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Patrón diurno de la presión arterial y riesgo de insuficiencia cardíaca congestiva
Erik Ingelsson1, Kristina Björklund-Bodegård, Lars Lind
1Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden. erik.ingelsson@pubcare.uu.se
JAMA
|June 29, 2006
Resumen
Los patrones nocturnos de presión arterial, específicamente "no deslizantes", predicen significativamente el riesgo de insuficiencia cardíaca congestiva (ICH) en hombres mayores. Este hallazgo ofrece nuevos conocimientos más allá de las mediciones tradicionales de la presión arterial para la prevención de la ECH.
Área de la Ciencia:
- Cardiología Cardiología.
- Investigación de la Hipertensión Investigación de la Hipertensión
- La medicina preventiva es la medicina preventiva de las enfermedades.
Sus antecedentes:
- La presión arterial alta es un factor de riesgo primario para la insuficiencia cardíaca congestiva (ICC).
- No se comprende bien el impacto de los patrones de presión arterial diurna alterados en el riesgo posterior de CHF.
Objetivo del estudio:
- Para evaluar las características de la presión arterial ambulatoria de 24 horas como predictores de la incidencia de insuficiencia cardíaca congestiva.
- Para determinar si los patrones de presión arterial diurna alterados proporcionan información de riesgo adicional más allá de las mediciones de oficina convencionales.
Principales métodos:
- Estudio de cohorte observacional prospectivo basado en la comunidad de 951 hombres mayores sin CHF al inicio.
- Monitoreo ambulatorio de la presión arterial de 24 horas realizado al inicio.
- Análisis de las variables de presión arterial como predictores de la posterior hospitalización por insuficiencia cardíaca congestiva.
Principales resultados:
- Un aumento de 1-SD en la presión arterial diastólica nocturna (HR, 1.26) y la presión arterial "sin descenso" (HR, 2.29) se asociaron con un mayor riesgo de CHF.
- "Nondipping" se mantuvo como un predictor significativo incluso después de ajustar las mediciones de presión arterial en el consultorio (HR, 2.21).
- Estas asociaciones persistieron después de excluir a los participantes con infarto de miocardio.
Conclusiones:
- Los patrones de presión arterial nocturna, en particular "no deslizante", proporcionan información de riesgo significativa para la insuficiencia cardíaca congestiva.
- Esta información es incremental a las lecturas convencionales de presión arterial en el consultorio y a los factores de riesgo establecidos.
- Se necesita más investigación para establecer la utilidad clínica de estos hallazgos.
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