾脏疾病中的夜间高血压和血压昼夜节律的异常,为调整用药时机和更全面有效地控制血压提供依据,弥补了传统血压测量的不足;并能发现隐匿性高血压,可以早期发现高血压前期,从而有利于随访和尽早干预.     

ABPM vs office blood pressure to define blood pressure control in treated hypertensive paediatric renal transplant recipients

While 24-h ambulatory blood pressure monitoring (ABPM) is an established tool for monitoring antihypertensive therapy in adults, data in children are scarce. We retrospectively analysed whether office blood pressure (BP) is reliable for the diagnosis of BP control in 26 treated hypertensive paediatric renal transplants. Controlled office BP was defined as the mean of three replicate systolic and diastolic BP recordings less than or equal to the 95th age-, sex- and height-matched percentile on the three-outpatient visits closest to ABPM. Controlled ABPM was defined as systolic and diastolic daytime BP < or =95th distribution adjusted height- and sex-related percentile of the adapted ABPM reference. Eight recipients (30%) with controlled office BP were in fact categorized as having non-controlled BP by ABPM criteria. Overall, when office BP and ABPM were compared using the Bland and Altman method, the 95% limits of agreement between office and daytime values ranged from -12.6 to 34.1 mmHg for systolic and -23.9 to 31.7 mmHg for diastolic BP, and the mean difference was 10.7 and 3.9 mmHg respectively. Office readings miss a substantial number of recipients who are hypertensive by ABPM criteria. Undertreatment of hypertension could be avoided if ABPM is applied as an adjunct to office readings.     

Ambulatory blood pressure monitoring (ABPM) in normotensive adolescents with type 1 diabetes

Abstract: Objective: To evaluate 24‐h ambulatory blood pressure monitoring (ABPM) for early detection of hypertension in adolescents with type 1 diabetes mellitus (DM1). Design: Patients underwent fundoscopy, albuminuria determinations, two repeated autonomic cardiovascular tests, heart rate (HR) variation during deep breathing and blood pressure (BP) variation during sustained handgrip. Twenty‐four hour BP measurements were taken automatically by an oscillometric portable monitor. Setting: A specialty pediatric diabetes clinic and subjects' homes. Participants: Eighteen children aged 10–17 yr with 2+ yr of DM1, without long‐term complications, and 34 controls. Results: Higher ambulatory HR during the day than at night did not differ between DM1 subjects and controls. Mean systolic (s) and diastolic (d) BP in patients during the daytime were not significantly different from the control values. During the night, both sBP and dBP mean values in patients differed from those of controls. Statistical analysis of day and night HR and BP measurements were not different in both groups. The percentage decrease during the night in sBP and dBP was significantly smaller in patients than in controls. There were no differences by gender or duration of diabetes > or < 5 yr or by HbA1 above and below 10%. No difference in nocturnal sBP or dBP decline was observed between patients with or without abnormal autonomic test results. Conclusion: ABPM is more reliable than casual BP measurement in detecting early BP alterations during the night, before the appearance of microalbuminuria, in young patients with DM1.     

Home blood pressure self-measurement in children and adolescents with renal replacement therapy

BACKGROUND: Most patients with terminal renal failure show arterial hypertension. In addition to casual blood pressure measurements in the clinic, home blood pressure measurement is recommended for these patients to control arterial blood pressure. PATIENTS: The study was performed in children with hemodialysis (HD; n = 11), peritoneal dialysis (PD; n = 14) or after renal transplantation (NTX; n = 21) from one department of Pediatric Nephrology. We performed a retrospective analysis of home blood pressure values from patients' diaries. METHODS: The average number of blood pressure measurements per day and the mean blood pressure values were calculated from the blood pressure data documented during one month at home. Single measurements above the 95th percentile for height and gender were defined to be hypertensive and the frequency as percentage of all documented values was calculated. RESULTS: Four patients did not document any blood pressure values at home. The other patients documented an average of 2.3 measurements per day. Systolic hypertension was found in 7% of patients defined by home BP measurements compared to 30% defined by casual BP measurements. Prevalence of diastolic hypertension did not differ between both methods (35% vs. 46%). Mean home BP was significantly higher than values after HD and lower than values before HD. Mean clinic BP was significantly higher in PD-patients compared to home BP. Home and clinic blood pressure values did not differ in patients after renal transplantation. The mean percentage of hypertensive readings for systolic BP was 5 and for diastolic BP 39%. CONCLUSIONS: Blood pressure measurement at home is performed reliably by most children and adolescents with chronic renal failure and shows lower values than clinic BP in many patients. It is an important method for control of blood pressure and a valuable supplement to 24 h blood pressure monitoring.     

