Blood Pressure Trajectories, Circadian Profiles and Antihypertensive Treatment Burden During the First Year After Kidney Transplantation: A Prospective Single-Center Study

Abstract

Hypertension remains highly prevalent after kidney transplantation, while office measurements alone do not characterize 24-hour blood pressure burden or nocturnal profiles. In this prospective single-center study, 80 adults underwent kidney transplantation in 2022–2023; 47 completed 12-month follow-up and had sufficient serial data. Office blood pressure was assessed before transplantation and at months 3, 6 and 12, and 24-hour ambulatory monitoring on days 7–14 and at months 3 and 6. Associations with age, sex, diabetes, eGFR, PTH, hemoglobin, uric acid, lipids, proteinuria, magnesium supplementation, rejection and corticosteroid exposure were explored. Hypertension remained present in 95.7–97.9%. Office blood pressure decreased from 145.0/89.1 mmHg before transplantation to 123.6/78.1 mmHg at month 3 and 122.1/77.2 mmHg at month 12 (both p < 0.001). Ambulatory blood pressure decreased from 140.8/83.2 mmHg on days 7–14 to 132.0/77.5 mmHg at month 6 (systolic p < 0.001; diastolic p = 0.004). Treatment burden declined from 2.74 to 2.32 agents, but not significantly (p = 0.139). Non-dipper or reverse-dipper profiles persisted in 81.0% at month 6. Following the early post-transplant period, graft function remained stable between months 3 and 12, with a modest further increase in eGFR (p = 0.003). PTH decreased markedly (p < 0.001), correlated inversely with contemporaneous eGFR, and was not an independent determinant of office blood pressure. Blood pressure improved early and remained stable through month 12. Nevertheless, hypertension, multidrug treatment and abnormal circadian profiles remained highly prevalent.