MO501INCREASED ALBUMINURIA RISK IN CHRONIC KIDNEY DISEASE PATIENTS WHOSE WHITE COAT-, MASKED-, AND SUSTAINED HYPERTENSION: SYSTEMATIC REVIEW AND META-ANALYSIS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Boby Pratama Putra ◽  
Felix Nugraha Putra
Keyword(s):  
Meta Analysis ◽  
Blood Pressure Measurement ◽  
Target Organ Damage ◽  
Random Effect ◽  
White Coat ◽  
Cochrane Library ◽  
White Coat Hypertension ◽  
Masked Hypertension ◽  
Sustained Hypertension ◽  
Standard Mean Difference

Abstract Background and Aims Latest classification of hypertension based on ambulatory blood pressure measurement was normotension (NT), white coat hypertension (WCHT), masked hypertension (MHT), and sustained hypertension (SHT). Recent studies suggest that WCHT, MHT, and SHT increase risk of target organ damage, particularly albuminuria, although the results were still inconsistent. Albuminuria is not only the sign of early glomerular damage in CKD patients, but also the signs of hypertension progression and predictors for cardiovascular events mortality. This study aims to compare the albuminuria risk among NT and WCHT, MHT, also SHT in CKD patients. Method We searched the literature comprehensively in online databases of Pubmed, EMBASE, ScienceDirect, and Cochrane Library to include all relevant studies using predefined terms until December 2020. We included studies that analyzed the albuminuria risk and compared the log2 urinary albumin-to-creatinine ratio (ACR) among NT and WCHT, MHT, or SHT in CKD patients. We used the Newcastle-Ottawa Scale for Observational Study checklist for evaluating bias risks. Analysis of the studies was conducted to provide pooled Odds Ratio (OR) for albuminuria risk and standard mean difference (SMD) for log2 ACR comparison with 95% Confidence Interval (CI) with random-effect heterogeneity test. Results We included 7 observational studies met our inclusion criteria. WCHT increases albuminuria risk although not statistically significant (pooled OR = 1.72, 95%CI 0.97 to 3.07, p = 0.06, I2 = 75%), while MHT and SHT significantly increase albuminuria risk with pooled OR respectively 1.62 (95%CI 1.03 to 2.53, p = 0.04, I2 = 82%) and 3.17 (95%CI 1.66 to 6.05, p = 0.0005, I2 = 94%). Controlled hypertension significantly protects CKD patients against albuminuria risk based on log2 ACR comparison with WCHT (SMD = 0.52, 95%CI 0.38 to 0.67, p<0.00001, I2 = 0%), MHT (SMD = 0.34, 95%CI 0.19 to 0.49, p<0.0001, I2 = 39%), and SHT (SMD = 0.63, 95%CI 0.31 to 0.95, p=0.0001, I2 = 76%). Conclusion White coat hypertension, masked hypertension, and sustained hypertension increase albuminuria risks in CKD patients. However, further studies are needed to determine the causality.

scholarly journals Target Organ Damage in "White Coat Hypertension" and "Masked Hypertension"

2008 ◽  
Vol 21 (4) ◽  
pp. 393-399 ◽  
Author(s):  
V. Kotsis ◽  
S. Stabouli ◽  
S. Toumanidis ◽  
C. Papamichael ◽  
J. Lekakis ◽  
...  
Keyword(s):  
Target Organ Damage ◽  
Organ Damage ◽  
Target Organ ◽  
White Coat ◽  
White Coat Hypertension ◽  
Masked Hypertension

scholarly journals Non-Clinic Blood Pressure Measurement – More Light, Less Darkness

2018 ◽  
Vol 10 (1) ◽  
pp. 13-18
Author(s):  
Vinay Kapur
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Measurement ◽  
Target Organ Damage ◽  
Early Morning ◽  
Morbidity And Mortality ◽  
White Coat Hypertension ◽  
Masked Hypertension ◽  
Clinic Blood Pressure ◽  
Night Time ◽  
Nocturnal Hypertension

Non-clinic blood pressure measurements are very important in confirming diagnosis of hypertension and they give us an idea of associated cardiovascular risk more precisely than clinic BP measurements. It can detect masked hypertension and white coat hypertension & ABPM especially can monitor night-time BP diagnosing individuals with nocturnal hypertension.  Masked hypertension and nocturnal hypertension are strongly related with target organ damage along with enhanced morbidity and mortality due to cardiovascular causes. ABPM can also measure early morning rise of BP, mean 24 hour BP, diurnal variation as well as average real variability. Home BP monitoring by patients themselves leads to their greater involvement in maintaining BP records and in achieving treatment goals. The purpose of this review is to preferentially discuss role of non-clinic BP monitoring in making accurate diagnosis and deciding treatment of hypertension that might help a great deal in reducing morbidity and mortality associated with it.        Asian Journal of Medical Sciences Vol.10(1) 2019 13-18 

scholarly journals Different Dosage Regimens of Eptinezumab for the Treatment of Migraine: A Meta-Analysis from Randomized Controlled Trials

2020 ◽  
Author(s):  
Zeya Yan ◽  
Tao Xue ◽  
Shujun Chen ◽  
Xin Wu ◽  
Xingyu Yang ◽  
...  
Keyword(s):  
Randomized Controlled Trials ◽  
Neurological Diseases ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Standard Mean Difference ◽  
Significant Efficacy

