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  • Rosa Emilia Moraes

Strict blood pressure monitoring post kidney transplant


Chronic kidney disease and high blood pressure are dangerously related.

Monitoring blood pressure changes requires special attention among patients

who underwent kidney transplantation. Researchers support the adoption of

ambulatory blood pressure monitoring (ABPM) as a post-transplant care

protocol to minimize cardiovascular risks and evaluate the antihypertensive treatment.

 

Article: Albuquerque FDA, Paes FJVN, Albuquerque FDA, Maciel VF, Abreu JS, Costa SD, Esmeraldo RM, Sandes-Freitas TV. Monitorização Ambulatorial da Pressão Arterial no Diagnóstico e Manejo da Hipertensão após o Transplante Renal. BJT. 2022.25(04):e0822. https://doi.org/10.53855/bjt.v25i4.487_IN

 

Strict blood pressure monitoring post kidney transplant is essential in the therapeutic management of hypertension


Ambulatory blood pressure monitoring (ABPM) is an exam in which the pressure is measured using a small portable device, which is attached to the patient for 24 hours while they perform their daily tasks and during sleep. ABPM is indicated in any situation where it is necessary to investigate changes in blood pressure, and its application in managing kidney transplant patients can be very beneficial.


The reciprocal influence between the systems of the cardiorenal axis makes the careful monitoring of hypertensive disease essential to provide greater precision in the diagnosis and more assertive prognoses, as evidenced by studies such as Lovibond et al. (2011).


Pointing out that even in large transplant centers around the world, this test is not routinely performed, the study "Ambulatory blood pressure monitoring in the diagnosis and management of hypertension after renal transplantation" published in the Brazilian Journal of Transplantation (v.25 n.4) by researchers from the Federal and State Universities of Ceará, reinforces the importance the application of ABPM in the post-transplant period, to provide greater efficiency in the diagnosis of blood pressure changes and enable a better assessment of the effects of antihypertensive treatment.


The study included data collected from June 2017 to July 2018 from patients treated in post-transplant follow-up at the Arterial Hypertension Service of the General Hospital of Fortaleza, a reference institution in transplants located in northeastern Brazil. The group selected for the sample consisted of recipients who had undergone surgery within a previous period of six to three months due to stabilization of renal function. Among these patients, 75% were using some antihypertensive medication at the time of the ABPM, as expected. The article includes detailed information about the sample's demographic characteristics, a descriptive evaluation of the result of ABPMs and manual measurements and their correlations, with data arranged in informative tables

and graphs.


Among the results, the lack of conformity between the data obtained by manual pressure measurement and those indicated by ABPM is noteworthy, revealing a high prevalence of masked hypertension - mainly due to inaccuracy in the measurement of diastolic blood pressure - and other abnormal pressure behaviors that were not diagnosed by manual instantaneous measurement.


The findings converged with previous studies (LEE et al., 2015), which also indicated a high prevalence of masked hypertension and changes in the nocturnal rise period, as well as nocturnal hypertension in transplant patients. Thus, the article in question affirms the need for a thorough investigation of the receptor's circadian pressure behavior to identify abnormalities and promptly ensure effective pharmacological control treatment.


 

Read more (References):


Lee MH, Ko KM, Ahn SW, et al. The impact of kidney transplantation on 24- hour ambulatory blood pressure in end-stage renal disease patients. J Am Soc Hypertens. 2015;9(6):427-34. https://doi.org/10.1016/j.jash.2015.04.00


Lovibond K, Jowett S, Barton P, Caulfield M, Heneghan C, Hobbs FD et al. Cost-effectiveness of options for the diagnosis of high blood pressure in primary care: A modeling study. Lancet. 2011;378(9798):1219-30.


 

Author


Rosa Emilia Moraes, Scientific journalist at Linceu Editorial, São José dos Campos, SP, Brazil (rosaemiliamoraes@gmail.com)

 

Links


Universidade Estadual do Ceará


Universidade Federal do Ceará


Brazilian Journal of Transplantation

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