The 3 mmHg underestimation of SBP with the auscultatory method may be due to the deflation rate chosen in this protocol (5mm/step).

Conclusion: The Diasys Integra achieved at least a B rating according to the criteria of the British Hypertension Society protocol. Results are better with auscultatory method for DBP. A trend to SBP underestimation by the device with auscultatory method may be linked to the deflation rate used in this protocol (5mm/step) and may be corrected.

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The Importance of 24 Hour Ambulatory Blood Pressure Monitoring After Thoracic Organ Transplantation

Antony Hayden Walker, MBChB, FRCS, Timothy J. Locke, MD, FRCS, Peter C. Braidley, FRCS, and Abdullah Al-Mohammed, MD, MRCP

Background
Hypertension is a significant complication after thoracic organ transplantation. In the non-transplant
population, 24-hour ambulatory blood pressure monitoring (24ABPM) is useful in the diagnosis of
white-coat hypertension, the assessment of resistant hypertension, and the monitoring of anti-hypertensive
therapy. The loss of nocturnal reductions in blood pressure is associated with hypertensive
end-organ damage. This study investigated the role of 24ABPM after orthotopic cardiac transplantation.

Methods
Thirty-three transplant recipients underwent 24ABPM. Clinical blood pressure (CPB) was measured
by using a sphygmomanometer before 24ABPM. Clinical data were collected and analyzed by a
single observer with p values of less than 0.05 being taken as significant.

Results
The incidence of hypertension (diastolic pressure
90 mm Hg) in the CPB and 24ABPM groups was
33% and 52% (p 0.002). Thirty-two percent of recipients who were normotensive by clinical
measurement were found to be hypertensive after 24ABPM. The converse was true in 1 case. We
identified no specific risk factors for 24ABPM hypertension. One recipient failed to complete the
24-hour monitoring period.

Conclusion
This study demonstrates that conventional blood pressure monitoring underestimates the incidence of
post-transplantation hypertension. Twenty-four hour ambulatory blood pressure monitoring is well
tolerated and may improve the management of post-transplantation hypertension. White-coat hypertension
is an uncommon diagnosis after cardiac transplantation, and those recipients who are hypertensive
in the clinic setting should be considered true hypertensives. J Heart Lung Transplant 2005;24:1770–3.
Copyright © 2005 by the International Society for Heart and Lung Transplantation.

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Blood pressure measurement

Part III - Automated sphygnomanometry: ambulatory blood pressure measurement

Eoin O’Brien, Gareth Beevers, Gregory Y H Lip

In recent years, the accuracy of the conventional Riva-Rocci/Korotkoff technique of blood pressure measurement has been questioned and efforts have been made to improve the technique with automated devices. In the same period, recognition of the phenomenon of white coat hypertension, whereby some subjects with apparent elevation of blood pressure have normal, orreduced, blood pressures whets measurement is repeated away front the medical environment, has focused attention on methods of measurement that provide profiles of blood pressure behaviour rather than relying on isolated measurements under circumstances that may in themselves influence the level of blood pressure recorded.

These methodologies have included repeated measurements of blood pressure using the traditional technique, self measurement of blood pressure in the home or workplace, and ambulatory bloodpressure measurement (ABPM) using innovative automated devices)

British Medical Journal 322, p. 1110-1114, 2001

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