Ambulatory Blood Pressure Monitoring Unmasks a High Prevalence of Hypertension in Kidney Transplant Recipients: A Prospective Cohort Study Comparing Clinic, Self-Measurement, and ABPM

Ambulatory Blood Pressure Monitoring Unmasks a High Prevalence of Hypertension in Kidney Transplant Recipients: A Prospective Cohort Study Comparing Clinic, Self-Measurement, and ABPM | 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 Ambulatory Blood Pressure Monitoring Unmasks a High Prevalence of Hypertension in Kidney Transplant Recipients: A Prospective Cohort Study Comparing Clinic, Self-Measurement, and ABPM Rabhia Mehdi, Mahrez Fissah, Houssem Baghous, Sihem Bahbouh, Hind Arzour This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9163040/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background Hypertension is a major modifiable risk factor affecting graft and patient survival after kidney transplantation. However, the optimal method for its diagnosis remains uncertain. This study aimed to compare clinic blood pressure measurement (CBPM), self-blood pressure measurement (SBPM), and ambulatory blood pressure monitoring (ABPM) in kidney transplant recipients (KTRs). Methods We conducted a prospective longitudinal study including 115 KTRs followed at the Nephrology Department of Mustapha University Hospital (Algiers). Blood pressure was assessed using CBPM, SBPM, and 24-hour ABPM at 1, 3, 6, and 12 months post-transplantation. Hypertension was defined according to ESH/ESC 2013 guidelines. White-coat hypertension (WCH) and masked hypertension (MH) were defined based on discrepancies between CBPM and ABPM. Results The prevalence of hypertension increased over time when assessed by ABPM, from 7.8% at 1 month to 50.4% at 12 months. CBPM consistently underestimated the true prevalence. Masked hypertension was highly prevalent, representing 33.3%, 52.6%, 71.8%, and 60.3% of hypertensive patients at 1, 3, 6, and 12 months, respectively. White-coat hypertension was less frequent and decreased over time. A non-dipping pattern was commonly observed among hypertensive patients. Conclusion ABPM is a superior tool for diagnosing hypertension in KTRs, revealing a substantial burden of masked hypertension missed by conventional measurements. Its systematic use should be considered in routine follow-up. Kidney transplantation ambulatory blood pressure monitoring masked hypertension white-coat hypertension graft survival Figures Figure 1 1. Introduction Hypertension (HTN) is one of the most common complications after kidney transplantation and represents a major modifiable risk factor for both graft dysfunction and cardiovascular morbidity and mortality [ 8 , 9 ]. Accurate diagnosis and optimal management of HTN are therefore critical in this high-risk population. However, blood pressure (BP) assessment in kidney transplant recipients (KTRs) remains challenging. Conventional clinic blood pressure measurement (CBPM) may not accurately reflect the true BP burden due to phenomena such as white-coat hypertension (WCH) and masked hypertension (MH). These discrepancies may lead to misclassification and inappropriate management. Ambulatory blood pressure monitoring (ABPM) and self-blood pressure measurement (SBPM) have been proposed as more reliable alternatives [ 12 ]. ABPM, in particular, provides valuable information on circadian BP patterns, including nocturnal hypertension and non-dipping status, which are associated with adverse outcomes [ 5 ]. Despite these advantages, there is limited prospective data comparing CBPM, SBPM, and ABPM longitudinally in KTRs [ 10 , 11 ]. The objective of this study was to prospectively compare these three methods for diagnosing hypertension and to determine the prevalence and evolution of WCH and MH during the first year following kidney transplantation. 2. Methods 2.1 Study Design and Population This prospective, single-center cohort study included 115 adult kidney transplant recipients followed at the Nephrology Department of Mustapha University Hospital (Algiers). Patients were included consecutively after transplantation and followed for 12 months. Inclusion criteria comprised adult patients (≥ 18 years) with a functioning graft. Exclusion criteria included graft loss within the first month, inability to perform BP monitoring, or incomplete follow-up data. The study was conducted in accordance with the Declaration of Helsinki and approved by the local ethics committee. The study was reported in accordance with the STROBE guidelines for observational studies. All participants provided written informed consent. All transplanted organs were obtained from voluntary donors in accordance with national regulations. No organs or tissues were obtained from prisoners. Transplantations were performed at Mustapha University Hospital (Algiers), through the Department of Nephrology, Dialysis and Kidney Transplantation. 