RESUMEN

Resumen Introducción : Los dispositivos electrónicos y tecno logías de la comunicación se emplean cada vez más frecuentemente para brindar atención médica a los pacientes con hipertensión arterial. El objetivo prin cipal del trabajo fue evaluar la percepción de los mé dicos sobre la utilidad de las tecnologías digitales en hipertensión arterial. Los objetivos secundarios fueron evaluar la prevalencia de uso de tecnologías digitales en el seguimiento de pacientes con hipertensión arterial e identificar las barreras percibidas por los médicos para la implementación de las mismas en la República Argentina. Métodos : Estudio observacional, de corte transversal, multicéntrico, basado en un cuestionario autoadminis trado, en el ámbito de la República Argentina y coordi nado por el grupo de Epidemiología de la Sociedad Ar gentina de Hipertensión Arterial. Población: Médicos que realizan atención de pacientes con hipertensión arterial. Resultados : Se obtuvieron 247 respuestas, 35.6% fue ron mujeres y 64.4% hombres; el 92.3 % consideró de utilidad el uso de tecnologías digitales para mejorar la adherencia terapéutica. Reciben resultados de presión arterial en domicilio por algún medio digital 54.7%. Realizan habitualmente teleconsultas 41.3%, solamente el 6.1% por plataformas digitales específicas de salud, el 29.1% por plataformas no específicas, telefónicamente 21.9% y correo electrónico (asincrónicas) 10.9%. Las principales barreras percibidas fueron: disponibilidad, remuneración económica, reglamentación, problemas de conectividad y falta de tiempo. Conclusión : La percepción de los profesionales es favorable, considerándolas útiles para mejorar la ad herencia terapéutica, por lo que podría tener un efecto facilitador en la implementación de las mismas, aunque las barreras percibidas forman parte de cuestiones or ganizacionales a resolver.

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Abstract Introduction : Electronic devices and communication technologies are increasingly used to provide medical care to patients with high blood pressure. The main objective was to evaluate doctors' perception on the usefulness of digital technologies in hypertension. The secondary objectives were to evaluate the prevalence of use of digital technologies in the follow-up of patients with hypertension and to identify the barriers perceived by doctors for their implementation in the Argentine Republic. Methods : Observational, cross-sectional, multicenter study, based on a self-administered questionnaire, in the Argentine Republic, and coordinated by the Epidemiol ogy group of the Argentine Society of Arterial Hyper tension. Population: Doctors who care for patients with high blood pressure. Results : 247 responses were obtained, 35.6% were women and 64.4% men; 92.3% indicated that the use of digital technologies was useful to improve therapeutic adherence; 54.7% received blood pressure results at home through some digital means; 41.3% regularly carry out teleconsultations, only 6.1% through specific digital health platforms, 29.1% through non-specific platforms, by telephone 21.9% and by email (asynchronous) 10.9%. The main perceived barriers were: availability, financial remuneration, regulations, connectivity problems and lack of time. Conclusion : The perception of professionals is fa vorable, as they considered these technologies useful to improve therapeutic adherence, which could have a facilitating effect on their implementation, although the perceived barriers are part of organizational issues to be resolved.

RESUMEN

INTRODUCTION: Electronic devices and communication technologies are increasingly used to provide medical care to patients with high blood pressure. The main objective was to evaluate doctors' perception on the usefulness of digital technologies in hypertension. The secondary objectives were to evaluate the prevalence of use of digital technologies in the follow-up of patients with hypertension and to identify the barriers perceived by doctors for their implementation in the Argentine Republic. METHODS: Observational, cross-sectional, multicenter study, based on a self-administered questionnaire, in the Argentine Republic, and coordinated by the Epidemiology group of the Argentine Society of Arterial Hypertension. POPULATION: Doctors who care for patients with high blood pressure. RESULTS: 247 responses were obtained, 35.6% were women and 64.4% men; 92.3% indicated that the use of digital technologies was useful to improve therapeutic adherence; 54.7% received blood pressure results at home through some digital means; 41.3% regularly carry out teleconsultations, only 6.1% through specific digital health platforms, 29.1% through non-specific platforms, by telephone 21.9% and by email (asynchronous) 10.9%. The main perceived barriers were: availability, financial remuneration, regulations, connectivity problems and lack of time. CONCLUSION: The perception of professionals is favorable, as they considered these technologies useful to improve therapeutic adherence, which could have a facilitating effect on their implementation, although the perceived barriers are part of organizational issues to be resolved.

