High prevalence of nocturnal arterial hypertension and non-dipping in lung transplant recipients

Objective - An abnormal circadian blood pressure (BP) profile is associated with adverse cardiovascular and all-cause outcomes. It is highly prevalent after heart, liver and kidney transplantation. We aimed to assess the prevalence of an abnormal ambulatory BP pattern in lung transplant recipients (LTx). Methods - Ambulatory BP monitoring (ABPM) was performed in 53 LTx and compared to those of 42 control subjects matched for age, gender and daytime BR In 19 patients in whom at least two recordings were performed, we compared the first and the last one. Results - The non-dipping pattern (a less than 10% reduction in nocturnal BP) was more prevalent in LTx than in control subjects (89 versus 64%, P < 0.01). Nighttime BP was higher in LTx than in control subjects (P < 0.01 and <0.001 for systolic BP (SBP) and diastolic BP (DBP), respectively). The nocturnal reduction of BP was lower in LTx than in control subjects (3 versus 8% for SBP and 6 versus 13% for DBP, both P < 0.001). These results remained significant after adjustment for the presence of diabetes mellitus and creatinine clearance. In the 19 patients in whom ABPM was performed twice (mean interval between the two recordings was 22 months), ambulatory BP values remained unchanged between the two recordings, although the number of antihypertensive agents was significantly higher. Conclusion - An abnormal circadian BP profile is highly prevalent after lung transplantation. It is observed consistently over prolonged periods of time.