Prediction of cardiovascular events after renal transplantation.

BACKGROUND: Pulse wave velocity (PWV) is a marker of arterial stiffness and predicts cardiovascular events in the nontransplantation population. Cardiovascular events (CVE) are the leading cause of death and one of the leading causes of graft failure in renal transplant recipients. The present prospective study investigates whether there is a correlation between PWV and CVE in renal transplant recipients. METHODS: A prospective study assessing the incidence of a composite cardiovascular endpoint within ≥ 3 years after pulse wave analysis was performed in 64 stable renal transplant recipients. Measurement of PWV, augmentation index (AI75), and aortic systolic pressure was conducted using the SphygmoCor (AtCor) device. The composite endpoint of the study was the incidence of either death, myocardial infarction, stroke, or admission for symptomatic intermittent claudication or decompensated congestive heart failure. RESULTS: Fifteen patients (23%) reached the composite endpoint during a follow-up of 4.4 years. Binary logistic regression using PWV, AI75, central aortic systolic pressure, peripheral systolic pressure, and pulse pressure as covariates revealed that PWV was significantly associated with cardiovascular events (10.1 ± 3.6 m/s in subjects reaching the endpoint vs 8.5 ± 1.5 m/s in subjects not reaching the endpoint; P = .048). CONCLUSION: Increased arterial stiffness as assessed by PWV predicts CVE in renal transplant recipients and may be regarded as a footprint of accelerated arteriosclerosis for those patients.

The impact of aerobic exercise on blood pressure variability.

There is increasing evidence that blood pressure variability (BPV, variation of blood pressure over time) constitutes a strong and independent marker of cardiovascular risk. The all-cause mortality is >50% greater in subjects with a standard deviation of inter-visit blood pressure >5 mm Hg. Regular aerobic exercise reduces blood pressure and is recommended by current hypertension guidelines as a basic lifestyle modification. It remains elusive, however, whether aerobic exercise is able to reduce BPV as well. In total, 72 hypertensive subjects were randomly assigned to an 8-12-week treadmill exercise program (target lactate 2.0±0.5 mmol l(-1)) or sedentary control. Blood pressure was measured by 24 h-ambulatory blood pressure monitoring (ABP). Two aspects of BPV were assessed: the variability of ABP and the variability of blood pressure on exertion. The coefficient of variation (CV) was used as a statistical measure of BPV. The CV of systolic daytime ABP was defined as primary outcome. The exercise program significantly decreased systolic and diastolic daytime ABP by 6.2±10.2 mm Hg (P<0.01) and 3.0±6.3 mm Hg (P=0.04), respectively. Moreover, it reduced blood pressure on exertion and increased physical performance (P<0.05 each). Exercise had no impact, however, on the CV of daytime (10.2±2.7 vs. 9.8±2.6%, P=0.30) and night-time systolic (8.9±3.2 vs. 10.5±4.1%, P=0.10) and diastolic ABP (daytime 11.5±3.3 vs. 11.5±3.1%, night-time 12.0±4.3 vs. 13.8±5.2%; P>0.05 each). Regular aerobic exercise is a helpful adjunct to control blood pressure in hypertension, but it has no effect on 24 h- BPV, an independent predictor of cardiovascular risk.