title: Correction of the hypertensive response in the treadmill testing by the work performance improves the prediction of hypertension by ambulatory blood pressure monitoring and incidence of cardiac abnormalities by echocardiography: results of an eight year follow-up study.
abstract: BACKGROUND
  Studies of the association between hypertensive response (HR) in the exercise treadmill testing (ETT) and end organ damage are mostly cross-sectional and have not used ABPM. We investigated the association of different definitions of HR with incidence of hypertension by ABPM and development of cardiac structural abnormalities.
  
  
  METHODS
  Normotensive individuals were submitted to ETT and had clinical, office BP, ABPM, and echocardiogram done in the baseline evaluation and after 8.1+/-1.0 years of follow-up. The variation of these parameters and the incidence of hypertension by tertiles of BP response corrected by MET and by the absolute variation of BP were tested in multivariate models.
  
  
  RESULTS
  69 of the 75 (92%) participants were examined in the follow-up. The higher baseline office BP and ABPM, BMI and left atrial dimension in individuals classified at the top tertile persisted in the follow-up. Posterior wall (8.7+/-1.4, 9.0+/-1.2, 10.0+/-1.2 mm, P=0.005), septum thickness (9.4+/-1.7, 10.1+/-2.3, 11.0+/-1.6 mm, P=0.030), and isovolumetric relaxation time (0.73+/-0.19, 0.76+/-0.15, 0.85+/-0.14 s, P=0.044) became significantly higher in the follow-up visit in the top tertile. The incidence of hypertension by ABPM was higher in individuals with HR defined by the top tertile in comparison with the absolute response >or=210 mmHg.
  
  
  CONCLUSIONS
  The correction of the HR in the ETT by MET may improve the prediction of hypertension by ABPM and of cardiac structural abnormalities.
authors.affiliation: Division of Cardiology, Hospital de Clínicas de Porto Alegre, UFRGS, Brazil.
authors.forename: João Otavio
authors.initials: JO
authors.lastname: Zanettini
authors.forename: Jacira
authors.initials: J
authors.lastname: Pisani Zanettini
authors.forename: Marco Tulio
authors.initials: MT
authors.lastname: Zanettini
authors.forename: Flávio Danni
authors.initials: FD
authors.lastname: Fuchs
mesh_terms: D000328:Adult; D018660:Blood Pressure Monitoring, Ambulatory / Q000592:standards / Q000706:statistics & numerical data*; D006332:Cardiomegaly / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D018450:Disease Progression; D004452:Echocardiography / Q000592:standards / Q000706:statistics & numerical data; D005080:Exercise Test / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006346:Heart Septum / Q000000981:diagnostic imaging; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000453:epidemiology*; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D055815:Young Adult