Abstract :
[en] Objective:
High blood pressure (BP) is a major risk factor for graft function in kidney transplant recipients (KTs) Our aim was to evaluate BP control in the office, but also in the ambulatory and home settings, in stable KTs, ali treated for hypertension, and to characterize patients with masked hypertension (MHT).
Design and Method:
Three BP measurement techniques were used in 70 late KT patients, (mean age 56.5 years; 43 males): ambulatory BP monitoring (ABPM-Spacelab 90207) office (OBP) and home BP monitoring (HBPM)- (OMRON M6). Carotid femoral pulse wave velocity was measured (Sphygmocor) as weil as a calcification score (arteries) and the systolic ankle brachial index (ABI) as recommended. The period since transplantation was 6.9±6.6 years, the mean GFR was 65.6±24±ml/min, Body Mass Index was 25.8±4.7 kg/m2 and the number of antihypertensive drug was 2.1±1 pills/d.
Results:
Uncontrolled hypertension (HTN) remained frequent in our treated population, 46 % were still hypertensive in the office, 39% using ABPM and 43% with HBPM. The proportion of MHT was 22% whatever the out-of-clinic method used, with more males, more overweight (BMI between, 25-30). lnterestingly when compared with controlled KTs (i.e both OBP and Daytime ABP controlled or both OBP and HBP controlled), using either ABPM or Home BP, patients with MHT had significantly higher PWV, a higher aortic augmentation pressure (AP), a higher calcification score and a higher ABI. However we did not find any significant impact of graft survival, immunosuppressive drugs, smoking habits, diabetes, or alcohol use.
Conclusion:
A high percentage of uncontrolled HTN was noted by OBP, but also by ABPM and HBPM despite antihypertensive treatment. MHT was frequently observed in KTs. This particular HT subtype, either defined by OBP vs ABPM or by OBP vs HBP, was significantly associated with major markers of arterial stiffness.
So, MHT is associated with a high cardiovascular (cv) risk and therefore has to be manage to reduce incidence of cv events and graft loss.