ORIGINAL
PAPER
Ambulatory vs Office Blood Pressure Monitoring in Renal Transplant Recipients Jafar Ahmed, MBChB; Valerie Ozorio, MBChB; Maritza Farrant, MBChB; Walter Van Der Merwe, MBChB, FRACP From the Department of Renal medicine, North Shore Hospital, Waitemata District Health Board, Takapuna, Auckland, New Zealand
Hypertension is common following renal transplantation and has adverse effects on cardiovascular and graft health. Ambulatory blood pressure monitoring (ABPM) is better at overall blood pressure (BP) assessment and is necessary to diagnose nocturnal hypertension, which is also implicated in poor outcomes. The authors performed a retrospective analysis of 98 renal transplant recipients (RTRs) and compared office BP and ambulatory BP recordings. ABPM revealed discordance between office BP and ambulatory BP in 61% of patients, with 3% caused by white-coat and 58%
caused by masked hypertension (of which 33% were caused by isolated nocturnal hypertension). Overall, mean systolic BP was 3.6 mm Hg (0.5–6.5) and diastolic BP was 7.5 mm Hg (5.7–9.3) higher via ambulatory BP than office BP. This was independent of estimated glomerular filtration rate, proteinuria, transplant time/type, and comorbidities. A total of 42% of patients had their management changed after results from ABPM. ABPM should be routinely offered as part of hypertension management in RTRs. J Clin Hypertens (Greenwich). 2015;17:46–50. ª 2014 Wiley Periodicals, Inc.
Post–renal transplant hypertension affects the majority of transplant recipients. It is noted that up to 90% (depending on cutoffs and series) of renal transplant recipients are either reported to have hypertension or to be taking antihypertensive drugs.1,2 We also know that hypertension not only increases the risk of poor cardiovascular outcomes, which is the leading cause of death in this demographic, but also increases the risk of graft failure.3,4 In fact, uncontrolled hypertension can precede graft dysfunction by a number of years.3 Although it is hard to establish causality absolutely between uncontrolled hypertension and graft and patient outcomes, it is well established that lowering blood pressure (BP) improves both. In a registry of 24,404 patients, even a temporary rise in BP at 3 years was associated with poor long-term outcomes.5 Guidelines for BP targets by different agencies vary slightly but most recommend a target of 130/80 mm Hg. The National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative (KDOQI) and Kidney Disease: Improving Global Outcomes (KDIGO) guidelines recommend a target BP
PAPER
Ambulatory vs Office Blood Pressure Monitoring in Renal Transplant Recipients Jafar Ahmed, MBChB; Valerie Ozorio, MBChB; Maritza Farrant, MBChB; Walter Van Der Merwe, MBChB, FRACP From the Department of Renal medicine, North Shore Hospital, Waitemata District Health Board, Takapuna, Auckland, New Zealand
Hypertension is common following renal transplantation and has adverse effects on cardiovascular and graft health. Ambulatory blood pressure monitoring (ABPM) is better at overall blood pressure (BP) assessment and is necessary to diagnose nocturnal hypertension, which is also implicated in poor outcomes. The authors performed a retrospective analysis of 98 renal transplant recipients (RTRs) and compared office BP and ambulatory BP recordings. ABPM revealed discordance between office BP and ambulatory BP in 61% of patients, with 3% caused by white-coat and 58%
caused by masked hypertension (of which 33% were caused by isolated nocturnal hypertension). Overall, mean systolic BP was 3.6 mm Hg (0.5–6.5) and diastolic BP was 7.5 mm Hg (5.7–9.3) higher via ambulatory BP than office BP. This was independent of estimated glomerular filtration rate, proteinuria, transplant time/type, and comorbidities. A total of 42% of patients had their management changed after results from ABPM. ABPM should be routinely offered as part of hypertension management in RTRs. J Clin Hypertens (Greenwich). 2015;17:46–50. ª 2014 Wiley Periodicals, Inc.
Post–renal transplant hypertension affects the majority of transplant recipients. It is noted that up to 90% (depending on cutoffs and series) of renal transplant recipients are either reported to have hypertension or to be taking antihypertensive drugs.1,2 We also know that hypertension not only increases the risk of poor cardiovascular outcomes, which is the leading cause of death in this demographic, but also increases the risk of graft failure.3,4 In fact, uncontrolled hypertension can precede graft dysfunction by a number of years.3 Although it is hard to establish causality absolutely between uncontrolled hypertension and graft and patient outcomes, it is well established that lowering blood pressure (BP) improves both. In a registry of 24,404 patients, even a temporary rise in BP at 3 years was associated with poor long-term outcomes.5 Guidelines for BP targets by different agencies vary slightly but most recommend a target of 130/80 mm Hg. The National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative (KDOQI) and Kidney Disease: Improving Global Outcomes (KDIGO) guidelines recommend a target BP
