Predictive Factors of Abnormal Circadian Blood Pressure Profile in Recipients of Kidney Transplantation

Camelia ACHIM, Anca ZGURA and Mihai VOICULESCU

ABSTRACT

Arterial hypertension (HT) plays an important role and is a major factor in the occurrence and progression of chronic graft nephropathy. We evaluated 24-hour blood pressure (BP) profile in kidney transplant patients to identify factors predictive of abnormal circadian BP profile. BP was measured over a period of 24 hours using a noninvasive automatic device (EC-3H / ABPM) in 40 renal transplant patients (mean age = 37.2±12.2 years, M = 30, mean serum creatinine = 2.0±1.4 mg/dl). They were under the triple immunosuppressive therapy (CsA / Ts + Aza / MMF + PDN). 35 recipients (87.5%) had a nondipper BP profile, with nocturnal values which fell by less than 10% from the daytime BP values. The other 5 containers (12.5%) had normal dipper BP, with lower nighttime values by more than 10% of the daytime BP values. 17/40 recipients (42.5%) had nocturnal BP values higher than daily rates (extreme non-dipper). In none of the patients there has been excessive dipper profile (low nighttime values over 20% less than the diurnal BP). There were no statistically significant differences between the dipper and non-dipper recipients profile in terms of age, gender, creatinine, mean systolic BP (SBP) and daytime SBP, short-term variability in BP and pulse pressure (p>0.05). Factors predictive of a non-dipper BP profile were elevated median 24h BP, median 24 systolic and diastolic blood pressure (DBP), diurnal, nocturnal and 24h pulse rate (p<0.05). In conclusion, the absence of normal nocturnal BP lower values was relatively frequent (87.5%) in renal allograft recipients. In many studied patients nocturnal BP values were higher than the diurnal ones..

Keywords: hypertension, kidney, transplantation

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