*Purpose: Approximately 80% kidney transplant (KT) recipients have high blood pressure, compromising graft survival and increasing cardiovascular risk. In the pre-transplant stage, alterations in blood pressure circadian (BP) rhythm is associated with end-organ damage and endothelial dysfunction. The objective is to characterize BP circadian behavior in KT recipients in the pre and post-transplant periods by 24 hour ambulatory BP monitoring (24H-ABPM).

*Methods: Prospective cohort study in which 24H-ABPM was performed before KT, at day +7 and +30 post KT. According to nocturnal systolic BP, the patients were classified into: dipper (D) (10% – 20%), non-dipper (ND) (0-10%) and reverse dipper (RD) (increase in nocturnal systolic BP). In-office BP and antihypertensive drugs use was also recorded. For statistical analysis, categorical variables were analyzed using frequencies and proportions. Continuous variables were analyzed using median and standard deviations.

*Results: We included 18 KT recipients, 13 (72.2%) male with an average age of 35.7 ± 12.6 years. In most cases the cause of CKD (50%) was unknown, followed by diabetes mellitus 2 (11.1%) and lupus 2 (11.1%). 15 (83.3%) received KT from a live donor. In 9 (50%) patients, basiliximab was used for induction. Hypertension was diagnosed in 16 (8.9%) patients. The most commonly used antihypertensives were angiotensin II receptor blockers in 6 (37.5%) and calcium channel blockers in 11 (68.7%). 8 (44.4%) received 2 antihypertensive pre-KT. After transplantation, 14 patients (87.5%) no longer required the use of antihypertensive drugs. There was a significant improvement in the mean values ​​of systolic, diastolic and mean systemic BP at day +7 and +30, compared to pre KT stage (Table 1). In pre-KT stage, an adequate ABPM was obtained in 15 recipients; the identified patterns were: 8 (53.3%) ND, 3 (20%) D, 4 (26.6%) RD. In the post-KT, 17 patients were included, the patterns identified on day 7 were: 7 (41.1%) ND, 2 (11.7%) D, 8 (47%) RD. At day 30 post-KT: 7 (41.1%) ND, 3 (17.6%) D and 4 (23.5%) with RD.

*Conclusions: Our study shows that following KT there is an important decrease in BP. The majority of patients with pre-KT hypertension were able to stop antihypertensive drugs in the post-KT period. Nevertheless, BP circadian rhythm was not significantly different in the majority of patients at 1 month post KT. However, the long-term effect of KT in the BP circadian rhythm was not evaluated in this study. Further studies are needed to characterize the long-term BP changes following KT.

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