Twenty-four-hour ambulatory blood pressure profiles in pediatric patients after renal transplantation

Abstract

Ambulatory blood pressure monitoring was applied in 27 pediatric patients aged 6.3-24.3 (median 15.0) years who had been transplanted 1.5-8.4 years previously. Daytime values were compared with the mean of 10 concomitant casual blood pressure recordings. At the time of the study, antihypertensive drugs were given to 17 patients. Inulin clearance ranged from 18 to 116 (median 66) ml/min per 1.73 m2. Ambulatory blood pressure monitoring confirmed hypertension or normotension determined by casual blood pressure measurements in 63% of patients. The physiological nocturnal dip in blood pressure was attenuated or reversed in 8 of 27 patients. It was reduced in all 3 patients with renal artery stenosis of the graft, in 3 of 4 patients with chronic rejection, in the only patient with recurrent focal segmental glomerulosclerosis, and in 1 of 6 patients with past acute rejection. The dipping was not related to inulin clearance. In conclusion, casual blood pressure measurements do not accurately reflect blood pressure in pediatric patients transplanted more than 1.5 years previously. A reduced nocturnal dip in blood pressure may indicate an underlying renovascular or renoparenchymal pathology. Ambulatory blood pressure monitoring should regularly be applied in patients with renal transplants.

2016 European Society of Hypertension guidelines for the management of high blood pressure in children and adolescents

“…The prevalence of HTN in pediatric CKD ranges from 20 to 80% depending on the degree of renal dysfunction (154)(155)(156)(157). However, even children with CKD stage 2 (i.e.…”

Hypertension in the Transplanted Patient

“…As in patients with primary renal disease [10], an attenuated decrease of nighttime blood pressure (‘nondipping’) has been well documented in graft recipients in most studies [11]although there are some reports to the contrary [12]. Therefore, ambulatory blood pressure monitoring allows a more intelligent interpretation of blood pressure measurements [13, 14].…”

Importance of Ambulatory Blood Pressure Monitoring in Adolescent Hypertension

“…to exclude hypertension) in chronic kidney disease. After renal transplantation, ABPM has proved to be more efficient than casual measurements [45] as renal transplantation is characterized by higher nocturnal BP values, a reversal of the diurnal rhythm [46] . Lack of nocturnal fall in BP and higher nocturnal BP values suggest target organ damage in primary hypertension [47] .…”