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.
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Background Obstructive sleep apnoea (OSA) has been described as a risk factor for arterial hypertension (HT). One of the proposed mechanisms linking these conditions is non dipping (ND) pattern in nocturnal blood pressure, however evidence is variable and based on specific populations with underlying conditions. Data for OSA and ND in subjects residing at high altitude are currently unavailable. Objective Identify the prevalence and association of moderate to severe OSA with HT and ND pattern in hypertensive and non-hypertensive otherwise healthy middle-aged individuals in residing at high altitude (Bogotá:2640 mt) Methods Adult individuals with diagnosis of moderate to severe OSA underwent 24 hour- ambulatory blood pressure monitoring (ABPM) between 2015 and 2017. Univariable and multivariable logistic regression analysis were performed to identify predictors of HT and ND pattern. Results Ninety-three (93) individuals (male 62.4% and median age 55) were included in the final analysis. Overall, 30.1% showed a ND pattern in ABPM and 14.9% had diurnal and nocturnal hypertension. Severe OSA (higher apnea-hiponea index [AHI]) was associated with HT (p = 0.006), but not with ND patterns (p = 0.54) in multivariable regression. Smoking status and lowest oxygen saturation during respiratory events where independently associated with ND pattern (p = 0.04), whereas age (p = 0.001) was associated with HT. Conclusions In our sample, one in three individuals with moderate to severe OSA have non dipping patterns suggesting lack of straight association between OSA and ND. Older individuals who have higher AHI are more likely to have HT, and those who smoke have a higher risk of ND. These findings add aditional information to the multiple mechanisms involved in the relationship between OSA and ND pattern, and questions the routine use of 24-hour ABPM, particullary in our region, with limited resources and healthcare acces. However, further work with more robust methodology is needed to draw conclusions.
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Abstract Background: Fragmented QRS (fQRS) is a sign of adverse cardiovascular events in various cardiovascular diseases. It is also associated with increased blood pressure and non-dipping in hypertensive patients. However, no study has investigated the importance of fQRS in prehypertensive patients. Objectives: The aim of our study is to investigate the relationship between fQRS and non-dipper status in prehypertensive patients. Methods: Two hundred and sixteen eligible, newly diagnosed prehypertensive patients who underwent 24-hour ambulatory blood pressure monitoring (ABPM) for further evaluation of blood pressure between June 2015 and July 2016 were included into the study. Patients were divided into three groups according to ABPM results: normotensives, dipper prehypertensives, and non-dipper prehypertensives. Groups were compared regarding presence of fQRS on electrocardiography. Additionally, multinomial logistic regression analysis was used to determine the relationship between fQRS and blood pressure pattern in prehypertensive patients. Results: According to ABPM recordings, 61 patients had normotensive blood pressure pattern (systolic blood pressure < 120 mmHg and diastolic blood pressure < 80 mmHg). Of the remaining 155 prehypertensive patients, 83 were dippers and 72 were non-dippers. Non-dipper prehypertensives had a significantly higher frequency of fQRS compared to normotensives (p = 0.048). Furthermore, multinomial logistic regression analysis revealed that fQRS is an independent predictor of non-dipping blood pressure pattern in prehypertensive patients (p = 0.017, OR: 4.071, 95% CI: 1.281-12.936). Conclusions: We found that fQRS is a predictor of non-dipping in prehypertensives. As a marker of fibrosis and higher fibrotic burden within myocardium, fQRS may be useful in identifying high-risk prehypertensive patients before the development of hypertension.
