RISK OF DEVELOPMENT OF HYPERTENSION AFTER DONOR NEPHRECTOMY

Objective: To assess live donor nephrectomy for development of hypertension. Study Design: Retrospective observational study. Place and Duration of Study: The study was conducted at Armed Forces Institute of Urology (AFIU) Rawalpindi, from May 2016 to May 2020. Methodology: All consenting kidney donors for live renal transplant were introduced with the process. Baseline blood pressure at time of workup of donation and annually afterwards after transplant on follow up examinations using retrospective data analysis of donor’s workup and follow up was used. Comparison of 1,2,3 and 4-year occurrence of hypertension among (normotensive) donors with 1,2,3 and 4-year of donation using estimates from Framingham Hypertension Risk Score. Results: A total of 79 donors with a completed annual follow-up rate of up to100 % during a 4-year period. The average age at donation was 33.96 ± 10.23 SD years; 50 donors (63.4%) were women. Overall 27% (22 out of 79) of all live donors developed post donation hypertension who were normotensive at the time of donation. Almost 2/3rd of the patients developing hypertension were females. There was a significant increase in blood pressure measurements each year after donation. Increased BMI of the patient was a risk factor for post donation development of hypertension. The donors who continue being normotensive 1-year post donation yielded an analogous risk to that fit Framingham populace. Conclusion: Live organ kidney givers are at augmented risk of development of hypertension post kidney donation. The study ascertains the potential significance of following donors and handling risk factors aggressively................

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Long-Term Follow-up of a Randomized Trial Comparing Laparoscopic and Mini-Incision Open Live Donor Nephrectomy

American Journal of Transplantation ◽

10.1111/j.1600-6143.2010.03281.x ◽

2010 ◽

Vol 10 (11) ◽

pp. 2481-2487 ◽

Cited By ~ 34

Author(s):

L. F. C. Dols ◽

J. N. M. IJzermans ◽

N. Wentink ◽

T. C. K. Tran ◽

W. C. Zuidema ◽

...

Keyword(s):

Randomized Trial ◽

Donor Nephrectomy ◽

Live Donor ◽

Live Donor Nephrectomy ◽

Long Term Follow Up ◽

Mini Incision

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Baseline and Cumulative Blood Pressure in Predicting the Occurrence of Cardiovascular Events

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.735679 ◽

2021 ◽

Vol 8 ◽

Author(s):

Yingting Zuo ◽

Deqiang Zheng ◽

Shuohua Chen ◽

Xinghua Yang ◽

Yuxiang Yan ◽

...

Keyword(s):

Blood Pressure ◽

Medical Records ◽

Roc Analysis ◽

Routine Clinical Practice ◽

Baseline Blood Pressure ◽

Predictive Values ◽

Hazard Ratios ◽

The Mean ◽

Single Baseline

Background: Both baseline blood pressure (BP) and cumulative BP have been used to estimate cardiovascular event (CVE) risk of higher BP, but which one is more reliable for recommendation to routine clinical practice is unclear.Methods: In this prospective study, conducted in the Kailuan community of Tanshan City, China, a total of 95,702 participants free of CVEs at baseline (2006–2007) were included and followed up until 2017. Time-weighted cumulative BP that expresses the extent of cumulative BP exposure is defined as the sum of the mean of two consecutive systolic or diastolic BP times the interval between the two determinations, then normalized by the total follow-up duration. Incident CVEs during 2006–2017 were confirmed by review of medical records. We performed a competing risk regression analysis to assess CVE risk of the different durations of higher BP exposure. ROC analysis was performed to assess the predictive value of higher BP on CVE occurrence.Results: We found that when the risk of higher BP on CVE occurrence was estimated based on time-weighted cumulative BP, the hazard ratios (HRs) increased with the increase in duration of higher BP exposure in each of the four BP groups: <120/<80, 120–129/<80, 130–139/80–89, and ≥140/≥90 mmHg; this time trend also occurred across the four different BP groups, with the higher BP group exhibiting CVE risk earlier during the follow-up. These results were confirmed by the same analysis performed on participants without baseline hypertension. However, such reasonable time trends did not occur when a single baseline BP was used as the primary estimation. We also demonstrated that the predictive values of baseline systolic and diastolic BP that predict CVE occurrence were only 0.6–3.2 and 0.2–3.1% lower, respectively, than those of cumulative BP combined with baseline BP during follow-up.Conclusions: Baseline BP remains a useful indicator for predicting future occurrence of CVEs. Nevertheless, time-weighted cumulative BP could more reliably estimate the CVE risk of higher BP exposure than baseline BP.

