AMBULATORY BLOOD-PRESSURE AND LEFT-VENTRICULAR MASS IN CYCLOSPORINE-TREATED AND NON-CYCLOSPORINE-TREATED RENAL-TRANSPLANT RECIPIENTS

Objectives: First, to determine the relationship between left ventricu lar mass (LVM) and clinic and 24-h ambulatory blood pressure parameter s in normotensive renal transplant recipients. Secondly, to assess the influence of immunosuppression protocol on diurnal blood pressure and target-organ response. Design: Measurement of supine clinic blood pre ssure, non-invasive 24-h ambulatory blood pressure and echocardiograph ically determined LVM. Patients: Twenty-eight stable, normotensive ren al transplant recipients taking no antihypertensive therapy (16 cyclos porin-treated and 12 non-cyclosporin-treated). Setting: Community-base d ambulatory patients reviewed in tertiary referral centre. Main outco me measures: Clinic blood pressure, mean 24-h, daytime and night-time ambulatory blood pressure and LVM. Results: Mean 24-h blood pressure e xceeded that recorded in the clinic. Twenty-five per cent of patients had left ventricular hypertrophy despite the absence of hypertension, and this was more common in cyclosporin-treated than in non-cyclospori n-treated patients. Mean daytime systolic blood pressure was the best predictor of LVM, being superior to clinic blood pressure and any dias tolic blood pressure parameter. An attenuated nocturnal blood pressure fall ('non-dipper' pattern) was common, especially in those patients treated with cyclosporin, and was associated with higher LVM. Conclusi on: In normotensive renal transplant recipients, a group at risk of ca rdiovascular disease, 24-h ambulatory blood pressure is closely relate d to the development of left ventricular hypertrophy, and may prove us eful in optimizing treatment strategies to reduce cardiovascular morbi dity.