Predominance of nocturnal hypertension in pediatric renal allograft recipients

:  Hypertension is common in children with end‐stage renal disease who have undergone renal transplantation. We performed ambulatory blood pressure monitoring (ABPM) in renal allograft recipients who were on stable maintenance immunosuppressive medications and were more than six months post‐transpla...

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Published in:Pediatric transplantation 2006-08, Vol.10 (5), p.558-564
Main Authors: McGlothan, Kim R., Wyatt, Robert J., Ault, Bettina H., Hastings, Margaret C., Rogers, Taurus, DiSessa, Thomas, Jones, Deborah P.
Format: Article
Language:English
Subjects:
ABPM
Adolescent
Blood Pressure Monitoring, Ambulatory
Child
Circadian Rhythm
Echocardiography
Female
Graft Survival
Humans
hypertension
Hypertension - diagnosis
Kidney Transplantation
Male
Pediatric renal transplant
Prognosis
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cited_by cdi_FETCH-LOGICAL-c4051-21da3d9752fd801d0aed0476975b2211837507bf80908859eaf116e3c384ba803
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container_end_page 564
container_issue 5
container_start_page 558
container_title Pediatric transplantation
container_volume 10
creator McGlothan, Kim R.
Wyatt, Robert J.
Ault, Bettina H.
Hastings, Margaret C.
Rogers, Taurus
DiSessa, Thomas
Jones, Deborah P.
description :  Hypertension is common in children with end‐stage renal disease who have undergone renal transplantation. We performed ambulatory blood pressure monitoring (ABPM) in renal allograft recipients who were on stable maintenance immunosuppressive medications and were more than six months post‐transplant. Echocardiographic measurement of left ventricular mass index (LVMI) was obtained at the time of ABPM. Twenty‐nine children with a mean age of 14.8 yr (8–18 yr) were evaluated 4.3 yr (0.6–12.8 yr) after deceased donor (n = 13) or living donor (n = 16) transplantation. BP levels were higher during sleep compared with when awake using the 95th percentile to standardize mean BP for each period: mean BP was expressed as a standard deviation score (SDS) for each time period, awake vs. sleep: systolic (s) BP SDS were 0.43 ± 1.3 vs. 1.29 ± 1.2 (p 
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We performed ambulatory blood pressure monitoring (ABPM) in renal allograft recipients who were on stable maintenance immunosuppressive medications and were more than six months post‐transplant. Echocardiographic measurement of left ventricular mass index (LVMI) was obtained at the time of ABPM. Twenty‐nine children with a mean age of 14.8 yr (8–18 yr) were evaluated 4.3 yr (0.6–12.8 yr) after deceased donor (n = 13) or living donor (n = 16) transplantation. BP levels were higher during sleep compared with when awake using the 95th percentile to standardize mean BP for each period: mean BP was expressed as a standard deviation score (SDS) for each time period, awake vs. sleep: systolic (s) BP SDS were 0.43 ± 1.3 vs. 1.29 ± 1.2 (p &lt; 0.001) and diastolic (d) BP SDS were 0.04 ± 1.3 vs. 1.34 ± 1.2 (p &lt; 0.001). Significant differences between awake and sleep BP were also confirmed using the mean BP for each period expressed as a BPI. Hypertension (HTN) during sleep was more common than awake HTN. Based upon BPI, 21% had sHTN when awake compared with 48% during sleep and 7% had dHTN when awake compared with 41% during sleep (p &lt; 0.05). Based upon mean BP load, 38% had sHTN when awake compared with 55% during sleep and 21% demonstrated dHTN when awake compared with 52% during