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The 10-year incidence of hypertension across blood pressure categories in a population-based cohort in southwestern Sweden

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-02334-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ulf Lindblad ◽

Klara Lundholm ◽

Jenny Eckner ◽

Ying Li ◽

Lennart Råstam ◽

...

Keyword(s):

Blood Pressure ◽

Lifestyle Modification ◽

Population Based ◽

Baseline Blood Pressure ◽

Swedish Population ◽

Incident Hypertension ◽

Pressure Lowering ◽

Optimal Blood Pressure ◽

The Impact

Abstract Background To explore the determinants of incident hypertension, and especially the impact of baseline blood pressure categories, in a representative Swedish population. Methods A 10-year longitudinal study of residents aged 30–74. Blood pressures were measured and categorized according to ESH guidelines with optimal blood pressure < 120/80 mmHg, normal 120–129/80–84 mmHg, and high normal 130–139/85–89 mmHg. Incident hypertension was defined as ongoing treatment or three consecutive blood pressure readings ≥ 140/ ≥ 90 mmHg (one or both) at follow-up, while those with ≥ 140 and/or ≥ 90 mmHg at only one or two visits were labelled as unstable. After excluding subjects with hypertension, ongoing blood pressure lowering medication or a previous CVD event at baseline, 1099 remained for further analyses. Results Sixteen (2.6%) subjects with optimal baseline blood pressure had hypertension at follow up. Corresponding numbers for subjects with normal, high normal and unstable blood pressure were 55 (19.4%), 50 (39.1%) and 46 (74.2%), respectively. Compared with subjects in optimal group those in normal, high normal and unstable blood pressure categories had significantly higher risk to develop manifest hypertension with odds ratios OR and (95% CI) of 7.04 (3.89–12.7), 17.1 (8.88–33.0) and 84.2 (37.4–190), respectively, with adjustment for age, BMI and family history for hypertension. The progression to hypertension was also independently predicted by BMI (p < 0.001), however, not by age. Conclusions Subjects with high normal or unstable blood pressure should be identified in clinical practice, evaluated for global hypertension risk and offered personalized advice on lifestyle modification for early prevention of manifest hypertension and cardiovascular disease.

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Value of Childhood Blood Pressure Measurements and Family History in Predicting Future Blood Pressure Status: Results From 8 Years of Follow-up in the Bogalusa Heart Study

PEDIATRICS ◽

10.1542/peds.77.6.862 ◽

1986 ◽

Vol 77 (6) ◽

pp. 862-869 ◽

Cited By ~ 1

Author(s):

Charles L. Shear ◽

Gregory L. Burke ◽

David S. Freedman ◽

Gerald S. Berenson

Keyword(s):

