Supine Hypertension and Extreme Reverse Dipping Phenomenon Decades after Kidney Transplantation: A Case Report

• Main Authors: Dóra Batta, Beáta Kőrösi, János Nemcsik
• Format: Article
• Language: English
• Published: Atlantis Press 2020-06-01
• Series: Artery Research
• Subjects: autonomic neuropathy; orthostatic hypotension; supine hypertension; reverse dipping; ambulatory blood pressure monitoring; central hemodynamic parameters
• Online Access: https://www.atlantis-press.com/article/125941083/view

Background: Supine hypertension, a consequence of autonomic neuropathy, is a rarely recognized pathological condition. Reported diseases in the background are pure autonomic failure, multiple system atrophy, Parkinson’s disease, diabetes and different autoimmune disorders. Methods: In our case report we present a case of supine hypertension which developed in a patient decades after kidney transplantation. The patient was followed for 25 months and we demonstrate the effect of the modification of antihypertensive medications. Results: At the time of the diagnosis supine hypertension appeared immediately after laying down (office sitting Blood Pressure (BP): 143/101 mmHg; office supine BP: 171/113 mmHg) and on Ambulatory Blood Pressure Monitoring (ABPM) extreme reverse dipping was registered (daytime BP: 130/86 mmHg, nighttime BP: 175/114 mmHg). After the modification of the antihypertensive medications, both office supine BP (office sitting BP: 127/92 mmHg; office supine BP: 138/100 mmHg) and on ABPM nighttime BP improved markedly (daytime BP: 135/92 mmHg, nighttime BP: 134/90 mmHg). Conclusion: In conclusions, our case report points out that autonomic neuropathy-caused supine hypertension and extreme reverse dipping can develop in chronic kidney disease, after kidney transplantation. The modification of the antihypertensive medications can slowly restore this pathological condition.