sleep (p &lt; 0.05). Left ventricular mass (LVM) was abnormally increased in six of 17 children (35%); LVM was not correlated with BP. Children prescribed angiotensin converting enzyme inhibitors or angiotensin II receptor blockers (ACEi/ARB) had significantly lower systolic BP compared with those on calcium channel blocking agents (CCB). Mean sSDS was −0.11 ± 1.1 in those children on ACEi/ARB compared with 1.6 ± 1.2 in those on CCB (p = 0.02): sSDS during sleep was significantly lower in the ACEi/ARB group compared with CCB (0.70 ± 1.1 vs. 2.0 ± 1.1, p = 0.04). Isolated nocturnal HTN is more common than daytime HTN among clinically stable pediatric renal allograft recipients. Detection and treatment of nocturnal HTN in pediatric allograft recipients could potentially affect graft survival.</description><identifier>ISSN: 1397-3142</identifier><identifier>EISSN: 1399-3046</identifier><identifier>DOI: 10.1111/j.1399-3046.2006.00521.x</identifier><identifier>PMID: 16856991</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Publishing Ltd</publisher><subject>ABPM ; Adolescent ; Blood Pressure Monitoring, Ambulatory ; Child ; Circadian Rhythm ; Echocardiography ; Female ; Graft Survival ; Humans ; hypertension ; Hypertension - diagnosis ; Kidney Transplantation ; Male ; Pediatric renal transplant ; Prognosis</subject><ispartof>Pediatric transplantation, 2006-08, Vol.10 (5), p.558-564</ispartof><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4051-21da3d9752fd801d0aed0476975b2211837507bf80908859eaf116e3c384ba803</citedby><cites>FETCH-LOGICAL-c4051-21da3d9752fd801d0aed0476975b2211837507bf80908859eaf116e3c384ba803</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/16856991$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>McGlothan, Kim R.</creatorcontrib><creatorcontrib>Wyatt, Robert J.</creatorcontrib><creatorcontrib>Ault, Bettina H.</creatorcontrib><creatorcontrib>Hastings, Margaret C.</creatorcontrib><creatorcontrib>Rogers, Taurus</creatorcontrib><creatorcontrib>DiSessa, Thomas</creatorcontrib><creatorcontrib>Jones, Deborah P.</creatorcontrib><title>Predominance of nocturnal hypertension in pediatric renal allograft recipients</title><title>Pediatric transplantation</title><addtitle>Pediatr Transplant</addtitle><description>:  Hypertension is common in children with end‐stage renal disease who have undergone renal transplantation. We performed ambulatory blood pressure monitoring (ABPM) in renal allograft recipients who were on stable maintenance immunosuppressive medications and were more than six months post‐transplant. Echocardiographic measurement of left ventricular mass index (LVMI) was obtained at the time of ABPM. Twenty‐nine children with a mean age of 14.8 yr (8–18 yr) were evaluated 4.3 yr (0.6–12.8 yr) after deceased donor (n = 13) or living donor (n = 16) transplantation. BP levels were higher during sleep compared with when awake using the 95th percentile to standardize mean BP for each period: mean BP was expressed as a standard deviation score (SDS) for each time period, awake vs. sleep: systolic (s) BP SDS were 0.43 ± 1.3 vs. 1.29 ± 1.2 (p &lt; 0.001) and diastolic (d) BP SDS were 0.04 ± 1.3 vs. 1.34 ± 1.2 (p &lt; 0.001). Significant differences between awake and sleep BP were also confirmed using the mean BP for each period expressed as a BPI. Hypertension (HTN) during sleep was more common than awake HTN. Based upon BPI, 21% had sHTN when awake compared with 48% during sleep and 7% had dHTN when awake compared with 41% during sleep (p &lt; 0.05). Based upon mean BP load, 38% had sHTN when awake compared