2.2 Blood Pressure Measurements Clinic Blood Pressure Measurement (CBPM) BP was measured using a validated oscillometric device after a 5-minute rest in the seated position. Three measurements were taken, and the average of the last two was recorded. Measurements were performed on the arm without an arteriovenous fistula. Self-Blood Pressure Measurement (SBPM) Patients performed SBPM over three consecutive days, with three measurements in the morning and three in the evening. The average of all readings was calculated. Ambulatory Blood Pressure Monitoring (ABPM) Twenty-four-hour ABPM was performed using a validated device (Spacelabs 90217). BP measurements were recorded every 15 minutes during the day and every 30 minutes at night. Recordings were considered valid if at least 70% of measurements were successful. 2.3 Definitions Hypertension was defined according to the ESH/ESC 2013 guidelines, which were the current reference at the time of study design and data collection. Although more recent guidelines are available, we used the 2013 ESH/ESC definitions to ensure consistency with the study protocol and longitudinal comparisons. White-coat hypertension was defined as CBPM ≥ 140/90 mmHg with daytime ABPM < 135/85 mmHg. Masked hypertension was defined as CBPM < 140/90 mmHg with daytime ABPM ≥ 135/85 mmHg. Nocturnal BP patterns were categorized as dipper or non-dipper based on the nocturnal decline in BP. 2.4 Statistical Analysis Statistical analyses were performed using SPSS version 20.0 and R software. Continuous variables were expressed as mean ± standard deviation or median (interquartile range), as appropriate. Categorical variables were expressed as percentages. Comparisons between groups were performed using the chi-square or Fisher’s exact test for categorical variables. A p-value < 0.05 was considered statistically significant. 3. Results 3.1 Patient Characteristics The study included 115 kidney transplant recipients. Baseline characteristics, including age, sex, donor type, and immunosuppressive therapy, are summarized in Table 1 . Table 1 Prevalence of hypertension at 12 months according to measurement method (N = 115) Measurement Method Hypertension Definition Hypertensive Patients (n) Prevalence (%) Clinic BP (CBPM) BP ≥ 140/90 mmHg 40 34.8 Self-Measured BP (SBPM) BP ≥ 135/85 mmHg 48 41.7 Ambulatory BP (ABPM) 24-hour average ≥ 130/80 mmHg 58 50.4 3.2 Prevalence of Hypertension According to Measurement Method The prevalence of hypertension increased over time when assessed by ABPM, reaching 50.4% at 12 months post-transplantation. In contrast, CBPM consistently underestimated hypertension prevalence across all time points. 3.3 Prevalence of White-Coat and Masked Hypertension Masked hypertension was highly prevalent and increased significantly during follow-up (Table 2 ). In contrast, white-coat hypertension remained relatively low and decreased over time. Among hypertensive patients, masked hypertension represented the predominant phenotype across all time points (Table 3 ). Table 2 Global prevalence of blood pressure phenotypes (N = 115) BP Phenotype 1 Month 3 Months 6 Months 12 Months Masked Hypertension 3 (2.6%) 10 (8.7%) 28 (24.3%) 35 (30.4%) White-Coat Hypertension 18 (15.7%) 13 (11.3%) 14 (12.2%) 14 (12.2%) Percentages are calculated based on the total study population (N = 115). Table 3 Distribution of hypertension phenotypes among hypertensive patients only BP Phenotype 1 Month (n = 9) 3 Months (n = 19) 6 Months (n = 39) 12 Months (n = 58) Masked Hypertension 3 (33.3%) 10 (52.6%) 28 (71.8%) 35 (60.3%) Sustained Hypertension 6 (66.7%) 9 (47.4%) 11 (28.2%) 23 (39.7%) Percentages are calculated within the hypertensive population at each time point. 3.4 Nocturnal Blood Pressure Profile A high proportion of hypertensive patients exhibited a non-dipping pattern, indicating abnormal circadian BP regulation. The evolution of blood pressure phenotypes over time is illustrated in Fig. 1 . 3.5 Therapeutic Implications Patients diagnosed with hypertension by ABPM required a higher number of antihypertensive medications compared to those diagnosed by CBPM alone. 4. Discussion 4.1 Main Findings This prospective study demonstrates that CBPM significantly underestimates the true prevalence of hypertension in KTRs. ABPM revealed a marked increase in hypertension prevalence over time, reaching more than 50% at one year post-transplantation. The most notable finding is the high prevalence of masked hypertension, affecting more than half of patients at 12 months. This highlights the limitations of relying solely on clinic measurements. 