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  • Title: The importance of 24 hour ambulatory blood pressure monitoring after thoracic organ transplantation.
    Author: Walker AH, Locke TJ, Braidley PC, Al-Mohammed A.
    Journal: J Heart Lung Transplant; 2005 Nov; 24(11):1770-3. PubMed ID: 16297780.
    Abstract:
    BACKGROUND: Hypertension is a significant complication after thoracic organ transplantation. In the non-transplant population, 24-hour ambulatory blood pressure monitoring (24ABPM) is useful in the diagnosis of white-coat hypertension, the assessment of resistant hypertension, and the monitoring of anti-hypertensive therapy. The loss of nocturnal reductions in blood pressure is associated with hypertensive end-organ damage. This study investigated the role of 24ABPM after orthotopic cardiac transplantation. METHODS: Thirty-three transplant recipients underwent 24ABPM. Clinical blood pressure (CPB) was measured by using a sphygmomanometer before 24ABPM. Clinical data were collected and analyzed by a single observer with p values of less than 0.05 being taken as significant. RESULTS: The incidence of hypertension (diastolic pressure > 90 mm Hg) in the CPB and 24ABPM groups was 33% and 52% (p =0.002). Thirty-two percent of recipients who were normotensive by clinical measurement were found to be hypertensive after 24ABPM. The converse was true in 1 case. We identified no specific risk factors for 24ABPM hypertension. One recipient failed to complete the 24-hour monitoring period. CONCLUSION: This study demonstrates that conventional blood pressure monitoring underestimates the incidence of post-transplantation hypertension. Twenty-four hour ambulatory blood pressure monitoring is well tolerated and may improve the management of post-transplantation hypertension. White-coat hypertension is an uncommon diagnosis after cardiac transplantation, and those recipients who are hypertensive in the clinic setting should be considered true hypertensives.
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