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01 February 2023

Lower blood pressure reduces cardiovascular disease for children with chronic kidney disease

The HOT-KID clinical trial looked at how lowering blood pressure in children with chronic kidney disease could prevent cardiac remodelling and associated cardiovascular diseases.


Chronic kidney disease (CKD) is a condition leading to a gradual loss of kidney function over time so the kidneys become less effective in filtering blood. In children it often occurs as a result of conditions that are present from birth.

A common problem with CKD in children is high blood pressure which is thought to lead to cardiovascular disease in early adulthood.

Previous research conducted in the ESCAPE clinical trial showed that lowering blood pressure slows down the progression of CKD. However, it’s still unknown what impact such treatment has on cardiac remodelling – changes to the heart’s shape and size that impair its normal function. In children with CKD, cardiac remodelling leads to cardiovascular diseases later in life.

The HOT-KID trial, led by Dr Manish Sinha (Consultant Paediatric Nephrologist at Guy’s & St Thomas’ Foundation Trust) and Professor Phil Chowienczyk (Professor of Clinical Cardiovascular Pharmacology, King’s College London) addressed these gaps in knowledge. It’s the first trial to analyse the impact of blood pressure on cardiac remodelling in children with CKD.

Children ages 2-15 with CKD from clinical centres around England and Scotland were recruited and divided into groups that received standard and intensive treatment. The standard treatment aimed to reduce systolic blood pressure between the 50-75th percentile (of the mean blood pressure for their age), while intensive aimed for below the 40th percentile.

Between the end of 2012 and 2017, 64 participants were given intensive treatment and 60 were given normal treatment.

When heart wall thickness was measured, the researchers discovered that intensive treatment reduced heart wall thickness more than standard treatment. This suggests the intensive treatment may prevent the development of cardiac disease in later life.

The trial also found that intensive treatment wasn’t associated with adverse side-effects or worse kidney outcomes than standard treatment.

These results support clinical advice to keep blood pressure below the 50th percentile for children with CKD.

“Trials like the HOTKID study showing how to prevent cardiovascular disease developing at an early age are key to reducing the burden of cardiovascular disease in adulthood.” Dr Sinha added: “This trial highlighted the importance of cardiovascular research in children particularly as during childhood they do not have major confounders like diabetes, long standing uncontrolled hypertension or smoking.”

Professor Phil Chowienczyk, Professor of Clinical Cardiovascular Pharmacology, King’s College London

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Professor of Clinical Cardiovascular Pharmacology