Key result
In individuals with a hypertensive response to exercise, masked hypertension was associated with a greater likelihood of left ventricular hypertrophy (OR 4.93; 95% CI 2.16-12.2; P<0.0001).
Why the study?
Whether a hypertensive response to exercise marks masked hypertension in individuals without prior hypertension, and whether masked hypertension associates with hypertension-mediated organ damage in this setting, remains unclear.
Does a hypertensive response to exercise indicate masked hypertension and subclinical organ damage in clinically normotensive individuals?
Meta-Analysis (n=1,155)
Does a hypertensive response to exercise indicate masked hypertension and subclinical organ damage in clinically normotensive individuals?
Odds Ratio: 4.93 (95% CI 2.16–12.2)
p-value: p=< 0.0001
A hypertensive response to exercise in clinically normotensive individuals is associated with a high prevalence of masked hypertension and subclinical organ damage, suggesting a need for 24-h BP monitoring in these patients.
BACKGROUND: Emerging evidence suggests that a hypertensive response to exercise (HRE) during dynamic or isometric stress tests assessing cardiac function is predictive of hypertension and cardiovascular events such coronary artery disease, heart failure and stroke. Whether HRE represents a marker of masked hypertension (MH) in individuals with no prior history of hypertension is still unclear. This is also the case for the association between MH and hypertension-mediated organ damage (HMOD) in the HRE setting. METHODS: We addressed this issue through a review and a meta-analysis of studies providing data on this topic in normotensive individuals undergone both to dynamic or static exercise and to 24-h blood pressure monitoring (ABPM). A systematic search was performed using Pub-Med, OVID, EMBASE and Cochrane library databases from inception up to February 28th 2023. RESULTS: Six studies including a total of 1,155 untreated clinically normotensive individuals were considered for the review. Data provided by the selected studies can be summarized as follows: (i) HRE is a BP phenotype linked to a high prevalence of MH (27.3% in the pooled population); (ii) MH is, in turn, associated with a greater, consistent likelihood of echocardiographic left ventricular hypertrophy (OR: 4.93, CI: 2.16-12.2, P < 0.0001) and vascular organ damage, as assessed by pulse wave velocity, (SMD: 0.34 ± 0.11, CI: 0.12-0.56, P = 0002). CONCLUSIONS: On the basis of this, albeit limited, evidence, the diagnostic work-up in individuals with HRE should primarily be addressed to look for MH as well as for markers of HMOD, a highly prevalent alteration in MH.
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Cuspidi et al. (2023) conducted a meta-analysis in Hypertensive response to exercise in clinically normotensive individuals (n=1,155). Masked hypertension was evaluated on Echocardiographic left ventricular hypertrophy (OR 4.93, 95% CI 2.16-12.2, p=< 0.0001). In individuals with a hypertensive response to exercise, masked hypertension was associated with a greater likelihood of left ventricular hypertrophy (OR 4.93; 95% CI 2.16-12.2; P<0.0001).
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