Kidney Week

Abstract: TH-PO1186

Association Between Ambulatory Blood Pressure Z-Scores and Echocardiographic Remodeling in Children and Adolescents

Session Information

• Pediatric Nephrology: CV Health, CKD, AKI, Dialysis, Transplantation, and Health Services Research
  October 22, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

• 1800 Pediatric Nephrology

Authors

• Kim, Jeong Yeon, Samsung Medical Center, Gangnam-gu, Seoul, Korea (the Republic of)

Jeong Yeon Kim, DrMed, DrPH

• Cho, Heeyeon, Samsung Medical Center, Gangnam-gu, Seoul, Korea (the Republic of)

Heeyeon Cho, MD, PhD

Background

Ambulatory blood pressure monitoring (ABPM) may better capture cardiovascular burden than clinic BP in children. We examined whether pediatric ABPM z-scores were associated with left ventricular (LV) remodeling and diastolic function.

Methods

We included pediatric subjects aged 0–18 years who underwent ABPM between 2015 and 2024, were not receiving antihypertensive medication, and had echocardiography within 3 months of ABPM. Awake and asleep systolic and diastolic BP z-scores were calculated using LMS-based pediatric reference values. Left ventricular hypertrophy (LVH) was defined by AAP (American Academy of Pediatrics) criteria as left ventricular mass index (LVMI) >51 g/m^2.7 and by ESH (European Society of Hypertension) criteria as LVMI above the age- and sex-specific 95th percentile. Abnormal relative wall thickness (RWT) was defined as >0.41 by AAP and >0.38 by ESH criteria. Associations with echocardiographic parameters and LVH/RWT outcomes were assessed using correlation analyses and multivariable linear or logistic regression adjusted for body surface area, age, and sex.

Results

A total of 107 untreated subjects were included (age 13.9±3.5 years; 72.9% male). Among evaluable subjects, ESH-defined LVH and abnormal RWT were present in 34.9% and 47.8%, respectively; AAP-defined LVH and abnormal RWT were present in 17.0% and 34.4%. All four ABPM z-scores were associated with higher LVMI, lower E′, and higher E/E′. In fully adjusted partial correlation analyses, asleep diastolic BP z-score showed the strongest associations with LVMI indexed to BSA (r=0.559, p<0.0001), LVMI indexed to height^2.7 (r=0.533, p<0.0001), E′ (r=-0.589, p<0.0001), and E/E′ (r=0.450, p<0.0001). In fully adjusted logistic models, all four ABPM z-scores were significantly associated with ESH-defined LVH and abnormal RWT. AAP-defined LVH was also associated with all four z-scores, whereas AAP-defined abnormal RWT was associated only with asleep diastolic BP z-score.

Conclusion

In untreated pediatric subjects, higher ABPM z-scores were independently associated with LV remodeling and diastolic dysfunction markers. Nighttime diastolic BP burden showed the strongest relationship with LVMI, E′, and E/E′, suggesting that nighttime diastolic BP warrants particular attention as a marker of cardiac target-organ involvement.