Kidney Week

Abstract: FR-PO544

Reduction of Nocturnal Hypertension in Pediatric Renal Transplant Recipients

Session Information

• Hypertension: Clinical and Translational
  November 03, 2017 | Location: Hall H, Morial Convention Center
  Abstract Time: 10:00 AM - 10:00 AM

Category: Hypertension

• 1106 Hypertension: Clinical and Translational - Secondary Causes

Authors

• Sethna, Christine B., Cohen Children's Medical Center of NY, New Hyde Park, New York, United States

Christine B. Sethna,

• Gurusinghe, Shari, Cohen Children''s Medical Center, New Hyde Park, New York, United States

Shari Gurusinghe,

• Frank, Rachel, Cohen Children's Medical Center, New Hyde Park, New York, United States

Rachel Frank,

• Infante, Lulette, Cohen Children's Medical Center of New York, New Hyde Park, New York, United States

Lulette Infante,

• Meyers, Kevin E.C., The Children Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania, United States

Kevin E.C. Meyers,

Background

Nocturnal hypertension (nHTN) and non-dipper (ND) status are commonly found during ambulatory blood pressure monitoring (ABPM) in pediatric renal transplant recipients (Txp). These entities are associated with cardiovascular risk in adults. The aim was to investigate chronotherapeutic alteration of anti-hypertensive medication on nHTN and end-organ injury in ND Txp.

Methods

33 ND Txp aged 5-21 with normal overall ABPM and eGFR >30 ml/min/1.73m² were randomized to intervention (enalapril, isradipine or propranolol added in the evening) or control (no medication change) in this open label, blinded endpoint clinical trial. ABPM, echocardiography for left ventricular mass index (LVMI) and pulse wave velocity (PWV) were performed at baseline, 3 and 6 months. ND was defined as a decline of <10% in average blood pressure (BP) from day to night. Differences were compared using Fisher’s, t-test and paired t-test by intention-to-treat analysis.

Results

Txp included 17 intervention and 16 controls, age 13 (IQR 8,16) yr, 64% male. Baseline demographics, ABPM, LVMI and PWV were similar between groups. Conversion to dipper status occurred in 43% vs 10% at 3 months (p=0.08) and 53% vs 8% (p=0.02) at 6 months for intervention and controls, respectively. Although all ABPM parameters at 3 and 6 months were lower in intervention compared with controls, only systolic night BP at 6 months showed a significant difference (114.9±9.5 vs 106±8.3 mmHg, p=0.01). Changes over time in the intervention group are shown in the table. There were no significant changes over time in controls for ABPM, LVMI or PWV.

Conclusion

Reduction of nHTN and restoration of nocturnal dip in Txp is possible with chronotherapy.Future studies are needed with larger sample sizes to delineate the effect of improved nHTN on end-organ damage.

Funding

• Private Foundation Support