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Association of Masked Hypertension and Left Ventricular Remodeling With the Hypertensive Response to Exercise

Citation

Sharman, JE and Hare, JL and Thomas, S and Davies, JE and Leano, R and Jenkins, C and Marwick, TH, Association of Masked Hypertension and Left Ventricular Remodeling With the Hypertensive Response to Exercise, American Journal of Hypertension, 24, (8) pp. 898-903. ISSN 0895-7061 (2011) [Refereed Article]


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DOI: doi:10.1038/ajh.2011.75

Abstract

Background A hypertensive response to exercise (HRE; defined as normal clinic blood pressure (BP) and exercise systolic BP (SBP) 210 mm Hg in men or 190 mm Hg in women, or diastolic BP (DBP) 105 mm Hg) independently predicts mortality. The mechanisms remain unclear but may be related to masked hypertension. This study aimed to assess the prevalence of masked hypertension and its association with cardiovascular risk factors, including left ventricular (LV) mass, in patients with a HRE. Methods Comprehensive clinical and echocardiographic evaluation (including central BP, aortic pulse wave velocity by tonometry) and 24-h ambulatory BP monitoring (ABPM) were performed in 72 untreated patients with HRE (aged 54 9 years; 60% male; free from coronary artery disease confirmed by exercise stress echocardiography). Masked hypertension was defined according to guidelines as daytime ABPM 135/85 mm Hg and clinic BP <140/90 mm Hg. Results Masked hypertension was present in 42 patients (58%). These patients had higher LV mass index (41.5 8.7g/m2.7 vs. 35.98.5g/m2.7; P = 0.01), LV relative wall thickness (RWT; 0.42 0.09 vs. 0.37 0.06; P = 0.004) and exercise SBP (222 17 mm Hg vs. 21214 mm Hg; P = 0.01), but no significant difference in aortic pulse wave velocity or central pulse pressure (P > 0.05 for both). The strongest independent determinant of LV mass index was the presence of masked hypertension (unstandardized = 5.6; P = 0.007), which was also independently related to LV RWT (unstandardized = 0.04; P = 0.03). Conclusions Masked hypertension is highly prevalent in HRE patients with a normal resting office BP and is associated with increased LV mass index and RWT. Clinicians should consider measuring ABPM or home BP in HRE patients.

Item Details

Item Type:Refereed Article
Keywords:ambulatory blood pressure monitoring; blood pressure; hypertension; hypertensive response to exercise; left ventricle
Research Division:Medical and Health Sciences
Research Group:Cardiorespiratory Medicine and Haematology
Research Field:Cardiology (incl. Cardiovascular Diseases)
Objective Division:Health
Objective Group:Clinical Health (Organs, Diseases and Abnormal Conditions)
Objective Field:Cardiovascular System and Diseases
Author:Sharman, JE (Professor James Sharman)
Author:Marwick, TH (Professor Tom Marwick)
ID Code:70960
Year Published:2011
Web of Science® Times Cited:44
Deposited By:Menzies Institute for Medical Research
Deposited On:2011-07-05
Last Modified:2014-05-05
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