with 55% during sleep and 21% demonstrated dHTN when awake compared with 52% during sleep (p &lt; 0.05). Left ventricular mass (LVM) was abnormally increased in six of 17 children (35%); LVM was not correlated with BP. Children prescribed angiotensin converting enzyme inhibitors or angiotensin II receptor blockers (ACEi/ARB) had significantly lower systolic BP compared with those on calcium channel blocking agents (CCB). Mean sSDS was −0.11 ± 1.1 in those children on ACEi/ARB compared with 1.6 ± 1.2 in those on CCB (p = 0.02): sSDS during sleep was significantly lower in the ACEi/ARB group compared with CCB (0.70 ± 1.1 vs. 2.0 ± 1.1, p = 0.04). Isolated nocturnal HTN is more common than daytime HTN among clinically stable pediatric renal allograft recipients. Detection and treatment of nocturnal HTN in pediatric allograft recipients could potentially affect graft survival.</description><subject>ABPM</subject><subject>Adolescent</subject><subject>Blood Pressure Monitoring, Ambulatory</subject><subject>Child</subject><subject>Circadian Rhythm</subject><subject>Echocardiography</subject><subject>Female</subject><subject>Graft Survival</subject><subject>Humans</subject><subject>hypertension</subject><subject>Hypertension - diagnosis</subject><subject>Kidney Transplantation</subject><subject>Male</subject><subject>Pediatric renal transplant</subject><subject>Prognosis</subject><issn>1397-3142</issn><issn>1399-3046</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2006</creationdate><recordtype>article</recordtype><recordid>eNqNkFFP2zAQxy00RIHxFaY87S3ZXZw4zsMeporBJFYQKmLixXKTy-YudTI7Fe23x2mr7hW_-M73_52lH2MRQoLhfFkmyMsy5pCJJAUQCUCeYrI5YefHwYddXcQcs3TCLrxfAqDIZHbGJihkLsoSz9nswVHdrYzVtqKoayLbVcPaWd1Gf7Y9uYGsN52NjI16qo0enKkiR-Nct2332-lmCH1lekN28B_ZaaNbT1eH-5I9fb-eT2_ju_ubH9Nvd3GVQY5xirXmdVnkaVNLwBo01ZAVIrws0hRR8iKHYtFIKEHKvCTdIAriFZfZQkvgl-zzfm_vun9r8oNaGV9R22pL3dorIUVeYiZDUO6Dleu8d9So3pmVdluFoEaXaqlGZWpUpkaXaudSbQL66fDHerGi-j94kBcCX_eBV9PS9t2L1cP1_DFUgY_3vPEDbY68dn-VKIIB9Ty7UY8vRfFrOn9WP_kbqZeSBg</recordid><startdate>200608</startdate><enddate>200608</enddate><creator>McGlothan, Kim R.</creator><creator>Wyatt, Robert J.</creator><creator>Ault, Bettina H.</creator><creator>Hastings, Margaret C.</creator><creator>Rogers, Taurus</creator><creator>DiSessa, Thomas</creator><creator>Jones, Deborah P.</creator><general>Blackwell Publishing Ltd</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>200608</creationdate><title>Predominance of nocturnal hypertension in pediatric renal allograft recipients</title><author>McGlothan, Kim R. ; Wyatt, Robert J. ; Ault, Bettina H. ; Hastings, Margaret C. ; Rogers, Taurus ; DiSessa, Thomas ; Jones, Deborah P.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4051-21da3d9752fd801d0aed0476975b2211837507bf80908859eaf116e3c384ba803</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2006</creationdate><topic>ABPM</topic><topic>Adolescent</topic><topic>Blood Pressure Monitoring, Ambulatory</topic><topic>Child</topic><topic>Circadian Rhythm</topic><topic>Echocardiography</topic><topic>Female</topic><topic>Graft Survival</topic><topic>Humans</topic><topic>hypertension</topic><topic>Hypertension - diagnosis</topic><topic>Kidney Transplantation</topic><topic>Male</topic><topic>Pediatric renal transplant</topic><topic>Prognosis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>McGlothan, Kim R.</creatorcontrib><creatorcontrib>Wyatt, Robert J.</creatorcontrib><creatorcontrib>Ault, Bettina H.</creatorcontrib><creatorcontrib>Hastings, Margaret C.