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Masked hypertension and hidden uncontrolled hypertension after renal transplantation

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Abstract

Arterial hypertension is a risk factor affecting graft function in pediatric kidney transplants. Recent pediatric studies reported a high prevalence of hypertension, especially nocturnal hypertension in this population. Data regarding the prevalence of masked hypertension in pediatric patients with kidney transplants are still scarce. The aim of this cross-sectional study was to assess the prevalence of masked and hidden uncontrolled hypertension after renal transplantation. A total of 41 patients (25 males) with stable functioning renal graft were included in the study. Their median age was 14.5 years with the median interval since transplantation of 2.5 years (range 0.3 to 20.6). Spacelabs 90207 was used to measure ambulatory blood pressure (BP) during a 24-h period. Ambulatory hypertension was defined as mean systolic and/or diastolic BP index at day-time or nighttime ≥1. Masked hypertension was defined as normal office BP but daytime ambulatory hypertension in patients without antihypertensive medications. Hidden uncontrolled hypertension was defined as daytime ambulatory hypertension undetected by office BP measurements in treated patients. Antihypertensive medications were prescribed to 58%. Prevalence of nocturnal hypertension was 68%. On the basis of combination of office and ABPM masked hypertension and hidden uncontrolled hypertension was detected in 24% and 21% of the study population, respectively. Regular use of ambulatory blood pressure monitoring in transplanted patients enables detection of masked and hidden uncontrolled hypertension.

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References

  1. Tutone VK, Mark PB, Stewart GA, Tan CC, Rodger RSC, Geddes CC, Jardine AG (2005) Hypertension, antihypertensive agents and outcomes following renal transplantation. Clin Transpl 19:181–192

    Article  CAS  Google Scholar 

  2. Seeman T (2009) Hypertension after renal transplantation. Pediatr Nephrol 24:959–972

    Article  PubMed  Google Scholar 

  3. Lezaic V, Naumovic R, Stanic M, Marinkovic J, Kostic M, Peco-Antic A, Djukanovic L (2007) Factors affecting graft function in pediatric and adult recipients of adult live donor kidney transplants. Pediatr Transplant 11:906–913

    Article  PubMed  Google Scholar 

  4. Peco-Antić A, Pejcić I (1997) Continuous ambulatory blood pressure measurement—a new method for the detection of arterial hypertension in children. Srp Arh Celok Lek 125:171–175

    PubMed  Google Scholar 

  5. Pickering TG, Davidson K, Gerin W, Schwartz JE (2002) Masked hypertension. Hypertension 40:795–796

    Article  CAS  PubMed  Google Scholar 

  6. Lurbe E, Torro I, Alvarez V, Nawrot T, Paya R, Redon J, Staessen JA (2005) Prevalence, persistence, and clinical significance of masked hypertension in youth. Hypertension 45:493–498

    Article  CAS  PubMed  Google Scholar 

  7. Verberk WJ, Kessels AG, de Leeuw PW (2008) Prevalence, causes, and consequences of masked hypertension: a meta-analysis. Am J Hypertens 21:969–975

    Article  PubMed  Google Scholar 

  8. Lingens N, Dobos E, Witte K, Busch C, Lemmer B, Klaus G, Schärer K (1997) Twenty-four-hour ambulatory blood pressure profiles in pediatric patients after renal transplantation. Pediatr Nephrol 11:23–26

    Article  CAS  PubMed  Google Scholar 

  9. Serdaroglu E, Mir S, Berdeli A (2005) Hypertension and ace gene insertion/deletion polymorphism in pediatric renal transplant patients. Pediatr Transplant 9:612–617

    Article  CAS  PubMed  Google Scholar 

  10. Ferraris JR, Ghezzi L, Waisman G, Krmar RT (2007) ABPM vs. office blood pressure to define blood pressure control in treated hypertensive paediatric renal transplant recipients. Pediatr Transplant 11:24–30

    Article  PubMed  Google Scholar 

  11. Sethna CB, Leonard MB, Gallagher PR, Meyers KE (2009) Serum adiponectin levels and ambulatory blood pressure monitoring in pediatric renal transplant recipients. Transplantation 88:1030–1037

    Article  CAS  PubMed  Google Scholar 

  12. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents (2004) The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 114:555–576

    Article  Google Scholar 

  13. Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, Grassi G, Heagerty AM, Kjeldsen SE, Laurent S, Narkiewicz K, Ruilope L, Rynkiewicz A, Schmieder RE, Boudier HA, Zanchetti A, Vahanian A, Camm J, De Caterina R, Dean V, Dickstein K, Filippatos G, Funck-Brentano C, Hellemans I, Kristensen SD, McGregor K, Sechtem U, Silber S, Tendera M, Widimsky P, Zamorano JL, Erdine S, Kiowski W, Agabiti-Rosei E, Ambrosioni E, Lindholm LH, Viigimaa M, Adamopoulos S, Agabiti-Rosei E, Ambrosioni E, Bertomeu V, Clement D, Erdine S, Farsang C, Gaita D, Lip G, Mallion JM, Manolis AJ, Nilsson PM, O’Brien E, Ponikowski P, Redon J, Ruschitzka F, Tamargo J, van Zwieten P, Waeber B, Williams B, Management of Arterial Hypertension of the European Society of Hypertension, European Society of Cardiology (2007) 2007 Guidelines for the Management of Arterial Hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 25:1105–1187

