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Tantisattamo E, Ferrey AJ, Reddy UG, Malik FT, Siu MKM, Ammary FA, Lau WL. A paradigm shift from office to home-based blood pressure measurement approaches in kidney transplant recipients. Curr Opin Nephrol Hypertens 2024; 33:67-76. [PMID: 37937540 DOI: 10.1097/mnh.0000000000000951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
PURPOSE OF REVIEW The unattended blood pressure (BP) readings from home blood pressure (HBP) monitoring should provide more accurate BP readings than attended BP obtained from office blood pressure (OBP). Here, we review evidence supporting the clinical utility of HBP and automatic remote monitoring of blood pressure (ARM-BP) in kidney transplant recipients (KTR). RECENT FINDINGS BP from 24-h ambulatory blood pressure monitoring (24-h ABPM) is higher than but better associated with kidney and cardiovascular outcomes compared to OBP and HBP. While there is discordance of BP readings across different BP measurement methods causing BP misclassification, HBP provides BP readings closer to the readings from the 24-h ABPM than those from OBP. Systolic and diastolic BP is better controlled within 30 days after utilizing ARM-BP. SUMMARY Compared to OBP, HBP minimizes the attended effect of OBP, and its readings are closer to the gold standard 24-h ABPM. ARM-BP improves BP control in the short term and trials of longer follow-up duration are required to evaluate sustained clinical benefits in KTR. The paradigm of BP monitoring may shift toward HBP, while OBP may be utilized primarily for KTR who cannot perform HBP for hypertension diagnosis and management.
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Affiliation(s)
- Ekamol Tantisattamo
- American Heart Association Comprehensive Hypertension Center at the University of California Irvine Medical Center, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange
- Nephrology Section, Department of Medicine, Tibor Rubin Veterans Affairs Medical Center, Veterans Affairs Long Beach Healthcare System, Long Beach, California
- Multi-Organ Transplant Center, Section of Nephrology, Department of Internal Medicine, William Beaumont Hospital, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan
| | - Antoney J Ferrey
- American Heart Association Comprehensive Hypertension Center at the University of California Irvine Medical Center, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange
| | - Uttam G Reddy
- American Heart Association Comprehensive Hypertension Center at the University of California Irvine Medical Center, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange
| | - Fatima T Malik
- American Heart Association Comprehensive Hypertension Center at the University of California Irvine Medical Center, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange
| | - Man Kit Michael Siu
- American Heart Association Comprehensive Hypertension Center at the University of California Irvine Medical Center, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange
- Division of Nephrology, West Los Angeles Veteran Affairs Medical Center, Los Angeles, California, USA
| | - Fawaz Al Ammary
- American Heart Association Comprehensive Hypertension Center at the University of California Irvine Medical Center, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange
| | - Wei Ling Lau
- American Heart Association Comprehensive Hypertension Center at the University of California Irvine Medical Center, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange
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Korogiannou M, Alexandrou ME, Sarafidis P, Pella E, Theodorakopoulou MP, Xagas E, Argyris A, Protogerou A, Boletis IN, Marinaki S. Sex-related short-term blood pressure variability differences in kidney transplant recipients. Blood Press Monit 2022; 27:371-377. [PMID: 36330767 DOI: 10.1097/mbp.0000000000000621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Kidney transplant recipients (KTRs) display higher cardiovascular morbidity and mortality than the general population. Increased short-term blood pressure variability (BPV) is associated with a higher risk of adverse cardiovascular outcomes in chronic kidney disease (CKD). The aim of this study is to investigate sex differences in short-term BPV in KTRs. METHODS In total, 136 male and 69 female KTRs with valid 24 h ambulatory blood pressure monitoring were included in this analysis. Systolic and diastolic BPV indices [SD, weighted SD (wSD), coefficient of variation (CV), average real variability (ARV) and variability independent of the mean (VIM)] were calculated with validated formulas for the 24 h, daytime and nighttime periods. RESULTS Age, time from transplantation surgery and history of major comorbidities did not differ between men and women. During the 24-h period, systolic BPV indices did not differ between men and women (SBP-ARV: 9.4 ± 2.2 vs. 9.9 ± 2.5; P = 0.212). During the daytime period, SBP-CV and SBP-VIM were significantly higher in females compared with male participants (SBP-CV: 9.9 ± 2.4 vs. 11 ± 3.1%; P = 0.022 and SBP-VIM: 12.6 ± 3.0 vs 14.2 ± 3.9; P = 0.008); daytime SBP-SD and SBP-ARV, and all studied indexes during nighttime did not differ between groups. No significant between-group differences in 24 h and daytime diastolic BPV indices were detected. Nighttime DBP-CV was marginally higher in men (12.0 ± 3.6 vs. 11.4 ± 4.0; P = 0.053); the rest nighttime diastolic BPV indices measured were also nonsignificantly higher in men. CONCLUSION In conclusion, 24-h systolic and diastolic BPV parameters did not differ between male and female KTRs, but short-term BPV over the respective day- and nighttime periods showed different trends in men and women. Further studies are needed to examine possible differences in long-term BPV in KTRs.
