Masked hypertension is “unmasked” by low-intensity exercise blood pressure
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PURPOSE: Masked hypertension (MH) independently predicts mortality but cannot be diagnosed from clinic blood pressure (BP) taken under resting conditions. We sought to determine if MH could be identified from BP taken during a single bout of low-intensity exercise. METHODS: BP was recorded at rest and during brief low-level cycling exercise (60-70% of age-predicted maximal heart rate) in 75 untreated subjects with a hypertensive response to exercise (aged 54 ± 9 years). All subjects underwent 24-h ambulatory BP monitoring (ABPM) and MH was defined as clinic BP < 140/90 mmHg and ABPM BP ≥ 130/80 mmHg. RESULTS: There were 42 (56%) patients with MH, and at rest systolic (SBP) was higher in subjects with MH compared with those without MH (127 ± 9 vs 120 ± 9 mmHg; p < 0.05). During exercise, MH subjects had significantly higher SBP (188 ± 22 vs 168 ± 15 mmHg; p < 0.05), with a greater change from baseline (61 ± 21 vs 48 ± 15 mmHg; p < 0.05). Low-level exercise SBP was independently associated with MH, and if ≥ 175 mmHg, identified MH with 74% sensitivity and 67% specificity (p < 0.001). CONCLUSION: MH can be identified in untreated individuals from low-intensity exercise SBP. Further research on the diagnostic value of BP during early phases of exercise stress testing is needed.
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Exaggerated exercise blood pressure during submaximal exercise seems to identify individuals with blood pressure-related risk undetected by standard in-office resting blood pressure measurement, including underlying or masked hypertension.
“Perhaps of even greater clinical relevance, EEBP during submaximal exercise seems to identify those with BP-related risk gone undetected by standard in-office measurement of BP at rest, including underlying or masked hypertension (17 -20,59).”
From Cardiorespiratory Fitness, Workload, and the Blood Pressure Response to Exercise Testing (2022) · cites this paper as [17]
Submaximal exercise BP recorded during moderate intensity exercise exposes BP-related risk undetected by standard in-clinic resting BP measurement, revealing or ruling out masked hypertension.
“Moreover, submaximal exercise BP recorded during moderate intensity exercise has been shown to expose BP-related risk undetected by standard in-clinic measurement of BP at rest [10], revealing [8,9,28] or ruling out [29] the presence of masked hypertension.”
From The Identification and Management of High Blood Pressure Using Exercise Blood Pressure: Current Evidence and Practical Guidance (2022) · cites this paper as [9]
Exaggerated exercise BP (EEBP) may signal high BP that has gone undetected with resting measures in the clinic by revealing underlying or masked hypertension.
“Research suggests that an exaggerated exercise BP (EEBP) may signal high BP that has gone undetected with resting measures in the clinic by revealing the presence of underlying or masked hypertension [8,9,10].”
From The Identification and Management of High Blood Pressure Using Exercise Blood Pressure: Current Evidence and Practical Guidance (2022) · cites this paper as [9]
Other studies report exercise systolic BP ranging from >160-170 mmHg recorded at various submaximal exercise workloads and relative intensities to be associated with increased CVD risk.
“Other studies report exercise systolic BP ranging from >160–170 mmHg recorded at various submaximal exercise workloads and relative intensities to be associated with increased CVD risk [9,50].”
From The Identification and Management of High Blood Pressure Using Exercise Blood Pressure: Current Evidence and Practical Guidance (2022) · cites this paper as [9]
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- Authors
- Schultz, M. G., Hare, J. L., Marwick, T. H., Stowasser, M., & Sharman, J. E.
- Affiliations
- University of Tasmania (AU)
- The University of Queensland (AU)
- Cleveland Clinic (US)
- Corresponding author
- Sharman, James E.
- Venue
- Blood Pressure
- Publisher
- Informa UK Limited
- Published
- 2011-03-30
- Volume
- 20
- Issue
- 5
- Pages
- 284-289
- ISSN
- 0803-7051 (ISSN-L)
- 1651-1999
- OpenAlex
- W1989811903
- Cited by
- 104
- References
- 36
- Citations by year
- 2026: 3 · 2025: 6 · 2024: 11 · 2023: 6 · 2022: 12 · 2021: 10 · 2020: 6 · 2019: 6 · 2018: 4 · 2017: 8 · 2016: 7 · 2015: 6 · 2014: 6 · 2013: 6 · 2012: 4
- FWCI
- 3.73
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Blood Pressure (publishedVersion)
- PubMed (publishedVersion)
- eCite Digital Repository (University of Tasmania) (submittedVersion)
- Figshare (submittedVersion, cc-by)
- Funders
- National Heart Foundation of Australia
- Medical Research Council
- National Health and Medical Research Council (569669, 569519)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Keywords
- masked hypertension, blood pressure response to exercise, ambulatory blood pressure monitoring, office blood pressure, systolic blood pressure, exercise stress testing, hypertension diagnosis, untreated hypertensive patients
- MeSH terms
- Blood Pressure, Exercise Test, Female, Humans, Male, Middle Aged, Sensitivity and Specificity, Blood Pressure Monitoring, Ambulatory, Masked Hypertension
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