Home blood pressure monitoring in heart transplant recipients: comparison with ambulatory blood pressure monitoring.
BACKGROUND
How reliable is home blood pressure monitoring (HBPM) in heart transplant recipients is not known. Possibly, it may underestimate hypertensive burden, because blood pressure (BP) nondipper profile is frequent among these patients. This prospective study has been designed to determine whether HBPM adequately identifies hypertension in heart transplant recipients.


METHODS
We compared HBPM with ambulatory blood pressure monitoring (ABPM) for the diagnosis of uncontrolled hypertension in 74 patients 13.5±6.7 years after heart transplantation. HBPM was measured with a validated semiautomatic device twice every morning and twice every evening on 7 consecutive days, within 15 days of ABPM. We also measured the relationship between HBPM, ABPM, and organ damage as measured by albuminuria and left ventricular mass.


RESULTS
A nondipper profile was found in 53 (72%) patients. HBPM and ABPM were close according to Pearson bivariate correlations. There was no significant correlation between left ventricular mass and BP either at HBPM or ABPM. Proteinuria significantly correlated with systolic BP either at HBPM (R=0.42; P=0.0002) or ABPM (R=0.25; P=0.03). HBPM adequately classified 61 of 74 (82%) patients as hypertensives or as nonhypertensives or controlled hypertensives.


CONCLUSIONS
Despite a high prevalence of nondipper profile, HBPM gives a reliable estimate of BP burden in most heart transplant recipients. Thus, our results strongly suggest that HBPM is useful for the long-term follow-up of heart transplant recipients.
1 Department of Cardiology, La Timone Hospital, Aix-Marseille University, Marseille, France. 2 Department of Cardiac Surgery, La Timone Hospital, Aix-Marseille University, Marseille, France. 3 Address correspondence to: Pierre Ambrosi, M.D., Ph.D., Department of Cardiology, La Timone Hospital, Aix-Marseille University, 13385 Marseille, France.
Pierre
P
Ambrosi
Bernard
B
Kreitmann
Gilbert
G
Habib
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000419:Albuminuria / Q000175:diagnosis; D001331:Automation; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory / Q000379:methods*; D009202:Cardiomyopathies / Q000150:complications / Q000628:therapy; D002311:Cardiomyopathy, Dilated / Q000150:complications / Q000628:therapy; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000628:therapy*; D016027:Heart Transplantation / Q000379:methods*; D006349:Heart Valve Diseases / Q000150:complications / Q000628:therapy; D006352:Heart Ventricles / Q000473:pathology; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia; D010349:Patient Compliance; D011446:Prospective Studies; D015203:Reproducibility of Results; D012648:Self Care; D055815:Young Adult