RESUMO
INTRODUCTION: Low resting heart rate (RHR) increases augmentation pressure (AP) and central pulse pressure (central PP) and decreases peripheral pressure wave amplification. Given that the contribution of AP to central PP increases with age we hypothesized that the influence of RHR on AP, central PP and peripheral amplification varies with age. AIM: To evaluate the interaction between age and RHR on the forward and backward components of central PP. METHODS: A cohort of 1249 ambulatory hypertensive patients with good quality radial wave recordings was stratified into age groups and quartiles of RHR (< 61, 61-68, 69-76 and > 76 bpm). Central aortic pressure was estimated from radial applanation tonometry. RESULTS: Forward wave (FW) and AP showed opposite changes until midlife, mutually canceling their effect on central PP, whereas both components of central PP increased in parallel after the fifth decade. The initial fall in FW was expressed in the brachial artery as a corresponding decrease in PP and in peripheral amplification. After midlife there was a further decrease in peripheral amplification at the expense of the rise in central PP. A lower RHR exaggerated the age-related increase in left ventricular ejection time (LVET), AP, central PP, and the decrease in peripheral amplification (P < 0.001, for all the interactions between decades and quartiles of RHR). Multivariable regression analyses (n = 1249) confirmed a significant interaction between age and RHR on central PP (P < 0.001), AP (P < 0.001), LVET (P < 0.001), AIx (P < 0.035), and peripheral amplification (P < 0.001). Multivariable regression analyses stratified by age groups (< 30, 30-59 and ≥ 60 years) showed an increasing strength in the relationship of RHR with AP, independently of sex, mean arterial pressure, pulse wave velocity and beta-blockers use. The average increase in AP for a decrease in 10 bpm was 1.4 mmHg before age < 30 years; 2.5 mmHg between age 30-59 years; and 5.4 mmHg at 60 years and older. CONCLUSIONS: A lower heart rate exaggerated AP and central PP in an age dependent fashion, being the effect particularly relevant in older patients.
Assuntos
Pressão Arterial , Frequência Cardíaca , Hipertensão/fisiopatologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Hipertensão/diagnóstico , Masculino , Pessoa de Meia-Idade , Volume Sistólico , Função Ventricular Esquerda , Adulto JovemRESUMO
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)
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)
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Registros/estatística & dados numéricos , Displasia Fibromuscular/diagnóstico , Argentina/epidemiologia , Algoritmos , Viés , Fatores Sexuais , Estudos Transversais , Fatores de Risco , Fatores Etários , Angioplastia/métodos , Fatores Culturais , Lesões do Sistema Vascular/diagnóstico por imagem , Displasia Fibromuscular/classificação , Displasia Fibromuscular/etiologia , Displasia Fibromuscular/terapia , Displasia Fibromuscular/epidemiologia , Hipertensão/epidemiologia , Dissecção Aórtica/diagnóstico por imagemRESUMO
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.
Assuntos
Pressão Arterial , Determinação da Pressão Arterial/instrumentação , Hipertensão/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Aorta/fisiologia , Aorta/fisiopatologia , Pressão Sanguínea , Feminino , Humanos , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Esfigmomanômetros , Adulto JovemRESUMO
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.
Assuntos
Pressão Sanguínea , Hipertensão/fisiopatologia , Hipotensão Ortostática/fisiopatologia , Decúbito Dorsal/fisiologia , Idoso , Idoso de 80 Anos ou mais , Cardiografia de Impedância , Feminino , Frequência Cardíaca , Humanos , Hipertensão/complicações , Hipotensão Ortostática/complicações , Masculino , Pessoa de Meia-Idade , Resistência VascularRESUMO
BACKGROUND: An alerting reaction is a physician-induced phenomenon which produces a transient blood pressure rise in the office. OBJECTIVE: To determine its relationship with target organ damage in treated hypertensives. METHOD: We used three different indexes for calculating alerting reaction depending on the first, second or third office blood pressure measurement. We correlated these indexes with glomerular filtration rate, left ventricular mass index and pulse wave velocity. Thereafter, for multivariate analysis, we selected the index which better correlated with each target organ damage subtype. RESULTS: We included 174 adults, mean age 67(±13.7) years. 75% of the patients had some degree of blood pressure fall between measurements 1-3. In multivariate linear regression models, after adjusting for classic risk factors, two out of the three systolic alerting reaction indexes showed an independent association with target organ damage. After further adjusting for office blood pressure and white coat effect (calculated with standardized home blood pressure monitoring), left ventricular mass index maintained a statistically significant association. CONCLUSION: A higher alerting reaction in the office seems to be related to increased target organ damage in treated hypertensives and should not be considered an innocent phenomenon.
