A comparison between office and ambulatory blood pressure measurements in renal transplant patients with chronic transplant nephropathy

Hypertension is an important risk factor for chronic transplant nephropathy . Therapy is usually based on casual office blood pressure (BP) measurement s. However, it is not well known how casual BP predicts 24-hour BP in this population. The main focus of this study is to compare casual office BP wit h 24-hour ambulatory BP monitoring in renal transplant recipients with sign s of chronic transplant nephropathy. Moreover, in this group, the day-night BP profile was assessed. In 36 renal transplant recipients with incipient or progressive proteinuria or an increase in serum creatinine level greater than 20%, 24-hour ambulatory BP was performed. Patients were defined as a nondipper if the mean BP decreased by less than 10% during the nighttime pe riod. The correlation between single office and 24-hour ambulatory BPs was 0.61 for systolic BP and 0.55 for diastolic BP (P < 0.001). The mean differ ence between 24-hour ambulatory and single office BPs was -4.2 +/- 18.6 mm Hg (range, -44 to 36 mm Hg) for systolic BP and -1.1 +/- 10.7 mm Hg (range, -34 to 27 mm Hg) for diastolic BP; 94.5% of patients were classified as no ndippers. There was a significant relation between the nightly decline in m ean arterial pressure and calculated creatinine clearance (r = 0.34; P < 0. 05). In conclusion, in renal transplant recipients with chronic transplant nephropathy, a large difference between office and ambulatory BPs is presen t, with both overestimation and underestimation of 24-hour BP by office BP measurements. Moreover, a severely disturbed day-night BP rhythm was observ ed. In transplant recipients with compromised graft function, office BP may not reflect 24-hour BP adequately, and ambulatory BP measurements should b e considered. (C) 2001 by the National Kidney Foundation, Inc.