TY - JOUR
T1 - Nocturnal hypertension and left ventricular hypertrophy in pediatric renal transplant recipients in South India
AU - Pais, Priya
AU - Dello Strologo, Luca
AU - Iyengar, Arpana
AU - Velusamy, Vasanthakumar
AU - Greenbaum, Larry A.
N1 - Funding Information:
This work was supported by the International Society of Nephrology (ISN) Mentorship Program and the ISN TTS (The Transplantation Society) Sister Transplant Centre Program.
Publisher Copyright:
© 2020 Wiley Periodicals LLC
PY - 2020/6/1
Y1 - 2020/6/1
N2 - HTN after renal transplantation is associated with cardiovascular morbidity. ABPM allows diagnosis of masked HTN and isolated nocturnal HTN. Longitudinal ABPM data in children post-transplant are limited. ABPM was performed in children post-transplant and repeated in 6-12 months. BP indices were used to determine the prevalence of masked HTN, masked uncontrolled HTN (masked HTN in patients on antihypertensive medications), and isolated nocturnal HTN. Linear regression determined the association between LVMI and ABPM indices. Thirty children underwent a baseline ABPM. Ambulatory HTN was present in 25 (83%). Masked HTN was present in 18 (60%) and isolated nocturnal HTN in 13 (43%). Nocturnal ambulatory BP was higher than corresponding daytime BPs (P <.001 for systolic and diastolic) and 25 (83%) had a blunted nocturnal dip. Prednisone dose predicted nocturnal DBP index and DBP load (r2 =.40, P =.024 and r2 =.178, P =.02). ABPM was repeated in 18 patients within 11 (±3) months. BP indices decreased with time, but nocturnal BPs remained higher than daytime (P <.001 for SBP and DBP). Blunted nocturnal dip did not improve. LVH was present in 12 (57%). LVMI was directly related to the nocturnal SBP index (r2 =.377, P =.003) and nocturnal DBP index (r2 =.493, P <.001). We found no association between LVMI and daytime BP indices. The prevalence of masked HTN, isolated nocturnal HTN, and blunted nocturnal dip was high in children with kidney transplants. Nocturnal BP predicted LVMI. Ambulatory BP improved on longitudinal follow-up, but the pattern of isolated nocturnal HTN persisted.
AB - HTN after renal transplantation is associated with cardiovascular morbidity. ABPM allows diagnosis of masked HTN and isolated nocturnal HTN. Longitudinal ABPM data in children post-transplant are limited. ABPM was performed in children post-transplant and repeated in 6-12 months. BP indices were used to determine the prevalence of masked HTN, masked uncontrolled HTN (masked HTN in patients on antihypertensive medications), and isolated nocturnal HTN. Linear regression determined the association between LVMI and ABPM indices. Thirty children underwent a baseline ABPM. Ambulatory HTN was present in 25 (83%). Masked HTN was present in 18 (60%) and isolated nocturnal HTN in 13 (43%). Nocturnal ambulatory BP was higher than corresponding daytime BPs (P <.001 for systolic and diastolic) and 25 (83%) had a blunted nocturnal dip. Prednisone dose predicted nocturnal DBP index and DBP load (r2 =.40, P =.024 and r2 =.178, P =.02). ABPM was repeated in 18 patients within 11 (±3) months. BP indices decreased with time, but nocturnal BPs remained higher than daytime (P <.001 for SBP and DBP). Blunted nocturnal dip did not improve. LVH was present in 12 (57%). LVMI was directly related to the nocturnal SBP index (r2 =.377, P =.003) and nocturnal DBP index (r2 =.493, P <.001). We found no association between LVMI and daytime BP indices. The prevalence of masked HTN, isolated nocturnal HTN, and blunted nocturnal dip was high in children with kidney transplants. Nocturnal BP predicted LVMI. Ambulatory BP improved on longitudinal follow-up, but the pattern of isolated nocturnal HTN persisted.
KW - ambulatory blood pressure monitoring
KW - kidney transplant
KW - left ventricular hypertrophy
KW - masked hypertension
KW - nocturnal hypertension
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U2 - 10.1111/petr.13710
DO - 10.1111/petr.13710
M3 - Article
C2 - 32320120
AN - SCOPUS:85083804898
VL - 24
JO - Pediatric Transplantation
JF - Pediatric Transplantation
SN - 1397-3142
IS - 4
M1 - e13710
ER -