Assuntos
Determinação da Pressão Arterial/métodos , Pressão Sanguínea , Doenças Cardiovasculares/etiologia , Nefropatias/etiologia , Visita a Consultório Médico , Hipertensão do Jaleco Branco/complicações , Idoso , Idoso de 80 Anos ou mais , Anti-Hipertensivos/uso terapêutico , Argentina , Pressão Sanguínea/efeitos dos fármacos , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/fisiopatologia , Feminino , Taxa de Filtração Glomerular , Humanos , Rim/fisiopatologia , Nefropatias/diagnóstico , Nefropatias/fisiopatologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Análise de Onda de Pulso , Medição de Risco , Fatores de Risco , Rigidez Vascular , Função Ventricular Esquerda , Remodelação Ventricular , Hipertensão do Jaleco Branco/diagnóstico , Hipertensão do Jaleco Branco/fisiopatologiaRESUMO
Arterial stiffness, assessed through pulse wave velocity (PWV), independently predicts cardiovascular outcomes. In untreated persons, white-coat hypertension (WCH) has been related to arterial stiffness, but data in treated patients with WCH are scarce. The authors aimed to determine a possible association between WCH and arterial stiffness in this population. Adult treated hypertensive patients underwent home blood pressure monitoring and PWV assessment. Variables associated with PWV in univariable analyses were entered into a multivariable linear regression model. The study included 121 patients, 33.9% men, median age 67.9 (interquartile range 18.4) years, 5.8% with diabetes, and 3.3% with a history of cardiovascular or cerebrovascular disease. In multivariable analysis, WCH in treated hypertensive patients remained a determinant of PWV: ß=1.1 (95% confidence interval, 0.1-2.1 [P=.037]; adjusted R2 0.49). In conclusion, WCH is independently associated with arterial stiffness in treated hypertensive patients. Whether this high-risk association is offset by antihypertensive treatment should be further investigated.
Assuntos
Anti-Hipertensivos/farmacologia , Rigidez Vascular , Hipertensão do Jaleco Branco/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Monitorização Ambulatorial da Pressão Arterial , Estudos Transversais , Feminino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Análise de Onda de Pulso , Fatores de Risco , Resultado do Tratamento , Hipertensão do Jaleco Branco/fisiopatologiaAssuntos
Humanos , Adulto , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Antagonistas Adrenérgicos beta/uso terapêutico , Hipertensão/tratamento farmacológico , Anti-Hipertensivos/uso terapêutico , Atenolol/uso terapêutico , Literatura de Revisão como Assunto , Bloqueadores dos Canais de Cálcio/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Metanálise como Assunto , Antagonistas Adrenérgicos beta/efeitos adversos , Doença das Coronárias/prevenção & controle , Acidente Vascular Cerebral/prevenção & controle , Diuréticos/uso terapêutico , Antagonistas de Receptores de Angiotensina/uso terapêutico , Revisões Sistemáticas como Assunto , Parada Cardíaca/prevenção & controle , Hipertensão/mortalidade , Anti-Hipertensivos/efeitos adversosRESUMO
Resumen Objetivo Evaluar la asociación entre las diferencias de mediciones de 2 ECG separados en el tiempo, con el desarrollo de fibrilación auricular (FA). Método Cohorte retrospectiva de 9,975 pacientes adultos, afiliados a la prepaga del Hospital Italiano de Buenos Aires, Argentina, con realización de al menos 2 ECG sinusales digitales entre 2006-2011. Se siguieron clínicamente para la detección de FA. Todas las mediciones electrocardiográficas y los deltas (diferencias entre los 2 ECG) fueron estandarizadas. Se estimaron los hazard ratio para desarrollo de FA, para cada delta de los distintos componentes electrocardiográficos utilizando un modelo de regresión de Cox. Resultados Durante una mediana de seguimiento de 3,5 años se detectaron 189 episodios de FA. El delta FC, delta intervalo ST y delta amplitud onda P se asociaron significativamente a FA. Ajustado por características clínicas y mediciones de ECG basal, el hazard ratio ajustado para FA fue 0.86 (IC95%: 0.75-0.98, p = 0.024) para delta FC; 1.12 (IC95%0.98-1.27, p = 0.082) para delta intervalo ST; y 1.21 (IC95%: 1.05-1.38, p = 0.006) para delta amplitud onda P. Conclusiones Las diferencias FC y amplitud onda P, entre mediciones de ECG, predicen FA en forma independiente de características clínicas y mediciones de ECG basal.
