**Title**
The impact of masked and white coat hypertension on carotid pulse wave velocity: a systematic review and meta-analysis.
**Review question(s)**
The impact of masked and white coat hypertension on subclinical arterial stiffness, specifically carotid-femoral pulse wave velocity.
**Searches**
We will search the following databases: MEDLINE (via PubMed), the Cochrane Library and PROSPERO for systematic reviews which have been already published. Two reviewers will independently extract data. Any disagreement will be resolved by consensus. Authors will be contacted in order to obtain any missing data relevant to the analysis. Potential confounders on the basis of biological plausibility, will also be extracted.
**Types of study to be included**
Case–control studies, Cross-sectional studies.
**Condition or domain being studied**
Arterial stiffness in hypertension phenotypes.
**Participants/ population**
Inclusion criteria:
(1) Full articles published in English in peer-reviewed journals;
(2) Elevated out-of-office BP defined by ABPM;
(3) Carotid-femoral pulse wave velocity measured by applanation tonometry.
Exclusion criteria:
(1) Inclusion of patients on antihypertensive drugs;
(2) Studies with less than 10 individuals in any arm;
(3) Other measures of arterial stiffness (augmenation index, arterial elasticity arterial complience) or pulse wave velocity measured by different methods (MRI, ultrasound, oscillometry) or at different sites (aorta) or paths (branchial-ankle).
**Intervention(s), exposure(s)**
Pulse Wave Velocity (PWV).
**Comparator(s)/ control**
Normotensive and hypertensive individuals.
**Context**
Case–control studies and cross-sectional studies including the comparison of masked, white coat hypertension or both with normotension or hypertension regarding carotid-femoral pulse wave velocity.
**Outcome(s)**
Primary: Risk of incident increased arterial stiffness.
**Data extraction, (selection and coding)**
All studies will be imported into a reference management software (EndNote X7). After duplicate removal, two reviewers will independently screen all titles and abstracts and peruse full texts for eligible studies. Any discordance regarding study eligibility will be resolved by consultation with a third review author.
**Risk of bias (quality) assessment**
The quality of the eligible studies was evaluated using a version of the New Castle Ottawa quality assessment scale. A sensitivity analysis will be performed excluding studies with low quality.
**Strategy for data synthesis**
-Random effects or fixed-effects models will be used and the inverse variance method. We will report effect sizes as mean differences (MD) and their 95% confidence intervals (CI), if the measures of PWV are expressed as means.
-Heterogeneity will be tested with the Cochran chi-square test and the degree of heterogeneity quantified by the I2 statistics and its 95% CI. An I2 between 30% and 60% will be described as moderate.
-Publication bias will be shown with funnel plots and formally tested with the Egger’s test.
-Sensitivity analyses and meta-regression will be performed if there is statistically significant heterogeneity.
-Subgroups for Meta-regression: Sex, Age, BMI.
**Subject index terms**
Masked hypertension, white coat hypertension, arterial stiffness, carotid-femoral pulse wave velocity
**Search strategy**
PubMed, Cochrane Library and Prospero will be used for all searches. A basic search strategy will be developed for PubMed and modified accordingly for other engines.
The search strategy will be accomplished by two members of the group. Discrepancies will be solved with discussion between the two researchers and, if needed, with the help of a third one.
**Last search date**
17 September, 18:30
**Organisational affiliation of the review**
Aristotle University of Thessaloniki, Greece
