What does this research mean for the field?

In kidney transplant recipients, increased nighttime blood pressure is significantly associated with blunted pre-awakening morning blood pressure surges. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This study investigates the link between nighttime blood pressure and various definitions of morning blood pressure surge in kidney transplant recipients.

June 3, 2026

Nighttime Blood Pressure and Association With Different Definitions of Morning Blood Pressure Surge in Kidney Transplant Recipients

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Kidney transplant recipients (n=120). Intervention: Nighttime systolic blood pressure ≥120 mmHg vs. Nighttime systolic blood pressure <120 mmHg. Primary outcome: Pre-awakening systolic blood pressure surge (p=0.006).

Key Result

Nighttime systolic blood pressure ≥120 mmHg in kidney transplant recipients was associated with significantly lower pre-awakening SBP surges compared to <120 mmHg (4.8 vs 9.2 mmHg; p=0.006).

Key Points

This study investigates the link between nighttime blood pressure and various definitions of morning blood pressure surge in kidney transplant recipients.
120 stable kidney transplant recipients underwent 24-h ambulatory blood pressure monitoring.
Patients were divided based on nighttime SBP (>=120mmHg and <120mmHg) and assessed for nocturnal hypertension and dipping patterns.
Morning BP surge was calculated using pre-awakening, sleep-trough, and rising definitions.
Mean nighttime SBP/DBP was 124.5±12.1/75.0±6.8 mmHg, with nocturnal hypertension found in 86.7%.
Patients with nighttime SBP >=120mmHg exhibited lower pre-awakening SBP/DBP surges (SBP: 4.8±10.0 vs 9.2±7.6mmHg, p=0.006).
No significant differences in sleep-trough and rising surges were discovered between groups.

Study Design

Type

Observational (n=120)

PICO

Population

120 stable kidney transplant recipients evaluated with 24-hour ambulatory blood pressure monitoring.

Exposure / Comparator

Nighttime systolic blood pressure ≥120 mmHg vs Nighttime systolic blood pressure <120 mmHg

Primary Outcome

Pre-awakening systolic blood pressure surge, p=0.006

Main Result

Absolute Event Rate: 4.8% vs 9.2%

p-value: p=0.006

Abstract

Objective: Nocturnal hypertension and abnormal circadian blood pressure (BP) patterns are highly prevalent in kidney transplant recipients (KTRs). Both exaggerated and blunted morning BP surges, which may be partly attributed to the presence of abnormal dipping patterns, have been associated with adverse cardiovascular outcomes. This is the first study to investigate the association between nighttime BP and different definitions of morning BP surge in KTRs. Design and method: 120 stable KTRs underwent 24-h ambulatory BP monitoring with ABPMpro device, divided into daytime (7:00-23:00) and nighttime (23:00-7:00) periods. Prevalence of nocturnal hypertension and dipping patterns was examined. Patients were divided into 2 groups based on nighttime SBP (>=120mmHg and =120 were older and had lower estimated-glomerular-filtration-rate (eGFR). No differences were observed in transplantation vintage and major comorbidities. Patients with nighttime SBP >=120mmHg displayed significantly lower pre-awakening SBP/DBP surges (SBP: 4.8±10.0 vs 9.2±7.6mmHg, p=0.006; DBP: 4.6±7.1 vs 8.7±6.6mmHg, p=0.001) compared to those with nighttime SBP =120mmHg showed a trend towards higher SBP surge with both definitions. Conclusions: In KTRs increased nighttime BP is associated with blunted pre-awakening BP surges. Future studies should further examine these complex interactions and their prognostic associations with adverse outcomes in this high-risk population

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