Abstract Objetive To evaluate the association between delta variations in the parameters of 2 sinusal ECG with atrial fibrillation (AF) onset. Method Retrospective cohort of 9,975 adult patients and members of the prepaid system at Hospital Italiano de Buenos Aires from Argentina, who had at least 2 sinusal ECG between 2006 and 2011. Population was followed up for detection of AF. All measurements and electrocardiographic deltas (differences between the 2 ECG) were standardized. Hazard ratio (HR) was estimated for the development of AF for each delta of the different ECG parameters using a Cox regression model. Results During a median follow up of 3.5 years, 189 patients (1.89%) developed AF. Heart rate delta, ST interval delta and P wave amplitude were predictors of AF. Hazard ratio Adjusted for clinical characteristics and ECGbasal values was 0,86 (CI95%: 0.75-0.98, p = 0.024) for heart rate delta, 1.12 (CI95%: 0.98-1.27, p = 0.082) for ST interval delta and 1.21 (CI95%: 1.05-1.38, p = 0.006) for P wave amplitude delta. Conclusion Differences of heart rate and P wave amplitude between ECG's measurements may predict AF, independently of clinical features and ECGbasal values.
Assuntos
Humanos , Masculino , Feminino , Idoso , Fibrilação Atrial/diagnóstico , Eletrocardiografia , Valor Preditivo dos Testes , Estudos Retrospectivos , Estudos de CoortesRESUMO
OBJETIVE: To evaluate the association between delta variations in the parameters of 2 sinusal ECG with atrial fibrillation (AF) onset. METHOD: Retrospective cohort of 9,975 adult patients and members of the prepaid system at Hospital Italiano de Buenos Aires from Argentina, who had at least 2 sinusal ECG between 2006 and 2011. Population was followed up for detection of AF. All measurements and electrocardiographic deltas (differences between the 2 ECG) were standardized. Hazard ratio (HR) was estimated for the development of AF for each delta of the different ECG parameters using a Cox regression model. RESULTS: During a median follow up of 3.5 years, 189 patients (1.89%) developed AF. Heart rate delta, ST interval delta and P wave amplitude were predictors of AF. Hazard ratio Adjusted for clinical characteristics and ECGbasal values was 0,86 (CI95%: 0.75-0.98, p=0.024) for heart rate delta, 1.12 (CI95%: 0.98-1.27, p=0.082) for ST interval delta and 1.21 (CI95%: 1.05-1.38, p=0.006) for P wave amplitude delta. CONCLUSION: Differences of heart rate and P wave amplitude between ECG's measurements may predict AF, independently of clinical features and ECGbasal values.
