Current Hypertension Reports

, Volume 14, Issue 6, pp 608–618

Ambulatory Blood Pressure Monitoring in Pediatric Renal Transplantation

Pediatric Hypertension (JT Flynn, Section Editor)

Abstract

Hypertension is a common and serious complication after renal transplantation. It is an important risk factor for graft loss and adverse cardiovascular outcomes. Blood pressure (BP) in transplanted children should be measured not only by clinic BP (cBP) measurement, but also by ambulatory blood pressure monitoring (ABPM), because ABPM has distinct advantages over cBP, specifically the ability to reveal nocturnal, masked or white-coat hypertension. These types of hypertension are common in transplanted children (nocturnal hypertension 36–71 %, masked hypertension 24–45 %). It may also reveal uncontrolled hypertension in treated children, thereby improving control of hypertension. Regular use of ABPM and ABPM-guided therapy of hypertension may help to decrease cardiovascular and renal target organ damage in transplanted children. Therefore, ABPM should be routinely performed in all transplanted children at least once a year, regardless of the values of cBP.

Keywords

Hypertension Blood pressure BP Children Pediatric Ambulatory blood pressure monitoring ABPM Renal transplantation Graft function Graft survival Left ventricular hypertrophy Antihypertensive therapy Control of hypertension 

References

Papers of particular importance, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Midtvedt K, Neumayer HH. Management strategies for posttransplant hypertension. Transplantation. 2000;70:SS64–9.PubMedGoogle Scholar
  2. 2.
    Baluarte HJ, Gruskin AB, Ingelfinger JR, Stablein D, Tejani A. Analysis of hypertension in children post renal transplantation—a report of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS). Pediatr Nephrol. 1994;8:570–3.PubMedCrossRefGoogle Scholar
  3. 3.
    Sorof JM, Sullivan EK, Tejani A, Portman RJ. Antihypertensive medication and renal allograft failure: A North American Pediatric Renal Transplant Cooperative Study report. J Am Soc Nephrol. 1999;10:1324–30.PubMedGoogle Scholar
  4. 4.
    Kasiske BL, Guijarro C, Massy ZA, Wiederkehr MR, Ma JZ. Cardiovascular disease after renal transplantation. J Am Soc Nephrol. 1996;7:158–65.PubMedGoogle Scholar
  5. 5.
    Tutone VK, Mark PB, Stewart GA, Tan CC, Rodger RSC, Geddes CC, Jardine AG. Hypertension, antihypertensive agents and outcomes following renal transplantation. Clin Transplant. 2005;19:181–92.PubMedCrossRefGoogle Scholar
  6. 6.
    Opelz G, Wujciak T, Ritz E for the Collaborative Transplant Study. Association of chronic kidney graft failure with recipient blood pressure. Kidney Int. 1998;53:217–222.Google Scholar
  7. 7.
    Mange KC, Gizman B, Joffe M, Feldman HI. Arterial hypertension and renal allograft survival. JAMA. 2000;283:633–8.PubMedCrossRefGoogle Scholar
  8. 8.
    Schwenger V, Zeier M, Ritz E. Hypertension after renal transplantation. Curr Hypertens Rep. 2001;5:434–9.CrossRefGoogle Scholar
  9. 9.
    Mitsnefes MM, Omoloja A, McEnery PT. Short-term pediatric renal transplant survival: blood pressure and allograft function. Pediatr Transplant. 2001;5:160–5.PubMedCrossRefGoogle Scholar
  10. 10.
    Mitsnefes MM, Khoury PR, McEnery PT. Early posttransplantation hypertension and poor long-term renal allograft survival in pediatric patients. J Pediatr. 2004;43:98–103.Google Scholar
  11. 11.
    National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics. 2004;114:555–576.Google Scholar
  12. 12.
    Calzolari A, Giordano U, Matteucci MC, Pastore E, Turchetta A, Rizzoni G, Alpert B. Hypertension in young patients after renal transplantation, ambulatory blood pressure monitoring versus casual blood pressure. Am J Hypertens. 1998;11:497–501.PubMedCrossRefGoogle Scholar
