Exaggerated Blood Pressure Response to Exercise – A New Portent of Masked Hypertension

Abstract

Masked hypertension (MHT) is a popular entity with increased risk of developing sustained hypertension, heart attack, stroke, and death. Subjects have normal blood pressure (BP) at office but elevated values at night so it is difficult to diagnose. Exaggerated blood pressure response to exercise (EBPR) is also a predictor of future hypertension. To investigate the relationship between these two entities, we evaluated 61 normotensive subjects with EBPR. The subjects underwent 24-h ambulatory blood pressure monitoring (ABPM). The prevalence of masked hypertension among subjects with EBPR was 41%. Body mass index (BMI), non-high density lipoprotein (HDL) cholesterol, diastolic blood pressure (DBP) at peak exercise and recovery, nondipping DBP pattern, and elevated early morning average BPs were associated with masked hypertension. In multivariate logistic regression analysis, the DBP measured at peak exercise was detected as an independent predictor of MHT in subjects with EBPR. Subjects with abnormally elevated BP during exercise are prone to MHT, necessitate medical assessment and close follow-up for hypertension.

Exaggerated Blood Pressure Response to Exercise Is Not Associated With Masked Hypertension in Patients With High Normal Blood Pressure Levels

“…In this subgroup, ExBPR is not useful to identify masked hypertension. However, it is still possible that in young patients with low BP levels, ExBPR is associated with masked hypertension, as has been previously described . In our population, we could not identify risk factors for masked hypertension.…”

An exaggerated blood pressure response to exercise is associated with nitric oxide bioavailability and inflammatory markers in normotensive females

“…43 Several studies have shown that the cardiovascular risk in patients with masked hypertension is elevated and that it is similar to the risk in patients with sustained hypertension. 44 Interestingly, a few studies 45,46 showed that an exaggerated blood pressure response during exercise was significantly correlated to the elevation of daytime and night time blood pressure as calculated by the ambulatory 24-h blood pressure measurement. On the basis of these studies, an exaggerated SBP response to exercise has been thought to reflect masked hypertension.…”

Effect of Sleep Quality on Hemodynamic Response to Exercise and Heart Rate Recovery in Apparently Healthy Individuals

“…It is a valuable means of identifying normotensive individuals at high risk for developing hypertension and further end-organ damage risk secondary to HT [38][39][40]. In addition, an association between exaggerated BP response to exercise and masked HT has been reported [7]. In a recent study, normotensive men with metabolic syndrome, but with exercise-induced HT, were found to have greater insulin resistance and lower HR variability indices [41].…”

“…Even in normotensive individuals, subjects with exaggerated BP responses to exercise were reported to be more prone to develop overt hypertension (HT) and associated unfavorable CV outcomes [6,7]. Impaired HR response to exercise, also known as chronotropic incompetence, is another parameter linked to adverse clinical outcomes in healthy adults and worse prognosis in patients with coronary artery disease (CAD) [8][9][10][11][12].…”