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

Background. Sparse studies show that ambulatory blood pressure monitoring (ABPM) is superior tooffice BP (oBP) measurements to predict target organ damage and cardiovascular (CV) events inkidney transplant recipients (KTRs). We performed a systematic review aimed at determining thepotential associations between BP recordings by different methods and renal and CV outcomes inthis population.Methods. Major medical databases were searched for studies enrolling adult KTRs undergoing 24hABPM compared to office or home BP measurements. Main outcomes were: associations betweendifferent BP recordings and renal and CV outcomes. Additionally, any association between thecircadian BP pattern (dipping/non-dipping status) and outcomes was assessed.Results. Twenty-two studies (2078 participants) were reviewed. Amongst 12 studies collecting dataon renal endpoints, ten studies found that BP assessed by ABPM was a stronger predictor of renalfunction decline, assessed by serum creatinine (SCr) and/or creatinine clearance (CrCl) or estimatedglomerular filtration rate (eGFR), than traditional office measurements. Twelve studies analyzed therelation between different BP recordings and CV target organ damages and reported robustcorrelations 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 withmarkers of vascular damage, such as carotid intima-media thickness (IMT), diffuse thickening, andendothelial dysfunction. Additionally, abnormal circadian BP pattern (non-dippers and reversedippers) 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 oBPin KTRs. Furthermore, altered circadian BP profile associated with renal and CV target organdamages.