Abstract: FR-PO552

Ventricular Dysfunction in Children with Controlled Hypertension and CKD

Session Information

Category: Hypertension

  • 1106 Hypertension: Clinical and Translational - Secondary Causes

Authors

  • Seeherunvong, Wacharee, University of Miami/ Pediatric Nephrology, Miami, Florida, United States
  • Arenas Morales, Aura Jeannette, University of Miami/ Pediatric Nephrology, Miami, Florida, United States
  • Agarwal, Arpit Kumar, University of Miami/Pediatric Cardiology, Miami, Florida, United States
  • Defreitas, Marissa J., University of Miami/ Pediatric Nephrology, Miami, Florida, United States
  • Katsoufis, Chryso P., University of Miami/ Pediatric Nephrology, Miami, Florida, United States
  • Zilleruelo, Gaston E., University of Miami/ Pediatric Nephrology, Miami, Florida, United States
  • Abitbol, Carolyn L., University of Miami/ Pediatric Nephrology, Miami, Florida, United States
  • Swaminathan, Sethuraman, University of Miami/Pediatric Cardiology, Miami, Florida, United States
  • Freundlich, Michael, University of Miami/ Pediatric Nephrology, Miami, Florida, United States
Background

Hypertension (HTN) contributes to left ventricular hypertrophy (LVH) and dysfunction, and accelerates cardiovascular (CV) disease in chronic kidney disease (CKD), but the thresholds linking blood pressure (BP) with eventual CV events in children are unknown. Suggested targets for optimal therapy are <95th %ile BP reference values, but whether sustaining BP within these targets averts LVH and ventricular dysfunction in children is uncertain.

Methods

From 70 patients (14.6±0.2 years) with an initial diagnosis of HTN and available echocardiographic evaluation, 33 (14 on renin-angiotensin system blockers) with controlled BP <95th %ile and eGFR-based CKD stages 1 (n=16), 2-4 (n=10) and 5D (n=7) were analyzed.

Results

BP Z-scores (Zs) were similar in all groups. Echocardiogram revealed LVH in 19%, 20% and 43% in stages 1, 2-4 and 5D, and abnormal relative wall thickness (RWT >0.37cm) in 44%, 60% and 71% respectively. While systolic function remained normal, diastolic function E/A ratio was reduced in 13%,20% and 71% of stages 1,2-4 and 5D and declined across stages (p<0.05) (Figure 1). E/Em and E/Es abnormal Zs were uncommon. At least 1 abnormal diastolic function was present in 25%, 50% and 86% in above stages (p<0.05). LVMI Zs correlated positively with BMI Zs, E/Em and E/Es Zs, and negatively with serum Ca (all p<0.05), but did not correlate with BP Zs. BP Zs did not correlate with any marker of diastolic function.

Conclusion

Despite controlled HTN, abnormal ventricular geometry and altered diastolic function were observed even in the earliest stages CKD. Other factors operative with declining kidney function may be responsible for the described changes. Longitudinal studies are needed to evaluate the effects of more stringent BP control on LVH and abnormal diastolic function in young CKD patients with HTN.

Funding

  • Clinical Revenue Support