Masked Hypertension and Exaggerated Blood Pressure Response to Exercise: A Review and Meta-Analysis
Aim: Whether exaggerated blood pressure response (EBPR) to exercise represents a marker of masked hypertension (MH) in individuals with no prior history of hypertension is still unclear. We investigated this issue through a review and a meta-analysis of studies providing data on this association in...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-03-01
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| Series: | Diagnostics |
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| Online Access: | https://www.mdpi.com/2075-4418/13/6/1005 |
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| author | Cesare Cuspidi Elisa Gherbesi Andrea Faggiano Carla Sala Stefano Carugo Guido Grassi Marijana Tadic |
| author_facet | Cesare Cuspidi Elisa Gherbesi Andrea Faggiano Carla Sala Stefano Carugo Guido Grassi Marijana Tadic |
| author_sort | Cesare Cuspidi |
| collection | DOAJ |
| description | Aim: Whether exaggerated blood pressure response (EBPR) to exercise represents a marker of masked hypertension (MH) in individuals with no prior history of hypertension is still unclear. We investigated this issue through a review and a meta-analysis of studies providing data on this association in normotensive individuals undergone both to dynamic or static exercise and to 24 h blood pressure monitoring (ABPM). Design: A systematic search was performed using Pub-Med, OVID, EMBASE, and Cochrane library databases from inception up to 31 December 2022. Studies were identified by using the following search terms: “masked hypertension”, “out-of-office hypertension”, “exercise blood pressure”, “exaggerated blood pressure exercise”, “exercise hypertension”. Results: Nine studies including a total of 387 participants with MH and 406 true normotensive controls were considered. Systolic BP (SBP) and diastolic BP (DBP) at rest were significantly higher in MH individuals than in sustained normotensives: 126.4 ± 1.4/78.5 ± 1.8 versus 124.0 ± 1.4/76.3 ± 1.3 mmHg (SMD: 0.21 ± 0.08, CI: 0.06–0.37, <i>p</i> = 0.007 for SBP; 0.24 ± 0.07, CI: 0.08–0.39, <i>p</i> = 0.002 for DBP). The same was true for BP values at peak exercise: 190.0 ± 9.5/96.8 ± 3.7 versus 173.3 ± 11.0/88.5 ± 1.8 mmHg (SMD 1.02 ± 0.32, CI: 0.39–1.65, <i>p</i> = 0.002 for SBP and 0.97 ± 0.25, CI: 0.47–1.96, <i>p</i> < 0.0001 for DBP). The likelihood of having an EBPR was significantly greater in MH than in their normotensive counterparts (OR: 3.33, CI: 1.83–6.03, <i>p</i> < 0.0001). Conclusions: Our meta-analysis suggests that EBPR reflects an increased risk of MH and that BP measurement during physical exercise aimed to assess cardiovascular health may unmask the presence of MH. This underscores the importance of BP measured in the medical setting at rest and in dynamic conditions in order to identify individuals at high cardiovascular risk due to unrecognized hypertension. |
| first_indexed | 2024-03-11T06:42:15Z |
| format | Article |
| id | doaj.art-da5558ab10704c0fa21ac440d0d881b7 |
| institution | Directory Open Access Journal |
| issn | 2075-4418 |
| language | English |
| last_indexed | 2024-03-11T06:42:15Z |
| publishDate | 2023-03-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Diagnostics |
| spelling | doaj.art-da5558ab10704c0fa21ac440d0d881b72023-11-17T10:33:02ZengMDPI AGDiagnostics2075-44182023-03-01136100510.3390/diagnostics13061005Masked Hypertension and Exaggerated Blood Pressure Response to Exercise: A Review and Meta-AnalysisCesare Cuspidi0Elisa Gherbesi1Andrea Faggiano2Carla Sala3Stefano Carugo4Guido Grassi5Marijana Tadic6Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milano, ItalyDepartment of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, ItalyDepartment of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, ItalyDepartment of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, ItalyDepartment of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, ItalyDepartment of Medicine and Surgery, University of Milano-Bicocca, 20126 Milano, ItalyDepartment of Cardiology, University Hospital “Dr. Dragisa Misovic-Dedinje”, Heroja Milana Tepica 1, 11000 Belgrade, SerbiaAim: Whether exaggerated blood pressure response (EBPR) to exercise represents a marker of masked hypertension (MH) in individuals with no prior history of hypertension is still unclear. We investigated this issue through a review and a meta-analysis of studies providing data on this association in normotensive individuals undergone both to dynamic or static exercise and to 24 h blood pressure monitoring (ABPM). Design: A systematic search was performed using Pub-Med, OVID, EMBASE, and Cochrane library databases from inception up to 31 December 2022. Studies were identified by using the following search terms: “masked hypertension”, “out-of-office hypertension”, “exercise blood pressure”, “exaggerated blood pressure exercise”, “exercise hypertension”. Results: Nine studies including a total of 387 participants with MH and 406 true normotensive controls were considered. Systolic BP (SBP) and diastolic BP (DBP) at rest were significantly higher in MH individuals than in sustained normotensives: 126.4 ± 1.4/78.5 ± 1.8 versus 124.0 ± 1.4/76.3 ± 1.3 mmHg (SMD: 0.21 ± 0.08, CI: 0.06–0.37, <i>p</i> = 0.007 for SBP; 0.24 ± 0.07, CI: 0.08–0.39, <i>p</i> = 0.002 for DBP). The same was true for BP values at peak exercise: 190.0 ± 9.5/96.8 ± 3.7 versus 173.3 ± 11.0/88.5 ± 1.8 mmHg (SMD 1.02 ± 0.32, CI: 0.39–1.65, <i>p</i> = 0.002 for SBP and 0.97 ± 0.25, CI: 0.47–1.96, <i>p</i> < 0.0001 for DBP). The likelihood of having an EBPR was significantly greater in MH than in their normotensive counterparts (OR: 3.33, CI: 1.83–6.03, <i>p</i> < 0.0001). Conclusions: Our meta-analysis suggests that EBPR reflects an increased risk of MH and that BP measurement during physical exercise aimed to assess cardiovascular health may unmask the presence of MH. This underscores the importance of BP measured in the medical setting at rest and in dynamic conditions in order to identify individuals at high cardiovascular risk due to unrecognized hypertension.https://www.mdpi.com/2075-4418/13/6/1005masked hypertensionhypertensive response to exerciseblood pressurecardiovascular risk |
| spellingShingle | Cesare Cuspidi Elisa Gherbesi Andrea Faggiano Carla Sala Stefano Carugo Guido Grassi Marijana Tadic Masked Hypertension and Exaggerated Blood Pressure Response to Exercise: A Review and Meta-Analysis Diagnostics masked hypertension hypertensive response to exercise blood pressure cardiovascular risk |
| title | Masked Hypertension and Exaggerated Blood Pressure Response to Exercise: A Review and Meta-Analysis |
| title_full | Masked Hypertension and Exaggerated Blood Pressure Response to Exercise: A Review and Meta-Analysis |
| title_fullStr | Masked Hypertension and Exaggerated Blood Pressure Response to Exercise: A Review and Meta-Analysis |
| title_full_unstemmed | Masked Hypertension and Exaggerated Blood Pressure Response to Exercise: A Review and Meta-Analysis |
| title_short | Masked Hypertension and Exaggerated Blood Pressure Response to Exercise: A Review and Meta-Analysis |
| title_sort | masked hypertension and exaggerated blood pressure response to exercise a review and meta analysis |
| topic | masked hypertension hypertensive response to exercise blood pressure cardiovascular risk |
| url | https://www.mdpi.com/2075-4418/13/6/1005 |
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