</creatorcontrib><creatorcontrib>Rogers, Taurus</creatorcontrib><creatorcontrib>DiSessa, Thomas</creatorcontrib><creatorcontrib>Jones, Deborah P.</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Pediatric transplantation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>McGlothan, Kim R.</au><au>Wyatt, Robert J.</au><au>Ault, Bettina H.</au><au>Hastings, Margaret C.</au><au>Rogers, Taurus</au><au>DiSessa, Thomas</au><au>Jones, Deborah P.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Predominance of nocturnal hypertension in pediatric renal allograft recipients</atitle><jtitle>Pediatric transplantation</jtitle><addtitle>Pediatr Transplant</addtitle><date>2006-08</date><risdate>2006</risdate><volume>10</volume><issue>5</issue><spage>558</spage><epage>564</epage><pages>558-564</pages><issn>1397-3142</issn><eissn>1399-3046</eissn><abstract>:  Hypertension is common in children with end‐stage renal disease who have undergone renal transplantation. We performed ambulatory blood pressure monitoring (ABPM) in renal allograft recipients who were on stable maintenance immunosuppressive medications and were more than six months post‐transplant. Echocardiographic measurement of left ventricular mass index (LVMI) was obtained at the time of ABPM. Twenty‐nine children with a mean age of 14.8 yr (8–18 yr) were evaluated 4.3 yr (0.6–12.8 yr) after deceased donor (n = 13) or living donor (n = 16) transplantation. BP levels were higher during sleep compared with when awake using the 95th percentile to standardize mean BP for each period: mean BP was expressed as a standard deviation score (SDS) for each time period, awake vs. sleep: systolic (s) BP SDS were 0.43 ± 1.3 vs. 1.29 ± 1.2 (p &lt; 0.001) and diastolic (d) BP SDS were 0.04 ± 1.3 vs. 1.34 ± 1.2 (p &lt; 0.001). Significant differences between awake and sleep BP were also confirmed using the mean BP for each period expressed as a BPI. Hypertension (HTN) during sleep was more common than awake HTN. Based upon BPI, 21% had sHTN when awake compared with 48% during sleep and 7% had dHTN when awake compared with 41% during sleep (p &lt; 0.05). Based upon mean BP load, 38% had sHTN when awake compared with 55% during sleep and 21% demonstrated dHTN when awake compared with 52% during sleep (p &lt; 0.05). Left ventricular mass (LVM) was abnormally increased in six of 17 children (35%); LVM was not correlated with BP. Children prescribed angiotensin converting enzyme inhibitors or angiotensin II receptor blockers (ACEi/ARB) had significantly lower systolic BP compared with those on calcium channel blocking agents (CCB). Mean sSDS was −0.11 ± 1.1 in those children on ACEi/ARB compared with 1.6 ± 1.2 in those on CCB (p = 0.02): sSDS during sleep was significantly lower in the ACEi/ARB group compared with CCB (0.70 ± 1.1 vs. 2.0 ± 1.1, p = 0.04). Isolated nocturnal HTN is more common than daytime HTN among clinically stable pediatric renal allograft recipients. Detection and treatment of nocturnal HTN in pediatric allograft recipients could potentially affect graft survival.</abstract><cop>Oxford, UK</cop><pub>Blackwell Publishing Ltd</pub><pmid>16856991</pmid><doi>10.1111/j.1399-3046.2006.00521.x</doi><tpages>7</tpages></addata></record>
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subjects ABPM
Adolescent
Blood Pressure Monitoring, Ambulatory
Child
Circadian Rhythm
Echocardiography
Female
Graft Survival
Humans
hypertension
Hypertension - diagnosis
Kidney Transplantation
Male
Pediatric renal transplant
Prognosis
title Predominance of nocturnal hypertension in pediatric renal allograft recipients
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