Patterns of hypertension in renal transplant patients evaluated with 24 h ambulatory blood pressure monitoring

Abstract

Prevalence of the different patterns of hypertension in renal transplant recipients (RTR) using 24 h ambulatory blood pressure monitoring (ABPM) along with their determining factor are lacking. The aim of our study was to describe the epidemiology of hypertension in RTR, based on ambulatory blood pressure monitoring (ABPM). In this cross-sectional study, prevalent RTR were proposed systematic blood pressure work-up consisting of ABPM, office blood pressure (3 consecutive blood pressure measurements performed by a nurse after 5 minutes of quiet rest) and detection of orthostatic hypotension. Optimal target was defined as BP < 130/80 mmHg for office BP. ABPM goals was defined using the ESH guidelines but we also defined another targets using only the 24 h average ABPM as seen in the literature. Two hundred and fifty-eight RTR underwent ABPM. Mean ABPM was 132/76 mmHg not different from the mean office BP (132/73 mmHg). Prevalence of patients with resistant hypertension and uncontrolled BP when we considered day-time and night-time values were respectively 23% and 48% versus 20% and 41% when we take into consideration only the 24 h average ABPM. Twenty % of RTR had orthostatic hypotension. When we identified the patterns of BP, 31% of patients had masked hypertension with circadian ABPM versus 20% with only 24 h average ABPM. All the patients identified as having uncontrolled BP or masked hypertension with circadian ABPM and not with 24 h average ABPM presented only nocturnal hypertension. Our results show a suboptimal control of BP in a cohort of RTR with 20% of patients with resistant hypertension and more than 50% of patients with uncontrolled BP. ABPM is a valuable tool to detect nocturnal hypertension. Prevalence of hypertension is underestimated in RTR because of the lack of established definition of blood pressure using ABPM in this population. ABPM goals need to be better defined to assess correctly hypertension and improve the management of BP in RTR.