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Blood pressure profiles 5 to 10 years after transplant in pediatric solid organ recipients
Juuso Tainio1, Erik Qvist, Jenni Miettinen
1Children's Hospital, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland.
Insights
Children with solid organ transplants frequently develop hypertension, including nocturnal hypertension. Ambulatory blood pressure monitoring (ABPM) is crucial for detecting this, as abnormal blood pressure index and load are common, especially at night.
Area of Science:
- Cardiology
- Nephrology
- Transplant Surgery
Background:
- Arterial hypertension is a significant risk factor for cardiovascular disease post-solid organ transplantation.
- Effective blood pressure (BP) monitoring is essential for managing transplant recipients.
Purpose of the Study:
- To evaluate 24-hour ambulatory BP monitoring (ABPM) parameters in pediatric solid organ transplant recipients.
- To assess the predictive value of ABPM for hypertension and its correlation with graft function and metabolic parameters.
Main Methods:
- Retrospective analysis of ABPM data from 111 renal, 29 heart, and 13 liver transplant recipients (5-10 years post-transplant).
- Evaluation of BP index, load, and dipping patterns, and their correlation with metabolic factors and kidney function.
Main Results:
- ABPM profiles were similar across transplant types.
- Abnormal BP index and load were common, particularly at night, with blunted nocturnal BP dipping in 49%-83% of patients.
- BP variables showed poor correlation with metabolic parameters and kidney function; a BP load cutoff of 50% may be more appropriate.
Conclusions:
- Hypertension, including nocturnal hypertension, is prevalent in pediatric solid organ transplant recipients.
- ABPM is vital for the comprehensive follow-up of these patients to detect and manage hypertension effectively.
Abstract:
Arterial hypertension is a major risk factor for cardiovascular disease after solid organ transplantation, emphasizing the need for blood pressure (BP) monitoring. The authors studied 24-hour ambulatory BP monitoring (ABPM) parameters (index, load, dipping) and their predictive value with regard to hypertension as well as correlations with graft function and metabolic parameters such as obesity and dyslipidemias. The ABPM profiles of 111 renal, 29 heart, and 13 liver transplant recipients were retrospectively analyzed 5 to 10 years after transplant (median 5.1 years). The BP profiles among the different transplant groups were similar. The BP index and load were abnormal especially at nighttime and the nocturnal BP dipping was often blunted (in 49% to 83% of the patients). The BP variables were found to be equally valued when assessing hypertension. BP load of 50% instead of 25% seems to be a more adequate cutoff value. The BP variables correlated poorly with the metabolic parameters and kidney function. Antihypertensive medication did not notably change the ABPM profile in renal transplant recipients. Hypertension, including nocturnal hypertension, is present in children receiving solid organ transplant, underlining the importance of use of ABPM in the follow-up of these patients.
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