scholarly journals The assessment of hypertension in kidney transplant patients: time to change our approach?

2021 ◽  
Author(s):  
Atalay Demiray ◽  
Mehmet Kanbay
Keyword(s):  
Blood Pressure ◽  
Kidney Disease ◽  
Blood Pressure Monitoring ◽  
Meta Analysis ◽  
Home Blood Pressure ◽  
White Coat Hypertension ◽  
Transplant Patients ◽  
Kidney Transplant Patients ◽  
End Stage ◽  
Patient And Graft Survival

Abstract Kidney transplantation (KT) is an increasingly utilized treatment for end-stage kidney disease (ESKD). Hypertension either as a cause of kidney disease or a complication of chronic kidney disease (CKD) is the most frequently encountered comorbidity of KT patients. Hence, the management of hypertension in KT patients is crucial to prolong patient and graft survival. Ambulatory blood pressure monitoring (ABPM) appeared as a promising technique that has superiority over the office and home blood pressure (BP) monitoring to correctly diagnose and manage hypertension. A recent meta-analysis of Pisano et al including 42 studies with 4115 participants provided strong data for the comparison of ABPM with office BP monitoring in KT patients. In addition to the current literature knowledge, findings of Pisano et al filled the long-awaited evidence gap to suggest ABPM as a first-line BP monitoring technique for KT patients. Despite its disadvantages such as patient discomfort, cost-effectiveness, limited availability, ABPM has crucial advantages in the management of hypertension including the detection of abnormal circadian BP patterns, the assessment of effects of physical activity and short-term variability of BP, and the exclusion of masked and white-coat hypertension.

Two-day home blood pressure monitoring may offer an alternative to costlier methods

2018 ◽  
Vol 4 (2) ◽  
pp. 84-90
Author(s):  
Gavin Devereux ◽  
Daniel Gibney ◽  
Fiqry Fadhlillah ◽  
Paul Brown ◽  
Neil Macey ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Blood Pressure Monitoring ◽  
Home Blood Pressure ◽  
White Coat Hypertension ◽  
Home Blood Pressure Monitoring ◽  
Pressure Measurements ◽  
Pressure Monitoring ◽  
Time Saving ◽  
Home Based

BackgroundKey benefits of home-based blood pressure measurements are the potential to reduce the risk of ‘white coat hypertension’, encouraging patients to take ownership of their condition and be more actively involved in their long-term condition care, and to move work out of the doctor’s office.AimTo assess whether performing 20 resting blood pressure measurements over a 2-day period would provide a reliable, stable representation of patients’ resting systolic and diastolic blood pressure. Following clinician recommendation, each participant completed the Stowhealth home blood pressure monitoring procedure.MethodOne thousand and forty-five participants (mean age 66±13 years, 531 women and 514 men) completed the procedure, of 10 resting measurements per day, for 2 days (20 resting systolic and diastolic blood pressure readings in total). All measurements were made using automated oscillometric monitors.ResultsWithin-patient coefficient of variation for the entire participant cohort was 8% for systolic blood pressure (cohort mean 141±11 mm Hg), and 8% for diastolic blood pressure (cohort mean 79±6 mm Hg). There were no significant differences between the first and second day, for either systolic (142±1vs 141±1 mm Hg, respectively, p>0.05) or diastolic blood pressures (79±1vs 78±1 mm Hg, respectively, p>0.05 in both cases).ConclusionThe overall duration of home blood pressure monitoring may be able to be reduced to just 48 hours. This method would offer meaningful time saving for patients, and financial and time benefits for doctors and their surgery administration.

scholarly journals Hypertension Subtypes among Thai Hypertensives: An Analysis of Telehealth-Assisted Instrument in Home Blood Pressure Monitoring Nationwide Pilot Project

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Sakolwat Montrivade ◽  
Pairoj Chattranukulchai ◽  
Sarawut Siwamogsatham ◽  
Yongkasem Vorasettakarnkij ◽  
Witthawat Naeowong ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Monitoring ◽  
Demographic Data ◽  
Real Life ◽  
Antihypertensive Agents ◽  
Home Blood Pressure ◽  
White Coat ◽  
White Coat Hypertension ◽  
Routine Practice ◽  
White Coat Effect

