Ambulatory Blood Pressure Monitoring in Children and Adolescents Post-Hematopoietic Stem Cell Transplantation

Abstract

Abstract Background: One of the long-term complications after hematopoietic stem cell transplantation (HSCT) is hypertension (HT). Previous studies showed that 10-15% of children post-HSCT had office HT but a few studies used ambulatory blood pressure monitoring (ABPM). The present study aimed to determine the frequency and explore the factors associated with ABPM HT in children post-HSCT. Methods: Patients aged ≥ 6 years who survived ≥ 2 years after HSCT were enrolled. ABPM and echocardiographic results were reviewed. ABPM HT was defined according to the 2022 American Heart Association guidelines. The blood pressure (BP) index was calculated as BP value divided by HT cut-off value for each patient. Factors associated with HT were analyzed by logistic regression. Results: Ninety-nine (61 males) patients with a mean age of 14.6 years were included. Sixteen patients (16.1%) had ABPM HT (2 ambulatory HT and 14 masked HT). The ABPM HT group had a higher age (18.8 vs 14.4 years, p < 0.01), a higher proportion of males (87.5% vs 56.6%, p = 0.02), a higher office systolic BP index (0.93 vs 0.85, p < 0.01), a higher office diastolic BP index (0.96 vs 0.83, p < 0.01), a higher proportion of current use of prednisolone and tacrolimus than those in the normal ABPM group. Multivariate analysis revealed that office diastolic BP index was associated with ABPM HT. Left ventricular mass index had a significant positive correlation with ABPM but not with office BP parameters. Conclusion: HT in children post-HSCT was not uncommon and most could not be detected with office BP measurement. A diastolic BP index can be used as a screening tool to refer these patients for ABPM.