Background: Precise blood pressure (BP) measurement to exclude hypertension (HTN) is critical in evaluating living kidney donors (LKDs). 24-hour ambulatory blood pressure monitoring (ABPM) is the gold standard method for diagnosing HTN, but is cumbersome to perform. Use of repeated clinic blood pressure readings (BpTRU^®) may reduce the need for ABPM in LKDs.

Methods: We measured BP in 578 prospective LKDs using three modalities: 1) single office BP; 2) BpTRU (average of 5 consecutive automated readings separated by 1 minute); and 3) ABPM. Diagnostic performance for detecting HTN was determined using average daytime ABPM readings as the gold standard.

Results: HTN was diagnosed in 82 (14.2%) patients by office BP, 45 (7.8%) patients by BpTRU, and 88 (15.2%) patients by ABPM. White coat HTN was diagnosed by ABPM in 6.7% using office BP and 3.3% using BpTRU (p=0.007). Normal BP was more common with BpTRU vs. office BP (65.9% vs. 49.5%, p<0.001), and normal readings predicted a similar low rate of masked HTN by ABPM (5.0% by BpTRU vs. 3.1% by office BP, p=0.242). Masked HTN was more common in pre-HTN patients by BpTRU vs. office BP (28.3% vs. 17.1%, p=0.011). The figure below shows outcomes and a proposed screening algorithm.

Conclusions: BpTRU readings provide a lower rate of white coat HTN and more normal BP readings vs. single office BP. The low rate of masked HTN in patients with normal BP by BpTRU may allow for the elimination of ABPM in the majority of LKDs. ABPM appears to remain beneficial in the subset of patients with pre-HTN and HTN to uncover masked and white coat HTN, respectively.

CITATION INFORMATION: Armanyous S., Lioudis M., Thomas G., Poggio E., Augustine J. Diagnostic Performance of Blood Pressure Measurement Modality in Prospective Living Kidney Donors Am J Transplant. 2017;17 (suppl 3).

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