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Introducción: Los dispositivos electrónicos y tecnologías de la comunicación se emplean cada vez más frecuentemente para brindar atención médica a los pacientes con hipertensión arterial. El objetivo principal del trabajo fue evaluar la percepción de los médicos sobre la utilidad de las tecnologías digitales en hipertensión arterial. Los objetivos secundarios fueron evaluar la prevalencia de uso de tecnologías digitales en el seguimiento de pacientes con hipertensión arterial e identificar las barreras percibidas por los médicos para la implementación de las mismas en la República Argentina. Métodos: Estudio observacional, de corte transversal, multicéntrico, basado en un cuestionario autoadministrado, en el ámbito de la República Argentina y coordinado por el grupo de Epidemiología de la Sociedad Argentina de Hipertensión Arterial. Población: Médicos que realizan atención de pacientes con hipertensión arterial. Resultados: Se obtuvieron 247 respuestas, 35.6% fueron mujeres y 64.4% hombres; el 92.3 % consideró de utilidad el uso de tecnologías digitales para mejorar la adherencia terapéutica. Reciben resultados de presión arterial en domicilio por algún medio digital 54.7%. Realizan habitualmente teleconsultas 41.3%, solamente el 6.1% por plataformas digitales específicas de salud, el 29.1% por plataformas no específicas, telefónicamente 21.9% y correo electrónico (asincrónicas) 10.9%. Las principales barreras percibidas fueron: disponibilidad, remuneración económica, reglamentación, problemas de conectividad y falta de tiempo. Conclusión: La percepción de los profesionales es favorable, considerándolas útiles para mejorar la adherencia terapéutica, por lo que podría tener un efecto facilitador en la implementación de las mismas, aunque las barreras percibidas forman parte de cuestiones organizacionales a resolver.

Asunto(s)

Hipertensión , Humanos , Femenino , Estudios Transversales , Masculino , Argentina , Persona de Mediana Edad , Encuestas y Cuestionarios , Adulto , Tecnología Digital , Telemedicina , Actitud del Personal de Salud

RESUMEN

Hypertension continues to be the leading cause of death and disability in the industrialized world, with a high level of unawareness and unacceptably poor control rates. Therefore, the Argentinian Society of Hypertension, in association with the May Measurement Month (MMM) charity, implemented an awareness campaign during May 2021. A voluntary cross-sectional survey was carried out during the month of May 2021 in public spaces and health centres across 29 cities in Argentina. Hypertension was defined as systolic blood pressure (BP) ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg based on the mean of the second and third of three BP measurements or in those volunteers on treatment for high BP. Statistical analysis including multiple imputation followed the MMM protocol. A total of 26 070 individuals (average age 53.4 years, 14 816 women and 11 254 men) were evaluated. The age- and sex-standardized mean BP was 125.1/77.6 mmHg. Of all participants, 54.4% had hypertension. Although 79.8% of the hypertensive participants were aware of their condition and 76.9% were on antihypertensive treatment, only 42.5% of all individuals with hypertension had their BP controlled (<140/90 mmHg). Of those on antihypertensive medication, 55.3% were controlled. The low level of hypertension control highlights the critical need for community-based prevention strategies to increase the awareness and control of hypertension, thereby reducing the enormous health burden attributed to this condition.

RESUMEN

Isolated nocturnal hypertension (INH) and masked nocturnal hypertension (MNH) increase cardiovascular risk. Their prevalence and characteristics are not clearly established and seem to differ among populations. We aimed to determine the prevalence and associated characteristics of INH and MNH in a tertiary hospital in the city of Buenos Aires. We included 958 hypertensive patients ≥ 18 years who underwent an ambulatory blood pressure monitoring (ABPM) between October and November 2022, as prescribed by their treating physician to diagnose or to assess hypertension control. INH was defined as nighttime BP ≥ 120 mmHg systolic or ≥70 diastolic in the presence of normal daytime BP (<135/85 mmHg regardless of office BP; MNH was defined as the presence of INH with office BP < 140/90 mmHg). Variables associated with INH and MNH were analyzed. The prevalences of INH and MNH were 15.7% (95% CI 13.5-18.2%) and 9.7 (95% CI 7.9-11.8%), respectively. Age, male sex, and ambulatory heart rate were positively associated with INH, whereas office BP, total cholesterol, and smoking habits showed a negative association. In turn, diabetes and nighttime heart rate were positively associated with MNH. In conclusion, INH and MNH are frequent entities, and determination of clinical characteristics such as those detected in this study is critical since this might contribute to a more appropriate use of resources.

