Relationship between nocturnal blood pressure patterns and end organ damage and diastolic dysfunction in heart transplant recipients

Abstract

Background:We assessed the relationship between circadian blood pressure (BP) patterns and clinical outcomes in a contemporary cohort of adult heart transplant recipients.Methods: This retrospective, cross-sectional study included adult heart transplant recipients at least 6 months post-transplant. Ambulatory BP measurements were recorded over 24 hours. Nondippers were defined as a decline in average nighttime BP ≤ 10% compared with daytime. Primary outcomes were the presence of end organ damage, that is, microalbuminuria, chronic kidney disease, and/or left ventricular hypertrophy.Secondary outcomes were measures of diastolic dysfunction (ie, mitral valve deceleration time, e/e′, E/A, and isovolumetric relaxation time), microalbumin/creatinine ratio, eGFR, interventricular septal thickness, and left ventricular posterior wall thickness.Results: Of 30 patients, 53.3% (n = 16) were systolic nondippers and 40% (n = 12) were diastolic nondippers. Diastolic nondippers had three times higher urine microalbumin/creatinine ratios than diastolic dippers (P = .03). Systolic nondippers had 16.3% lower mitral valve deceleration time (P = .05) than systolic dippers, while diastolic nondippers had 20.4% higher e/e′ (P = .05) than diastolic dippers. There were no significant relationships between BP dipping status and any of the primary outcomes.Conclusions: These data suggest that systolic and diastolic nondipping BP patterns are associated with subclinical kidney damage and diastolic dysfunction in heart transplant recipients. K E Y W O R D Sambulatory blood pressure, diastolic dysfunction, end organ damage, heart transplant, nocturnal blood pressure