Blood Pressure ◽

Family History ◽

Age Groups ◽

Correlation Coefficients ◽

Pressure Measurements ◽

Bogalusa Heart Study ◽

Heart Study ◽

History Of ◽

Family History Of Hypertension

The value of BP measurements and family history of cardiovascular disease in predicting future BP status was studied in 1,501 children, initially 2 to 14 years of age, who were examined four times during an 8-year period in the Bogalusa Heart Study. Correlation coefficients between year 1 and year 9 BPs were as follows for systolic and diastolic BPs, respectively: 0.41 and 0.35 (P < .0001). These correlations were significant in all age groups. For children in the upper quartile of BP at any one prior examination, the percentage remaining in the year 9 upper quartile ranged from 41% to 52% for systolic BP and 35% to 44% for diastolic BP. Three serial BP measurements in the upper quartile increased the percentages remaining in the upper quartile to 68% for systolic BP and 62% for diastolic BP. Conversely, of those children not in the upper quartile of systolic BP at year 9, 96.8% did not have all three prior measurements in the upper quartile. Family history of hypertension was shown to independently predict year 9 systolic BP status. These results confirm the importance of serial BP measurements and family history of hypertension for the practicing physician.

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How Should We Measure and Deal with Office Blood Pressure in 2021?

Diagnostics ◽

10.3390/diagnostics11020235 ◽

2021 ◽

Vol 11 (2) ◽

pp. 235

Author(s):

Annina S. Vischer ◽

Thilo Burkard

Keyword(s):

Blood Pressure ◽

Cardiovascular Disease ◽

Risk Factor ◽

Clinical Practice ◽

Arterial Hypertension ◽

Pressure Measurement ◽

Blood Pressure Measurement ◽

Office Blood Pressure ◽

Pressure Measurements

Arterial hypertension is a major risk factor for cardiovascular disease worldwide. Office blood pressure measurements (OBPMs) are still recommended for diagnosis and follow-up by all major guidelines; however, the recommended procedures differ significantly. In analogy, major outcome studies usually apply OBPMs, again, with a variety of procedures. This variety of OBPM procedures complicates the comparability between studies and challenges daily clinical practice. In this narrative review, we compile the most recent recommendations for office blood pressure measurement together with the major limitations and strategies and how these could be overcome.

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678 Safety and clinical role of the exercise testing during pregnancy

European Heart Journal Supplements ◽

10.1093/eurheartj/suab128.002 ◽

2021 ◽

Vol 23 (Supplement_G) ◽

Author(s):

Massimiliano Domenico Rizzaro ◽

Irene Rota ◽

Andrea D'Errico ◽

Nicola Persico ◽

Alessio Maruccio ◽

...

Keyword(s):