  13. 13.
    Mitsnefes MM, Portman RJ. Ambulatory blood pressure monitoring in pediatric renal transplantation. Pediatr Transplant. 2003;7:86–92.PubMedCrossRefGoogle Scholar
  14. 14.
    Ferraris JR, Ghezzi L, Waisman G, Krmar RT. ABPM vs. office blood pressure to define blood pressure control in treated hypertensive paediatric renal transplant recipients. Pediatr. Transplantation. 2007;11:24–30.Google Scholar
  15. 15.
    Lingens N, Dobos E, Witte K, Busch C, Lemmer B, Klaus G, Schärer K. Twenty-four-hour ambulatory blood pressure profiles in pediatric patients after renal transplantation. Pediatr Nephrol. 1997;11:23–6.PubMedCrossRefGoogle Scholar
  16. 16.
    Matteucci MC, Giordano U, Calzolari A, Turchetta A, Santilli A, Rizzoni G. Left ventricular hypertrophy, treadmill tests, and 24-hour blood pressure in pediatric transplant patients. Kidney Int. 1999;56:1566–70.PubMedCrossRefGoogle Scholar
  17. 17.
    Giordano U, Matteucci MC, Calzolari A, Turchetta A, Rizzoni G, Alpert BS. Ambulatory blood pressure monitoring in children with aortic coarctation and kidney transplantation. J Pediatr. 2000;136:520–3.PubMedCrossRefGoogle Scholar
  18. 18.
    Sorof JM, Poffenbarger T, Portman R. Abnormal 24-hour blood pressure patterns in children after renal transplantation. Am J Kidney Dis. 2000;35:681–6.PubMedCrossRefGoogle Scholar
  19. 19.
    Morgan H, Khan I, Hashmi A, Hebert D, McCrindle BW, Balfe JW. Ambulatory blood pressure monitoring after renal transplantation in children. Pediatr Nephrol. 2001;16:843–7.PubMedCrossRefGoogle Scholar
  20. 20.
    Serdaroglu E, Mir S, Berdelli A. Hypertension and ACE gene insertion/deletion polymorphism in pediatric renal transplant patients. Pediatr Transplant. 2005;9:612–7.PubMedCrossRefGoogle Scholar
  21. 21.
    Seeman T, Dušek J, Vondrák K, Šimková E, Kreisinger J, Feber J, Janda J. Ambulatory blood pressure monitoring in children after renal transplantation. Transplant Proc. 2004;36:1355–6.PubMedCrossRefGoogle Scholar
  22. 22.
    Seeman T, Šimková E, Kreisinger J, Vondrák K, Dušek J, Gilík J, Feber J, Dvořák P, Janda J. Control of hypertension in children after renal transplantation. Pediatr Transplant. 2006;10:316–22.PubMedCrossRefGoogle Scholar
  23. 23.
    • McGlothan KR, Wyatt RJ, Ault BH, Hastings MC, Rogers T, DiSessa T, Jones DP. Predominance of nocturnal hypertension in pediatric renal allograft recipients. Pediatr Transplant. 2006;10:558–64. This study firstly showed that masked hypertension is very common in transplanted children and confirmed high prevalence of treated but uncontrolled hypertension. PubMedCrossRefGoogle Scholar
  24. 24.
    Paripovic D, Kostic M, Spasojevic B, Kruscic D. Peco–Antic A: masked hypertension and hidden uncontrolled hypertension after renal transplantation. Pediatr Nephrol. 2010;25:1719–24.PubMedCrossRefGoogle Scholar
  25. 25.
    Tangeraas T, Midtvedt K, Fredriksen PM, Cvancarova M, Morkrid L, Bjerr A. Cardiovascular fitness is a marker of cardiovascular health in renal transplanted children. Pediatr Nephrol. 2010;25:2343–50.PubMedCrossRefGoogle Scholar
  26. 26.
    •• Basiratnia M, Esterghamati M, Ajami GH, Amoozgar H, Cheriki C, Soltani M, Derakhshan A, Fallahzadeh MH. Blood pressure profile in renal transplant recipients and its relation to diastolic function: tissue Doppler echocardiographic study. Pediatr Nephrol. 2011;26:449–57. This study on ABPM guided management of hypertension showed an extraordinarily good control of hypertension that has been associated with exceptionally low prevalence of left ventricular hypertrophy. PubMedCrossRefGoogle Scholar
  27. 27.
