Masked hypertension and hidden uncontrolled hypertension after renal transplantation

Abstract

Arterial hypertension is a risk factor affecting graft function in pediatric kidney transplants. Recent pediatric studies reported a high prevalence of hypertension, especially nocturnal hypertension in this population. Data regarding the prevalence of masked hypertension in pediatric patients with kidney transplants are still scarce. The aim of this cross-sectional study was to assess the prevalence of masked and hidden uncontrolled hypertension after renal transplantation. A total of 41 patients (25 males) with stable functioning renal graft were included in the study. Their median age was 14.5 years with the median interval since transplantation of 2.5 years (range 0.3 to 20.6). Spacelabs 90207 was used to measure ambulatory blood pressure (BP) during a 24-h period. Ambulatory hypertension was defined as mean systolic and/or diastolic BP index at day-time or nighttime >or=1. Masked hypertension was defined as normal office BP but daytime ambulatory hypertension in patients without antihypertensive medications. Hidden uncontrolled hypertension was defined as daytime ambulatory hypertension undetected by office BP measurements in treated patients. Antihypertensive medications were prescribed to 58%. Prevalence of nocturnal hypertension was 68%. On the basis of combination of office and ABPM masked hypertension and hidden uncontrolled hypertension was detected in 24% and 21% of the study population, respectively. Regular use of ambulatory blood pressure monitoring in transplanted patients enables detection of masked and hidden uncontrolled hypertension.

Ambulatory Blood Pressure, Left Ventricular Hypertrophy, and Allograft Function in Children and Young Adults After Kidney Transplantation

“…As in previous studies 19,21,22 , we found no significant association between ABP status and graft function. However, as in the case of LVH, patients with normal BP who did not require antihypertensive medications had less allograft dysfunction than patients taking antihypertensives, even in those whose BP was within normal levels.…”

Inadequate blood pressure control demonstrated by ambulatory blood pressure monitoring in pediatric renal transplant recipients

“…Of the seven subjects with normal BP by office measurements, four had mask hypertension by ABPM. Underestimation of BP control by office measurement was also found in a previous study, which showed 21% were hypertensive by ABPM but normotensive by office BP measurement. Even though our study did not reveal white coat hypertension, the previous studies demonstrated 3%‐10% of RT patients had white coat hypertension .…”

Influence of distance between residence and health facilities on non-communicable diseases: An assessment over hypertension and diabetes in Bangladesh

“…13.4% (n = 259) respondents who never checked their blood pressure, had been tested to have hypertension. Considering hypertension does not show any eminent symptoms [33] or it could be masked [34], presence of medical check-up is necessary for early detection. This phenomenon was demonstrated in Table 1 where presence of qualified (MBBS) doctors and pharmacies showed significant ( P value < 0.001) association with hypertension.…”