"Cardiovascular Response to Maximal Exercise in Young Men with Masked Hypertension" by Keng-Yu Chang, Jonathan Pham et al.
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Abstract

Masked hypertension is a risk factor for cardiovascular diseases. Individuals with masked hypertension have elevated out-of-office blood pressure (BP), but usually have normal office BP, making masked hypertension less likely to be diagnosed. PURPOSE: The aim of this study was to determine whether in-laboratory measurements of BP and vascular function in response to exercise can serve as indicators of masked hypertension in young adults. METHODS: Thirty-three young men with normal office BP (<130/80 mmHg), free of smoking and clinical diseases, were included in this study. All participants underwent 24-hr ambulatory BP monitoring for determination of BP classification. Masked hypertension is defined as 24-hr average BP ≥125/75 mmHg, daytime BP ≥130/80 mmHg, or nighttime BP ≥110/65 mmHg. All participants received a comprehensive in-laboratory BP and vascular assessment in the supine position after a 10-min rest and after a maximal graded exercise test on a cycle ergometer. The assessment includes brachial and central BP, arterial stiffness measured as carotid to femoral pulse wave velocity, wave reflection measured as augmentation index and reflection magnitude, and endothelial function measured as flow-mediated dilation. RESULTS: Compared to normotensive participants (CON; n=17), those with masked hypertension (MH; n=16) had a higher level of 24-hr, daytime, and nighttime systolic BP (P≤0.005), but similar office BP (P≥0.5). Prior to exercise, no differences between groups were found in all in-laboratory BP and vascular function measurements (P≥0.2). While brachial BP and vascular function responses to exercise were not different between groups (P≥0.2 for group by time interaction effects), MH had an overall higher central systolic BP from resting to 30 min following the exercise than CON (P=0.047 for group effect). CONCLUSION: Our study demonstrates that young men with masked hypertension had a similar in-laboratory brachial BP and vascular function at rest and in response to maximal exercise tests as normotensive young men. These findings suggest that these in-laboratory measurements are unable to detect pathophysiological changes associated with masked hypertension in young men. On the other hand, central BP response to exercise was elevated in young men with masked hypertension, suggesting this measure may serve as an early indicator of masked hypertension in men.

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