Relationship between Clinical Factors Including Physical Activity and Job Category and Masked Effect Defined by Ambulatory Blood Pressure Monitoring

Yu-Mi Kim; Hyung Min Lee; Joo Youn Seo; Yeon Soo Kim; Bae Ken Kim; Mi Kyung Kim; Bo Youl Choi; Jin Ho Shin

doi:10.5646/jksh.2011.17.4.166

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Kim, Lee, Seo, Kim, Kim, Kim, Choi, and Shin: Relationship between Clinical Factors Including Physical Activity and Job Category and Masked Effect Defined by Ambulatory Blood Pressure Monitoring

Original Article

J Korean Soc Hypertens 2011;17(4):166-176.

Published online: 10 December 2011

DOI: https://doi.org/10.5646/jksh.2011.17.4.166

Relationship between Clinical Factors Including Physical Activity and Job Category and Masked Effect Defined by Ambulatory Blood Pressure Monitoring

Yu-Mi Kim, MD¹, Hyung Min Lee, MD², Joo Youn Seo, MD³, Yeon Soo Kim, MD⁴, Bae Ken Kim, MD⁵, Mi Kyung Kim, MD³, Bo Youl Choi, MD³, Jin Ho Shin, MD^5,

¹Department of Preventive Medicine, Dong-A University College of Medicine, Busan, Korea

²Division of HIV and TB Control, Korea Centers for Disease Control & Prevention, Cheongwon, Korea

³Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea

⁴Department of Physical Exercise, Seoul National University College of Education, Seoul, Korea

⁵Department of Preventive Medicine, Hanyang University College of Medicine, Seoul, Korea

Tel: 02) 2290-8308, Fax: 02) 2299-0278 E-mail: jhs2003@hanyang.ac.kr

Received 7 September 201130 November 2011 Accepted 30 November 2011

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Background:

Masked hypertension is well known for its poor cardiovascular outcome. But clinical clues related to the masked hypertension and/or masked effect (ME) are rarely known. Physical activity and/or job stress are related to increased daytime blood pressure (BP). This study is to identify whether ME is caused by physical activity and/or job category.

Methods:

Physical activity using Actical and masked effect by clinic BP and ambulatory BP monitoring were applied to 167 person for this study.

Results:

Age of the subjects was 54.9±9.6 and 74 subjects were female (57.4%). Field worker was 81 (48.5%) and office worker was 86 (51.5%). Clinic BP was 125.8±14.3 mmHg/ 79.8 ±10.9 mmHg in male and 119.0±14.0 mmHg/ 74.2 ±8.9 mmHg in female (p =0.03). Daily energy expenditure representing physical activity was 1,831.1±420.4 kcal. ME for systolic BP was 11.0 ±11.1 mmHg and ME for diastolic BP was 3.9 ±8.0 mmHg. In multiple linear regression adjusted by smoking and antihypertensive medication showed that clinic systolic BP was the only significant factor related to the ME (β =-0.44755, p< 0.0001 in male, β =-0.396, p <0.0001 in female). Physical activity or job category was not related to ME.

Conclusions:

Neither physical activity nor job category is related to ME. This indicates that diagnosis of the masked hypertension is not affected by physical activity or job status.

Keywords: Motor activity, Workplace, Hypertension, Blood pressure monitoring, Ambulatory

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Table 1.

General characteristics of the study subjects in number

	Overall(n=167)	Men(n=80)	Women(n=87)	p-value
Age(yr)				0.9767
38–49	55 (32.9)	27 (33.8)	28 (32.2)
50–64	72 (43.1)	34 (42.5)	38 (43.7)
≥65	40 (24.0)	19 (23.8)	21 (24.1)
Smoking	26 (15.6)	24 (30.0)	2 (2.3)	＜0.0001
Regular exercise	68 (40.7)	34 (42.5)	34 (39.1)	0.6532
BMI ≥25kg/m²	66 (39.5)	33 (41.3)	33 (37.9)	0.6612
Anti-HTN medicaiton	40 (24.0)	18 (22.5)	22 (25.3)	0.6733
Cholesterol ≥240mg/dL	10 (5.6)	4 (5.0)	6 (6.9)	0.7485
Triglyceride ≥200mg/dL	44 (26.4)	29 (36.2)	15 (17.2)	0.0053
HDL ＜40mg/dL	75 (44.9)	24 (30.0)	51 (58.6)	0.0002
LDL ≥160mg/dL	7 (4.5)	2 (2.7)	5 (6.1)	0.4468

Values are presented as number (%).

BMI, body mass index; HTN, hypertensive; HDL, high density lipotprotein; LDL, low density lipoprotein.

Table 2.