Blood Pressure ◽

Exercise Testing ◽

Maximum Load ◽

Peak Exercise ◽

Pressure Measurements ◽

Peripheral Oxygen Saturation ◽

Clinical Role ◽

Test Analysis ◽

In Pregnancy

Abstract Aims The prevalence of arterial hypertension (AH) during pregnancy is ranging from 2% to 10%. Diagnostic criteria are based on rest blood pressure measurements. Exercise testing (ET) is a useful approach to detect latent hypertensive condition and may allow early diagnosis. Despite physical activity is encouraged during pregnancy in order to prevent systemic disorders, ET is not commonly performed during pregnancy due to limited data of safety. The aim of the study is to test the safety of ET during pregnancy and to explore its role in predicting the development of AH. Methods Pregnant women were tested through submaximal ET at Dyspnoea Unit of Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico of Milano. The exercise was performed on a stationary cycle on which the power was increased of 15 W every 2 min starting from 5 W (first step). Subjects were continuously monitored during exercise through EKG, non-invasive blood pressure measurements every 2 min and peripheral oxygen saturation. 3 months clinical follow-up was made in order to assess the presence of AH or other pregnancy disorders. U-test analysis was performed in order to verify statistical difference between hypertensive and non-hypertensive women. Heart rate, systolic and diastolic blood pressure (SBP and DBP) were measured at rest, at the first step and at peak of ET and have been considered in analysis. U-test (Mann–Whitney analysis) was adopted to test difference between hypertensive and non-hypertensive group. Women were followed-up at second trimester (22nd–25th week of pregnancy) in order to monitor the clinical condition, the development of AH or any gestational disorders (e.g. diabetes and pre-eclampsia). Results All 73 women (mean age 32 years, gestational age 12–14 weeks) consecutively enrolled have completed the ET. The mean maximum load achieved was 65 W, no abrupt interruption of ET was needed because of symptoms or intolerance. Mean HR at rest, at the first step and at the peak was 80 b.p.m., 91 b.p.m. and 128 b.p.m., respectively. Mean arterial pressure reached values of 97/62 mmHg at rest, 107/66 mmHg at the first step and 140/73 mmHg at peak exercise. At follow-up 9 of 73 showed clinical disorders (12%) of which 5 patients had hypertension (6.8%), 3 patients had diabetes (4.1%) and 1 had pre-eclampsia (1.4%). Comparing the group with AH (n 5) with the group without AH (n 68), SBP at the first step (median values 127 mmHg vs 104 mmHg, P = 0.009), the DBP at rest (median values 72 mmHg vs 60 mmHg, P = 0.039) and the DBP at the peak (median values 90 mmHg vs 69.5 mmHg, P = 0.038) were significantly higher in the group with AH. Among these parameters a logistic regression selected the SBP as best predictor for developing AH (OR 1.139, 95% IC 029–1.261, P = 0.012). Conclusions Our results showed that submaximal ET is safe in pregnancy. Although limited, our data seem to support the validity of ET, even submaximal, in order to stratify the risk of developing AH in pregnancy. Moreover, even SBP response at first step could be considered in a normal and expected range, we can speculate that a relatively excessive increase of BP in the early phase of exercise could reflect a pre-clinical impairment of vascular compliance predisposing AH during the second gestational trimester. Further data are needed to validate our results.

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Five-year follow-up after live donor nephrectomy - cross-sectional and longitudinal analysis of a prospective cohort within the era of extended donor eligibility criteria

Transplant International ◽

10.1111/tri.12872 ◽

2016 ◽

Vol 30 (3) ◽

pp. 266-276 ◽

Cited By ~ 8

Author(s):

Shiromani Janki ◽

Leonienke F. C. Dols ◽

Reinier Timman ◽

Evalyn E. A. P. Mulder ◽

Ine M. M. Dooper ◽

...

Keyword(s):

Longitudinal Analysis ◽

Prospective Cohort ◽

Donor Nephrectomy ◽

Live Donor ◽

Eligibility Criteria ◽

Cross Sectional ◽

Live Donor Nephrectomy

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SGLT2 Inhibition in Patients With Type 2 Diabetes Mellitus Post-Nephrectomy: A Single-Center Case Series

Canadian Journal of Kidney Health and Disease ◽

10.1177/20543581211065528 ◽

2021 ◽

Vol 8 ◽

pp. 205435812110655

Author(s):

Marko Škrtić ◽

David Z. I. Cherney ◽

Vikas S. Sridhar ◽

Christopher T. M. Chan ◽

Abhijat Kitchlu

Keyword(s):

