Impact of the 2022 Ambulatory Blood Pressure Monitoring Guidelines on Blood Pressure Phenotypes in Pediatric Kidney Transplant Recipients

Impact of the 2022 Ambulatory Blood Pressure Monitoring Guidelines on Blood Pressure Phenotypes in Pediatric Kidney Transplant Recipients | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Impact of the 2022 Ambulatory Blood Pressure Monitoring Guidelines on Blood Pressure Phenotypes in Pediatric Kidney Transplant Recipients Shanthi Sree Balani, Ruchi Gupta Mahajan, Yashwanth Gollapudi, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8563273/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 10 Mar, 2026 Read the published version in Pediatric Nephrology → Version 1 posted 5 You are reading this latest preprint version Abstract Background The American Academy of Pediatrics Clinical Practice Guidelines (AAPCPG) recommend 24-hour ambulatory blood pressure monitoring (ABPM) for diagnosing hypertension (HTN) in pediatric kidney transplant recipients. The ABPM guidelines were updated in 2022 to incorporate the 2017 AAPCPG thresholds for those ≥ 13 years and exclude blood pressure loads. The effect of the 2022 update on ABPM phenotype and its association with end-organ damage in this population remains unexplored. Method We retrospectively evaluated pediatric kidney transplant recipients (age < 22 years) who underwent 24-hour ABPM for HTN surveillance between 1/2021 and 9/2024. We grouped ABPM phenotypes into two categories: HTN (masked, ambulatory, and 2014-specific severe ambulatory) and no HTN (normal, white-coat, and 2014-specific uncategorized). We assessed systematic differences between the two guidelines using McNemar’s test and agreement using Cohen’s Kappa coefficient. Results Our cohort included 105 recipients. Compared to 2014, the 2022 guidelines identified more recipients with HTN (49.5% vs 36.2%; McNemar’s p < 0.001); however, the overall agreement remained substantial (kappa: 0.73, 95% CI: 0.61, 0.86). Among the 10 recipients with elevated ambulatory arterial stiffness index (AASI), the 2022 guidelines identified 80.0% as abnormal compared to only 30.0% under the 2014 guidelines (McNemar’s p = 0.025), reflecting no significant agreement (Kappa: 0.19; 95% CI: -0.1, 0.49). Conclusion Compared to the 2014 criteria, the 2022 guidelines identified a higher proportion of pediatric kidney transplant recipients with HTN and more effectively identified abnormalities in recipients with elevated AASI. Our findings indicate that 2022 guidelines are better aligned with markers of arterial stiffness and cardiovascular risk. pediatric kidney transplantation ambulatory blood pressure monitoring hypertension pediatric hypertension AAP hypertension guidelines Introduction Kidney transplantation is the treatment of choice for children with end-stage kidney disease. However, despite improvements in patient and graft survival, transplantation is associated with significant morbidity and mortality. Hypertension is a prevalent comorbidity among pediatric kidney transplant recipients, with an estimated prevalence of 58–89%[ 1 ]. It is associated with increased mortality, likely mediated by early-onset cardiovascular and cerebrovascular disease[ 1 ], and is an independent predictor of kidney graft failure across all age groups[ 1 – 3 ]. A timely and accurate diagnosis with effective management is necessary to optimize the long-term outcomes of kidney transplant recipients. The American Academy of Pediatrics Clinical Practice Guidelines (AAP CPG) for Screening and Managing Hypertension in Children and Adolescents recommend 24-hour ambulatory blood pressure monitoring (ABPM) to confirm hypertension in children with elevated clinic blood pressures[ 4 , 5 ]. This recommendation is based on several proven benefits of ABPM compared to clinic measurements. ABPM provides more precise therapeutic targets for delaying the progression of chronic kidney disease (CKD) in children[ 6 ]. Furthermore, the ABPM-identified BP abnormalities in children are associated with end-organ damage, including alterations in carotid intima-media thickness (cIMT) and pulse wave velocity, left ventricular hypertrophy (LVH), and changes in neurocognition[ 7 ]. Studies in pediatric kidney transplantation also indicate that ABPM (2014 guidelines) outperforms clinic blood pressure measurements in predicting end-organ damage[ 8 ]. The AAP CPG recommends using ABPM in all kidney transplant recipients, irrespective of clinic blood pressure measurements, due to its ability to identify nocturnal and masked hypertension (MH)[ 9 ]. Until recently, ABPM was interpreted according to the 2014 ABPM guidelines, which recommend diagnosing hypertension based on mean ambulatory blood pressure (ABP) and ambulatory BP load (proportion of ABP readings > 95th percentile)[ 5 ]. However, the 2014 guidelines had limitations, frequently resulting in an 'unclassified' category for patients. Furthermore, the 2014 guidelines preceded the 2017 AAP CPG, which introduced static thresholds for hypertension for children ≥ 13 years (blood pressure < 130/80 mmHg), adapted from the 2017 American Heart Association (AHA) guidelines for adults. Therefore, the ABPM guidelines were revised in 2022 to incorporate the 2017 AAP CPG thresholds for hypertension for children 13 years and older. Additionally, based on the recent Chronic Kidney Disease in Children (CKid) and the SHIP AHOY studies, which showed no association between BP loads and end-organ damage[ 2 , 10 , 11 ], BP loads were excluded from ABPM interpretation[ 12 ]. The ABP phenotypes of pediatric kidney transplant recipients under the 2022 ABPM guidelines have not been explored. Additionally, the association between the 2022 ABP phenotype and end-organ damage in pediatric kidney transplant recipients is unknown. This study aimed to evaluate the ABP phenotype of pediatric kidney transplant recipients according to the revised 2022 ABPM guidelines and compare it to the phenotype based on the 2014 guidelines. The study also examined the association between ABP phenotype and end-organ damage. Given the static threshold for children aged 13 years and older, we hypothesized a higher prevalence of ambulatory hypertension under the 2022 guidelines compared to the 2014 guidelines. To our knowledge, this is the first pediatric study to characterize ABP in kidney transplant recipients using the new guidelines. Methods The Institutional Review Board (IRB) at the University of Minnesota approved this study (STUDY00017370). Study population We retrospectively identified all pediatric kidney transplant recipients (age < 22 years) who successfully completed 24-hour ABPM for hypertension surveillance per the institutional protocol at the University of Minnesota between 1/2021 and 9/2024. The ABPM protocol was introduced at our center in January 2020. It required all pediatric kidney transplant recipients with heights greater than 120 cm to undergo annual ABPM studies for the surveillance of hypertension starting 12 months post-transplant, regardless of their hypertension history. Study variables We used data from a prospectively maintained, IRB-approved, solid organ transplant registry at the University of Minnesota. The transplant database contains post-transplant, peri-transplant, and minimal pre-transplant data on recipients and donors. Information on demographics, pre-transplant comorbidities, transplant surgery variables, post-transplant complications, and outcomes is captured via manual chart abstraction and electronic data transfer from the electronic medical record. The variables not available in the registry were abstracted directly from electronic medical records. We examined the following variables: demographic characteristics, pre-transplant dialysis status (yes/no), donor source (living or deceased), body mass index (BMI) (calculated as weight in kilograms divided by height in meters squared), underlying cause of kidney failure, and ABP phenotype. Echocardiograms were ordered per the physicians’ discretion, and echocardiograms completed within 6 months of the ABPM study were included. Elevated left ventricular mass index (LVMI) was defined as LVMI > 95th percentile for age and sex[ 13 ]. Ambulatory arterial stiffness index (AASI) calculated by Spacelabs sentinel report was used and considered elevated if greater than 0.5[ 14 ]. ABP phenotype The 2014 and the 2022 AHA pediatric ABPM guidelines are presented in Table 1 [ 5 , 15 ]. Normotension was defined as normal clinic blood pressure and normal ABPM results. Ambulatory hypertension was defined as elevated clinic blood pressure and abnormal ABPM. White coat hypertension was defined as elevated clinic blood pressure but normal ABPM results. Masked hypertension was indicated by normal clinic blood pressure but abnormal ABPM results. We defined isolated nocturnal hypertension (INH) as normal daytime blood pressure but elevated nocturnal blood pressure, and isolated diastolic hypertension as elevated diastolic blood pressure but normal systolic blood pressure. Table 1 Classification of Hypertension based on 2022 updated criteria vs 2014 criteria 2022 ABPM guidelines 2014 ABPM guidelines Category Clinic systolic or diastolic blood pressure* Mean ambulatory SBP or DBP Office BP Mean ambulatory SBP or DBP SBP or DBP Load % < 13 y of age ≥ 13 y of age < 13 y of age ≥ 13 y of age Normal Blood pressure < 95th percentile < 130/80 < 95th percentile OR adolescent cut points* < 125/75 mm Hg 24-h AND < 130/80 mm Hg wake AND < 110/65 mm Hg sleep < 90%th percentile < 95%th percentile < 25 White coat Hypertension ≥ 95th percentile ≥ 130/80 ≥ 95th percentile < 95%th percentile < 25 Masked Hypertension < 95th percentile < 130/80 ≥ 95th percentile OR adolescent cut points* ≥ 125/75 mm Hg 24-h OR ≥ 130/80 mm Hg wake OR ≥ 110/65 mm Hg sleep 95%th percentile ≥ 25 Ambulatory Hypertension ≥ 95th percentile ≥ 130/80 > 95th percentile > 95%th percentile 25–50 Prehypertension > 95th percentile 95th percentile > 95%th percentile > 50 Under normal circumstances, BP drops by 10% to 20% during sleep, a phenomenon referred to as dipping. We defined ‘non-dipping’ or ‘blunted dipping’ as a < 10% decrease in BP during sleep and defined ‘reversed-dipping’ as a higher mean sleep BP compared to the mean wake BP[ 5 ]. We defined pre-existing hypertension as the use of antihypertensive agents for blood pressure regulation at the time of ABPM. Statistical analysis Data are summarized as medians with interquartile ranges (IQRs) and proportions. We compared continuous and categorical variables between patients with and without BP abnormalities using the Wilcoxon rank sum and Fisher’s exact tests. To compare the 2014 and 2022 guidelines, ABPM phenotypes were grouped into two categories: hypertension (masked, ambulatory, and 2014-specific severe ambulatory) and no hypertension (normal, white-coat, and 2014-specific uncategorized). Systematic differences in classification were assessed using McNemar’s test, and concordance was quantified using Cohen’s Kappa coefficient. These analyses were conducted for the total cohort and for a subgroup of patients with an elevated AASI, defined as > 0.5. Statistical analyses were performed using SAS software, version 9.4 (SAS Institute Inc., Cary, NC). A two-sided P < .05 was considered statistically significant. Results Our cohort included 105 recipients with a median duration since transplant at the time of ABPM of 5.26 years (IQR: 2.12, 8.81). At the time of the study, 76 recipients were on antihypertensive medications for existing hypertension, while 29 had no history of hypertension. According to the 2022 guidelines, 52 recipients (49.5%) were identified as having blood pressure abnormalities (AH and MH); this included 12 recipients with new-onset hypertension and 40 with poorly controlled, pre-existing hypertension. When combined with the 36 recipients whose hypertension was well-controlled on medication, the overall prevalence of hypertension in our cohort was 83.8% (n = 88). Baseline characteristics Table 2 presents the demographic and baseline clinical characteristics of pediatric kidney transplant recipients with and without blood pressure abnormalities on ABPM, according to the 2022 guidelines. Abnormal ABPM (AH, MH) was significantly more common in recipients older at transplant (median: 11.8 vs 6.1; p = 0.002). Abnormal ABPM was also more prevalent in the group maintained on tacrolimus and mycophenolate compared to those on other maintenance immunosuppression combinations (p = 0.06). We observed no differences between recipients with abnormal ABPM (n = 52) and those with normal ABPM (n = 53) regarding sex (p = 0.71), racial distribution (p = 0.48), donor source (p = 0.91), and the cause of kidney failure (p = 0.42). Table 2 Demographic and baseline characteristics by ambulatory hypertension per the 2022 guidelines Variables Ambulatory HTN on ABPM* N = 52 No ambulatory HTN on ABPM* N = 53 P value Age at transplant Median (IQR) 11.8 (6.5, 15.8) 6.1 (2.6, 12.5) 0.002 Age at ABPM Median (IQR) 16.4 (14.0, 19.4) 14.5 (10.7, 16.4) 0.002 Sex Male n (%) 38 (73.1) 37 (69.8) 0.71 Race n (%) White Black Asian Native American 37 (71.1) 4 (7.7) 5 (9.6) 6 (11.5) 38 (71.7) 8 (15.1) 4 (7.5) 3 (5.7) 0.48 Deceased donor transplant n (%) 23 (44.2) 24 (45.3) 0.91 BMI percentile Median (IQR) 80.8(60.6, 94.7) 72.3 (46.4, 94.3) 0.61 Primary disease n (%) CAKUT Non-CAKUT 25 (51.0) 24 (49.0) 29 (59.2) 20 (40.8) 0.42 CSA/MMF CSA/MMF/steroids CSA/Aza CSA/Aza/steroids other Tac/MMF Tac/MMF/steroids Tac/Aza Tac/Aza/steroids 2 (3.8) 3 (5.8) 2 (3.8) 1 (1.9) 2 (3.8) 23 (44.2) 9 (17.3) 4 (7.7) 6 (11.5) 0 (0.0) 1 (1.9) 1 (1.9) 5 (9.4) 10 (18.9) 16 (30.2) 6 (11.3) 4 (7.5) 10 (18.9) 0.06 ABP phenotype (2022 guidelines) Entire cohort Table 3 presents the ABP phenotype of the study cohort according to the 2022 guidelines. AH and MH were seen in 21% and 29.5% of the cohort, respectively. White coat hypertension, or white coat effect (in those with pre-existing hypertension), was observed in 7.6% of recipients, while isolated nocturnal hypertension and isolated diastolic hypertension were observed in 35.2% and 12.4%, respectively. Furthermore, 53.3% of the recipients displayed blunted dipping, and another 8.6% showed reverse dipping. Table 3 Prevalence and characteristics of post-transplant ambulatory hypertension 2022 Prevalence All N = 105 On antihypertensive medication(s) at the time of ABPM* N = 76 No prior diagnosis of hypertension** N = 29 Ambulatory hypertension (abnormal ABPM and abnormal clinic BP) 21 (20.0%) 16(21.1%) 5(17.2%) Masked hypertension (abnormal ABPM but normal clinic BP) 31 (29.5%) 24(31.6%) 7(24.1%) Normal 45 (42.8) 31 (40.8) 14 (48.3) White coat hypertension or white coat effect (normal ABPM but abnormal clinic BP) 8(7.6%) 5(6.6%) 3(10.3%) Isolated nocturnal hypertension 37 (35.2%) 28 (36.8%) 9(31.0%) Isolated diastolic hypertension 13 (12.4%) 11 (14.5%) 2 (6.9%) Blunted nocturnal dipping 56 (53.3%) 42 (55.3%) 14 (48.3%) Reverse dipping 9 (8.6%) 6 (7.9%) 3 (10.3) *Indicates hypertension control among those with a known history of hypertension Recipients with pre-existing hypertension AH was observed in 21.1%, and MH was seen in 31.6% of the recipients already on medications for hypertension, indicating poor control. Additionally, the white-coat effect was observed in 6.6% of recipients with pre-existing hypertension. 2022 versus 2014 guidelines Table 4 compares ABP phenotypes according to the 2022 vs. the 2014 guidelines. Table 4: The 2022 versus the 2014 Ambulatory Blood Pressure Phenotypes Compared to the 2014 guidelines, the 2022 guidelines identified a higher number of pediatric recipients with AH (20.0% (n = 21) vs 14.3% (n = 15)) and MH (29.5% (n = 31) vs 21.9% (n = 23)). Overall, the prevalence of hypertension was significantly higher using the 2022 criteria compared to the 2014 criteria (49.5% vs. 36.2%; McNemar’s p < 0.001). Despite the increased sensitivity of the newer guidelines, the overall agreement between the two standards remained substantial (kappa statistic: 0.73, 95% CI: 0.61, 0.86). Of the 44 recipients with normal ABPM according to the 2014 guidelines, 6 recipients had abnormal ABPM (AH = 3, MH = 3) according to the 2022 guidelines. Additionally, of the 16 recipients who were uncategorized under the 2014 guidelines (elevated loads only), 3 were classified as AH and 5 as MH under the 2022 guidelines. 2022 vs. 2014 ABP phenotypes by age Among recipients aged ≥ 13 years, the 2022 guidelines identified a higher proportion of AH (23.0% [n = 17] vs. 14.9% [n = 11]) and MH (33.8% [n = 25] vs. 23.0% [n = 17]) compared to the 2014 guidelines. This difference was primarily driven by recipients labeled as ‘uncategorized’ under the 2014 guidelines; of the 16 uncategorized recipients in the entire cohort, 13 (81.2%) were in the ≥ 13 age group. Under the 2022 guidelines, 8 (61.5%) of these 13 recipients were reclassified as AH (n = 3) or MH (n = 5). Overall, the prevalence of hypertension among recipients aged ≥ 13 years was significantly higher using the 2022 criteria compared to the 2014 criteria (56.76% vs. 37.84%; McNemar’s p < 0.001). Despite these differences, the overall agreement between the two guidelines in identifying hypertension for the recipients aged ≥ 13 years was substantial (kappa: 0.63, 95% CI: 0.47, 0.79). In contrast, there was almost perfect agreement between the 2022 and 2014 guidelines for recipients aged < 13 years (kappa: 1.0, 95% CI: 1.0, 1.0). In this younger group, both guidelines identified 4 recipients with AH (3 with ambulatory and 1 with severe ambulatory under 2014) and 6 with MH. Furthermore, the three younger recipients who were uncategorized per the 2014 guidelines were all diagnosed as normal per the 2022 guidelines. Ambulatory hypertension and target organ injury Of the 47 recipients who underwent echocardiogram, elevated LVMI was found in 17 (36.2%). The association between hypertension (existing and new-onset according to the 2022 guidelines) and elevated LVMI approached statistical significance (hypertension vs no hypertension: 41.5% vs. 0.0%; p = 0.07). Ten recipients had an elevated AASI. Among these, the 2022 guidelines identified 8 (80%) with abnormal ABPM phenotypes compared to only 3 (30%) under the 2014 guidelines (McNemar’s p = 0.025). Overall, the agreement between the 2014 and 2022 guidelines in identifying blood pressure abnormalities in recipients with elevated AASI was poor and statistically non-significant (Kappa: 0.19; 95% CI: -0.1, 0.49). Discussion This is the first study to examine the prevalence of hypertension in pediatric kidney transplant recipients using the revised 2022 AHA guidelines and to compare the 2022 ABP phenotype with the 2014 ABP phenotype. The overall prevalence of hypertension using the 2022 guidelines was 84%, which is consistent with the previously reported prevalence in pediatric kidney recipients, ranging from 58% to 89% [ 1 ]. Using the 2022 criteria, we identified a significantly higher prevalence of AH and MH compared to the 2014 guidelines, particularly among recipients aged ≥ 13 years. We observed significant rates of masked hypertension (30%) and isolated nocturnal hypertension (35%), diagnoses that cannot be ascertained using clinic blood pressure measurements. Furthermore, the 2022 guidelines demonstrated greater sensitivity in identifying recipients with elevated arterial stiffness (AASI), underscoring the clinical utility of the updated criteria. Our study findings highlight the burden of hypertension in pediatric kidney transplant recipients and indicate the necessity of routine surveillance using 24-hour ABPM. Although there was a substantial agreement between the 2022 and 2014 guidelines in identifying hypertension (kappa: 0.73), the 2022 guidelines classified a higher proportion of recipients as hypertensive (p < 0.001). The 2022 guidelines captured every recipient identified as abnormal by the 2014 criteria, while also diagnosing an additional 11.4% with AH and 7.6% with MH. Notably, this included six recipients who had previously been classified as normal under the 2014 thresholds. These findings are similar to the 11% increase in AH reported in a Canadian study comparing the 2022 guidelines to the 2014 AHA and 2016 ESH guidelines in the general pediatric population[ 16 ]. The present study is the first study to evaluate this diagnostic shift in pediatric kidney transplant recipients specifically. One of the significant updates in the revised 2022 ABPM guidelines was the recommendation to use static, adult-aligned blood pressure thresholds for adolescents aged 13 and older, consistent with the 2017 AAP CPG. Unsurprisingly, the shift in diagnostic criteria primarily affected the older age group; we observed a significantly higher proportion of AH and MH diagnoses in recipients ≥ 13 years using the 2022 guidelines. However, we observed no difference in AH or MH when we applied the two guidelines to the younger age group. These findings align with previous reports from the SHIP-AHOY and CKiD cohorts, which demonstrated significantly increased AH prevalence when using adult rather than pediatric cutoffs for older children (26.9% vs. 16.9% and 44% vs. 27%, respectively)[ 2 , 17 ]. We observed a high prevalence of masked hypertension (MH) in our cohort, which increased from 21.9% under the 2014 guidelines to 29.5% using the 2022 guidelines. MH was also present in 23.6% of recipients already receiving antihypertensive therapy, indicating undertreated hypertension. Our