Assuntos
Fibrilação Atrial/diagnóstico , Eletrocardiografia , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Valor Preditivo dos Testes , Estudos RetrospectivosRESUMO
Los feocromocitomas y paragangliomas (Feo/PGL) son tumores neurendocrinos raros con diferentes presentaciones clínicas, asociados a alta morbimortalidad. Reconocer los signos y síntomas es el paso diagnóstico inicial. Las metanefrinas fraccionadas urinarias tienen una excelente sensibilidad y especificidad. La tomografía computarizada (TC) es el método de elección para su localización. La tomografía por emisión de positrones (PET) con F18-fluordeoxiglucosa (F18-FDG) es el método funcional recomendado para detectar metástasis. La resección quirúrgica constituye la única opción curativa en estos pacientes. La adrenalectomía laparoscópica es la vía de abordaje para la mayoría los Feo/PGL. El tratamiento farmacológico, 7 a 14 días previos con alfabloqueantes y betabloqueantes, tiene como objetivo normalizar la presión arterial y prevenir complicaciones cardiovasculares periquirúrgicas. Se conoce que al menos un tercio de los pacientes presentan una mutación genética germinal. El estudio genético debe estar orientado a las características sindrómicas, formas de presentación, localización y fenotipo bioquímico del tumor. Se recomienda el abordaje interdisciplinario en centros especializados con experiencia en esta patología poco frecuente. (AU)
Pheochromocytomas and paragangliomas are rare neuroendocrine tumors with different clinical manifestation associated with high morbidity and mortality. Recognize signs and symptoms is the first step in diagnosis. Urinary fractionated metanephrines have an excellent specificity and sensitivity. Computed Tomography (CT) is the first-choice imaging modality for location. F18-DG positron tomography (PET)/CT scanning is the functional modality of choice for metastatic disease. Surgery is the only curative treatment. Minimally invasive adrenalectomy is the surgical approach for most adrenal pheochromocytomas. Perioperative alpha and beta blockade for 7 to 14 days normalize blood pressure and prevent perioperative cardiovascular complications. Is recognize that at least one-third of the patients have disease-causing germline mutations. Genetic testing must be orientated to syndromic features, presentation, localization and biochemical profile of these tumors. Multidisciplinary teams at centers with appropriate expertise are recommended to ensure a favorable outcome. (AU)
Assuntos
Humanos , Paraganglioma/cirurgia , Paraganglioma/diagnóstico , Feocromocitoma/cirurgia , Feocromocitoma/diagnóstico , Paraganglioma/genética , Paraganglioma/urina , Paraganglioma/sangue , Equipe de Assistência ao Paciente , Feocromocitoma/genética , Feocromocitoma/urina , Feocromocitoma/sangue , Tomografia Computadorizada por Raios X , Adrenalectomia/métodos , Diagnóstico Precoce , Tomografia por Emissão de Pósitrons , Diagnóstico DiferencialRESUMO
Introducción: En un estudio previo que incorporó mediciones posalmuerzo al esquema convencional de monitoreo domiciliario de la presión arterial hemos detectado hipotensión posprandial en alrededor de la cuarta parte de nuestros pacientes hipertensos. Objetivos: Comparar el cambio posprandial de la presión arterial sistólica, y la correspondiente respuesta cronotrópica, en relación con el control de la hipertensión. Material y métodos: Se evaluaron prospectivamente con monitoreo domiciliario de la presión arterial 140 pacientes hipertensos tratados, mayores de 40 años. El control de la hipertensión se basó en el promedio de la presión arterial matinal y la vespertina, tomando como valor de corte 135/85 mm Hg. Se consideró hipotensión posprandial cuando la presión arterial sistólica disminuyó 20 mm Hg o más respecto del valor preprandial en al menos uno de tres almuerzos. Resultados: Se detectó hipotensión posprandial en el 13,2% (n = 10) de los hipertensos controlados y en el 42,2% (n = 27) de los no controlados (p < 0,001). Después de los almuerzos, la presión arterial sistólica disminuyó en promedio 9,5 ± 10,5 mm Hg (6,4% ± 7,8%) en los hipertensos no controlados y 3,2 ± 7,8 mm Hg (2,6% ± 6,5%) en los controlados (p < 0,001), sin diferencia significativa en la respuesta cronotrópica. Al estratificar a los pacientes por el control de la hipertensión se observó una correlación inversa entre la respuesta posprandial de la frecuencia cardíaca y de la presión arterial sistólica en los controlados (r = -0,24; p = 0,035), sin relación significativa en los no controlados. En el análisis de regresión lineal múltiple, la falta de control de la hipertensión (beta = -0,26; p = 0,002) y el sexo femenino (beta = 0,22; p < 0,001) fueron predictores significativos de la caída posprandial en la presión arterial sistólica, sin influencia significativa de la edad o del número de fármacos antihipertensivos. Conclusión: La falta de control de la hipertensión se asoció con una respuesta circulatoria posprandial anormal que favorece la hipotensión.