4.2 Comparison with Existing Literature Our findings are consistent with previous studies reporting a high prevalence of masked hypertension in KTRs and its association with adverse renal and cardiovascular outcomes [ 1 , 7 ]. The prevalence of white-coat hypertension observed in our cohort is also consistent with published data [ 2 ]. 4.3 Clinical Implications These results support the systematic use of ABPM in the follow-up of kidney transplant recipients [ 6 ]. Early detection of masked hypertension may allow timely therapeutic intervention and improve long-term outcomes. These findings suggest that a substantial proportion of transplant recipients may remain undertreated if ABPM is not routinely implemented. Calcineurin inhibitor-related mechanisms may further contribute to hypertension burden in this population [ 3 , 4 ]. 4.4 Strengths and Limitations The strengths of this study include its prospective design and longitudinal follow-up. Limitations include its single-center nature and the lack of long-term outcome data. 5. Conclusion Masked hypertension is highly prevalent and frequently missed by conventional clinic measurements in kidney transplant recipients. ABPM provides a more accurate assessment of blood pressure and should be integrated into routine clinical practice. Declarations Ethics approval and consent to participate The study was conducted in accordance with the Declaration of Helsinki and approved by the local ethics committee of Mustapha University Hospital. Written informed consent was obtained from all participants. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. Funding No specific funding was received for this study. Author Contribution MR contributed to study conception, data collection, analysis, and manuscript drafting. All authors contributed to manuscript revision and approved the final version. Acknowledgments The authors thank the medical and nursing staff of the Nephrology Department for their support in patient follow-up and data collection. Data Availability The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. References Sezer S, Uyar ME, Ozdemir FN, et al. Masked hypertension is associated with lower graft function and albuminuria in renal transplant recipients. Clin Nephrol. 2021;95(3):143–51. Booth JN, Abdalla M, Tanner RM, et al. The clinical significance of white-coat hypertension in kidney transplant recipients: a systematic review and meta-analysis. Am J Hypertens. 2022;35(4):319–27. Salvadori M, Tsalouchos A. Calcineurin inhibitor-induced hypertension: mechanisms and management. Transpl Rev (Orlando). 2023;37(1):100769. Helmer P, et al. Longitudinal assessment of renal function and blood pressure in kidney transplant recipients. Nephrol Dial Transpl. 2022;37(Suppl 3):gfac063. Kaur H, et al. Non-dipping blood pressure pattern and allograft outcomes in kidney transplant recipients. J Clin Hypertens (Greenwich). 2024;26(1):45–53. Gabbai FB et al. Consensus conference on ambulatory blood pressure monitoring in kidney transplant patients. Kidney Int Rep. 2023;8(2):223–235. Wang Y, et al. Impact of masked hypertension on cardiovascular and renal outcomes in kidney transplant recipients: a systematic review and meta-analysis. Transplantation. 2023;107(5):1069–77. Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018;39(33):3021–104. Unger T, Borghi C, Charchar F, et al. 2020 International Society of Hypertension global hypertension practice guidelines. Hypertension. 2020;75(6):1334–57. Agarwal R, Andersen MJ. Blood pressure control in kidney transplant recipients: emerging evidence and perspectives. Hypertension. 2019;74(6):1274–81. Pisano A, Mallamaci F, Tripepi G. Hypertension in kidney transplant recipients: pathophysiology and management. J Nephrol. 2021;34(3):701–13. Sarafidis PA, et al. Ambulatory blood pressure monitoring in chronic kidney disease and transplantation. Curr Opin Nephrol Hypertens. 2020;29(5):560–7. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 04 May, 2026 Reviewers agreed at journal 10 Apr, 2026 Reviewers invited by journal 10 Apr, 2026 Editor invited by journal 30 Mar, 2026 Editor assigned by journal 30 Mar, 2026 Submission checks completed at journal 28 Mar, 2026 First submitted to journal 28 Mar, 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. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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-9163040","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":621645384,"identity":"70de3468-76e2-4541-8e8f-d5ca0ece45dc","order_by":0,"name":"Rabhia Mehdi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+klEQVRIiWNgGAWjYJACZsYGCQZ+IOMAEMuAhXiI0SLZANHCQ6wWBgaDAwxIivFp0W3gffi5cIeFvPGN3IOHeRjseOTdex8wvPmDW4vZAXZj6ZlnJAy33chLAGpJ5jE8c9yAcQ4ea8wOsDFI87ZJMG67kWNwcOY/Zh7DGWkMzDwSeLUw/wZqsd88A6hlBkM9j+H8Z0AtBni1sIFsSdwgkWNw4APDYR55CTaglgQ8Wg6zsVnPbJNInnHmDUjLcR4DnjSGg3MO4NFyvI35dmFbnW1/e47xhwSGajn59mOMD/CFGAMzugAogvDYgQ3IN5CmfhSMglEwCoY/AAA7nElSN7MlYwAAAABJRU5ErkJggg==","orcid":"","institution":"University of Health Sciences Algiers","correspondingAuthor":true,"prefix":"","firstName":"Rabhia","middleName":"","lastName":"Mehdi","suffix":""},{"id":621645385,"identity":"a6b5b4cb-9292-4bdd-a0c1-fecea66775aa","order_by":1,"name":"Mahrez Fissah","email":"","orcid":"","institution":"University of Health Sciences Algiers","correspondingAuthor":false,"prefix":"","firstName":"Mahrez","middleName":"","lastName":"Fissah","suffix":""},{"id":621645386,"identity":"8ba5cf6d-1da0-4bb8-aef5-cf867f54a1e4","order_by":2,"name":"Houssem Baghous","email":"","orcid":"","institution":"University of Health Sciences Algiers","correspondingAuthor":false,"prefix":"","firstName":"Houssem","middleName":"","lastName":"Baghous","suffix":""},{"id":621645387,"identity":"0be00683-41dd-4155-8d4e-79b52321c5f5","order_by":3,"name":"Sihem Bahbouh","email":"","orcid":"","institution":"University of Health Sciences Algiers","correspondingAuthor":false,"prefix":"","firstName":"Sihem","middleName":"","lastName":"Bahbouh","suffix":""},{"id":621645388,"identity":"2437768d-c4a5-4f5f-b5b3-a55bc0df04e2","order_by":4,"name":"Hind Arzour","email":"","orcid":"","institution":"University of Health Sciences Algiers","correspondingAuthor":false,"prefix":"","firstName":"Hind","middleName":"","lastName":"Arzour","suffix":""}],"badges":[],"createdAt":"2026-03-18 21:24:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9163040/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9163040/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":107257867,"identity":"20761408-12bd-4cca-b7f0-d35f705ffc95","added_by":"auto","created_at":"2026-04-19 12:35:26","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":32343,"visible":true,"origin":"","legend":"\u003cp\u003eEvolution of blood pressure phenotypes over time.\u003c/p\u003e","description":"","filename":"output.png","url":"https://assets-eu.researchsquare.com/files/rs-9163040/v1/e0051f87094a898c0e2a274e.png"},{"id":107482570,"identity":"319e8239-af82-4375-bd3e-454570f2a4b3","added_by":"auto","created_at":"2026-04-22 02:24:03","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":302446,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9163040/v1/25482dfd-eb35-4cf5-bcd9-c62f607ac2a7.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Ambulatory Blood Pressure Monitoring Unmasks a High Prevalence of Hypertension in Kidney Transplant Recipients: A Prospective Cohort Study Comparing Clinic, Self-Measurement, and ABPM","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eHypertension (HTN) is one of the most common complications after kidney transplantation and represents a major modifiable risk factor for both graft dysfunction and cardiovascular morbidity and mortality [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Accurate diagnosis and optimal management of HTN are therefore critical in this high-risk population.\u003c/p\u003e \u003cp\u003eHowever, blood pressure (BP) assessment in kidney transplant recipients (KTRs) remains challenging. Conventional clinic blood pressure measurement (CBPM) may not accurately reflect the true BP burden due to phenomena such as white-coat hypertension (WCH) and masked hypertension (MH). These discrepancies may lead to misclassification and inappropriate management.\u003c/p\u003e \u003cp\u003eAmbulatory blood pressure monitoring (ABPM) and self-blood pressure measurement (SBPM) have been proposed as more reliable alternatives [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. ABPM, in particular, provides valuable information on circadian BP patterns, including nocturnal hypertension and non-dipping status, which are associated with adverse outcomes [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite these advantages, there is limited prospective data comparing CBPM, SBPM, and ABPM longitudinally in KTRs [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe objective of this study was to prospectively compare these three methods for diagnosing hypertension and to determine the prevalence and evolution of WCH and MH during the first year following kidney transplantation.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Study Design and Population\u003c/h2\u003e \u003cp\u003e This prospective, single-center cohort study included 115 adult kidney transplant recipients followed at the Nephrology Department of Mustapha University Hospital (Algiers). Patients were included consecutively after transplantation and followed for 12 months.