Diabetes Mellitus ◽

Blood Pressure ◽

Type 2 Diabetes ◽

Sglt2 Inhibitor ◽

Case Series ◽

Pressure Measurements ◽

Sglt2 Inhibition ◽

The Mean

Background: Nephrectomy is the mainstay of treatment for many kidney cancers, but has been correlated with increased incidence of acute kidney injury (AKI) and chronic kidney disease (CKD). Recently, sodium-glucose cotransporter-2 (SGLT2) inhibition has been shown to decrease the incidence of end-stage kidney disease and death in people with type 2 diabetes mellitus (T2D). However, at present, there has been no description of the use of SGLT2 inhibition in patients with T2D and solitary kidney despite the high risk of CKD progression. Objective: To characterize the use of SGLT2 inhibition and kidney function in a series of patients with T2D with prior nephrectomy for renal cell carcinoma (RCC). Design: Retrospective case series. Setting: University hospital outpatient onco-nephrology clinic. Patients: Patients post-nephrectomy for RCC with T2D who were prescribed an SGLT2 inhibitor. Measurements: Serum creatinine, albumin to creatinine ratio (ACR), HgA1c, and blood pressure measurements. Methods: Patients post-nephrectomy with incident use of SGLT2 inhibitor were identified from an existing registry of patients followed in the Onco-Nephrology Clinic at our institution from May 2019 to March 2021. Demographics, medication use, time since nephrectomy, cancer diagnosis, serum creatinine, ACR measurements, and blood pressure measurements were extracted from electronic medical records. Results: Five patients were identified who had initiated SGLT2 inhibition post-nephrectomy. All patients were male, had T2D, and a prior history of hypertension. Renal cell carcinoma was the clinical indication for nephrectomy in all patients. None of patients were prescribed diuretics, and all were receiving renin-angiotensin system (RAS) inhibition therapies. The time from nephrectomy to SGLT2 inhibitor initiation ranged from 5 to 74 months. Baseline mean estimated glomerular filtration rate (eGFR) values were 49 mL/min/1.73 m2 (95% confidence interval [CI]: 31.5-66.5), and mean ACRs were 8.7 mg/mmol (95% CI: 0.6-16.9). After 6 months of SGLT2 inhibition, the mean eGFR and ACR values were 58 mL/min/1.73 m2 (95% CI: 29.7-86.2) and 23.8 mg/mmol (95% CI: 0-60), respectively. After 16 to 18 months of follow-up (4 patients), the mean eGFR was 56 mL/min/1.73 m2 (95% CI: 37.3-74.7), and mean ACR was 10.5 (95% CI: 0-30.5), similar to baseline values before SGTL2i therapy initiation. At baseline, mean systolic blood pressure was 128 mm Hg (95% CI: 118.3-140.9) and remained similar after 12 months of treatment (mean 131 mm Hg [95% CI: 112.3-149.7]). There were no adverse events related to AKI, electrolyte disturbances, ketoacidosis, or genitourinary infections during the 18-month follow-up period. Limitations: Small sample size, lack of a comparison group, and the variable timing of clinical data collection, including eGFR levels following initiation of SGLT2 inhibition. Conclusions: SGLT2 inhibition is becoming a standard component of nephrology care to reduce kidney function decline, cardiovascular risk, and mortality. To our knowledge, our report is the first to provide longitudinal data on SGLT2 inhibitor usage in patients with T2D and solitary kidneys post-nephrectomy. Larger prospective studies are needed to determine the efficacy and safety of SGLT2 inhibition strategies for kidney protection in patients post-nephrectomy.

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Tracking Correlations of Blood Pressure Levels in Infancy

PEDIATRICS ◽

10.1542/peds.61.1.121 ◽

1978 ◽

Vol 61 (1) ◽

pp. 121-125

Author(s):

Robert S. Levine ◽

C. H. Hennekens ◽

B. Klein ◽

J. Gourley ◽

F. W. Briese ◽

...

Keyword(s):

Blood Pressure ◽

Prospective Studies ◽

Diastolic Pressure ◽

Systolic Pressure ◽

Pressure Measurements ◽

Elevated Blood ◽

Increased Risk ◽

Adults And Children ◽

The Relationship

The association between elevated blood pressure levels in adults and increased risk of coronary and cerebrovascular disease has been well documented.1,2 Prospective studies of blood pressure in both adults and children have also shown strongly positive tracking correlations,3-5 tracking correlations being defined as the relationship between blood pressure measurements obtained at two points in time from the same individuals. In adults 35 to 70 years of age, tracking correlations of 0.6 for systolic pressure3,4 and 0.5 for diastolic pressure4 have been reported over four-year follow-up intervals. In children, Zinner et al.5 reported correlations of 0.25 for systolic pressure and 0.14 for diastolic pressure over a four-year follow-up interval.

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