Casual and ambulatory blood pressure monitoring in children with renal scarring

INTRODUCTION: Renal scarring is the most common cause of arterial hypertension in children. High blood pressure (BP) and microalbuminuria contribute to the progression of chronic renal disease. OBJECTIVE: The aims of the study were: to assess BP in children with renal scarring by continuous ambulatory blood pressure measurement (ABPM) in comparison to the casual method (CBP), and to determine the correlation between ambulatory blood pressure (ABP) and/or casual blood pressure (CBP) values and proteinuria in children with renal scarring, METHOD: This forward-looking study comprised thirty-five children (26 girls and 9 boys), aged between 3-18 years, 10.4 +/- 3.9, X +/- SD. Blood pressure was measured using the casual method (CBP) with a mercury manometer; BP was measured three times and the average was taken as a referent value. ABPM was performed using the oscillometric method with the SpaceLabs device, model 90207. RESULTS: 45.71% of patients were classified as hypertensive by ABPM, while only 22.6% of CBP measurements were above the 95th percentile (p < 0.01). "White coat hypertension" was present in 40% of the patients. Non-dipping BP alteration was detected in 37.14% of the patients. CONCLUSION: Nocturnal systolic hypertension (systolic non-dipping alteration) is very frequent in children with renal scarring. Nocturnal diastolic blood pressure, detectable only via ABPM, is positively correlated with proteinuria and may be an initial sign of the progression of renal scarring. ABPM is more sensitive than CBP in the evaluation of BP in children with renal scarring.