Ambulatory vs Office Blood Pressure Monitoring in Renal Transplant Recipients

Ahmed, Jafar; Ozorio, Valerie; Farrant, Matthew; Merwe, Walter van der

doi:10.1111/jch.12448

Cited by 40 publications

(37 citation statements)

References 23 publications

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“…Underestimation of BP control by office measurement was also found in a previous study, which showed 21% were hypertensive by ABPM but normotensive by office BP measurement. Even though our study did not reveal white coat hypertension, the previous studies demonstrated 3%‐10% of RT patients had white coat hypertension . Among patients with uncontrolled hypertension not detected by office BP measurement, 13.3% (2/15) had nighttime hypertension.…”

Section: Discussioncontrasting

confidence: 82%

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Inadequate blood pressure control demonstrated by ambulatory blood pressure monitoring in pediatric renal transplant recipients

Tangnararatchakit

Kongkhanin

Katanyuwong

et al. 2019

Pediatric Transplantation

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Background Adequate BP control in RT recipients should not rely only by normal office BP but also on normal 24‐hour BP. This study aims to assess adequacy of BP control by ABPM and to assess ABPM parameters associated with LVMI in pediatric RT recipients. Materials and methods Patients aged 5‐20 years who have been followed after RT were enrolled. Demographic data and BP assessed by office and ABPM were collected. Echocardiography was performed to detect LVMI. Results Thirty RT recipients (18 males) with median age of 15 years (IQR 13‐18.5) were included. Among 23 patients who were taking antihypertensive drugs, uncontrolled hypertension was detected in 34.8% and 78.3% by office BP measurement and ABPM, respectively. Thus, the difference in prevalence of uncontrolled hypertension observed by ABPM versus office BP was 43.5%. Those seven patients who were not taking antihypertensive drugs because of normal office BP, four patients (57.1%) had masked hypertension and one patient had elevated BP. Fifteen patients have progression of LVH after RT. Multivariate analysis revealed that age (OR 1.369, 95%CI 0.985‐1.904, P‐value = 0.062) had a trend to be associated with progression of LVH. Moreover, nighttime systolic BP z‐score was significantly correlated with LVMI (r = 0.551, P‐value = 0.002). Conclusion The difference in prevalence of uncontrolled hypertension uncovered by ABPM was 43.5%. Nighttime SBP z‐score was significantly correlated with LVMI.

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Section: Discussioncontrasting

confidence: 82%

“…Among patients with uncontrolled hypertension not detected by office BP measurement, 13.3% (2/15) had nighttime hypertension. In a previous study in pediatric RT patients, 33%‐38% of nocturnal hypertension would be missed by office BP measurement and accentuated the importance of ABPM for the detection nocturnal hypertension …”

Section: Discussionmentioning

confidence: 99%

Inadequate blood pressure control demonstrated by ambulatory blood pressure monitoring in pediatric renal transplant recipients

Tangnararatchakit

Kongkhanin

Katanyuwong

et al. 2019

Pediatric Transplantation

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“…Posttransplant HTN is a multifactorial phenomenon and the known causes of HTN include immunosuppressive drugs, renal graft artery stenosis, recipient's native kidney, allograft dysfunction, obesity, recurrent or de novo renal disease, and genetic factors . However, optimal office and ambulatory BP targets have not been well‐defined in the renal transplant populatıon and there is variance depending on the cutoffs and series …”

Section: Discussionmentioning

confidence: 99%

Ambulatory Blood Pressure Monitoring and Echocardiographic Findings in Renal Transplant Recipients