    Balzano R, Lindblad YT, Vavilis G, Jogestrand T, Berg UB, Krmar RT. Use of annual ABPM, and repeated carotic scan and echocardiography to monitor cardiovascular health over nine yr in pediatric and young adult renal transplant recipients. Pediatr Transplant. 2011;15:635–41.PubMedGoogle Scholar
  28. 28.
    Belsha CW, Wells TG, McNiece KL, Seib PM, Plummer JK, Berry PL. Influence of diurnal blood pressure variations on target organ abnormalities in adolescents with mild essential hypertension. Am J Hypertens. 1998;11:410–7.PubMedCrossRefGoogle Scholar
  29. 29.
    Harshfield GA, Pulliam DA, Alpert BS. Ambulatory blood pressure and renal function in healthy children and adolescents. Am J Hypertens. 1994;7:282–5.PubMedGoogle Scholar
  30. 30.
    •• Paoletti E, Gherzi M, Armidone M, Massarino F, Cannella G. Association of arterial hypertension with renal target organ damage in kidney transplant recipients: the predictive role of ambulatory blood pressure monitoring. Transplantation. 2009;87:1864–9. This adult study demonstrated that ambulatory BP has a predictive role for graft function and graft survival that is superior to clinic BP. PubMedCrossRefGoogle Scholar
  31. 31.
    Lurbe E, Redon J, Kesani A, Pascual JM, Tacons J, Alvarez V, Batlle D. Increase in nocturnal blood pressure and progression to microalbuminuria in type 1 diabetes. N Engl J Med. 2002;347:797–805.PubMedCrossRefGoogle Scholar
  32. 32.
    Seeman T, Šimková E, Kreisinger J, Vondrák K, Dušek J, Gilík J, Dvořák P, Janda J. Improved control of hypertension in children after renal transplantation: Results of a two-yr interventional trial. Pediatr Transplant. 2007;11:491–7.PubMedCrossRefGoogle Scholar
  33. 33.
    Pickering TG, Eguchi K, Kario K. Masked hypertension: a review. Hypertens Res. 2007;30:479–88.PubMedCrossRefGoogle Scholar
  34. 34.
    Lurbe E, Torro I, Alvarez V, Nawrot T, Paya R, Redon J, Staessen JA. Prevalence, persistence, and clinical significance of masked hypertension in youth. Hypertension. 2005;45:493–8.PubMedCrossRefGoogle Scholar
  35. 35.
    Stabouli S, Kotsis V, Toumanidis S, Papamichael C, Constantopoulos A, Zakopoulos N. White-coat and masked hypertension in children: association with target-organ damage. Pediatr Nephrol. 2005;20:1151–5.PubMedCrossRefGoogle Scholar
  36. 36.
    Matsuoka S, Awazu M. Masked hypertension in children and young adults. Pediatr Nephrol. 2004;19:651–4.PubMedCrossRefGoogle Scholar
  37. 37.
    Suláková T, Janda J, Cerná J, Janstová V, Suláková A, Slaný J, Feber J. Arterial HTN in children with T1DM—frequent and not easy to diagnose. Pediatr Diabetes. 2009;10:441–8.PubMedCrossRefGoogle Scholar
  38. 38.
    Flynn JT, Urbina EM. Pediatric ambulatory blood pressure monitoring: indications and interpretation. Clin Hypertens (Greenwich). 2012;14:372–82.CrossRefGoogle Scholar
  39. 39.
    Kramer AM, van Stralen KJ, Jager KJ, Schaefer F, Verrina E, Seeman T, Lewis MA, Boehm M, Simonetti GD, Novljan G, Groothoff JW. Demographics of blood pressure and hypertension in children on renal replacement therapy in Europe. Kidney Int. 2011;80:1092–8.PubMedCrossRefGoogle Scholar
  40. 40.
    Sinha MD, Kerecuk L, Gilg J, Reid CJD on behalf of the British Association for Paediatric Nephrology: Systemic arterial hypertension in children following renal transplantation: prevalence and risk factors. Nephrol Dial Transplant 2012, Feb 10. [Epub ahead of print]Google Scholar
  41. 41.
    Höcker B, Weber LT, Feneberg R, Drube J, John U, Fehrenbach H, Pohl M, Zimmering M, Fründ S, Klaus G, Wühl E, Tönshoff B. Improved growth and cardiovascular risk after late steroid withdrawal: 2-year results of a prospective, randomized trial in paediatric renal transplantation. Nephrol Dial Transplant. 2010;25:617–24.PubMedCrossRefGoogle Scholar
  42. 42.
