Alerting Reaction in Office Blood Pressure and Target Organ Damage: An Innocent Phenomenon?

BACKGROUND: An alerting reaction is a physician-induced phenomenon which produces a transient blood pressure rise in the office.

OBJECTIVE: To determine its relationship with target organ damage in treated hypertensives.

METHOD: 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.

RESULTS: 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.

CONCLUSION: 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.