title: The importance of 24 hour ambulatory blood pressure monitoring after thoracic organ transplantation.
abstract: BACKGROUND
  Hypertension is a significant complication after thoracic organ transplantation. In the non-transplant population, 24-hour ambulatory blood pressure monitoring (24ABPM) is useful in the diagnosis of white-coat hypertension, the assessment of resistant hypertension, and the monitoring of anti-hypertensive therapy. The loss of nocturnal reductions in blood pressure is associated with hypertensive end-organ damage. This study investigated the role of 24ABPM after orthotopic cardiac transplantation.
  
  
  METHODS
  Thirty-three transplant recipients underwent 24ABPM. Clinical blood pressure (CPB) was measured by using a sphygmomanometer before 24ABPM. Clinical data were collected and analyzed by a single observer with p values of less than 0.05 being taken as significant.
  
  
  RESULTS
  The incidence of hypertension (diastolic pressure > 90 mm Hg) in the CPB and 24ABPM groups was 33% and 52% (p =0.002). Thirty-two percent of recipients who were normotensive by clinical measurement were found to be hypertensive after 24ABPM. The converse was true in 1 case. We identified no specific risk factors for 24ABPM hypertension. One recipient failed to complete the 24-hour monitoring period.
  
  
  CONCLUSIONS
  This study demonstrates that conventional blood pressure monitoring underestimates the incidence of post-transplantation hypertension. Twenty-four hour ambulatory blood pressure monitoring is well tolerated and may improve the management of post-transplantation hypertension. White-coat hypertension is an uncommon diagnosis after cardiac transplantation, and those recipients who are hypertensive in the clinic setting should be considered true hypertensives.
authors.affiliation: Department of Cardiothoracic Surgery, Northern General Hospital, Sheffield, South Yorkshire, United Kingdom.
authors.forename: Antony Hayden
authors.initials: AH
authors.lastname: Walker
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Locke
authors.forename: Peter C
authors.initials: PC
authors.lastname: Braidley
authors.forename: Abdullah
authors.initials: A
authors.lastname: Al-Mohammed
mesh_terms: D000328:Adult; D000368:Aged; D018660:Blood Pressure Monitoring, Ambulatory; D002940:Circadian Rhythm / Q000502:physiology; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011184:Postoperative Period