\u003c/p\u003e \u003cp\u003eInclusion criteria comprised adult patients (\u0026ge;\u0026thinsp;18 years) with a functioning graft. Exclusion criteria included graft loss within the first month, inability to perform BP monitoring, or incomplete follow-up data.\u003c/p\u003e \u003cp\u003e The study was conducted in accordance with the Declaration of Helsinki and approved by the local ethics committee. The study was reported in accordance with the STROBE guidelines for observational studies. All participants provided written informed consent.\u003c/p\u003e \u003cp\u003e All transplanted organs were obtained from voluntary donors in accordance with national regulations. No organs or tissues were obtained from prisoners. Transplantations were performed at Mustapha University Hospital (Algiers), through the Department of Nephrology, Dialysis and Kidney Transplantation.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Blood Pressure Measurements\u003c/h2\u003e \u003cp\u003e \u003cb\u003eClinic Blood Pressure Measurement (CBPM)\u003c/b\u003e \u003c/p\u003e \u003cp\u003eBP was measured using a validated oscillometric device after a 5-minute rest in the seated position. Three measurements were taken, and the average of the last two was recorded. Measurements were performed on the arm without an arteriovenous fistula.\u003c/p\u003e \u003cp\u003e \u003cb\u003eSelf-Blood Pressure Measurement (SBPM)\u003c/b\u003e \u003c/p\u003e \u003cp\u003ePatients performed SBPM over three consecutive days, with three measurements in the morning and three in the evening. The average of all readings was calculated.\u003c/p\u003e \u003cp\u003e \u003cb\u003eAmbulatory Blood Pressure Monitoring (ABPM)\u003c/b\u003e \u003c/p\u003e \u003cp\u003eTwenty-four-hour ABPM was performed using a validated device (Spacelabs 90217). BP measurements were recorded every 15 minutes during the day and every 30 minutes at night. Recordings were considered valid if at least 70% of measurements were successful.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Definitions\u003c/h2\u003e \u003cp\u003e Hypertension was defined according to the ESH/ESC 2013 guidelines, which were the current reference at the time of study design and data collection.\u003c/p\u003e \u003cp\u003e Although more recent guidelines are available, we used the 2013 ESH/ESC definitions to ensure consistency with the study protocol and longitudinal comparisons.\u003c/p\u003e \u003cp\u003eWhite-coat hypertension was defined as CBPM\u0026thinsp;\u0026ge;\u0026thinsp;140/90 mmHg with daytime ABPM\u0026thinsp;\u0026lt;\u0026thinsp;135/85 mmHg.\u003c/p\u003e \u003cp\u003eMasked hypertension was defined as CBPM\u0026thinsp;\u0026lt;\u0026thinsp;140/90 mmHg with daytime ABPM\u0026thinsp;\u0026ge;\u0026thinsp;135/85 mmHg.\u003c/p\u003e \u003cp\u003eNocturnal BP patterns were categorized as dipper or non-dipper based on the nocturnal decline in BP.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Statistical Analysis\u003c/h2\u003e \u003cp\u003eStatistical analyses were performed using SPSS version 20.0 and R software. Continuous variables were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation or median (interquartile range), as appropriate. Categorical variables were expressed as percentages.\u003c/p\u003e \u003cp\u003eComparisons between groups were performed using the chi-square or Fisher\u0026rsquo;s exact test for categorical variables. A p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n\u003ch2\u003e3.1 Patient Characteristics\u003c/h2\u003e\n\u003cp\u003eThe study included 115 kidney transplant recipients. Baseline characteristics, including age, sex, donor type, and immunosuppressive therapy, are summarized in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003ePrevalence of hypertension at 12 months according to measurement method (N\u0026thinsp;=\u0026thinsp;115)\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eMeasurement Method\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eHypertension Definition\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eHypertensive Patients (n)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ePrevalence (%)\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\u003eClinic BP (CBPM)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBP\u0026thinsp;\u0026ge;\u0026thinsp;140/90 mmHg\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e40\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e34.8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSelf-Measured BP (SBPM)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBP\u0026thinsp;\u0026ge;\u0026thinsp;135/85 mmHg\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e48\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e41.