RESUMEN
AIMS: 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.
Asunto(s)
Prueba de Esfuerzo , Hipertensión/epidemiología , Enfermedad del Hígado Graso no Alcohólico/complicaciones , Adulto , Presión Sanguínea , Determinación de la Presión Sanguínea , Brasil/epidemiología , Femenino , Humanos , Hipertensión/etiología , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Estudios Prospectivos , UltrasonografíaRESUMEN
Trinta portadores de hipertensäo leve ou moderada foram submetidos a uma avaliaçäo comparativa, aberta e "randomizada" de 12 semanas, durante a qual as doses diárias de nifedipina (em nova formulaçäo retard) e de cloridrato de prazozin foram tateadas, com o objetivo de reduzir a pressäo diastólica a um valor igual ou inferior a 90 mm Hg. Concomitante ao uso de ambas as substâncias, observou-se diminuiçäo significativa (p < 0,001) das pressöes sistólica e diastólica, assim como da freqüência cardíaca. O efeito anti-hipertensivo da nifedipina mostrou-se mais precoce (p < 0,05) e superior (p < 0,02) ao do cloridrato de prazosin. Esta substância mostrou-se de difícil manuseio, pois a dose ótima para a maioria dos pacientes foi alcançada no fim da observaçäo e o ajuste da dose individual foi acompanhado de freqüentes hipotensöes. Ambas as substâncias foram bem toleradas, porém, um paciente teve sua terapia com nifedipina interrompida em virtude de "flush" e edema de membros inferiores, apesar de importante efeito anti-hipertensivo