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

J.E. Sharman, J.L. Hare, S. Thomas, R. Leano, T.H. Marwick
2008 Artery Research  
associated SNP (rs1081161) within the 9p21 region were genotyped. Aortic stiffness was decreased in male carriers of the rs10757274G and rs2891168G alleles. Accordingly, aortic compliance and distensibility were higher in men who carried the rs10757274G and rs2891168G alleles. Adjustment for age and mean arterial pressure had no effect on these associations. None of the SNPs were associated with either intima-media thickness or lumen diameter of the abdominal aorta. There were no associations
more » ... e no associations between the T2D-associated rs10811661 SNP and any measure of aortic stiffness. Impaired mechanical properties of the aortic wall may be a link between the association between chromosome 9p21 polymorphisms and vascular disease. 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 54AE9 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 (92.1AE17.8 g/m 2 versus 77.2AE17.9g/m 2 ; pZ0.01) aortic reservoir pressure (104AE9mmHg versus 97AE10mmHg; pZ0.001) and exercise SBP (226AE15mmHg versus 210þ15mmHg; 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 (rZ0.34; pZ0.002). The strongest independent determinant of LV mass index was the pressure of masked hypertension (bZ0.37; pZ0.001) , 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.
doi:10.1016/j.artres.2008.08.405 fatcat:miki6ltt7vd55dzzppbbgeoemm