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Neurogenic abnormalities in masked hypertension.

Guido Grassi1, Gino Seravalle, Fosca Quarti Trevano

  • 1Clinica Medica, Università Milano-Bicocca, Ospedale S Gerardo, Monza, Italy. guido.grassi@unimib.it

Hypertension (Dallas, Tex. : 1979)
|July 11, 2007
PubMed
Summary

Masked hypertension, a condition with normal office blood pressure but elevated ambulatory readings, shows significantly increased sympathetic nerve activity, similar to other hypertension types. This sympathetic overdrive is linked to metabolic and baroreflex abnormalities.

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Area of Science:

  • Cardiovascular Physiology
  • Neuroendocrinology
  • Hypertension Research

Background:

  • Hypertension is associated with increased sympathetic nervous system activity.
  • The sympathetic activity in masked hypertension remains largely uncharacterized.
  • Masked hypertension presents normal blood pressure in clinical settings but elevated readings during ambulatory monitoring.

Purpose of the Study:

  • To investigate sympathetic nerve traffic in individuals with masked hypertension.
  • To compare sympathetic activity and baroreflex control in masked hypertension versus other hypertensive states and normotensive individuals.
  • To explore the relationship between sympathetic activity, insulin sensitivity, and baroreflex function in masked hypertension.

Main Methods:

  • Muscle sympathetic nerve traffic was measured using microneurography in middle-aged subjects.
  • Beat-to-beat arterial blood pressure, anthropometric values, and insulin sensitivity (homeostasis model assessment index) were assessed.
  • Data were compared across four groups: masked hypertension, white-coat hypertension, sustained hypertension (in-office and out-of-office), and normotensive controls.

Main Results:

  • Patients with masked hypertension exhibited significantly elevated resting sympathetic nerve activity, comparable to other hypertensive groups.
  • Baroreflex-heart rate control was attenuated in all hypertensive states compared to normotensive subjects.
  • Insulin resistance, indicated by a higher homeostasis model assessment index, was more pronounced in masked hypertension and directly correlated with sympathetic nerve traffic.

Conclusions:

  • Masked hypertension is characterized by significant sympathetic nervous system overdrive.
  • Neurogenic alterations in masked hypertension are associated with metabolic dysfunction and baroreflex abnormalities.
  • These findings highlight the clinical importance of identifying and managing masked hypertension due to its underlying sympathetic activation.