    Krischock L, Gullett A, Bockenhauer D, Rees L, Trompetes RS, Marks SD. Calcineurin-inhibitor free immunosuppression with mycophenolate mofetil and corticosteroids in paediatric renal transplantation improves renal allograft function without increasing acute rejection. Pediatr Transplant. 2009;13:475–81.PubMedCrossRefGoogle Scholar
  43. 43.
    Soergel M, Kirschstein M, Busch C, Danne T, Gellermann J, Holl R, Krull F, Reichert H, Reusz GS, Rascher W. Oscillometric twenty-four-hour ambulatory blood pressure values in healthy children and adolescents: a multicenter trial including 1141 subjects. J Pediatr. 1997;130:178–84.PubMedCrossRefGoogle Scholar
  44. 44.
    • Seeman T. Hypertension after renal transplantation. Pediatr Nephrol. 2009;24:959–72. Recent review on the causes and consequences of hypertension in transplanted children. PubMedCrossRefGoogle Scholar
  45. 45.
    Lipkin GW, Tucker B, Giles M, Raine AE. Ambulatory blood pressure and left ventricular mass in cyclosporin- and non-cyclosporin-treated renal transplant recipients. J Hypertens. 1993;11:439–42.PubMedCrossRefGoogle Scholar
  46. 46.
    Wadei HM, Amer H, Taler SJ, Cosio FG, Griffin MD, Grande JP, Larson TS, Schwab TR, Stegall MD, Textor SC. Diurnal blood pressure changes one year after kidney transplantation: relationship to allograft function, histology, and resistive index. J Am Soc Nephrol. 2007;18:1607–15.PubMedCrossRefGoogle Scholar
  47. 47.
    Wadei HM, Amer H, Griffin MD, Taler SJ, Stegall MD, Textor SC. Abnormal circadian blood pressure pattern 1-year after kidney transplantation is associated with subsequent lower glomerular filtration rate in recipients without rejection. J Am Soc Hypertens. 2011;5:39–47.PubMedCrossRefGoogle Scholar
  48. 48.
    Krmar RT, Berg UB. Long-term reproducibility of routine ambulatory blood pressure monitoring in stable pediatric renal transplant recipients. Am J Hypertens. 2005;18:1408–14.PubMedCrossRefGoogle Scholar
  49. 49.
    Mitsnefes MM, Kimball TR, Border WL, Glascock BJ, Khoury PR, Daniels SR. Abnormal cardiac function in children after renal transplantation. Am J Kidney Dis. 2004;43:721–6.PubMedCrossRefGoogle Scholar
  50. 50.
    Kitzmueller E, Vécsei A, Pichler J, Bohm M, Muller T, Vargha R, Csaicsich D, Aufricht C. Changes of blood pressure and left ventricular mass in pediatric renal transplantation. Pediatr Nephrol. 2004;19:1385–9.PubMedCrossRefGoogle Scholar
  51. 51.
    Mitsnefes MM, Kimball TR, Win SA, Glascock BJ, Khoury PR, Daniels SR. Abnormal carotid artery structure and function in children and adolescents with successful renal transplantation. Circulation. 2004;110:97–101.PubMedCrossRefGoogle Scholar
  52. 52.
    Berber I, Aydin C, Yigit B, Kara VM, Yildar M, Duzyol C, Turkmen F, Titiz MI, Altaca G. Blood pressure and graft outcome in renal transplantation. Transplant Proc. 2005;37:997–8.PubMedCrossRefGoogle Scholar
  53. 53.
    Akioka K, Takahara S, Ichikawa S, Yoshimura N, Akiyama T, Ohshima S. Factors predicting long-term graft survival after kidney transplantation: Multicenter study in Japan. World J Surg. 2005;29:249–56.PubMedCrossRefGoogle Scholar
  54. 54.
    Jacobi J, Rockstroh J, John S, Schreiber M, Schlaich MP, Neumayer HH, Schmieder RE. Prospective analysis of the value of 24-hour ambulatory blood pressure on renal function after kidney transplantation. Transplantation. 2000;70:819–27.PubMedCrossRefGoogle Scholar
  55. 55.
    Seeman T, Simková E, Kreisinger J, Vondrák K, Dusek J, Dvorák P, Janda J. Proteinuria in children after renal transplantation. Transplant Proc. 2005;37:4282–3.PubMedCrossRefGoogle Scholar
  56. 56.
    Fernández-Fresnedo G, Plaza JJ, Sánchez-Plumed J, Sanz-Guajardo A, Palomar-Fontanet R, Arias M. Proteinuria: a new marker of long-term graft and patient survival in kidney transplantation. Nephrol Dial Transplant. 2004;19:47–51.CrossRefGoogle Scholar
