PURPOSE OF REVIEW: The goal is to review masked hypertension (MH) as a relatively new phenomenon when patients have normal office BP but elevated out-of-office BP. Firstly, it was described in children in 2004. It has received increased attention in the past decade. RECENT FINDINGS: The prevalence of MH in different pediatric populations differs widely between 0 and 60% based on the population studied, definition of MH, or method of out-of-office BP measurement. The highest prevalence of MH has been demonstrated in children with chronic kidney disease (CKD), obesity, diabetes, and after heart transplantation. In healthy children but with risk factors for hypertension such as prematurity, overweight/obesity, diabetes, chronic kidney disease, or positive family history of hypertension, the prevalence of MH is 9%. In healthy children without risk factors for hypertension, the prevalence of MH is very low ranging 0-3%. In healthy children, only patients with the following clinical conditions should be screened for MH: high-normal/elevated office BP, positive family history of hypertension, and those referred for suspected hypertension who have normal office BP in the secondary/tertiary center.

• Keywords
• ABPM, Ambulatory blood pressure monitoring, BP, Blood pressure, LVH, Left ventricular hypertrophy, MH, Masked hypertension,
• MeSH
• Renal Insufficiency, Chronic * MeSH
• Child MeSH
• Hypertension * diagnosis   epidemiology   MeSH
• Humans MeSH
• Masked Hypertension * diagnosis   epidemiology   MeSH
• Adolescent MeSH
• Obesity MeSH
• Risk Factors MeSH
• Check Tag
• Child MeSH
• Humans MeSH
• Adolescent MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Review MeSH

BACKGROUND: High prevalence of arterial hypertension is known in pediatric renal transplant patients, but how blood pressure (BP) distribution and control differ between age groups and whether sex and age interact and potentially impact BP after transplantation have not been investigated. METHODS: This retrospective analysis included 336 pediatric renal transplant recipients (62% males) from the Cooperative European Pediatric Renal Transplant Initiative Registry (CERTAIN) with complete BP measurement at discharge and 1, 2 and 3 years post-transplant. RESULTS: At discharge and 3 years post-transplant, arterial hypertension was highly prevalent (84% and 77%); antihypertensive drugs were used in 73% and 68% of the patients. 27% suffered from uncontrolled and 9% from untreated hypertension at 3 years post-transplant. Children transplanted at age < 5 years showed sustained high systolic BP z-score and received consistently less antihypertensive treatment over time. Younger age, shorter time since transplantation, male sex, higher body mass index (BMI), high cyclosporine A (CSA) trough levels, and a primary renal disease other than congenital anomalies of the kidney and urinary tract (CAKUT) were significantly associated with higher systolic BP z-score. Sex-stratified analysis revealed a significant association between high CSA and higher systolic BP in older girls that likely had started puberty already. An association between BP and estimated glomerular filtration rate was not detected. CONCLUSIONS: BP control during the first 3 years was poor in this large European cohort. The description of age- and sex-specific risk profiles identified certain recipient groups that may benefit from more frequent BP monitoring (i.e. young children) or different choices of immunosuppression (i.e. older girls).

• Keywords
• Children, Cyclosporine, Hypertension, Immunosuppression, Kidney transplantation, Sex differences,
• MeSH
• Time Factors MeSH
• Cyclosporine administration & dosage   adverse effects   pharmacokinetics   MeSH
• Child MeSH
• Hypertension diagnosis   epidemiology   etiology   MeSH
• Immunosuppressive Agents administration & dosage   adverse effects   pharmacokinetics   MeSH
• Humans MeSH
• Longitudinal Studies MeSH
• Blood Pressure Determination statistics & numerical data   MeSH
• Adolescent MeSH
• Follow-Up Studies MeSH
• Child, Preschool MeSH
• Prevalence MeSH
• Transplant Recipients statistics & numerical data   MeSH
• Registries statistics & numerical data   MeSH
• Graft Rejection immunology   prevention & control   MeSH
• Retrospective Studies MeSH
• Sex Factors MeSH
• Tacrolimus administration & dosage   adverse effects   pharmacokinetics   MeSH
• Kidney Transplantation adverse effects   MeSH
• Age Factors MeSH
• Check Tag
• Child MeSH
• Humans MeSH
• Adolescent MeSH
• Male MeSH
• Child, Preschool MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Geographicals
• Europe epidemiology   MeSH
• Names of Substances
• Cyclosporine MeSH
• Immunosuppressive Agents MeSH
• Tacrolimus MeSH

