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Incidencia de enfermedades cardiovasculares en adultos con presión arterial < 140/90 mm Hg

Gabriel S Tajeu1, John N Booth2, Lisandro D Colantonio2

  • 1From Department of Health Services Administration and Policy, Temple University, Philadelphia, PA (G.S.T.); Department of Epidemiology (J.N.B., L.D.C., R.M.T., P.M.), Department of Biostatistics (G.H.), Department of Medicine, Division of Cardiovascular Disease, Vascular Biology and Hypertension Program (S.O.), Department of Medicine (M.M.S.), University of Alabama at Birmingham; Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); Department of Neurology, Medical University of South Carolina, Charleston (D.T.L.); Duke Clinical Research Institute, Duke University, Durham, NC (E.C.O.); Department of Population Health, New York University School of Medicine (J.R., T.S.); Department of Medicine, Weill Cornell Medical College, New York (M.M.S.); Department of Mathematics and Statistics, University of West Florida, Pensacola, FL (S.R.S.); Department of Medicine (D.S.), Departments of Medicine and Epidemiology (S.S.), Columbia University, New York. gabriel.tajeu@temple.edu.

Circulation
|June 22, 2017
PubMed
Resumen
Este resumen es generado por máquina.

La mayoría de los eventos de enfermedad cardiovascular en adultos estadounidenses ocurren por debajo de 140/90 mm Hg, incluso con un mejor control de la hipertensión. Puede ser necesaria una reducción adicional del riesgo para las personas con niveles más bajos de presión arterial.

Palabras clave:
Enfermedad cardiovascularriesgo de enfermedad cardiovascularenfermedad cerebrovascularCiencias de la saludinsuficiencia cardíacaPresión arterial altahipertensiónInfarto de miocardioel golpe

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Área de la Ciencia:

  • Cardiología
  • Salud pública
  • Epidemiología

Sus antecedentes:

  • Históricamente, la presión arterial alta (presión arterial sistólica/ diastólica ≥140/ 90 mm Hg) se ha relacionado con la mayoría de los eventos de enfermedad cardiovascular (ECV).
  • Las últimas décadas muestran una disminución de los niveles de presión arterial y una mejor gestión de la hipertensión en adultos estadounidenses.

Objetivo del estudio:

  • Estimar la proporción de eventos cardiovasculares incidentes que ocurren en adultos estadounidenses con presión arterial por debajo de 140/ 90 mm Hg.
  • Para analizar estos eventos en diferentes grupos demográficos y estados de medicación.

Principales métodos:

  • Análisis combinado de tres cohortes estadounidenses contemporáneas: REGARDS, MESA y JHS (n=31,856).
  • Medición estandarizada de la presión arterial y uso autoinformado de medicamentos antihipertensivos.
  • Incidencia de ECV definida como accidente cerebrovascular fatal o no fatal, infarto de miocardio, enfermedad coronaria o insuficiencia cardíaca, juzgada en cada estudio.

Principales resultados:

  • Durante un seguimiento medio de 7,7 años, el 63,0% de los eventos cardiovasculares incidentes ocurrieron en participantes con presión arterial < 140/ 90 mm Hg.
  • Este patrón se mantuvo en todos los grupos de edad, sexos y grupos raciales / étnicos.
  • Entre los que tomaban medicamentos con presión arterial <140/90 mm Hg, muchos eran elegibles para estatinas o objetivos intensivos de presión arterial (ensayo SPRINT), pero no recibieron el tratamiento adecuado.

Conclusiones:

  • Contrariamente a los datos históricos, la mayoría de los eventos de ECV en la era moderna ocurren en adultos estadounidenses con presión arterial < 140/ 90 mm Hg.
  • Se pueden justificar otras estrategias de reducción del riesgo de ECV para las personas de alto riesgo, incluso con presión arterial inferior a 140/90 mm Hg, teniendo en cuenta el riesgo absoluto y la rentabilidad.