RESUMEN

The prognostic value of home blood pressure monitoring (HBPM) has been investigated in several studies in the general population, demonstrating its independent association with cardiovascular events. However, in the case of treated hypertensive subjects, evidence is controversial. Our purpose was to evaluate the prognostic value of HBPM in this population. Medicated hypertensive patients who performed a 4-day HBPM (Omron® HEM-705CP-II) between 2008 and 2015 were followed up for a median of 5.9 years, registering the occurrence of a composite primary outcome of fatal and non-fatal cardiovascular events. Cox regression models were used to analyze the prognostic value of HBPM, considering 4-day measurements, discarding the first day, and analyzing morning, afternoon and evening periods separately. We included 1582 patients in the analysis (33.4% men, median age 70.8 years, on an average of 2.1 antihypertensive drugs). During follow-up, 273 events occurred. HBPM was significantly associated with cardiovascular events in all five scenarios in the unadjusted models. When adjusting for office BP and other cardiovascular risk factors, the association remained marginally significant for the 4-day period, discarding first-day measurements HBPM (HR 1.04 [95% CI 1-1.1] and 1.04 [95% CI 1-1.1], respectively) and statistically significant for all separate periods of measurement: HR 1.32 (95% CI 1.01-1.72); 1.33 (95% CI 1.02-1.72); and 1.30 (95% CI 1.01-1.67), for morning, afternoon and evening, respectively. When analyzing separately fatal and non-fatal events, statistical significance was held for the former only. In conclusion, HBPM is an independent predictor of cardiovascular events in hypertensives under treatment.

Asunto(s)

Antihipertensivos , Hipertensión , Masculino , Humanos , Anciano , Femenino , Antihipertensivos/efectos adversos , Pronóstico , Monitoreo Ambulatorio de la Presión Arterial , Reproducibilidad de los Resultados , Hipertensión/diagnóstico , Hipertensión/tratamiento farmacológico

Asunto(s)

Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Accidente Cerebrovascular/tratamiento farmacológico , Hipertensión/tratamiento farmacológico , Infarto del Miocardio/tratamiento farmacológico , Antihipertensivos/administración & dosificación , Enfermedades Cardiovasculares/prevención & control , Ensayos Clínicos Controlados Aleatorios como Asunto , Resultado del Tratamiento , Accidente Cerebrovascular/epidemiología , Reino Unido , Infarto del Miocardio/epidemiología , Antihipertensivos/efectos adversos

Asunto(s)

Humanos , Masculino , Femenino , Anciano , Hipertensión Enmascarada , Hipertensión/diagnóstico , Hipertensión/tratamiento farmacológico , Pronóstico , Presión Sanguínea , Monitoreo Ambulatorio de la Presión Arterial

RESUMEN

INTRODUCTION: Cardiovascular risk seems not to be greater in patients with white coat uncontrolled hypertension (WUCH) than in patients with sustained blood pressure (BP) control. Therefore, its detection is important to avoid overtreatment. The COVID-19 pandemic determined a massive migration of hypertension consultations from the face-to-face modality to teleconsultations, and it is unknown whether WUCH exists in this context. AIM: We aimed to evaluate the prevalence of WUCH through home BP monitoring (HBPM) in treated hypertensive patients evaluated by teleconsultation. METHODS: We included treated hypertensive patients that owned a digital BP monitor. During teleconsultation, patients were asked to perform two BP measurements and then a 7-day HBPM, using the same device. Patients were classified as having WUCH if BP was ≥ 140 and/or 90 mmHg in teleconsultation and < 135/85 mmHg on HBPM. The prevalence of WUCH and its 95% confidence interval were estimated. One-way ANOVA, the Chi-square test or Fisher's exact test were used to compare the characteristics of these patients with the other groups. RESULTS: We included 341 patients (45.2% male, mean age 62.3 years). The prevalence of WUCH was 33.1% (95% CI 28.3-38.3%). Significant differences were found in terms of age, the number of antihypertensive drugs and the use of calcium channel blockers, all lower in the WUCH group as compared with the groups with elevated BP on HBPM. CONCLUSION: WUCH exists in teleconsultation and is very frequent. It can be easily detected though HBPM, thus avoiding overmedication, and its potential impact on side-effects and health costs.

