Ambulatory monitoring unmasks hypertension among kidney transplant patients: single center experience and review of the literature

Abstract

Background Disagreements between clinic and ambulatory blood pressure (BP) measurements are well-described in the general population. Though hypertension is frequent in renal transplant recipients, only a few studies address the clinic-ambulatory discordance in this population. We aimed to describe the difference between clinic and ambulatory BP in kidney transplant patients at our institution. Methods We compared the clinic and ambulatory BP of 76 adult recipients of a kidney allograft followed at our transplant center and investigated the difference between these methods, considering confounding by demographic and clinical variables. Results Clinic systolic BP (SBP) and diastolic BP (DBP) were 128 ± 13/79 ± 9 mmHg. Awake SBP and DBP were 147 ± 18/85 ± 10 mmHg. The clinic-minus-awake SBP and DBP differences were − 18 and − 6 mmHg, respectively. The negative clinic-awake ΔSBP was more pronounced at age > 60 years ( p = 0.026) and with tacrolimus use compared to cyclosporine ( p = 0.046). Sleep SBP and DBP were 139 ± 21/78 ± 11 mmHg. A non-dipping sleep BP pattern was noted in 73% of patients and was associated with tacrolimus use ( p = 0.020). Conclusions Our findings suggest pervasive underestimation of BP when measured in the kidney transplant clinic, emphasizes the high frequency of a non-dipping pattern in this population and calls for liberal use of ambulatory BP monitoring to detect and manage hypertension. Electronic supplementary material The online version of this article (10.1186/s12882-019-1442-7) contains supplementary material, which is available to authorized users.

The relevance of performing 24-hour ambulatory blood pressure and pulse wave analysis in kidney transplant recipients

“…However, in the literature there are significant differences in the prevalence of white coat and masked hypertension, and dipping status. For example, the prevalence of white coat hypertension ranged from 3% to 24.1% (23,24,25), masked hypertension from 14% to 58% (23,24,25) and isolated nocturnal hypertension from 11% to 33% (23,25,26). Similarly, in regard to dipping status, normal dipping ranged from 5.4% to 26.7% of patients (22,26), reverse dipping in 20% of patients (26) and non-dipping BP from 53% to 94.6% of patients (22,24,26).…”

“…For example, the prevalence of white coat hypertension ranged from 3% to 24.1% (23,24,25), masked hypertension from 14% to 58% (23,24,25) and isolated nocturnal hypertension from 11% to 33% (23,25,26). Similarly, in regard to dipping status, normal dipping ranged from 5.4% to 26.7% of patients (22,26), reverse dipping in 20% of patients (26) and non-dipping BP from 53% to 94.6% of patients (22,24,26). The difference in these studies is probably related to the method of office BP measurement (AOBP unobserved versus traditional measurement), the severity of CKD, and ethnic mix of patients.…”

Hipertensão arterial no transplante renal: grande importância, mas poucas respostas

“…Gluskin et al 34 compararam medidas de consultório e fora de consultório pela MAPA em adultos transplantados. A PA de consultório foi em média 128/79 mmHg.…”

Isolated nocturnal hypertension in pediatric kidney transplant recipients

“…Hypertension is common in children after any solid organ transplants, and it has been demonstrated that hypertension rates are higher in 24-h ABPM assessments than in clinical BP measurements. 86,87 This is likely due to the prevalence of INH in transplant patients. The current clinical practice guidelines state that annual ABPM is appropriate for children with CKD.…”