Alerting Reaction in Office Blood Pressure and Target Organ Damage: An Innocent Phenomenon?
Jessica Barochiner1, Lucas S Aparicio1, Jose Alfie1
1Hypertension Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires. Argentina.
Insights
The physician-induced alerting reaction, a transient blood pressure rise, is linked to target organ damage in treated hypertension patients. This phenomenon warrants clinical attention, as it is not an innocent effect.
Area of Science:
- Cardiology
- Nephrology
- Hypertension Research
Background:
- The alerting reaction is a transient increase in blood pressure observed during physician visits.
- This phenomenon is common in patients with treated hypertension.
Purpose of the Study:
- To investigate the association between the alerting reaction and target organ damage in treated hypertensive individuals.
- To determine if the alerting reaction is an independent predictor of cardiovascular and renal damage.
Main Methods:
- Three distinct indexes were calculated to quantify the alerting reaction based on serial office blood pressure measurements.
- These indexes were correlated with markers of target organ damage, including glomerular filtration rate, left ventricular mass index, and pulse wave velocity.
- Multivariate regression analyses were performed to adjust for confounding factors and assess independent associations.
Main Results:
- In multivariate analyses, two systolic alerting reaction indexes independently associated with target organ damage.
- Left ventricular mass index remained significantly associated with the alerting reaction after adjusting for office blood pressure and white coat effect.
- 75% of participants exhibited a decrease in blood pressure between serial measurements, indicating variability in the alerting response.
Conclusions:
- A heightened alerting reaction in the clinical setting is associated with increased target organ damage in patients with treated hypertension.
- The alerting reaction should be recognized as a potentially significant clinical finding, not merely an incidental observation.
Background:
An alerting reaction is a physician-induced phenomenon which produces a transient blood pressure rise in the office.
Objective:
To determine its relationship with target organ damage in treated hypertensives.
Method:
We used three different indexes for calculating alerting reaction depending on the first, second or third office blood pressure measurement. We correlated these indexes with glomerular filtration rate, left ventricular mass index and pulse wave velocity. Thereafter, for multivariate analysis, we selected the index which better correlated with each target organ damage subtype.
Results:
We included 174 adults, mean age 67(±13.7) years. 75% of the patients had some degree of blood pressure fall between measurements 1-3. In multivariate linear regression models, after adjusting for classic risk factors, two out of the three systolic alerting reaction indexes showed an independent association with target organ damage. After further adjusting for office blood pressure and white coat effect (calculated with standardized home blood pressure monitoring), left ventricular mass index maintained a statistically significant association.
Conclusion:
A higher alerting reaction in the office seems to be related to increased target organ damage in treated hypertensives and should not be considered an innocent phenomenon.
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