Background: In a previous study that incorporated post-lunch measurements to the conventional scheme of home-based blood pressure monitoring, we detected postprandial hypotension in about a quarter of hypertensive patients. Objectives: The aim of this study was to compare the postprandial change of systolic blood pressure, and the corresponding chronotropic response, associated to the control of hypertension. Methods: We prospectively evaluated 140 treated hypertensive patients, aged over 40 years, with home-based blood pressure monitoring. The control of hypertension was based on the average morning and evening blood pressure, considering 135/85 mmHg as cutoff value. Postprandial hypotension was defined as a drop in systolic blood pressure equal to or greater than 20 mmHg with respect to the preprandial value in at least one of three lunches. Results: Postprandial hypotension was found in 13.2% (n=10) of patients with controlled hypertension and in 42.2% (n=27) with uncontrolled hypertension (p<0.001). After lunch, the average decrease of systolic blood pressure was 9.5±10.5 mmHg (6.4%±7.8%) in patients with uncontrolled hypertension and 3.2±7.8 mmHg (2.6%±6.5%) in those with controlled hypertension (p<0.001), with no significant difference in the chronotropic response. After stratifying the patients by hypertension control, the postprandial response of heart rate and systolic blood pressure showed a significant inverse correlation in controlled hypertensive patients (r=-0.24; p=0.035), and a not significant correlation in uncontrolled patients. On the multiple linear regression analysis, lack of blood pressure control (beta=0.26, p=0.002) and female gender (beta=0.22; p<0.001) were significant predictors of a postprandial drop in systolic blood pressure, without a significant influence of age or number of antihypertensive drugs. Conclusion: Lack of blood pressure control was associated with an abnormal postprandial circulatory response that predisposes to hypotension.
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We aimed to determine the characteristics of home blood pressure (BP) in very elderly hypertensives. A total of 485 treated hypertensive patients ≥18 years (median age, 70.8 [interquartile range, 18]; 67.2% women) underwent home BP measurements. Characteristics of patients ≥80 and <80 years of age and prevalence of office and home uncontrolled hypertension, isolated morning (IMH), isolated evening, isolated office, and masked hypertension were compared. Very elderly subjects had higher levels of systolic and lower levels of diastolic BP at home, a higher prevalence of home uncontrolled hypertension (68.5% vs. 37.7%; P < .001), masked hypertension (30.6% vs. 14.9%; P = .02), and IMH (19.4% vs. 10.9%; P = .02), and a lower prevalence of isolated office hypertension (8.3% vs. 18.8%; P = .01). When using differential home BP thresholds in the very elderly, determined through the percentile method, statistical differences disappeared, except for IMH. The very elderly depict a particular home BP profile. Benefit from using differential home BP thresholds should be determined in prospective studies.
Assuntos
Anti-Hipertensivos/uso terapêutico , Monitorização Ambulatorial da Pressão Arterial , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Argentina , Determinação da Pressão Arterial/métodos , Monitorização Ambulatorial da Pressão Arterial/métodos , Monitorização Ambulatorial da Pressão Arterial/normas , Estudos Transversais , Feminino , Idoso Fragilizado , Humanos , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Hipertensão/fisiopatologia , Masculino , Assistência Centrada no Paciente/métodos , Assistência Centrada no Paciente/normas , PrevalênciaRESUMO
We aimed to determine a possible association between isolated morning hypertension (IMH) and meal-induced blood pressure (BP) fall in adult treated hypertensive patients who underwent home BP measurements. A total of 230 patients were included, median age 73.6, 65.2% women. After adjusting for age, sex, number of antihypertensive drugs, office and home BP levels, the association between IMH and meal-induced BP fall was statistically significant. In conclusion, meal-induced BP fall and IMH detected through home blood pressure monitoring (HBPM) are independently associated in hypertensive patients. The therapeutic implications of such observation need to be clarified in large-scale prospective studies.
