Hypertension in children with chronic renal failure

Hypertension is one of the main risk factors of mortality for children on renal replacement therapy. It has also been recognised as one of the major risk factors for progression of renal failure. The aim of the study was to define the prevalence of hypertension in children with chronic renal failure, treated in a single centre, and to assess the efficacy of its diagnosis and management. Hypertension was present in 27% of 40 children before the onset of chronic renal failure, increasing to 57% with the development of CRF, and reaching 86% at onset of dialysis. Reflux nephropathy, hemolytic-uraemic syndrome and glomerular disease were most frequently associated with severe hypertension. ACE inhibitors (70%), diuretics (52%), and calcium channel blockers were the most frequently used antihypertensives with 49% of the children being on monotherapy. Despite therapy 43% of children had elevated blood pressure levels and 16% had echocardiographic signs of LVH. A 24 hour ambulatory blood pressure measurements were more sensitive in diagnosing hypertension and assessing adequacy of blood pressure control. Early and intensified treatment should prevent end organ damage though optimal blood pressure values to aim obtain are still to be defined.