Hypertension often undetected in children with chronic kidney disease

Many children with chronic kidney disease have unidentified or undertreated hypertension, which increases the risk for left ventricular hypertrophy and cardiovascular disease later in life, according to a study published online in November in the Journal of the American Society of Nephrology.

Researchers analyzed data on 198 children enrolled in the ongoing Chronic Kidney Disease in Children study for patients age 1 to 16 with mild to moderate CKD. They found that 18% of the children had hypertension and 38% had masked hypertension. Among children with masked hypertension, 29% were not taking antihypertensive medications (link).

"We didn't anticipate such a high frequency of untreated or unrecognized hypertension in these children. That's really surprising," said study lead author Mark Mitsnefes, MD, pediatric nephrologist and associate professor at Cincinnati Children's Hospital Medical Center.

Even more surprising, Dr. Mitsnefes said, was that children identified as having masked hypertension were four times more likely to have left ventricular hypertrophy than were children with normal blood pressure.

"We need to be more diligent with recognizing blood pressure problems in these children. ... The early recognition and treatment of this problem will prevent the progression of heart disease when these children become young adults," he said.

Dr. Mitsnefes said echocardiography and 24-hour blood pressure monitoring should be ordered when a child is diagnosed with CKD. If problems are detected, the procedures should be repeated frequently. If the results are normal, the procedures should be repeated every two years.

It's not always easy to convince children diagnosed with hypertension to take their medication as prescribed, said Jens Goebel, MD, associate professor of pediatrics, clinical director of nephrology and hypertension, and medical director of kidney transplantation at Cincinnati Children's Hospital Medical Center.

In addition to explaining the importance of the medication, Dr. Goebel said, doctors can prescribe medicine that is easy for children to swallow, has once daily dosing and few side effects.

"The take-home message is if you're a physician who [treats] children with CKD, you better make sure you're really on top of these kids' blood pressure. Measure it accurately. ... And if it's elevated, treat it adequately," Dr. Goebel said.