Assuntos
Pressão Sanguínea/fisiologia , Hipertensão/fisiopatologia , Hipotensão/etiologia , Refeições/fisiologia , Período Pós-Prandial/fisiologia , Idoso , Anti-Hipertensivos/uso terapêutico , Monitorização Ambulatorial da Pressão Arterial , Feminino , Seguimentos , Humanos , Hipertensão/tratamento farmacológico , Hipotensão/fisiopatologia , Masculino , Estudos Prospectivos , Fatores de TempoRESUMO
The absence of an outcome-driven reference frame for self-measured pulse pressure (PP) limits its clinical applicability. In an attempt to derive an operational threshold for self-measured PP, we analyzed 6470 participants (mean age 59.3 years; 56.9% women; 22.5% on antihypertensive treatment) from 5 general population cohorts included in the International Database on HOme blood pressure in relation to Cardiovascular Outcome. During 8.3 years of follow-up (median), 294 cardiovascular deaths, 393 strokes and 336 cardiac events occurred. In 3285 younger subjects (<60 years), home PP only predicted all-cause and cardiovascular mortality (P⩽0.036), whereas in 3185 older subjects (⩾60 years) PP predicted total and cardiovascular mortality (P⩽0.0067) and all cardiovascular and coronary events (P⩽0.044). However, PP did not substantially refine risk prediction based on classical risk factors including mean blood pressure (generalized R(2) statistic ⩽0.20%). In older subjects, the adjusted hazard ratios expressing the risk in the upper decile of home PP (⩾76 mm Hg) versus the average risk in whole population were 1.41 (95% confidence interval, 1.09-1.81; P=0.0081) for all-cause mortality, 1.62 (1.11-2.35; P=0.012) for cardiovascular mortality and 1.31 (1.00-1.70; P=0.047) for all fatal and nonfatal cardiovascular end points combined. The low number of events precluded an analysis by tenths of the PP distribution in younger participants. In conclusion, a home PP of ⩾76 mm Hg predicted cardiovascular outcomes in the elderly with the exception of stroke, whereas in younger subjects no threshold could be established.
Assuntos
Pressão Sanguínea , Doenças Cardiovasculares/etiologia , Adulto , Idoso , Doenças Cardiovasculares/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , RiscoRESUMO
Background. The morning home blood pressure (BP) rise is a significant asymptomatic target organ damage predictor in hypertensives. Our aim was to evaluate determinants of home-based morning-evening difference (MEdiff) in Argentine patients. Methods. Treated hypertensive patients aged ≥18 years participated in a cross-sectional study, after performing home morning and evening BP measurement. MEdiff was morning minus evening home average results. Variables identified as relevant predictors were entered into a multivariable linear regression analysis model. Results. Three hundred sixty-seven medicated hypertensives were included. Mean age was 66.2 (14.5), BMI 28.1 (4.5), total cholesterol 4.89 (1.0) mmol/L, 65.9% women, 11.7% smokers, and 10.6% diabetics. Mean MEdiff was 1.1 (12.5) mmHg systolic and 2.3 (6.1) mmHg diastolic, respectively. Mean self-recorded BP was 131.5 (14.1) mmHg systolic and 73.8 (7.6) mmHg diastolic, respectively. Mean morning and evening home BPs were 133.1 (16.5) versus 132 (15.7) systolic and 75.8 (8.4) versus 73.5 (8.2) diastolic, respectively. Significant beta-coefficient values were found in systolic MEdiff for age and smoking and in diastolic MEdiff for age, smoking, total cholesterol, and calcium-channel blockers. Conclusions. In a cohort of Argentine medicated patients, older age, smoking, total cholesterol, and use of calcium channel blockers were independent determinants of home-based MEdiff.
