The importance of 24 hour ambulatory blood pressure monitoring after thoracic organ transplantation.
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.
Walker
Antony Hayden
AH
Department of Cardiothoracic Surgery, Northern General Hospital, Sheffield, South Yorkshire, United Kingdom.
Locke
Timothy J
TJ
Braidley
Peter C
PC
Al-Mohammed
Abdullah
A
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