Office or home versus 24-hour blood pressure measurement in stable kidney transplant recipients

Author:

Eleftheriadis Georgios1,Naik Marcel G1,Osmanodja Bilgin1,Halleck Fabian1,Schrezenmeier Eva1,Liefeldt Lutz1,Choi Mira1,Bachmann Friederike1,Avaniadi Despina Parthenopi1,von Hoerschelmann Ellen1,Lücht Christian1,Zaks Marina1,Duettmann Wiebke12,Budde Klemens1

Affiliation:

1. Department of Nephrology and Medical Intensive Care, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin , Berlin , Germany

2. Berlin Institute of Health , Berlin , Germany

Abstract

ABSTRACT Background The aim of this study was to quantify hypertension control and evaluate concordance between all commonly available blood pressure (BP) modalities in kidney transplant recipients (KTRs). Methods For this prospective cross-sectional study, 89 stable KTRs were recruited at the Charité Transplant Outpatient Clinic. For each study participant office [manual office BP (MOBP) and automated office BP (AOBP)], 7-day home (HBPM) and 24-hour ambulatory BP (24h-ABPM) measurements were performed. Results 80 of the 89 patients recruited had sufficient BP recordings. The mean BP for MOBP, AOBP, HBPM and 24h-ABPM was 129/73, 126/71, 131/85 and 130/81 mmHg, respectively. Uncontrolled hypertension, as defined by 24h-ABPM (mean ≥130/80 mmHg), was present in 53 (66%) patients. MOBP, AOBP and HBPM classified 19 (24%), 22 (28%) and 41 (51%) patients, respectively, as ‘uncontrolled hypertensive’. The Bland–Altman plot showed good agreement between systolic MOBP, AOBP, HBPM and daytime-ABPM (mean bias: −1 ± 13 mmHg, −4 ± 13 mmHg, 1 ± 10 mmHg, respectively). Uncontrolled night-time hypertension was present in 74 (93%) KTRs, with 71 (89%) patients showing a non-physiological dipping pattern. Moderate positive correlation between daytime-ABPM/HBPM and night-time-ABPM (Pearson correlation coefficients: 0.62–0.73), followed by MOBP/AOBP (Pearson correlation coefficients: 0.49–0.59) was noted. Estimated eGFR and proteinuria displayed weak correlation with 24h-, daytime- and night-time-ABPM (absolute values of Pearson correlation coefficients: 0.04–0.41). No robust association with either 24h-, daytime- or night-time-ABPM was observed for volume status exams. Conclusions Masked hypertension is highly prevalent in KTRs, especially due to high rates of uncontrolled night-time hypertension. HBPM shows the narrowest limits of agreement with daytime-ABPM. Daytime-ABPM and HBPM show the highest, albeit clinically insufficient, correlation with night-time-ABPM. Systematic integration of 24h-ABPM into clinical practice, as proposed by the 2023 ESH guidelines for the management of arterial hypertension, should not be withheld for the KTR population. Clinical trials evaluating the treatment of hypertension in KTRs are urgently needed.

Funder

Berlin Institute of Health

Publisher

Oxford University Press (OUP)

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