Ambulatory blood pressure variations relative to sitting or standing position in renal transplant patients

OBJECTIVE: High blood pressure is almost constant in renal transplant patients for whom dysautonomia is frequently described. The main objective of this study was to analyse the variations in blood pressure and heart rate recorded by ambulatory measurement during changes in position in renal transplant patients. METHODS: Thirty-nine non-diabetic renal transplant patients with a renal transplant functioning for more than a year, were selected at random. Blood pressure was measured using the validated monitor Diasys Integra with a position sensor to discriminate between standing and sitting/lying. RESULTS: Systolic blood pressure and heart rate were significantly higher when the patient was standing than when sitting/lying (+2.9 mmHg, P<0.05 and +9 beats/min, P<0.001 respectively) and diastolic blood pressure tends to be higher (+1.7 mmHg, NS) when standing. One minute after standing up, the heart rate rises by about 9 beats/min (P<0.001) while systolic and diastolic blood pressures do not vary significantly. Variations in systolic blood pressure and heart rate on changing position are therefore in the same direction as those recorded in elderly normotensive or hypertensive untreated subjects, but with a lower amplitude. CONCLUSIONS: In most of non-diabetic functional renal transplant patients, there is an absence of an orthostatic decline in blood pressure. Thus, it could be considered that there is no real dysautonomia in this specific population.