Evaluating the utility of ambulatory blood pressure monitoring in kidney transplant recipients.

Hypertension is a major risk factor for graft dysfunction and cardiovascular disease in kidney transplant recipients (KTX). Accurate monitoring is therefore essential to provide optimal therapy. We evaluated whether 24-h ambulatory blood pressure monitoring (ABPM) is superior to clinic blood pressure (CBP) measurement in prevalent KTX. Twenty-four-hour ABPM was performed in 244 prevalent KTX. The average clinic systolic blood pressure (SBP) was 137.1 ± 19.4 mm Hg, and diastolic blood pressure (DBP) was 79.9 ± 10.5 mm Hg. The ABPM average SBP was 131.3 ± 15.4 mm Hg and DBP was 75.37 ± 8.8 mm Hg; daytime ABPM average SBP was 133.5 ± 15.0 mm Hg and DBP 77.4 ± 9.1 mm Hg. The correlations between CBP, 24-h ABPM, and daytime ABPM were approximately 0.5. CBP measurements overestimate both 24-h and daytime ABPM by linear regression (p < 0.001). In this largest study to date evaluating blood pressure monitoring in KTX, we found that CBP overestimates ABPM, highlighting the prevalence of white coat hypertension. The improved accuracy of ABPM will decrease overprescribing of BP medications to avoid hypotension, drug interactions, and non-adherence. In contrast, identifying the nocturnal "non-dippers", not evident by CBP, facilitates appropriate management, as under-treatment of hypertension could lead to accelerated graft dysfunction, cardiovascular disease, and mortality. These data suggest the improved accuracy of 24-h ABPM is beneficial for BP monitoring in KTX recipients.