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Changes of blood pressure and left ventricular mass in pediatric renal transplantation
Erwin Kitzmueller1, Andreas Vécsei, Judith Pichler
1Department of Pediatrics, AKH Wien, Vienna, Austria.
Insights
Blood pressure control is crucial for maintaining heart structure in children post-kidney transplant. Managing arterial hypertension and monitoring left ventricular mass index are key to preventing long-term cardiovascular issues.
Area of Science:
- Pediatric Nephrology
- Cardiology
- Transplantation Medicine
Background:
- Cardiovascular events are a major cause of morbidity and mortality in pediatric renal transplant recipients.
- Arterial hypertension and left ventricular hypertrophy are highly prevalent in this population.
- Understanding the impact of blood pressure on cardiac structure is vital for long-term outcomes.
Purpose of the Study:
- To investigate the effects of post-transplant arterial hypertension, assessed by 24-hour ambulatory blood pressure monitoring (ABPM), on myocardial architecture.
- To analyze the longitudinal relationship between blood pressure control and left ventricular mass index (LVMI) in children after renal transplantation.
Main Methods:
- Retrospective chart review of 39 pediatric renal transplant recipients.
- Assessment of 24-hour ABPM and echocardiography within 3 months post-transplantation.
- Longitudinal analysis of 20 patients with repeated measurements after a mean follow-up of 2 years.
Main Results:
- High prevalence of arterial hypertension (59%) and left ventricular hypertrophy (50%) was observed.
- Initially, renal allograft function and medication count correlated with LVMI, not ABPM.
- At follow-up, significant correlations emerged between ABPM and LVMI, influenced by cyclosporine dosage and blood pressure changes.
Conclusions:
- Blood pressure control is directly correlated with changes in left ventricular mass index in pediatric renal allograft recipients.
- Maintaining optimal blood pressure is essential for preserving myocardial architecture and reducing cardiovascular risk.
- Longitudinal monitoring of ABPM and cardiac structure is recommended for these patients.
Abstract:
Cardiovascular events are among the most frequent causes for long-term morbidity and mortality in children after renal transplantation. The aim of this study was to analyze the effects of post-transplant changes in arterial hypertension, as assessed by 24-h ambulatory blood pressure measurement (ABPM), on myocardial architecture, as assessed by echocardiography. In a retrospective chart review analysis, 39 children were identified in whom 24-h ABPM and echocardiography had been assessed within a 3-month interval after a mean of 4 years post transplantation; 20 repeated pairs of measurements after a mean of 2 years of follow-up were available to analyze the longitudinal effects of post-transplant changes of blood pressure control on left ventricular mass index (LVMI). Arterial hypertension (59%) and left ventricular hypertrophy (50%) were highly prevalent in children after renal transplantation. Renal allograft function and number of antihypertensive medications, but not ABPM variables, were correlated with LVMI at the initial observation. However, at repeat assessment, a significant correlation between ABPM and LVMI was found. In the longitudinal assessment, left ventricular remodeling was dependent on change of dosage of cyclosporine and interval changes of blood pressure levels. Hence, control of blood pressure correlates with changes of LVMI in children with renal allografts. These results clearly underline the importance of blood pressure control for the maintenance of the myocardial architecture.
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