title: Association between non-alcoholic hepatic steatosis and hyper reactive blood pressure response on the exercise treadmill test.
abstract: OBJECTIVE
  Non-alcoholic hepatic steatosis (HS) is associated with hypertension and increased cardiovascular risk. While Blood pressure hyper-reactive response (HRR) during peak exercise indicates an increased risk of incident hypertension and increased cardiovascular risk, no data on the association of non-alcoholic HS and HRR exists. In this study, we have evaluated the association of HS with HRR.
  
  
  METHODS
  We included 13 410 consecutive individuals with a mean age: 42.4  ±  8.9 years, 3561 (26.6%) female with normal resting blood pressure and without a previous diagnosis of hypertension, who underwent symptom limited exercise treadmill test, abdominal ultrasonography and clinical and laboratory evaluation. HS was detected by abdominal ultrasonography. HRR was defined by a peak exercise systolic blood pressure  >220 mmHg and/or elevation of 15 mmHg or more in diastolic blood pressure from rest to peak exercise.
  
  
  RESULTS
  The prevalence of HS was 29.5% (n  =  3956). Overall, 4.6% (n  =  619) of the study population presented a HRR. Subjects with HS had a higher prevalence of HRR (8.1 vs. 3.1%, odds ratio 2.8, 95% CI 2.4-3.3, P  <  0.001). After adjustment for body mass index, waist circumference, fasting plasma glucose and low density lipoprotein cholesterol, HS (odds ratio 1.4, 95% CI 1.1-1.6, P  =  0.002) remained independently associated with HRR. HS was additive to obesity markers in predicting exercise HRR.
  
  
  CONCLUSIONS
  Non-alcoholic HS is independently associated with hyper-reactive exercise blood pressure response.
authors.affiliation: From the Preventive Medicine Center Hospital Israelita Albert Einstein, Av. Brasil, 953, CEP-01431-000, Säo Paulo, Brazil, Lipid Clinic Heart Institute (InCor) University of Sao Paulo, Medical School Hospital, Av. Eneas de Carvalho Aguiar, 44, CEP-05403-900, Säo Paulo, Brazil.
authors.forename: A G
authors.initials: AG
authors.lastname: Laurinavicius
authors.affiliation: From the Preventive Medicine Center Hospital Israelita Albert Einstein, Av. Brasil, 953, CEP-01431-000, Säo Paulo, Brazil, Center for Clinical and Epidemiological Research, University Hospital, University of Sao Paulo, Av. Lineu Prestes, 2565, CEP-05508-000, Säo Paulo, Brazil.
authors.forename: M S
authors.initials: MS
authors.lastname: Bittencourt
authors.affiliation: Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, 601 North Caroline Street,Suite 7200, Baltimore, MD 21287, USA and.
authors.forename: M J
authors.initials: MJ
authors.lastname: Blaha
authors.affiliation: From the Preventive Medicine Center Hospital Israelita Albert Einstein, Av. Brasil, 953, CEP-01431-000, Säo Paulo, Brazil.
authors.forename: F C
authors.initials: FC
authors.lastname: Nary
authors.affiliation: From the Preventive Medicine Center Hospital Israelita Albert Einstein, Av. Brasil, 953, CEP-01431-000, Säo Paulo, Brazil.
authors.forename: N M
authors.initials: NM
authors.lastname: Kashiwagi
authors.affiliation: From the Preventive Medicine Center Hospital Israelita Albert Einstein, Av. Brasil, 953, CEP-01431-000, Säo Paulo, Brazil.
authors.forename: R D
authors.initials: RD
authors.lastname: Conceiçao
authors.affiliation: From the Preventive Medicine Center Hospital Israelita Albert Einstein, Av. Brasil, 953, CEP-01431-000, Säo Paulo, Brazil.
authors.forename: R S
authors.initials: RS
authors.lastname: Meneghelo
authors.affiliation: From the Preventive Medicine Center Hospital Israelita Albert Einstein, Av. Brasil, 953, CEP-01431-000, Säo Paulo, Brazil.
authors.forename: R R
authors.initials: RR
authors.lastname: Prado
authors.affiliation: From the Preventive Medicine Center Hospital Israelita Albert Einstein, Av. Brasil, 953, CEP-01431-000, Säo Paulo, Brazil.
authors.forename: J A M
authors.initials: JA
authors.lastname: Carvalho
authors.affiliation: Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, 601 North Caroline Street,Suite 7200, Baltimore, MD 21287, USA and Preventive Cardiology and Wellness Center, Baptist Hospital, 1691 Michigan Ave Suite 500, Miami Beach, FL 33139, United States.
authors.forename: K
authors.initials: K
authors.lastname: Nasir
authors.affiliation: Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, 601 North Caroline Street,Suite 7200, Baltimore, MD 21287, USA and.
authors.forename: R S
authors.initials: RS
authors.lastname: Blumenthal
authors.affiliation: From the Preventive Medicine Center Hospital Israelita Albert Einstein, Av. Brasil, 953, CEP-01431-000, Säo Paulo, Brazil, Lipid Clinic Heart Institute (InCor) University of Sao Paulo, Medical School Hospital, Av. Eneas de Carvalho Aguiar, 44, CEP-05403-900, Säo Paulo, Brazil, rdsf@uol.com.br.
authors.forename: R D
authors.initials: RD
authors.lastname: Santos
mesh_terms: D000328:Adult; D001794:Blood Pressure; D001795:Blood Pressure Determination; D001938:Brazil / Q000453:epidemiology; D005080:Exercise Test; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology* / Q000209:etiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D065626:Non-alcoholic Fatty Liver Disease / Q000150:complications*; D011446:Prospective Studies; D014463:Ultrasonography