Routine use of ambulatory blood pressure monitoring in potential living kidney donors.
OBJECTIVE
Most transplant centers exclude prospective living kidney donors with hypertension from donation. Centers routinely identify hypertension using BP measured in the clinic, but it is not clear that clinic BP accurately detects the presence or absence of hypertension in potential donors. We therefore conducted a prospective study to determine the impact of routine ambulatory BP monitoring on diagnosis of hypertension in potential donors and the value of other baseline characteristics in predicting ambulatory BP results.


METHODS
We compared classification of hypertension status by clinic BP and by ambulatory BP monitoring in 178 potential living kidney donors.


RESULTS
Of 63 individuals with hypertension by clinic BP, 62% had white-coat hypertension by ambulatory BP and were therefore eligible to donate. Of 115 individuals who were normotensive by clinic BP, 17% had masked hypertension by ambulatory BP and were excluded from donation. Individuals with masked hypertension were older, were more likely to be male, and had a somewhat higher clinic BP than individuals with sustained normotension. Individuals with white-coat hypertension had a somewhat lower clinic diastolic BP than individuals with sustained hypertension.


CONCLUSIONS
Routine ambulatory BP monitoring may identify a large number of individuals with white-coat hypertension and a smaller but significant number of individuals with masked hypertension, ensuring adequate protection of potential donors and accurate assessment of donor risk. Differences in baseline characteristics are small and are not clinically useful in distinguishing individuals with masked hypertension from individuals with sustained normotension or individuals with white-coat hypertension from individuals with sustained hypertension, demonstrating the importance of ambulatory BP monitoring in this population.
Ommen
Elizabeth S
ES
Mount Sinai Medical Center, Division of Nephrology, Box 1243, 1 Gustave Levy Place, New York, NY 10029, USA. elizabeth.ommen@mssm.edu
Schröppel
Bernd
B
Kim
Jin-Yon
JY
Gaspard
Gabrielle
G
Akalin
Enver
E
de Boccardo
Graciella
G
Sehgal
Vinita
V
Lipkowitz
Michael
M
Murphy
Barbara
B
D000328:Adult; D018660:Blood Pressure Monitoring, Ambulatory / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis*; D016030:Kidney Transplantation; D019520:Living Donors; D008297:Male; D011446:Prospective Studies; D009927:Tissue and Organ Procurement