Abnormal circadian blood pressure (BP) pattern is common after kidney transplantation but its relationship to long term allograft function is unclear. Of 119 kidney recipients who had ambulatory BP monitoring I year from transplantation, 36 patients without history of rejection were selected. Twenty-nine recipients were followed for 4 years and seven for 3 years. Iothalamate glomerular filtration rate (GFR) was obtained at 3 weeks then annually. Dippers (n = 10) had day-night systolic BP (SBP) drop (ASBP) of >= 10%, nondippers (n = 15) had Delta SBP 0%-9%, whereas reverse dippers (n = 11) had nocturnal rise in SBP. Compared with dippers, reverse and nondippers had a higher Banff cv score at 1 year (P = .03), lower GFR at last follow-up (73.7 +/- 18.1, 55.7 +/- 16.3, and 56.6 +/- 21 mL/min/1.73 m(2) for dippers, non-, and reverse dippers, respectively, P = .05) and higher kidney function loss (8.0 +/- 20, -9 +/- 17, and 1 +/- 14 mL/min/1.73 m(2) for dippers, non-, and reverse dippers, respectively, P = .02). GFR at 4 years and at last follow-up independently correlated with Delta SBP at 1 year (r = 0.46, P = .01; r = 0.34, P = .03). The current study indicates that abnormal circadian BP pattern at 1 year identifies a group of kidney recipients at risk for increased kidney function loss and lower GFR 3-4 years from transplantation. J Am Soc Hypertens 2011;5(1):39-47. (c) 2011 American Society of Hypertension. All rights reserved.