Resumo Fundamento: A fragmentação do QRS (fQRS) é um sinal de eventos cardiovasculares adversos em várias doenças cardiovasculares. É associado também à pressão arterial elevada e à ausência de descenso da pressão arterial durante o sono (non-dipping) em pacientes pré-hipertensos. Objetivos: O objetivo do estudo presente é investigar a relação entre fQRS e ausência de descenso da pressão arterial durante o sono em pacientes pré-hipertensos. Métodos: Duzentos e dezesseis pacientes elegíveis, recém-diagnosticados com pré-hipertensão, que foram submetidos a monitorização ambulatorial da pressão arterial (MAPA) durante 24 horas para avaliação mais aprofundada da pressão arterial entre junho de 2015 e julho de 2016, foram incluídos no estudo. De acordo com os resultados da MAPA, os pacientes foram divididos em três grupos: normotensos, pré-hipertensos com descenso da pressão arterial durante o sono (padrão dipping) e pré-hipertensos com ausência de descenso da pressão arterial durante o sono (padrão non-dipping). Os grupos foram comparados quanto à presença de fQRS no eletrocardiograma. Adicionalmente, utilizou-se a análise de regressão logística multinomial para determinar a relação entre a fQRS e o padrão de pressão arterial em pacientes pré-hipertensos. Resultados: De acordo com os registos da MAPA, 61 pacientes apresentavam padrão de pressão arterial normotenso (pressão arterial sistólica < 120 mmHg e pressão arterial diastólica < 80 mmHg). Dos 155 pacientes pré-hipertensos, 83 tinham padrão dipping e 72 tinham padrão non-dipping. Os pacientes pré-hipertensos com padrão non-dipping tinham uma frequência significativamente mais alta de fQRS em comparação com os pacientes normotensos (p = 0,048). Além disso, a análise de regressão logística multinomial revelou que fQRS é um preditor independente do padrão non-dipping de pressão arterial em pacientes pré-hipertensos (p = 0,017, OR: 4,071, 95 % CI: 1,281-12,936). Conclusões: Verificamos que a fQRS é um preditor do padrão non-dipping em pacientes pré-hipertensos. Como marcador de fibrose e aumento na carga fibrótica do miocárdio, a fQRS pode ser útil na identificação de pacientes pré-hipertensos de alto risco antes do desenvolvimento da hipertensão.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Eletrocardiografia/métodos , Pré-Hipertensão/fisiopatologia , Hipertensão/fisiopatologia , Valores de Referência , Fatores de Tempo , Pressão Sanguínea/fisiologia , Estudos de Casos e Controles , Modelos Logísticos , Valor Preditivo dos Testes , Fatores de Risco , Análise de Variância , Estatísticas não ParamétricasRESUMO
OBJECTIVE: The association between polycystic ovarian syndrome and increased cardiovascular disease risk is still a controversial issue. In light of data documenting some common pathways or common end-points, the present study was undertaken to determine whether there is a relationship between sleep blood pressure pattern disturbances and polycystic ovarian syndrome in young women. METHOD: The daytime and nighttime ambulatory blood pressures (BPs) were determined for each subject, according to the actual waking and sleeping times recorded in their individual diaries, in this cross-sectional study. RESULTS: The study group comprised 168 women (mean age: 25.7+/-5.5) diagnosed with polycystic ovarian syndrome, while the control group included 52 age- and BMI-matched healthy subjects (mean age: 26.1+/-5.4). When nocturnal BP declines very little or not at all, with the BP falling less than 10% during sleep compared with waking values, this pattern is classified as a non-dipping BP pattern. However, the non-dipping pattern of BP changes was significantly more common in polycystic ovarian syndrome patients compared to the control group (p<0.01). The prevalence of a non-dipping BP pattern was 43.4% (73 patients) in polycystic ovarian syndrome patients and 3.9% (2 patients) in the control group. CONCLUSION: Our cross-sectional study revealed that a non-dipping BP pattern is highly prevalent in polycystic ovarian syndrome patients, even if they are young and non-obese.
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Monitorização Ambulatorial da Pressão Arterial , Hipertensão/complicações , Síndrome do Ovário Policístico/complicações , Adulto , Pressão Sanguínea/fisiologia , Estudos de Casos e Controles , Estudos Transversais , Feminino , Humanos , Hipertensão/sangue , Hipertensão/fisiopatologia , Pessoa de Meia-Idade , Síndrome do Ovário Policístico/sangue , Síndrome do Ovário Policístico/fisiopatologia , Fatores de Risco , Adulto JovemRESUMO
OBJECTIVE: The association between polycystic ovarian syndrome and increased cardiovascular disease risk is still a controversial issue. In light of data documenting some common pathways or common end-points, the present study was undertaken to determine whether there is a relationship between sleep blood pressure pattern disturbances and polycystic ovarian syndrome in young women. METHOD: The daytime and nighttime ambulatory blood pressures (BPs) were determined for each subject, according to the actual waking and sleeping times recorded in their individual diaries, in this cross-sectional study. RESULTS: The study group comprised 168 women (mean age: 25.7±5.5) diagnosed with polycystic ovarian syndrome, while the control group included 52 age- and BMI-matched healthy subjects (mean age: 26.1±5.4). When nocturnal BP declines very little or not at all, with the BP falling less than 10 percent during sleep compared with waking values, this pattern is classified as a non-dipping BP pattern. However, the non-dipping pattern of BP changes was significantly more common in polycystic ovarian syndrome patients compared to the control group (p<0.01). The prevalence of a non-dipping BP pattern was 43.4 percent (73 patients) in polycystic ovarian syndrome patients and 3.9 percent (2 patients) in the control group. CONCLUSION: Our cross-sectional study revealed that a non-dipping BP pattern is highly prevalent in polycystic ovarian syndrome patients, even if they are young and non-obese.