Background

Children undergoing cardiac surgery are at risk of high blood pressure (BP), a risk factor for cardiovascular and kidney disease. Twenty-four-hour ambulatory BP monitoring (ABPM) is a reference standard hypertension (HTN) test. Little data exist on ABPM abnormalities in children several years post cardiac surgery. This study aimed to (a) determine ABPM feasibility; (b) describe and compare ABPM measures and abnormalities (percent load, masked HTN [MH]; non-dipping, mean systolic/diastolic BP > 95th percentile; pre-HTN (ABPM); white-coat HTN [WCH]) to casual BP; and (c) compare BP in patients with and without acute kidney injury (AKI).

Methods

Prospective, follow-up pilot study of children (0–18 years) who underwent cardiac surgery from 2007 to 2009 at Montreal Children’s Hospital. We recorded if participants had post-operative AKI and assessed the following outcomes at 9-year follow-up: casual BP classified by three single-visit measures (normal; elevated BP [eBP_SingleVisit]; HTN_SingleVisit); ABPM. Bivariable analyses were used to compare characteristics between groups.

Results

Twenty-three patients (median [interquartile range], 8.6 [8.0, 9.0] years post cardiac surgery) were included; 16 (70%) male. Six participants (26%) had eBP_SingleVisit or higher. On ABPM, 11 (48%) had ≥ 1 abnormality: 9 (39%) had non-dipping; 3 (13%) had pre-HTN; 3 (13%) had WCH; none had HTN or MH. There were no differences in ABPM according to AKI status.

Conclusion

Our pilot study determined that ABPM was feasible in children years after cardiac surgery and frequently identified ABPM abnormalities. Future research in larger populations is needed to define specific risk factors for HTN in children after cardiac surgery.

中文翻译：

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小儿心脏手术后 9 年的 24 小时动态血压监测：试点和可行性研究

 背景

接受心脏手术的儿童面临高血压 (BP) 的风险，这是心血管和肾脏疾病的危险因素。二十四小时动态血压监测 (ABPM) 是参考标准高血压 (HTN) 测试。关于心脏手术后数年儿童 ABPM 异常的数据很少。本研究旨在 (a) 确定 ABPM 的可行性； (b) 描述和比较 ABPM 测量值和异常情况（负荷百分比、掩蔽 HTN [MH]；非浸渍、平均收缩压/舒张压 > 95%；HTN 前 (ABPM)；白大衣 HTN [WCH]）与休闲测量血压； (c) 比较患有和不患有急性肾损伤 (AKI) 的患者的血压。

 方法

对 2007 年至 2009 年在蒙特利尔儿童医​​院接受心脏手术的儿童（0-18 岁）进行的前瞻性后续试点研究。我们记录了参与者是否患有术后 AKI，并在 9 年随访时评估了以下结果：按三种单次就诊测量分类的偶然血压（正常；血压升高 [eBP _SingleVisit ]；HTN _SingleVisit ）；动态血压监测。双变量分析用于比较组间特征。

 结果

纳入 23 名患者（中位[四分位距]，心脏手术后 8.6 [8.0，9.0] 年）； 16 名 (70%) 男性。六名参与者 (26%) 拥有 eBP _SingleVisit或更高版本。在 ABPM 中，11 名（48%）有 ≥ 1 项异常：9 名（39%）有非倾斜； 3 人 (13%) 患有 HTN 前期； 3 人（13%）有 WCH；没有人患有 HTN 或 MH。根据 AKI 状态，ABPM 没有差异。

 结论

我们的试点研究确定 ABPM 对于心脏手术后数年的儿童是可行的，并且经常发现 ABPM 异常。未来需要对更多人群进行研究，以确定心脏手术后儿童发生高血压的具体危险因素。