Target organ complications and prognostic significance of alerting reaction: analysis from the Dallas Heart Study.
OBJECTIVE
Noninvasive blood pressure (BP) measurement often triggers a transient rise in BP, known as an alerting reaction. However, the prevalence and prognostic significance of the alerting reaction has never been assessed in the general population.


METHODS
We evaluated the association between the alerting reaction and left ventricular mass by MRI and urinary albumin-to-creatinine ratio in the Dallas Heart Study, a large population sample of 3069 individuals. Participants were categorized into four groups based on levels of consecutive BP: first, normal first BP and average third to fifth (avg3-5) BP of less than 140/90 mmHg (control group); second, high first BP of at least 140/90 mmHg and normal (avg3-5) BP (alerting reaction group); third, normal first BP and high (avg3-5) BP; and fourth, high first to fifth BP. Then, associations between BP categories with incident cardiovascular outcomes (coronary heart disease, stroke, atrial fibrillation, heart failure, and cardiovascular death) over a median follow-up period of 9.4 years were assessed.


RESULTS
The sample-weighted prevalence of isolated hypertension during the first BP measurement was 9.6%. Presence of an alerting reaction was independently associated with increased left ventricular mass, urinary albumin-to-creatinine ratio, cardiovascular events after adjustment for traditional cardiovascular risk factors, and baseline BP (adjusted hazard ratio 1.24, 95% confidence interval 1.07-1.43).


CONCLUSIONS
Our study indicated that the alerting reaction is independently associated with increased cardiovascular and renal complications.
aHypertension SectionbCardiology Division, University of Texas Southwestern Medical Center, Dallas, TexascCedars-Sinai Heart Institute/ Hypertension Center, Los Angeles, California, USA.
Alejandro
A
Velasco
Colby
C
Ayers
Sandeep R
SR
Das
James A
JA
de Lemos
Amit
A
Khera
Ronald G
RG
Victor
Norman M
NM
Kaplan
Wanpen
W
Vongpatanasin
D000328:Adult; D000419:Albuminuria / Q000453:epidemiology; D001281:Atrial Fibrillation / Q000453:epidemiology; D001794:Blood Pressure / Q000502:physiology; D001795:Blood Pressure Determination; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000401:mortality; D003327:Coronary Disease / Q000453:epidemiology; D003404:Creatinine / Q000652:urine; D005260:Female; D006333:Heart Failure / Q000453:epidemiology; D006352:Heart Ventricles / Q000473:pathology*; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000503:physiopathology*; D017379:Hypertrophy, Left Ventricular / Q000453:epidemiology / Q000473:pathology; D015994:Incidence; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D016016:Proportional Hazards Models; D051437:Renal Insufficiency / Q000453:epidemiology / Q000652:urine; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology
D003404:Creatinine