results align with a study by Hamdani et al.,[ 18 ] which identified MH in 38% of pediatric kidney transplant recipients using 2014 criteria. These findings are also consistent with a systematic review and meta-analysis of pediatric and young adult populations (ages 4–25 years), which found that while the prevalence of MH in the general population is 10.4%, it is significantly higher in children with chronic kidney disease (RR: 2.44) and solid organ transplant recipients (RR: 2.34)[ 19 ]. The clinical significance of these findings is underscored by the association between MH and adverse outcomes, including lower estimated glomerular filtration rates[ 18 ], increased left ventricular hypertrophy, and elevated pulse wave velocity [ 19 ]. Since masked hypertension remains undetectable via clinic measurements and occurs at a high rate even in patients on antihypertensive medications, it is important for pediatric kidney transplant recipients to undergo routine ABPM testing. The prevalence of isolated nocturnal hypertension in our cohort (35.2% overall and 36.8% for those on therapy) aligns with reported estimates of 30% to 40% in pediatric kidney transplant recipients[ 20 ]. Similar to masked hypertension, isolated nocturnal hypertension is clinically significant due to its association with cardiovascular abnormalities in patients with CKD, including LVH and increased cIMT [ 21 ]. Furthermore, the observed rates of blunted nocturnal dipping (61.9%) and reverse dipping (8.6%) are consistent with previous reports documenting abnormal dipping in 30%–72% of transplanted children[ 22 ]. Isolated diastolic hypertension was seen in 12% of our cohort, with a large majority (84.6%; n = 11/13) of them representing poorly controlled hypertension. However, it may be an underestimation of the true prevalence as ABPM devices performed less reliably for diastolic compared to systolic measurements in validation studies[ 23 ]. The lack of variability in diastolic measurements in the ABPM normative data also suggests limited performance of ABPM for diastolic measurements[ 24 ]. We observed white coat hypertension in 7.6% of the entire cohort and white coat effect in 6.5% of those on anti-hypertensive therapy. The relatively lower prevalence of white coat hypertension in pediatric kidney recipients compared to the general pediatric population (30–40%)[ 25 ] is likely related to the overall high incidence of hypertension in transplant recipients. However, the white coat effect in 6.5% of patients with existing hypertension indicates the role of ABPM in preventing unnecessary escalation of antihypertensive therapy, which could result in clinically significant hypotension and potential graft hypoperfusion. In our cohort, more than a third of recipients who underwent echocardiography demonstrated elevated LVMI, underscoring the substantial burden of cardiovascular end-organ damage in this population. The high prevalence of elevated LVMI in the hypertensive (pre-existing and new-onset) versus normotensive recipients suggests a clinically relevant relationship, even though it did not reach statistical significance, likely due to the limited sample size. Additionally, the majority of recipients with elevated AASI were classified as abnormal ABP under the revised 2022 ABPM guidelines compared with the 2014 guidelines, highlighting the updated recommendations' increased sensitivity in detecting vascular stiffness, which is closely linked to adverse cardiovascular remodeling. Our findings are consistent with those of a pediatric cross-sectional study conducted at a tertiary care outpatient hypertension clinic, which found that only the 2022 guideline significantly predicted elevated AASI (odds ratio: 2.4; p = 0.02)[ 16 ]. Our study had several limitations. Our sample size was small, limiting our ability to examine the association between ABP phenotype and LVH. Since the prevalence of hypertension varies with the length of posttransplant follow-up, our results may be an underestimation of the prevalence of abnormal blood pressure patterns within the first year posttransplant and an overestimation for patients who are several years posttransplant. Despite its limitations, this study is important as it describes the ABP phenotype using the newer guidelines and underscores the burden of hypertension in this population, emphasizing the need for routine ABPM to diagnose masked and isolated nocturnal hypertension. To conclude, abnormal blood pressure patterns are highly prevalent in pediatric kidney transplant recipients. Our study demonstrated significantly higher prevalence of all ABP phenotypes under the 2022 guidelines compared to the 2014 guidelines. Furthermore, the significantly high prevalence of MH and isolated nocturnal hypertension, regardless of prior diagnosis, indicates that clinic blood pressures alone are insufficient to diagnose new-onset hypertension or to ensure treatment adequacy. The increased identification of ABPM abnormalities in those with elevated AASI using the 2022 guidelines underscores its role in identifying patients with increased cardiovascular risk. Based on our findings, we suggest that transplant centers consider incorporating 24-hour ABPM into standard protocols to optimize the diagnosis and management of hypertension in the pediatric kidney transplant population. Declarations Authors Shanthi Sree Balani 1 ; Ruchi Gupta Mahajan 2 ; Yashwanth Gollapudi 3 ; Anjalin Sebastian 1 ; Michael Evans 5 ; Sarah Javed Kizilbash 1 Declarations The authors have no competing interests to declare that are relevant to the content of this article. Disclosure: AI-assisted tools were used exclusively for language improvement and stylistic editing. All scientific content, data analysis, and clinical interpretations were produced solely by the authors, who take full responsibility for the integrity of the final manuscript. References Seeman T, Myette RL, Feber J (2023) Hypertension in pediatric kidney transplantation. Pediatr Transpl 27:e14522 Hamdani G, Mitsnefes MM, Flynn JT, Becker RC, Daniels S, Falkner BE, Ferguson M, Hooper SR, Hanevold CD, Ingelfinger JR, Lande M, Martin LJ, Meyers KE, Rosner B, Samuels J, Urbina EM (2021) Pediatric and Adult Ambulatory Blood Pressure Thresholds and Blood Pressure Load as Predictors of Left Ventricular Hypertrophy in Adolescents. Hypertension 78:30–37 Group ET, Wuhl E, Trivelli A, Picca S, Litwin M, Peco-Antic A, Zurowska A, Testa S, Jankauskiene A, Emre S, Caldas-Afonso A, Anarat A, Niaudet P, Mir S, Bakkaloglu A, Enke B, Montini G, Wingen AM, Sallay P, Jeck N, Berg U, Caliskan S, Wygoda S, Hohbach-Hohenfellner K, Dusek J, Urasinski T, Arbeiter K, Neuhaus T, Gellermann J, Drozdz D, Fischbach M, Moller K, Wigger M, Peruzzi L, Mehls O, Schaefer F (2009) Strict blood-pressure control and progression of renal failure in children. N Engl J Med 361:1639–1650 Flynn JT, Kaelber DC, Baker-Smith CM, Blowey D, Carroll AE, Daniels SR, de Ferranti SD, Dionne JM, Falkner B, Flinn SK, Gidding SS, Goodwin C, Leu MG, Powers ME, Rea C, Samuels J, Simasek M, Thaker VV, Urbina EM (2017) Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents. Pediatrics 140. Flynn JT, Daniels SR, Hayman LL, Maahs DM, McCrindle BW, Mitsnefes M, Zachariah JP, Urbina EM, American Heart Association, Atherosclerosis H, Obesity in Youth Committee of the Council on Cardiovascular Disease in the Y (2014) Update: ambulatory blood pressure monitoring in children and adolescents: a scientific statement from the American Heart Association. Hypertension 63:1116–1135 Group ET (2009) Strict blood-pressure control and progression of renal failure in children. N Engl J Med 361:1639–1650 Hamdani G, Mitsnefes MM, Flynn JT, Becker RC, Daniels S, Falkner BE, Ferguson M, Hooper SR, Hanevold CD, Ingelfinger JR (2021) Pediatric and adult ambulatory blood pressure thresholds and blood pressure load as predictors of left ventricular hypertrophy in adolescents. Hypertension 78:30–37 Pisano A, Mallamaci F, D’Arrigo G, Bolignano D, Wuerzner G, Ortiz A, Burnier M, Kanaan N, Sarafidis P, Persu A (2021) Blood pressure monitoring in kidney transplantation: a systematic review on hypertension and target organ damage. Nephrol Dialysis Transplantation 36:1326–1346 Flynn JT, Kaelber DC, Baker-Smith CM, Blowey D, Carroll AE, Daniels SR, de Ferranti SD, Dionne JM, Falkner B, Flinn SK, Gidding SS, Goodwin C, Leu MG, Powers ME, Rea C, Samuels J, Simasek M, Thaker VV, Urbina EM, Subcommittee On S (2017) Management Of High Blood Pressure In C Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents. Pediatrics 140 Pisano A, Mallamaci F, D'Arrigo G, Bolignano D, Wuerzner G, Ortiz A, Burnier M, Kanaan N, Sarafidis P, Persu A, Ferro CJ, Loutradis C, Boletis IN, London G, Halimi JM, Sautenet B, Rossignol P, Vogt L, Zoccali C (2021) Blood pressure monitoring in kidney transplantation: a systematic review on hypertension and target organ damage. Nephrol Dial Transpl 36:1326–1346 Lee J, McCulloch CE, Flynn JT, Samuels J, Warady BA, Furth SL, Seth D, Grimes BA, Mitsnefes MM, Ku E (2020) Prognostic Value of Ambulatory Blood Pressure Load in Pediatric CKD. Clin J Am Soc Nephrol 15:493–500 Flynn JT, Urbina EM, Brady TM, Baker-Smith C, Daniels SR, Hayman LL, Mitsnefes M, Tran A, Zachariah JP (2022) Ambulatory Blood Pressure Monitoring in Children and Adolescents: 2022 Update: A Scientific Statement From the American Heart Association. Hypertension 79:e114–e124 Khoury PR, Mitsnefes M, Daniels SR, Kimball TR (2009) Age-specific reference intervals for indexed left ventricular mass in children. J Am Soc Echocardiogr 22:709–714 Li Y, Wang JG, Dolan E, Gao PJ, Guo HF, Nawrot T, Stanton AV, Zhu DL, O'Brien E, Staessen JA (2006) Ambulatory arterial stiffness index derived from 24-hour ambulatory blood pressure monitoring. Hypertension 47:359–364 Flynn JT, Urbina EM, Brady TM, Baker-Smith C, Daniels SR, Hayman LL, Mitsnefes M, Tran A, Zachariah JP, Atherosclerosis H, Obesity in the Young Committee of the American Heart Association Council on Lifelong Congenital Heart D, Heart Health in the Y, Council on Cardiovascular R, Intervention L, Cardiometabolic H (2022) Ambulatory Blood Pressure Monitoring in Children and Adolescents: 2022 Update: A Scientific Statement From the American Heart Association. Hypertension 79:e114-e124 Sharma AP, Kirpalani A, Sharma A, Altamirano-Diaz L, Filler G, Norozi K (2023) Impact of the 2022 American Heart Association pediatric ambulatory blood pressure monitoring statement on the diagnosis of hypertension. Pediatr Nephrol 38:2741–2751 Black E, Lee J, Flynn JT, McCulloch CE, Samuels JA, Seth D, Warady B, Furth S, Mitsnefes M, Ku E (2022) Discordances between pediatric and adult thresholds in the diagnosis of hypertension in adolescents with CKD. Pediatr Nephrol 