Increased cardiovascular risk in patients with a hypertensive response to exercise may be explained by masked hypertension

Sharman, J. E., Thomas, S., Hare, J. L., Leano, R. and Marwick, T. H. (2008). Increased cardiovascular risk in patients with a hypertensive response to exercise may be explained by masked hypertension. In: Artery Research. Artery Career Development Lectures: Artery 8, Ghent, Belgium, (116-116). 25-27 September, 2008.


Author Sharman, J. E.
Thomas, S.
Hare, J. L.
Leano, R.
Marwick, T. H.
Title of paper Increased cardiovascular risk in patients with a hypertensive response to exercise may be explained by masked hypertension
Conference name Artery Career Development Lectures: Artery 8
Conference location Ghent, Belgium
Conference dates 25-27 September, 2008
Proceedings title Artery Research   Check publisher's open access policy
Place of Publication Amsterdam ; London
Publisher Elsevier
Publication Year 2008
ISSN 1872-9312
Volume 2
Issue 3
Start page 116
End page 116
Total pages 1
Language eng
Formatted Abstract/Summary
Background
A hypertensive response to exercise (HRE; defined as normal clinic blood pressure [BP] and exercise BP >210/105mmHg in men or >190/105mmHg in women) independently predicts incident hypertension and cardiovascular mortality. The mechanisms remain unclear but may be related to masked hypertension. This study aimed to assess the prevalence of masked hypertension and cardiovascular risk factors, including aortic reservoir function, in patients with a HRE.

Methods
Comprehensive clinical and echocardiographic evaluation (including central BP, aortic reservoir pressure, aortic pulse wave velocity by tonometry) and 24 hour ambulatory BP monitoring (ABPM) were performed in 81 untreated patients with HRE (aged 54±9 years; 60% male; free from coronary artery disease). Masked hypertension was defined as ABPM systolic BP (SBP) ≥130 mmHg and clinic BP <140/90 mmHg.

Results

Masked hypertension was present in 50 patients (62%). These patients had higher left ventricular (LV) mass index (92.1±17.8 g/m2 versus 77.2±17.9g/m2; p=0.01) aortic reservoir pressure (104±9mmHg versus 97±10mmHg; p=0.001) and exercise SBP (226±15mmHg versus 210+15mmHg; p<0.001), despite no significant difference in aortic pulse wave velocity or central pulse pressure (p>0.05 for both). Aortic reservoir pressure was significantly correlated with peak exercise SBP (r=0.34; p=0.002). The strongest independent determinant of LV mass index was the pressure of masked hypertension (β=0.37; p=0.001) ,

Conclusions
Aortic reservoir pressure is significantly elevated, and masked hypertension highly prevalent in HRE patients with a normal resting office BP. This may help to explain increased risk in patients with a HRE and clinicians should suspect masked hypertension in this population.
Subjects 1103 Clinical Sciences
Keyword Cardiology
Arteries
Hypertension
Q-Index Code EX
Q-Index Status Provisional Code
Institutional Status Unknown

 
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Created: Mon, 01 Mar 2010, 09:49:19 EST by Therese Egan on behalf of Faculty Of Health Sciences