BACKGROUND: Hypertension (HTN) occurs after solid organ transplant and may have an impact on future cardiovascular disease and associated co-morbidities. Little has been reported on the prevalence of HTN in pediatric liver transplantation (PLT) recipients. Therefore, we recently initiated a more complete assessment during the PLT annual evaluations. We sought to describe the prevalence of HTN based on office blood pressure (BP) measurements and compare it to the prevalence of HTN using ambulatory blood pressure monitoring (ABPM). When identified, HTN was consistently managed using a care guideline.

METHODS: 33 consecutive liver transplant recipients were studied from January 2015 – September 2016. Data that were analyzed include: office (clinic) oscillometric BP, ABPM, calculated glomerular filtration rate (cGFR), and lipid profile. Office hypertension was defined as any BP that exceeded the 95^th percentile for age, gender, and height. ABPM hypertension was defined as a mean BP (day or night interval) that exceeded normative values based on gender and height.

RESULTS: There were a total of 33 patients, aged 5 – 18 years, of which 17 were males. Patients were studied 1-17 years after transplantation. Overall, 17/33 (52%) of ABPM studies were abnormal. 9/33 (27%) found HTN and 8/33 (24%) demonstrated an increased BP load (pre-hypertension). Of the 9 patients with HTN by ABPM, 4(44%) had HTN only at night (masked HTN). 5/33 (15%) had an abnormal clinic BP and of those, 2/5(40%) had HTN confirmed by ABPM and 3/5(60%) had a normal ABPM (white coat HTN). There were no significant differences in cGFR, elevated BMI or lipid abnormalities in those with and without HTN on ABPM. Of the 9 patients identified with HTN by ABPM, 6 were prescribed anti-hypertensive therapy and the remaining 3 are to be reassessed by ABPM following a trial of lifestyle modifications.

CONCLUSION: Our data has identified that clinic BP is a poor marker of BP status and a significant number of PLT recipients have abnormal ABPM studies, and 27% have HTN. Moreover, 44% of hypertensive patients had masked HTN. The finding of HTN was not correlated with BMI, cGFR or lipid profiles. Further clinical investigation and studies are warranted to help identify and treat HTN in pediatric liver transplant patients.

CITATION INFORMATION: Hendrickson R, Davis M, Sherman A, Andrews W, Daniel J, Fischer R, Blowey D. Identify Clinical and Masked Hypertension and Management Strategies in Pediatric Liver Transplant Patients. Am J Transplant. 2017;17 (suppl 3).

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