Journal Article

Reverse dipper pattern of blood pressure at 3 months is associated with inflammation and outcome after renal transplantation

Meritxell Ibernon, Francesc Moreso, Xavier Sarrias, Maria Sarrias, Josep M. Grinyó, José M. Fernandez-Real, Wifredo Ricart and Daniel Serón

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 27, issue 5, pages 2089-2095
Published in print May 2012 | ISSN: 0931-0509
Published online October 2011 | e-ISSN: 1460-2385 | DOI:
Reverse dipper pattern of blood pressure at 3 months is associated with inflammation and outcome after renal transplantation

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Cardiovascular disease is the major cause of morbidity and mortality after renal transplantation. It has been shown that both traditional and transplant-specific risk factors contribute to the high cardiovascular burden after renal transplantation The aim is to evaluate the association among ambulatory blood pressure monitoring (ABPM) at 3 months, inflammation and graft outcome.


ABPM at 3 months was performed in 126 consecutive renal transplants. According to the nocturnal reduction of systolic blood pressure (SBP), dipper (ΔSBP ≥ 10%), non-dipper (0 < ΔSBP < 10%) and reverse dipper (SBP nocturnal rise) pattern were defined. The outcome variable was the combination of any cardiovascular event and graft failure for any reason.


Circadian blood pressure pattern was dipper (n = 22), non-dipper (n = 65) and reverse dipper (n = 39). Reverse dipper pattern was associated with pre-transplant diabetes (18 versus 2%, P = 0.004), body mass index (26.9 ± 5.0 versus 24.8 ± 3.8 kg/m2, P = 0.001), calcineurin inhibitor treatment (74 versus 54%, P = 0.001) and serum soluble tumour necrosis factor receptor 2 levels (18 ± 15 versus 11 ± 6 ng/mL, P = 0.010). During 45 ± 11 months of follow-up, 22 patients reached the combined outcome variable. Multivariate Cox regression analysis showed that reverse dipper pattern [relative risk (RR): 3.50 and 95% confidence interval (CI): 1.36–8.93; P = 0.009] and creatinine clearance (RR: 0.94 and 95% CI: 0.91–0.98, P = 0.003) were independently associated with outcome.


The reverse dipper circadian pattern is associated with inflammation and constitutes an independent predictor of graft outcome.

Keywords: ambulatory blood pressure monitoring; circadian rhythm; inflammation; graft failure; cardiovascular disease

Journal Article.  4330 words.  Illustrated.

Subjects: Nephrology

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