37:179–188 Hamdani G, Nehus EJ, Hooper DK, Mitsnefes MM (2016) Masked hypertension and allograft function in pediatric and young adults kidney transplant recipients. Pediatr Transpl 20:1026–1031 Chung J, Robinson C, Sheffield L, Paramanathan P, Yu A, Ewusie J, Sanger S, Mitsnefes M, Parekh RS, Sinha MD, Rodrigues M, Thabane L, Dionne J, Chanchlani R (2023) Prevalence of Pediatric Masked Hypertension and Risk of Subclinical Cardiovascular Outcomes: A Systematic Review and Meta-Analysis. Hypertension 80:2280–2292 Morgan H, Khan I, Hashmi A, Hebert D, McCrindle BW, Balfe JW (2001) Ambulatory blood pressure monitoring after renal transplantation in children. Pediatr Nephrol 16:843–847 Düzova A, Bayazit AK, Canpolat N, Niemirska A, Bulut IK, Azukaitis K, Karagoz T, Oguz B, Erdem S, Anarat A (2019) Isolated nocturnal and isolated daytime hypertension associate with altered cardiovascular morphology and function in children with chronic kidney disease: findings from the Cardiovascular Comorbidity in Children with Chronic Kidney Disease study. J Hypertens 37:2247–2255 Seeman T, Myette RL, Feber J (2023) Hypertension in pediatric kidney transplantation. Pediatr Transplant 27:e14522 Duncombe SL, Voss C, Harris KC (2017) Oscillometric and auscultatory blood pressure measurement methods in children: a systematic review and meta-analysis. J Hypertens 35:213–224 Wühl E, Witte K, Soergel M, Mehls O, Schaefer F, Hypertension GWGP (2002) Distribution of 24-h ambulatory blood pressure in children: normalized reference values and role of body dimensions. J Hypertens 20:1995–2007 Seeman T (2012) Ambulatory blood pressure monitoring in pediatric renal transplantation. Curr Hypertens Rep 14:608–618 Cite Share Download PDF Status: Published Journal Publication published 10 Mar, 2026 Read the published version in Pediatric Nephrology → Version 1 posted Editorial decision: Major Revisions Needed 20 Jan, 2026 Reviewers agreed at journal 12 Jan, 2026 Reviewers invited by journal 12 Jan, 2026 Editor assigned by journal 12 Jan, 2026 First submitted to journal 09 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8563273","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":573451309,"identity":"cda77c9c-887c-4f91-90d1-690c759e6db9","order_by":0,"name":"Shanthi Sree Balani","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAsklEQVRIiWNgGAWjYDACCQbGA0BSDsJjI04LA0iLMclaGBIbiNYiP7v5wYGfOyzSN1w7e4DhQ9lhwloM7hwzONh7RiJ3w+28BMYZ54jRIpFgcIC3DaQlx4CZt40ILfIz0j8c/NsmkW4A0vKXGC0MN3IMDgNtSQBrYSRGi8GdMwWHZdskDGcCtRzsOZdOhMNmt298+LatTp7vdo7hgx9l1kQ4DBkcIFH9KBgFo2AUjAJcAACa9D7tRQ2q9gAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0009-0005-7209-0687","institution":"University of Minnesota Medical Center: M Health Fairview University of Minnesota Medical Center East Bank","correspondingAuthor":true,"prefix":"","firstName":"Shanthi","middleName":"Sree","lastName":"Balani","suffix":""},{"id":573451310,"identity":"c76d4fc1-05f1-4678-8669-eaf91af95732","order_by":1,"name":"Ruchi Gupta Mahajan","email":"","orcid":"","institution":"Levine Children's 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12:42:23","extension":"html","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":126300,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8563273/v1/6198624af5797f672ff896b7.html"},{"id":104739585,"identity":"f182568d-7d82-45b7-a552-7e275d991bf4","added_by":"auto","created_at":"2026-03-16 16:09:47","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1014052,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8563273/v1/fd0e75c4-0b36-43e2-a3e6-98c7eca6ad05.pdf"}],"financialInterests":"","formattedTitle":"Impact of the 2022 Ambulatory Blood Pressure Monitoring Guidelines on Blood Pressure Phenotypes in Pediatric Kidney Transplant Recipients","fulltext":[{"header":"Introduction","content":"\u003cp\u003eKidney transplantation is the treatment of choice for children with end-stage kidney disease. However, despite improvements in patient and graft survival, transplantation is associated with significant morbidity and mortality. Hypertension is a prevalent comorbidity among pediatric kidney transplant recipients, with an estimated prevalence of 58\u0026ndash;89%[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. It is associated with increased mortality, likely mediated by early-onset cardiovascular and cerebrovascular disease[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], and is an independent predictor of kidney graft failure across all age groups[\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. A timely and accurate diagnosis with effective management is necessary to optimize the long-term outcomes of kidney transplant recipients.\u003c/p\u003e \u003cp\u003eThe American Academy of Pediatrics Clinical Practice Guidelines (AAP CPG) for Screening and Managing Hypertension in Children and Adolescents recommend 24-hour ambulatory blood pressure monitoring (ABPM) to confirm hypertension in children with elevated clinic blood pressures[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. This recommendation is based on several proven benefits of ABPM compared to clinic measurements. ABPM provides more precise therapeutic targets for delaying the progression of chronic kidney disease (CKD) in children[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Furthermore, the ABPM-identified BP abnormalities in children are associated with end-organ damage, including alterations in carotid intima-media thickness (cIMT) and pulse wave velocity, left ventricular hypertrophy (LVH), and changes in neurocognition[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Studies in pediatric kidney transplantation also indicate that ABPM (2014 guidelines) outperforms clinic blood pressure measurements in predicting end-organ damage[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The AAP CPG recommends using ABPM in all kidney transplant recipients, irrespective of clinic blood pressure measurements, due to its ability to identify nocturnal and masked hypertension (MH)[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eUntil recently, ABPM was interpreted according to the 2014 ABPM guidelines, which recommend diagnosing hypertension based on mean ambulatory blood pressure (ABP) and ambulatory BP load (proportion of ABP readings\u0026thinsp;\u0026gt;\u0026thinsp;95th percentile)[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. However, the 2014 guidelines had limitations, frequently resulting in an 'unclassified' category for patients. Furthermore, the 2014 guidelines preceded the 2017 AAP CPG, which introduced static thresholds for hypertension for children\u0026thinsp;\u0026ge;\u0026thinsp;13 years (blood pressure\u0026thinsp;\u0026lt;\u0026thinsp;130/80 mmHg), adapted from the 2017 American Heart Association (AHA) guidelines for adults. Therefore, the ABPM guidelines were revised in 2022 to incorporate the 2017 AAP CPG thresholds for hypertension for children 13 years and older. Additionally, based on the recent Chronic Kidney Disease in Children (CKid) and the SHIP AHOY studies, which showed no association between BP loads and end-organ damage[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], BP loads were excluded from ABPM interpretation[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. The ABP phenotypes of pediatric kidney transplant recipients under the 2022 ABPM guidelines have not been explored. Additionally, the association between the 2022 ABP phenotype and end-organ damage in pediatric kidney transplant recipients is unknown.\u003c/p\u003e \u003cp\u003e This study aimed to evaluate the ABP phenotype of pediatric kidney transplant recipients according to the revised 2022 ABPM guidelines and compare it to the phenotype based on the 2014 guidelines. The study also examined the association between ABP phenotype and end-organ damage. Given the static threshold for children aged 13 years and older, we hypothesized a higher prevalence of ambulatory hypertension under the 2022 guidelines compared to the 2014 guidelines. To our knowledge, this is the first pediatric study to characterize ABP in kidney transplant recipients using the new guidelines.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e The Institutional Review Board (IRB) at the University of Minnesota approved this study (STUDY00017370).\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy population\u003c/h2\u003e \u003cp\u003eWe retrospectively identified all pediatric kidney transplant recipients (age\u0026thinsp;\u0026lt;\u0026thinsp;22 years) who successfully completed 24-hour ABPM for hypertension surveillance per the institutional protocol at the University of Minnesota between 1/2021 and 9/2024.\u003c/p\u003e \u003cp\u003eThe ABPM protocol was introduced at our center in January 2020. It required all pediatric kidney transplant recipients with heights greater than 120 cm to undergo annual ABPM studies for the surveillance of hypertension starting 12 months post-transplant, regardless of their hypertension history.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy variables\u003c/h3\u003e\n\u003cp\u003e We used data from a prospectively maintained, IRB-approved, solid organ transplant registry at the University of Minnesota. The transplant database contains post-transplant, peri-transplant, and minimal pre-transplant data on recipients and donors. Information on demographics, pre-transplant comorbidities, transplant surgery variables, post-transplant complications, and outcomes is captured via manual chart abstraction and electronic data transfer from the electronic medical record. The variables not available in the registry were abstracted directly from electronic medical records.\u003c/p\u003e \u003cp\u003eWe examined the following variables: demographic characteristics, pre-transplant dialysis status (yes/no), donor source (living or deceased), body mass index (BMI) (calculated as weight in kilograms divided by height in meters squared), underlying cause of kidney failure, and ABP phenotype.\u003c/p\u003e \u003cp\u003eEchocardiograms were ordered per the physicians\u0026rsquo; discretion, and echocardiograms completed within 6 months of the ABPM study were included. Elevated left ventricular mass index (LVMI) was defined as LVMI\u0026thinsp;\u0026gt;\u0026thinsp;95th percentile for age and sex[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAmbulatory arterial stiffness index (AASI) calculated by Spacelabs sentinel report was used and considered elevated if greater than 0.5[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eABP phenotype\u003c/h3\u003e\n\u003cp\u003eThe 2014 and the 2022 AHA pediatric ABPM guidelines are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Normotension was defined as normal clinic blood pressure and normal ABPM results. Ambulatory hypertension was defined as elevated clinic blood pressure and abnormal ABPM. White coat hypertension was defined as elevated clinic blood pressure but normal ABPM results. Masked hypertension was indicated by normal clinic blood pressure but abnormal ABPM results. We defined isolated nocturnal hypertension (INH) as normal daytime blood pressure but elevated nocturnal blood pressure, and isolated diastolic hypertension as elevated diastolic blood pressure but normal systolic blood pressure.