Restoration of nocturnal blood pressure dip and reduction of nocturnal blood pressure with evening anti‐hypertensive medication administration in pediatric kidney transplant recipients: A pilot randomized clinical trial

Abstract

Non-dipping and nocturnal hypertension are commonly found during ABPM in pediatric kidney transplant recipients. These entities are independently associated with increased cardiovascular disease risk in adults. Kidney transplant recipients aged 5-21 years with eGFR > 30 mL/min/1.73 m 2 and ABPM demonstrating nondipping status and normal daytime BP were randomized to intervention (short acting BP medication added in the evening) or control (no medication change) in this pilot, randomized, open-label, blinded end-point clinical trial. ABPM, echocardiography, and PWV were performed at baseline, 3 months, and 6 months. The trial included 17 intervention and 16 control participants. Conversion to dipper status occurred in 53.3% vs 7.7% (P = .01) at 6 months for intervention and controls, respectively. Systolic dip was greater in the intervention group compared to controls (10.9 ± 4.5 vs 4.2 ± 4.6, P = .001), and average systolic nighttime BP was significantly lower in the intervention group (106 ± 8.3 vs 114.9 ± 9.5 mm Hg, P = .01) at 6 months. There were no significant differences in LVMI, PWV, or eGFR between groups. Within-group changes in the intervention group demonstrated improvements in non-dippers, dipping, systolic nighttime BP and nighttime BP load. Restoration of nocturnal dip and improvement in nocturnal BP were observed in the population following chronotherapy. Future studies are needed with larger sample sizes over a longer period of time to delineate the long-term effect of improved nocturnal dip on target organ damage. K E Y W O R D S ambulatory blood pressure monitoring, chronotherapy, nocturnal hypertension, non-dipping, pediatric renal transplant, randomized clinical trial How to cite this article: Sethna CB, Grossman LG, Dhanantwari P, et al. Restoration of nocturnal blood pressure dip and reduction of nocturnal blood pressure with evening anti-hypertensive medication administration in pediatric kidney transplant recipients: A pilot randomized clinical trial.

Isolated Nocturnal Hypertension in Children

“…In pediatric renal transplant recipients with INH, evening dosing of antihypertensive medication reduced nocturnal BP and restored nocturnal BP dip (51).…”

Isolated nocturnal hypertension in pediatric kidney transplant recipients

“…A pilot study that we conducted found that nighttime administration of hypertension medication restored dipper status in pediatric kidney transplant recipients with no effect on target organ damage markers. 76 3). In the intervention group, nocturnal SBP at 6 months was lower compared to baseline.…”

“…Changes of nocturnal BP and non‐dipper status during evening dosing of anti‐hypertensive drugs in pediatric kidney transplant recipients (adapted from Sethna et al 2019) 76 …”

“…A pilot study that we conducted found that nighttime administration of hypertension medication restored dipper status in pediatric kidney transplant recipients with no effect on target organ damage markers 76 . Pediatric kidney transplant non‐dippers with normal daytime BP received a new evening BP medication (enalapril or isradipine, N = 17) or control (no medication changes, N = 16) in an open‐label randomized controlled trial.…”

“…Anywhere from 50% to 80% of adults will not have controlled BP within 1 year following transplant, this includes nocturnal and diurnal BP control. 76,79 The extent to which treatment for INH is effective has not been well described, but the use of ACEI has been questioned after outcomes were not significantly better for patients taking ACEI posttransplant. 80 Additionally, research has shown that there may be a link between INH and treatment-resistant HTN.…”