Asunto(s)

COVID-19 , Hipertensión , Consulta Remota , Hipertensión de la Bata Blanca , Antihipertensivos/efectos adversos , Presión Sanguínea , Monitoreo Ambulatorio de la Presión Arterial , Femenino , Humanos , Hipertensión/diagnóstico , Hipertensión/tratamiento farmacológico , Hipertensión/epidemiología , Masculino , Persona de Mediana Edad , Pandemias , Hipertensión de la Bata Blanca/diagnóstico , Hipertensión de la Bata Blanca/tratamiento farmacológico , Hipertensión de la Bata Blanca/epidemiología

RESUMEN

OBJECTIVE: To address to what extent central hemodynamic measurements, improve risk stratification, and determine outcome-based diagnostic thresholds, we constructed the International Database of Central Arterial Properties for Risk Stratification (IDCARS), allowing a participant-level meta-analysis. The purpose of this article was to describe the characteristics of IDCARS participants and to highlight research perspectives. METHODS: Longitudinal or cross-sectional cohort studies with central blood pressure measured with the SphygmoCor devices and software were included. RESULTS: The database included 10,930 subjects (54.8% women; median age 46.0 years) from 13 studies in Europe, Africa, Asia, and South America. The prevalence of office hypertension was 4,446 (40.1%), of which 2,713 (61.0%) were treated, and of diabetes mellitus was 629 (5.8%). The peripheral and central systolic/diastolic blood pressure averaged 129.5/78.7 mm Hg and 118.2/79.7 mm Hg, respectively. Mean aortic pulse wave velocity was 7.3 m per seconds. Among 6,871 participants enrolled in 9 longitudinal studies, the median follow-up was 4.2 years (5th-95th percentile interval, 1.3-12.2 years). During 38,957 person-years of follow-up, 339 participants experienced a composite cardiovascular event and 212 died, 67 of cardiovascular disease. CONCLUSIONS: IDCARS will provide a unique opportunity to investigate hypotheses on central hemodynamic measurements that could not reliably be studied in individual studies. The results of these analyses might inform guidelines and be of help to clinicians involved in the management of patients with suspected or established hypertension.

Asunto(s)

Enfermedades Cardiovasculares , Hipertensión , Presión Sanguínea/fisiología , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/epidemiología , Estudios Transversales , Femenino , Humanos , Hipertensión/diagnóstico , Hipertensión/epidemiología , Masculino , Persona de Mediana Edad , Análisis de la Onda del Pulso

RESUMEN

Information regarding predictors of a worse COVID-19 prognosis in the South American population is scarce. We aimed to determine whether the blockade of the renin-angiotensin system is associated with a worse clinical course of COVID-19, and to evaluate what clinical variables are associated with COVID severity in our population. We included adult subjects with rtPCR-confirmed COVID-19. The use of renin system inhibitors was defined according to its registration in the electronic medical record or the hospital pharmacy registry during the previous three months. Our endpoint was a composite of death or mechanical ventilation requirement. Patients were followed up until discharge or death. A multiple logistic regression model was used to determine the predictors of the composite endpoint. In all, we included 4930 COVID+ patients, the median age was 52 years, and 48.1% were male. The endpoint occurred in 488 patients (9.9%). In adjusted analysis, neither angiotensin converting enzyme inhibitors nor angiotensin receptor blockers were associated with the outcome. Independent predictors of mortality and/or mechanical ventilation requirement were age, male sex, a history of diabetes and/or chronic kidney disease, smoking and dementia. To conclude, renin system inhibitors seem to be unrelated to COVID-19 severity, whereas prognosis is independently associated with age, male sex and comorbidities.

Asunto(s)

Antagonistas de Receptores de Angiotensina/uso terapéutico , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Tratamiento Farmacológico de COVID-19 , Respiración Artificial/estadística & datos numéricos , Índice de Severidad de la Enfermedad , Adulto , Factores de Edad , Anciano , Argentina/epidemiología , COVID-19/epidemiología , COVID-19/mortalidad , Ciudades/epidemiología , Comorbilidad , Demencia/epidemiología , Diabetes Mellitus/epidemiología , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Pandemias , Pronóstico , Insuficiencia Renal Crónica/epidemiología , Factores Sexuales , Fumar/epidemiología , Centros de Atención Terciaria

