B-CRF: cardiovascular complications
E-01: Hypertension with renal diseases
H-15: Hypertension and CV complications
Hypertension in Chronic Kidney Disease: The Influence of Renal
Transplantation
Azancot, Maria A.1; Ramos, Natalia1; Moreso, Francesc J.1; Ibernon, Meritxell1; Espinel,
Eugenia1; Torres, Irina B.1; Fort, Joan1; Seron, Daniel1,2
Transplantation:
15 September 2014 - Volume 98 - Issue 5 - p 537-542
Author Information
1
Nephrology Department, Hospital Universitari Vall d’Hebron, Universitat Autònoma de
Barcelona, Barcelona, Spain.
2
Address correspondence to: Daniel Serón M.D., Ph.D., Nephrology Department, Hospital
Universitari Vall d’Hebron, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain.
E-mail: dseron@vhebron.net
ABSTRACT
Background
Hypertension is one of the most prevalent cardiovascular risk factors in chronic kidney
disease (CKD) and kidney transplants. The contribution of transplantation to hypertension in
comparison to patients with CKD and similar renal function has not been characterized.
Methods
Ninety-two transplants and 97 CKD patients with an estimated glomerular filtration rate less
than 60 mL/min/1.73 m2 not receiving dialysis were enrolled. At entry, office blood pressure
(BP) and 24-hr ambulatory blood pressure monitoring (ABPM) were obtained.
Results
Office BP was not different between transplants and CKD patients (139.5±14.3 vs.
135.2±19.3, P=1.00, respectively). ABPM 24-hr systolic blood pressure (SBP) (133.9±14.3
vs. 126.2±16.1, P=0.014), awake SBP (135.6±15.2 vs. 128.7±16.2, P=0.042), and sleep SBP
(131.2±16.2 vs. 120.2 ±17.9, P=0.0014) were higher in renal transplants. When patients
were classified according to BP patterns associated with highest cardiovascular risk, the
proportion of patients with both nocturnal hypertension and non-dipper pattern was higher in
transplants (68.5% vs. 47.4%, P=0.03). In the multivariate regression analysis,
transplantation was an independent predictor of 24-hr, awake, and sleep SBP.
Conclusion
Office BP is similar in kidney transplants and CKD patients with similar renal function. On the
contrary, hypertension is more severe in kidney transplants when evaluated with ABPM
mainly as a result of increased sleep systolic BP. Thus, precise evaluation of hypertension in
kidney transplants requires ABPM.
COMMENTS
Hypertension is an important risk factor for cardiovascular events and progression of chronic
kidney disease (CKD) . Its prevalence is 79% in patients with CKD stage 1 and 96% in
stages 4 and 5 . After transplantation, the prevalence of hypertension is as high as 90%
In renal transplant patients, hypertension is associated with decreased allograft survival,
major adverse cardiac events, and poorer patient survival. The association between
hypertension and outcome is independent from renal function
Ambulatory blood pressure monitoring (ABPM) allows accurate and reproducible BP
estimate. In patients with CKD, ABPM better detects patients at risk of cardiovascular events
and at risk for progression of CKD than office BP
One hundred patients with a first renal transplant and 100 patients with chronic kidney
disease were consecutively recruited according to the following criteria: (1) age greater than
or equal to 18 years and less than or equal to 70 years, (2) patients with eGFR less than 60
mL/min/1.73 m2 not receiving dialysis treatment, (3) no history of cardiovascular events
(angina, myocardial infarction, heart failure, stroke, or peripheral vascular disease), (4) stable
renal function defined as variability of e-GFR less than 10% between the actual and previous
visit, and (5) signed informed consent.
ABPM was measured using an overnight-automated ABPM monitor (Spacelab 90207;
Spacelabs Healthcare, USA) with appropriate cuff sizes for each patient. In patients with
arteriovenous fistula, BP was measured in the contralateral arm. ABPM was performed for
24 hr and BP was recorded every 20 min during awake hours (8–23 hr) and every 30 min
during nocturnal hours (23–8 hr).
The authors did not observe any difference in office BP between transplants and CKD
patients with an e-GFR less than 60 mL/min/1.73 m2. However, hypertension was more
severe in kidney transplants when measured with ABPM, mainly caused by increased
systolic 24-hr BP, and especially sleep SBP. Thus, office blood pressure underestimates the
severity of hypertension in transplant patients.
ABPM should be the preferred method to assess blood pressure in kidney transplants to
assure BP control and avoid hypertension-associated long-term consequences.
Pr. Jacques CHANARD
Professor of Nephrology