BACKGROUND: Variable effects of steroid minimization strategies on blood pressure in pediatric renal transplant recipients have been reported, but data on the effect of steroid withdrawal on ambulatory blood pressure and circadian blood pressure rhythm have not been published so far. METHODS: In a prospective, randomized, multicenter study on steroid withdrawal in pediatric renal transplant recipients (n = 42) on cyclosporine, mycophenolate mofetil, and methylprednisolone, we performed a substudy in 28 patients, aged 11.2 ± 3.8 years, for whom ambulatory blood pressure monitoring (ABPM) data were available. RESULTS: In the steroid-withdrawal group, the percentage of patients with arterial hypertension, defined as systolic and/or diastolic blood pressure values recorded by ABPM > 1.64 SDS and/or antihypertensive medication, at month 15 was significantly lower (35.7%, p = 0.002) than in controls (92.9%). The need of antihypertensive medication dropped significantly by 61.2% (p < 0.000 vs. control), while in controls, it even rose by 69.3%. One year after steroid withdrawal, no patient exhibited hypertensive blood pressure values above the 95th percentile, compared to 35.7% at baseline (p = 0.014) and to 14.3% of control (p = 0.142). The beneficial impact of steroid withdrawal was especially pronounced for nocturnal blood pressure, leading to a recovered circadian rhythm in 71.4% of patients vs. 14.3% at baseline (p = 0.002), while the percentage of controls with an abnormal circadian rhythm (35.7%) did not change. CONCLUSIONS: Steroid withdrawal in pediatric renal transplant recipients with well-preserved allograft function is associated with less arterial hypertension recorded by ABPM and recovery of circadian blood pressure rhythm by restoration of nocturnal blood pressure dipping.

• Keywords
• Ambulatory blood pressure, Nocturnal blood pressure dipping, Pediatric renal transplantation, Randomized controlled trial, Steroid withdrawal,
• MeSH
• Allografts immunology   physiopathology   MeSH
• Blood Pressure Monitoring, Ambulatory MeSH
• Circadian Rhythm physiology   MeSH
• Cyclosporine administration & dosage   adverse effects   MeSH
• Child MeSH
• Glucocorticoids administration & dosage   adverse effects   MeSH
• Glomerular Filtration Rate physiology   MeSH
• Transplantation, Homologous adverse effects   MeSH
• Hypertension chemically induced   diagnosis   prevention & control   MeSH
• Immunosuppressive Agents administration & dosage   adverse effects   MeSH
• Blood Pressure drug effects   MeSH
• Mycophenolic Acid administration & dosage   adverse effects   MeSH
• Kidney immunology   physiopathology   MeSH
• Humans MeSH
• Methylprednisolone MeSH
• Adolescent MeSH
• Withholding Treatment * MeSH
• Prospective Studies MeSH
• Graft Rejection immunology   physiopathology   prevention & control   MeSH
• Kidney Transplantation adverse effects   MeSH
• Check Tag
• Child MeSH
• Humans MeSH
• Adolescent MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Randomized Controlled Trial MeSH
• Names of Substances
• Cyclosporine MeSH
• Glucocorticoids MeSH
• Immunosuppressive Agents MeSH
• Mycophenolic Acid MeSH
• Methylprednisolone MeSH