Kosin Med J.  2020 Dec;35(2):89-100. 10.7180/kmj.2020.35.2.89.

Effects of White-coat Hypertension on Heart Rate Recovery and Blood Pressure Response during Exercise Test

Affiliations
  • 1Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
  • 2Department of Cardiology, Kosin University College of Medicine, Busan, Korea

Abstract


Objectives
White-coat hypertension is defined as high blood pressure (BP) on clinical assessment but normal BP elsewhere or on ambulatory measurement. Autonomic dysfunction may be one of the mechanisms causing white-coat hypertension. Slowed heart rate recovery and excessive BP response during exercise test are associated with autonomic dysfunction. The purpose of this study was to determine the association between white-coat hypertension and abnormal autonomic nervous system response.
Methods
We assessed 295 patients stratified into three groups via 24hr ambulatory BP monitoring, following 2017 ACC/AHA guidelines : normal BP group, white-coat hypertension group, and a hypertension group. We analyzed medical history, blood test, echocardiography, 24hr ambulatory BP monitoring, and exercise test data.
Results
There was no difference in basement characteristics and echocardiography among the groups. Blunted heart rate recovery of each group showed a significant difference. Control group had 0% blunted heart rate recovery, but 33.3% in white coat group and 27.6% in true hypertension group (P < 0.001). Also, in the control group, 4.5% showed excessive BP response, but 31.5% in the white coat hypertension group and 29.3% in the true hypertension group (P < 0.001). Excessive BP response during the exercise test or blunted heart rate recovery, which is an indicator of autonomic nervous system abnormality, was more common in the hypertensive group and white-coat hypertension group than in the normal BP group.
Conclusions
These results confirmed that white-coat hypertension has an autonomic nervous system risk. Therefore, white-coat hypertension can be a future cardiovascular risk factor.

Keyword

Autonomic dysfunction; Exercise test; White-coat hypertension

Figure

  • Fig. 1 The percentage of blunted heart rate recovery and exaggerated blood pressure response to exercise according to blood pressure pattern.


