Key result
Awake systolic blood pressure was the only variable that independently influenced left ventricular mass index early after renal transplantation (regression coefficient = 0.49, p = 0.01).
Why the study?
Does awake blood pressure load influence left ventricular mass index early after renal transplantation?
Cross-Sectional (n=30)
Does awake blood pressure load influence left ventricular mass index early after renal transplantation?
Awake systolic blood pressure is the primary independent determinant of left ventricular hypertrophy in the early post-renal transplant period, highlighting the utility of ABPM.
Awake SBP may influence early post-transplant LVH; hypothesis-generating for ABPM, with prospective trials needed before practice change.
BACKGROUND: Left ventricular hypertrophy is common in renal transplant patients but the factors influencing its development remain to be determined. The present investigation was conducted to study the effect of blood pressure load on the left ventricular mass of recently transplanted patients using 24-h ambulatory blood pressure monitoring (ABPM). METHODS: We studied 30 renal transplant (RT) patients (36.1+/-13.7 years old, 11 males, 26 Whites, 4 diabetics, 15 under antihypertensive medication, 21 recipients of cadaver donors, and all treated with steroids, cyclosporin and azathioprine and with adequate (serum creatinine < 1.8 mg/100 ml) renal function). The median duration of dialysis treatment before transplant was 37 months, and the studies were performed during the first 40 days post-transplantation. Blood pressure was measured after a 15-min rest (casual blood pressure) and during a 24-h period with a SpaceLabs apparatus. Echocardiograms were obtained from all patients. RESULTS: Mean left ventricular mass index (LVMI) was 153+/-44 g/m2; casual systolic and diastolic BP (mmHg) was 152+/-25 and 92+/-13, whereas systolic and diastolic 24-h BP was 133+/-12 and 85+/-8, respectively. The systolic sleeping BP/awake systolic BP (SSBP/ASBP) ratio was 0.94+/-0.07, and 73% of the patients did not show a significant (>10%) fall of systolic blood pressure during sleep. Multivariate analysis showed that awake systolic blood pressure was the only variable that independently influenced LVMI after adjusting for confounding factors (regression coefficient = 0.49, p = 0.01). Casual systolic and diastolic BP, sleeping systolic and diastolic blood pressure, 24-h heart rate, age, race, gender, smoking, body mass index, duration of dialysis, diabetes, antihypertensive and immunosuppressive drugs and levels of hematocrit, creatinine and serum lipids did not correlate with LVMI. CONCLUSION: The data indicate that left ventricular hypertrophy during the early post-transplant period is mainly influenced by awake blood pressure load. They also suggest that ABPM may be more useful in the diagnosis and management of post-transplant hypertension than casual BP. The findings emphasize the importance of rigid blood pressure control in renal transplant recipients.
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Marcondes et al. (2002) conducted a cross-sectional in Renal transplantation (n=30). Awake systolic blood pressure was evaluated on Left ventricular mass index (LVMI) (regression coefficient 0.49, p=0.01). Awake systolic blood pressure was the only variable that independently influenced left ventricular mass index early after renal transplantation (regression coefficient = 0.49, p = 0.01).
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