Routine use of ambulatory blood pressure monitoring in potential living kidney donors.

BACKGROUND AND OBJECTIVES: Most transplant centers exclude prospective living kidney donors with hypertension from donation. Centers routinely identify hypertension using BP measured in the clinic, but it is not clear that clinic BP accurately detects the presence or absence of hypertension in potential donors. We therefore conducted a prospective study to determine the impact of routine ambulatory BP monitoring on diagnosis of hypertension in potential donors and the value of other baseline characteristics in predicting ambulatory BP results. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We compared classification of hypertension status by clinic BP and by ambulatory BP monitoring in 178 potential living kidney donors. RESULTS: Of 63 individuals with hypertension by clinic BP, 62% had white-coat hypertension by ambulatory BP and were therefore eligible to donate. Of 115 individuals who were normotensive by clinic BP, 17% had masked hypertension by ambulatory BP and were excluded from donation. Individuals with masked hypertension were older, were more likely to be male, and had a somewhat higher clinic BP than individuals with sustained normotension. Individuals with white-coat hypertension had a somewhat lower clinic diastolic BP than individuals with sustained hypertension. CONCLUSIONS: Routine ambulatory BP monitoring may identify a large number of individuals with white-coat hypertension and a smaller but significant number of individuals with masked hypertension, ensuring adequate protection of potential donors and accurate assessment of donor risk. Differences in baseline characteristics are small and are not clinically useful in distinguishing individuals with masked hypertension from individuals with sustained normotension or individuals with white-coat hypertension from individuals with sustained hypertension, demonstrating the importance of ambulatory BP monitoring in this population.

Impact of aortic stiffness on ischemic stroke in elderly patients.

BACKGROUND AND PURPOSE: Large atherosclerotic plaques in the aortic arch detected by transesophageal echocardiography (TEE) are associated with increased risk of ischemic stroke in the elderly. The atherosclerotic process also affects aortic distensibility, which can also be assessed by TEE. The purpose of this study was to evaluate the possible association of aortic stiffness by TEE with ischemic stroke in elderly patients. METHODS: We performed TEE in 40 consecutive elderly patients aged > or =55 years with acute ischemic stroke and in 42 consecutive control subjects aged > or =55 years. Aortic stiffness index beta, which has been used in the literature to express the stiffness of the aortic wall, was calculated as follows: beta=ln (systolic blood pressure/diastolic blood pressure)/([D(max)-D(min)]/D(min)), where ln is natural logarithm, D(max) is maximum aortic lumen diameter, and D(min) is minimum aortic lumen diameter by TEE. The association of index beta with ischemic stroke was evaluated by logistic regression analysis after adjustment for potential confounders, including thickness of aortic arch plaques. RESULTS: Index beta was significantly greater in stroke patients than in controls (9.7+/-5.0 versus 5.3+/-3.5; P<0.0001). When aortic plaque thickness and other stroke risk factors were entered in multivariate analysis, index beta was found to be independently associated with ischemic stroke (odds ratio, 1.28 per unit increase; 95% CI, 1.10 to 1.52). CONCLUSIONS: Aortic stiffness by TEE is associated with ischemic stroke, independent of thickness of aortic arch plaques and other stroke risk factors. This suggests that aortic stiffness by TEE may add prognostic information when assessing the risk of ischemic stroke in the elderly.