Utility of Ambulatory Blood Pressure Monitoring for Diagnosis of Hypertension in Liver Allograft Recipients E. Otero-Anto ´n, E. Padı´n, S. Tome ´ , A. Gonza ´ lez-Quintela, C. Calvo, R.C. Hermida, D.E. Ayala, J.F. Castroagudin, M. Delgado, and E. Varo H YPERTENSION is a risk factor for ischemic heart disease, stroke, renal dysfunction, and peripheral vascular disease. Hypertension is frequently encountered in liver transplant recipients and, therefore, its diagnosis and therapy are essential in order to prevent complications and early death. 1 Classically, the diagnosis of hypertension is based on office or clinic blood pressure measurement (CBPM), but in recent years noninvasive automatic devices have become available for ambulatory blood pressure mon- itoring (ABPM) over periods of 24 hours or more. More- over, ABPM is the only noninvasive technique that permits blood pressure measurements during sleep. 2 In the present study we investigated ABPM findings in a series of liver transplant patients previously classified as hypertensive or normotensive by means of CBPM. MATERIAL AND METHODS The study included 39 patients (85% male, mean age 45 years, range 14 – 67 years) who had received a liver transplant in a single institution with a minimum follow-up of 6 months (median 40 months, range 6 – 85 months). According to CBPM, eight patients were normotensive (Group A) and 31 patients were hypertensive (Group B). All patients in Group B received antihypertensive therapy. Antihypertensive therapy was withdrawn 2 weeks before entering the study in 15 patients from Group B (Group B1), and maintained in the remaining 16. Of these, eight patients showed adequate blood pressure control as assessed by CBPM (Group B2), and the remaining eight patients showed poor blood pressure control as assessed by CBPM (Group B3). A standard 48-hour ABPM was performed in all cases. Hypertension was defined as an arterial blood pressure above 140/90 mm Hg during the diurnal period or above 125/75 mm Hg during the nocturnal period. 3 RESULTS In the apparently normotensive group (Group A), five patients (63%) were hypertensive according to ABPM. In the hypertensive group without current antihypertensive therapy (Group B1), all patients were also hypertensive according to ABPM. In the hypertensive group with appar- ently adequate control (Group B2), three cases (40%) were hypertensive according to ABPM. In the hypertensive group under current antihypertensive therapy with appar- ently poor control (Group B3), two cases (25%) were normotensive according to ABPM. Overall, ABPM re- vealed (a) adequate blood pressure control in two patients (9%) apparently hypertensive by CBPM, and (b) inade- quate blood pressure control in eight patients (50%) appar- ently normotensive by CBPM (either with or without anti- hypertensive therapy). Isolated nocturnal hypertension was present in four of eight patients with inadequate blood pressure control revealed by ABPM (50%). DISCUSSION In the present study a considerable discordance between CBPM and ABPM was observed for the diagnosis of high blood pressure. In some cases, this difference was due to nocturnal hypertension. Whereas CBPM provides only di- urnal measurement of blood pressure, ABPM provides both diurnal and nocturnal measurements, including the sleep period. 2 This advantage is especially important since there is evidence that night-time hypertension is indepen- dently associated with end organ damage, over and above the risk associated with day–time hypertension. 4 In our experience, isolated CBPM is an inadequate method for diagnosis and surveillance of hypertension in liver trans- plant recipients. The efficiency of ABPM in this setting should be investigated in further studies. REFERENCES 1. Gonwa TA: Liver Transpl 7(suppl):S22, 2001 2. O’Brien E, Beevers G, Lip GY: BMJ 322:1110, 2001 3. O’Brien ET, Staessen J: Blood Press 4:266, 1995 4. Verdecchia P, Schillaci G, Guerrieri M, et al: Circulation 81:528, 1990 From the Transplantation Unit (ED., E.P., S.T., A.G., J.F.C., M.D., E.V.), and Arterial Hypertension Unit (C.C., R.C.H.), Uni- versity Hospital, Santiago de Compostela, Spain; Bioengineering and Chronobiology Laboratory (D.E.A.), Vigo University, Spain. Address reprint requests to Dr E. Otero-Anton, Transplanta- tion Unit, Hospital Clı´nico Universitario, 15706 Santiago de Compostela, Spain. E-mail: eoteroa@nexo.es 0041-1345/03/$–see front matter © 2003 by Elsevier Science Inc. doi:10.1016/S0041-1345(03)00062-9 360 Park Avenue South, New York, NY 10010-1710 718 Transplantation Proceedings, 35, 718 (2003)