Blood pressure monitoring in kidney transplantation: a systematic review on hypertension and target organ damage

Anna Pisano; Francesca Mallamaci; Graziella D'Arrigo; Davide Bolignano; Gregoire Wuerzner; Alberto Ortiz; Michel Burnier; Nada Kanaan; Pantelis Sarafidis; Alexandre Persu; Charles J Ferro; Charalampos Loutradis; Ioannis N Boletis; Gérard London; Jean-Michel Halimi; Bénédicte Sautenet; Patrick Rossignol; Liffert Vogt; Carmine Zoccali

doi:10.1093/ndt/gfab076

Blood pressure monitoring in kidney transplantation: a systematic review on hypertension and target organ damage

Nephrol Dial Transplant. 2021 Mar 25:gfab076. doi: 10.1093/ndt/gfab076. Online ahead of print.

Authors

Anna Pisano¹, Francesca Mallamaci¹, Graziella D'Arrigo¹, Davide Bolignano^{1

2}, Gregoire Wuerzner³, Alberto Ortiz⁴, Michel Burnier³, Nada Kanaan⁵, Pantelis Sarafidis⁶, Alexandre Persu^{7

8}, Charles J Ferro⁹, Charalampos Loutradis⁶, Ioannis N Boletis¹⁰, Gérard London¹¹, Jean-Michel Halimi¹², Bénédicte Sautenet¹³, Patrick Rossignol¹⁴, Liffert Vogt¹⁵, Carmine Zoccali¹

Affiliations

¹ CNR-Institute of Clinical Physiology; Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, Reggio Calabria, Italy.
² Department of Surgical and Medical Sciences-Magna Graecia, University of Catanzaro, Italy.
³ Service of Nephrology and Hypertension, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
⁴ Nephrology and Hypertension. IIS-Fundacion Jimenez Diaz UAM, Madrid, Spain.
⁵ Division of Nephrology, Division of Cardiology, Cliniques Universitaires Saint-Luc and Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium.
⁶ Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Greece.
⁷ Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
⁸ Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium.
⁹ Department of Renal Medicine, University Hospitals Birmingham and Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.
¹⁰ Department of Nephrology and Renal Transplantation, Athens Medical School, Laiko Hospital.
¹¹ FCRIN INI-CRCT Cardiovascular and Renal Clinical Trialists, Manhes Hospital and FCRIN INI-CRCT, Manhes, France.
¹² Service de Néphrologie-Hypertension, Dialyses, Transplantation rénale, CHRU Tours, Tours, France, and Equipe d'Accueil EA4245, université de Tours, and FCRIN INI-CRCT, Nancy, France.
¹³ Service de Néphrologie-Hypertension, Dialyses, Transplantation rénale, CHRU Tours, Tours, France and INSERM SPHERE U1246, Université Tours, Université de Nantes, Tours, France, and FCRIN INI-CRCT, Nancy, France.
¹⁴ Université de Lorraine, Inserm 1433 CIC-P CHRU de Nancy, Inserm U1116 and FCRIN INI-CRCT, Nancy, France.
¹⁵ Department of Internal Medicine, section Nephrology, Amsterdam UMC, University of Amsterdam, The Netherlands.

PMID: 33764450
DOI: 10.1093/ndt/gfab076

Abstract

Background: Sparse studies show that ambulatory blood pressure monitoring (ABPM) is superior to office BP (oBP) measurements to predict target organ damage and cardiovascular (CV) events in kidney transplant recipients (KTRs). We performed a systematic review aimed at determining the potential associations between BP recordings by different methods and renal and CV outcomes in this population.

Methods: Major medical databases were searched for studies enrolling adult KTRs undergoing 24h ABPM compared to office or home BP measurements. Main outcomes were: associations between different BP recordings and renal and CV outcomes. Additionally, any association between the circadian BP pattern (dipping/non-dipping status) and outcomes was assessed.

Results: Twenty-two studies (2078 participants) were reviewed. Amongst 12 studies collecting data on renal endpoints, ten studies found that BP assessed by ABPM was a stronger predictor of renal function decline, assessed by serum creatinine (SCr) and/or creatinine clearance (CrCl) or estimated glomerular filtration rate (eGFR), than traditional office measurements. Twelve studies analyzed the relation between different BP recordings and CV target organ damages and reported robust correlations between echocardiographic abnormalities [i.e. left ventricular mass index (LVM/LVMI)] and 24h ABPM, but not with office BPs. Furthermore, 24h ABPM correlated better than oBP with markers of vascular damage, such as carotid intima-media thickness (IMT), diffuse thickening, and endothelial dysfunction. Additionally, abnormal circadian BP pattern (non-dippers and reverse dippers) identified a group of kidney recipients at risk for kidney function loss and CV abnormalities.

Conclusions: In our systematic review, ABPM reflected target organ damage more closely than oBP in KTRs. Furthermore, altered circadian BP profile associated with renal and CV target organ damages.

Keywords: ambulatory blood pressure monitoring; hypertension; kidney transplantation; systematic review; target organ damage.