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Masked hypertension and submaximal exercise blood pressure among adolescents from the Avon Longitudinal Study of Parents and Children (ALSPAC)


Huang, Z and Sharman, JE and Fonseca, R and Park, C and Chaturvedi, N and Davey Smith, G and Howe, LD and Lawlor, DA and Hughes, AD and Schultz, MG, Masked hypertension and submaximal exercise blood pressure among adolescents from the Avon Longitudinal Study of Parents and Children (ALSPAC), Scandinavian Journal of Medicine and Science in Sports pp. 1-6. ISSN 0905-7188 (2019) [Refereed Article]

Copyright Statement

2019 John Wiley & Sons A/S.

DOI: doi:10.1111/sms.13525


Purpose: Masked hypertension is associated with increased cardiovascular risk but is undetectable by clinic blood pressure (BP). Elevated systolic BP responses to submaximal exercise reveal the presence of masked hypertension in adults, but it is unknown whether this is the case during adolescence. We aimed to determine if exercise BP was raised in adolescents with masked hypertension, and its association with cardiovascular risk markers.

Methods: A total of 657 adolescents (aged 17.7 0.3 years; 41.9% male) from the Avon longitudinal study of parents and children (ALSPAC) completed a step-exercise test with pre-, post-, and recovery-exercise BP, clinic BP and 24-hour ambulatory BP. Masked hypertension was defined as clinic BP <140/90 mm Hg and 24-hour ambulatory BP ≥130/80 mm Hg. Assessment of left-ventricular (LV) mass index and carotid-femoral pulse wave velocity (aortic PWV) was also undertaken. Thresholds of clinic, pre-, post-, and recovery-exercise systolic BP were explored from ROC analysis to identify masked hypertension.

Results: Fifty participants (7.8%) were classified with masked hypertension. Clinic, pre-, post-, and recovery-exercise systolic BP were associated with masked hypertension (AUC ≥ 0.69 for all, respectively), with the clinic systolic BP threshold of 115 mm Hg having high sensitivity and specificity and exercise BP thresholds of 126, 150, and 130 mm Hg, respectively, having high specificity and negative predictive value (individually or when combined) for ruling out the presence of masked hypertension. Additionally, this exercise systolic BP above the thresholds was associated with greater left-ventricular mass index and aortic PWV.

Conclusions: Submaximal exercise systolic BP is associated with masked hypertension and adverse cardiovascular structure in adolescents. Exercise BP may be useful in addition to clinic BP for screening of high BP and cardiovascular risk in adolescents.

Item Details

Item Type:Refereed Article
Keywords:ALSPAC, adolescent, body composition, exercise test, masked hypertension, vascular stiffness
Research Division:Biomedical and Clinical Sciences
Research Group:Cardiovascular medicine and haematology
Research Field:Cardiology (incl. cardiovascular diseases)
Objective Division:Health
Objective Group:Clinical health
Objective Field:Clinical health not elsewhere classified
UTAS Author:Huang, Z (Ms Huang Zhengzheng)
UTAS Author:Sharman, JE (Professor James Sharman)
UTAS Author:Fonseca, R (Mr Ricardo Fonseca Diaz)
UTAS Author:Schultz, MG (Dr Martin Schultz)
ID Code:135281
Year Published:2019
Web of Science® Times Cited:2
Deposited By:Menzies Institute for Medical Research
Deposited On:2019-10-10
Last Modified:2019-11-21

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