RESUMO
Postprandial hypotension (PPH) is a frequently under-recognized entity associated with increased morbidity and mortality. The prevalence of PPH detected through home blood pressure monitoring (HBPM) is unknown. To determine the prevalence and clinical predictors of PPH in hypertensive patients assessed through HBPM. Hypertensive patients of 18 years or older underwent home blood pressure (BP) measurements (duplicate measurements for 4 days: in the morning, 1 h before and 1 h after their usual lunch, and in the evening; OMRON 705 CP). PPH was defined as a meal-induced systolic BP decrease of ≥20 mm Hg. Variables identified as relevant predictors of PPH were entered into a multivariate logistic regression analysis. In total, 230 patients were included in the analysis, with a median age of 73.6 (interquartile range 16.9) years, and 65.2% were female. The prevalence of PPH (at least one episode) was 27.4%. Four variables were independently associated with PPH: age of 80 years or older (odds ratio (OR) 3.45, 95% confidence interval (CI) 1.35-8.82), body mass index (BMI) (OR 0.88, 95%CI 0.81-0.96), office systolic BP (OR 1.03, 95%CI 1.01-1.05) and a history of cerebrovascular disease (OR 3.29, 95%CI 1.03-10.53). PPH after a typical meal is a frequent phenomenon that can be detected through HBPM. Easily measurable parameters in the office such as older age, higher systolic BP, lower BMI and a history of cerebrovascular disease may help to detect patients at risk of PPH who would benefit from HBPM.
Assuntos
Pressão Sanguínea/fisiologia , Hipertensão/complicações , Hipotensão/complicações , Período Pós-Prandial/fisiologia , Idoso , Idoso de 80 Anos ou mais , Monitorização Ambulatorial da Pressão Arterial , Estudos Transversais , Feminino , Humanos , Hipertensão/fisiopatologia , Hipotensão/fisiopatologia , Masculino , Pessoa de Meia-IdadeRESUMO
UNLABELLED: The morning blood pressure (BP) rise entails a higher cardiovascular risk. Studies evaluating the association between home BP morning rise and target organ damage are scarce and almost exclusively based on Asians. The aim of our study was to characterize hypertensive patients with morning rise in home BP and to establish a possible association with left ventricular hypertrophy (LVH). METHODS: treated hypertensive patients ≥ 18 years underwent home BP measurements (duplicate measurements for 4 days in the morning, afternoon and evening), and completed a questionnaire regarding risk factors and history of cardiovascular disease. Medical records were reviewed to extract data from grams. A morning rise in systolic home BP was defined as a difference between morning and evening systolic BP averages ≥15 mmHg. Subjects were considered to have LVH if the left ventricular mass index was >95 g/m2 in women and >115 g/m2 in men. Variables identified as relevant predictors of home BP morning rise were entered into a multivariable logistic regression analysis model. RESULTS: 216 patients were included, mean age 68 (+13.3), 69.4% women and 99.1% Caucasians. The prevalence of BP morning rise was 13.4% and independently associated factors were LVH (OR 3.5; 95%CI 1.1-11.4), age (OR 1.05; 95%CI 1.003-1.1) and a history of cerebrovascular disease (OR 3.9; 95%CI 1.1-14.2). In conclusion, a morning rise in systolic BP detected through home BP monitoring is independently associated with LVH, age and a history of cerebrovascular disease. The therapeutic implications of this observation need to be clarified in large-scale prospective studies.
El incremento matutino de la presión arterial (IMPA) aumenta el riesgo cardiovascular. Los estudios que evalúan la asociación entre IMPA domiciliaria y daño de órgano blanco son escasos y casi exclusivamente basados en población asiática. Nuestro objetivo fue caracterizar a los pacientes hipertensos con IMPA domiciliaria y establecer una posible asociación con la presencia de hipertrofia ventricular izquierda (HVI). Métodos: se incluyeron hipertensos medicados ≥18 años que realizaron mediciones de PA domiciliaria (4 días de mediciones por duplicado, a la mañana, tarde y noche) y completaron un cuestionario acerca de sus factores de riesgo y antecedentes de enfermedad cardiovascular. Se revisaron las historias clínicas para extraer datos ecocardiográficos. Se definió como IMPA a una diferencia entre el promedio de PA sistólica domiciliaria matutina vespertina ≥15 mmHg. Se consideró que los pacientes tenían HVI si el índice de masa ventricular era >95 g/m2 en mujeres y >115 g/m2 en varones. Las variables identificadas como predictores relevantes de IMPA fueron introducidos en un modelo multivariado de regresión logística. Resultados: se incluyeron 216 pacientes, con una edad media de 68 (+13,3) años, 69,4% mujeres y 99,1% caucásicos. La prevalencia de IMPA fue de 13,4% y las variables independientemente asociadas fueron HVI (OR 3,5; 95%CI 1,1-11,4), edad (OR 1,05; 95%CI 1,003-1,1) y antecedente de enfermedad cerebrovascular (OR 3,9; 95%CI 1,1-14,2). En conclusión, el IMPA evaluado por monitoreo domiciliario presenta asociación independiente con HVI, edad y antecedentes de enfermedad cerebrovascular, debiendo esclarecerse las implicancias terapéuticas de esta observación en estudios prospectivos a gran escala.
