Night-time blood pressure load is associated with higher left ventricular mass index in renal transplant recipients

Abstract

The absence of nocturnal fall in blood pressure (BP) is named as nondipper status, which has been shown to be an additional risk factor for the development of left ventricular hypertrophy and cardiovascular events in several high-risk groups. The aim of this study was to determine the influences of the nondipper status and nocturnal blood pressure loads on left ventricular mass index (LVMI) in renal transplant recipients. A total of 35 nondiabetic renal transplant recipients were included into the study. A 24-h ambulatory blood pressure monitoring (ABPM) was performed for all recipients. The nondipper status was defined as either an increase in night-time mean arterial pressure (MAP) or a decrease of no more than 10% of daytime MAP. LVMI was measured by using two-dimensional guided M-mode echocardiography. The night-time systolic blood pressure (SBP) load was defined as the percentage of the time, during which SBP exceeded 125 mmHg during night time. The nondipping was common among renal transplant recipients, of whom 60% were nondipper in our study. LVMI was significantly higher in the nondipper group vs the dipper group (133 7 35 g/m 2 vs 109 7 26 g/m 2 , P ¼ 0.04). A fall in MAP at night time was 14.5 7 4.3% in the dipper group, while it was 1.4 7 6.1% in the nondipper group (Po0.001). On stepwise multiple regression analysis, night-time SBP load and haemoglobin were independent predictors of LVMI (R 2 ¼ 0.53).In conclusion, nondipping is common after renal transplantation. Night-time SBP load and low haemoglobin are closely related to the increase in LVMI in renal transplant recipients. ABPM may be a more useful tool in optimizing treatment strategies to reduce cardiovascular events in renal transplant recipients.

Prevalence and Correlates of Left Ventricular Hypertrophy in the African American Study of Kidney Disease Cohort Study

“…23,24 The majority of patients with uncomplicated hypertension experience a fall in their nighttime BP of Ͼ10% of the daytime mean arterial BP. The absence of a fall in nocturnal BP has been linked to target organ damage, such as carotid artery structural alterations and LVH in some studies [25][26][27][28][29] but not others. 30,31 Observational studies have shown that hypertensive patients with elevated nighttime BP are at greater risk for experiencing cardiovascular outcomes and stroke compared with hypertensive patients with a normal decrease in nocturnal BP.…”

Abnormal blood pressure circadian rhythm: A target organ damage?

“…The non-dipper status is also common in renal transplant recipients [35]. Lipkin et al [36] studied 28 normotensive renal transplant recipients, of whom 16 were on cyclosporine-based and 12 were on azathioprine-based immunosuppressive regimen.…”

Diurnal Blood Pressure Changes One Year after Kidney Transplantation

“…Is the loss of circadian BP rhythm a pathogenic factor involved in allograft function loss? Loss of circadian BP changes has been linked to target organ damage and accelerated kidney function loss in hypertensive patients with and without CKD (9,33,34). Although uncontrolled systemic hypertension is related to poor allograft and patient survival after kidney transplantation, loss of normal nocturnal fall in SBP, independent of BP control, has not been fully defined as a promoter of kidney function attrition after transplantation (2,35,36).…”