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.

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.