Masked Hypertension and Exaggerated Blood Pressure Response to Exercise: A Review and Meta-Analysis

Cuspidi, Cesare; Gherbesi, Elisa; Faggiano, Andrea; Sala, Carla; Carugo, Stefano; Tadić, Marijana

doi:10.3390/diagnostics13061005

Cited by 5 publications

(1 citation statement)

References 54 publications

(77 reference statements)

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“…Fourth, middle-aged long-distance runners must check their exercise blood pressure at least once every year via an exercise stress test. The recent meta-analysis by Cuspidi et al [139] reported that individuals with EIH face an increased risk of masked hypertension. This finding suggests that an exaggerated blood pressure response to exercise could serve as a forewarning of cardiovascular risk associated with blood pressure, regardless of any prior diagnosis of heart disease [140].…”

Section: Interventions For Prevention Of Scd In Runners With Eihmentioning

confidence: 99%

Possible Mechanisms for Adverse Cardiac Events Caused by Exercise-Induced Hypertension in Long-Distance Middle-Aged Runners: A Review

Kim,

Park

2024

JCM

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Sudden cardiac death (SCD) is rare among athletes. However, hypertrophic cardiomyopathy is the leading cause of SCD among those <35 years of age. Meanwhile, coronary artery disease (CAD) is the primary SCD cause among those ≥35 years of age. CAD-induced plaque ruptures are believed to be a significant cause of cardiovascular diseases in middle-aged individuals who participate in extreme long-distance running activities such as marathons. A total of 1970 articles related to EIH were identified using search terms. Out of these, 1946 studies were excluded for reasons such as arterial hypertension, exercise-induced pulmonary hypertension, the absence of exercise stress testing (EST), and a lack of relevance to EIH. The study analyzed 24 studies related to both long-distance runners with exercise-induced hypertension (EIH) and the general public. Among these, 11 studies were quasi-experimentally designed studies used in randomized controlled trials (RCTs) on long-distance runners with EIH. Additionally, 12 studies utilized cohort designs, and one study with a quasi-experimental design was conducted among the general population. Recent studies suggest that an imbalance between oxygen demand and supply due to ventricular hypertrophy may be the actual cause of cardiovascular disease, regardless of CAD. Exercising excessively over an extended period can reduce endothelial function and increase arterial stiffness, which in turn increases afterload and leads to an excessive increase in blood pressure during exercise. Exercise-induced hypertension (EIH), which increases the morbidity rate of resting hypertension and is a risk factor for cardio-cerebro-vascular diseases, is more prevalent in middle-aged long-distance runners than in runners from other age groups, and it increases the prevalence of critical arrhythmias, such as atrial fibrillation or ventricular arrhythmias. EIH is associated with angiotensin II activity, and angiotensin II receptor blockers show promising effects in middle-aged runners. Further, guidelines for preventing excessive participation in races and restricting exercise intensity and frequency would be useful. This review identifies EIH as a potential risk factor for cardiovascular diseases and describes how EIH induces SCD.

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Section: Interventions For Prevention Of Scd In Runners With Eihmentioning

confidence: 99%

Possible Mechanisms for Adverse Cardiac Events Caused by Exercise-Induced Hypertension in Long-Distance Middle-Aged Runners: A Review

Kim,

Park

2024

JCM

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Exercise systolic blood pressures are unaffected by time of day in healthy young adults

Boettcher,

Penfold,

Currie

2024

J Hum Hypertens

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Targeting Hypertensive Response to Exercise and the Association of Masked Hypertension With Subclinical Organ Damage: A Mini-Review and Meta-Analysis

Cuspidi

Gherbesi

Faggiano

et al. 2023

American Journal of Hypertension

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Background Emerging evidence suggests that a hypertensive response to exercise (HRE) during dynamic or isometric stress tests assessing cardiac function is predictive of hypertension and cardiovascular events such coronary artery disease, heart failure and stroke. Whether HRE represents a marker of masked hypertension (MH) in individuals with no prior history of hypertension is still unclear. This is also the case for the association between MH and hypertension-mediated organ damage (HMOD) in the HRE setting. Methods We addressed this issue through a review and a meta-analysis of studies providing data on this topic in normotensive individuals undergone both to dynamic or static exercise and to 24-hour blood pressure monitoring (ABPM). A systematic search was performed using Pub-Med, OVID, EMBASE and Cochrane library databases from inception up to February 28 th 2023. Results Six studies including a total of 1155 untreated clinically normotensive individuals were considered for the review. Data provided by the selected studies can be summarized as follows: I) HRE is a BP phenotype linked to a high prevalence of MH (27.3% in the pooled population ); II) MH is, in turn, associated with a greater, consistent likelihood of echocardiographic left ventricular hypertrophy (OR: 4.93, CI: 2.16-12.2, p < 0.0001) and vascular organ damage, as assessed by pulse wave velocity, (SMD: 0.34±0.11, CI: 0.12-0.56, p=0002). Conclusions On the basis of this, albeit limited, evidence, the diagnostic work-up in individuals with HRE should primarily be addressed to look for MH as well as for markers of HMOD, a highly prevalent alteration in MH.

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Masked Hypertension and Exaggerated Blood Pressure Response to Exercise: A Review and Meta-Analysis

Cited by 5 publications

References 54 publications

Possible Mechanisms for Adverse Cardiac Events Caused by Exercise-Induced Hypertension in Long-Distance Middle-Aged Runners: A Review

Possible Mechanisms for Adverse Cardiac Events Caused by Exercise-Induced Hypertension in Long-Distance Middle-Aged Runners: A Review

Exercise systolic blood pressures are unaffected by time of day in healthy young adults

Targeting Hypertensive Response to Exercise and the Association of Masked Hypertension With Subclinical Organ Damage: A Mini-Review and Meta-Analysis

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