RESUMEN

INTRODUCTION: Although multiple home blood pressure variability (HBPV) indices have been proposed, the superiority of one over another is not clear in treated hypertensives. AIM: We evaluated the correlation between different indices of HBPV and hypertension-mediated organ damage (HMOD) in this population and determined predictors of greater HBPV. METHODS: We included adult treated hypertensives who performed an HBP monitoring (duplicate sitting BP readings in the morning, afternoon, and evening for 4 days, Omron HEM-705CP-II), laboratory measurements, transthoracic echocardiogram and carotid-femoral pulse wave velocity. We selected HBPV indices from three different calculation approaches: coefficient of variation (CoV), difference between maximum and minimum BP (MMD), and morning BP increase (MI), and evaluated their correlation with left ventricular mass index, relative wall thickness (RWT), ejection fraction, arterial stiffness and estimated glomerular filtration rate through a correlation matrix. For those variability indices significantly associated with HMOD, we constructed multiple linear regression models to determine independent predictors of HBPV. RESULTS: We included 204 patients, mean age 67.2 (± 13.8) years, 64% female. CoV and MMD for systolic BP showed the greatest correlation with HMOD. Factors independently associated both with CoV and MMD were: older age (b = 0.07; 95% CI 0.04-0.07; p < 0.001 and b = 0.4; 95% CI 0.2-0.5; p < 0.001, respectively), history of stroke (b = 3.6; 95% CI 0.9-6.4; p = 0.01 and b = 25.7; 95% CI 10.1-41.2; p = 0.001, respectively), and body mass index [b = - 0.1; 95% CI - 0.2 to (- 0.02); p = 0.01 and b = - 0.5; 95% CI - 0.9 to (- 0.1); p = 0.01, respectively]. CONCLUSION: CoV and MMD showed the greatest association with HMOD in treated hypertensives. Older age, history of stroke and lower body mass index were easy-to-detect predictors.

Asunto(s)

Monitoreo Ambulatorio de la Presión Arterial , Presión Sanguínea , Hipertensión/diagnóstico , Factores de Edad , Anciano , Anciano de 80 o más Años , Índice de Masa Corporal , Estudios Transversales , Femenino , Cardiopatías/diagnóstico , Cardiopatías/etiología , Cardiopatías/fisiopatología , Humanos , Hipertensión/complicaciones , Hipertensión/fisiopatología , Hipertensión/terapia , Enfermedades Renales/diagnóstico , Enfermedades Renales/etiología , Enfermedades Renales/fisiopatología , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Pronóstico , Reproducibilidad de los Resultados , Medición de Riesgo , Factores de Riesgo , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/fisiopatología

Asunto(s)

Hipotensión Ortostática , Rigidez Vascular , Anciano , Biomarcadores , Presión Sanguínea , Estudios Transversales , Humanos

RESUMEN

WHAT IS KNOWN AND OBJECTIVE: Controversy has arisen in the scientific community on whether the use of renin-angiotensin system (RAS) inhibitors in the context of COVID-19 would be beneficial or harmful. A meta-analysis of eligible studies comparing the occurrence of severe and fatal COVID-19 in infected hypertensive patients who were under treatment with angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) vs no treatment or other antihypertensives was conducted. METHODS: PubMed, Google Scholar, the Cochrane Library, medRxiv and bioRxiv were searched for relevant studies. Fixed-effects models or random-effects models were used depending on the heterogeneity between estimates. RESULTS AND DISCUSSION: A total of eighteen studies with 17 311 patients were included. The use of RAS inhibitors was associated with a significant 16% decreased risk of the composite outcome (death, admission to intensive care unit, mechanical ventilation requirement or progression to severe or critical pneumonia): RR: 0.84 (95% CI: 0.73-0.95), P = .007, I2  = 65%. WHAT IS NEW AND CONCLUSION: The results of this pooled analysis suggest that the use of ACEI/ARB does not worsen the prognosis of COVID-19, and could even be protective in hypertensive subjects. Hypertensive patients should continue these drugs even if they become infected with SARS-CoV-2.

Asunto(s)

Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Antihipertensivos/uso terapéutico , COVID-19/complicaciones , Hipertensión/complicaciones , Hipertensión/tratamiento farmacológico , Sistema Renina-Angiotensina/efectos de los fármacos , Humanos , Índice de Severidad de la Enfermedad

RESUMEN

En la Argentina no existen datos epidemiológicos sobre displasia fibromuscular. La realización de un registro nacional puede aportar información que conduzca a una actualización de los consensos y recomendaciones para un correcto diagnóstico, evaluación y tratamiento. El Registro Argentino de Displasia Fibromuscular (SAHARA-DF) inició su actividad de recopilación de datos en octubre de 2015. Al año 2019 se confirmaron 49 pacientes (44 mujeres, 38 hipertensos, edad 45,3 ± 17,2 años, 12 con presentación neurológica). Veintidós pacientes tuvieron lesiones vasculares en más de un sitio, a pesar del sesgo diagnóstico por falta de estudios complementarios en casi la mitad de los casos. El sitio afectado más frecuente fue el renovascular, seguido por el carotídeo y el ilíaco, y las lesiones multifocales fueron más frecuentes que las unifocales (35 versus 14, respectivamente). Se constató la presencia de aneurismas asociados en 13 casos y disección arterial en 4 casos. De las 22 angioplastias renales realizadas, 14 fueron con colocación de stent (endoprótesis). En este estudio preliminar de una población argentina se evidencia el carácter sistémico de la enfermedad y se plantea un llamado a actuar en cuanto a la necesidad de debatir el algoritmo diagnóstico y el método de tratamiento. (AU)

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In Argentina there are no epidemiological data regarding fibromuscular dysplasia. Building a National Registry may provide information leading to updated consensus and recommendations for a correct diagnosis, assessment and treatment. Data gathering for the Argentine Registry of Fibromuscular Dysplasia (SAHARA-DF) was initiated in October 2015. By 2019, 49 patients were confirmed (44 women, 38 hypertensives, age 45.3 ± 17.2 years, 12 with a neurological presentation). Twenty-two patients had multi-site vascular lesions, in spite of a diagnosis bias due to lack of supporting studies in almost half of the cases. The renovascular site was the most affected, followed by the carotid and iliac sites, and multifocal lesions were more frequent than unifocal (35 versus 14, respectively). Associated aneurysms were found in 13 cases, and arterial dissection in 4. Twenty-two renal angioplasties were performed, 14 with stent placement. In this preliminary study of an Argentinian population, the systemic nature of the disease is evidenced, and a call for action arises regarding the need for discussing the diagnostic algorithm and treatment method. (AU)

Asunto(s)

Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Adulto Joven , Registros/estadística & datos numéricos , Displasia Fibromuscular/diagnóstico , Argentina/epidemiología , Algoritmos , Sesgo , Factores Sexuales , Estudios Transversales , Factores de Riesgo , Factores de Edad , Angioplastia/métodos , Factores Culturales , Lesiones del Sistema Vascular/diagnóstico por imagen , Displasia Fibromuscular/clasificación , Displasia Fibromuscular/etiología , Displasia Fibromuscular/terapia , Displasia Fibromuscular/epidemiología , Hipertensión/epidemiología , Disección Aórtica/diagnóstico por imagen

RESUMEN

Worldwide, hypertension control rate is far from ideal. Some studies suggest that patients treated by specialists have a greater chance to achieve control. The authors aimed to determine the BP control rate among treated hypertensive patients under specialist care in Argentina, to characterize patients regarding their cardiovascular risk profile and antihypertensive drug use, and to assess the variables independently associated with adequate BP control. The authors included adult hypertensive patients under stable treatment, managed in 10 specialist centers across Argentina. Office BP was measured thrice with a validated oscillometric device. Adequate BP control was defined as an average of the three readings <140/90 mm Hg (and <150/90 in patients older than 80 years). The authors estimated the proportion of adequate BP control and the variables independently associated with it through a multiple conditional logistic regression model. Among the 1146 included patients, 48.2% were men with a mean age of 63.5 (±13.1) years old. Mean office BP was 135.3 (±14.8)/80.8 (±10) mm Hg, with a 64.8% (95% CI: 62%-67.6%) of adequate control. The mean number of antihypertensive drugs was 2.1 per participant, the commonest being angiotensin receptor blockers and calcium channel blockers. In multivariable analysis, only female sex was a predictor of adequate BP control (OR 1.33 [95% CI 1.02-1.72], P = .04). In conclusion, almost 65% of hypertensive patients treated in specialist centers in Argentina have adequate BP control. The challenge for future research is to define strategies in order to translate this control rate to the primary care level, where most patients are managed.

