Target organ complications and prognostic significance of alerting reaction: Analysis from the Dallas Heart Study

Alejandro Velasco, Colby Ayers, Sandeep R. Das, James A. De Lemos, Amit Khera, Ronald G. Victor, Norman M. Kaplan, Wanpen Vongpatanasin

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Objective: Noninvasive blood pressure (BP) measurement often triggers a transient rise in BP, known as an alerting reaction. However, the prevalence and prognostic significance of the alerting reaction has never been assessed in the general population. Methods: We evaluated the association between the alerting reaction and left ventricular mass by MRI and urinary albumin-to-creatinine ratio in the Dallas Heart Study, a large population sample of 3069 individuals. Participants were categorized into four groups based on levels of consecutive BP: first, normal first BP and average third to fifth (avg3-5) BP of less than 140/90 mmHg (control group); second, high first BP of at least 140/90 mmHg and normal (avg3-5) BP (alerting reaction group); third, normal first BP and high (avg3-5) BP; and fourth, high first to fifth BP. Then, associations between BP categories with incident cardiovascular outcomes (coronary heart disease, stroke, atrial fibrillation, heart failure, and cardiovascular death) over a median follow-up period of 9.4 years were assessed. Results: The sample-weighted prevalence of isolated hypertension during the first BP measurement was 9.6%. Presence of an alerting reaction was independently associated with increased left ventricular mass, urinary albumin-to-creatinine ratio, cardiovascular events after adjustment for traditional cardiovascular risk factors, and baseline BP (adjusted hazard ratio 1.24, 95% confidence interval 1.07-1.43). Conclusion: Our study indicated that the alerting reaction is independently associated with increased cardiovascular and renal complications.

Original languageEnglish (US)
Pages (from-to)226-234
Number of pages9
JournalJournal of Hypertension
Issue number2
StatePublished - Feb 1 2016
Externally publishedYes


  • Blood pressure measurement
  • Cardiovascular events
  • Prognosis
  • Systemic hypertension
  • Target organ damage

ASJC Scopus subject areas

  • Internal Medicine
  • Physiology
  • Cardiology and Cardiovascular Medicine


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