Advertisement

Pediatric Nephrology

, Volume 26, Issue 3, pp 449–457 | Cite as

Blood pressure profile in renal transplant recipients and its relation to diastolic function: tissue Doppler echocardiographic study

  • Mitra BasiratniaEmail author
  • Maryam Esteghamati
  • Gholam Hossein Ajami
  • Hamid Amoozgar
  • Cyrus Cheriki
  • Manoochehr Soltani
  • Ali Derakhshan
  • Mohammad Hossein Fallahzadeh
Original Article

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.

Keywords

Renal transplantation Tissue Doppler echocardiography Ambulatory blood pressure monitoring Diastolic function 

Notes

Acknowledgements

The authors would like to thank Dr Nasrin Shokrpoor at the Center for Development of Clinical Research of Nemazee Hospital for editorial assistance.

References

  1. 1.
    Baluarte HJ, Gruskin AB, Ingelfinger JR, Stablein D, Tejani A (1994) Analysis of hypertension in children post renal transplantation—a report of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS). Pediatr Nephrol 8:570–573PubMedCrossRefGoogle Scholar
  2. 2.
    Kasiske BL, Guijarro C, Massy ZA, Wiederkehr MR, Ma JZ (1996) Cardiovascular disease after renal transplantation. J Am Soc Nephrol 7:158–165PubMedGoogle Scholar
  3. 3.
    Opelz G, Wujciak T, Ritz E; Collaborative Transplant Study (1998) Association of chronic kidney graft failure with recipient blood pressure. Kidney Int 53:217–222CrossRefGoogle Scholar
  4. 4.
    Buescher R, Vester U, Wingen A-M, Hoyer PF (2004) Pathomechanism and the diagnosis of arterial hypertension in pediatric renal allograft recipients. Pediatr Nephrol 19:1202–1211CrossRefGoogle Scholar
  5. 5.
    Seeman T (2009) Hypertension after renal transplantation. Pediatr Nephrol 24:959–972PubMedCrossRefGoogle Scholar
  6. 6.
    Kavey RE, Kveselis DA, Atallah N, Smith FC (2007) White coat hypertension in childhood: evidence for end-organ effect. J Pediatr 150:491–497PubMedCrossRefGoogle Scholar
  7. 7.
    McGlothan KR, Wyatt RJ, Ault BH, Hastings MC, Rogers T, DiSessa T, Jones DP (2006) Predominance of nocturnal hypertension in pediatric renal allograft recipients. Pediatr Transplant 10:558–564PubMedCrossRefGoogle Scholar
  8. 8.
    Paripovic D, Kostic M, Spasojevic B, Kruscic D, Peco-Antic A (2010) Masked hypertension and hidden uncontrolled hypertension after renal transplantation. Pediatr Nephrol 25:1719–1724PubMedCrossRefGoogle Scholar
  9. 9.
    Lipkin GW, Tucker B, Giles M, Raine AE (1993) Ambulatory blood pressure and left ventricular mass in cyclosporin- and non cyclosporin treated renal transplant recipients. J Hypertens 11:439–442PubMedCrossRefGoogle Scholar
  10. 10.
    Matteucci MC, Giordano U, Calzolari A, Turchetta A, Santilli A, Rizzoni G (1999) Left ventricular hypertrophy, treadmill tests, and 24-hour blood pressure in pediatric transplant patients. Kidney Int 56:1566–1570PubMedCrossRefGoogle Scholar
  11. 11.
    Morgan H, Khan I, Hashmi A, Hebert D, McCrindle BW, Balfe JW (2001) Ambulatory blood pressure monitoring after renal transplantation in children. Pediatr Nephrol 16:843–847PubMedCrossRefGoogle Scholar
  12. 12.
    Wühl E, Witte K, Soergel M, Mehls O, Schaefer F; German Working Group on Pediatric Hypertension (2002) Distribution of 24-h ambulatory blood pressure in children: normalized reference values and role of body dimensions. J Hypertens 20:1995–2007CrossRefGoogle Scholar
  13. 13.
    Devereux RB, Alonso DR, Lutas EM, Gottlieb GJ, Campo E, Sachs I, Reichek N (1986) Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol 57:450–458PubMedCrossRefGoogle Scholar
  14. 14.
    Sahn DJ, DeMaria A, Kisslo J, Weyman A (1978) Recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements. Circulation 58:1072–1083PubMedGoogle Scholar