Demirkol

Oruç

İkitimur

et al. 2015

J of Clinical Hypertension

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Hypertension is common in renal transplant recipients (RTRs). Ambulatory blood pressure (BP) monitoring (ABPM) is important in diagnosing hypertension and diurnal BP variation. The authors set out to compare office BP and ABPM measurements to determine diurnal pattern and to evaluate echocardiographic findings in RTRs. ABPM and office BP measurements were compared in 87 RTRs. Echocardiographic evaluation was performed for each patient. The correlations between office and 24-hour ABPM were 0.275 for mean systolic BP (P=.011) and 0.260 for mean diastolic BP (P=.017). Only 36.8% had concordant hypertension between office BP and ABPM, with a masked hypertension rate of 16.1% and white-coat effect rate of 24.1%. Circadian BP patterns showed a higher proportion of nondippers (67.8%). Left ventricular mass index was increased in 21.8% of all recipients. There was a significant but weak correlation between office BP and ABPM. J Clin Hypertens (Greenwich). 2016;18:766-771. ª 2015 Wiley Periodicals, Inc.Hypertension (HTN) is a prevalent disorder in renal transplant recipients (RTRs) and is considered one of the major risk factors for the development of cardiovascular disease (CVD).1 CVD represents the single most frequent cause of death in RTRs, accounting for approximately 40% of all-cause mortality. 2Diagnosis of HTN has traditionally been based on measurements of blood pressure (BP) in the office or clinic. However, inadequate BP control may occur when office BP is used as the only method to monitor BP and drug adjustment.3 Ambulatory BP monitoring (ABPM) has recently gained popularity in more accurately diagnosing HTN and predicting outcome in hypertensive patients and those with chronic kidney disease.4 It has been shown that ABPM can predict left ventricular hypertrophy (LVH), mortality and morbidity, and progression toward end-stage renal disease better than BP in patients with CKD. 5,6 In addition to accurate BP measurement, one of the variables measured by ABPM is diurnal BP variation. However, the optimal method for monitoring BP in RTRs remains unclear.In our study, we compared office and ABPM measurements to determine the diurnal BP pattern and to assess the relationship between BP parameters and echocardiographic findings in RTRs. MATERIALS AND METHODS Study PatientsWe examined 498 consecutive adult RTRs (age ≥18 years) in whom the duration of transplantation was more than 1 year. The following exclusion criteria were used: history of diabetes mellitus, heart failure, ischemic heart disease, cardiomyopathy, or significant valvular heart disease; active infection; a serum creatinine level >1.5 mg/dL; or hemoglobin level <10 g/dL. Of the remaining 150 RTRs, 60 refused to participate in the study and three did not show up for the echocardiography appointment. Thus, 87 patients completed the study. Study ProtocolDemographic (age and sex) and clinical (etiology of previous renal disease, date of transplant, donor type, height, and weight) data and previous renal replacement therapy (type and duration) records were...

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“…Nonetheless, 24 hr monitoring should be performed routinely [18,19] in this category of patients, due to involvement of immunosuppressant drugs and pro-inflammatory status in the development of arterial hypertension [20,21,22].…”

Section: Discussionmentioning

confidence: 99%

Office Assessed Blood Pressure and Ambulatory Blood Pressure Monitoring in Chronic Kidney Disease Patients Versus Kidney Transplant Recipients

Tarta

Denise

Tarta

et al. 2015

Acta Medica Marisiensis

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How reliable is office assessed blood pressure (BP) in chronic kidney disease (CKD) patients and kidney transplant (KTx) recipients is yet to be determined, although the diagnosis of arterial hypertension has been based on these measurements. The aim of this study was to investigate the potential differences between office assessed BP and ambulatory blood pressure monitoring (ABPM) in CKD patients and KTx recipients. We conducted a prospective study which enrolled 45 patients. Morning and evening seated office BPs were assessed using a sphygmomanometer at 5 consecutive outpatient visits. A mean systolic BP (SBP) and diastolic BP (DBP) was calculated. Ambulatory blood pressure was measured over 24 hours using a Meditech ABPM-05 device. Office SBP was statistically significant higher in CKD patients than KTx recipients both in the morning and evening (p=0.0433 and p=0.0066 respectively). ABPM showed higher night-time SBPs (p=0.0445) and higher overall, day-time and night-time DBPs in KTX recipients (p=0.0001, p=0.0006, p<0.0001 respectively). In CKD patients, office SBPs and DBPs are significantly higher than overall SBPs and DBPs as assessed by 24hr ABPM. Office BP monitoring as assessed by clinician is acceptable but tends to overestimate BP in both CKD and KTx study groups.

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Ambulatory vs Office Blood Pressure Monitoring in Renal Transplant Recipients

Cited by 40 publications

References 23 publications

Inadequate blood pressure control demonstrated by ambulatory blood pressure monitoring in pediatric renal transplant recipients

Inadequate blood pressure control demonstrated by ambulatory blood pressure monitoring in pediatric renal transplant recipients

Ambulatory Blood Pressure Monitoring and Echocardiographic Findings in Renal Transplant Recipients

Office Assessed Blood Pressure and Ambulatory Blood Pressure Monitoring in Chronic Kidney Disease Patients Versus Kidney Transplant Recipients

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