RESUMO
Resumen El comportamiento circadiano de la presión arterial se clasifica en distintos fenotipos que aportan conocimiento adicional sobre el estado mórbido y el pronóstico de los pacientes. La monitorización ambulatoria de la presión arterial (MAPA) es la herramienta ideal para obtener un registro de estas variaciones. Su etiología es multifactorial, incluyendo disregulaciones en el sistema nervioso autónomo, ejes neuroendocrinos y sistema de recambio mineral, mostrando un comportamiento complejo desde el punto de vista fisiopatológico. Existen diversas asociaciones de fenotipos circadianos alterados, como el non dipper, con desenlaces cardiovasculares adversos como mortalidad cardiovascular, enfermedad coronaria, cerebrovascular, enfermedad renal crónica y hospitalización por falla cardiaca. El conocimiento de estos aspectos es fundamental para definir grupos especiales de riesgo en pacientes con hipertensión.
Abstract Circadian blood pressure variations are classified into different phenotypes that provide additional knowledge about patients morbidity and prognosis of patients. Ambulatory blood pressure monitoring (ABPM) is the ideal tool to obtain a record of these variations. The etiology of non-dipper hypertension is multifactorial, including dysregulations in the autonomic nervous system, neuroendocrine axes, and mineral turnover system, with complex pathophysiological behavior. There are many associations between altered circadian phenotypes (such as the non dipper phenotype) and adverse cardiovascular outcomes such as cardiovascular mortality, coronary and cerebrovascular disease, chronic kidney disease, and heart failure. Knowledge of these aspects is essential to define special risk groups in patients with hypertension.
RESUMO
INTRODUCTION: Isolated nocturnal hypertension is associated with a greater number of cardiovascular events and target organ damage due to arterial hypertension. It has been observed that patients in the general population with this entity do not have high blood pressure figures in the office; and it is necessary to perform an outpatient measurement to unmask it. The prevalence in special populations is not fully described. The objective of the following study is to describe the prevalence of isolated nocturnal hypertension in a population living with the human immunodeficiency virus and to observe its relationship with the categories of office blood pressure and the phenotypes of the 24-hour ambulatory blood pressure measurement. METHODOLOGY: A retrospective cohort was carried out in a population with human immunodeficiency virus in a public hospital in Spain, clinical epidemiological characteristics, office blood pressure measurements and 24-hour ambulatory blood pressure measurement (ABPM) were recorded. An analysis was performed based on the different ABPM blood pressure phenotypes, as well as based on the different office blood pressure categories, the risks for isolated nocturnal hypertension were calculated. RESULTS: One hundred and sixteen individuals, without antihypertensive medication or history of established cardiovascular disease, were included in the analysis. A prevalence of nocturnal hypertension of 23.3% was described. It was not possible to demonstrate significant differences between phenotypes by ABPM of any variable specific to HIV. There were no adjusted risk differences between the different categories of office normotensives. CONCLUSIONS: Isolated nocturnal hypertension is more frequent in patients with HIV and office blood pressure values in normotensive patients are not sufficient to predict isolated nocturnal hypertension.