Ambulatory Blood Pressure Monitoring (ABPM) in Children with Thalassemia Major (TM).

In TM chronic anemia, blood transfusions and iron over load result in impairments in many organs. Little is known about the changes in blood pressure (BP) patterns of children with TM. To evaluate ABPM changes and associated laboratory and clinical features in children with TM. ABPM was performed in 20 TM patients with no cardiac or renal dysfunction (12M, 8F; 11.3+/−3.8 years), and 20 healthy children (11M, 9F; 11.6+/−2.4 years). Blood and timed urine samples were collected for hematological and biochemical tests. [Dipping: a fall in the mean systolic (diastolic) BP during nighttime of more than 10% of the mean daytime systolic (diastolic) BP]. Mean daytime (8AM–8PM) and nighttime (midnight to 6AM) systolic (SBP) and diastolic (DBP) blood pressures were comparable. No patient in TM and control group had mean 24-h, day time, nighttime SBP or DBP above 90^th percentile. SBP and DBP- loads were always less than 20% in control group. In TM group: SBP-load was more than 20% in 1, and 1 patient during daytime and nighttime, respectively; and DBP- load was more than 20% in 1, and 2 patients during daytime and nighttime, respectively. The percentage of systolic (60% vs 35%; p:0.102) and diastolic (30% vs 20%; p:0.118) non-dippers among TM patients were higher, compared to control group. In TM group: the percentage of systolic (80% vs 40%; p:0.063) and diastolic (50% vs 10%; p:0.044) non-dippers among older (12–16 years) patients were higher, compared to younger (5–11 years) patients. There was no association between non-dipping pattern and hemoglobin, ferritin or albuminuria level. Our preliminary results suggest that BP anomalies in TM occur before the development of cardiac or renal dysfunction. There is an association between non-dipping and the age of the patient. Long-term follow-up will make clear whether abnormalities in ABPM patterns have a predictive value in the development of renal and cardiac dysfunction in TM patients.