Asunto(s)

Presión Sanguínea/fisiología , Enfermedades Cardiovasculares/diagnóstico , Hipertensión/complicaciones , Anciano , Antagonistas de Receptores de Angiotensina/uso terapéutico , Antihipertensivos/uso terapéutico , Argentina/epidemiología , Determinación de la Presión Sanguínea/instrumentación , Bloqueadores de los Canales de Calcio/uso terapéutico , Enfermedades Cardiovasculares/epidemiología , Estudios de Casos y Controles , Estudios Transversales , Femenino , Humanos , Hipertensión/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Atención Primaria de Salud/normas , Estudios Prospectivos , Factores de Riesgo

Asunto(s)

Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Adulto Joven , Monitoreo Ambulatorio de la Presión Arterial/métodos , Hipertensión Enmascarada/patología , Enfermedades Cardiovasculares/mortalidad , Enfermedades Cardiovasculares/prevención & control , Conductas Terapéuticas Homeopáticas , Factores de Riesgo , Monitoreo Ambulatorio de la Presión Arterial/clasificación , Hipertensión Enmascarada/diagnóstico , Hipertensión Enmascarada/terapia , Hipertensión/terapia

RESUMEN

Masked uncontrolled hypertension (MUCH) is an entity described in treated hypertensive subjects, where office blood pressure (BP) is well controlled and out-of-office BP is elevated. It has been related to a higher cardiovascular risk. However, the reproducibility of MUCH has been scarcely studied. In this study, we aimed to determine the reproducibility of MUCH detected through home blood pressure monitoring (HBPM). Two sets of measurements were performed in hypertensive adults under stable treatment with a 1-week interval. Each set of measurements included three office BP readings and a 4-day HBPM with duplicate readings in the morning, afternoon, and evening (the same validated oscillometric device was employed in both settings). We determined the percentage of agreement regarding the presence of MUCH in the two sets of measurements and quantified such agreement through the Cohen's kappa coefficient (κ), its 95% confidence interval, and P value. We included 105 patients (median age 58.6 [IQR 45.6-67.2] years old, 53.4% men). MUCH prevalence on at least one occasion was 22.3% (95% CI: 15.2-31.5). The reproducibility of MUCH was scant: κ = 0.19 (95% CI: 0.0002-0.38), P = 0.02, due to the poor reproducibility of the office BP component of MUCH in comparison with the home BP component: κ = 0.21 (95% CI: 0.03-0.39), P = 0.01 vs κ = 0.48 (95% CI 0.29-0.67), P < 0.001, respectively. In conclusion, the reproducibility of MUCH detected through HBPM is minimal, mainly due to the poor reproducibility of office BP measurements. An HBPM-based strategy for the management of patients with MUCH may be more adequate in terms of cardiovascular morbidity and mortality.

Asunto(s)

Antihipertensivos/uso terapéutico , Monitoreo Ambulatorio de la Presión Arterial , Enfermedades Cardiovasculares , Hipertensión Enmascarada/diagnóstico , Visita a Consultorio Médico/estadística & datos numéricos , Argentina/epidemiología , Monitoreo Ambulatorio de la Presión Arterial/métodos , Monitoreo Ambulatorio de la Presión Arterial/estadística & datos numéricos , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/prevención & control , Femenino , Humanos , Masculino , Hipertensión Enmascarada/tratamiento farmacológico , Hipertensión Enmascarada/epidemiología , Persona de Mediana Edad , Prevalencia , Reproducibilidad de los Resultados , Factores de Riesgo

RESUMEN

BACKGROUND: Older hypertensive adults under treatment are especially susceptible to hypotensive episodes, which entail an elevated risk. However, data on this subject are very scarce. AIM: The purpose of this study was to determine the prevalence and predictors of office and home hypotension in older (≥ 65 years) treated hypertensive adults. METHODS: Blood pressure (BP) was measured at the office and at home, using a validated oscillometric device. Office and home hypotension were defined as systolic BP (SBP) < 110 and/or diastolic BP (DBP) < 70 mmHg, and SBP < 105 and/or DBP < 65 mmHg, respectively. Masked hypotension was considered when office BP ≥ 110/70 and home BP < 105 and/or < 65 mmHg. We evaluated factors associated with hypotension both at the office and at home through multivariable models. RESULTS: The prevalence of hypotension among the 302 patients included in the study was 29.8% at the office and 23.9% at home, whereas the prevalence of masked hypotension was 10.4%. Older age, lower body mass index and use of calcium channel blockers were associated with office hypotension, while older age, diabetes and ischemic heart disease were predictors for home hypotension. CONCLUSION: Hypotension is frequent in older hypertensive adults under treatment. The presence of diabetes, ischemic heart disease and older age should alert for screening of hypotension at home to avoid overtreatment.

