Graduation Semester and Year
Spring 2026
Language
English
Document Type
Dissertation
Degree Name
Doctor of Philosophy in Kinesiology
Department
Kinesiology
First Advisor
Chueh-Lung Hwang
Abstract
Masked hypertension (MH), characterized by office blood pressure (BP) below but out-of-office BP above the hypertension cutoffs, is associated with increased risks of cardiovascular disease and mortality. Up to 60% of adults exhibit MH. While the prevalence of MH is higher in men compared with women, cardiovascular risks associated with MH may be greater in women compared with men. Several studies have reported physiological characteristics of MH, including enhanced BP response to exercise and reduced vascular function, such as increased aortic stiffness, enhanced wave reflection, and/or reduced endothelial function. Notably, BP response to exercise and measures of vascular function are risk indicators of future cardiovascular disease. However, most of these prior studies were conducted in middle-aged and older adults or in clinical populations with pre-existing comorbidities. Whether these physiological changes and cardiovascular risk profiles are present at the early stage of MH remains unclear. Moreover, none of these prior studies provide sex-specific findings. To solve these gaps in knowledge, this dissertation proposed to examine the sex-specific effects of MH on BP response to exercise and vascular function in young adults. Our overall hypothesis was that MH would be associated with an enhanced BP response to exercise and reduced vascular function in young adults (21-35 years). To test our hypotheses and determine the sex-specific effects, we conducted two studies, one in 33 young men (Study 1) and another one in young women (Study 2). All participants were free of smoking and clinical diseases and had in-laboratory BP < 130/80 mmHg. All participants underwent 24-hr ambulatory BP monitoring for BP classification, as well as in-laboratory BP and vascular assessments at rest and after a maximal graded exercise test on a cycle ergometer. These assessments included peripheral and central BP, aortic stiffness, aortic wave reflection, and endothelial function.
In Study 1, a total of 16 young men had MH (48%), while 17 young men were non-hypertensive controls (CON). No differences between groups were found in peripheral BP and vascular function measurements at baseline (P≥0.2) and in responses to exercise (P≥0.2 for group by time interaction effects). While central systolic BP at rest was similar between groups (P=0.17), MH had a higher marginal mean of central systolic BP from resting, following exercise, and during recovery (MH vs. CON: 113±2 vs. 108±2 mmHg, P=0.047 for group effect). These findings suggest that in young men, MH may be associated with an elevated central systolic BP, which could be induced by exercise. In Study 2, a total of 10 young women had MH (27%), while 27 young women were non-hypertensive controls (CON). No interaction was found between group (CON vs. MH) and time in BP measurements and vascular function (P≥0.3). Compared with CON, MH had higher marginal mean of supine peripheral systolic BP (MH vs. CON: 127±9 vs. 120±9 mmHg; P=0.038 for group effect) and peripheral pulse pressure (55±6 vs. 48±6 mmHg; P=0.008 for group effect) from resting, following exercise, and during recovery. No difference between groups was found in vascular function, except higher forward pressure amplitude (Pf) in MH compared with CON (27±3 vs. 24±3 mmHg, P=0.002). These findings suggest that in young women, MH is associated with increased systolic BP and increased pulsatile load at the periphery, as well as increased initial pressure generated by the heart in a supine position. In Chapter 4, we performed a statistical analysis to examine whether the effect of MH would differ by sex. We found that in young women, MH had a higher Pf compared with CON (P=0.004), while no difference in Pf was found in young men with MH compared with CON (P=0.9). No sex by group interactions were found for BP response to exercise and other vascular measures (P≥0.1). Regardless of sex, we found that MH was associated with increased supine peripheral systolic BP (P=0.007), pulse pressure (P=0.018), and central systolic BP (P=0.026). Altogether, this dissertation provides novel findings on the physiological characteristics of MH in young men and women.
Keywords
Hypertension Phenotype, Ambulatory Blood Pressure, Acute Exercise, Arterial Stiffness, Wave Reflection, Central Hemodynamic, Endothelial Function, Cardiovascular Risk Factor
Disciplines
Exercise Physiology | Systems and Integrative Physiology
License
This work is licensed under a Creative Commons Attribution-NonCommercial-No Derivative Works 4.0 International License.
Recommended Citation
Chang, Keng-Yu, "Sex-Specific Effects of Masked Hypertension on Blood Pressure Response to Exercise and Vascular Function in Young Adults" (2026). Kinesiology Dissertations. 1.
https://mavmatrix.uta.edu/kinesiology_dissertations2/1