Out-patient versus in-hospital ambulatory 24-h blood pressure monitoring in heart transplant recipients.
OBJECTIVE
To study the effect of the environment--in-hospital vs. out-patient situation--on blood pressure as measured by ambulatory blood pressure monitoring (ABPM).


METHODS
Twenty-four hour ABPM was performed sequentially in-hospital and again 9+/-3 days later on an out-patient basis, in 30 consecutive heart transplant recipients (27 men, median age 56 years, median time post-transplant 3 years). The same equipment was used on both occasions, without any interim change in medical treatment.


RESULTS
Both systolic and diastolic blood pressure were higher in-hospital than as an out-patient: +7+/-7 and +6+/-5 mm Hg respectively for the 24-h average (P<0.001). Daytime and night-time pressures were affected similarly. Depending on the specific cut-off values used, 37 to 87% of the individual patients were hypertensive in-hospital; 31 to 73% of these had an acceptable blood pressure as an out-patient. The converse was very rare (0 to 3% of the total group).


CONCLUSIONS
In heart transplant patients blood pressure as assessed from 24-h ABPM is lower in the home environment than during a hospital stay. The post-transplant attenuation of the circadian variation in blood pressure is not influenced by the environment. Checking an unsatisfactory in-hospital ABPM with an outpatient recording may obviate the need for an (intensified) antihypertensive treatment in a substantial number of patients.
Vanhaecke
J
J
Department of Molecular and Cardiovascular Research, University of Leuven School of Medicine, Belgium.
Van Cleemput
J
J
Droogné
W
W
Fagard
R
R
Staessen
J
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory; D002940:Circadian Rhythm / Q000502:physiology; D004777:Environment; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation / Q000502:physiology*; D006801:Humans; D006973:Hypertension / Q000503:physiopathology; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D011237:Predictive Value of Tests