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClassification of Hypertension based on 2022 updated criteria vs 2014 criteria\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e2022 ABPM guidelines\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e \u003cp\u003e2014 ABPM guidelines\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eClinic systolic or diastolic blood pressure*\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eMean ambulatory SBP or DBP\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOffice BP\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMean ambulatory SBP or DBP\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eSBP or DBP Load %\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;13 y of age\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;13 y of age\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;13 y of age\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;13 y of age\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNormal Blood pressure\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;95th percentile\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;130/80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;95th percentile OR adolescent cut points*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;125/75 mm Hg 24-h AND\u003c/p\u003e \u003cp\u003e\u0026lt;\u0026thinsp;130/80 mm Hg wake AND\u003c/p\u003e \u003cp\u003e\u0026lt;\u0026thinsp;110/65 mm Hg sleep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;90%th percentile\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;95%th percentile\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWhite coat Hypertension\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;95th percentile\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;130/80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;95th percentile\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;95%th percentile\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMasked Hypertension\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;95th percentile\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;130/80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;95th percentile OR adolescent cut points*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;125/75 mm Hg 24-h OR\u003c/p\u003e \u003cp\u003e\u0026thinsp;\u0026ge;\u0026thinsp;130/80 mm Hg wake OR\u003c/p\u003e \u003cp\u003e\u0026thinsp;\u0026ge;\u0026thinsp;110/65 mm Hg sleep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;95th percentile\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;95%th percentile\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAmbulatory Hypertension\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;95th percentile\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;130/80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;95th percentile\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;95%th percentile\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e25\u0026ndash;50\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePrehypertension\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;95th percentile\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;95%th percentile\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSevere ambulatory hypertension\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;95th percentile\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;95%th percentile\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;50\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eUnder normal circumstances, BP drops by 10% to 20% during sleep, a phenomenon referred to as dipping. We defined \u0026lsquo;non-dipping\u0026rsquo; or \u0026lsquo;blunted dipping\u0026rsquo; as a\u0026thinsp;\u0026lt;\u0026thinsp;10% decrease in BP during sleep and defined \u0026lsquo;reversed-dipping\u0026rsquo; as a higher mean sleep BP compared to the mean wake BP[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWe defined pre-existing hypertension as the use of antihypertensive agents for blood pressure regulation at the time of ABPM.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eData are summarized as medians with interquartile ranges (IQRs) and proportions. We compared continuous and categorical variables between patients with and without BP abnormalities using the Wilcoxon rank sum and Fisher\u0026rsquo;s exact tests. To compare the 2014 and 2022 guidelines, ABPM phenotypes were grouped into two categories: hypertension (masked, ambulatory, and 2014-specific severe ambulatory) and no hypertension (normal, white-coat, and 2014-specific uncategorized). Systematic differences in classification were assessed using McNemar\u0026rsquo;s test, and concordance was quantified using Cohen\u0026rsquo;s Kappa coefficient. These analyses were conducted for the total cohort and for a subgroup of patients with an elevated AASI, defined as \u0026gt;\u0026thinsp;0.5. Statistical analyses were performed using SAS software, version 9.4 (SAS Institute Inc., Cary, NC). A two-sided P\u0026thinsp;\u0026lt;\u0026thinsp;.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eOur cohort included 105 recipients with a median duration since transplant at the time of ABPM of 5.26 years (IQR: 2.12, 8.81). At the time of the study, 76 recipients were on antihypertensive medications for existing hypertension, while 29 had no history of hypertension.\u003c/p\u003e\n\u003cp\u003eAccording to the 2022 guidelines, 52 recipients (49.5%) were identified as having blood pressure abnormalities (AH and MH); this included 12 recipients with new-onset hypertension and 40 with poorly controlled, pre-existing hypertension. When combined with the 36 recipients whose hypertension was well-controlled on medication, the overall prevalence of hypertension in our cohort was 83.8% (n\u0026thinsp;=\u0026thinsp;88).\u003c/p\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003eBaseline characteristics\u003c/h2\u003e\n \u003cp\u003eTable \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e presents the demographic and baseline clinical characteristics of pediatric kidney transplant recipients with and without blood pressure abnormalities on ABPM, according to the 2022 guidelines. Abnormal ABPM (AH, MH) was significantly more common in recipients older at transplant (median: 11.8 vs 6.1; p\u0026thinsp;=\u0026thinsp;0.002). Abnormal ABPM was also more prevalent in the group maintained on tacrolimus and mycophenolate compared to those on other maintenance immunosuppression combinations (p\u0026thinsp;=\u0026thinsp;0.06). We observed no differences between recipients with abnormal ABPM (n\u0026thinsp;=\u0026thinsp;52) and those with normal ABPM (n\u0026thinsp;=\u0026thinsp;53) regarding sex (p\u0026thinsp;=\u0026thinsp;0.71), racial distribution (p\u0026thinsp;=\u0026thinsp;0.48), donor source (p\u0026thinsp;=\u0026thinsp;0.91), and the cause of kidney failure (p\u0026thinsp;=\u0026thinsp;0.42).\u003c/p\u003e\n \u003cp\u003e\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eDemographic and baseline characteristics by ambulatory hypertension per the 2022 guidelines\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAmbulatory HTN on ABPM*\u003c/p\u003e\n \u003cp\u003eN\u0026thinsp;=\u0026thinsp;52\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNo ambulatory HTN on ABPM*\u003c/p\u003e\n \u003cp\u003eN\u0026thinsp;=\u0026thinsp;53\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge at transplant\u003c/p\u003e\n \u003cp\u003eMedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11.8 (6.5, 15.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6.1 (2.6, 12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge at ABPM\u003c/p\u003e\n \u003cp\u003eMedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16.4 (14.0, 19.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14.5 (10.7, 16.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003cp\u003eMale n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e38 (73.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e37 (69.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.71\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRace n (%)\u003c/p\u003e\n \u003cp\u003eWhite\u003c/p\u003e\n \u003cp\u003eBlack\u003c/p\u003e\n \u003cp\u003eAsian\u003c/p\u003e\n \u003cp\u003eNative American\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37 (71.1)\u003c/p\u003e\n \u003cp\u003e4 (7.7)\u003c/p\u003e\n \u003cp\u003e5 (9.6)\u003c/p\u003e\n \u003cp\u003e6 (11.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38 (71.7)\u003c/p\u003e\n \u003cp\u003e8 (15.1)\u003c/p\u003e\n \u003cp\u003e4 (7.5)\u003c/p\u003e\n \u003cp\u003e3 (5.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDeceased donor transplant n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e23 (44.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e24 (45.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.91\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBMI percentile\u003c/p\u003e\n \u003cp\u003eMedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e80.8(60.6, 94.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e72.3 (46.4, 94.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrimary disease n (%)\u003c/p\u003e\n \u003cp\u003eCAKUT\u003c/p\u003e\n \u003cp\u003eNon-CAKUT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25 (51.0)\u003c/p\u003e\n \u003cp\u003e24 (49.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29 (59.2)\u003c/p\u003e\n \u003cp\u003e20 (40.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCSA/MMF\u003c/p\u003e\n \u003cp\u003eCSA/MMF/steroids\u003c/p\u003e\n \u003cp\u003eCSA/Aza\u003c/p\u003e\n \u003cp\u003eCSA/Aza/steroids\u003c/p\u003e\n \u003cp\u003eother\u003c/p\u003e\n \u003cp\u003eTac/MMF\u003c/p\u003e\n \u003cp\u003eTac/MMF/steroids\u003c/p\u003e\n \u003cp\u003eTac/Aza\u003c/p\u003e\n \u003cp\u003eTac/Aza/steroids\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2 (3.8)\u003c/p\u003e\n \u003cp\u003e3 (5.8)\u003c/p\u003e\n \u003cp\u003e2 (3.8)\u003c/p\u003e\n \u003cp\u003e1 (1.9)\u003c/p\u003e\n \u003cp\u003e2 (3.8)\u003c/p\u003e\n \u003cp\u003e23 (44.2)\u003c/p\u003e\n \u003cp\u003e9 (17.3)\u003c/p\u003e\n \u003cp\u003e4 (7.7)\u003c/p\u003e\n \u003cp\u003e6 (11.