title: Alerting Reaction in Office Blood Pressure and Target Organ Damage: An Innocent Phenomenon?
abstract: An alerting reaction is a physician-induced phenomenon which produces a transient blood pressure rise in the office.
  
  
  
  To determine its relationship with target organ damage in treated hypertensives.
  
  
  
  We used three different indexes for calculating alerting reaction depending on the first, second or third office blood pressure measurement. We correlated these indexes with glomerular filtration rate, left ventricular mass index and pulse wave velocity. Thereafter, for multivariate analysis, we selected the index which better correlated with each target organ damage subtype.
  
  
  
  We included 174 adults, mean age 67(±13.7) years. 75% of the patients had some degree of blood pressure fall between measurements 1-3. In multivariate linear regression models, after adjusting for classic risk factors, two out of the three systolic alerting reaction indexes showed an independent association with target organ damage. After further adjusting for office blood pressure and white coat effect (calculated with standardized home blood pressure monitoring), left ventricular mass index maintained a statistically significant association.
  
  
  
  A higher alerting reaction in the office seems to be related to increased target organ damage in treated hypertensives and should not be considered an innocent phenomenon.
authors.affiliation: Hypertension Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires. Argentina.
authors.forename: Jessica
authors.initials: J
authors.lastname: Barochiner
authors.affiliation: Hypertension Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires. Argentina.
authors.forename: Lucas S
authors.initials: LS
authors.lastname: Aparicio
authors.affiliation: Hypertension Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires. Argentina.
authors.forename: Jose
authors.initials: J
authors.lastname: Alfie
authors.affiliation: Hypertension Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires. Argentina.
authors.forename: Paula E
authors.initials: PE
authors.lastname: Cuffaro
authors.affiliation: Hypertension Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires. Argentina.
authors.forename: Marcos J
authors.initials: MJ
authors.lastname: Marin
authors.affiliation: Hypertension Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires. Argentina.
authors.forename: Margarita S
authors.initials: MS
authors.lastname: Morales
authors.affiliation: Hypertension Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires. Argentina.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Rada
authors.affiliation: Hypertension Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires. Argentina.
authors.forename: Gabriel D
authors.initials: GD
authors.lastname: Waisman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001118:Argentina; D001794:Blood Pressure / Q000187:drug effects; D001795:Blood Pressure Determination / Q000379:methods*; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D007674:Kidney Diseases / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009819:Office Visits; D011237:Predictive Value of Tests; D011379:Prognosis; D063177:Pulse Wave Analysis; D018570:Risk Assessment; D012307:Risk Factors; D059289:Vascular Stiffness; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling; D059466:White Coat Hypertension / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology
chemical_list: D000959:Antihypertensive Agents
keywords: Alerting reaction; alarm reaction; blood pressure monitoring; blood pressure variability; hypertension; office blood
  pressure