  57. 57.
    Krmar RT, Berg UB. Blood pressure control in hypertensive pediatric renal transplants: role of repeated ABPM following transplantation. Am J Hypertens. 2008;21:1093–9.PubMedCrossRefGoogle Scholar
  58. 58.
    Swartz SJ, Srivaths PR, Croix B, Feig DI. Cost-effectiveness of ambulatory blood pressure monitoring in the initial evaluation of hypertension in children. Pediatrics. 2008;122:1177–81.PubMedCrossRefGoogle Scholar
  59. 59.
    • Flynn JT. Ambulatory blood pressure monitoring in children: imperfect yet essential. Pediatr Nephrol. 2011;26:2089–94. Most recent editorial on ABPM in children. PubMedCrossRefGoogle Scholar
  60. 60.
    Urbina E, Alpert B, Flynn J, Hayman L, Harshfield GA, Jacobson M, Mahoney L, McCrindle B, Mietus-Snyder M, Steinberger J, Daniels S. American Heart Association Atherosclerosis, Hypertension, and Obesity in Youth Committee. Ambulatory blood pressure monitoring in children and adolescents: recommendations for standard assessment: a scientific statement from the American Heart Association Atherosclerosis, Hypertension, and Obesity in Youth Committee of the council on cardiovascular disease in the young and the council for high blood pressure research. Hypertension. 2008;52:433–51.PubMedCrossRefGoogle Scholar
  61. 61.
    Task force on cardiovascular disease. Special report from the National Kidney Foundation. Am J Kidney Dis. 1998;32(Suppl 3):1–121.Google Scholar
  62. 62.
    Groothoff JW, Gruppen MP, Offringa M, Hutten J, Lilien MR, Van De Kar NJ, Wolff ED, Davin JC, Heymans HS. Mortality and causes of death of end-stage renal diseases in children: a Dutch cohort study. Kidney Int. 2002;61:621–9.PubMedCrossRefGoogle Scholar
  63. 63.
    Opelz G, Dohler B. Collaborative Transplant Study. Improved long-term outcomes after renal transplantation associated with blood pressure control. Am J Transplant. 2005;5:2725–31.PubMedCrossRefGoogle Scholar
  64. 64.
    Wühl E, Trivelli A, Picca S, Litwin M, Peco-Antic A, Zurowska A, Testa S, Jankauskiene A, Emre S, Caldas-Afonso A, Anarat A, Niaudet P, Mir S, Bakkaloglu A, Enke B, Montini G, Wingen AM, Sallay P, Jeck N, Berg U, Caliskan S, Wygoda S, Hohbach-Hohenfellner K, Dusek J, Urasinski T, Arbeiter K, Neuhaus T, Gellermann J, Drozdz D, Fischbach M, Möller K, Wigger M, Peruzzi L, Mehls O, Schaefer F. Strict blood-pressure control and progression of renal failure in children. N Engl J Med. 2009;361:1639–50.PubMedCrossRefGoogle Scholar
  65. 65.
    • Lurbe E, Cifkova R, Cruickshank JK, Dillon MJ, Ferreira I, Invitti C, Kuznetsova T, Laurent S, Mancia G, Morales-Olivas F, Rascher W, Redon J, Schaefer F, Seeman T, Stergiou G, Wühl E, Zanchetti A. European Society of Hypertension. Management of high blood pressure in children and adolescents: recommendations of the European Society of Hypertension. J Hypertens. 2009;27:1719–42. Most recent European guidelines on management of hypertension in children. PubMedCrossRefGoogle Scholar
  66. 66.
    Flynn JT. Ambulatory blood pressure monitoring should be routinely performed after pediatric renal transplantation. Pediatr Transplant. 2011 Dec 21. doi: 10.1111/j.1399-3046.2011.01626.x. [Epub ahead of print]
  67. 67.
    Seeman T. Hypertension in children after renal transplantation. Curr Hypertens Rev. 2007;3:59–68.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Department of Pediatrics and Transplantation Center, University Hospital MotolCharles University Prague, 2nd Faculty of MedicinePragueCzech Republic
  2. 2.Biomedical Centre, Faculty of Medicine in PlzenCharles University in PraguePlzenCzech Republic

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