  15. 15.
    Daniels SR, Loggie J, Khoury P, Kimball TR (1998) Left ventricular hypertrophy in children and adolescents with essential hypertension. Circulation 97:1907–1911PubMedGoogle Scholar
  16. 16.
    Calzolari A, Giordano U, Matteucci MC, Pastore E, Turchetta A, Rizzoni G, Alpert B (1998) Hypertension in young patients after renal transplantation: ambulatory blood pressure monitoring versus casual blood pressure. Am J Hypertens 11:497–501PubMedCrossRefGoogle Scholar
  17. 17.
    Giordano U, Matteucci MC, Calzolari A, Turchetta A, Rizzoni G, Alpert BS (2000) Ambulatory blood pressure monitoring in children with aortic coarctation and kidney transplantation. J Pediatr 136:520–523PubMedCrossRefGoogle Scholar
  18. 18.
    Seeman T, Šimková E, Kreisinger J, Vondrák K, Dušek J, Gilík J, Feber J, Dvorák P, Janda J (2006) Control of hypertension in children after renal transplantation. Pediatr Transplant 10:316–322PubMedCrossRefGoogle Scholar
  19. 19.
    Sorof JM, Poffenbarger T, Portman R (2000) Abnormal 24-hour blood pressure patterns in children after renal transplantation. Am J Kidney Dis 35:681–686PubMedCrossRefGoogle Scholar
  20. 20.
    Mitsnefes MM, Kimball TR, Border WL, Witt SA, Glascock BJ, Khoury PR, Daniels SR (2004) Abnormal cardiac function in children after renal transplantation. Am J Kidney Dis 43:721–726PubMedCrossRefGoogle Scholar
  21. 21.
    Gordjani N, Offner G, Hoyer PF, Brodehl J (1990) Hypertension after renal transplantation in patients treated with cyclosporine and azathioprine. Arch Dis Child 65:275–279PubMedCrossRefGoogle Scholar
  22. 22.
    Ten Harkel AD, Cransberg K, Van Osch-Gevers M, Nauta J (2009) Diastolic dysfunction in paediatric patients on peritoneal dialysis and after renal transplantation. Nephrol Dial Transplant 24:1987–1991PubMedCrossRefGoogle Scholar
  23. 23.
    Zweiker R, Eber B, Schumacher M, Toplak H, Klein W (1994) “non dipping” related to cardiovascular events in essential hypertensive patients. Acta Med Austriaca 21:86–89PubMedGoogle Scholar
  24. 24.
    Verdecchia P, Porcellati C, Schillaci G, Borgioni C, Ciucci A, Battistelli M, Guerrieri M, Gatteschi C, Zampi I, Santucci A (1994) Ambulatory blood pressure. An independent predictor of prognosis in essential hypertension. Hypertension 24:793–801PubMedGoogle Scholar
  25. 25.
    Johnstone LM, Jones CL, Grigg LE, Wilkinson JL, Walker RG, Powell HR (1996) Left ventricular abnormalities in children, adolescents and young adults with renal disease. Kidney Int 50:998–1006PubMedCrossRefGoogle Scholar
  26. 26.
    Atalay S, Ekim M, Tutar HE, Koçak G, Bakkaloğlu S, Tümer N (2002) Systolic and diastolic function in children with chronic renal failure. Pediatr Int 44:18–23PubMedCrossRefGoogle Scholar
  27. 27.
    Virga G, Stomaci B, Munaro A, Mastrosimone S, Cara M, Artuso E, Piovesana P (2006) Systolic and diastolic function in renal replacement therapy a cross-sectional study. J Nephrol 19:155–160PubMedGoogle Scholar

Copyright information

© IPNA 2010

Authors and Affiliations

  • Mitra Basiratnia
    • 1
    • 3
    Email author
  • Maryam Esteghamati
    • 1
  • Gholam Hossein Ajami
    • 2
  • Hamid Amoozgar
    • 2
  • Cyrus Cheriki
    • 2
  • Manoochehr Soltani
    • 2
  • Ali Derakhshan
    • 1
  • Mohammad Hossein Fallahzadeh
    • 1
  1. 1.Shiraz Nephrology Urology Research CenterShiraz University of Medical SciencesShirazIran
  2. 2.Division of Pediatric Cardiology, Nemazee HospitalShiraz University of Medical SciencesShirazIran
  3. 3.Pediatric Nephrology Ward, Nemazee HospitalShiraz University of Medical SciencesShirazIran

Personalised recommendations