Physical activities according to the job status and gender

	Overall (n=167)	Men(n=80)	Women(n=87)	p-value
PA by questionnaire^* (kcal/day)	2076.1 ± 793.5	2251.2 ± 841.8	1911.3 ±710.1	0.030
Field worker	2043.2 ± 794.4	2277.1 ± 876.8	1828.7 ±650.5	0.010
Officer	2115.2 ± 795.4	2232.4 ± 819.4	1994.2 ±760.9	0.040
PA by Actical^† (kcal/day)	1831.1 ± 420.4	2004.2 ± 444.9	1666.9 ±319.4	0.001
Field worker	1759.1 ± 455.8	1883.2 ± 498.4	1646.6 ±385.2	0.001
Officer	1897.2 ± 375.8	2109.2 ± 366.3	1684.9 ±243.3	0.001

Values are presented as mean±standard deviation.

PA, physical activity.

^* Modified questionnaire from Five-City Project study.

^† Philips Respironics, Bend, OR, USA.

Table 3.

Distribution of clinic blood pressure, ambulatory blood pressure, and masked effect

	Overall(n=167)	Men(n=80)	Women(n=87)	p-value
Clinic SBP (mmHg)	123.0 ±14.1	127.1 ±12.0	119.3 ±14.9	0.0003
Clinic DBP (mmHg)	78.6 ±10.6	82.1 ±10.7	75.3 ±9.5	＜0.0001
24 hr SBP (mmHg)	128.0 ±11.9	130.4 ±9.9	125.8 ±13.2	0.0124
24 hr DBP (mmHg)	78.8 ±7.4	81.1 ±7.2	76.7 ±7.0	0.0001
Daytime SBP (mmHg)	134.1 ±12.6	136.9 ±10.9	131.6 ±13.6	0.0059
Daytime DBP (mmHg)	82.5 ±7.8	84.7 ±7.9	80.4 ±7.2	0.0003
ME in SBP (mmHg)	11.0 ±11.1	9.8 ±10.1	12.2 ±11.9	0.1581
ME in DBP (mmHg)	3.9 ±8.0	2.6 ±8.7	5.1 ±7.2	0.0437

Values are presented as mean±standard deviation.

DBP, diastolic blood pressure; ME, masked effect defined by daytime blood pressure minus clinic blood pressure; SBP, systolic blood pressure.

Table 4.

Univariate regression between masked effects and the study parameters

	Men(n=80)		Women(n=87)
	ME in SBP(mm Hg)	ME in DBP(mm Hg)	ME in SBP(mm Hg)	ME in DBP(mm Hg)
	B^‡	B^‡	B^‡	B^‡
Age
≥65 yr	3.280	-1.163	-1.044	-1.096
＜65 yr	0.652	-7.168^*	1.157	-3.041
Job
Field worker	-1.692	-6.644^*	-0.176	0.785
Office worker	1.597	0.021	-5.391	-1.292
PA by questionnaire (kcal/day)	-0.788	-0.888	1.132	-2.085
PA by Actical^§ (kcal/day)	-0.133	0.006	-0.466	0.206
Clinic SBP (mm Hg)	0.444^†	0.133	0.403^†	0.149^*
BMI (kg/m²)	1.539	3.794	4.055	5.564^†

ME, masked effect; SBP, systolic blood pressure; DBP, diastolic blood pressure; PA, physical activity; BMI, body mass index.

^* p<0.01.

^† p<0.001.

^‡ B; standardized coefficient.

^§ Philips Respironics, Bend, OR, USA.

Table 5.

Multiple linear regression analysis on masked effect by the study parameters with adjustment of smoking status and anti-hypertension medication status

	Men(n=80)		Women(n=87)
	ME in SBP(mm Hg)	ME in DBP(mm Hg)	ME in SBP(mm Hg)	ME in DBP(mm Hg)
	B^§	B^§	B^§	B^§
Age
≥65 yr	-0.671	0.755	4.198	4.321^*
＜65 yr	-0.764	3.982	2.707	7.092^†
Job
Field worker	2.482	3.455	2.046	-1.316
Office worker	-0.614	-2.321	5.987	0.674
PA by questionnaire (kcal/day)	0.966	0.296	-0.430	2.828
PA by Actical^∥ (kcal/day)	0.133	0.262	-0.331	0.468
Clinic SBP (mm Hg)	-0.447^‡	-0.102	-0.396^‡	-0.150^†
BMI (kg/m²)	-1.645	-2.539	-3.559	-5.511^‡

ME, masked effect; SBP, systolic blood pressure; DBP, diastolic blood pressure; PA, physical activity; BMI, body mass index.

^* p<0.05.

^† p<0.01.

^‡ p<0.001.

^§ B; standardized coefficient.

^∥ Philips Respironics, Bend, OR, USA.

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