    Article  CAS  PubMed  Google Scholar 

  14. Soergel M, Kirschstein M, Busch C, Danne T, Gellermann J, Holl R, Krull F, Reichert H, Reusz GS, Rascher W (1997) Oscillometric twenty-four-hour ambulatory blood pressure values in healthy children and adolescents: a multicenter trial including 1141 subjects. J Pediatr 130:178–184

    Article  CAS  PubMed  Google Scholar 

  15. 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 10:316–322

    Article  CAS  PubMed  Google Scholar 

  16. 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 8:570–573

    Article  CAS  PubMed  Google Scholar 

  17. Sorof JM, Sullivan EK, Tejani A, Portman RJ (1999) Antihypertensive medication and renal allograft failure: a North American Pediatric Renal Transplant Cooperative Study report. J Am Soc Nephrol 10:1324–1330

    CAS  PubMed  Google Scholar 

  18. Mitsnefes MM, Portman RJ (2003) Ambulatory blood pressure monitoring in pediatric renal transplantation. Pediatr Transplant 7:86–92

    Article  PubMed  Google Scholar 

  19. Krmar RT, Berg UB (2005) Long-term reproducibility of routine ambulatory blood pressure monitoring in stable pediatric renal transplant recipients. Am J Hypertens 18:1408–1414

    Article  PubMed  Google Scholar 

  20. Peco-Antić A (2008) Problems with current hypertension definition in children. Srp Arh Celok Lek 136:62–67

    PubMed  Google Scholar 

  21. Sorof JM, Cardwell G, Franco K, Portman RJ (2002) Ambulatory blood pressure and left ventricular mass index in hypertensive children. Hypertension 39:903–908

    Article  CAS  PubMed  Google Scholar 

  22. 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 11:497–501

    Article  CAS  PubMed  Google Scholar 

  23. 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 10:558–564

    Article  PubMed  Google Scholar 

  24. Stabouli S, Kotsis V, Toumanidis S, Papamichael C, Constantopoulos A, Zakopoulos N (2005) White-coat and masked hypertension in children: association with target-organ damage. Pediatr Nephrol 20:1151–1155

    Article  PubMed  Google Scholar 

  25. Mitsnefes M, Flynn J, Cohn S, Samuels J, Blydt-Hansen T, Saland J, Kimball T, Furth S, Warady B, for the CKiD Study Group (2010) Masked hypertension associates with left ventricular hypertrophy in children with CKD. J Am Soc Nephrol 21:137–144

    Article  CAS  PubMed  Google Scholar 

  26. Matsuoka S, Awazu M (2004) Masked hypertension in children and young adults. Pediatr Nephrol 19:651–654

    Article  PubMed  Google Scholar 

  27. Levy D, Garrison RJ, Savage DD, Kannel WB, Castelli WP (1990) Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study. N Engl J Med 322:1561–1566

    Article  CAS  PubMed  Google Scholar 

  28. Mitsnefes MM, Kimball TR, Witt SA, Glascock BJ, Khoury PR, Daniels SR (2004) Abnormal carotid artery structure and function in children and adolescents with successful renal transplantation. Circulation 110:97–101

    Article  PubMed  Google Scholar 

  29. Seeman T, Šimková E, Kreisinger J, Vondrák K, Gilík J, Dvorák P, Janda J (2007) Improved control of hypertension in children after renal transplantation: results of a two-year interventional trial. Pediatr Transplant 11:491–497

    Article  CAS  PubMed  Google Scholar 

  30. Krmar RT, Berg UB (2008) Blood pressure control in hypertensive pediatric renal transplants: role of repeated ABPM following transplantation. Am J Hypertens 21:1093–1099

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Nephrology Department, University Children’s Hospital, Tirsova 10, 11 000, Belgrade, Serbia

    Dusan Paripovic, Mirjana Kostic, Brankica Spasojevic, Divna Kruscic & Amira Peco-Antic

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  1. Dusan Paripovic
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  2. Mirjana Kostic
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  3. Brankica Spasojevic
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  4. Divna Kruscic
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  5. Amira Peco-Antic
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Correspondence to Dusan Paripovic.

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Paripovic, D., Kostic, M., Spasojevic, B. et al. Masked hypertension and hidden uncontrolled hypertension after renal transplantation. Pediatr Nephrol 25, 1719–1724 (2010). https://doi.org/10.1007/s00467-010-1552-8

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  • DOI: https://doi.org/10.1007/s00467-010-1552-8

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