Blood pressure profile in renal transplant recipients and its relation to diastolic function: tissue Doppler echocardiographic study

Abstract

Hypertension is a common complication after renal transplantation and is associated with increased risk of cardiovascular disease. The aim of the current study was to investigate the diurnal blood pressure pattern and its relation to structural and functional cardiac changes in renal transplant recipients. Sixty-six stable renal transplant patients (34 female, 32 male), aged 7 to 25 years (mean 17.4±4.3 years) were enrolled in this study. Cardiac function assessed by tissue Doppler echocardiography and blood pressure measurement performed using both the ambulatory and the casual method. Hypertension was demonstrated in 57% of recipients by the casual method and in 75.7% by ambulatory blood pressure monitoring (ABPM). The efficacy of BP control among patients on antihypertensive drugs was 60%. The prevalence of non-dipping was 73%. There was significant inverse correlation between systolic or diastolic day-time or night-time BP index and post-transplant duration (p<0.001, r=-0.386), but no correlation between ABP parameters and BMI, gender, and eGFR. There was a significant relationship between all ABP parameters and left ventricular mass index (LVMI) (p=0.025-0.007, r=0.28-0.38). LVMI was significantly higher in hypertensive than in normotensive cases (p=0.034). There was no difference in diastolic function between hypertensive and normotensive patients or between patients with and without left ventricular hypertrophy (LVH). In conclusion, our study showed the advantage of ABPM over the casual method of diagnosis of hypertension. LVH is common in transplant patients and is likely associated with arterial hypertension. Hypertension and LVH cannot differentiate transplant patients with diastolic malfunction.

Ambulatory Blood Pressure, Left Ventricular Hypertrophy, and Allograft Function in Children and Young Adults After Kidney Transplantation

“…This is similar to or slightly higher that the prevalence of 19-31%, reported in previous studies 14,16,18-20,30 although most of these studies reported a higher prevalence of sustained hypertension. Importantly, even patients taking antihypertensive medications frequently were found to have masked and sustained hypertension, suggesting that hypertension is both underdiagnosed and inadequately treated in this population.…”

“…Some have found an association of abnormal ABP status with LVMI, 4,13,20,29,34 , with others did not confirm this finding 17,35,36 . Given a large size of study population we were able to stratify patients according to both ABP results and BP treatment and to clarify previous data of a higher prevalence of LVH in patients with controlled hypertension (treated) compared with normotensive patients not receiving BP medications.…”

“…Based on previous data suggesting patients with controlled hypertension (i.e., normotensive and receiving blood pressure medications) have a different cardiovascular risk profile than those without any history of hypertension 17,20,29 , BP status, LVMI and LVH were evaluated according the use of antihypertensive medications (Table 4). Among patients receiving antihypertensive medications, the distribution of patients amongst the BP categories was not significantly different than that observed in patients not receiving treatment.…”

Possible Correlation Among Echocardiographic Measures, Serum Brain Natriuretic Peptide, and Angiotensin II Levels in Hypertensive Kidney Transplanted Children

“…However, ABPM showed that 75.7% of their patients were hypertensive. 28 We recorded hypertension in 43.4% and 86% of patients measured by the conventional method and ABPM. The significant difference between the prevalence of hypertension defined by our 2 methods warrant the risk of missed hypertension and consequently, LVH in kidney transplanted recipients.…”

Hypertension in the Pediatric Kidney Transplant Recipient

“…Long-standing hypertension has been shown to result in LVH and increased LVMI and cIMT, all known risk factors for CVD (2). LVH is prevalent in approximately 50% of patients with CKD and ESRD and in kidney transplant recipients.…”