Nephrology Division, Renal Transplantation Service, University of Sao Paulo School of Medicine.
Nephrol Dial Transplant. 2011 Nov;26(11):3745-9. doi: 10.1093/ndt/gfr143. Epub 2011 Mar 25.
Hypertension is highly prevalent among kidney transplantation recipients and considered as an important cardiovascular risk factor influencing patient survival and kidney graft survival. Aim. Compare the blood pressure (BP) control in kidney transplant patients through the use of home blood pressure monitoring (HBPM) is more comparable with the results of ambulatory blood pressure monitoring compared to the measurement of office blood pressure.
From March 2008 to April 2009 prospectively were evaluated 183 kidney transplant recipients with time after transplantation between 1 and 10 years. Patients underwent three methods for measuring BP: office blood pressure measurement (oBP), HBPM and ambulatory blood pressure monitoring (ABPM).
In total, 183 patients were evaluated, among them 94 were men (54%) and 89 women (46%). The average age was 50 ± 11 years. The average time of transplant was 57 ± 32 months. Ninety-nine patients received grafts from deceased donors (54%) and 84 were recipients of living donors (46%). When assessed using oBP, 56.3% presented with uncontrolled and 43.7% with adequate control of BP with an average of 138.9/82.3 ± 17.8/12.1 mmHg. However, when measured by HBPM, 55.2% of subjects were controlled and 44.8% presented with uncontrolled BP with an average of 131.1/78.5 ± 17.4/8.9 mmHg. Using the ABPM, we observed that 63.9% of subjects were controlled and 36.1% of patients presented uncontrolled BP with an average 128.8/80.5 ± 12.5/8.1 mmHg. We found that the two methods (oBP and HBPM) have a significant agreement, but the HBPM has a higher agreement that oBP, confirmed P = 0.026. We found that there is no symmetry in the data for both methods with McNemar test. The correlation index of Pearson linear methods for the ABPM with the other two methods were 0.494 for office measurement and 0.768 for HBPM, best value of HBPM with ABPM. Comparing the errors of the two methods by paired t-test, we obtained the descriptive level of 0.837. Looking at the receiver operating characteristic curve for BP measurements in each method, we observed that oBP is lower than those obtained by HBPM in relation to ABPM.
We conclude that the results obtained with HBPM were closer to the ABPM results than those obtained with BP obtained at oBP, being more sensitive to detect poor control of hypertension in renal transplant recipients.
高血压在肾移植受者中非常普遍，被认为是影响患者生存和肾脏移植物生存的重要心血管危险因素。目的：通过使用家庭血压监测（HBPM）来比较肾移植患者的血压（BP）控制情况，与动态血压监测（ABPM）相比，与诊室血压测量的结果更具可比性。
2008 年 3 月至 2009 年 4 月前瞻性评估了 183 例肾移植受者，移植后时间为 1 至 10 年。患者接受三种方法测量血压：诊室血压测量（oBP）、HBPM 和 ABPM。
共评估了 183 例患者，其中 94 例为男性（54%），89 例为女性（46%）。平均年龄为 50±11 岁。平均移植时间为 57±32 个月。99 例患者接受了已故供者的移植物（54%），84 例为活体供者（46%）。使用 oBP 评估时，56.3%的患者血压未得到控制，43.7%的患者血压得到控制，平均为 138.9/82.3±17.8/12.1mmHg。然而，通过 HBPM 测量时，55.2%的受试者血压得到控制，44.8%的受试者血压未得到控制，平均为 131.1/78.5±17.4/8.9mmHg。使用 ABPM 时，我们观察到 63.9%的患者血压得到控制，36.1%的患者血压未得到控制，平均为 128.8/80.5±12.5/8.1mmHg。我们发现两种方法（oBP 和 HBPM）具有显著的一致性，但 HBPM 的一致性高于 oBP，P=0.026。我们发现，使用 McNemar 检验，两种方法的数据都没有对称性。Pearson 线性方法的相关指数为 oBP 与 ABPM 之间的 0.494 和 HBPM 与 ABPM 之间的 0.768，HBPM 与 ABPM 的相关性最好。通过配对 t 检验比较两种方法的误差，我们获得了描述性水平为 0.837。观察每种方法的 BP 测量的受试者工作特征曲线，我们发现 oBP 低于 HBPM 与 ABPM 相关的 oBP。
我们得出的结论是，HBPM 获得的结果比 oBP 获得的结果更接近 ABPM 结果，对肾移植受者高血压控制不良的检测更敏感。
