Ambulatory blood pressure patterns in children and adolescents: influence of renin-sodium profiles

• Published in: Pediatrics (Evanston) Vol. 87; no. 1; p. 94
• Main Authors: Harshfield, G A, Pulliam, D A, Alpert, B S, Stapleton, F B, Willey, E S, Somes, G W
• Format: Journal Article
• Language: English
• Published: United States 01.01.1991
• Subjects: Adolescent; Blood Pressure - physiology; Child; Diastole - physiology; Female; Humans; Male; Monitoring, Physiologic; Reference Values; Renin - blood; Risk Factors; Sodium - urine; Systole - physiology
• ISSN: 0031-4005; 1098-4275
• DOI: 10.1542/peds.87.1.94

A renin-sodium nomogram for normotensive children and adolescents was developed at our institution. The ambulatory blood pressure patterns of subjects classified by the nomogram were then compared. A biracial sample of 159 children and adolescents were classified as having a low, intermediate, or high renin-sodium profile based on the relationship between their plasma renin activity and 24-hour urinary sodium excretion. Casual (106/58 vs 107/61 vs 106/62 mm Hg) and awake (116/69 vs 117/69 vs 116/70 mm Hg) blood pressure values were comparable among subjects with low, intermediate, and high renin-sodium profiles. Subjects with high renin-sodium profiles, however, had a smaller decline in systolic blood pressure with sleep than did subjects with low renin-sodium profiles (7 vs 11 mm Hg; P less than .04), and higher diastolic blood pressure readings during sleep than subjects with intermediate renin-sodium profiles (65 vs 62 mm Hg; P less than .05). Subjects with high renin-sodium profiles also had greater variance of diastolic blood pressure readings during sleep than either subjects with low renin-sodium profiles (P less than .01) or those with intermediate renin-sodium profiles (P less than .02). The blunted nocturnal decline and increased nocturnal variance of blood pressure among subjects with high renin-sodium profiles may be a marker or mechanism for the future development of essential hypertension.