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KMID : 1141320200350020089
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Kosin Medical Journal
2020 Volume.35 No. 2 p.89 ~ p.100
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Effects ofWhite-coat Hypertension on Heart Rate Recovery and Blood Pressure Response during Exercise Test
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Jin Sol
Heo Jung-Ho
Kim Bong-Jun
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Abstract
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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/AHAguidelines: 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.
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KEYWORD
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Autonomic dysfunction, Exercise test, White-coat hypertension
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