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Proteinuria and nocturnal blood pressure dipping in hypertensive children and adolescents

Abstract

Background

The absence of nocturnal blood pressure dipping is associated with adverse cardiovascular outcomes in adults, and proteinuria is a risk factor for non-dipping in this population. Risk factors for non-dipping in children are largely unknown.

Methods

We retrospectively identified patients aged 5–19 years who underwent 24-h ambulatory blood pressure monitoring (ABPM) from August 2018 to January 2019 and had a spot urine protein-to-creatinine ratio (PCR) within 1 year of their ABPM. Dipping was defined as ≥10% reduction in systolic and diastolic blood pressure from day to night. Multivariable logistic and linear regression models evaluated the association of proteinuria with non-dipping.

Results

Among 77 children identified, 27 (35.1%) were non-dippers. Each two-fold higher urine PCR was associated with 38% higher odds of non-dipping, after adjusting for body mass index (BMI). Higher urine PCR was also associated with a lower diastolic dipping percentage by 1.33 (95% confidence interval 0.31–2.34), after adjusting for BMI, age, and estimated glomerular filtration rate.

Conclusions

Limitations of this study include its retrospective design and the time lapse between urine PCR and ABPM. Proteinuria appears to be associated with blood pressure non-dipping in children. This finding needs to be confirmed in prospective studies.

Impact

  • Our study demonstrates the association of proteinuria with non-dipping of blood pressure in children.

  • This association has been explored in adults, but to our knowledge, this is the first time it is evaluated in children referred for evaluation of elevated blood pressure.

  • Non-dipping is a modifiable risk factor for kidney function decline and cardiovascular disease in adulthood, and thus early identification in children is important. The association between proteinuria and non-dipping in children will allow us to more readily identify those at risk, with a future focus on interventions to modify blood pressure dipping patterns.

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Fig. 1: A total of 214 ABPMs were completed between August 2018 and January 2019, of which 213 were first-time ABPMs.
Fig. 2: The distribution of log2(PCR).
Fig. 3: The correlation between dipping and and log2(PCR).

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Acknowledgements

This work was supported by the National Institutes of Diabetes and Digestive and Kidney Disease through Grants 5T32DK104717-04 (C.Y.B.), K23 DK114556 (P.S.G.), and K24 DK110427 (J.H.I.).

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Contributions

C.Y.B, J.H.I., and P.S.G.: substantial contributions to conception and design, and analysis and interpretation of data. C.Y.B. and K.T.V.: acquisition of data. C.Y.B., K.T.V., C.E.C., F.B.G., J.H.I., and P.S.G.: drafting the article and revising it critically for important intellectual content, and final approval of the version to be published.

Corresponding author

Correspondence to Pranav S. Garimella.

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The authors declare no competing interests.

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This retrospective, cross-sectional study was approved by the UCSD IRB (#200336). Consent was not required.

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Bakhoum, C.Y., Vuong, K.T., Carter, C.E. et al. Proteinuria and nocturnal blood pressure dipping in hypertensive children and adolescents. Pediatr Res (2021). https://doi.org/10.1038/s41390-020-01315-3

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