Relationship Between Peripheral-Central Blood Pressure and Cardiac-Renal Damage in Kidney Transplant Recipients

Hypertension is a common and important problem in kidney transplant recipients, directly affecting graft and patient survival. Here, we evaluated the relationship between renal-cardiac damage and peripheral and central aortic blood pressure levels in renal transplant recipients.

We measured peripheral blood pressure (office, daytime ambulatory, and central aortic) in 46 kidney transplant recipients. Biochemical parameters were simultaneously measured. Electrocardiography and echocardiography were performed. Patients with office blood pressure > 140/90 mm Hg or who were treated with antihypertensive drugs were accepted as hypertensive.

Ambulatory blood pressure measurements were higher than office blood pressure measurements (at 135.6/85.6 mm Hg vs 121.8/77.5 mm Hg in hypertensive and at 118.8/77.6 mm Hg vs 101.6/62.5 mm Hg in normotensive patients) (P < .05). There were 40 hypertensive and 6 normotensive kidney transplant recipients according to ambulatory blood pressure measurement and 33 hypertensive and 13 normotensive according to office blood pressure measurements. Central aortic pressure measurements were significantly higher in hypertensive patients versus office or ambulatory blood pressure (P = .045 and .048, respectively). Left ventricle mass index and proteinuria were significantly correlated with central aortic pres sure (P = .015, r = 0.358 and P = .022, r = 0.499, respectively) and nonsignificantly correlated with peripheral blood pressure measurements (P > .05). Left ventricle hypertrophy was found to be less common in patients using angiotensin-converting enzyme, although not significantly (P > .05).

In kidney transplant recipients, blood pressure should be monitored with ambulatory blood pressure measurements, even when normal office pressure levels are shown. The aim of antihypertensive therapy is not only to decrease brachial artery pressure but also to keep central aortic systolic blood pressure in the proper interval, adjusted according to age. This may more effectively prevent the development of renal cardiac damage versus peripheral blood pressure measurement monitoring.