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003cp\u003e1 (1.9)\u003c/p\u003e\n \u003cp\u003e1 (1.9)\u003c/p\u003e\n \u003cp\u003e5 (9.4)\u003c/p\u003e\n \u003cp\u003e10 (18.9)\u003c/p\u003e\n \u003cp\u003e16 (30.2)\u003c/p\u003e\n \u003cp\u003e6 (11.3)\u003c/p\u003e\n \u003cp\u003e4 (7.5)\u003c/p\u003e\n \u003cp\u003e10 (18.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eABP phenotype (2022 guidelines)\u003c/h3\u003e\n\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\n \u003ch2\u003eEntire cohort\u003c/h2\u003e\n \u003cp\u003eTable\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e presents the ABP phenotype of the study cohort according to the 2022 guidelines. AH and MH were seen in 21% and 29.5% of the cohort, respectively. White coat hypertension, or white coat effect (in those with pre-existing hypertension), was observed in 7.6% of recipients, while isolated nocturnal hypertension and isolated diastolic hypertension were observed in 35.2% and 12.4%, respectively. Furthermore, 53.3% of the recipients displayed blunted dipping, and another 8.6% showed reverse dipping.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003ePrevalence and characteristics of post-transplant ambulatory hypertension 2022\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePrevalence\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAll\u003c/p\u003e\n \u003cp\u003eN\u0026thinsp;=\u0026thinsp;105\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eOn antihypertensive medication(s) at the time of ABPM*\u003c/p\u003e\n \u003cp\u003eN\u0026thinsp;=\u0026thinsp;76\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNo prior diagnosis of hypertension**\u003c/p\u003e\n \u003cp\u003eN\u0026thinsp;=\u0026thinsp;29\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAmbulatory hypertension (abnormal ABPM and abnormal clinic BP)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e21 (20.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16(21.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5(17.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMasked hypertension (abnormal ABPM but normal clinic BP)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e31 (29.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e24(31.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7(24.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e45 (42.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e31 (40.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14 (48.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWhite coat hypertension or white coat effect (normal ABPM but abnormal clinic BP)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8(7.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5(6.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3(10.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIsolated nocturnal hypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e37 (35.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e28 (36.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9(31.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIsolated diastolic hypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13 (12.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11 (14.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2 (6.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBlunted nocturnal dipping\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e56 (53.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e42 (55.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14 (48.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReverse dipping\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9 (8.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6 (7.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3 (10.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\"\u003e*Indicates hypertension control among those with a known history of hypertension\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n \u003ch2\u003eRecipients with pre-existing hypertension\u003c/h2\u003e\n \u003cp\u003eAH was observed in 21.1%, and MH was seen in 31.6% of the recipients already on medications for hypertension, indicating poor control. Additionally, the white-coat effect was observed in 6.6% of recipients with pre-existing hypertension.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;2022 versus 2014 guidelines\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eTable \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e compares ABP phenotypes according to the 2022 vs. the 2014 guidelines.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cstrong\u003eTable 4: The 2022 versus the 2014 Ambulatory Blood Pressure Phenotypes\u003c/strong\u003e\u003c/div\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cimg 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\"\u003e\u003c/strong\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cdiv align=\"center\" style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cbr\u003e\u003c/div\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003eCompared to the 2014 guidelines, the 2022 guidelines identified a higher number of pediatric recipients with AH (20.0% (n\u0026thinsp;=\u0026thinsp;21) vs 14.3% (n\u0026thinsp;=\u0026thinsp;15)) and MH (29.5% (n\u0026thinsp;=\u0026thinsp;31) vs 21.9% (n\u0026thinsp;=\u0026thinsp;23)). Overall, the prevalence of hypertension was significantly higher using the 2022 criteria compared to the 2014 criteria (49.5% vs. 36.2%; McNemar\u0026rsquo;s p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Despite the increased sensitivity of the newer guidelines, the overall agreement between the two standards remained substantial (kappa statistic: 0.73, 95% CI: 0.61, 0.86).\u003c/div\u003e\n \u003c/div\u003e\n \u003cp\u003eOf the 44 recipients with \u003cstrong\u003enormal\u003c/strong\u003e ABPM according to the 2014 guidelines, 6 recipients had abnormal ABPM (AH\u0026thinsp;=\u0026thinsp;3, MH\u0026thinsp;=\u0026thinsp;3) according to the 2022 guidelines. Additionally, of the 16 recipients who were uncategorized under the 2014 guidelines (elevated loads only), 3 were classified as AH and 5 as MH under the 2022 guidelines.\u003c/p\u003e\n \u003cp\u003e\u003cspan type=\"ItalicUnderline\" class=\"ItalicUnderline\" name=\"Emphasis\"\u003e2022 vs. 2014 ABP phenotypes by age\u003c/span\u003e\u003c/p\u003e\n \u003cp\u003eAmong recipients aged\u0026thinsp;\u0026ge;\u0026thinsp;13 years, the 2022 guidelines identified a higher proportion of AH (23.0% [n\u0026thinsp;=\u0026thinsp;17] vs. 14.9% [n\u0026thinsp;=\u0026thinsp;11]) and MH (33.8% [n\u0026thinsp;=\u0026thinsp;25] vs. 23.0% [n\u0026thinsp;=\u0026thinsp;17]) compared to the 2014 guidelines. This difference was primarily driven by recipients labeled as \u0026lsquo;uncategorized\u0026rsquo; under the 2014 guidelines; of the 16 uncategorized recipients in the entire cohort, 13 (81.2%) were in the \u0026ge;\u0026thinsp;13 age group. Under the 2022 guidelines, 8 (61.5%) of these 13 recipients were reclassified as AH (n\u0026thinsp;=\u0026thinsp;3) or MH (n\u0026thinsp;=\u0026thinsp;5). Overall, the prevalence of hypertension among recipients aged\u0026thinsp;\u0026ge;\u0026thinsp;13 years was significantly higher using the 2022 criteria compared to the 2014 criteria (56.76% vs. 37.84%; McNemar\u0026rsquo;s p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Despite these differences, the overall agreement between the two guidelines in identifying hypertension for the recipients aged\u0026thinsp;\u0026ge;\u0026thinsp;13 years was substantial (kappa: 0.63, 95% CI: 0.47, 0.79).\u003c/p\u003e\n \u003cp\u003eIn contrast, there was almost perfect agreement between the 2022 and 2014 guidelines for recipients aged\u0026thinsp;\u0026lt;\u0026thinsp;13 years (kappa: 1.0, 95% CI: 1.0, 1.0). In this younger group, both guidelines identified 4 recipients with AH (3 with ambulatory and 1 with severe ambulatory under 2014) and 6 with MH. Furthermore, the three younger recipients who were uncategorized per the 2014 guidelines were all diagnosed as normal per the 2022 guidelines.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n \u003ch2\u003eAmbulatory hypertension and target organ injury\u003c/h2\u003e\n \u003cp\u003eOf the 47 recipients who underwent echocardiogram, elevated LVMI was found in 17 (36.2%). The association between hypertension (existing and new-onset according to the 2022 guidelines) and elevated LVMI approached statistical significance (hypertension vs no hypertension: 41.5% vs. 0.0%; p\u0026thinsp;=\u0026thinsp;0.07).\u003c/p\u003e\n \u003cp\u003eTen recipients had an elevated AASI. Among these, the 2022 guidelines identified 8 (80%) with abnormal ABPM phenotypes compared to only 3 (30%) under the 2014 guidelines (McNemar\u0026rsquo;s p\u0026thinsp;=\u0026thinsp;0.025). Overall, the agreement between the 2014 and 2022 guidelines in identifying blood pressure abnormalities in recipients with elevated AASI was poor and statistically non-significant (Kappa: 0.19; 95% CI: -0.1, 0.49).\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003e This is the first study to examine the prevalence of hypertension in pediatric kidney transplant recipients using the revised 2022 AHA guidelines and to compare the 2022 ABP phenotype with the 2014 ABP phenotype. The overall prevalence of hypertension using the 2022 guidelines was 84%, which is consistent with the previously reported prevalence in pediatric kidney recipients, ranging from 58% to 89% [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Using the 2022 criteria, we identified a significantly higher prevalence of AH and MH compared to the 2014 guidelines, particularly among recipients aged\u0026thinsp;\u0026ge;\u0026thinsp;13 years. We observed significant rates of masked hypertension (30%) and isolated nocturnal hypertension (35%), diagnoses that cannot be ascertained using clinic blood pressure measurements. Furthermore, the 2022 guidelines demonstrated greater sensitivity in identifying recipients with elevated arterial stiffness (AASI), underscoring the clinical utility of the updated criteria. Our study findings highlight the burden of hypertension in pediatric kidney transplant recipients and indicate the necessity of routine surveillance using 24-hour ABPM.