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Affiliation(s)
- Maria Korogiannou
- Clinic of Nephrology and Renal Transplantation, Laiko General Hospital, Medical School of Athens, National and Kapodistrian University, Athens
| | | | - Pantelis Sarafidis
- Department of Nephrology, Hippokration Hospital, Aristotle University, Thessaloniki
| | - Eva Pella
- Department of Nephrology, Hippokration Hospital, Aristotle University, Thessaloniki
| | | | - Efstathios Xagas
- Clinic of Nephrology and Renal Transplantation, Laiko General Hospital, Medical School of Athens, National and Kapodistrian University, Athens
| | - Antonis Argyris
- Cardiovascular Prevention & Research Unit, Clinic & Laboratory of Pathophysiology, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Greece
| | - Athanase Protogerou
- Cardiovascular Prevention & Research Unit, Clinic & Laboratory of Pathophysiology, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Greece
| | - Ioannis N Boletis
- Clinic of Nephrology and Renal Transplantation, Laiko General Hospital, Medical School of Athens, National and Kapodistrian University, Athens
| | - Smaragdi Marinaki
- Clinic of Nephrology and Renal Transplantation, Laiko General Hospital, Medical School of Athens, National and Kapodistrian University, Athens
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Jarmi T, Spaulding AC, Jebrini A, Sella DM, Alexander LF, Nussbaum S, Shoukry M, White L, Wadei HM, Farres H. Association of Abdominal Arterial Calcification Score with Patients' Survival and Kidney Allograft Function after Kidney Transplant. World J Surg 2022; 46:2468-2475. [PMID: 35854013 DOI: 10.1007/s00268-022-06665-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Abdominal arterial calcification (AAC) is common among candidates for kidney transplant. The aim of this study is to correlate AAC score value with post-kidney transplant outcomes. METHODS We modified the coronary calcium score by changing the intake data points and used it to quantitate the AAC. We conducted a retrospective clinical study of all adult patients who were transplanted at our center, between 2010 and 2013, and had abdominal computed tomography scan done before transplantation. Outcomes included mortality, pulse pressure (PP) measured by 24 h ambulatory blood pressure monitoring system, and kidney allograft function measured by iothalamate clearance. RESULTS For each 1000 increase of AAC score value, there is an associated 1.05 increase in the risk of death (95% CI 1.02, 1.08) (p < 0.001). Overall median AAC value for all patients was 1784; Kaplan-Meier curve showed reduced survival of all-cause mortality for patients with AAC score value above median and reduced survival among patients with cardiac related mortality. The iothalamate clearance was lower among patients with total AAC score value above the median. Patients with abnormal PP (< 40 or > 60 mmHg) had an elevated median AAC score value at 4319.3 (IQR 1210.4, 11097.1) compared to patients with normal PP with AAC score value at 595.9 (IQR 9.9, 2959.9) (p < 0.001). CONCLUSION We showed an association of AAC with patients' survival and kidney allograft function after kidney transplant. The AAC score value could be used as a risk stratification when patients are considered for kidney transplant.