Reference

1. Kim KI, Ihm SH, Kim GH, Kim HC, Kim JH, Lee HY, et al. 2018 Korean society of hypertension guidelines for the management of hypertension: part III-hypertension in special situations. Clin Hypertens. 2019; 25:19.
Article
2. Mariampillai JE, Engeseth K, Kjeldsen SE, Grundvold I, Liestøl K, Erikssen G, et al. Exercise systolic blood pressure at moderate workload predicts cardiovascular disease and mortality through 35 years of follow-up in healthy, middle-aged men. Blood pressure. 2017; 26:229–36.
Article
3. Mancia G, Grassi G. The autonomic nervous system and hypertension. Circ Res. 2014; 114:1804–14.
Article
4. Miyai N, Arita M, Morioka I, Takeda S, Miyashita K. Ambulatory blood pressure, sympathetic activity, and left ventricular structure and function in middle-aged normotensive men with exaggerated blood pressure response to exercise. Med Sci Monit. 2005; 11:Cr478–84.
5. Singh JP, Larson MG, Manolio TA, O’Donnell CJ, Lauer M, Evans JC, et al. Blood pressure response during treadmill testing as a risk factor for new-onset hypertension. The Framingham heart study. Circulation. 1999; 99:1831–6.
6. Lima SG, Albuquerque MF, Oliveira JR, Ayres CF, Cunha JE, Oliveira DF, et al. Exaggerated blood pressure response during the exercise treadmill test as a risk factor for hypertension. Braz J Med Biol Res. 2013; 46:368–47.
Article
7. Cole CR, Blackstone EH, Pashkow FJ, Snader CE, Lauer MS. Heart-rate recovery immediately after exercise as a predictor of mortality. N Engl J Med. 1999; 341:1351–7.
Article
8. Huang PH, Leu HB, Chen JW, Cheng CM, Huang CY, Tuan TC, et al. Usefulness of attenuated heart rate recovery immediately after exercise to predict endothelial dysfunction in patients with suspected coronary artery disease. Am J Cardiol. 2004; 93:10–3.
Article
9. Kizilbash MA, Carnethon MR, Chan C, Jacobs DR, Sidney S, Liu K. The temporal relationship between heart rate recovery immediately after exercise and the metabolic syndrome: the CARDIA study. Eur Heart J. 2006; 27:1592–6.
Article
10. Nishime EO, Cole CR, Blackstone EH, Pashkow FJ, Lauer MS. Heart rate recovery and treadmill exercise score as predictors of mortality in patients referred for exercise ECG. Jama. 2000; 284:1392–8.
Article
11. Franklin SS, Thijs L, Hansen TW, O’Brien E, Staessen JA. White-coat hypertension: new insights from recent studies. Hypertension. 2013; 62:982–7.
12. Neumann SA, Jennings JR, Muldoon MF, Manuck SB. White-coat hypertension and autonomic nervous system dysregulation. Am J Hypertens. 2005; 18:584–8.
Article
13. Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Himmelfarb CD, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018; 71:e127–e248.
14. Bruce RA, Gey GO Jr, Cooler MN, Fisher LD, Peterson DR. Seattle heart watch: Initial clinical, circulatory and electrocardiographic responses to maximal exercise. Am J Cardiol. 1974; 33:459–69.
Article
15. Campbell L, Marwick TH, Pashkow FJ, Snader CE, Lauer MS. Usefulness of an exaggerated systolic blood pressure response to exercise in predicting myocardial perfusion defects in known or suspected coronary artery disease. Am J Cardiol. 1999; 84:1304–10.
Article
16. Gibbons RJ, Balady GJ, Bricker JT, Chaitman BR, Fletcher GF, Froelicher VF, et al. ACC/AHA 2002 Guideline Update for Exercise Testing: Summary Article. Circulation. 2002; 106:1883–92.
Article
17. Vivekananthan DP, Blackstone EH, Pothier CE, Lauer MS. Heart rate recovery after exercise is a predictor of mortality, independent of the angiographic severity of coronary disease. J Am Coll Cardiol. 2003; 42:831–8.
Article
18. Levy D, Savage DD, Garrison RJ, Anderson KM, Kannel WB, Castelli WP. Echocardiographic criteria for left ventricular hypertrophy: The framingham heart study. Am J Cardiol. 1987; 59:956–60.
Article
19. Faria J, Mesquita-Bastos J, Bertoquini S, Silva J, Barbosa L, Polonia J. Long-term cardiovascular risk of white-coat hypertension with normal night-time blood pressure values. Blood Press Monit. 2019; 24:59–66.
Article
20. Pierdomenico SD, Cuccurullo F. Prognostic value of white-coat and masked hypertension diagnosed by ambulatory monitoring in initially untreated subjects: an updated meta analysis. Am J Hypertens. 2011; 24:52–8.
Article
21. Verdecchia P, Angeli F, Gattobigio R, Borgioni C, Castellani C, Sardone M, et al. The clinical significance of white-coat and masked hypertension. Blood Press Monit. 2007; 12:387–9.
Article
22. Stergiou GS, Asayama K, Thijs L, Kollias A, Niiranen TJ, Hozawa A, et al. Prognosis of white-coat and masked hypertension: International Database of HOme blood pressure in relation to Cardiovascular Outcome. Hypertension. 2014; 63:675–82.
23. Briasoulis A, Androulakis E, Palla M, Papageorgiou N, Tousoulis D. White-coat hypertension and cardiovascular events: a meta-analysis. J Hypertens. 2016; 34:593–9.
24. Grassi G. Role of the sympathetic nervous system in human hypertension. J Hypertens. 1998; 16:1979–87.
Article
25. Mark AL. The sympathetic nervous system in hypertension: a potential long-term regulator of arterial pressure. J Hypertens. 1996; 14:S159–65.
26. Javorka M, Zila I, Balhárek T, Javorka K. Heart rate recovery after exercise: relations to heart rate variability and complexity. Braz J Med Biol Res. 2002; 35:991–1000.
Article
27. Buchheit M, Papelier Y, Laursen PB, Ahmaidi S. Noninvasive assessment of cardiac parasympathetic function: postexercise heart rate recovery or heart rate variability? Am J physiol Heart Circ Physiol. 2007; 293:H8–H10.
Article
28. Jae SY, Fernhall B, Heffernan KS, Kang M, Lee MK, Choi YH, et al. Exaggerated blood pressure response to exercise is associated with carotid atherosclerosis in apparently healthy men. J Hypertens. 2006; 24:881–7.
Article
29. Androulakis E, Papageorgiou N, Lioudaki E, Chatzistamatiou E, Zacharia E, Kallikazaros I, et al. Subclinical Organ Damage in White-Coat Hypertension: The Possible Role of Cystatin C. J Clin Hypertens (Greenwich). 2017; 19:190–7.
Article
30. Thanassoulis G, Lyass A, Benjamin EJ, Larson MG, Vita JA, Levy D, et al. Relations of exercise blood pressure response to cardiovascular risk factors and vascular function in the Framingham heart study. Circulation. 2012; 125:2836–43.
Article
Full Text Links
  • KMJ
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr