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Assessment of hypertension in kidney transplantation by ambulatory blood pressure monitoring: a systematic review and meta-analysis
BACKGROUND: Hypertension (HTN) is common following renal transplantation and it is associated with adverse effects on cardiovascular (CV) and graft health. Ambulatory blood pressure monitoring (ABPM) is the preferred method to characterize blood pressure (BP) status, since HTN misclassification by o...
Autores principales: | , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8757429/ https://www.ncbi.nlm.nih.gov/pubmed/35035934 http://dx.doi.org/10.1093/ckj/sfab135 |
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author | Pisano, Anna Mallamaci, Francesca D’Arrigo, Graziella Bolignano, Davide Wuerzner, Gregoire Ortiz, Alberto Burnier, Michel Kanaan, Nada Sarafidis, Pantelis Persu, Alexandre Ferro, Charles J Loutradis, Charalampos Boletis, Ioannis N London, Gérard Halimi, Jean-Michel Sautenet, Bénédicte Rossignol, Patrick Vogt, Liffert Zoccali, Carmine |
author_facet | Pisano, Anna Mallamaci, Francesca D’Arrigo, Graziella Bolignano, Davide Wuerzner, Gregoire Ortiz, Alberto Burnier, Michel Kanaan, Nada Sarafidis, Pantelis Persu, Alexandre Ferro, Charles J Loutradis, Charalampos Boletis, Ioannis N London, Gérard Halimi, Jean-Michel Sautenet, Bénédicte Rossignol, Patrick Vogt, Liffert Zoccali, Carmine |
author_sort | Pisano, Anna |
collection | PubMed |
description | BACKGROUND: Hypertension (HTN) is common following renal transplantation and it is associated with adverse effects on cardiovascular (CV) and graft health. Ambulatory blood pressure monitoring (ABPM) is the preferred method to characterize blood pressure (BP) status, since HTN misclassification by office BP (OBP) is quite common in this population. We performed a systematic review and meta-analysis aimed at determining the clinical utility of 24-h ABPM and its potential implications for the management of HTN in this population. METHODS: Ovid-MEDLINE and PubMed databases were searched for interventional or observational studies enrolling adult kidney transplant recipients (KTRs) undergoing 24-h ABP readings compared with OBP or home BP. The main outcome was the proportion of KTRs diagnosed with HTN by ABPM, home or OBP recordings. Additionally, day–night BP variability and dipper/non-dipper status were assessed. RESULTS: Forty-two eligible studies (4115 participants) were reviewed. A cumulative analysis including 27 studies (3481 participants) revealed a prevalence of uncontrolled HTN detected by ABPM of 56% [95% confidence interval (CI) 46–65%]. The pooled prevalence of uncontrolled HTN according to OBP was 47% (95% CI 36–58%) in 25 studies (3261 participants). Very few studies reported on home BP recordings. The average concordance rate between OBP and ABPM measurements in classifying patients as controlled or uncontrolled hypertensive was 66% (95% CI 59–73%). ABPM revealed HTN phenotypes among KTRs. Two pooled analyses of 11 and 10 studies, respectively, revealed an average prevalence of 26% (95% CI 19–33%) for masked HTN (MHT) and 10% (95% CI 6–17%) for white-coat HTN (WCH). The proportion of non-dippers was variable across the 28 studies that analysed dipping status, with an average prevalence of 54% (95% CI 45–63%). CONCLUSIONS: In our systematic review, comparison of OBP versus ABP measurements disclosed a high proportion of MHT, uncontrolled HTN and, to a lesser extent, WCH in KTRs. These results suggest that HTN is not adequately diagnosed and controlled by OBP recordings in this population. Furthermore, the high prevalence of non-dippers confirmed that circadian rhythm is commonly disturbed in KTRs. |
format | Online Article Text |
