Predominance of nocturnal hypertension in pediatric renal allograft recipients*

McGlothan, Kim R.; Wyatt, Robert; Ault, Bettina H.; Hastings, Margaret; Rogers, Taurus; DiSessa, Thomas G.; Jones, Deborah

doi:10.1111/j.1399-3046.2006.00521.x

Cited by 68 publications

(54 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Similar to that in other pediatric studies, we found that daytime hypertension in renal TX children occurred in conjunction with night-time hypertension [45][46][47]. Although the significance of night-time hypertension as a predictor of CV risk is not well elucidated in children post-TX, in studies on adults with hypertension, nocturnal hypertension is a better predictor of cardiovascular events than daytime BP [48].…”

Section: Discussionsupporting

confidence: 84%

Cardiorespiratory fitness is a marker of cardiovascular health in renal transplanted children

et al. 2010

View full text Add to dashboard Cite

Children with renal transplants (TX) are at increased risk of cardiovascular (CV) disease. Study objectives were to assess the level of cardiorespiratory fitness (CR fitness) and daily physical activity (PA) in renal TX children and adolescents in relation to traditional cardiovascular risk factors. Laboratory testing included assessment of CR fitness by treadmill exercise testing (VO(2peak)), 24-h ambulatory blood-pressure (ABPM) measurement, oral glucose tolerance test (OGTT), anthropometrics and measurement of lipid levels. PA was self-reported by questionnaire. Twenty-two TX patients with a median (range) age 14.5 (9-18) years were tested. Median V0(2peak) was 66% (36-97) of the expected values compared with controls. Nineteen (86%) children reported <60 min of daily moderate to vigorous physical activity (MVPA). Sixteen (73%) were hypertensive and 8 (34%) were overweight or obese. Four children fulfilled the criteria for a metabolic syndrome. Children with at least 2 of the 3 metabolic risk factors (hypertension, overweight, and glucose intolerance, n=7) achieved significantly lower VO(2peak) compared with those with one or none of these factors (median V0(2peak) 45% and 73% of the expected values respectively, p=0.003). Renal TX children and adolescents have severely impaired CR fitness and PA. Reduced CR fitness was associated with the clustering of CV risk factors. Routine counseling for increased PA is strongly recommended.

show abstract

Section: Discussionsupporting

confidence: 84%

Cardiorespiratory fitness is a marker of cardiovascular health in renal transplanted children

et al. 2010

View full text Add to dashboard Cite

show abstract

“…Previous studies in pediatric transplanted patients accentuated importance of ABPM for detection of nocturnal hypertension [16,23]. As in these studies, ABPM revealed a high prevalence of daytime and nighttime hypertension in pediatric allograft recipients.…”

Section: Discussionsupporting

confidence: 50%

Masked hypertension and hidden uncontrolled hypertension after renal transplantation

et al. 2010

View full text Add to dashboard Cite

Arterial hypertension is a risk factor affecting graft function in pediatric kidney transplants. Recent pediatric studies reported a high prevalence of hypertension, especially nocturnal hypertension in this population. Data regarding the prevalence of masked hypertension in pediatric patients with kidney transplants are still scarce. The aim of this cross-sectional study was to assess the prevalence of masked and hidden uncontrolled hypertension after renal transplantation. A total of 41 patients (25 males) with stable functioning renal graft were included in the study. Their median age was 14.5 years with the median interval since transplantation of 2.5 years (range 0.3 to 20.6). Spacelabs 90207 was used to measure ambulatory blood pressure (BP) during a 24-h period. Ambulatory hypertension was defined as mean systolic and/or diastolic BP index at day-time or nighttime >or=1. Masked hypertension was defined as normal office BP but daytime ambulatory hypertension in patients without antihypertensive medications. Hidden uncontrolled hypertension was defined as daytime ambulatory hypertension undetected by office BP measurements in treated patients. Antihypertensive medications were prescribed to 58%. Prevalence of nocturnal hypertension was 68%. On the basis of combination of office and ABPM masked hypertension and hidden uncontrolled hypertension was detected in 24% and 21% of the study population, respectively. Regular use of ambulatory blood pressure monitoring in transplanted patients enables detection of masked and hidden uncontrolled hypertension.

show abstract

“…Studies show the prevalence of masked hypertension (normal office BP and elevated ABPM) was 50% greater than that identified using casual BP [98][99][100][101] and an increased prevalence of nondippers among children with kidney transplants. 101,102 A study by Polónia et al 103 concurs with other studies showing significant rates of nocturnal hypertension in pediatric transplant recipients and that a significant proportion of patients thought to be adequately controlled by medications still had masked hypertension.…”

Section: Hypertension In the Pediatric Transplant Recipient Or Recipimentioning

confidence: 66%

Assessment and Management of Hypertension in Transplant Patients

Weir

Burgess

Cooper

et al. 2015

Journal of the American Society of Nephrology

149

111

View full text Add to dashboard Cite

Hypertension in renal transplant recipients is common and ranges from 50% to 80% in adult recipients and from 47% to 82% in pediatric recipients. Cardiovascular morbidity and mortality and shortened allograft survival are important consequences of inadequate control of hypertension. In this review, we examine the epidemiology, pathophysiology, and management considerations of post-transplant hypertension. Donor and recipient factors, acute and chronic allograft injury, and immunosuppressive medications may each explain some of the pathophysiology of post-transplant hypertension. As observed in other patient cohorts, renal artery stenosis and adrenal causes of hypertension may be important contributing factors. Notably, BP treatment goals for renal transplant recipients remain an enigma because there are no adequate randomized controlled trials to support a benefit from targeting lower BP levels on graft and patient survival. The potential for drugdrug interactions and altered pharmacokinetics and pharmacodynamics of the different antihypertensive medications need to be carefully considered. To date, no specific antihypertensive medications have been shown to be more effective than others at improving either patient or graft survival. Identifying the underlying pathophysiology and subsequent individualization of treatment goals are important for improving long-term patient and graft outcomes in these patients.

show abstract

Predominance of nocturnal hypertension in pediatric renal allograft recipients*

Cited by 68 publications

References 34 publications

Cardiorespiratory fitness is a marker of cardiovascular health in renal transplanted children

Cardiorespiratory fitness is a marker of cardiovascular health in renal transplanted children

Masked hypertension and hidden uncontrolled hypertension after renal transplantation

Assessment and Management of Hypertension in Transplant Patients

Contact Info

Product

Resources

About