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M. EL Bakkali*., T. Dakka., L. Coghlan, S. Aboudrar., H. Benjelloun.


Background: Masked hypertension (mHT) is a frequent and poorly understood clinical form of primary HT but whose pathogenesis is not clear yet. The purpose of this study was to evaluate mHT using cardiovascular autonomic tests contributing to the understanding of this disease. Patients and methods: Inclusion criteria: This prospective study was conducted on 2 groups of 73 patients. Group 1 constituted of 40 Masked hypertensive patients (MHT) with normal office BP and with an impact of HT on heart such as left ventricular hypertrophy (LVH) detected by echocardiography. Group 2 was constituted of 33 Normotensive patients (NT). The cardiovascular autonomic tests performed have included Deep Breathing (DB), Hand- Grip (HG), orthostatic and Mental Stress (MS) tests. Exclusion criteria: the patients with severe HT, secondary or complicated HT, or being under any antihypertensive treatment, or in pregnancy. Results: alpha peripheral sympathetic response obtained on HG test was 27.0±5.4% in MHT vs 16.4±4.5% in NT (p<0.001), alpha central sympathetic response obtained during MS was 24.0±7.2% in MHT vs 15.2±4.5% in NT (p<0.001) and alpha peripheral adrenergic sympathetic response (Alpha PAS) obtained during OT was 40.4±2.8% in MHT vs 15.2±3.7% in NT (p<0.001). A univariate and multivariate logistic regression analysis showed that the odds of mHT increased with sympathetic hyperactivity in patients with mHT. Conclusion: The cardiovascular autonomic reflexes tests have shown a significant high sympathetic response in masked hypertensive patients when compared to normotensive subjects. The present data showed that this high sympathetic activity can be considered as a cardiovascular risk factor.

Keywords: Masked hypertension, cardiovascular autonomic tests, home blood pressure self-measurement, ambulatory blood pressure monitoring.

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