Abstract 16676: Prognostic Significance of Isolated Hypertension During the Alerting Reaction to Predict 10-Year Risk of Cardiovascular Events in the Dallas Heart Study
Measurement of BP in the office often induces a transient rise in BP, known as an alerting reaction. A recent analysis from the National Health and Nutrition Examination Survey (NHANES) indicated that 5-25% of subjects who had high BP (≥ 140/90 mmHg) on 1st measurement were reclassified to have normal BP on 2nd and 3rd measurement. The prognostic significance of this alerting reaction remains unknown.
Methods: We determined hypertensive target organ effects and cardiovascular outcomes in the individuals with and without an alerting reaction in the Dallas Heart Study, a multiethnic population-based probability sample of Dallas County residents ages 18 to 65 years old, (49% women, 54% African American). Study participants (N=3069) underwent 5 serial BP measurements and measurement of left ventricular mass (LVM) by MRI at study entry. Participants were followed for a median of 9.5 years for incident composite CV events (CV death, stroke, acute coronary events, hospitalization for heart failure and atrial fibrillation). Subjects were categorized into 4 groups based on the 1st (BP 1) and the average of the 3rd to fifth systolic BP (BP 3-5): 1) normal BP (< 140/90 mmHg) in all readings (NN, n =2,119), 2) high BP in all readings (HH, n = 576), 3) high BP1 then normal BP3-5 (HN, n = 298), 4) Normal BP1 then high BP3-5 (NH, n = 76).
Results: Compared to the NN group, individuals in the HN group, the group with the highest alerting reaction, had a significantly greater LVM index (83.1 vs. 80.3 g/m2, p<0.01) and had higher odds of having LVH (odds ratio 2.22, 95% CI 1.44-3.44, figure 1). The 10-year risk for CV events was significantly increased in the HN group compared to the NN group after adjustment for age, gender, BMI, ethnicity, diabetes, dyslipidemia, cigarette use, and alcohol use (HR 1.48, 95% CI 1.02-2.16, p=0.03, figure 2).
Conclusions: These data provide the first direct evidence for an adverse cardiovascular impact associated with the alerting reaction in a multiethnic population.
Author Disclosures: A. Velasco: None. C. Ayers: None. S.R. Das: None. J.A. De Lemos: None. W. Vongpatanasin: None.
- © 2014 by American Heart Association, Inc.