Non-Dipping Hypertension in Renal Transplant Recipients.

Abstract

Purpose: Posttransplantation hypertension has been asociated with the incidence of both cardiovascular disorders and renal allograft failure.Additionally, the loss of circadian blood pressure (BP) may be an additional risk factor for comorbid conditions. The aim of this study is to evaluate the association between impact of post transplant hypertension determined by office and ambulatory blood pressure monitoring (ABPM), presence of nondipper status on cardiovascular indices and graft dysfunction in kidney recipients. Methods: One hundred recipients with normal graft functions (38.74±11.03 years, 67 male, 45.9±9.8 months post-transplantation period) were enrolled into the study. Office and ambulatory blood pressure monitoring (ABPM), pulse wave velocity and body composition analysis were cross-sectionally performed and patient's post-transplant clinical and laboratory data were retrieved from the records. Renal graft function is evaluated with the yearly decline in eGFR. Patients body composition were analyzed by the Body Composition Analyzer (Tanita BC- 420MA) and PWv was determined from pressure tracing over carotid and femoral arteries using the SphygmoCor system. Results: Thirty-five patients (%35) were hypertensive with office BP>140/80 mmHg and ABPM mean levels>130/85 mmHg. Sistolic hypertension was positively correlated with PWv (r:0.697, p:0.04) and serum uric acid levels (r:0.588, p:0.013). Majority (n:75, 75%) of patients had non-dipping BP pattern. Patients with non-dipping BP pattern had significantly lower HDL levels before (38.1 vs. 46.4 mg/dL, p: 0.044) and after transplantation (47.2 vs. 54.6 mg/dL, p:0.046) than patients with dipper HT. Non-dipper patients had significantly higher PWv levels than dipper patients (7.25 vs. 5.59 m/s respectivelyi p:0.0001). Transplantation from a deceased donor was more frequent in patients with non-dipping BP pattern than dipper patients (25% vs. 9.5%, p:0.039). Yearly decline in eGFR levels were significantly higher in hypertensive patients (7.6% vs. 9.4%, p:.0001) than normotensive ones. Conclusions: The non-dipper pattern was associated with arterial stiffness, dyslipidemia, graft dysfunction and transplantation from deceased donor. Posttransplantation HT should be aggressively treated to prevent the development of end-organ damage.