Home blood pressure (BP) monitoring in kidney transplant recipients is more adequate to monitor BP than office BP

Agena, Fabiana; Prado, Elisângela; Souza, Paulo Sérgio Lopes de; Silva, Giovânio Vieira da; Lemos, Francisco José Alves; Mion, Décio; Nahas, William Carlos; David‐Neto, Elias

doi:10.1093/ndt/gfr143

Cited by 35 publications

(29 citation statements)

References 24 publications

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“…The use of standardized techniques, as used in clinical trials of hypertension with .1 measurement of BP, can provide improved concordance rates between CBP and ABPM as seen in a study by Haydar et al 19 Other researchers have demonstrated that HBPM determinations had a significantly better agreement with ABPM than CBP (72% versus 54%) even though both the CBP and the HBPM correlated with ABPM. 20 The use of ABPM is being recommended more broadly in the general population 21 to better assess the clinical importance of nocturnal hypertension, masked hypertension, and white-coat hypertension on the risk for vascular events. Patients with high-normal or normal CBP with asymptomatic target organ damage or high CV risk should undergo ABPM for possible masked hypertension.…”

Section: Diagnosis Of Hypertensionmentioning

confidence: 99%

Assessment and Management of Hypertension in Transplant Patients

Weir

Burgess

Cooper

et al. 2015

Journal of the American Society of Nephrology

152

111

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Hypertension in renal transplant recipients is common and ranges from 50% to 80% in adult recipients and from 47% to 82% in pediatric recipients. Cardiovascular morbidity and mortality and shortened allograft survival are important consequences of inadequate control of hypertension. In this review, we examine the epidemiology, pathophysiology, and management considerations of post-transplant hypertension. Donor and recipient factors, acute and chronic allograft injury, and immunosuppressive medications may each explain some of the pathophysiology of post-transplant hypertension. As observed in other patient cohorts, renal artery stenosis and adrenal causes of hypertension may be important contributing factors. Notably, BP treatment goals for renal transplant recipients remain an enigma because there are no adequate randomized controlled trials to support a benefit from targeting lower BP levels on graft and patient survival. The potential for drugdrug interactions and altered pharmacokinetics and pharmacodynamics of the different antihypertensive medications need to be carefully considered. To date, no specific antihypertensive medications have been shown to be more effective than others at improving either patient or graft survival. Identifying the underlying pathophysiology and subsequent individualization of treatment goals are important for improving long-term patient and graft outcomes in these patients.

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Section: Diagnosis Of Hypertensionmentioning

confidence: 99%

Assessment and Management of Hypertension in Transplant Patients

Weir

Burgess

Cooper

et al. 2015

Journal of the American Society of Nephrology

152

111

View full text Add to dashboard Cite

show abstract

“…This study have taken multiple measurements for HBPM, OBPM, and ABPM to produce the maximum reliability among the three methods of BP measurements as in other studies[3467] in literature, where the measurements have been few. We have used ABPM as a “gold standard”[13] for comparing with HBPM using the average daytime BP for comparison as in another report by Agena et al [6] With HBPM, there is no consensus regarding the frequency of readings or the days needed for observation.…”

Section: Discussionmentioning

confidence: 99%

“…We have used ABPM as a “gold standard”[13] for comparing with HBPM using the average daytime BP for comparison as in another report by Agena et al [6] With HBPM, there is no consensus regarding the frequency of readings or the days needed for observation. Studies are based on reproducibility and consistency of BP with HBPM.…”

Section: Discussionmentioning

confidence: 99%

“…[5] The reliability of the three methods of BP measurement has been based on one or two time points following renal transplantation. [67] To assess the reliability of the three methods, prospective and longitudinal studies have been suggested. This study assess the reliability of OBPM and ABPM from the pretransplant period, 2 nd , 4 th 6 th , and 9 th months and all the three methods at 6 th month after renal transplantation.…”

