Perfil clínico de los pacientes tratados con evolocumab en unidades hospitalarias de nefrología en España

Describir las características clínicas de los pacientes tratados con evolocumab, las razones del inicio de la terapia y los efectos del tratamiento en la fase inicial de disponibilidad de evolocumab en las unidades de nefrología de España.

Predictors of Progression in Hypertensive Renal Disease in Children

In hypertensive renal disease in children, several risk factors influence the development and the rate of progression of renal damage, including blood pressure levels, proteinuria, lipid disorders, and genetic differences. The impact of blood pressure on renal structures, the most important of the factors, depends not only on blood pressure levels, but also on the persistence of the blood pressure levels over time, mainly during the hours when the patient is resting or sleeping. Abnormal circadian variability is frequently observed in patients with renal damage, and nocturnal blood pressure reduction should be a major therapeutic objective to protect against a decline in renal function. Pro…

Increase in Nocturnal Blood Pressure and Progression to Microalbuminuria in Type 1 Diabetes

Patients with type 1 diabetes mellitus and microalbuminuria often have elevated blood pressure while they are asleep, but it is not known whether the elevation develops concomitantly with microalbuminuria or precedes it.We monitored 75 adolescents and young adults who had had type 1 diabetes with normal urinary albumin excretion and blood pressure for more than five years. Ambulatory blood-pressure monitoring was used to assess blood pressure at the initial evaluation and about two years later, at which time all subjects had normal urinary albumin excretion. Subsequently, subjects were monitored for the development of microalbuminuria.Microalbuminuria developed in 14 subjects, whereas the o…

The impact of birth weight on pulse pressure during adolescence

Background The objective was to study the influence of birth weight on office and ambulatory pulse pressure. Methods and results Three hundred healthy children (176 girls), aged 10–18 years, born at term after a normotensive pregnancy were included. The subjects were divided according to birth weight: 2.000–2.500 kg, 2.501–3.000 kg, 3.001–3.500 kg and >3.500 kg. For each subject, office and 24-h ambulatory blood pressure monitoring were performed according to the protocol designed. There were significant differences among groups in 24-h ambulatory systolic blood pressure, and pulse pressure (PP). No differences were observed in terms of sex, current age, weight and height. Using a multiple …

Obesity, Body Fat Distribution, and Ambulatory Blood Pressure in Children and Adolescents

Obesity is a common disease with an ever-increasing prevalence and usually with late-onset consequences. If acquired during childhood, it tracks into adult life to some extent, and since the relationship between obesity and hypertension is well established in adults, obese children appear to be at particularly high risk of becoming hypertensive adults. In the authors' study, obese children seemed to have significantly higher casual and ambulatory blood pressure than nonobese children, except for nighttime diastolic blood pressure. The health effects of obesity may depend on the anatomic distribution of body fat, which in turn may be a better indicator of endocrinologic imbalance, environmen…

Obesity modifies the relationship between ambulatory blood pressure and natriuresis in children

The objective in the present study was to evaluate if obesity beginning in the first two decades of life influences the relationship between ambulatory blood pressure and urinary sodium excretion.Eighty-five obese and 88 non-obese children aged 3-19 years were included in the study. For each subject, a 24h ambulatory blood pressure monitoring and a complete urine collection were simultaneously performed according to the protocols designed. The averages of ambulatory blood pressure and of the urinary excretion rates for sodium, potassium and creatinine were calculated separately for 24-h, awake and sleep periods as defined by a mini-diary.Weight and sodium excretion are directly associated w…

Current and birth weights exert independent influences on nocturnal pressure-natriuresis relationships in normotensive children

The objective was to study the impact of birth weight on the relationship between ambulatory blood pressure and urinary sodium excretion in children and adolescents. The study included 134 healthy children (61 boys), all Caucasians, who were born at term after a normotensive pregnancy. For each subject, a 24-hour ambulatory blood pressure monitoring and a complete urine collection were simultaneously performed according to the protocols designed. Average ambulatory blood pressure (BP) and the urinary excretion rates for sodium, potassium, and creatinine were calculated separately for 24-hour, awake, and sleep periods defined by a mini-diary. The excretion rate of sodium during sleep time wa…

Ambulatory blood pressure monitoring in normotensive children

OBJECTIVE To assess reference values of ambulatory blood pressure in normotensive children. SUBJECTS AND DESIGN Twenty-four-hour non-invasive ambulatory blood pressure monitoring (ABPM) was carried out in 241 healthy normotensive children aged from 6 to 16 years (126 boys, mean +/- SD age 11.2 +/- 2.7 years; 115 girls, mean +/- SD age 10.9 +/- 2.9 years). The subjects were subdivided into three age-sex groups: 6-9, 10-12 and 13-16 years. SETTING Primary care. MAIN OUTCOME MEASURES ABPM was performed using an oscillometric device (SpaceLabs model 90207) and appropriate cuff size during a regular school day. Blood pressure was measured every 20 min from 0600 to 2400 h, and thereafter every 30…

Birth weight modifies pulse pressure in children and adolescents

Current and birth weights exert independent influences on nocturnal pressure-natriuresis relationships in normotensive children.