\u003c/p\u003e \u003cp\u003eAlthough there was a substantial agreement between the 2022 and 2014 guidelines in identifying hypertension (kappa: 0.73), the 2022 guidelines classified a higher proportion of recipients as hypertensive (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The 2022 guidelines captured every recipient identified as abnormal by the 2014 criteria, while also diagnosing an additional 11.4% with AH and 7.6% with MH. Notably, this included six recipients who had previously been classified as normal under the 2014 thresholds. These findings are similar to the 11% increase in AH reported in a Canadian study comparing the 2022 guidelines to the 2014 AHA and 2016 ESH guidelines in the general pediatric population[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. The present study is the first study to evaluate this diagnostic shift in pediatric kidney transplant recipients specifically.\u003c/p\u003e \u003cp\u003e One of the significant updates in the revised 2022 ABPM guidelines was the recommendation to use static, adult-aligned blood pressure thresholds for adolescents aged 13 and older, consistent with the 2017 AAP CPG. Unsurprisingly, the shift in diagnostic criteria primarily affected the older age group; we observed a significantly higher proportion of AH and MH diagnoses in recipients\u0026thinsp;\u0026ge;\u0026thinsp;13 years using the 2022 guidelines. However, we observed no difference in AH or MH when we applied the two guidelines to the younger age group. These findings align with previous reports from the SHIP-AHOY and CKiD cohorts, which demonstrated significantly increased AH prevalence when using adult rather than pediatric cutoffs for older children (26.9% vs. 16.9% and 44% vs. 27%, respectively)[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e We observed a high prevalence of masked hypertension (MH) in our cohort, which increased from 21.9% under the 2014 guidelines to 29.5% using the 2022 guidelines. MH was also present in 23.6% of recipients already receiving antihypertensive therapy, indicating undertreated hypertension. Our results align with a study by Hamdani et al.,[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] which identified MH in 38% of pediatric kidney transplant recipients using 2014 criteria. These findings are also consistent with a systematic review and meta-analysis of pediatric and young adult populations (ages 4\u0026ndash;25 years), which found that while the prevalence of MH in the general population is 10.4%, it is significantly higher in children with chronic kidney disease (RR: 2.44) and solid organ transplant recipients (RR: 2.34)[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The clinical significance of these findings is underscored by the association between MH and adverse outcomes, including lower estimated glomerular filtration rates[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], increased left ventricular hypertrophy, and elevated pulse wave velocity [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Since masked hypertension remains undetectable via clinic measurements and occurs at a high rate even in patients on antihypertensive medications, it is important for pediatric kidney transplant recipients to undergo routine ABPM testing.\u003c/p\u003e \u003cp\u003eThe prevalence of isolated nocturnal hypertension in our cohort (35.2% overall and 36.8% for those on therapy) aligns with reported estimates of 30% to 40% in pediatric kidney transplant recipients[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Similar to masked hypertension, isolated nocturnal hypertension is clinically significant due to its association with cardiovascular abnormalities in patients with CKD, including LVH and increased cIMT [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Furthermore, the observed rates of blunted nocturnal dipping (61.9%) and reverse dipping (8.6%) are consistent with previous reports documenting abnormal dipping in 30%\u0026ndash;72% of transplanted children[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIsolated diastolic hypertension was seen in 12% of our cohort, with a large majority (84.6%; n\u0026thinsp;=\u0026thinsp;11/13) of them representing poorly controlled hypertension. However, it may be an underestimation of the true prevalence as ABPM devices performed less reliably for diastolic compared to systolic measurements in validation studies[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. The lack of variability in diastolic measurements in the ABPM normative data also suggests limited performance of ABPM for diastolic measurements[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWe observed white coat hypertension in 7.6% of the entire cohort and white coat effect in 6.5% of those on anti-hypertensive therapy. The relatively lower prevalence of white coat hypertension in pediatric kidney recipients compared to the general pediatric population (30\u0026ndash;40%)[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] is likely related to the overall high incidence of hypertension in transplant recipients. However, the white coat effect in 6.5% of patients with existing hypertension indicates the role of ABPM in preventing unnecessary escalation of antihypertensive therapy, which could result in clinically significant hypotension and potential graft hypoperfusion.\u003c/p\u003e \u003cp\u003eIn our cohort, more than a third of recipients who underwent echocardiography demonstrated elevated LVMI, underscoring the substantial burden of cardiovascular end-organ damage in this population. The high prevalence of elevated LVMI in the hypertensive (pre-existing and new-onset) versus normotensive recipients suggests a clinically relevant relationship, even though it did not reach statistical significance, likely due to the limited sample size. Additionally, the majority of recipients with elevated AASI were classified as abnormal ABP under the revised 2022 ABPM guidelines compared with the 2014 guidelines, highlighting the updated recommendations' increased sensitivity in detecting vascular stiffness, which is closely linked to adverse cardiovascular remodeling. Our findings are consistent with those of a pediatric cross-sectional study conducted at a tertiary care outpatient hypertension clinic, which found that only the 2022 guideline significantly predicted elevated AASI (odds ratio: 2.4; p\u0026thinsp;=\u0026thinsp;0.02)[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOur study had several limitations. Our sample size was small, limiting our ability to examine the association between ABP phenotype and LVH. Since the prevalence of hypertension varies with the length of posttransplant follow-up, our results may be an underestimation of the prevalence of abnormal blood pressure patterns within the first year posttransplant and an overestimation for patients who are several years posttransplant. Despite its limitations, this study is important as it describes the ABP phenotype using the newer guidelines and underscores the burden of hypertension in this population, emphasizing the need for routine ABPM to diagnose masked and isolated nocturnal hypertension.\u003c/p\u003e \u003cp\u003eTo conclude, abnormal blood pressure patterns are highly prevalent in pediatric kidney transplant recipients. Our study demonstrated significantly higher prevalence of all ABP phenotypes under the 2022 guidelines compared to the 2014 guidelines. Furthermore, the significantly high prevalence of MH and isolated nocturnal hypertension, regardless of prior diagnosis, indicates that clinic blood pressures alone are insufficient to diagnose new-onset hypertension or to ensure treatment adequacy. The increased identification of ABPM abnormalities in those with elevated AASI using the 2022 guidelines underscores its role in identifying patients with increased cardiovascular risk. Based on our findings, we suggest that transplant centers consider incorporating 24-hour ABPM into standard protocols to optimize the diagnosis and management of hypertension in the pediatric kidney transplant population.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eAuthors\u003c/h2\u003e \u003cp\u003eShanthi Sree Balani\u003csup\u003e1\u003c/sup\u003e; Ruchi Gupta Mahajan\u003csup\u003e2\u003c/sup\u003e; Yashwanth Gollapudi\u003csup\u003e3\u003c/sup\u003e; Anjalin Sebastian\u003csup\u003e1\u003c/sup\u003e; Michael Evans\u003csup\u003e5\u003c/sup\u003e; Sarah Javed Kizilbash\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eDeclarations\u003c/h2\u003e \u003cp\u003eThe authors have no competing interests to declare that are relevant to the content of this article.\u003c/p\u003e\u003cp\u003e \u003ch2\u003eDisclosure:\u003c/h2\u003e \u003cp\u003e \u003cb\u003eAI-assisted tools were used exclusively for language improvement and stylistic editing. All scientific content, data analysis, and clinical interpretations were produced solely by the authors, who take full responsibility for the integrity of the final manuscript.\u003c/b\u003e \u003c/p\u003e \u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSeeman T, Myette RL, Feber J (2023) Hypertension in pediatric kidney transplantation. Pediatr Transpl 27:e14522\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHamdani G, Mitsnefes MM, Flynn JT, Becker RC, Daniels S, Falkner BE, Ferguson M, Hooper SR, Hanevold CD, Ingelfinger JR, Lande M, Martin LJ, Meyers KE, Rosner B, Samuels J, Urbina EM (2021) Pediatric and Adult Ambulatory Blood Pressure Thresholds and Blood Pressure Load as Predictors of Left Ventricular Hypertrophy in Adolescents. Hypertension 78:30\u0026ndash;37\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGroup ET, Wuhl E, Trivelli A, Picca S, Litwin M, Peco-Antic A, Zurowska A, Testa S, Jankauskiene A, Emre S, Caldas-Afonso A, Anarat A, Niaudet P, Mir S, Bakkaloglu A, Enke B, Montini G, Wingen AM, Sallay P, Jeck N, Berg U, Caliskan S, Wygoda S, Hohbach-Hohenfellner K, Dusek J, Urasinski T, Arbeiter K, Neuhaus T, Gellermann J, Drozdz D, Fischbach M, Moller K, Wigger M, Peruzzi L, Mehls O, Schaefer F (2009) Strict blood-pressure control and progression of renal failure in children. N Engl J Med 361:1639\u0026ndash;1650\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFlynn JT, Kaelber DC, Baker-Smith CM, Blowey D, Carroll AE, Daniels SR, de Ferranti SD, Dionne JM, Falkner B, Flinn SK, Gidding SS, Goodwin C, Leu MG, Powers ME, Rea C, Samuels J, Simasek M, Thaker VV, Urbina EM (2017) Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents. Pediatrics 140.