24-hour ambulatory blood pressure monitoring 9 years after pediatric cardiac surgery: a pilot and feasibility study

Daniel Fredric; Jason H. Greenberg; Chirag R. Parikh; Prasad Devarajan; Hayton Chui; Vedran Cockovski; Michael Pizzi; Ana Palijan; Erin Hessey; Yaqi Jia; Heather R. Thiessen-Philbrook; Michael Zappitelli

doi:10.1007/s00467-020-04847-2

24-hour ambulatory blood pressure monitoring 9 years after pediatric cardiac surgery: a pilot and feasibility study

Daniel Fredric, Jason H. Greenberg, Chirag R. Parikh, Prasad Devarajan, Hayton Chui, Vedran Cockovski, Michael Pizzi, Ana Palijan, Erin Hessey, Yaqi Jia, Heather R. Thiessen-Philbrook, Michael Zappitelli

School of Medicine

Research output: Contribution to journal › Article › peer-review

Abstract

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.

Original language	English (US)
Pages (from-to)	1533-1541
Number of pages	9
Journal	Pediatric Nephrology
Volume	36
Issue number	6
DOIs	https://doi.org/10.1007/s00467-020-04847-2
State	Published - Jun 2021

Keywords

Ambulatory blood pressure monitoring
Blood pressure
Cardiac surgery
Children
Hypertension

ASJC Scopus subject areas

Pediatrics, Perinatology, and Child Health
Nephrology

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10.1007/s00467-020-04847-2

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Fredric, D., Greenberg, J. H., Parikh, C. R., Devarajan, P., Chui, H., Cockovski, V., Pizzi, M., Palijan, A., Hessey, E., Jia, Y., Thiessen-Philbrook, H. R., & Zappitelli, M. (2021). 24-hour ambulatory blood pressure monitoring 9 years after pediatric cardiac surgery: a pilot and feasibility study. Pediatric Nephrology, 36(6), 1533-1541. https://doi.org/10.1007/s00467-020-04847-2

Fredric, D, Greenberg, JH, Parikh, CR, Devarajan, P, Chui, H, Cockovski, V, Pizzi, M, Palijan, A, Hessey, E, Jia, Y, Thiessen-Philbrook, HR & Zappitelli, M 2021, '24-hour ambulatory blood pressure monitoring 9 years after pediatric cardiac surgery: a pilot and feasibility study', Pediatric Nephrology, vol. 36, no. 6, pp. 1533-1541. https://doi.org/10.1007/s00467-020-04847-2

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title = "24-hour ambulatory blood pressure monitoring 9 years after pediatric cardiac surgery: a pilot and feasibility study",

abstract = "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{\textquoteright}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 [eBPSingleVisit]; HTNSingleVisit); 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 eBPSingleVisit 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.",

keywords = "Ambulatory blood pressure monitoring, Blood pressure, Cardiac surgery, Children, Hypertension",

author = "Daniel Fredric and Greenberg, {Jason H.} and Parikh, {Chirag R.} and Prasad Devarajan and Hayton Chui and Vedran Cockovski and Michael Pizzi and Ana Palijan and Erin Hessey and Yaqi Jia and Thiessen-Philbrook, {Heather R.} and Michael Zappitelli",

note = "Funding Information: This study was supported by the National Institutes of Health (NIH) (grant R01HL085757 to Dr. Parikh) to fund the TRIBE-AKI Consortium to study novel biomarkers of acute kidney injury in cardiac surgery. Dr. Greenberg is funded by the NIH career development grant K08DK110536 and a Charles H. Hood Foundation grant. Dr. Devarajan is supported by the NIH (grant P50DK096418). Dr. Parikh is also a member of the NIH-sponsored Assessment, Serial Evaluation, and Subsequent Sequelae in Acute Kidney Injury Consortium (U01DK082185). MZ was supported by a salary award from the Fonds de Recherche du Quebec – Sante (FRQ-S) during the majority of the conduct of this study. The funders/sponsors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Publisher Copyright: {\textcopyright} 2021, IPNA.",

year = "2021",

month = jun,

doi = "10.1007/s00467-020-04847-2",

language = "English (US)",

volume = "36",

pages = "1533--1541",

journal = "Pediatric Nephrology",

issn = "0931-041X",

publisher = "Springer Verlag",

number = "6",

}

TY - JOUR

T1 - 24-hour ambulatory blood pressure monitoring 9 years after pediatric cardiac surgery

T2 - a pilot and feasibility study

AU - Fredric, Daniel

AU - Greenberg, Jason H.

AU - Parikh, Chirag R.

AU - Devarajan, Prasad

AU - Chui, Hayton

AU - Cockovski, Vedran

AU - Pizzi, Michael

AU - Palijan, Ana

AU - Hessey, Erin

AU - Jia, Yaqi

AU - Thiessen-Philbrook, Heather R.

AU - Zappitelli, Michael

N1 - Funding Information: This study was supported by the National Institutes of Health (NIH) (grant R01HL085757 to Dr. Parikh) to fund the TRIBE-AKI Consortium to study novel biomarkers of acute kidney injury in cardiac surgery. Dr. Greenberg is funded by the NIH career development grant K08DK110536 and a Charles H. Hood Foundation grant. Dr. Devarajan is supported by the NIH (grant P50DK096418). Dr. Parikh is also a member of the NIH-sponsored Assessment, Serial Evaluation, and Subsequent Sequelae in Acute Kidney Injury Consortium (U01DK082185). MZ was supported by a salary award from the Fonds de Recherche du Quebec – Sante (FRQ-S) during the majority of the conduct of this study. The funders/sponsors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Publisher Copyright: © 2021, IPNA.

PY - 2021/6

Y1 - 2021/6

N2 - 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 [eBPSingleVisit]; HTNSingleVisit); 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 eBPSingleVisit 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.

AB - 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 [eBPSingleVisit]; HTNSingleVisit); 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 eBPSingleVisit 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.

KW - Ambulatory blood pressure monitoring

KW - Blood pressure

KW - Cardiac surgery

KW - Children

KW - Hypertension

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JO - Pediatric Nephrology

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ER -

24-hour ambulatory blood pressure monitoring 9 years after pediatric cardiac surgery: a pilot and feasibility study

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