Reverse dipper pattern of blood pressure at 3 months is associated with inflammation and outcome after renal transplantation.
BACKGROUND
Cardiovascular disease is the major cause of morbidity and mortality after renal transplantation. It has been shown that both traditional and transplant-specific risk factors contribute to the high cardiovascular burden after renal transplantation The aim is to evaluate the association among ambulatory blood pressure monitoring (ABPM) at 3 months, inflammation and graft outcome.


METHODS
ABPM at 3 months was performed in 126 consecutive renal transplants. According to the nocturnal reduction of systolic blood pressure (SBP), dipper (ΔSBP ≥ 10%), non-dipper (0 < ΔSBP < 10%) and reverse dipper (SBP nocturnal rise) pattern were defined. The outcome variable was the combination of any cardiovascular event and graft failure for any reason.


RESULTS
Circadian blood pressure pattern was dipper (n = 22), non-dipper (n = 65) and reverse dipper (n = 39). Reverse dipper pattern was associated with pre-transplant diabetes (18 versus 2%, P = 0.004), body mass index (26.9 ± 5.0 versus 24.8 ± 3.8 kg/m(2), P = 0.001), calcineurin inhibitor treatment (74 versus 54%, P = 0.001) and serum soluble tumour necrosis factor receptor 2 levels (18 ± 15 versus 11 ± 6 ng/mL, P = 0.010). During 45 ± 11 months of follow-up, 22 patients reached the combined outcome variable. Multivariate Cox regression analysis showed that reverse dipper pattern [relative risk (RR): 3.50 and 95% confidence interval (CI): 1.36-8.93; P = 0.009] and creatinine clearance (RR: 0.94 and 95% CI: 0.91-0.98, P = 0.003) were independently associated with outcome.


CONCLUSIONS
The reverse dipper circadian pattern is associated with inflammation and constitutes an independent predictor of graft outcome.
Department of Nephrology, Hospital Universitari Germans Trias i Pujol, Universitat Autonoma Barcelona, Badalona, Barcelona, Spain.
Meritxell
M
Ibernon
Francesc
F
Moreso
Xavier
X
Sarrias
Maria
M
Sarrias
Josep M
JM
Grinyó
José M
JM
Fernandez-Real
Wifredo
W
Ricart
Daniel
D
Serón
D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory; D002940:Circadian Rhythm / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D006973:Hypertension / Q000503:physiopathology; D007249:Inflammation / Q000503:physiopathology*; D007674:Kidney Diseases / Q000601:surgery*; D016030:Kidney Transplantation / Q000502:physiology*; D008297:Male; D059468:Masked Hypertension / Q000503:physiopathology; D008875:Middle Aged; D009819:Office Visits; D011446:Prospective Studies; D016896:Treatment Outcome; D059466:White Coat Hypertension / Q000503:physiopathology