Ambulatory monitoring unmasks hypertension among kidney transplant patients: Single center experience and review of the literature

Eitan Gluskin, Keren Tzukert, Irit Mor-Yosef Levi, Olga Gotsman, Itamar Sagiv, Roy Abel, Aharon Bloch, Dvorah Rubinger, Michal Aharon, Michal Dranitzki Elhalel, Iddo Z. Ben-Dov*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

8 Scopus citations

Abstract

Background: Disagreements between clinic and ambulatory blood pressure (BP) measurements are well-described in the general population. Though hypertension is frequent in renal transplant recipients, only a few studies address the clinic-Ambulatory discordance in this population. We aimed to describe the difference between clinic and ambulatory BP in kidney transplant patients at our institution. Methods: We compared the clinic and ambulatory BP of 76 adult recipients of a kidney allograft followed at our transplant center and investigated the difference between these methods, considering confounding by demographic and clinical variables. Results: Clinic systolic BP (SBP) and diastolic BP (DBP) were 128 ± 13/79 ± 9 mmHg. Awake SBP and DBP were 147 ± 18/85 ± 10 mmHg. The clinic-minus-Awake SBP and DBP differences were-18 and-6 mmHg, respectively. The negative clinic-Awake ΔSBP was more pronounced at age > 60 years (p = 0.026) and with tacrolimus use compared to cyclosporine (p = 0.046). Sleep SBP and DBP were 139 ± 21/78 ± 11 mmHg. A non-dipping sleep BP pattern was noted in 73% of patients and was associated with tacrolimus use (p = 0.020). Conclusions: Our findings suggest pervasive underestimation of BP when measured in the kidney transplant clinic, emphasizes the high frequency of a non-dipping pattern in this population and calls for liberal use of ambulatory BP monitoring to detect and manage hypertension.

Original languageAmerican English
Article number284
JournalBMC Nephrology
Volume20
Issue number1
DOIs
StatePublished - 27 Jul 2019
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2019 The Author(s).

Keywords

  • Ambulatory blood pressure monitoring
  • Calcineurin inhibitors
  • Cyclosporine
  • Kidney transplantation
  • Masked hypertension
  • Non-dipping
  • Tacrolimus

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