Relationship between nocturnal blood pressure patterns and end organ damage and diastolic dysfunction in heart transplant recipients

OBJECTIVES/SPECIFIC AIMS: Heart transplant (HTx) recipients are more likely to exhibit abnormal circadian blood pressure (BP) patterns (e.g., lack of nocturnal dip in BP) compared with the general population. Our goal was to assess the relationship between abnormal circadian BP patterns and end-organ damage in HTx recipients. METHODS/STUDY POPULATION: The retrospective study included 30 patients who were ≥ 6 months post-heart transplant and had 24-hour ambulatory BP data collected during a parent study. Nocturnal BP decline was categorized as: ≥10% decline, dipper; <10% decline, non-dipper. The primary end-organ damage outcomes we plan to analyze are left ventricular hypertrophy (LVH), chronic kidney disease (CKD), and proteinuria. The association between nocturnal BP decline and the primary outcomes will be analyzed using logistic regression. RESULTS/ANTICIPATED RESULTS: The study cohort consists of 83% men and 83% Caucasians (mean age=57±14 years; mean time post-transplant =9.0±6.6 years). Systolic and diastolic non-dippers represent 53.3% and 40% of the cohort, respectively. Data are currently being analyzed for the association between nocturnal BP dipping status and LVH, CKD, and proteinuria. These findings will be presented at the conference. DISCUSSION/SIGNIFICANCE OF IMPACT: An understanding of factors, such as abnormal circadian BP patterns, that contribute to the development of end-organ damage following HTx may provide opportunities to improve BP management and prevent adverse complications in this high-risk population.

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485: Inadequate Blood Pressure Control in Orthotopic Heart Transplant Recipients (OHT)

The Journal of Heart and Lung Transplantation ◽

10.1016/j.healun.2009.11.501 ◽

2010 ◽

Vol 29 (2) ◽

pp. S159-S159

Author(s):

P. Przybylowski ◽

J. Malyszko ◽

J.M. Malyszko

Keyword(s):

Blood Pressure ◽

Blood Pressure Control ◽

Heart Transplant ◽

Pressure Control ◽

Transplant Recipients ◽

Orthotopic Heart Transplant ◽

Heart Transplant Recipients

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Abstract 2280: Urine Albumin/creatinine Ratio, Cardiac Structure And Diastolic Function In Patients With Hypertension And Diastolic Dysfunction: The Validd Study

Circulation ◽

10.1161/circ.116.suppl_16.ii_497-c ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Anil Verma ◽

Rajesh Janardhanan ◽

William L Daley ◽

Susan Ritter ◽

William A Kaye ◽

...

Keyword(s):

Blood Pressure ◽

Diastolic Dysfunction ◽

Diastolic Function ◽

Organ Damage ◽

Left Ventricular ◽

Creatinine Ratio ◽

Albumin Creatinine Ratio ◽

End Organ Damage ◽

Urine Albumin ◽

Urine Albumin Creatinine Ratio

Background: Increasing urine albumin/creatinine ratio (ACR) is associated with systemic microvascular damage and increased cardiovascular morbidity and mortality. However, the relationship between albuminuria and left ventricular (LV) diastolic function, an early measure of myocardial end-organ damage in hypertension, has not been well defined. Methods: Urine ACR and echocardiographic measures of LV structure and function were assessed in 384 patients enrolled in the VALsartan In Diastolic Dysfunction (VALIDD) trial with mild hypertension and no heart failure and evidence of diastolic dysfunction based on Doppler assessment of myocardial relaxation velocities. Results: Urine ACR was undetected in 151 (39.3%) subjects, between 1 to 30 mg/g in 194 (50.5%), and > 30mg/g in 39 (10.2%). The mean blood pressure in the cohort was 143.8 ± 16.1/86.2 ± 10.3 mmHg and LV hypertrophy was present in < 4% of enrolled patients. Higher urine ACR was associated with lower annular relaxation velocity (E′), higher E/E′ (Figure ), higher prevalence of concentric LV remodeling and higher NT-ProBNP even after adjusting for age, diabetes, systolic BP, eGFR and LV mass index (LVMi) (p < 0.02 for all associations). Conclusion: Albuminuria is associated with worsening diastolic function in patients with hypertension, and both measures may represent important and modifiable markers of early end-organ damage even in patients with mild blood pressure elevation. E′ stratified by urine albumin creatinine ratio E/E′ stratified by urine albumin creatinine ratio

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Enhanced brain natriuretic peptide response to peak exercise in heart transplant recipients

Journal of Applied Physiology ◽

10.1152/jappl.1998.85.6.2270 ◽

1998 ◽

Vol 85 (6) ◽

pp. 2270-2276 ◽

Cited By ~ 24

Author(s):

Bernard Geny ◽

Anne Charloux ◽

Eliane Lampert ◽

Jean Lonsdorfer ◽

Pascal Haberey ◽

...

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Heart Transplantation ◽

Left Ventricular Mass ◽

Heart Transplant ◽

Left Ventricular Mass Index ◽

Left Ventricular ◽

Peak Exercise ◽

Transplant Recipients ◽

Heart Transplant Recipients

We investigated the atrial (ANP) and brain natriuretic peptides (BNP), catecholamines, heart rate, and blood pressure responses to graded upright maximal cycling exercise of eight matched healthy subjects and cardiac-denervated heart transplant recipients (HTR). Baseline heart rate and diastolic blood pressure, together with ANP (15.2 ± 3.7 vs. 4.4 ± 0.8 pmol/l; P < 0.01) and BNP (14.3 ± 2.6 vs. 7.4 ± 0.6 pmol/l; P< 0.01), were elevated in HTR, but catecholamine levels were similar in both groups. Peak exercise O2uptake and heart rate were lower in HTR. Exercise-induced maximal ANP increase was similar in both groups (167 ± 34 vs. 216 ± 47%). Enhanced BNP increase was significant only in HTR (37 ± 8 vs. 16 ± 8%; P < 0.05). Similar norepinephrine but lower peak epinephrine levels were observed in HTR. ANP and heart rate changes from rest to 75% peak exercise were negatively correlated ( r = −0.76, P < 0.05), and BNP increase was correlated with left ventricular mass index ( r = 0.83, P < 0.01) after heart transplantation. Although ANP increase was not exaggerated, these data support the idea that the chronotropic limitation secondary to sinus node denervation might stimulate ANP release during early exercise in HTR. Furthermore, the BNP response to maximal exercise, which is related to the left ventricular mass index of HTR, is enhanced after heart transplantation.

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