Nocturnal Hypertension in Pediatric Transplant Recipients

New Orleans—Pediatric kidney transplant recipients commonly exhibit nocturnal hypertension and non-dipper status during ambulatory blood pressure monitoring, both of which are associated with cardiovascular risk in adults. Christine B. Sethna, MD, and colleagues conducted an open label, blinded end point clinical trial to examine the chronotherapeutic alteration of anti-hypertensive medication on nocturnal hypertension and non-dipper status in a cohort of pediatric transplant recipients.

Results of the study were reported during a poster session at Kidney Week 2017. The poster was titled Reduction of Nocturnal Hypertension in Pediatric Renal Transplant Recipients.

The study randomized 33 non-dipper status pediatric transplant recipients 5 to 21 years of age with normal overall ambulatory blood pressure monitoring and estimated glomerular filtration rate (>30 mL/min/1.73 m2) to either an intervention group (enalapril, isradipine, or propranolol added in the evenings) or control (no medication change).

At baseline and at 3 and 6 months, ambulatory blood pressure monitoring, echocardiography for left ventricular mass index (LVMI), and pulse wave velocity (PWV) were performed. Non-dipper status was defined as a decline of <10% in average blood pressure from day to night. Fisher’s, t-test, and paired t-test by intention-to-treat analyses were used to compare differences.

The total cohort included 17 participants in the intervention group and 16 in the control group, mean age was 13 years and 64% were male. The two groups were similar in baseline demographics, ambulatory blood pressure monitoring, LVMI, and PWV.

In the intervention group, conversion to dipper status occurred in 43% at 3 months, compared with 10% in the control group (P=.08). At 6 months, conversion to dipper status occurred in 53% of the intervention group compared with 8% in the control group (P=.02). All ambulatory blood pressure monitoring parameters at both 3 and 6 months were lower in the intervention group than in the control group; however, only systolic night blood pressure at 6 months demonstrated a significant difference (114.9 vs 106 mmHg, respectively; P=.01.

“Reduction of nocturnal hypertension and restoration of nocturnal dip in pediatric transplant recipients is possible with chronotherapy. Future studies are needed with larger sample sizes to delineate the effect of improved nocturnal hypertension on end-organ damage,” the researchers said.

Source: Sethna CB, Gurusinghe S, Frank R, Infante L, Meyers KE. Reduction of nocturnal hypertension in pediatric renal transplant recipients. Abstract of a poster presented at the American Society of Nephrology 2017 Kidney Week, November 3, 2017, New Orleans, Louisiana.