Koletsos N, Dipla K, Triantafyllou A, Gkaliagkousi E, Sachpekidis V, Zafeiridis A, Douma S.

A brief submaximal isometric exercise test ‘unmasks’ systolic and diastolic masked hypertension.

J Hypertens. 2019 Apr;37(4):710-719.  doi: 10.1097/HJH.0000000000001943.

1) Summarize your work in one sentence.

We sought to examine whether isometric exercise can be used to “unmask” masked hypertension, so we evaluated, in normotensives, untreated newly diagnosed, masked and true hypertensives, blood pressure (BP) and total peripheral resistance (TPR) responses during a submaximal handgrip exercise and subsequently tried to identify their possible associations with central and ambulatory BP and target organ damage (aortic stiffness and cardiac hypertrophy).

2) Summarize your findings in one sentence.

Masked hypertensives exhibited significantly greater hemodynamic responses (BP and TPR) during isometric exercise than normotensives and similar to those of true hypertensives, that was evident even from the 1st minute of exercise and correlated with central and ambulatory blood pressure, as well as indices of target organ damage.

3) Which were the more important methods you used in this work? If it is not a traditional method, you can briefly explain the concept of that methodology.

To our knowledge this was the first study to evaluate hemodynamic responses during isometric exercise in recently diagnosed masked hypertensives. Previous studies investigating whether masked hypertension can be “unmasked” during exercise, have used dynamic exercise. Isometric exercise involves static contractions, increases afterload, and is accompanied by a marked increase in both systolic and diastolic BP. This type of exercise elicits an augmented sympathetic stimulation causing greater and more rapid increases in BP (<3 min) than dynamic exercise. In our study, continuous (beat-by-beat) assessment of BP was performed via photoplethysmography. 4) What did you learn from this paper, what was your take-home message? The novel finding of this study is that masked hypertensives exhibit an exaggerated systolic and diastolic BP response during low intensity handgrip exercise, mimicking those exhibited by true hypertensives. The exaggerated BP responses in masked hypertensives were evident from the 1st min of handgrip exercise and were linked to higher TPR responses during exercise. Our findings suggest that submaximal isometric exercise could aid as a tool to “unmask” both systolic and diastolic masked hypertension.