Abstract BackgroundMigraine is one of the most common neurological diseases around the world and calcitonin gene-related peptide（CGRP）plays an important role in its pathophysiology. Therefore, in the present study, we evaluated the efficacy of monoclonal antibodies blocking the CGRP ligand or receptor in episodic and chronic migraine. ObjectiveThe objective of our study is implementing a meta-analysis to systematically evaluate the efficacy and safety of eptinezumab for the treatment of migraine compared with placebo.MethodWe searched the Medline, Embase, Cochrane Library and Clinicaltrials.gov for randomized controlled trials (RCTs) which were performed to evaluate eptinezumab versus placebo for migraine up to September 2020. The data was assessed by Review Manager 5.3 software. The risk ratio (RR) and standard mean difference (SMD) were analyzed using dichotomous outcomes and continuous outcomes respectively with a random effect model.ResultWe collected 2,739 patients from 4 RCTs: the primary endpoint of efficacy was the change from baseline to week 12 in mean monthly migraine days (MMDs). We found that eptinezumab (30mg，100mg，300mg) led to a significant reduction in MMDs (P=0.0001,P < 0.00001, P < 0.00001) during 12 weeks compared with placebo, especially with 300mg. For the safety, we compared and concluded the treatment emergent adverse events (TEAEs) of the 4 RCTs. This indicated no evident statistical difference between eptinezumab and placebo.ConclusionsIn the present study, we found that eptinezumab is safe and has significant efficacy in the treatment of migraine, especially the dose of 300 mg.

Abstract P216: Association Between White-coat Hypertension and Arterial Stiffness: a Systematic Review and Meta-analysis

Hypertension ◽  
2016 ◽  
Vol 68 (suppl_1) ◽  
Author(s):  
Sikarin Upala ◽  
Anawin Sanguankeo
Keyword(s):  
Arterial Stiffness ◽  
Pulse Wave Velocity ◽  
Wave Velocity ◽  
Observational Studies ◽  
Pulse Wave ◽  
Meta Analysis ◽  
White Coat ◽  
White Coat Hypertension ◽  
P Value ◽  
Sustained Hypertension

Background: Previous studies have shown inconclusive effects of target organ damage from white-coat hypertension (WCHT). Arterial stiffness is involved in the atherosclerotic processes in the setting of sustained hypertension. This meta-analysis aimed to compare arterial stiffness in subjects with diagnosis of WCHT to subjects with normotension (NT) and SHT. Methods: A comprehensive search of the databases of the MEDLINE and EMBASE was performed from inception through May 2016. The inclusion criterion was the observational studies’ assessment of the association between WCHT and NT or SHT in adult subjects. European Society of Hypertension practice guidelines for ambulatory blood pressure (BP) monitoring was used to define WCHT (office BP≥140/90mmHg and daytime BP <135/85mmHg), and SHT (office BP≥140/90mmHg and daytime BP≥135/85mmHg). Aortic stiffness was assessed using Carotid-femoral pulse wave velocity (PWV) measurements. Pooled mean difference (MD) of PWV and 95% confidence interval (CI) were calculated using a random-effect, generic inverse variance method. Results: Data were extracted from 4 observational studies involving 2,413 subjects. PWV is not different in patients with WCHT compared with SHT (pooled MD= -0.25 m/sec; 95% CI, -0.81 to 0.30; P-value=0.37, I 2 =74%). PWV in WCHT is also not different when compared with PWV in NT (MD= 0.86 m/sec; 95% CI, -0.30 to 2.03; P-value=0.15, I 2 =97%). Conclusion: In a meta-analysis, we observe that arterial stiffness measured by pulse wave velocity is not different in patients with white-coat hypertension when compared with sustained hypertension or normotension.

scholarly journals Is there a need to redo many of the diagnoses of hypertension?

2012 ◽  
Vol 130 (3) ◽  
pp. 173-178
Author(s):  
José Marcos Thalenberg ◽  
Bráulio Luna Filho ◽  
Maria Teresa Nogueira Bombig ◽  
Yoná Afonso Francisco ◽  
Rui Manuel dos Santos Póvoa
Keyword(s):  
Blood Pressure ◽  
Drug Withdrawal ◽  
Blood Pressure Monitoring ◽  
Target Organ Damage ◽  
Diagnostic Procedures ◽  
White Coat ◽  
White Coat Hypertension ◽  
Masked Hypertension ◽  
Cross Sectional ◽  
Clinical Measurements

CONTEXT AND OBJECTIVE: Most hypertensive subjects undergoing treatment were diagnosed solely through measurements made in the consultation office. The objective of this study was to redo the diagnosis of treated patients after new clinical measurements and ambulatory blood pressure monitoring (ABPM). DESIGN AND SETTING: Cross-sectional study conducted in an outpatient specialty clinic. METHODS: Patients with mild-to-moderate hypertension or undergoing anti-hypertensive treatment, without target organ damage or diabetes, were included. After drug withdrawal lasting 2-3 weeks, new blood pressure (BP) measurements were made during two separate visits. ABPM was performed blindly, in relation to clinical measurements. The BP thresholds used for diagnosing hypertension, white-coat hypertension, normotension and masked hypertension were: 140 (systolic) and 90 (diastolic) mmHg for office measurements and 135 (systolic) and 85 (diastolic) mmHg for mean awake ABPM (MAA). RESULTS: Evaluations were done on 101 subjects (70% women); mean age 51 ± 10 years. The clinical BP was 155 ± 18/97 ± 10 mmHg (first visit) and 150 ± 16/94 ± 11 mmHg (second visit); MAA was 137 ± 13/ 86 ± 10 mmHg. Sixty-four patients (63%) were confirmed as hypertensive, 28 (28%) as white-coat hypertensive, nine (9%) as normotensive and none as masked hypertensive. After ABPM, 37% of the presumed hypertensive patients did not fit into this category. CONCLUSION: This study showed that hypertension was overdiagnosed among hypertensive subjects undergoing treatment. New diagnostic procedures should be performed after drug withdrawal, with the aid of BP monitoring.

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