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFlynn JT, Daniels SR, Hayman LL, Maahs DM, McCrindle BW, Mitsnefes M, Zachariah JP, Urbina EM, American Heart Association, Atherosclerosis H, Obesity in Youth Committee of the Council on Cardiovascular Disease in the Y (2014) Update: ambulatory blood pressure monitoring in children and adolescents: a scientific statement from the American Heart Association. Hypertension 63:1116\u0026ndash;1135\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGroup ET (2009) Strict blood-pressure control and progression of renal failure in children. N Engl J Med 361:1639\u0026ndash;1650\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHamdani G, Mitsnefes MM, Flynn JT, Becker RC, Daniels S, Falkner BE, Ferguson M, Hooper SR, Hanevold CD, Ingelfinger JR (2021) Pediatric and adult ambulatory blood pressure thresholds and blood pressure load as predictors of left ventricular hypertrophy in adolescents. Hypertension 78:30\u0026ndash;37\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePisano A, Mallamaci F, D\u0026rsquo;Arrigo G, Bolignano D, Wuerzner G, Ortiz A, Burnier M, Kanaan N, Sarafidis P, Persu A (2021) Blood pressure monitoring in kidney transplantation: a systematic review on hypertension and target organ damage. Nephrol Dialysis Transplantation 36:1326\u0026ndash;1346\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFlynn JT, Kaelber DC, Baker-Smith CM, Blowey D, Carroll AE, Daniels SR, de Ferranti SD, Dionne JM, Falkner B, Flinn SK, Gidding SS, Goodwin C, Leu MG, Powers ME, Rea C, Samuels J, Simasek M, Thaker VV, Urbina EM, Subcommittee On S (2017) Management Of High Blood Pressure In C Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents. Pediatrics 140\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePisano A, Mallamaci F, D'Arrigo G, Bolignano D, Wuerzner G, Ortiz A, Burnier M, Kanaan N, Sarafidis P, Persu A, Ferro CJ, Loutradis C, Boletis IN, London G, Halimi JM, Sautenet B, Rossignol P, Vogt L, Zoccali C (2021) Blood pressure monitoring in kidney transplantation: a systematic review on hypertension and target organ damage. Nephrol Dial Transpl 36:1326\u0026ndash;1346\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee J, McCulloch CE, Flynn JT, Samuels J, Warady BA, Furth SL, Seth D, Grimes BA, Mitsnefes MM, Ku E (2020) Prognostic Value of Ambulatory Blood Pressure Load in Pediatric CKD. Clin J Am Soc Nephrol 15:493\u0026ndash;500\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFlynn JT, Urbina EM, Brady TM, Baker-Smith C, Daniels SR, Hayman LL, Mitsnefes M, Tran A, Zachariah JP (2022) Ambulatory Blood Pressure Monitoring in Children and Adolescents: 2022 Update: A Scientific Statement From the American Heart Association. Hypertension 79:e114\u0026ndash;e124\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhoury PR, Mitsnefes M, Daniels SR, Kimball TR (2009) Age-specific reference intervals for indexed left ventricular mass in children. J Am Soc Echocardiogr 22:709\u0026ndash;714\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi Y, Wang JG, Dolan E, Gao PJ, Guo HF, Nawrot T, Stanton AV, Zhu DL, O'Brien E, Staessen JA (2006) Ambulatory arterial stiffness index derived from 24-hour ambulatory blood pressure monitoring. Hypertension 47:359\u0026ndash;364\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFlynn JT, Urbina EM, Brady TM, Baker-Smith C, Daniels SR, Hayman LL, Mitsnefes M, Tran A, Zachariah JP, Atherosclerosis H, Obesity in the Young Committee of the American Heart Association Council on Lifelong Congenital Heart D, Heart Health in the Y, Council on Cardiovascular R, Intervention L, Cardiometabolic H (2022) Ambulatory Blood Pressure Monitoring in Children and Adolescents: 2022 Update: A Scientific Statement From the American Heart Association. Hypertension 79:e114-e124\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSharma AP, Kirpalani A, Sharma A, Altamirano-Diaz L, Filler G, Norozi K (2023) Impact of the 2022 American Heart Association pediatric ambulatory blood pressure monitoring statement on the diagnosis of hypertension. Pediatr Nephrol 38:2741\u0026ndash;2751\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBlack E, Lee J, Flynn JT, McCulloch CE, Samuels JA, Seth D, Warady B, Furth S, Mitsnefes M, Ku E (2022) Discordances between pediatric and adult thresholds in the diagnosis of hypertension in adolescents with CKD. Pediatr Nephrol 37:179\u0026ndash;188\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHamdani G, Nehus EJ, Hooper DK, Mitsnefes MM (2016) Masked hypertension and allograft function in pediatric and young adults kidney transplant recipients. Pediatr Transpl 20:1026\u0026ndash;1031\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChung J, Robinson C, Sheffield L, Paramanathan P, Yu A, Ewusie J, Sanger S, Mitsnefes M, Parekh RS, Sinha MD, Rodrigues M, Thabane L, Dionne J, Chanchlani R (2023) Prevalence of Pediatric Masked Hypertension and Risk of Subclinical Cardiovascular Outcomes: A Systematic Review and Meta-Analysis. Hypertension 80:2280\u0026ndash;2292\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMorgan H, Khan I, Hashmi A, Hebert D, McCrindle BW, Balfe JW (2001) Ambulatory blood pressure monitoring after renal transplantation in children. Pediatr Nephrol 16:843\u0026ndash;847\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eD\u0026uuml;zova A, Bayazit AK, Canpolat N, Niemirska A, Bulut IK, Azukaitis K, Karagoz T, Oguz B, Erdem S, Anarat A (2019) Isolated nocturnal and isolated daytime hypertension associate with altered cardiovascular morphology and function in children with chronic kidney disease: findings from the Cardiovascular Comorbidity in Children with Chronic Kidney Disease study. J Hypertens 37:2247\u0026ndash;2255\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSeeman T, Myette RL, Feber J (2023) Hypertension in pediatric kidney transplantation. Pediatr Transplant 27:e14522\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDuncombe SL, Voss C, Harris KC (2017) Oscillometric and auscultatory blood pressure measurement methods in children: a systematic review and meta-analysis. J Hypertens 35:213\u0026ndash;224\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eW\u0026uuml;hl E, Witte K, Soergel M, Mehls O, Schaefer F, Hypertension GWGP (2002) Distribution of 24-h ambulatory blood pressure in children: normalized reference values and role of body dimensions. J Hypertens 20:1995\u0026ndash;2007\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSeeman T (2012) Ambulatory blood pressure monitoring in pediatric renal transplantation. Curr Hypertens Rep 14:608\u0026ndash;618\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"pediatric-nephrology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pnep","sideBox":"Learn more about [Pediatric Nephrology](http://link.springer.com/journal/467)","snPcode":"467","submissionUrl":"https://www.editorialmanager.com/pnep/default2.aspx","title":"Pediatric Nephrology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"pediatric kidney transplantation, ambulatory blood pressure monitoring, hypertension, pediatric hypertension, AAP hypertension guidelines","lastPublishedDoi":"10.21203/rs.3.rs-8563273/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8563273/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003e The American Academy of Pediatrics Clinical Practice Guidelines (AAPCPG) recommend 24-hour ambulatory blood pressure monitoring (ABPM) for diagnosing hypertension (HTN) in pediatric kidney transplant recipients. The ABPM guidelines were updated in 2022 to incorporate the 2017 AAPCPG thresholds for those\u0026thinsp;\u0026ge;\u0026thinsp;13 years and exclude blood pressure loads. The effect of the 2022 update on ABPM phenotype and its association with end-organ damage in this population remains unexplored.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e \u003cp\u003eWe retrospectively evaluated pediatric kidney transplant recipients (age\u0026thinsp;\u0026lt;\u0026thinsp;22 years) who underwent 24-hour ABPM for HTN surveillance between 1/2021 and 9/2024. We grouped ABPM phenotypes into two categories: HTN (masked, ambulatory, and 2014-specific severe ambulatory) and no HTN (normal, white-coat, and 2014-specific uncategorized). We assessed systematic differences between the two guidelines using McNemar\u0026rsquo;s test and agreement using Cohen\u0026rsquo;s Kappa coefficient.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eOur cohort included 105 recipients. Compared to 2014, the 2022 guidelines identified more recipients with HTN (49.5% vs 36.2%; McNemar\u0026rsquo;s p\u0026thinsp;\u0026lt;\u0026thinsp;0.001); however, the overall agreement remained substantial (kappa: 0.73, 95% CI: 0.61, 0.86). Among the 10 recipients with elevated ambulatory arterial stiffness index (AASI), the 2022 guidelines identified 80.0% as abnormal compared to only 30.0% under the 2014 guidelines (McNemar\u0026rsquo;s p\u0026thinsp;=\u0026thinsp;0.025), reflecting no significant agreement (Kappa: 0.19; 95% CI: -0.1, 0.49).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003e Compared to the 2014 criteria, the 2022 guidelines identified a higher proportion of pediatric kidney transplant recipients with HTN and more effectively identified abnormalities in recipients with elevated AASI. Our findings indicate that 2022 guidelines are better aligned with markers of arterial stiffness and cardiovascular risk.\u003c/p\u003e","manuscriptTitle":"Impact of the 2022 Ambulatory Blood Pressure Monitoring Guidelines on Blood Pressure Phenotypes in Pediatric Kidney Transplant Recipients","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-14 12:42:18","doi":"10.21203/rs.3.rs-8563273/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major Revisions Needed","date":"2026-01-20T16:49:39+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"","date":"2026-01-12T18:02:31+00:00","index":0,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-12T17:45:46+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-12T10:33:33+00:00","index":"","fulltext":""},{"type":"submitted","content":"Pediatric Nephrology","date":"2026-01-09T12:22:19+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"pediatric-nephrology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pnep","sideBox":"Learn more about [Pediatric Nephrology](http://link.springer.com/journal/467)","snPcode":"467","submissionUrl":"https://www.editorialmanager.com/pnep/default2.aspx","title":"Pediatric Nephrology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"ec2b9531-2c9b-4e81-9f17-009ce536f74d","owner":[],"postedDate":"January 14th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-03-16T16:05:11+00:00","versionOfRecord":{"articleIdentity":"rs-8563273","link":"https://doi.org/10.1007/s00467-026-07241-6","journal":{"identity":"pediatric-nephrology","isVorOnly":false,"title":"Pediatric Nephrology"},"publishedOn":"2026-03-10 15:59:42","publishedOnDateReadable":"March 10th, 2026"},"versionCreatedAt":"2026-01-14 12:42:18","video":"","vorDoi":"10.1007/s00467-026-07241-6","vorDoiUrl":"https://doi.org/10.1007/s00467-026-07241-6","workflowStages":[]},"version":"v1","identity":"rs-8563273","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8563273","identity":"rs-8563273","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}