Περίληψη:
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.
Συγγραφείς:
Pisano, Anna
Mallamaci, Francesca
D'Arrigo, Graziella and
Bolignano, Davide
Wuerzner, Gregoire
Ortiz, Alberto
Burnier,
Michel
Kanaan, Nada
Sarafidis, Pantelis
Persu, Alexandre and
Ferro, Charles J.
Loutradis, Charalampos
Boletis, Ioannis N. and
London, Gerard
Halimi, Jean-Michel
Sautenet, Benedicte and
Rossignol, Patrick
Vogt, Liffert
Zoccali, Carmine
