Abstract
Hypertension is a highly prevalent co-morbidity in pediatric kidney transplant recipients. Undertreated hypertension is associated with cardiovascular complications and negatively impacts renal graft survival. Thus, the accurate measurement of blood pressure is of the utmost importance for the correct diagnosis and subsequent management of post-renal transplant hypertension. Data derived from the general population, and to a lesser extent from the pediatric population, indicates that ambulatory blood pressure monitoring (ABPM) is superior to blood pressure measurements taken in the clinical setting for the evaluation of true mean blood pressure, identification of patients requiring antihypertensive treatment, and in the prediction of cardiovascular outcome. This Educational Review will discuss the clinical value of ABPM in the identification of individual blood pressure phenotypes, i.e., normotension, new-onset hypertension, white-coat hypertension, masked hypertension, controlled blood pressure, and undertreated/uncontrolled hypertension in pediatric kidney transplant recipients. Finally, we examine the utility of performing repeated ABPM for treatment monitoring of post-renal transplant hypertension and on surrogate markers related to relevant clinical cardiovascular outcomes. Taken together, our review highlights the clinical value of the routine use of ABPM as a tool for identifying and monitoring hypertension in pediatric kidney transplant recipients.
Highlights
Hypertension is a central risk factor for the development of cardiovascular disease and a major cause of morbidity and mortality in the general adult population [1,2,3]
We examined the degree of repeatability of office and ambulatory blood pressure measurements in pediatric kidney transplant recipients and observed that ambulatory blood pressure monitoring (ABPM) shows a better reproducibility than blood pressure recordings taken in the clinical setting [82]
Reducing the cumulative burden of uncontrolled hypertension and cardiovascular injury should be a priority for clinical care and research in pediatric renal transplant recipients
Summary
Hypertension is a central risk factor for the development of cardiovascular disease and a major cause of morbidity and mortality in the general adult population [1,2,3]. We examined the degree of repeatability of office and ambulatory blood pressure measurements in pediatric kidney transplant recipients and observed that ABPM shows a better reproducibility than blood pressure recordings taken in the clinical setting [82]. In children with chronic kidney disease and left ventricular hypertrophy, previous controlled studies indicate that controlled blood pressure, defined as ambulatory blood pressure levels below the 95th percentile, was associated with left ventricular mass index regression and improvement of myocardial function [100, 107] While such data is lacking in pediatric renal transplant recipients, the presence of left ventricular hypertrophy has been well documented in this high-risk population [54, 72]. Since we assumed a linear association between blood pressure and carotid intima-media thickness, we infer that our results might reflect the effect of long-standing blood pressure control (point prevalence of controlled blood pressure at the last carotid scan was 82%, 95% confidence interval 56.5– 96.2%) [120]
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