Key result
The overall pooled prevalence of masked hypertension in children and young adults with CKD was 27%, with left ventricular hypertrophy present in 23% of those with masked hypertension.
Why the study?
Studies using ambulatory blood pressure monitoring to assess blood pressure status in young patients with chronic kidney disease on dialysis or after kidney transplantation were limited.
What is the prevalence of masked hypertension and white-coat hypertension using ABPM in children and young adults with CKD?
Meta-Analysis (n=1,140)
What is the prevalence of masked hypertension and white-coat hypertension using ABPM in children and young adults with CKD?
Masked hypertension is highly prevalent (27%) in children and young adults with CKD and is associated with a 23% prevalence of left ventricular hypertrophy, highlighting the importance of routine ABPM and echocardiography in this population.
Answers are grounded in this paper and cite their sources.
Supports routine ABPM screening in young CKD patients on dialysis or post-transplant; leaves open whether treating masked hypertension reduces LVH or improves outcomes.
OBJECTIVES: There are limited studies using ambulatory blood pressure monitoring (ABPM) to assess blood pressure (BP) status in young patients with chronic kidney disease (CKD) on dialysis or after kidney transplantation. The aim of this meta-analysis is to estimate the prevalence of both white-coat hypertension (WCH) and masked hypertension, along with the prevalence of left ventricular hypertrophy (LVH), in children and young adults with CKD on dialysis or after kidney transplantation. METHODS: We performed a systematic review and meta-analysis of observational studies assessing the prevalence of BP phenotypes using ABPM, in children and young adults with CKD stages 2-5d. Records were identified by search in databases (Medline, Web of Science, CENTRAL) and sources of grey literature, until 31 December 2021. A random-effects meta-analysis of proportions (double arcsine transformation) was conducted. RESULTS: Ten studies were included in the systematic review, reporting data from 1140 individuals (children and young adults with CKD with a mean age of 13.79 ± 4.35 years). Masked hypertension and WCH were diagnosed in 301 and 76 patients, respectively. It was estimated an overall pooled masked hypertension prevalence of 27% [95% confidence interval (95% CI) 18-36, I2 = 87%] and an overall pooled WCH prevalence of 6% (95% CI 3-9, I2 = 78%). Among kidney transplant recipients, masked hypertension had a prevalence of 29% (95% CI 14-47, I2 = 86%). The prevalence of LVH was found 28% (95% CI 0.19-0.39) in a total of 238 CKD patients with ambulatory hypertension. In 172 CKD patients with masked hypertension, LVH was present in 49, with the estimated prevalence being 23% (95% CI 0.15-0.32). CONCLUSION: Masked hypertension has a significant prevalence in children and young adults with CKD. Masked hypertension carries an adverse prognosis, with an increased risk of LVH, warranting clinical attention when assessing cardiovascular risk in this population. Therefore, ABPM and echocardiography is of high importance when assessing BP status in children with CKD. PROTOCOL REGISTRATION NUMBER DOI: 10.17605/OSF.IO/UKXAF.
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Goulas et al. (2023) conducted a meta-analysis in chronic kidney disease (n=1,140). Masked hypertension was evaluated on overall pooled masked hypertension prevalence (95% CI 18-36). The overall pooled prevalence of masked hypertension in children and young adults with CKD was 27%, with left ventricular hypertrophy present in 23% of those with masked hypertension.
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