Section: Introductionmentioning

confidence: 99%

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Prospective blood pressure measurement in renal transplant recipients

et al. 2014

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Blood pressure (BP) control at home is difficult when managed only with office blood pressure monitoring (OBPM). In this prospective study, the reliability of BP measurements in renal transplant patients with OBPM and home blood pressure monitoring (HBPM) was compared with ambulatory blood pressure monitoring (ABPM) as the gold standard. Adult patients who had living-related renal transplantation from March 2007 to February 2008 had BP measured by two methods; OBPM and ABPM at pretransplantation, 2nd, 4th, 6th, and 9th months and all the three methods: OBPM, ABPM, and HBPM at 6 months after transplantation. A total of 49 patients, age 35 ± 11 years, on prednisolone, tacrolimus, and mycophenolate were evaluated. A total of 39 were males (79.6%). Systolic BP (SBP) and diastolic BP (DBP) measured by OBPM were higher than HBPM when compared with ABPM. When assessed using OBPM and awake ABPM, both SBP and DBP were significantly overestimated by OBPM with mean difference of 3-12 mm Hg by office SBP and 6-8 mm Hg for office DBP. When HBPM was compared with mean ABPM at 6 months both the SBP and DBP were overestimated by and 7 mm Hg respectively. At 6 months post transplantation, when compared with ABPM, OBPM was more specific than HBPM in diagnosing hypertension (98% specificity, Kappa: 0.88 vs. 89% specificity, Kappa: 0.71). HBPM was superior to OBPM in identifying patients achieving goal BP (89% specificity, Kappa: 0.71 vs. 50% specificity Kappa: 0.54). In the absence of a gold standard for comparison the latent class model analysis still showed that ABPM was the best tool for diagnosing hypertension and monitoring patients reaching targeted control. OBPM remains an important tool for the diagnosis and management of hypertension in renal transplant recipients. HBPM and ABPM could be used to achieve BP control.

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“…Poor control not only has detrimental CV effects for the recipient but also is an independent risk factor for graft failure [55]. Agena et al [56 ]found that HBPM correlated better with ABPM than with OBPM in kidney recipients between 1 and 10 years after transplantation. More study is needed to determine the prognostic value of HBPM in graft failure, CV outcomes, and its utility in the management of hypertension in this population.…”

Section: Dialysis and Transplantmentioning

confidence: 99%

Practical Use of Home Blood Pressure Monitoring in Chronic Kidney Disease

Sanghavi

Vassalotti

2014

Cardiorenal Med

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Despite the availability of blood pressure (BP)-lowering medications and dietary education, hypertension is still poorly controlled in the chronic kidney disease (CKD) population. As glomerular filtration rate declines, the number of medications required to achieve BP targets increases, which may lead to reduced patient adherence and therapeutic inertia by the clinician. Home BP monitoring (HBPM) has emerged as a means of improving diagnostic accuracy, risk stratification, patient adherence, and therapeutic intervention. The definition of hypertension by HBPM is an average BP >135/85 mm Hg. Twelve readings over the course of 3-5 days are sufficient for clinical decision making. Diagnostic accuracy is especially important in the CKD population as approximately half of these patients have either white coat hypertension or masked hypertension. Preliminary data suggest that HBPM outperforms office BP monitoring in predicting progression to end-stage renal disease or death. When combined with additional support such as telemonitoring, medication titration, or behavioral therapy, HBPM results in a sustained improvement in BP control. HBPM must be adapted to provide information on the phenomena of nondipping (absence of nocturnal fall in BP) and reverse dipping (paradoxical increase in BP at night). These diurnal patterns are more prevalent in the CKD population and are important cardiovascular risk factors. Ambulatory BP monitoring provides nocturnal BP readings and unlike HBPM may be reimbursed by Medicare when certain criteria are met. Further studies are needed to determine whether HBPM is cost-effective in the current US healthcare system.

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Home blood pressure (BP) monitoring in kidney transplant recipients is more adequate to monitor BP than office BP

Abstract: We conclude that the results obtained with HBPM were closer to the ABPM results than those obtained with BP obtained at oBP, being more sensitive to detect poor control of hypertension in renal transplant recipients.

Cited by 35 publications

References 24 publications

Assessment and Management of Hypertension in Transplant Patients

Assessment and Management of Hypertension in Transplant Patients

Prospective blood pressure measurement in renal transplant recipients

Practical Use of Home Blood Pressure Monitoring in Chronic Kidney Disease

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