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Affiliation(s)
- Tambi Jarmi
- Department of Transplant, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
| | - Aaron C Spaulding
- Division of Health Delivery Research, Mayo Clinic Florida, Jacksonville, USA
| | - Abdullah Jebrini
- Department of Transplant, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - David M Sella
- Department of Radiology, Mayo Clinic Florida, Jacksonville, USA
| | | | - Samuel Nussbaum
- Division of Vascular Surgery, Mayo Clinic Florida, Jacksonville, USA
| | - Mira Shoukry
- Division of Vascular Surgery, Mayo Clinic Florida, Jacksonville, USA
| | - Launia White
- Department of Quantitative Health Sciences, Mayo Clinic Florida, Jacksonville, USA
| | - Hani M Wadei
- Department of Transplant, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Houssam Farres
- Division of Vascular Surgery, Mayo Clinic Florida, Jacksonville, USA
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Zhu W, Xu L, Chen X, Lee YJ, Zhang Z, Lou Q. Effects of different blood pressures and their long-term variability on the development of diabetic kidney disease in patients with type 2 diabetes mellitus. Clin Exp Hypertens 2022; 44:464-469. [PMID: 35531897 DOI: 10.1080/10641963.2022.2071917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Weiyan Zhu
- Department of Nephrology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, ZJ, China
| | - Lichen Xu
- Department of Nephrology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, ZJ, China
| | - Xue Chen
- Nursing College, Nanjing University of Chinese Medicine, Nanjing, JS, China
| | - Yau-Jiunn Lee
- Division of Cardiology, Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan
| | - Zongjun Zhang
- Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Department of Radiology, Nanjing, JS, China
| | - Qingqing Lou
- eDepartment of Endocrinology,The First Affiliated Hospital of Hainan Medical University, HI, China
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Benmira AM, Moranne O, Prelipcean C, Pambrun E, Dauzat M, Demattei C, Pérez-Martin A. Direct Determination rather than Oscillometric Estimation of Systolic Blood Pressure in Patients with Severe Chronic Kidney Disease. Am J Nephrol 2022; 53:41-49. [PMID: 35021175 DOI: 10.1159/000520996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 11/16/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Although arterial hypertension is a major concern in patients with chronic kidney disease (CKD), obtaining accurate systolic blood pressure (SBP) measurement is challenging in this population for whom automatic oscillometric devices may yield erroneous results. METHODS This cross-sectional study was conducted in 89 patients with stages 4, 5, and 5D CKD, for whom we compared SBP values obtained by the recently described systolic foot-to-apex time interval (SFATI) technique which provides direct SBP determination, the standard technique (Korotkoff sounds), and oscillometry. We investigated the effects of age, sex, diabetes, CKD stage, and pulse pressure to explain measurement errors defined as biases or misclassification relative to the SBP thresholds of 110-130-mm Hg. RESULTS All 3 techniques showed satisfactory reproducibility for SBP measurement (CCC > 0.84 and >0.91, respectively, in dialyzed and nondialyzed patients). The mean ± SD from SBP as determined via Korotkoff sounds was 1.7 ± 4.6 mm Hg for SFATI (CCC = 0.98) and 5.9 ± 9.3 mm Hg for oscillometry (CCC = 0.88). Referring to the 110-130-mm Hg SBP range outside which treatment prescription or adaptation is recommended for CKD patients, SFATI underestimated SBP in 3 patients and overestimated it in 1, whereas oscillometry underestimated SBP in 12 patients and overestimated it in 3. Higher pulse pressure was the main explanatory factor for measurement and classification errors. DISCUSSION/CONCLUSION SFATI provides accurate SBP measurements in patients with severe CKD and paves the way for the standardization of automated noninvasive blood pressure measurement devices. Before prescribing or adjusting antihypertensive therapy, physicians should be aware of the risk of misclassification when using oscillometry.
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Affiliation(s)
- Amir M Benmira
- Vascular Medicine, Nimes University Hospital, Nimes, France
- IDESP, INSERM & Montpellier University, Montpellier, France
| | - Olivier Moranne
- IDESP, INSERM & Montpellier University, Montpellier, France,
- Nephology - Dialysis - Apheresis, Nimes University Hospital, Nimes, France,
| | - Camelia Prelipcean
- Nephology - Dialysis - Apheresis, Nimes University Hospital, Nimes, France
| | - Emilie Pambrun
- Nephology - Dialysis - Apheresis, Nimes University Hospital, Nimes, France
| | - Michel Dauzat
- Vascular Medicine, Nimes University Hospital, Nimes, France
- EA2992, Montpellier University, Montpellier, France
| | | | - Antonia Pérez-Martin
- Vascular Medicine, Nimes University Hospital, Nimes, France
- IDESP, INSERM & Montpellier University, Montpellier, France
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