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAmbulatory BP (ABPM)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e24-hour average\u0026thinsp;\u0026ge;\u0026thinsp;130/80 mmHg\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e58\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e50.4\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"char\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\n\u003ch2\u003e3.2 Prevalence of Hypertension According to Measurement Method\u003c/h2\u003e\n\u003cp\u003eThe prevalence of hypertension increased over time when assessed by ABPM, reaching 50.4% at 12 months post-transplantation. In contrast, CBPM consistently underestimated hypertension prevalence across all time points.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\n\u003ch2\u003e3.3 Prevalence of White-Coat and Masked Hypertension\u003c/h2\u003e\n\u003cp\u003eMasked hypertension was highly prevalent and increased significantly during follow-up (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). In contrast, white-coat hypertension remained relatively low and decreased over time. Among hypertensive patients, masked hypertension represented the predominant phenotype across all time points (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab3\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eGlobal prevalence of blood pressure phenotypes (N\u0026thinsp;=\u0026thinsp;115)\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eBP Phenotype\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e1 Month\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e3 Months\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e6 Months\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e12 Months\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\u003eMasked Hypertension\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3 (2.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e10 (8.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e28 (24.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e35 (30.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eWhite-Coat Hypertension\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e18 (15.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e13 (11.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e14 (12.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e14 (12.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"5\"\u003e\u003cem\u003ePercentages are calculated based on the total study population (N\u0026thinsp;=\u0026thinsp;115).\u003c/em\u003e\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"char\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"char\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab5\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eDistribution of hypertension phenotypes among hypertensive patients only\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eBP Phenotype\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e1 Month (n\u0026thinsp;=\u0026thinsp;9)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e3 Months (n\u0026thinsp;=\u0026thinsp;19)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e6 Months (n\u0026thinsp;=\u0026thinsp;39)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e12 Months (n\u0026thinsp;=\u0026thinsp;58)\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\u003eMasked Hypertension\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3 (33.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e10 (52.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e28 (71.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e35 (60.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSustained Hypertension\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e6 (66.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e9 (47.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e11 (28.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e23 (39.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"5\"\u003e\u003cem\u003ePercentages are calculated within the hypertensive population at each time point.\u003c/em\u003e\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n\u003ch2\u003e3.4 Nocturnal Blood Pressure Profile\u003c/h2\u003e\n\u003cp\u003eA high proportion of hypertensive patients exhibited a non-dipping pattern, indicating abnormal circadian BP regulation. The evolution of blood pressure phenotypes over time is illustrated in Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n\u003ch2\u003e3.5 Therapeutic Implications\u003c/h2\u003e\n\u003cp\u003ePatients diagnosed with hypertension by ABPM required a higher number of antihypertensive medications compared to those diagnosed by CBPM alone.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e4.1 Main Findings\u003c/h2\u003e \u003cp\u003eThis prospective study demonstrates that CBPM significantly underestimates the true prevalence of hypertension in KTRs. ABPM revealed a marked increase in hypertension prevalence over time, reaching more than 50% at one year post-transplantation.