Left ventricular hypertrophy, treadmill tests, and 24-hour blood pressure in pediatric transplant patients

Matteucci, Maria Chiara; Giordano, Ugo; Calzolari, A.; Turchetta, Attilio; Santilli, Antonella; Rizzoni, Gianfranco

doi:10.1046/j.1523-1755.1999.00667.x

Cited by 86 publications

(100 citation statements)

References 20 publications

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“…However, in their study, blood pressure values were higher in the group who had undergone transplantation. In a study by Matteuci and colleagues a very high frequency of LVH (82%) was seen, although only 36% had uncontrolled hypertension [6].…”

Section: Discussionmentioning

confidence: 93%

“…Left ventricular hypertrophy (LVH) is the most common cardiac abnormality observed in pediatric and adult dialysis patients, and has been associated with hypertension and volume overload [3]. However, LVH is prevalent even after successful RTx, in between 7% and 82% of children in various cross-sectional studies [4][5][6][7][8]. LVH is a significant risk factor for cardiovascular mortality, both in the general population and in patients with renal disease [9].…”

Section: Introductionmentioning

confidence: 99%

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Improved left ventricular mass index in children after renal transplantation

et al. 2008

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Left ventricular hypertrophy (LVH) is a risk factor for cardiovascular disease, and it is prevalent in children with end-stage renal disease (ESRD) and after renal transplantation (RTx) on cross-sectional studies. Our aim was to compare prospectively left ventricular mass index (LVMI) in children with ESRD, before and after RTx. Thirteen patients aged 1.5-15 years underwent echocardiogram prior to and at least 3 months after RTx, and again in the second year after transplantation. A control group consisted of children with ESRD who remained on dialysis. Systolic and diastolic blood pressure index decreased significantly over the study period only in the children who had undergone RTx. Mean LVMI in children with ESRD decreased from 45.4 +/- 12.6 g/m(2.7) to 34.9 +/- 10.4 g/m(2.7) after RTx (P = 0.001), but it remained unchanged in patients who remained on dialysis. The prevalence of LVH decreased from 54% to 8% (P = 0.03) after RTx. Systolic and diastolic blood pressure index were correlated with LVMI. Mean body mass index increased during the study period from 17.3 +/- 2.5 to 20 +/- 4.6 (P = 0.05); however, no correlation was found with LVMI. LVH in children with ESRD is potentially reversible after RTx, especially with good control of hypertension.

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Section: Discussionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Improved left ventricular mass index in children after renal transplantation

et al. 2008

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“…97 The prevalence of hypertension is even higher with ABPM, approaching 70%-80%. Studies show the prevalence of masked hypertension (normal office BP and elevated ABPM) was 50% greater than that identified using casual BP [98][99][100][101] and an increased prevalence of nondippers among children with kidney transplants. 101,102 A study by Polónia et al 103 concurs with other studies showing significant rates of nocturnal hypertension in pediatric transplant recipients and that a significant proportion of patients thought to be adequately controlled by medications still had masked hypertension.…”

Section: Hypertension In the Pediatric Transplant Recipient Or Recipimentioning

confidence: 96%

Assessment and Management of Hypertension in Transplant Patients

Weir

Burgess

Cooper

et al. 2015

Journal of the American Society of Nephrology

152

111

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Hypertension in renal transplant recipients is common and ranges from 50% to 80% in adult recipients and from 47% to 82% in pediatric recipients. Cardiovascular morbidity and mortality and shortened allograft survival are important consequences of inadequate control of hypertension. In this review, we examine the epidemiology, pathophysiology, and management considerations of post-transplant hypertension. Donor and recipient factors, acute and chronic allograft injury, and immunosuppressive medications may each explain some of the pathophysiology of post-transplant hypertension. As observed in other patient cohorts, renal artery stenosis and adrenal causes of hypertension may be important contributing factors. Notably, BP treatment goals for renal transplant recipients remain an enigma because there are no adequate randomized controlled trials to support a benefit from targeting lower BP levels on graft and patient survival. The potential for drugdrug interactions and altered pharmacokinetics and pharmacodynamics of the different antihypertensive medications need to be carefully considered. To date, no specific antihypertensive medications have been shown to be more effective than others at improving either patient or graft survival. Identifying the underlying pathophysiology and subsequent individualization of treatment goals are important for improving long-term patient and graft outcomes in these patients.

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“…23 Matteucci and associates reported LVH in 82% of pediatric kidney transplant recipients. 24 We observed LVH in 53.3% of patients (mild LVH = 16%; moderate = 17.3%; severe = 20%). The prevalence of severe LVH was unexpectedly high in our patients.…”

Section: Discussionmentioning

confidence: 67%

“…24,29,30 Repeat BP measurements by the ABPM method enhanced the chance of finding a correlation between ABPM and LVMI. 31 Nonetheless, Morgan and associates found no correlation between LVMI and ABPM data.…”

Section: Discussionmentioning

confidence: 99%