Office blood pressure measurements overestimate blood pressure control in renal transplant patients.
OBJECTIVE
As hypertension is an important risk factor for renal allograft failure, we aimed to assess blood pressure control in renal transplant patients with deteriorating graft function using different methods of blood pressure measurements.


METHODS
Forty-nine patients with a graft survival of >1 year, and with more than a two-fold increase in urinary albumin excretion, and/or an increase in serum creatinine level >20% during the previous 12 months, were included. Office blood pressure and home BP were measured, and ambulatory blood pressures were obtained in all patients.


RESULTS
The mean office blood pressure (133.2+/-16.3/81.7+/-9.6 mmHg) and 24 h ambulatory blood pressure (133.1+/-12.0/79.8+/-8.3 mmHg) were similar. Home blood pressure in the morning (144.2+/-23.3/87.1+/-12.7 mmHg) and evening (143.2+/-20.6/86.4+/-10.3 mmHg) were significantly higher than ambulatory blood pressure (P<0.001 for both). Only 18% of the patients exhibited a reduction of >or=10% in systolic blood pressure during nighttime while 39% had an overt rise. Adequate blood pressure control was found in 53% of the patients using office blood pressure (<140/90 mmHg), contrasting 29% using home blood pressure (<135/85 mmHg), and 16% using mean 24-h ambulatory blood pressure (<125/80 mmHg). These findings were substantiated by the use of receiver-operating characteristic curve analysis.


CONCLUSIONS
Using the 24-h blood pressure as a standard, home blood pressure was superior to office blood pressure in estimating blood pressure control in renal transplant patients. Nocturnal hypertension, however, was observed frequently, adding important clinical information about blood pressure control in this high-risk population.
Stenehjem
Aud-E
AE
Department of Nephrology, Ullevål University Hospital, Oslo, Norway. a.e.stenehjem@medisin.uio.no
Gudmundsdottir
Helga
H
Os
Ingrid
I
D000328:Adult; D000368:Aged; D000419:Albuminuria / Q000209:etiology; D001795:Blood Pressure Determination / Q000379:methods*; D018660:Blood Pressure Monitoring, Ambulatory; D002940:Circadian Rhythm; D003404:Creatinine / Q000097:blood; D005260:Female; D006085:Graft Survival / Q000502:physiology; D006701:Home Nursing; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000188:drug therapy; D016030:Kidney Transplantation / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D009819:Office Visits; D012680:Sensitivity and Specificity; D012890:Sleep / Q000502:physiology; D013997:Time Factors; D016896:Treatment Outcome
D003404:Creatinine