Efficacy of 24-hour ambulatory blood pressure monitoring in children

OBJECTIVES: To determine whether the use of an ambulatory blood pressure monitor (ABPM) is feasible and gives accurate readings in children, and to provide data on normal daily blood pressures (BPs) and BP patterns in children. DESIGN: Cohort. SUBJECTS: Ninety-nine healthy fifth-grade students. INTERVENTIONS: Students wore an ABPM for 24 hours while recording their activities in diaries. Before and after the study period, each subject had three BPs simultaneously measured with the ABPM and a mercury manometer to assess the accuracy of the ABPM. An activity scale was retrospectively applied to diary entries to help explain the variety of BP patterns noted during data analysis. RESULTS: Systolic BPs obtained with the ABPM at the beginning and end of the study were slightly higher than those obtained with a mercury manometer; diastolic BPs were virtually identical. A circadian pattern of BPs was noted: mean systolic and diastolic BPs were higher during the day than at night. The BP patterns ranged from "hypoactive" (little baseline variation) to "hyperactive" (wide fluctuations with spikes to elevated BP ranges) during various activities. In general, higher BPs were noted at times of increased activity or emotional levels. CONCLUSIONS: Ambulatory BP monitoring was well tolerated, and measurements were reproducible and accurate. The variety of BP measurements noted at different activity levels indicate that a child's activity should be considered during data analysis. As further experience is gained, the ABPM should prove helpful in diagnosis and management of hypertension in children.     

Isolated systolic hypertension,obesity, and hyperkinetic hemodynamic states in children

OBJECTIVE: To determine the factors that contribute to the pathogenesis of isolated systolic hypertension in children. METHODS: School-based measurement was performed of blood pressure (BP), heart rate, weight, and height in 2460 students (49% Hispanic, 31% black, 13% white) 12 to 16 years of age in 8 urban public schools. An independent group of 71 untreated children underwent 24-hour ambulatory BP monitoring (ABPM) to confirm clinic hypertension and assess circadian BP patterns. RESULTS: Hypertension and obesity were found in 17% and 23% of students, respectively. Among hypertensive students, 88% (363/413) had isolated systolic hypertension. Hypertension was more prevalent in obese than nonobese students (33% vs 11%, P <.0001). Obese hypertensive students had higher resting heart rate than nonobese normotensive patients (85.9 vs 79.6 beats/min, P <.001). Among patients who underwent ABPM, isolated systolic hypertension was found in 51% (36/71) by clinic BP and in 62% (18/29) with confirmed hypertension by ABPM. Blood pressure variability during daytime and sleep periods was higher in obese than nonobese patients for systolic BP (P <.01) and diastolic BP (P <.05). CONCLUSIONS: The findings of increased heart rate and BP variability in obese children with isolated systolic hypertension suggest that sympathetic nervous system hyperactivity may contribute to its pathogenesis.     

Elevated blood pressure and decreased cognitive function among school-age children and adolescents in the United States

OBJECTIVE: To evaluate the relationship between elevated blood pressure (BP) and cognitive test performance in a nationally representative sample of children.Study design The National Health and Nutrition Examination Survey III provides cross-sectional data for children 6 to 16 years, including BP and cognitive test scores. Elevated BP was defined as systolic or diastolic BP >or=90th percentile. Cognitive tests were compared for children with elevated and normal BP. Linear regression was used to evaluate the relation between elevated BP and decreased test scores. RESULTS: Among the 5077 children, 3.4% had systolic BP >or=90th percentile and 1.6% diastolic BP >or=90th percentile. Children with elevated systolic BP had lower average scores compared with normotensive children for digit span (7.9 vs 8.7, P=.01), block design (8.6 vs 9.5, P=.03), and mathematics (89.6 vs 93.8, P=.01). Elevated diastolic BP was associated with lower average scores on block design (9.5 vs 11, P=.01). Linear regression showed that elevated systolic BP was independently associated with lower digit span scores (P=.032). CONCLUSION: Children with elevation of systolic BP are at risk for central nervous system end-organ damage, as manifested by decreased digit span test scores.     

