Isolated nocturnal hypertension: A prognostic marker of cardiovascular outcomes in renal transplant recipients with masked hypertension
Clinical Nephrology, vol.105, no.2, pp.103-108, 2026 (SCI-Expanded, Scopus)
- Publication Type: Article / Article
- Volume: 105 Issue: 2
- Publication Date: 2026
- Doi Number: 10.5414/cn111654
- Journal Name: Clinical Nephrology
- Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, EMBASE
- Page Numbers: pp.103-108
- Keywords: inflammation, left ventricular mass index, nocturnal diastolic blood pressure, renal transplantation
- Ankara Yıldırım Beyazıt University Affiliated: Yes
Abstract
Aims: Isolated nocturnal hypertension (INH) is characterized by normal daytime blood pressure (BP) and elevated nighttime BP diagnosed by ambulatory BP monitoring (ABPM). In the present study, we aimed to evaluate the influence of nocturnal diastolic hypertension on left ventricular mass index (LVMI), renal resistive index (RRI), and inflammation in renal transplant recipients (RTR) with masked hypertension. Materials and methods: We cross-sectionally analyzed the ABPM monitoring data in 250 RTRs from living related first and/or second degree or from deceased donors without the diagnosis of hypertension with stable allograft function from our renal transplant outpatient clinic. Daytime hypertensive as well as nocturnal systolic hypertensive patients were excluded, and 74 patients with isolated nocturnal diastolic hypertension (INDHT) (mean age: 39.2 ± 11.4 years, 58% male) were enrolled in the study. LVMI was calculated by conventional echocardiography. RRI was measured by doppler ultrasound. Patients were divided into two groups according to mean RRI values as group 1 (RRI < 0.67; n = 29) and group 2 (RRI ≥ 0.67; n = 45). Results: The mean post-transplantation time, RRI, and LVMI were 34.9 ± 1.7 months, 0.67 ± 0.1, and 193.0 ± 115.5 g/m2, respectively. In correlation analysis, nocturnal diastolic BP was positively correlated with gender (p = 0.039), post transplantation time (p = 0.01), C-reactive protein (CRP) (p = 0.04), neutrophil/ lymphocyte ratio (p = 0.01), RRI (p = 0.01), and LVMI (p = 0.033). RRI was significantly higher in males than in females (p = 0.04). In subgroup analysis, patients in group 1 had lower serum ferritin (p = 0.04), CRP (p = 0.04), LVMI (p = 0.01), nocturnal diastolic BP (p = 0.01), and neutrophil/lymphocyte ratio (p = 0.04) but higher serum albumin (p = 0.03) levels. In multiple regression analysis; RRI (p = 0.012) and LVMI (p = 0.02) were detected as the predictors of nocturnal diastolic BP. Conclusion: INDHT has a significant influence on LVMI, RRI, and inflammation. Thus, INH could be an early predicting factor for graft function and cardiovascular outcome in RTRs.