\u003c/p\u003e \u003cp\u003eThe most notable finding is the high prevalence of masked hypertension, affecting more than half of patients at 12 months. This highlights the limitations of relying solely on clinic measurements.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e4.2 Comparison with Existing Literature\u003c/h2\u003e \u003cp\u003eOur findings are consistent with previous studies reporting a high prevalence of masked hypertension in KTRs and its association with adverse renal and cardiovascular outcomes [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. The prevalence of white-coat hypertension observed in our cohort is also consistent with published data [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003e4.3 Clinical Implications\u003c/h2\u003e \u003cp\u003eThese results support the systematic use of ABPM in the follow-up of kidney transplant recipients [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Early detection of masked hypertension may allow timely therapeutic intervention and improve long-term outcomes. These findings suggest that a substantial proportion of transplant recipients may remain undertreated if ABPM is not routinely implemented. Calcineurin inhibitor-related mechanisms may further contribute to hypertension burden in this population [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003e4.4 Strengths and Limitations\u003c/h2\u003e \u003cp\u003eThe strengths of this study include its prospective design and longitudinal follow-up. Limitations include its single-center nature and the lack of long-term outcome data.\u003c/p\u003e \u003c/div\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eMasked hypertension is highly prevalent and frequently missed by conventional clinic measurements in kidney transplant recipients. ABPM provides a more accurate assessment of blood pressure and should be integrated into routine clinical practice.\u003c/p\u003e"},{"header":"Declarations","content":" \u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e \u003cp\u003e The study was conducted in accordance with the Declaration of Helsinki and approved by the local ethics committee of Mustapha University Hospital. Written informed consent was obtained from all participants.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eNo specific funding was received for this study.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eMR contributed to study conception, data collection, analysis, and manuscript drafting. All authors contributed to manuscript revision and approved the final version.\u003c/p\u003e\u003ch2\u003eAcknowledgments\u003c/h2\u003e \u003cp\u003eThe authors thank the medical and nursing staff of the Nephrology Department for their support in patient follow-up and data collection.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSezer S, Uyar ME, Ozdemir FN, et al. Masked hypertension is associated with lower graft function and albuminuria in renal transplant recipients. Clin Nephrol. 2021;95(3):143\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBooth JN, Abdalla M, Tanner RM, et al. The clinical significance of white-coat hypertension in kidney transplant recipients: a systematic review and meta-analysis. Am J Hypertens. 2022;35(4):319\u0026ndash;27.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSalvadori M, Tsalouchos A. Calcineurin inhibitor-induced hypertension: mechanisms and management. Transpl Rev (Orlando). 2023;37(1):100769.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHelmer P, et al. Longitudinal assessment of renal function and blood pressure in kidney transplant recipients. Nephrol Dial Transpl. 2022;37(Suppl 3):gfac063.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKaur H, et al. Non-dipping blood pressure pattern and allograft outcomes in kidney transplant recipients. J Clin Hypertens (Greenwich). 2024;26(1):45\u0026ndash;53.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGabbai FB et al. Consensus conference on ambulatory blood pressure monitoring in kidney transplant patients. Kidney Int Rep. 2023;8(2):223\u0026ndash;235.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang Y, et al. Impact of masked hypertension on cardiovascular and renal outcomes in kidney transplant recipients: a systematic review and meta-analysis. Transplantation. 2023;107(5):1069\u0026ndash;77.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWilliams B, Mancia G, Spiering W, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018;39(33):3021\u0026ndash;104.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUnger T, Borghi C, Charchar F, et al. 2020 International Society of Hypertension global hypertension practice guidelines. Hypertension. 