Twenty-four hour monitoring of blood pressure and heart rate in patients with chronic renal failure or renal transplant recipients: Analysis by the cosinor method

Hypertension is a major problem of patients with chronic renal failure or renal transplant recipients. To clarify the characteristics of blood pressure, heart rate, and circadian rhythms of these patients we used an ambulatory blood pressure monitor (ABPM) for 24 h monitoring and analyzed the data by the cosinor method. In eight chronic renal failure patients without dialysis the midline estimating statistic of rhythm (MESOR) of diastolic blood pressure was higher than in controls, but the MESOR of systolic blood pressure was not. Of 11 patients on dialysis some had hypertension and some had hypotension. In 14 renal transplant recipients, especially those with chronic graft rejection, the MESOR of systolic and diastolic pressures were higher than controls, and the increase of blood pressure MESOR had a significant correlation with the elevation of serum creatinine levels. Circadian rhythms of blood pressure were frequently absent in the patients on dialysis, but circadian rhythms of heart rate were not. The use of an ABPM is a non-invasive method to monitor patients and allowed us to know changes of blood pressure and heart rate in the daytime as well as during the night. For the control of hypertension in chronic renal failure, monitoring with an ABPM seems to provide invaluable information.     

24小时动态血压监测直立性高血压患儿血压类型的病例对照研究

目的采用24 h动态血压(ABPM)方法探讨直立性高血压(OHT)患儿的血压类型。方法选取2009年10月至2013年9月在中南大学湘雅二医院(我院)儿童晕厥门诊就诊或住院的患儿,以不明原因晕厥及先兆晕厥为主诉,经直立倾斜试验确诊为OHT者为OHT组。与OHT组年龄及性别匹配,选择同期来我院儿童保健门诊检查的健康儿童为对照组。OHT组和对照组均行ABPM监测,观察收缩压昼夜差值、舒张压昼夜差值,24 h、日间、夜间平均收缩压和舒张压参数,并探讨血压类型。结果 OHT组40例,男23例,女17例,年龄(11.5±1.9)岁。对照组40例,男22例,女18例,年龄(10.6±2.4)岁。1收缩压昼夜差值对照组高于OHT组,(9.8±3.3)vs(8.4±4.7)mm Hg,P0.05。OHT组24 h、日间、夜间的平均收缩压和舒张压稍高于对照组(P0.05)。舒张压昼夜差值对照组稍高于OHT组(P0.05)。2OHT组以非勺型血压为主(72.5%),对照组以勺型血压为主(55.0%),两组血压类型差异有统计学意义(P=0.012)。结论 OHT患儿收缩压昼夜差值较正常儿童明显降低,血压类型以非勺型血压多见,多数患儿血压昼夜节律消失。     

Arterial HTN in children with T1DM—frequent and not easy to diagnose

Introduction: To evaluate the diagnostic efficacy of the office blood pressure (OBP) and ambulatory blood pressure monitoring (ABPM) in the assessment of hypertension (HTN) in children with diabetes mellitus type 1 (T1DM).
Methods: We analyzed OBP and ABPM measurements in 84 diabetic children (43 boys) obtained at a median age of 14.9 yr and 6.3 ± 3.5 yr after diagnosis of T1DM. OBP and ABPM results were converted into standard deviation scores (SDS). In addition, we analyzed blood pressure loads and nighttime dipping. The comparison between OBP and ABPM was performed using kappa coefficient and receiver operator curve (ROC).
Results: HTN was diagnosed in 43/84 (51%) patients using OBP (>95th percentile), and in 24/84 (29%) patients using ABPM ( ≥95th percentile during 24 h, day or night). Both methods were in agreement in 33 ABPM normotensive and 16 ABPM hypertensive patients (most had nighttime HTN); 32% patients had white-coat HTN and 9.5% patients had masked HTN. The kappa coefficient was 0.175 (95% CI from −0.034 to 0.384) suggesting poor agreement between OBP and ABPM. Diastolic OBP was a better predictor of ABPM HTN (ROC area under the curve (AUC) = 0.71 ± 0.06) than systolic OBP (AUC = 0.58 ± 0.07). The percentage of non-dippers ranged from 7 to 23% in ABPM normotensive patients, and 21–42% in ABPM hypertensive patients who also had significantly higher BP loads (p < 0.0001).
Conclusion: Children with T1DM often suffer from nocturnal, white coat- and masked HTN, which can not be assessed and predicted by the OBP.     

