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MONITORIZACIÓN AMBULATORIA DE LA PRESIÓN ARTERIAL, MÉTODOS, INDICACIONES Y UTILIDADES Translated title: AMBULATORY BLOOD PRESSURE MONITORING. METHODS, INDICATIONS AND UTILITIES

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      Abstract

      Introducción. El exámen registra automáticamente la presión arterial en el paciente, en forma intermitente, durante sus actividades habituales, en vigilia y en sueño; es útil para: diagnóstico de hipertensión arterial y valoración del efecto de los antihipertensivos. Objetivos. Mostrar resultados del registro de 24 horas de la presión arterial, sus indicaciones y utilidades y establecer frecuencia y valores de referencia. Métodos. Estudiados 245 pacientes. El registro fue dividido en dos periodos: vigilia y sueño. Se consideraron estudios validos, aquellos mayores a 40. Variables analizadas: edad, sexo, motivos de estudio: sospecha de hipertensión, de hipotensión y evaluación de tratamiento antihipertensivo, caida nocturna, cargas presóricas, alzas tensionales. Criterios de anormalidad: cifras de presión anormales, ausencia de caida nocturna, cargas presóricas mayores de 50%, alzas tensionales mayores a 3, hipotensión arterial. Resultados. Edad media, 52 años. Mujeres 63%. Sospecha de hipertensión 125, de hipotensión 9 y evaluación de tratamiento 111. En 14% no hubo caída nocturna. Cargas presóricas anormales en 27%. Alzas tensionales en 64%. Hipertensión de bata blanca en 33%. Presiones medias anormales en 23%. Tratamiento insuficiente en 69%. Resultados anormales en 70%, por presiones aumentadas en 36% , en 55% por alzas tensionales, en 6%,por hipotensión y en 2% por ausencia de caída nocturna. Conclusiones. Se muestra la experiencia inicial del registro ambulatorio de la presión arterial. Se menciona la utilidad del examen, para definir la variación circadiana y las presiones medias de 24 horas, sistólicas y diastólicas, en vigilia y en sueño.

      Translated abstract

      Introduction. The test automatically recorded blood pressure in the patient, intermittently, during their usual activities in wakefulness and sleep and is useful for diagnosing hypertension arterial and assessing the effect of the antihypertensive drugs. Objetives. Show, results of 24 hour record of blood pressure, indications, Utilities and to establish frecuency an reference values. For study: suspicion of hypertension, hypotension and evaluation of antihypertensive treatment: sleeping blood pressure declines, blood pressure load, pressures peaks. Criteria of abnormality: Abnormal pressure levels, absence of sleeping blood pressure declines, pressure loads greater than 50%, pressure peaks greater than 3, low blood pressure. Results. Average age: 52. Women 63%. Suspected hipertensión 125, hypotension 9 and evaluation treatment 111. In 14% there was no sleeping blood pressure decline. Blood pressure loads abnormal 27%. Pressure peaks 64%. White coat hypertension 33%. Mean pressures abnormal 23%. Insufficient treatment 69%. Abnormal results 70%, increased presures in 36%, in 55% pressure peaks, hypotension in 6% and 2% for lack sleeping blood pressure declines. Conclusions. Shows the initial experience of the ambulatory recording arterial blood pressure. The usefulness of the test is mentioned, to define the circadian variation and the average pressures of 24 hours, systolic an diastolic, in waking and sleep.

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      Most cited references 51

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      Prognostic value of ambulatory blood-pressure recordings in patients with treated hypertension.

      It is uncertain whether ambulatory blood-pressure measurements recorded for 24 hours in patients with treated hypertension predict cardiovascular events independently of blood-pressure measurements obtained in the physician's office and other cardiovascular risk factors. We assessed the association between base-line ambulatory blood pressures in treated patients and subsequent cardiovascular events among 1963 patients with a median follow-up of 5 years (range, 1 to 66 months). We documented new cardiovascular events in 157 patients. In a Cox proportional-hazards model with adjustment for age, sex, smoking status, presence or absence of diabetes mellitus, serum cholesterol concentration, body-mass index, use or nonuse of lipid-lowering drugs, and presence or absence of a history of cardiovascular events, as well as blood pressure measured at the physician's office, higher mean values for 24-hour ambulatory systolic and diastolic blood pressure were independent risk factors for new cardiovascular events. The adjusted relative risk of cardiovascular events associated with a 1-SD increment in blood pressure was 1.34 (95 percent confidence interval, 1.11 to 1.62) for 24-hour ambulatory systolic blood pressure, 1.30 (95 percent confidence interval, 1.08 to 1.58) for ambulatory systolic blood pressure during the daytime, and 1.27 (95 percent confidence interval, 1.07 to 1.57) for ambulatory systolic blood pressure during the nighttime. For ambulatory diastolic blood pressure, the corresponding relative risks of cardiovascular events associated with a 1-SD increment were 1.21 (95 percent confidence interval, 1.01 to 1.46), 1.24 (95 percent confidence interval, 1.03 to 1.49), and 1.18 (95 percent confidence interval, 0.98 to 1.40). In patients with treated hypertension, a higher ambulatory systolic or diastolic blood pressure predicts cardiovascular events even after adjustment for classic risk factors including office measurements of blood pressure. Copyright 2003 Massachusetts Medical Society
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        Circadian blood pressure changes and left ventricular hypertrophy in essential hypertension.

