Ambulatory Blood Pressure and Endothelial Dysfunction in Hematopoietic Cell Transplantation Recipients

Abstract

Hematopoietic cell transplantation (HCT) is a common treatment for many disorders. Albuminuria post-HCT, which may represent endothelial injury or inflammation from graft- versus-host disease, increases the risk of chronic kidney disease and nonrelapse mortality at 1 year. HCT recipients also have abnormal blood pressure (BP) and increased rates of cardiovascular complications. We sought to determine the relationships among albuminuria, endothelial dysfunction, and BP in HCT recipients. Patients age ≥12 years who underwent their first allogeneic HCT between 2012 and 2015 and survived through day 80 post-HCT were eligible. Peripheral endothelial function was assessed using the EndoPAT2000 device at day 80 along with 24-hour ambulatory BP monitoring (ABPM). Clinical and laboratory data were collected along with a urine sample for calculation of the albumin-to-creatinine ratio. Both logistic and linear regression analyses were used to identify associations between EndoPAT score and clinical variables. Sixty patients (median age, 48 years; range, 14 to 69 years) completed the study. The median EndoPAT score was 2.05 (range, 1.02 to 4.45), and 17 patients (28%) had abnormal endothelial function. Forty-two patients (72%) had ambulatory hypertension (HTN), and 38 (63%) had blunted nocturnal dipping. HTN on ABPM (P = .045) and blunted nocturnal dipping (P = .04) were associated with a lower EndoPAT score. Albuminuria was not associated with EndoPAT score. There was a lack of agreement between our clinical definition of HTN (office BP and/or use of medications) and ABPM results (P = .04). We did not find an association between lower EndoPAT scores and albuminuria, but did find an association between an abnormal nocturnal dip and HTN diagnosed by ABPM. This suggests that albuminuria may reflect local endothelial injury and inflammation rather than a systemic process. Office BP readings do not accurately reflect true BP, suggesting that 24-hour ABPM studies are needed to diagnose and treat HTN appropriately.

Nocturnal blood pressure dipping as a marker of endothelial function and subclinical atherosclerosis in pediatric-onset systemic lupus erythematosus

“…In our study, lower magnitudes of diastolic BP dipping correlated with worse peripheral endothelial function by digital reactive hyperemia. Associations between nondipping and endothelial function have also been observed in pediatric hematopoietic cell transplant patients [38] and adults with resistant hypertension [39]. Furthermore, abnormal digital reactive hyperemia by EndoPAT has been shown to be predictive of cardiovascular events in adults [40], especially non-obstructive coronary events in women mediated by coronary microvascular dysfunction [41].…”

Nocturnal Blood Pressure Dipping As a Marker of Endothelial Function and Subclinical Atherosclerosis in Pediatric-onset Systemic Lupus Erythematosus

“…In our study, lower magnitudes of diastolic BP dipping correlated with worse peripheral endothelial function by digital reactive hyperemia. Associations between non-dipping and endothelial function have also been observed in pediatric hematopoietic cell transplant patients [38] and adults with resistant hypertension. [39] Furthermore, abnormal digital reactive hyperemia by EndoPAT has been shown to be predictive of cardiovascular events in adults, [40] especially non-obstructive coronary events in women mediated by coronary microvascular dysfunction.…”

Nocturnal Blood Pressure Dipping As a Marker of Endothelial Function and Subclinical Atherosclerosis in Pediatric-onset Systemic Lupus Erythematosus

“…In our study, lower magnitudes of diastolic BP dipping correlated with worse peripheral endothelial function by digital reactive hyperemia. Associations between non-dipping and endothelial function have also been observed in pediatric hematopoietic cell transplant patients [35] and adults with resistant hypertension. [36] Furthermore, abnormal digital reactive hyperemia by EndoPAT has been shown to be predictive of cardiovascular events in adults, [37] especially non-obstructive coronary events in women mediated by coronary microvascular dysfunction.…”