title: Ambulatory Blood Pressure, Left Ventricular Hypertrophy, and Allograft Function in Children and Young Adults After Kidney Transplantation.
abstract: BACKGROUND
  Hypertension is a common complication and is an important risk factor for graft loss and adverse cardiovascular outcomes in pediatric kidney transplantation. Ambulatory blood pressure monitoring (ABPM) is the preferred method to characterize blood pressure status.
  
  
  METHODS
  We conducted a retrospective review of a large cohort of children and young adults with kidney transplant to estimate the prevalence of abnormal ambulatory blood pressure (ABP), assess factors associated with abnormal ABP, and examine whether ambulatory hypertension is associated with worse allograft function and left ventricular hypertrophy (LVH).
  
  
  RESULTS
  Two hundred twenty-one patients had ABPM, and 142 patients had echocardiographic results available for analysis. One third of the patients had masked hypertension, 32% had LVH, and 38% had estimated glomerular filtration rate less than 60 mL/min per 1.73 m. African-American race/Hispanic ethnicity and requirement for more than 1 antihypertensive medication were independently associated with having masked hypertension. In a multivariate analysis, abnormal blood pressure (masked or sustained hypertension combined) was an independent predictor for LVH among patients not receiving antihypertensive treatment (P = 0.025). In a separate analysis, the use of antihypertensive medications was independently associated with worse allograft function (P = 0.002) although abnormal blood pressure was not a significant predictor.
  
  
  CONCLUSIONS
  In young kidney transplant recipients, elevated ABP is frequently unrecognized and undertreated. The high prevalence of abnormal ABP, including masked hypertension, and its association with LVH supports the case for routine ABPM and cardiac structure evaluation as the standard of care in these patients.
authors.affiliation: 1 Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH. 2 Division of Pediatric Nephrology, Seattle Children's Hospital, Seattle, WA. 3 Division of Pediatric Nephrology, Children's Mercy Hospital, Kansas City, MO. 4 Division of Pediatric Nephrology, Stony Brook University Hospital, New York, NY. 5 Pediatric Renal Section, Texas Children's Hospital, Baylor College of Medicine, Houston, TX. 6 Division of Nephrology and Hypertension, J.W. Riley Hospital for Children, Indianapolis, IN.
authors.forename: Gilad
authors.initials: G
authors.lastname: Hamdani
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Nehus
authors.forename: Coral D
authors.initials: CD
authors.lastname: Hanevold
authors.forename: Judith
authors.initials: J
authors.lastname: Sebestyen Van Sickle
authors.forename: Robert
authors.initials: R
authors.lastname: Woroniecki
authors.forename: Scott E
authors.initials: SE
authors.lastname: Wenderfer
authors.forename: David K
authors.initials: DK
authors.lastname: Hooper
authors.forename: Douglas
authors.initials: D
authors.lastname: Blowey
authors.forename: Amy
authors.initials: A
authors.lastname: Wilson
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Warady
authors.forename: Mark M
authors.initials: MM
authors.lastname: Mitsnefes
mesh_terms: D000293:Adolescent; D000367:Age Factors; D064591:Allografts; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D018660:Blood Pressure Monitoring, Ambulatory; D016009:Chi-Square Distribution; D002648:Child; D004452:Echocardiography; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000503:physiopathology; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000453:epidemiology*; D016030:Kidney Transplantation / Q000009:adverse effects*; D016015:Logistic Models; D008297:Male; D015146:Midwestern United States / Q000453:epidemiology; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000959:Antihypertensive Agents