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Blood pressure profile in renal transplant recipients and its relation to diastolic function: tissue Doppler
Mitra Basiratnia1, Maryam Esteghamati, Gholam Hossein Ajami
1Shiraz Nephrology Urology Research Center, Shiraz University of Medical Sciences, and Nemazee Hospital, Shiraz, Iran. m_basiratnia@yahoo.com
Insights
Ambulatory blood pressure monitoring (ABPM) is superior for diagnosing hypertension in renal transplant recipients. This method revealed high rates of hypertension and non-dipping, linked to left ventricular hypertrophy (LVH), indicating significant cardiac changes post-transplant.
Area of Science:
- Nephrology
- Cardiology
- Transplantation Medicine
Background:
- Hypertension is a frequent complication post-renal transplantation, elevating cardiovascular disease risk.
- Understanding diurnal blood pressure patterns is crucial for managing cardiac complications in these patients.
Purpose of the Study:
- To investigate the diurnal blood pressure (BP) pattern in stable renal transplant recipients.
- To examine the relationship between BP patterns and structural/functional cardiac changes.
Main Methods:
- Sixty-six stable renal transplant recipients (age 7-25 years) underwent ambulatory blood pressure monitoring (ABPM) and casual BP measurements.
- Cardiac function was assessed using tissue Doppler echocardiography.
- Left ventricular mass index (LVMI) and left ventricular hypertrophy (LVH) were evaluated.
Main Results:
- Hypertension prevalence was 57% by casual measurement and 75.7% by ABPM, with 73% exhibiting non-dipping patterns.
- ABPM parameters showed a significant inverse correlation with post-transplant duration.
- All ABPM parameters correlated significantly with LVMI, which was higher in hypertensive patients. No differences in diastolic function were observed.
Conclusions:
- ABPM is more effective than casual BP measurement for diagnosing hypertension in renal transplant recipients.
- Left ventricular hypertrophy is prevalent and associated with arterial hypertension in this population.
- Hypertension and LVH do not differentiate patients with diastolic dysfunction.
Abstract:
Hypertension is a common complication after renal transplantation and is associated with increased risk of cardiovascular disease. The aim of the current study was to investigate the diurnal blood pressure pattern and its relation to structural and functional cardiac changes in renal transplant recipients. Sixty-six stable renal transplant patients (34 female, 32 male), aged 7 to 25 years (mean 17.4±4.3 years) were enrolled in this study. Cardiac function assessed by tissue Doppler echocardiography and blood pressure measurement performed using both the ambulatory and the casual method. Hypertension was demonstrated in 57% of recipients by the casual method and in 75.7% by ambulatory blood pressure monitoring (ABPM). The efficacy of BP control among patients on antihypertensive drugs was 60%. The prevalence of non-dipping was 73%. There was significant inverse correlation between systolic or diastolic day-time or night-time BP index and post-transplant duration (p<0.001, r=-0.386), but no correlation between ABP parameters and BMI, gender, and eGFR. There was a significant relationship between all ABP parameters and left ventricular mass index (LVMI) (p=0.025-0.007, r=0.28-0.38). LVMI was significantly higher in hypertensive than in normotensive cases (p=0.034). There was no difference in diastolic function between hypertensive and normotensive patients or between patients with and without left ventricular hypertrophy (LVH). In conclusion, our study showed the advantage of ABPM over the casual method of diagnosis of hypertension. LVH is common in transplant patients and is likely associated with arterial hypertension. Hypertension and LVH cannot differentiate transplant patients with diastolic malfunction.
Related Concept Videos
01:19Assessing Blood pressure using a doppler ultrasound
Pre-Procedural Guidelines for Doppler Ultrasound Blood Pressure Assessment:
Preparation of Equipment:
01:28Kidney Transplant I: Introduction
01:16Kidney Transplant III: Nursing Management
01:28Special considerations while measuring blood pressure
Monitoring Both Arms:
Monitoring BP in both arms during the initial assessment is advisable, as the systolic value may differ by five to ten mm Hg between arms. For subsequent BP assessments, use the arm with the higher reading.