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

Abstract

We assessed the relationship between circadian blood pressure (BP) patterns and clinical outcomes in a contemporary cohort of adult heart transplant recipients. This retrospective, cross-sectional study included adult heart transplant recipients at least 6months post-transplant. Ambulatory BP measurements were recorded over 24hours. 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. 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. These data suggest that systolic and diastolic nondipping BP patterns are associated with subclinical kidney damage and diastolic dysfunction in heart transplant recipients.