Hypertension phenotypes in nondialysis patients with chronic kidney disease: systematic review and meta-analysis.
Vasileios Thymis, Konstantinos G Kyriakoulis, Ariadni Menti et al.
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In 30 seconds
This systematic review and meta-analysis estimated the prevalence of hypertension phenotypes in people with nondialysis chronic kidney disease (CKD). Across included studies, pooled prevalence was 23% for masked hypertension, 11% for white-coat hypertension and 57% for nocturnal hypertension. Nondipping prevalence was 66% in analyses using two nighttime patterns and 43% in analyses distinguishing four patterns. Ambulatory and home blood pressure monitoring showed no detected difference in identifying masked or white-coat hypertension. The authors conclude that out-of-office blood pressure assessment is important in this population.
Key findings
- Pooled masked hypertension prevalence was 23% (19, 27%) across 33 studies (n = 26 542).
- Pooled white-coat hypertension prevalence was 11% [95% confidence interval (CI) (8, 14%)] across 33 studies (n = 26 539).
- Nocturnal hypertension prevalence was 57% (47, 67%) across 14 studies (n = 15 701).
- Ambulatory and home monitoring did not differ in detecting masked or white-coat hypertension (P = 0.4 and P = 0.68, respectively).
Why it matters
Clinic blood pressure alone may not identify the substantial burden of masked and nocturnal hypertension in nondialysis CKD. These pooled estimates highlight the frequency of phenotypes that can complicate diagnosis and management, while the reported similarity between ambulatory and home monitoring offers relevant context for out-of-office assessment.
What to keep in mind
The estimates were pooled across studies with differing phenotype analyses; nondipping prevalence varied according to whether two or four nighttime patterns were assessed.