AMBULATORY BLOOD-PRESSURE MONITORING IN PEDIATRIC-PATIENTS TREATED BYREGULAR HEMODIALYSIS AND PERITONEAL-DIALYSIS

Ambulatory blood pressure monitoring (ABPM) has been shown to be more representive of blood pressure (BP) levels than casual BP measurements in adult patients treated by haemodialysis (HD). In this study we com pared ABPM using the oscillometric SpaceLabs 90207 monitor with casual BP measurements in 35 paediatric patients [17 treated by peritoneal d ialysis (PD) and 18 by HD]. Heart rate and plasma concentrations of at rial natriuretic peptide were also measured. No correlations were foun d between ABPM and casual BP measurements, except for systolic day-tim e BP in PD patients (r = 0.63). Seventy percent of PD and 33% of HD pa tients were regarded as hypertensive when evaluated by ABPM, while cas ual BP measurements demonstrated hypertension in 47% (P < 0.05) of PD patients and in 44% (NS) of HD patients. One-third of patients were re classified by ABPM either from normotensive to hypertensive (7/19) or from hypertensive to normotensive (5/16). BP assessed by ABPM was high er in PD than in HD patients. The physiological decline of BP at night was significant and more pronounced in PD than in HD patients. In HD patients day-time BP did not differ between the Ist and the 2nd interd ialytic day, but increased in the night hours before the following dia lysis session. A positive correlation was found between day-time BP an d pre-dialysis plasma atrial natriuretic peptide in both treatment gro ups. In conclusion this study demonstrates that casual BP recordings a re not representative of average BP in dialysed paediatric patients. A BPM is useful in the diagnosis and treatment of hypertension in childr en with endstage renal disease.