Clinical Investigation
Comparison of Office, Home, and Ambulatory Blood Pressure in Heart Transplant Recipients

Presented, in part, as a poster at the 33rd International Society for Heart and Lung Transplantation Annual Meeting and Scientific Sessions, Montreal, Quebec, Canada, April 24–27, 2013.
https://doi.org/10.1016/j.cardfail.2014.05.005Get rights and content

Abstract

Background

The purpose of this study was to prospectively evaluate the relationship between office, home, and ambulatory blood pressure (BP) in heart transplant recipients.

Methods and Results

The study enrolled 30 adults ≥6 months after heart transplantation. Morning seated office BP was measured with the use of an automatic device at 3 outpatient visits. Seated home BP was measured in the morning and evening for 5 consecutive days. Ambulatory BP was measured over 24 hours with the use of a Spacelabs monitor. The strongest correlation was observed between home and 24-hour ambulatory BP (r = 0.79 systolic; r = 0.72 diastolic). Office and home systolic BPs were significantly lower than daytime ambulatory BP (office, −3.7 mm Hg, P = .009; home, −2.6 mm Hg, P = .05). Ambulatory monitoring identified more participants with BP above hypertensive limits than did office or home measurements (63%, 50%, and 13%, respectively; P = .003). Ambulatory monitoring also revealed high BP loads, abnormal nocturnal BP patterns (eg, 30% nondippers), and a high percentage of masked hypertension (37% home, 50% ambulatory).

Conclusions

Office and home BP monitoring are acceptable but may underestimate BP burden in heart transplant recipients. Additional studies are needed to determine which BP method is superior for the management of hypertension and associated outcomes after heart transplantation.

Section snippets

Methods

The study was approved by the Colorado Multiple Institutional Review Board, and all participants provided written informed consent. Study data were managed with the use of Research Electronic Data Capture (REDCap) tools hosted at the University of Colorado, Denver.14

Results

The demographic and clinical characteristics of the 30 study participants are presented in Table 1. The population was 80% male, 83% white, and 6.7% Hispanic. Mean age at the time of study enrollment was 57 ± 13 years, and the median time after cardiac transplantation was 3,189 days (range 408–8,840 days). There was 1 current smoker in the study population, and 63.3% of participants had stage 3 or 4 chronic kidney disease. Common comorbidities included cardiac allograft vasculopathy (40%),

Discussion

In this prospective study, we sought to systematically compare office, home, and ambulatory BPs in heart transplant recipients. We found that office and home BPs were significantly correlated with ambulatory BP, but that office and home systolic BPs were significantly lower than daytime ambulatory BP. Through 24-hour ambulatory monitoring, we also found that abnormal nocturnal BP patterns and high systolic and diastolic BP loads were common in the population; 24-hour ambulatory monitoring

Conclusion

Together, our data suggest that office and home BP measurements underestimate BP burden, particularly during the daytime, in heart transplant recipients; 24-hour ambulatory monitoring appears to have advantages by providing information on abnormal circadian BP patterns and BP loads, which we found to be high in this population. Our data also suggest that ambulatory BP monitoring may identify a greater percentage of patients with masked hypertension than home BP monitoring. However, we

Acknowledgements

The authors thank the study volunteers for their participation, the nursing staff at the University of Colorado CTRC for assisting with the conduct of the study, and the University of Colorado Heart Transplant Coordinators for assisting with participant recruitment.

Disclosures

None.

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    Funding: American Heart Association (10GRNT4290040 to CLA) and National Institutes of Health/National Center for Advancing Translational Sciences (UL1 TR000154 to University of Colorado).

    See page 609 for disclosure information.

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