2020;75(6):1334\u0026ndash;57.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAgarwal R, Andersen MJ. Blood pressure control in kidney transplant recipients: emerging evidence and perspectives. Hypertension. 2019;74(6):1274\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePisano A, Mallamaci F, Tripepi G. Hypertension in kidney transplant recipients: pathophysiology and management. J Nephrol. 2021;34(3):701\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSarafidis PA, et al. Ambulatory blood pressure monitoring in chronic kidney disease and transplantation. Curr Opin Nephrol Hypertens. 2020;29(5):560\u0026ndash;7.\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":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nephrology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bnep","sideBox":"Learn more about [BMC Nephrology](http://bmcnephrol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bnep/default.aspx","title":"BMC Nephrology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Kidney transplantation, ambulatory blood pressure monitoring, masked hypertension, white-coat hypertension, graft survival","lastPublishedDoi":"10.21203/rs.3.rs-9163040/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9163040/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e\u003c/p\u003e \u003cp\u003eHypertension is a major modifiable risk factor affecting graft and patient survival after kidney transplantation. However, the optimal method for its diagnosis remains uncertain. This study aimed to compare clinic blood pressure measurement (CBPM), self-blood pressure measurement (SBPM), and ambulatory blood pressure monitoring (ABPM) in kidney transplant recipients (KTRs).\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e \u003cp\u003e We conducted a prospective longitudinal study including 115 KTRs followed at the Nephrology Department of Mustapha University Hospital (Algiers). Blood pressure was assessed using CBPM, SBPM, and 24-hour ABPM at 1, 3, 6, and 12 months post-transplantation. Hypertension was defined according to ESH/ESC 2013 guidelines. White-coat hypertension (WCH) and masked hypertension (MH) were defined based on discrepancies between CBPM and ABPM.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe prevalence of hypertension increased over time when assessed by ABPM, from 7.8% at 1 month to 50.4% at 12 months. CBPM consistently underestimated the true prevalence. Masked hypertension was highly prevalent, representing 33.3%, 52.6%, 71.8%, and 60.3% of hypertensive patients at 1, 3, 6, and 12 months, respectively. White-coat hypertension was less frequent and decreased over time. A non-dipping pattern was commonly observed among hypertensive patients.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e\u003c/p\u003e \u003cp\u003eABPM is a superior tool for diagnosing hypertension in KTRs, revealing a substantial burden of masked hypertension missed by conventional measurements. Its systematic use should be considered in routine follow-up.\u003c/p\u003e","manuscriptTitle":"Ambulatory Blood Pressure Monitoring Unmasks a High Prevalence of Hypertension in Kidney Transplant Recipients: A Prospective Cohort Study Comparing Clinic, Self-Measurement, and ABPM","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-19 12:35:23","doi":"10.21203/rs.3.rs-9163040/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-05-04T08:02:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"290725562743066792766830927450256873867","date":"2026-04-10T09:20:12+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-10T09:00:14+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-30T07:07:49+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-30T06:43:33+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-28T12:47:22+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nephrology","date":"2026-03-28T12:42:55+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nephrology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bnep","sideBox":"Learn more about [BMC Nephrology](http://bmcnephrol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bnep/default.aspx","title":"BMC Nephrology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"aedae28b-28ae-4313-88c4-48bd20317bc2","owner":[],"postedDate":"April 19th, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-04T08:02:47+00:00","index":39,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-19T12:35:23+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-19 12:35:23","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9163040","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9163040","identity":"rs-9163040","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}