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.