Diastolic hypertension is associated with proteinuria in pediatric patients

Abstract

Background and Aims: Blood pressure lability has been observed in certain cohorts of pediatric patients with variable degrees of proteinuria; however, the impact of proteinuria on blood pressure is not fully elucidated. The objective of our study was to analyze blood pressure and heart rate in pediatric patients with proteinuria. Methods: We performed a retrospective chart review of patients (age 1-18) diagnosed with idiopathic nephrotic syndrome, with varying degrees of proteinuria. Blood pressure and heart rate data were analyzed in relation to anthropometric and biochemical parameters. A total of 72 urine sample analyses, along with associated blood pressure measurements, were obtained from the charts of 33 children (males = 25). Results: Diastolic blood pressure Z-scores were significantly higher in proteinuric patients (urine protein/creatinine >0.02 g/mmol) compared to non-proteinuric patients (P =.006; Cohen-d 0.97 [0.41; 1.53]). Systolic blood pressure was also significantly higher in proteinuric patients (P =.04), but with a less significant effect size (Cohen-d 0.54 [−0.002; 1.08]). Proteinuria (>0.02 g/mmol) was the most significant predictor of diastolic (β =.79, P =.04), but not systolic blood pressure elevation on multivariate analysis. Conclusions: We observed a disproportionate increase in diastolic blood pressure vs systolic blood pressure in patients with proteinuria.