CIRCADIAN BLOOD-PRESSURE CHANGES IN UNTREATED CHILDREN WITH KIDNEY-DISEASE AND CONSERVED RENAL-FUNCTION

Ambulatory blood pressure monitoring over 24 h was applied in 31 child ren with kidney disease, aged 3-19 (median 11) years, in the absence o f renal insufficiency and without antihypertensive therapy. Median cre atinine clearance was 112 ml/min/1.73 m(2). Ambulatory blood pressure monitoring revealed that eight patients (26%) were hypertensive during the daytime, compared to 62% through casual recordings obtained in th e office and 38% when blood pressure was taken at home. Nocturnal hype rtension was detected by ambulatory monitoring in six patients, two of whom had normal blood pressure in the daytime. Median nocturnal dippi ng was 13% for systolic and 21% for diastolic blood pressure, i.e. sim ilar to healthy children. Rhythm analysis recognized a distorted circa dian pattern for systolic and/or diastolic blood pressure in eight pat ients. In conclusion, ambulatory blood pressure monitoring allows the evaluation of hypertension more reliably than casual recordings in the office. Nocturnal hypertension, as a major risk factor for renal dete rioration, is detected in a similar proportion as daytime hypertension in almost 20% of untreated children with kidney disease and normal re nal function.