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Precisión del pronóstico de la presión arterial ambulatoria diurna frente a la nocturna: un estudio de cohorte
José Boggia1, Yan Li, Lutgarde Thijs
1Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay.
Lancet (London, England)
|October 9, 2007
Resumen
La presión arterial nocturna es un fuerte predictor de la mortalidad, incluso después de tener en cuenta las lecturas diurnas. Se recomienda el monitoreo ambulatorio de la presión arterial durante todo el día para una evaluación completa del riesgo cardiovascular.
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:
- Existe una investigación limitada sobre el valor predictivo independiente de la presión arterial nocturna en comparación con las lecturas diurnas.
- El significado pronóstico de las relaciones de presión arterial de noche a día requiere una investigación adicional.
Objetivo del estudio:
- Para evaluar el significado pronóstico de la presión arterial ambulatoria durante el día y la noche.
- Para evaluar el valor predictivo de la relación de la presión arterial de noche a día para la mortalidad y los eventos cardiovasculares.
Principales métodos:
- Se realizó un monitoreo ambulatorio de la presión arterial de 24 horas en 7458 personas en seis países.
- Se calcularon las proporciones de riesgo ajustadas por multivariables para la presión arterial diurna, nocturna y la relación sistólica noche-día, controlando las covariables.
Principales resultados:
- La presión arterial nocturna predijo de forma independiente la mortalidad total, cardiovascular y no cardiovascular.
- La presión arterial diurna, ajustada para las lecturas nocturnas, predijo la mortalidad no cardiovascular y todos los eventos cardiovasculares.
- Una relación sistólica noche-día de 1 o más se asoció con un mayor riesgo de mortalidad.
Conclusiones:
- La presión arterial diurna, cuando se ajusta a las lecturas nocturnas, conserva el valor pronóstico para eventos cardiovasculares, excepto en pacientes tratados.
- Los hallazgos apoyan el registro rutinario de la presión arterial ambulatoria durante un período completo de 24 horas.
- El aumento de la presión arterial durante la noche puede indicar causalidad inversa, lo que justifica más investigaciones.
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