Fernandez Fresnedo G, Franco Esteve A, Gómez Huertas E, Cabello Chaves V, Díz Gómez J M, Osorio Moratalla J M, Gallego Samper R, Gallego Valcárcel E, Campistol Plana J M, Marín Iranzo R, Arias Rodríguez M
Hospital Universitario Marqués de Valdecilla, Santander, Spain.
Transplant Proc. 2012 Nov;44(9):2601-2. doi: 10.1016/j.transproceed.2012.09.037.
Hypertension is common following renal transplantation, affecting up to 80% of transplant recipients. It is generally accepted that hypertension is associated with poor graft survival and reduced life expectancy, contributing to increased cardiovascular risk factors and mortality rates. The aim of the study was to compare the blood pressure (BP) control in kidney transplant patients through the use of ambulatory BP monitoring (ABMP) versus office BP measurements (oBP). A multicenter, cross-sectional, observational study was conducted in 30 nephrology/kidney transplant units. Eligible patients included hypertensive cadaveric kidney transplant recipients aged <70 years, with a functioning kidney for at least 1 year and with an estimated glomerular filtration ≥30 mL/min/1.73 m(2) and a serum creatinine < 2.5 mg/dL. Recorded data included demographic characteristics, oBP, and ABPM and labroatory investigations. The 868 patients showed a mean recipient age of was 53.2 ± 11.6 years and mean follow-up after transplantation, 5.5 ± 2.8 years. Mean systolic and diastolic oBP were 140.2 ± 18 and 80.4 ± 10 mm Hg, respectively. Seventy-six percent of patients had oBP higher than or equal to 130/80 mm Hg. Mean 24 hour ABPM were 131.5 ± 14 and 77.4 ± 8.7 mm Hg for systolic and diastolic BP, respectively. Using the ABPM, we observed that 36.5% of subjects were controlled (mean 24-hour BP < 130/85 mm Hg). The two methods (oBP and ABPM) showed significant agreement. After ABPM, 65% of patients diagnosed as true controlled hypertension were considered to have white-coat RH. In clinical practice ABPM may help for better adjustment of drugs for adequate BP control.
高血压在肾移植后很常见，影响高达80%的移植受者。人们普遍认为高血压与移植肾存活率低和预期寿命缩短有关，会导致心血管危险因素增加和死亡率上升。该研究的目的是通过使用动态血压监测（ABMP）与诊室血压测量（oBP）来比较肾移植患者的血压（BP）控制情况。在30个肾脏病/肾移植单位进行了一项多中心、横断面观察性研究。符合条件的患者包括年龄<70岁的高血压尸体肾移植受者，移植肾有功能至少1年，估计肾小球滤过率≥30 mL/min/1.73 m²且血清肌酐<2.5 mg/dL。记录的数据包括人口统计学特征、oBP、ABPM和实验室检查。868例患者的受者平均年龄为53.2±11.6岁，移植后平均随访时间为5.5±2.8年。平均收缩压和舒张压oBP分别为140.2±18和80.4±10 mmHg。76%的患者oBP高于或等于130/80 mmHg。平均24小时ABPM的收缩压和舒张压分别为131.5±14和77.4±8.7 mmHg。使用ABPM，我们观察到36.5%的受试者血压得到控制（平均24小时血压<130/85 mmHg）。两种方法（oBP和ABPM）显示出显著的一致性。ABPM后，65%被诊断为真正血压控制良好的高血压患者被认为患有白大衣性高血压。在临床实践中，ABPM可能有助于更好地调整药物以实现充分的血压控制。