Asunto(s)

Antihipertensivos/uso terapéutico , Hipertensión/tratamiento farmacológico , Hipotensión/epidemiología , Anciano , Anciano de 80 o más Años , Presión Sanguínea/efectos de los fármacos , Monitoreo Ambulatorio de la Presión Arterial , Índice de Masa Corporal , Estudios de Casos y Controles , Estudios Transversales , Femenino , Humanos , Hipertensión/epidemiología , Masculino , Prevalencia

RESUMEN

Exaggerated orthostatic blood pressure variation (EOV) is a poorly understood phenomenon related to high cardiovascular risk. We aimed to determine whether hypertensive patients with EOV have a distinct hemodynamic pattern, assessed through impedance cardiography. METHODS: In treated hypertensive patients, we measured the cardiac index (CI), systemic vascular resistance index (SVRI), blood pressure (BP), and heart rate (HR) in the supine and standing (after 3 minutes) positions, defining three groups according to BP variation: 1) Normal orthostatic BP variation (NOV): standing systolic BP (stSBP)-supine systolic BP (suSBP) between -20 and 20 mmHg and standing diastolic BP (stDBP)-supine diastolic BP (suDBP) between -10 and 10 mmHg; 2) orthostatic hypotension (OHypo): stSBP-suSBP≤-20 or stDBP-suDBP≤-10 mmHg; 3) orthostatic hypertension (OHyper): stSBP-suSBP≥20 or stDBP-suDBP≥10 mmHg. We performed multivariable analyses to determine the association of hemodynamic variables with EOV. RESULTS: We included 186 patients. Those with OHyper had lower suDBP and higher orthostatic SVRI variation compared to NOV. In multivariable analyses, orthostatic HR variation (OR = 1.06 (95%CI 1.01-1.13), p = 0.03) and orthostatic SVRI variation (OR = 1.16 (95%CI 1.06-1.28), p = 0.002) were independently related to OHyper. No variables were independently associated with OHypo. CONCLUSION: Patients with OHyper have a distinct hemodynamic pattern, with an exaggerated increase in SVRI and HR when standing.

Asunto(s)

Presión Sanguínea , Hipertensión/fisiopatología , Hipotensión Ortostática/fisiopatología , Posición Supina/fisiología , Anciano , Anciano de 80 o más Años , Cardiografía de Impedancia , Femenino , Frecuencia Cardíaca , Humanos , Hipertensión/complicaciones , Hipotensión Ortostática/complicaciones , Masculino , Persona de Mediana Edad , Resistencia Vascular

RESUMEN

OBJECTIVE: The objective of this study was to compare the aortic piezoelectric device for noninvasive measurement of central aortic systolic blood pressure (cSBP) with the SphygmoCor. PARTICIPANTS AND METHODS: A total of 85 participants from both sexes, aged 18-80 years, were stratified into three age groups (<30, 30-60, >60 years), with an equal number of healthy volunteers and hypertensive patients. We performed three cSBP measurements with each device, in an alternate manner, using the Bland-Altman method to determine the level of agreement. The standard of the Association for the Advancement of Medical Instrumentation for brachial blood pressure evaluation was used for the comparison. RESULTS: The mean cSBPs were 109.3±12.05 and 109.0±12.2 mmHg with the SphygmoCor and the Aortic device, respectively, showing a strong correlation (r=0.98, P<0.001). A mean difference of 0.35±2.43 mmHg (95% confidence interval: 0.17-0.87, P=NS) was obtained with the Bland-Altman method. The 95% limits of agreement was -4.4 to +5.1 mmHg. CONCLUSION: Complying with the Association for the Advancement of Medical Instrumentation criteria, cSBP measurements obtained with the Aortic and the SphygmoCor devices are equivalent.

Asunto(s)

Presión Arterial , Determinación de la Presión Sanguínea/instrumentación , Hipertensión/diagnóstico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Aorta/fisiología , Aorta/fisiopatología , Presión Sanguínea , Femenino , Humanos , Hipertensión/fisiopatología , Masculino , Persona de Mediana Edad , Sensibilidad y Especificidad , Esfigmomanometros , Adulto Joven