Nocturnal hypertension associated with stroke and silent cerebral infarcts in children with sickle cell disease.
ambulatory blood pressure monitoring (ABPM)
hypertension
sickle cell disease (SCD)
silent cerebral infarct (SCI)
stroke
Journal
Pediatric blood & cancer
ISSN: 1545-5017
Titre abrégé: Pediatr Blood Cancer
Pays: United States
ID NLM: 101186624
Informations de publication
Date de publication:
05 2021
05 2021
Historique:
revised:
15
12
2020
received:
11
09
2020
accepted:
16
12
2020
pubmed:
7
1
2021
medline:
15
10
2021
entrez:
6
1
2021
Statut:
ppublish
Résumé
Strokes and silent cerebral infarcts (SCIs) lead to significant morbidity and mortality in children with sickle cell disease (SCD). Higher systolic blood pressures increase risk for stroke and SCIs; however, patients with SCD often have lower clinic blood pressures than the general population. Twenty-four-hour ambulatory blood pressure monitoring (ABPM) allows for more robust examination of blood pressures. This study evaluated associations between abnormal ABPM measurements with stroke and SCIs. A cross-sectional study was performed. Children with SCD completed 24-hour ABPMs. Children with a documented magnetic resonance imaging (MRI) brain within a year of the ABPM were included in the analysis. Bivariate analyses were performed to identify associations between ABPM parameters with cerebrovascular outcomes. Forty-two children with a median age of 13 years (10, 17) were included in the analysis. Seven (17%) had history of stroke and seven (17%) had SCIs. Nocturnal hypertension, elucidated via 24-hour ABPM, was noted in 25% of subjects. The presence of nocturnal hypertension was significantly higher in the SCI/stroke group (55% vs 12%, P = .01). Sensitivity analyses were performed during which stroke patients were removed from analysis. Nocturnal hypertension remained significantly associated with the presence of SCIs (P = .006). This study reveals an association between nocturnal hypertension and a higher prevalence of SCI and stroke in children with SCD. Larger, prospective studies are needed to confirm these findings and evaluate the contributory nature of blood pressure abnormalities to cerebrovascular events in children with SCD.
Sections du résumé
BACKGROUND
Strokes and silent cerebral infarcts (SCIs) lead to significant morbidity and mortality in children with sickle cell disease (SCD). Higher systolic blood pressures increase risk for stroke and SCIs; however, patients with SCD often have lower clinic blood pressures than the general population. Twenty-four-hour ambulatory blood pressure monitoring (ABPM) allows for more robust examination of blood pressures. This study evaluated associations between abnormal ABPM measurements with stroke and SCIs.
PROCEDURE
A cross-sectional study was performed. Children with SCD completed 24-hour ABPMs. Children with a documented magnetic resonance imaging (MRI) brain within a year of the ABPM were included in the analysis. Bivariate analyses were performed to identify associations between ABPM parameters with cerebrovascular outcomes.
RESULTS
Forty-two children with a median age of 13 years (10, 17) were included in the analysis. Seven (17%) had history of stroke and seven (17%) had SCIs. Nocturnal hypertension, elucidated via 24-hour ABPM, was noted in 25% of subjects. The presence of nocturnal hypertension was significantly higher in the SCI/stroke group (55% vs 12%, P = .01). Sensitivity analyses were performed during which stroke patients were removed from analysis. Nocturnal hypertension remained significantly associated with the presence of SCIs (P = .006).
CONCLUSIONS
This study reveals an association between nocturnal hypertension and a higher prevalence of SCI and stroke in children with SCD. Larger, prospective studies are needed to confirm these findings and evaluate the contributory nature of blood pressure abnormalities to cerebrovascular events in children with SCD.
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
e28883Subventions
Organisme : NCATS NIH HHS
ID : UL1 TR001073
Pays : United States
Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2021 Wiley Periodicals LLC.
Références
Moerdler S, Manwani D. New insights into the pathophysiology and development of novel therapies for sickle cell disease. Hematology Am Soc Hematol Educ Program. 2018;2018(1):493-506.
Kato GJ, Steinberg MH, Gladwin MT. Intravascular hemolysis and the pathophysiology of sickle cell disease. J Clin Invest. 2017;127(3):750-760.
