aRTICLE Possible Correlation Among Echocardiographic Measures, Serum Brain Natriuretic Peptide, and Angiotensin II Levels in Hypertensive Kidney Transplanted Children Alaleh Gheissari, Mohammadreza Sabri, Majidreza Pirpiran, Alireza Merrikhi Abstract Objectives: Ambulatory blood pressure monitoring is the standard for determining patients at risk of hypertension. Left ventricular hypertrophy is common in kidney transplant recipients. We evaluated the correlation between blood pressure measures achieved by ambulatory blood pressure monitoring and conventional (office) methods. Materials and Methods: This cross-sectional study was done from December 2009 to October 2010 at Alzahra Hospital in Isfahan, Iran. Sixty five participants, 35 kidney transplant recipients under 20 years old, and 30 control subjects of the same age were recruited. Five kidney recipients did not complete the study and were excluded. Blood pressure was measured by ambulatory blood pressure monitoring and conventional methods. Echocardiographic study was done for kidney transplant recipients. Serum brain natriuretic peptide and angiotensin II levels were determined in case and control groups. Results: Office-recorded systolic and/or diastolic hypertension was observed in 43.4% and 55.3% of patients. According to ambulatory blood pressure monitoring, 86% of kidney transplant recipients had systolic BP load. Left ventricular hypertrophy (defined according to the left ventricular mass index [left ventricular mass index/height 2.7 ]) was seen in 53.3% of the patients. The existence of left ventricular hypertrophy revealed a positive correlation with ambulatory blood pressure monitoring systolic and diastolic night blood pressure and systolic nondipper. Left ventricular mass index showed a positive correlation with brain natriuretic peptide level. Furthermore, the existence of left ventricular hypertrophy was positively correlated with angiotensin II level. Conclusions: Only ambulatory blood pressure monitoring systolic and diastolic blood pressures (nondippers) were positively correlated with left ventricular hypertrophy and higher left ventricular mass index. Serum levels of brain natriuretic peptide and angiotensin II had a positive relation with left ventricular hypertrophy. Measuring brain natriuretic peptide and angiotensin II in the clinical setting screens patients at risk of left ventricular hypertrophy. Key words: Ambulatory blood pressure monitoring, Non dipping, Left ventricular mass index, Left ventricular hypertrophy, Children, Nocturnal blood pressure Introduction Cardiovascular complications including left ventricular dysfunction and left ventricular hypertrophy (LVH) are considered independent risk factors for mortality in end-stage renal disease and kidney transplant recipients. 1,2 The nondipping pattern (defined as a nocturnal blood pressure falling less than 10%) is high among kidney transplant recipients. 3,4 High blood pressure (BP) measures 1 year after kidney transplant is considered a predictor of graft function. 5 Nondipper kidney transplant recipients have been regarded as a high risk for end-organ damage. 6 Ambulatory BP monitoring (ABPM) allows physicians to find nondippers. From the Pediatric Nephrology Department, St Alzahra Hospital, Soffeh St, Isfahan, Iran Acknowledgements: This study was conducted with corporation of Isfahan University of Medical Sciences, and Isfahan Kidney Diseases Research Center and was funded by Isfahan University of Medical Sciences. Corresponding author: Alaleh Gheissari, Isfahan Kidney Diseases Research Center, Associate Professor, Isfahan University of Medical Sciences, Isfahan, Iran Phone: +98 311 226 4748 Fax: +98 311 250 2430 E-mail: gheisari@med.mui.ac.ir Experimental and Clinical Transplantation (2013) 2: 128-133 Copyright © Başkent University 2013 Printed in Turkey. All Rights Reserved. DOI: 10.6002/ect.2012.0140