        The effects of circadian blood pressure (BP) changes on the echocardiographic parameters of left ventricular (LV) hypertrophy were investigated in 235 consecutive subjects (137 unselected untreated patients with essential hypertension and 98 healthy normotensive subjects) who underwent 24-hour noninvasive ambulatory blood pressure monitoring (ABPM) and cross-sectional and M-mode echocardiography. In the hypertensive group, LV mass index correlated with nighttime (8:00 PM to 6:00 AM) systolic (r = 0.51) and diastolic (r = 0.35) blood pressure more closely than with daytime (6:00 AM to 8:00 PM) systolic (r = 0.38) and diastolic (r = 0.20) BP, or with casual systolic (r = 0.33) and diastolic (r = 0.27) BP. Hypertensive patients were divided into two groups by presence (group 1) and absence (group 2) of a reduction of both systolic and diastolic BP during the night by an average of more than 10% of the daytime pressure. Casual BP, ambulatory daytime systolic and diastolic BP, sex, body surface area, duration of hypertension, prevalence of diabetes, quantity of sleep during monitoring, funduscopic changes, and serum creatinine did not differ between the two groups. LV mass index, after adjustment for the age, the sex, the height, and the daytime BP differences between the two groups (analysis of covariance) was 82.4 g/m2 in the normotensive patient group, 83.5 g/m2 in hypertensive patients of group 1 and 98.3 g/m2 in hypertensive patients of group 2 (normotensive patients vs. group 1, p = NS; group 1 vs. group 2, p = 0.002).(ABSTRACT TRUNCATED AT 250 WORDS)
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          Comparison of agreement between different measures of blood pressure in primary care and daytime ambulatory blood pressure.

          To assess alternatives to measuring ambulatory pressure, which best predicts response to treatment and adverse outcome. Three general practices in England. Validation study. Patients with newly diagnosed high or borderline high blood pressure; patients receiving treatment for hypertension but with poor control. Overall agreement with ambulatory pressure; prediction of high ambulatory pressure (>135/85 mm Hg) and treatment thresholds. Readings made by doctors were much higher than ambulatory systolic pressure (difference 18.9 mm Hg, 95% confidence interval 16.1 to 21.7), as were recent readings made in the clinic outside research settings (19.9 mm Hg,17.6 to 22.1). This applied equally to treated patients with poor control (doctor v ambulatory 21.4 mm Hg, 17.3 to 25.4). Doctors' and recent clinic readings ranked systolic pressure poorly compared with ambulatory pressure and other measurements (doctor r=0.46; clinic 0.47; repeated readings by nurse 0.60; repeated self measurement 0.73; home readings 0.75) and were not specific at predicting high blood pressure (doctor 26%; recent clinic 15%; nurse 72%; patient in surgery 81%; home 60%), with poor likelihood ratios for a positive test (doctor 1.2; clinic 1.1; nurse 2.1, patient in surgery 4.7; home 2.2). Nor were doctor or recent clinic measures specific in predicting treatment thresholds. The "white coat" effect is important in diagnosing and assessing control of hypertension in primary care and is not a research artefact. If ambulatory or home measurements are not available, repeated measurements by the nurse or patient should result in considerably less unnecessary monitoring, initiation, or changing of treatment. It is time to stop using high blood pressure readings documented by general practitioners to make treatment decisions.
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            Author and article information

            Affiliations
            La Paz orgnameCentro de Electrocardiología 'La Paz' roblavadenz2001@ 123456yahoo.com
            Contributors
            Role: ND
            Journal
            rmcmlp
            Revista Médica La Paz
            Rev. Méd. La Paz
            Colegio Médico de La Paz (La Paz, , Bolivia )
            1726-8958
            2009
            : 15
            : 2
            : 5-14
            S1726-89582009000200002

            This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

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            Figures: 0, Tables: 0, Equations: 0, References: 39, Pages: 10
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            Product Information: SciELO Bolivia

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