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Office blood pressure measurements overestimate blood pressure control in renal transplant patients

Stenehjem, Aud-E.a; Gudmundsdottir, Helgaa; Os, Ingrida b

doi: 10.1097/01.mbp.0000209080.24870.2d
Clinical Methods and Pathophysiology

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 ≥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.

aDepartment of Nephrology, Ullevål University Hospital

bFaculty of Medicine, University of Oslo, Oslo, Norway

Correspondence and requests for reprints to Aud-E. Stenehjem, Department of Nephrology, Ullevål University Hospital, N-0407 Oslo, Norway

Tel: +47 22119100; fax: +47 22119181; e-mail: a.e.stenehjem@medisin.uio.no

Sponsorship: This study was in part supported by a grant from the Norwegian Society of Nephrology.

Received 29 September 2005; Accepted 9 December 2005

© 2006 Lippincott Williams & Wilkins, Inc.