Key result
A systolic blood pressure increase of >10 mmHg was associated with a significantly higher pulse wave velocity z-score (β = 0.78) compared to stable or decreasing blood pressure in pediatric kidney transplant recipients.
Why the study?
The extent to which blood pressure changes contribute to arterial stiffness and the factors influencing blood pressure in children after kidney transplantation remained to be determined.
Does an increase in blood pressure worsen arterial stiffness (measured by pulse wave velocity) in pediatric kidney transplant recipients?
Cohort (n=70)
Yes
Does an increase in blood pressure worsen arterial stiffness (measured by pulse wave velocity) in pediatric kidney transplant recipients?
Mean Difference: 0.78 (95% CI 0.22–1.34)
In pediatric kidney transplant recipients, greater increases in blood pressure are associated with progressive arterial stiffening, highlighting BP as a crucial modifiable cardiovascular risk factor.
BP changes may contribute to post-transplant arterial stiffness in children; leaves open causal role and need for prospective trials.
BACKGROUND: Pulse wave velocity (PWV) is a measure of arterial stiffness. We investigated PWV and blood pressure (BP) to determine to what extent BP changes contribute to arterial stiffness, and secondly, to identify influencing factors on BP in children after kidney transplantation. METHODS: Seventy children ≥ 2.5 years post-transplantation with at least two PWV measurements were included. Changes of systolic (Δ SBP) and diastolic BP (Δ DBP) were classified into "stable/decreasing," "1-10 mmHg increase," and " > 10 mmHg increase." Linear mixed modeling for PWV z-score (PWVz) adjusted either for Δ SBP or Δ DBP was performed. An extended dataset with monthly entries of BP, immunosuppression, and creatinine was obtained in 35 participants over a median of 74 months to perform linear mixed modeling for SBP and DBP. RESULTS: PWVz increased with a rate of 0.11/year (95% CI 0.054 to 0.16). Compared to participants with stable BP, those with 1-10-mmHg SBP and DBP increase showed a higher PWVz of 0.59 (95% CI 0.046 to 1.13) and 0.86 (95% CI 0.43 to 1.30), respectively. A > 10-mmHg BP increase was associated with an even higher PWVz (SBP β = 0.78, 95% CI 0.22 to 1.34; DBP β = 1.37, 95% CI 0.80 to 1.94). Female sex and participants with lower eGFR showed higher PWVz. In the extended analysis, DBP was positively associated with cyclosporin A and everolimus trough levels. CONCLUSIONS: A higher increase of PWV is seen in patients with greater BP increase, with higher cyclosporin A and everolimus trough levels associated with higher BP. This emphasizes the role of BP as a modifiable risk factor for the improvement of cardiovascular outcome after transplantation. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Sugianto et al. (2022) conducted a cohort in Pediatric kidney transplant recipients (n=70). Systolic blood pressure increase > 10 mmHg vs. Stable/decreasing systolic blood pressure was evaluated on Pulse wave velocity z-score (PWVz) (β = 0.78, 95% CI 0.22 to 1.34). A systolic blood pressure increase of >10 mmHg was associated with a significantly higher pulse wave velocity z-score (β = 0.78) compared to stable or decreasing blood pressure in pediatric kidney transplant recipients.
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