Hypertension phenotypes in nondialysis patients with chronic kidney disease: systematic review and meta-analysis.

In nondialysis chronic kidney disease (CKD) patients, masked hypertension (MH), white-coat hypertension (WCH), nondipping, and nocturnal hypertension phenotypes are known to complicate the diagnostic and therapeutic approach, but their prevalence remains unclear. A systematic search of two databases (PubMed, EmBase) from inception through October 1, 2025 was performed to identify records reporting MH, WCH, nocturnal hypertension, and nondipping prevalence in this population. A meta-analysis (REML model) was conducted to calculate respective pooled prevalences. From 2355 records screened, 68 were selected including 41 989 patients. Meta-analysis of 33 studies (n = 26 539, weighted mean age 60.9 years, 58% males, mean eGFR 49.3 ml/min) indicated 11% pooled WCH prevalence [95% confidence interval (CI) (8, 14%)]. Further analyses (33 studies, n = 26 542) indicated pooled MH prevalence 23% (19, 27%), pooled nondipping and dipping prevalence 66% (61, 70%) and 34% (30, 39%), respectively (49 studies, n = 22 773 - two phenotype analysis) and pooled dipping, nondipping, extreme dipping and reverse dipping pooled prevalence 28% (24, 33%), 43% (40, 46%), 3% (2, 6%), 23% (18, 27%) respectively (20 studies, n = 10 865 - four phenotype analysis). Meta-analysis of 14 studies (n = 15 701) indicated nocturnal hypertension prevalence 57% (47, 67%). Ambulatory and home blood pressure monitoring were equivalent in detecting WCH and MH (P = 0.68/0.4, respectively). Glomerular filtration rate was not associated with the MH/WCH prevalence. Nondialysis CKD patients experience an important burden of MH, nocturnal hypertension and nondipping, and lesser WCH. These results strongly support the necessity for out-of-office blood pressure evaluation in these patients.