Office blood pressure measurements overestimate blood pressure control in renal transplant patients

Stenehjem, Aud‐E.; Gudmundsdottir, Helga; Os, Ingrid

doi:10.1097/01.mbp.0000209080.24870.2d

Cited by 32 publications

(23 citation statements)

References 31 publications

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“…This may be due to the fact that patients were motivated as renal transplant recipients to assess their blood pressure with an extensive explanation of the positive impact both by doctors and the nurses. Stenehjem et al have already showed that home BP was superior to office BP in estimating BP control in renal transplant patients with deteriorating graft function [12]. It can also be inferred from previous studies and the present results that the predictive power of home blood pressure is largely attributable to the fact that it has multiple measurements [17].…”

Section: Discussionsupporting

confidence: 62%

“…To clarify the level of agreement among these different blood pressure measures, a recent study compared and showed that under rigorously standardized conditions, clinic and home BP could be used as an alternative to awake ABP [11]. Even though some data exist regarding ambulatory BP monitoring in RTR, there is only few data available concerning home BP monitoring in this specific population [12]. …”

Section: Introductionmentioning

confidence: 99%

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Home and Office Blood Pressure Monitoring in Renal Transplant Recipients

Sberro-Soussan

Rabant

Snanoudj

et al. 2012

Journal of Transplantation

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Background. Arterial hypertension in renal transplant recipients (RTR) is associated with increased morbid mortality. In the general population, home blood pressure monitoring (HBPM) was found to be superior to office blood pressure (OBP) in identifying true hypertensive patients. The aim of this study was to investigate HBPM for the assessment of blood pressure profile in RTR. Methodology and Principal Findings. We included prospectively 87 stable RTR. Sitting OBP was measured during the outpatient clinic. HBPM was performed by measuring BP every morning and night for 4 days. The accepted limits for the OBP and HBPM, were respectively, 140/90 mmHg and 135/85 mmHg. Patients were classified as “normotensive,” “uncontrolled,” “white-coat hypertensive” and “masked hypertensive”, (OBP below the limit and HBPM above). During the study, 81 patients (55 males, age 48.5 ± 14 years) were available for analysis. The mean OBP and HBP were 138/83 ± 14/10 mmHg and 133/79 ± 14/8 mmHg; 29% of patients were uncontrolled, 28% normotensive, 21% white coat, and 21% masked hypertensive. Age, glycemia, and number of antihypertensive drugs were associated with hypertension. Conclusion and Significance. In RTR, HBPM is well accepted and better define BP profile since there is 42% discrepancy between OBPM and HBPM. Whether this discrepancy is associated with worst outcome in the long term remains to be demonstrated.

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Section: Discussionsupporting

confidence: 62%

Section: Introductionmentioning

confidence: 99%

Home and Office Blood Pressure Monitoring in Renal Transplant Recipients

Sberro-Soussan

Rabant

Snanoudj

et al. 2012

Journal of Transplantation

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“…With transplantation, some studies suggest that dipping can be restored [57] whereas others have reported a high prevalence of non-dipping [54;58;59]. Whereas successful kidney transplantation may restore kidney function to normal, more often these patients continue to have impaired kidney function and hypertension [60].…”

Section: Diseases Associated With Impaired Circadian Bp Rhythmsmentioning

confidence: 99%

“…In a study of 36 kidney transplant recipients, all patients had either proteinuria or impaired GFR and 95% were non-dippers [61]. In another study of 49 kidney transplant recipients where all patients had either proteinuria or impaired GFR and 82% were non-dippers [58]. In a longitudinal cohort of kidney transplant recipients, GFR and age were independent correlates of non-dipping [62]Other reasons could be the use of corticosteroids which can cause endothelial dysfunction and the use of calcineurin inhibitors that can cause both endothelial dysfunction and sympathetic activation.…”

Section: Diseases Associated With Impaired Circadian Bp Rhythmsmentioning

confidence: 99%

Regulation of circadian blood pressure: from mice to astronauts

Agarwal

2010

Current Opinion in Nephrology and Hypertension

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Purpose of Review-Circadian variation is commonly seen in healthy people; aberration in these biological rhythms is an early sign of disease. Impaired circadian variation of BP has been shown to be associated with greater target organ damage and to be associated with an elevated risk of cardiovascular events independent of the BP load. The purpose of this review is to examine the physiology of circadian BP variation and propose a tripartite model that explains the regulation of circadian BP Recent findings-The time-keeper of the mammals resides centrally in the suprachiasmatic nucleus. Besides this central clock, molecular clocks exist in most peripheral tissues including vascular tissue and the kidney. These molecular clocks regulate sodium balance, sympathetic function and vascular tone. A physiological model is proposed that integrates our understanding of molecular clocks in mice to the circadian BP variation among humans. The master regulator in this proposed model is the sleep-activity cycle. The equivalents of peripheral clocks are endothelial and adrenergic functions. Thus, in the proposed model, the variation in circadian BP is dependent upon 3 major factors: physical activity, autonomic function, and sodium sensitivity.Summary-The integrated consideration of physical activity, autonomic function, and sodium sensitivity appear to explain the physiology of circadian BP variation and the pathophysiology of disrupted BP rhythms in various conditions and disease states. Our understanding of molecular clocks in mice may help to explain the provenance of blunted circadian BP variation even among astronauts.

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“…Usually, the diagnosis of arterial hypertension is set using measurements performed at the physician's office, recordings traditionally called office blood pressure (BP). How reliable is office assessed blood pressure in chronic kidney disease (CKD) patients and kidney transplant (KTx) recipients is yet to be determined, as it was shown before that office BP tends to overestimate blood pressure control in renal transplantation [3]. On the other hand, ambulatory blood pressure monitoring (ABPM) seems to offer a more reliable view over arterial hypertension both in CKD and KTx patients [4][5] and also a prognostic superiority [6].…”

Section: Introductionmentioning

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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Office blood pressure measurements overestimate blood pressure control in renal transplant patients

Cited by 32 publications

References 31 publications

Home and Office Blood Pressure Monitoring in Renal Transplant Recipients

Home and Office Blood Pressure Monitoring in Renal Transplant Recipients

Regulation of circadian blood pressure: from mice to astronauts

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

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