The objective was to study the impact of birth weight on the relationship between ambulatory blood pressure and urinary sodium excretion in children and adolescents. The study included 134 healthy children (61 boys), all Caucasians, who were born at term after a normotensive pregnancy. For each subject, a 24-hour ambulatory blood pressure monitoring and a complete urine collection were simultaneously performed according to the protocols designed. Average ambulatory blood pressure (BP) and the urinary excretion rates for sodium, potassium, and creatinine were calculated separately for 24-hour, awake, and sleep periods defined by a mini-diary. The excretion rate of sodium during sleep time w…

The Impact of Obesity and Body Fat Distribution on Ambulatory Blood Pressure in Children and Adolescents

To assess the relationship between obesity, body fat distribution, and blood pressure in children and adolescents, various measures of obesity and the waist-to-hip circumference ratio were related to casual and ambulatory blood pressure as measured using a SpaceLabs 90207 monitor during a regular school day. Seventy obese and 70 nonobese children aged 6 to 16 years were included in the study. Regardless of the time period analyzed (24 h, daytime, or nighttime), ambulatory blood pressure and casual blood pressure were significantly higher among the obese children. The differences in systolic blood pressure observed between the groups were attributable to the presence of obesity as estimated …

Reduction in aortic compliance in adolescents with suboptimal intrauterine growth

Reproducibility of ambulatory blood pressure monitoring in children

Birth weight impacts on wave reflections in children and adolescents.

The objective of the present study was to assess central aortic pressure and wave reflection in children and adolescents at different birth weights. Two hundred nineteen healthy children (126 girls), from 7 to 18 years of age (mean, 11.3 years) and born at term after a normotensive pregnancy, were included. The subjects were divided according to birth weight: <2.5 kg, from 2.5 to 2.999 kg, from 3.0 to 3.5 kg, and >3.5 kg. Pressure waveforms were recorded from the radial artery of the wrist, and the waveform data were then processed by the SphygmoCor radial/aortic transform software module to produce the estimated aortic pressure waveform. Augmentation index, an estimate of the pulse …

Birth Weight Influences Blood Pressure Values and Variability in Children and Adolescents

The objective of the present study was to assess the relationships between birth weight and the values and variability of ambulatory blood pressure. Six hundred thirty healthy children (369 girls) age 4 to 18 years (mean, 9.9 years) born at term after a normotensive pregnancy were included. The subjects were divided into 5 groups according to birth weight. For each subject, a 24-hour ambulatory blood pressure monitoring was performed according to the protocol designed. Average and variability (estimated as the standard deviation) of ambulatory blood pressure and heart rate were calculated separately for 24-hour, daytime, and nighttime periods. When values were adjusted for gender, current …

Relationship between birth weight and awake blood pressure in children and adolescents in absence of intrauterine growth retardation.

This study was designed to examine the relationship between birth weight (BW) and ambulatory blood pressure in children and adolescents, born at term in absence of intrauterine growth retardation. Twenty-four hour ambulatory blood pressure monitoring (ABPM) was performed on 332 children (150 boys), aged from 6 to 16 years. Subjects were stratified by BW tertiles and age. ABPM was performed using SpaceLabs 90207 monitor during a regular school day. Blood pressure (BP) was measured every 20 min from 06:00 to 24:00, and thereafter every 30 min. Means of systolic BP (SBP) and diastolic BP (DBP) during 24 h, daytime (08:00 to 22:00), and nighttime (24:00 to 06:00) were calculated. Systolic and d…

The spectrum of circadian blood pressure changes in type I diabetic patients.

Background The objective of the present study was to characterize the spectrum of circadian blood pressure changes in type I diabetes at different stages of nephropathy by using two monitorings in each patient in order to avoid intra-individual variability. Patients and methods A total of 80 type I diabetic subjects and the same number of age, sex and awake mean blood pressure (BP)-matched controls were included. According to urinary albumin excretion, there were 57 normoalbuminurics, 15 persistent microalbuminurics and eight proteinurics. Two 24 h ambulatory blood pressure monitorings were performed at the same urinary albumin excretion stage in absence of antihypertensive treatment for ea…

Steep blood pressure increase in low birth weight newborns

Factors related to quality of ambulatory blood pressure monitoring in a pediatric population.

To assess the factors related to the quality of ambulatory blood pressure monitoring in a pediatric population, we performed 24-h ambulatory blood pressure monitorings on 333 unselected children aged 3 to 18 years using a Spacelabs 90207 monitor. For each individual, the percentages of valid measurements (ratio between valid and total number of measurements, 76.4% +/-15.6%) and of successful measurements (percentage of valid preset measurements, 89.8% +/- 11.5%) were calculated. Two hundred eighty-one (84.1%) monitorings had a successful measurement rate of >80%. Two hundred thirteen (64%) were of excellent quality, as defined by the percentage of successful measurements being higher than o…

Birth weight influences blood pressure values and variability in children and adolescents

The objective of the present study was to assess the relationships between birth weight and the values and variability of ambulatory blood pressure. Six hundred thirty healthy children (369 girls) age 4 to 18 years (mean, 9.9 years) born at term after a normotensive pregnancy were included. The subjects were divided into 5 groups according to birth weight. For each subject, a 24-hour ambulatory blood pressure monitoring was performed according to the protocol designed. Average and variability (estimated as the standard deviation) of ambulatory blood pressure and heart rate were calculated separately for 24-hour, daytime, and nighttime periods. When values were adjusted for gender, current a…

Diurnal blood pressure curve in children and adolescents

Objective To investigate the diurnal blood pressure curve in healthy normotensive children. Thirty-one children were re-examined after a median interval of 123 days in order to study the reproducibility of the diurnal profile. Subjects Twenty-four-hour ambulatory blood pressure monitoring and conventional blood pressure readings were obtained in 228 normotensive children, whose ages ranged from 6 to 16 years and of whom 116 were boys and 112 girls. Results The conventional blood pressure averaged 99+/-11/57+/-9 mmHg in boys and 98+/-12/56+/-9 mmHg in girls (means+/-SD); the corresponding 24 h pressures were 111+/-7/66+/-5 mmHg and 109+/-7/65+/-5 mmHg, respectively. Of the children, 83% had …