Background. White-coat hypertension (HT), masked HT, HT with white-coat effect, and masked uncontrolled HT are well-recognized problems of over- and undertreatment of high blood pressure in real-life practice. However, little is known about the true prevalence in Thailand. Objectives. To examine the prevalence and characteristics of each HT subtype defined by mean home blood pressure (HBP) and clinic blood pressure (CBP) using telemonitoring technology in Thai hypertensives. Methods. A multicenter, observational study included adult hypertensives who had been diagnosed for at least 3 months based on CBP without the adoption of HBP monitoring. All patients were instructed to manually measure their HBP twice a day for the duration of at least one week using the same validated automated, oscillometric telemonitoring devices (Uright model TD-3128, TaiDoc Corporation, Taiwan). The HBP, CBP, and baseline demographic data were recorded on the web-based system. HT subtypes were classified according to the treatment status, CBP (≥or <140/90 mmHg), and mean HBP (≥or <135/85 mmHg) into the following eight subtypes: in nonmedicated hypertensives, there are four subtypes that are normotension, white-coat HT, masked HT, and sustained HT; in treated hypertensives, there are four subtypes that are well-controlled HT, HT with white-coat effect, masked uncontrolled HT, and sustained HT. Results. Of the 1,184 patients (mean age 58 ± 12.7 years, 59% women) from 46 hospitals, 1,040 (87.8%) were taking antihypertensive agents. The majority of them were enrolled from primary care hospitals (81%). In the nonmedicated group, the prevalence of white-coat and masked HT was 25.7% and 7.0%, respectively. Among the treated patients, the HT with white-coat effect was found in 23.3% while 46.7% had uncontrolled HBP (a combination of the masked uncontrolled HT (9.6%) and sustained HT (37.1%)). In the medicated older subgroup (n = 487), uncontrolled HBP was more prevalent in male than in female (53.6% vs. 42.4%, p=0.013). Conclusions. This is the first nationwide study in Thailand to examine the prevalence of HT subtypes. Almost one-fourth had white-coat HT or HT with white-coat effect. Approximately half of the treated patients especially in the older males had uncontrolled HBP requiring more intensive interventions. These results emphasize the role of HBP monitoring for appropriate HT diagnosis and management. The cost-effectiveness of utilizing THAI HBPM in routine practice needs to be examined in the future study.

scholarly journals Patient Barriers and Facilitators to Ambulatory and Home Blood Pressure Monitoring: A Qualitative Study

2018 ◽  
Vol 31 (8) ◽  
pp. 919-927 ◽  
Author(s):  
Eileen J Carter ◽  
Nathalie Moise ◽  
Carmela Alcántara ◽  
Alexandra M Sullivan ◽  
Ian M Kronish
Keyword(s):  
Blood Pressure ◽  
New York ◽  
Blood Pressure Monitoring ◽  
Home Blood Pressure ◽  
Barriers And Facilitators ◽  
White Coat ◽  
White Coat Hypertension ◽  
Home Blood Pressure Monitoring ◽  
Pressure Monitoring ◽  
Monitoring Method

Abstract BACKGROUND Guidelines recommend that patients with newly elevated office blood pressure undergo ambulatory blood pressure monitoring (ABPM) or home blood pressure monitoring (HBPM) to rule-out white coat hypertension before being diagnosed with hypertension. We explored patients’ perspectives of the barriers and facilitators to undergoing ABPM or HBPM. METHODS Focus groups were conducted with twenty English- and Spanish-speaking individuals from underserved communities in New York City. Two researchers analyzed transcripts using a conventional content analysis to identify barriers and facilitators to participation in ABPM and HBPM. RESULTS Participants described favorable attitudes toward testing including readily understanding white coat hypertension, agreeing with the rationale for out-of-office testing, and believing that testing would benefit patients. Regarding ABPM, participants expressed concerns over the representativeness of the day the test was performed and the intrusiveness of the frequent readings. Regarding HBPM, participants expressed concerns over the validity of the monitoring method and the reliability of home blood pressure devices. For both tests, participants noted that out-of-pocket costs may deter patient participation and felt that patients would require detailed information about the test itself before deciding to participate. Participants overwhelmingly believed that out-of-office testing benefits outweighed testing barriers, were confident that they could successfully complete either testing if recommended by their provider, and described the rationale for their testing preference. CONCLUSIONS Participants identified dominant barriers and facilitators to ABPM and HBPM testing, articulated testing preferences, and believed that they could successfully complete out-of-office testing if recommended by their provider.

