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Abstract: PO2087

Ambulatory Blood Pressure Monitoring Patterns in Children and Adolescents with Lupus Nephritis

Session Information

Category: Hypertension and CVD

  • 1402 Hypertension and CVD: Clinical, Outcomes, and Trials

Authors

  • Mazo, Alexandra, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York, United States
  • Duong, Minh Dien, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York, United States
  • Mahgerefteh, Joseph, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York, United States
  • Goilav, Beatrice, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York, United States
Background

Hypertension (HTN) is often underdiagnosed and undertreated. Masked HTN can reach 49% in chronic kidney disease (CKD) in children. The prevalence of HTN in systemic lupus erythematosus (SLE) varies from 30 to 77%. A small study demonstrated that children with SLE are prone to have blunted dipping. Nocturnal HTN and blunted dipping are independent predictors for all-cause cardio-vascular morbidity/mortality, independent of 24-hr systolic blood pressure (BP) levels.

Methods

Patients (<21 years) with lupus nephritis (LN) were enrolled. Clinical, laboratory, ambulatory blood pressure monitor (ABPM) and echo were reviewed. Max dose of steroids was 20 mg (1 patient). Variables included age, gender, ethnicity, CKD stage, BMI, MMF level, complement levels, dsDNA, proteinuria.

Results

Of the 10 patients (8 F, 2 M), 8 were Hispanic, 2 African American, 9 had CKD stage 1, 1 had CKD stage 2, and mean age was 16.2 y (11-20y). Class III LN was in 4 patients, class IV and V – in 3 patients each. BP during the previous 3 visits were normal in 8 patients and 6 patients were on BP medications. Based on ABPM data, 3 of 6 treated patients had uncontrolled HTN. Of the 4 patients without BP treatment 2 had pre-HTN. Blunted dipping was seen in 6 patients. Echo was done for 5 patients with ABPM abnormalities. Left ventricular mass index (LVMI), relative wall thickness (RWT) and ejection fraction were normal. Left ventricle was dilated in 1 patient. Obesity, dsDNA, MMF level, proteinuria, use of steroids and antihypertensives did not differ significantly between the patients with and without BP abnormalities.

Conclusion

Masked HTN and blunted nocturnal dipping is common in adolescents with SLE and can be missed if ABPM is not applied in clinical practice. Additional studies are required to find risk factors and management strategy.

PatientObesityLN classUrine protein creatinine ratio, g/gPrednisone, mg dailyOffice BPBP medicationsABPMBlunted dippingLVMI,
g/m2.7
RWT
1-40.215Normal-Normal+  
2+31.80Normal-Normal+470.28
3+40.30Normal+Controlled HTN-  
4+30.17.5Normal+Controlled HTN-  
5-50.110Normal+Controlled HTN+370.32
6-50.10Normal-Pre-HTN-  
7-30.10Normal-Pre-HTN+290.37
8+30.15Normal+Uncontrolled HTN-330.38
9-50.420HTN+Uncontrolled HTN+  
10-40.80HTN+Uncontrolled HTN+310.33