Assuntos
Pressão Arterial/fisiologia , Hipertensão/complicações , Hipertrofia Ventricular Esquerda/etiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Monitorização Ambulatorial da Pressão Arterial , Ritmo Circadiano , Feminino , Humanos , Hipertensão/fisiopatologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Masked hypertension (MH) entails an increased cardiovascular risk. Therefore, it is important to identify those individuals who would benefit the most from out-of-office blood pressure (BP) measurement. We sought to determine the prevalence and identify predictors of MH among adult hypertensive patients under treatment. METHODS: Treated hypertensive patients aged ≥ 18 years underwent office (duplicate sitting and standing BP in 1 visit) and home BP measurements (duplicate measurements for 4 days in the morning, afternoon, and evening; at least 16 measurements) and completed a questionnaire regarding risk factors and history of cardiovascular disease. MH was defined as normal office BP (<140/90mm Hg) with elevated home BP (≥135/85mm Hg, average of all readings discarding first day measurements). Patients with a systolic BP rise upon standing ≥5mm Hg were considered to have orthostatic hypertension (OHT). Variables indentified as relevant predictors of MH were entered into a multivariable logistic regression analysis model. RESULTS: Three hundred and four patients were included (mean age = 66.7 ±13.8; 67.4% women). The prevalence of MH in the whole population was 12.4% and was 20.9% among patients with office-controlled hypertension. Factors independently associated with MH were age (odds ratio (OR) = 1.08, 95% confidence interval (CI) = 1.03-1.14), high-normal office systolic BP (OR = 5.61, 95% CI = 1.39-22.57), history of peripheral artery disease (PAD) (OR = 8.83, 95% CI = 1.5-51.84), moderate alcohol consumption (OR = 0.08, 95% CI = 0.01-0.73), and OHT (OR = 3.65, 95% CI = 1.27 to 10.51). CONCLUSIONS: Easily measurable parameters such as age, office systolic BP, history of PAD, and OHT may help to detect a population at risk of MH that would benefit from home BP monitoring.
Assuntos
Pressão Sanguínea/fisiologia , Hipertensão Mascarada/epidemiologia , Intolerância Ortostática/complicações , Postura , Medição de Risco/métodos , Idoso , Argentina/epidemiologia , Determinação da Pressão Arterial , Ritmo Circadiano/fisiologia , Estudos Transversais , Feminino , Seguimentos , Humanos , Hipertensão/complicações , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Incidência , Masculino , Hipertensão Mascarada/etiologia , Pessoa de Meia-Idade , Intolerância Ortostática/epidemiologia , Intolerância Ortostática/fisiopatologia , Prevalência , Prognóstico , Estudos Retrospectivos , Fatores de RiscoRESUMO
We assessed prevalence and clinical characteristics of resistant hypertension (RH) and prevalence of false RH (white-coat effect [WCE] by home blood pressure [BP] monitoring), among a population of 302 treated hypertensive patients, mean age 66.6 (± 13.8), 67.5% women. Resistant hypertension was defined according to the American Heart Association criteria. Prevalence of RH was 10%, and the following five variables were independently associated with it: body mass index, diabetes, isolated systolic hypertension, orthostatic hypotension, and use of beta-blockers. Prevalence of WCE among subjects with office-RH was 27.6%. Our study identified easily measurable parameters related to RH. Standing BP should be systematically measured in individuals with RH.