scholarly journals White coat hypertension: current state of the issue

2021 ◽  
Vol 28 (2) ◽  
pp. 71-78
Author(s):  
K. H. Uvarova
Keyword(s):  
Blood Pressure ◽  
Antihypertensive Treatment ◽  
Blood Pressure Monitoring ◽  
Target Organ Damage ◽  
Prognostic Significance ◽  
Home Blood Pressure ◽  
White Coat ◽  
White Coat Hypertension ◽  
Lifestyle Modifications ◽  
Cardiovascular Morbidity And Mortality

More than 30 years have passed since the first description of such a concept as white coat hypertension was presented in the scientific literature, but since then, scientists are paying more and more attention to this condition. White coat hypertension is defined when the blood pressure readings obtained in the doctor’s office meet the criteria for hypertension, but the latter is not confirmed by outpatient or home blood pressure monitoring. Initially, the term was only applied to patients who had not received antihypertensive treatment, but recently this definition has been extended to people who regularly take drugs for lowering blood pressure, and this condition was called uncontrolled white coat hypertension. Some of the world’s most influential organizations in the field of cardiology have not reached a consensus on the definition of white coat hypertension on the background of common criteria, which has affected the differences in blood pressure thresholds according to outpatient monitoring. Quite a few studies in recent years have examined the clinical and prognostic significance of white coat hypertension in terms of its probable effects such as metabolic disorders, subclinical and extracardiac target organ damage, cardiovascular morbidity and mortality, and all-cause mortality. At present, there is no doubt that white coat hypertension is not an innocent condition; however, hypotheses about the prognostic role of this condition and the management of patients with white coat hypertension are still controversial. The question of treating white coat hypertension as a condition remains unsolved and requires further investigation. Today, it is considered most appropriate not to prescribe antihypertensive treatment to persons with office blood pressure at normal or below target levels, but to intensify lifestyle modifications and focus on reduction of cardiovascular risk.

scholarly journals Efficacy and Safety of SGLT-2 Inhibitors for Treatment of Diabetes Mellitus among Kidney Transplant Patients: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 8 (4) ◽  
pp. 47
Author(s):  
Api Chewcharat ◽  
Narut Prasitlumkum ◽  
Charat Thongprayoon ◽  
Tarun Bathini ◽  
Juan Medaura ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Systematic Review ◽  
Blood Pressure ◽  
Body Weight ◽  
Kidney Transplant ◽  
Meta Analysis ◽  
Efficacy And Safety ◽  
Transplant Patients ◽  
Treatment Of Diabetes ◽  
Kidney Transplant Patients

Background: The objective of this systematic review was to evaluate the efficacy and safety profiles of sodium-glucose co-transporter 2 (SGLT-2) inhibitors for treatment of diabetes mellitus (DM) among kidney transplant patients. Methods: We conducted electronic searches in Medline, Embase, Scopus, and Cochrane databases from inception through April 2020 to identify studies that investigated the efficacy and safety of SGLT-2 inhibitors in kidney transplant patients with DM. Study results were pooled and analyzed utilizing random-effects model. Results: Eight studies with 132 patients (baseline estimated glomerular filtration rate (eGFR) of 64.5 ± 19.9 mL/min/1.73 m2) treated with SGLT-2 inhibitors were included in our meta-analysis. SGLT-2 inhibitors demonstrated significantly lower hemoglobin A1c (HbA1c) (WMD = −0.56% [95%CI: −0.97, −0.16]; p = 0.007) and body weight (WMD = −2.16 kg [95%CI: −3.08, −1.24]; p < 0.001) at end of study compared to baseline level. There were no significant changes in eGFR, serum creatinine, urine protein creatinine ratio, and blood pressure. By subgroup analysis, empagliflozin demonstrated a significant reduction in body mass index (BMI) and body weight. Canagliflozin revealed a significant decrease in HbA1C and systolic blood pressure. In terms of safety profiles, fourteen patients had urinary tract infection. Only one had genital mycosis, one had acute kidney injury, and one had cellulitis. There were no reported cases of euglycemic ketoacidosis or acute rejection during the treatment. Conclusion: Among kidney transplant patients with excellent kidney function, SGLT-2 inhibitors for treatment of DM are effective in lowering HbA1C, reducing body weight, and preserving kidney function without reporting of serious adverse events, including euglycemic ketoacidosis and acute rejection.

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