Subclinical target organ damage in a sample of children and adolescents with solitary functioning kidney. A pilot study

医学 心脏病学 亚临床感染 内科学 脉冲波速 血压 动态血压 隐匿性高血压 优势比 颈动脉超声检查 左心室肥大 置信区间 颈动脉
作者
Angela Tagetti,Filippo Cattazzo,Denise Marcon,Simone Romano,Alice Giontella,Stefano Bortolotti,Pietro Minuz,Luca Pecoraro,Milena Brugnara,Cristiano Fava
出处
期刊:Journal of Hypertension [Lippincott Williams & Wilkins]
标识
DOI:10.1097/hjh.0000000000003857
摘要

Background: Patients with solitary functioning kidney appear to be exposed to an increased cardiovascular risk. This study aimed to evaluate the impact of peripheral and central blood pressure on subclinical cardiovascular organ damage in a sample of children and adolescents with solitary functioning kidney. Methods: Carotid ultrasonography was performed to measure the carotid intima-media thickness (cIMT) and the carotid distensibility coefficient. The carotid-femoral pulse wave velocity (PWV) was assessed by tonometry. Cardiac mass and remodeling were estimated using transthoracic echocardiography. Central and peripheral (both office and 24-h ambulatory) BP measurements were collected. Results: Forty-four patients were included. Eighteen subjects (45%) were hypertensive as assessed by 24-h ABPM, with a prevalence of masked hypertension of 43%. Twenty-three subjects (52%) had an increased cIMT, while 2 and 3 patients (5% and 7%) demonstrated an impaired carotid distensibility coefficient and PWV, respectively. Nineteen subjects (43%) showed concentric cardiac remodeling. Central systolic blood pressure (cSBP) correlated with cIMT ( r = 0.35) and left ventricular mass index (LVMi) ( r = 0.32) demonstrating a positive independent association with an increased cIMT (odds ratio 1.14, 95% confidence interval 1.01–1.29) in multivariate regression analysis. Conclusion: Children and adolescents with solitary functioning kidney exhibited a high prevalence of masked hypertension and subclinical cardiovascular organ damage. These findings support the use of 24-h ABPM to identify patients with a higher cardiovascular risk who would benefit from hypertension treatment and closer monitoring during growth and into adulthood. Additionally, cSBP measurement should be considered as part of a more detailed cardiovascular risk assessment in these patients.
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