ABPM Used to Identify Masked Hypertension in Children with Chronic Kidney Disease

A recent article published in the Journal of the American Society of Nephrology (JASN)¹ emphasizes the key role of 24 hour ambulatory blood pressure monitoring (ABPM) as a means to identify masked hypertension in pediatric patients with Chronic Kidney Disease (CKD). The study, published in January 2010, showed that many children with CKD who have normal blood pressure readings at the doctor's office often have high blood pressure readings at home. The researchers used ABPM to collect blood pressure measurements throughout the day including periods of sleep and normal daily activity, which provides a more accurate BP profile for each pediatric patient.

As a result of the study, they found that many of the CKD patients with mild to moderate conditions who present normal BP readings in the doctor's office were likely to have elevated BP measurements outside of the office. This is referred to as masked hypertension. If left untreated, these hypertensive patients are at risk for developing heart disease, specifically an enlarged heart, also known as left ventricular hypertrophy (LVH).

It is easy to forget how often our blood pressure changes in response to our surroundings and other influences (see earlier blog post for more details). This makes Hypertension often difficult to diagnose in the course of a single doctor's visit. This is precisely why ABPM should be viewed as the standard of care for the detection of this deadly disease and this latest study is yet another example as to why.

1. Mark Mitsnefes, Joseph Flynn, Silvia Cohn, Joshua Samuels, Tom Blydt-Hansen, Jeffrey Saland, Thomas Kimball, Susan Furth, Bradley Warady and for the CKiD Study Group, Masked Hypertension Associates with Left Ventricular Hypertrophy in Children with CKD, J Am Soc Nephrol 21: 137-144, 2010, © 2010 American Society of Nephrology, doi: 10.1681/ASN.2009060609
2. Medical News Today, November 13, 2009: “Doctors' Tests Often Miss High Blood Pressure In Kids with Kidney Disease”