Office and Home Systolic Blood Pressures Are Underestimated in Heart Transplant Recipients

Purpose Few data exist regarding the relationships between home (HBP), office (OBP) and ambulatory (ABP) blood pressure following cardiac transplantation (CTx). The objective of this study was to systematically compare HBP, OBP, and ABP (gold standard) in stable CTx recipients. Methods and Materials This prospective study enrolled adults ≥ 6 months post-CTx. Morning seated OBP was measured using an automatic monitor at 3 office visits (3 times/visit). Seated HBP was measured by participants for 5 consecutive days (2 times/AM, 2 times/PM), using the same automatic monitor. Following the HBP period, ABP was measured over 24 hours using Spacelabs devices. Paired t tests were used to compare mean OBP and HBP with 24-hour ABP (24ABP) and daytime ABP (dayABP, 06:00-22:00). Pearson’s r was used to assess correlations. Results The study included 14 men and 4 women [mean age=58 ± 11 years, median # of BP meds=1.5 (range 0-5), median days post-CTx=2712 (range 408-7838)]. The table shows differences in BP between the methods. Systolic and diastolic HBP were similar to 24ABP; however, systolic HBP was significantly lower than dayABP. Systolic OBP was also significantly lower than dayABP and 24ABP, but differences in diastolic BP were not evident between OBP and ABP. When OBP and HBP were compared with each other, systolic BP and diastolic BP were similar. Conclusions Unlike studies in other populations, these data show that systolic HBP and OBP are lower than ABP, particularly day ABP. Furthermore, diastolic BP did not differ greatly between the methods. Although HBP and OBP are correlated with ABP, systolic BP burden may not be adequately captured with HBP or OBP alone. Comparison of Methods Systolic Differences (mmHg) P value Systolic Correlations (r) Diastolic Differences (mmHg) P value Diastolic Correlations (r) HBP—24ABP -1.8 ± 6.5 0.27 0.66** 1.8 ± 4.0 0.07 0.57* HBP—dayABP -3.9 ± 6.6 0.02 0.65** -0.2 ± 5.0 0.89 0.40 OBP—24ABP -3.4 ± 6.9 0.05 0.50* 2.4 ± 4.9 0.06 0.48* OBP—dayABP -5.6 ± 6.0 0.001 0.62* 0.4 ± 4.9 0.74 0.50* OBP—HBP -1.6 ± 6.2 0.29 0.70** 0.6 ± 4.7 0.62 0.51* Mean±SD; **p