Long-Term Observation on the Development of 24-Hour Ambulatory Blood Pressure Monitoring after Primary SPK with Special Regard to Antihypertensive Treatment and the Type of Exocrine Drainage: 2351

Introduction: Cardiovascular disease (CVD) is a leading cause of death in patients with type 1 diabetes. Regarding cardiovascular risk profile as well as patient survival SPK was shown to be superior to kidney transplantation alone or to dialysis therapy in type 1 diabetics. One major cardiovascular risk factor is arterial hypertension. Some but not all small studies with short-term observation and single blood pressure readings (RR) indicated that there might be a reduction of RR after successful SPK, which in addition might be influenced by the type of exocrine drainage of the pancreas secretion. We here present the longterm follow-up results of 24-hour ambulatory blood pressure monitoring (ABPM) in 90 SPK patients. Methods: In this retrospective study we analysed patient and graft survival as well as cardiovascular risk factors of 90 patients with type 1 diabetes who consecutively underwent primary SPK between 1995 and 2000 with a median follow-up of 9.4 years. Before and every year after SPK we analysed systolic, diastolic blood pressure (BP) and mean arterial pressure (MAP) by ABPM, antihypertensive medication and several possibly associated factors of influence on BP control. Results: Survival of patients/PTX/KTX was 87/75 /79 % after 9.4 years (not censored for death). BP regulation was significantly improved over the long-term follow-up after transplantation [87% with a BP level >130/80 mmHg before compared to an average of 30% in the followup period after SPK; median BP was 138/81 mmHg (MAP 100 mmHg) before and 123/72 mmHg (MAP 89 mmHg) during the follow-up period after SPK]. However the dipper/non-dipper ratio did not change. Compared to patients with enteric drainage (ED) of the exocrine pancreas secretion the subgroup of patients with bladder drainage (BD) showed significant lower systolic BP and took smaller numbers of antihypertensive agents. Further factors associated with BP control are shown in table 1.Conclusion: To our knowledge this is the first study, which confirms in a long-term follow-up and by ABPM the beneficial effects of SPK on BP and antihypertensive treatment. Furthermore there are indicators, that bladder drainage has more impact on lowering BP than enteric drainage of the exocrine pancreas secretion. Normalisation of glucose metabolism and its effects are probably the most important factors leading to these results.