An exploratory analysis on diastolic function in the intensive compared with less intensive blood pressure control to prevent adverse cardiac remodelling in children with chronic kidney disease (HOT-KID): a parallel-group, open-label, multicentre, randomised, controlled trial
Year: 2025
Type: article
Abstract: BACKGROUND: Relationship between blood pressure (BP) control and left ventricular (LV) diastolic function in children with chronic kidney disease (CKD) is uncertain. The aim of this study is to investigate whether achieving lower BP yields a favourable impact on diastolic function. METHODS: We performed an exploratory analysis in the HOT-KID, a parallel group, open-label, multicentre, randomised, controlled trial (ISRCTN25006406). Children with CKD were randomised to standard (50th-75th percentile) or intensive (<40th percentile) standardised office systolic BP targets. Echocardiograms were performed at baseline and at follow-up visits. Diastolic function was assessed by early (E) and late mitral inflow (A) E/A ratio, mitral annular motion of myocardial relaxation (e') and atrial contraction (a') velocity, LV compliance of E/e' and e'/a' ratio, and left atrial volume index (LAVi) by a blinded observer. FINDINGS: per year, 95% CI: 0·22-1·42) in the standard (n = 60) compared to the intensive treatment arm (n = 64). However, the average annual changes in all other diastolic function measures were similar between standard and intensive treatment groups. There was no difference for overall adverse events or serious adverse events between the two treatment groups. INTERPRETATION: Our exploratory analysis in a small, open label RCT suggests that achieving lower blood pressure may favourably impact some measures of LV diastolic function in children with CKD. FUNDING: British Heart Foundation (PG/11/90/28,994); The authors MDS, PJC acknowledge financial support from the Department of Health via the National Institute for Health Research (NIHR) comprehensive Biomedical Research Centre and Clinical Research Facilities awards to Guy's and St Thomas' NHS Foundation Trust in partnership with King's College London and King's College Hospital NHS Foundation Trust. There are no relationships with industry.
Source: EBioMedicine
Authors: Haotian Gu, Haotian Gu, John M. Simpson, Janette Cansick, Eric Finlay, Rodney Gilbert, Andrew Lunn, Heather Maxwell, Henry Morgan, Mohan Shenoy, Rukshana Shroff, Pushpa Subramaniam, Jane Tizard, Yincent Tse, Phil Chowienczyk, Manish D. Sinha, Manish D. Sinha, Janette Cansick, Abdel Douiri, Eric Finlay, Rodney Gilbert, Haotian Gu, Haotian Gu, Larissa Kerecuk, Andrew Lunn, Heather Maxwell, Henry Morgan, Reza Razavi, Mohan Shenoy, Rukshana Shroff, Pushpa Subramaniam, Jane Tizard, Yincent Tse, Poothirikovil Venugopalan, John Simpson, Phil Chowienczyk, Manish Sinha, Manish Sinha
Institutions: King's College London, British Heart Foundation, Guy's and St Thomas' NHS Foundation Trust, Evelina London Children's Healthcare, Medway Maritime Hospital, Leeds General Infirmary, Southampton General Hospital, Nottingham University Hospitals NHS Trust, Royal Hospital for Children, Alder Hey Children's Hospital, Royal Manchester Children's Hospital, Great Ormond Street Hospital, University College London, St George's Hospital, Bristol Royal Hospital for Children, Great North Children's Hospital
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $5,780
OpenAlex ID: W4409643759