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Resultados cardiovasculares en abrigos blancos versus hipertensión leve sostenida: un estudio de seguimiento de 10
R S Khattar1, R Senior, A Lahiri
1Department of Cardiovascular Medicine, Northwick Park, and St Mark's Hospital NHS Trust and Institute for Medical Research, Harrow, Middlesex, UK.
Circulation
|November 3, 1998
Resumen
La hipertensión de bata blanca plantea un menor riesgo de enfermedad cardiovascular que la hipertensión leve sostenida. Este estudio encontró que los hipertensos de bata blanca experimentaron menos eventos y menos daño a los órganos.
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 hipertensión es un factor de riesgo importante para las enfermedades cardiovasculares (ECV).
- Diferenciar entre la hipertensión de bata blanca y la hipertensión sostenida es crucial para la evaluación del riesgo.
- Estudios anteriores han dado resultados contradictorios sobre el pronóstico a largo plazo de la hipertensión de bata blanca.
Objetivo del estudio:
- Para comparar el riesgo de enfermedad cardiovascular asociado con la hipertensión de bata blanca frente a la hipertensión leve sostenida.
- Para identificar predictores de eventos cardiovasculares en pacientes con presión arterial clínica elevada.
Principales métodos:
- 479 pacientes con presión arterial sistólica clínica elevada (140-180 mm Hg) se sometieron a un monitoreo ambulatorio de la presión arterial durante 24 horas.
- Los pacientes fueron seguidos durante una media de 9,1 años para eventos cardiovasculares.
- El análisis del subgrupo incluyó ecocardiografía y ecografía carotídea para evaluar el daño de órganos.
Principales resultados:
- La hipertensión de bata blanca (presión arterial clínica elevada, presión arterial ambulatoria normal) fue diagnosticada en 126 pacientes.
- Los hipertensivos de bata blanca eran más jóvenes y tenían una incidencia significativamente menor de eventos de ECV (1,32 frente a 2,56 eventos por cada 100 pacientes-años) en comparación con los hipertensivos sostenidos.
- La hipertensión de bata blanca fue un predictor independiente de menos eventos cardiovasculares (HR, 0,29; P = 0,04), con menos hipertrofia ventricular izquierda y carótida observada.
Conclusiones:
- La hipertensión de bata blanca se asocia con un pronóstico relativamente benigno en comparación con la hipertensión leve sostenida.
- Estos hallazgos apoyan un enfoque de manejo menos agresivo para la hipertensión de bata blanca.
- Investigaciones adicionales pueden aclarar las estrategias óptimas de monitoreo y tratamiento para diferentes fenotipos hipertensivos.
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