Background: Office blood pressure (BP) trajectories may help assess hypertension progression and the effects of antihypertensive treatment in children with chronic kidney disease.

Methods: Analysis of antihypertensive treatment and BP slopes in 320 patients from the 4C study (Cardiovascular Comorbidity in Children with Chronic Kidney Disease) cohort with chronic kidney disease before renal replacement therapy, based on a minimum of 3 individual observations and 2 years of follow-up.

Results: At enrollment, 70 (22%) patients had uncontrolled or untreated hypertension, 130 (41%) patients had controlled hypertension, and 120 (37%) patients had normotension without antihypertensive treatment. Antihypertensive treatment medication was prescribed for 53% of patients at baseline and initiated or added for 91 patients (AHT-I group, 28%) during follow-up. Overall BP SD score remained stable over time in the cohort (β=-0.037±0.034, P=0.34 and -0.029±0.348, P=0.093 per year for systolic and diastolic BP SD score). In the AHT-I group, systolic and diastolic BP SD scores were higher at baseline and decreased significantly during follow-up (-0.22±0.07, P<0.003 and -0.12±0.05 SD score per year, P=0.01). Only 8 of 70 (11%) patients from the previously untreated/uncontrolled group remained untreated at the last observation, while 31 (44%) were controlled during follow-up. Of the 120 normotensive patients at baseline, 60% remained normotensive while 40% progressed to uncontrolled/untreated (n=23, 19%) or controlled (n=24, 20%) hypertension.

Conclusions: Although the overall BP of the population remained stable over time, individual patterns of BP management showed considerable variability. BP control improved significantly with intensified antihypertensive therapy; however, a significant number of previously normotensive individuals developed new-onset hypertension during the observation period.

Keywords: antihypertensive agents; blood pressure; child; humans; hypertension.

背景： 办公室血压（BP）轨迹可能有助于评估慢性肾脏疾病儿童高血压的发展进程和抗高血压治疗的效果。

方法： 基于4C研究（慢性肾脏疾病儿童心血管合并症）队列中320名在肾替代治疗前患有慢性肾脏疾病的患者的数据，分析了至少进行了三年随访的患者样本中的抗高血压药物使用情况和血压变化趋势。

结果： 在入组时，70（22%）名患者的高血压未得到控制或未经治疗，130（41%）名患者患有受控的高血压，而另外120（37%）名患者无高血压且未接受抗高血压药物治疗。基础状态时有53%的患者被开出了抗高血压药物处方，在随访期间为91名患者开始了或增加了抗高血压治疗(AHT-I组，占28%)。总体而言，队列中的血压标准差分数（BP SD score）随着时间保持稳定(收缩压和舒张压的BP SD score每年变化系数分别为β=-0.037±0.034, P=0.34 和 -0.029±0.348, P=0.093)。在AHT-I组中，基础状态时收缩压和舒张压的BP SD分数较高，并且随访期间显著下降(-0.22±0.07, P

结论： 尽管整体上人群的血压随着时间保持稳定，但个体血压管理模式表现出较大的差异性。随着抗高血压治疗的加强，血压控制显著改善；然而，在观察期间相当数量的基础状态为正常血压的人群发展出了新发高血压。

关键词： 抗高血压药物; 血压; 儿童; 人类; 高血压.