id | pubmed-8757429 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-87574292022-01-14 Assessment of hypertension in kidney transplantation by ambulatory blood pressure monitoring: a systematic review and meta-analysis Pisano, Anna Mallamaci, Francesca D’Arrigo, Graziella Bolignano, Davide Wuerzner, Gregoire Ortiz, Alberto Burnier, Michel Kanaan, Nada Sarafidis, Pantelis Persu, Alexandre Ferro, Charles J Loutradis, Charalampos Boletis, Ioannis N London, Gérard Halimi, Jean-Michel Sautenet, Bénédicte Rossignol, Patrick Vogt, Liffert Zoccali, Carmine Clin Kidney J CKJ Review BACKGROUND: Hypertension (HTN) is common following renal transplantation and it is associated with adverse effects on cardiovascular (CV) and graft health. Ambulatory blood pressure monitoring (ABPM) is the preferred method to characterize blood pressure (BP) status, since HTN misclassification by office BP (OBP) is quite common in this population. We performed a systematic review and meta-analysis aimed at determining the clinical utility of 24-h ABPM and its potential implications for the management of HTN in this population. METHODS: Ovid-MEDLINE and PubMed databases were searched for interventional or observational studies enrolling adult kidney transplant recipients (KTRs) undergoing 24-h ABP readings compared with OBP or home BP. The main outcome was the proportion of KTRs diagnosed with HTN by ABPM, home or OBP recordings. Additionally, day–night BP variability and dipper/non-dipper status were assessed. RESULTS: Forty-two eligible studies (4115 participants) were reviewed. A cumulative analysis including 27 studies (3481 participants) revealed a prevalence of uncontrolled HTN detected by ABPM of 56% [95% confidence interval (CI) 46–65%]. The pooled prevalence of uncontrolled HTN according to OBP was 47% (95% CI 36–58%) in 25 studies (3261 participants). Very few studies reported on home BP recordings. The average concordance rate between OBP and ABPM measurements in classifying patients as controlled or uncontrolled hypertensive was 66% (95% CI 59–73%). ABPM revealed HTN phenotypes among KTRs. Two pooled analyses of 11 and 10 studies, respectively, revealed an average prevalence of 26% (95% CI 19–33%) for masked HTN (MHT) and 10% (95% CI 6–17%) for white-coat HTN (WCH). The proportion of non-dippers was variable across the 28 studies that analysed dipping status, with an average prevalence of 54% (95% CI 45–63%). CONCLUSIONS: In our systematic review, comparison of OBP versus ABP measurements disclosed a high proportion of MHT, uncontrolled HTN and, to a lesser extent, WCH in KTRs. These results suggest that HTN is not adequately diagnosed and controlled by OBP recordings in this population. Furthermore, the high prevalence of non-dippers confirmed that circadian rhythm is commonly disturbed in KTRs. Oxford University Press 2021-09-23 /pmc/articles/PMC8757429/ /pubmed/35035934 http://dx.doi.org/10.1093/ckj/sfab135 Text en © The Author(s) 2021. Published by Oxford University Press on behalf of ERA. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | CKJ Review Pisano, Anna Mallamaci, Francesca D’Arrigo, Graziella Bolignano, Davide Wuerzner, Gregoire Ortiz, Alberto Burnier, Michel Kanaan, Nada Sarafidis, Pantelis Persu, Alexandre Ferro, Charles J Loutradis, Charalampos Boletis, Ioannis N London, Gérard Halimi, Jean-Michel Sautenet, Bénédicte Rossignol, Patrick Vogt, Liffert Zoccali, Carmine Assessment of hypertension in kidney transplantation by ambulatory blood pressure monitoring: a systematic review and meta-analysis |
title | Assessment of hypertension in kidney transplantation by ambulatory blood pressure monitoring: a systematic review and meta-analysis |
title_full | Assessment of hypertension in kidney transplantation by ambulatory blood pressure monitoring: a systematic review and meta-analysis |
title_fullStr | Assessment of hypertension in kidney transplantation by ambulatory blood pressure monitoring: a systematic review and meta-analysis |
title_full_unstemmed | Assessment of hypertension in kidney transplantation by ambulatory blood pressure monitoring: a systematic review and meta-analysis |
title_short | Assessment of hypertension in kidney transplantation by ambulatory blood pressure monitoring: a systematic review and meta-analysis |
title_sort | assessment of hypertension in kidney transplantation by ambulatory blood pressure monitoring: a systematic review and meta-analysis |
topic | CKJ Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8757429/ https://www.ncbi.nlm.nih.gov/pubmed/35035934 http://dx.doi.org/10.1093/ckj/sfab135 |
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