Kwiatkowski KL, Voeks JK, Kanter J, et al. Ischemic stroke in children and young adults with sickle cell disease in the post-STOP era. Am J Hematol. 2019;94(12):1335-1343.
Hoppe C. Defining stroke risk in children with sickle cell anemia. Br J Haemotol. 2004;128:751-766.
Ohene-Frempong K, Weiner SJ, Sleeper LA, et al. Cerebrovascular accidents in sickle cell diseases: rates and risk factors. Blood. 1998;91(1):288-294.
Adams RJ, McKie VC, Hsu L, et al. Prevention of a first stroke by transfusions in children with sickle cell anemia and abnormal results on transcranial Doppler ultrasonography. N Engl J Med. 1998;339(1):5-11.
DeBaun MR, Gordon M, McKinstry RC, et al. Controlled trial of transfusions for silent cerebral infarcts in sickle cell anemia. N Engl J Med. 2014;371(8):699-710.
DeBaun MR, Kirkham FJ. Central nervous system complication and management in sickle cell disease. Blood. 2016;127(7):829-838.
King A, Strouse JJ, Rodeghier MJ, et al. Parent education and biologic factors influence on cognition in sickle cell anemia. Am J Hematol. 2014;89(2):162-167.
Chalmers J, Todd A, Chapman N, et al. International Society of Hypertension (ISH): statement on blood pressure lowering and stroke prevention. J Hypertens. 2003;21(4):651-663.
Kuperferman JC, Zafeiriou DI, Lande MB. Stroke and hypertension in children and adolescents. J Child Neurol. 2017;32(4):408-417.
Pegelow CH, Colangelo L, Steinberg M, et al. Natural history of blood pressure in sickle cell disease: risks for stroke and death associated with relative hypertension in sickle cell anemia. Am J Med. 1997;102:171-177.
DeBaun MR, Sarnaik SA, Rodeghier MJ, et al. Associated risk factors for silent cerebral infarcts in sickle cell anemia: low baseline hemoglobin, sex, and relative high systolic blood pressure. Blood. 2012;119(16):3684-3690.
Homi J, Homi-Levee L, Gentles S, et al. Adolescent blood pressure in a cohort study of sickle cell disease. Arch Intern Med. 1993;153:1233-1236.
Moodalbail DG, Falkner B, Keith SW, et al. Ambulatory hypertension in a pediatric cohort of sickle cell disease. J Am Soc Hypertens. 2018;12:542-550.
Becker AM, Goldberg JH, Henson M, et al. Blood pressure abnormalities in children with sickle cell anemia. Pediatr Blood Cancer. 2014;61:518-522.
Shatat IF, Jakson SM, Blue AE, Johnson MA, Orak JK, Kalpatthi R. Masked hypertension is prevalent in children with sickle cell disease: a Midwest Pediatric Nephrology Consortium study. Pediatr Nephrol. 2013;28:115-120.
Lebensberger JD, Cutter GR, Howard TH, et al. Evaluating risk factors for chronic kidney disease in pediatric patients with sickle cell anemia. Pediatr Nephrol. 2017;32(9):1565-1573.
Ranabothu S, Hafeman M, Manwani D, et al. Ambulatory hypertension in pediatric patients with sickle cell disease and its association with end-organ damage. Cureus. 2020;12(11):e11707.
Flynn JT, Daniels SR, Hayman LL, et al. Update: ambulatory blood pressure monitoring in children and adolescents. A scientific statement from the American Heart Association. Hypertension. 2014;63:1116-1135.
Flynn JT, Kaelber DC, Baker-Smith CM, et al. Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics. 2017;140(3):e20171904.
DeBaun MR, Jordan LC, King AA, et al. American Society of Hematology 2020 guidelines for sickle cell disease: prevention, diagnosis, and treatment of cerebrovascular disease in children and adults. Blood Adv. 2020;4(8):1554-1588.
Collins R, MacMahon S. Blood pressure, antihypertensive drug treatment and the risks of stroke and of coronary heart disease. Br Med Bull. 1994;50:272-298.
MacMahon S, Rodgers A. Blood pressure, antihypertensive treatment and stroke risk. J Hypertens. 1994;12(10):S5-S14.