Absent circadian variation of blood pressure in patients with anorexia nervosa

OBJECTIVE: To examine whether circadian rhythm of blood pressure (BP) is altered in patients with anorexia nervosa (AN), and if so, to determine whether it is reversible after refeeding.Study design: Ambulatory BP monitoring was performed on 17 female inpatients with AN (mean age, 13.3 +/- 1.9 years) at the time of admission and serially during refeeding; 17 age-matched normal weight, normotensive female inpatients served as control subjects. RESULTS: Patients with AN had lost an average of 23.4% +/- 11.5% of body weight before the illness. Weight after refeeding was 105.6% +/- 9. 2% of that before illness. Mean 24-hour systolic BP (SBP) (96.5 +/- 8.6 mm Hg) and diastolic BP (DBP) (53.4 +/- 5.8 mm Hg) were significantly lower in patients with AN compared with those of control subjects (SBP, 106.1 +/- 6.5 mm Hg; DBP, 60.2 +/- 5.8 mm Hg). Although awake SBP and DBP were also lower in patients with AN, asleep SBP and DBP were not statistically different from those of control subjects. Night/day BP ratio in the control group was 0.93 +/- 0.06 in systolic and 0.92 +/- 0.09 in diastolic. Those values were significantly elevated in patients with AN (systolic 1.00 +/- 0. 09 and diastolic 1.00 +/- 0.09). After refeeding, the ratio decreased to 0.88 +/- 0.09 and 0.90 +/- 0.08,respectively (both P <. 05 vs baseline). CONCLUSIONS: In patients with AN, circadian variation of BP is absent. This reverts to normal after refeeding.     

Systolic and diastolic function in children with chronic renal failure

BACKGROUND: Cardiovascular complications are the most frequent cause of death in patients with end-stage renal failure (ESRF). We aimed to investigate systolic and diastolic functions in children with ESRF. METHODS: Thirty-nine children with ESRF (17 on continuous ambulatory peritoneal dialysis (CAPD), eight on hemodialysis and 14 on predialysis) were examined to assess systolic and diastolic functions by echocardiography and ultrasound Doppler. Left ventricular systolic and diastolic functions were measured both in patients and age-matched healthy controls (n = 20) and the indices of cardiac performance were compared. RESULTS: Increased left ventricular mass index (LVMI) and decreased volume/mass ratio with normal systolic left ventricular function was found in patients, as compared with controls. Left ventricular diastolic dysfunction was observed in dialysis patients. In most of these patients, left ventricular isovolumic relaxation time was prolonged, except in CAPD patients. The peak of late diastolic flow (A) velocities were increased with a reduction of the early diastolic flow velocity (E)--the E/A ratio. The E velocities were unchanged in all patients as compared with controls. Our data indicated an abnormality of myocardial relaxation in patients with ESRF. We found no relationship between E/A ratio and LVMI. Among three groups of patients, the LVMI and diastolic abnormalities were highest in the hemodialysis group indicative of poor control of hypervolemia and hypertension. CONCLUSIONS: The technique of CAPD has some advantages as a renal replacement therapy for preserving cardiac functions as compared with hemodialysis. However, it must be remembered that patients with hemodialysis have features that effects cardiac status, such as higher volume load and higher afterload (hypertension).     

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??Objective To discuss the changes of ambulatory blood pressure monitoring??ABPM?? in children with vasovagal syncope ??VVS??.Methods A total of 72 children ??VVS group??32 males??40 females??mean age ??10.98±1.86??years?? were enrolled in this study??who came from Children Syncope Outpatient Department or Inpatient Department of the Second Xiangya Hospital of Central South University from Sep 2008 to Feb 2010.After confirmed diagnosis of VVS by positive head-up tilt test ??HUTT????each patient was given ABPM.Forty healthy children ??19 males??21 females??mean age 10.24 ± 2.01 years?? were as controls ??control group??.Parameters of ABPM in children were analyzed.SPSS 17.0 software was used for the statistical analysis of these data.Results ??1??Mean pressure??24-hour mean systolic pressure ??24hSBP????24-hour mean diastolic pressure ??24hDBP????daytime mean systolic pressure ??DSBP?? and nighttime mean systolic pressure ??NSBP?? in VVS group were higher than those of the control group ??P??0.05??.??2??Blood pressure pattern??the ratio of non-spoon pressure pattern was higher than that of spoon pressure pattern with VVS ??67%vs.18%??P ??0.05??.NDBP ??P??0.05?? and NSBP ??P ??0.05?? were decreased and the systolic pressure differences and diastolic pressure differences in the daytime and at nighttime were higher in spoon pressure pattern than those of non-spoon pressure pattern with VVS ??P??0.05??.??3??Diagnostic experimental evaluation??the specificity??sensitivity??diagnostic coincidence??positive predict value and negative predict value of non-spoon pattern of ambulatory blood pressure pattern to VVS was 82.5%??66.67%??72.32%??87.27% and 57.89%??respectively.The Youden index was 45.28%.Conclusion There is autonomic nerve adjustment imbalance in children with VVS during asymptomatic time periods??especially the sympathetic nerve.The non-spoon pattern rate of fluctuation curve of ambulatory blood pressure in VVS children is higher??which is of diagnosis value to VVS children.