Association between ambulatory monitoring blood pressure variables and occurrence of cardiovascular events among octogenarians with controlled arterial hypertension / Associação entre as variáveis da monitorização ambulatorial da pressão arterial e a ocorrência de eventos cardiovasculares em octogenários com hipertensão arterial controlada

AUTOR(ES)
DATA DE PUBLICAÇÃO

2009

RESUMO

Introduction: In studies on hypertension among the elderly, the participating population is predominantly in the 60-79 year age group, while those over 80 account for an insignificant number in these studies. The evaluation of antihypertensive treatment effect has been based mainly on office BP. However, several studies have indicated that 24-hour ambulatory blood pressure monitoring (ABPM) is a better predictor of cardiovascular events than office blood pressure (BP). The objective of this study was to evaluate the variables obtained by AMBP and associate them with the occurrence of cardiovascular and cerebrovascular events among treated hypertensive octogenarians patients with blood pressure values in the office equal to or lower than 140x90 mmHg. Methods: We included 126 hypertensive elderly octogenarian (age 83.8±3.4 years) outpatients with stable antihypertensive drug treatment for at least 3 months in the office. Values of blood pressure were measured with the patient in the seated, supine and orthostatic positions as well as data about cardiovascular risk factors, comorbidities, and medications were collected. The patients were submitted to AMBP and were followed-up for an average period of 23 ±5.6 months to obtain information on the occurrence of cardiovascular events. Results: The population consisted of 62.7% women and the most prevalent diseases were coronary arterial disease (33.3%), diabetes mellitus (23.8%) and cardiac insufficiency (22.2%). Of the antihypertensive drugs, the most commonly used were angiotensin-converting enzyme inhibitors (62.7%), diuretics (57.9%) and beta-adrenergic blockers (41.3%). In the office, the average blood pressure in the seated position was 130.9±9.2 mmHg x 73.3±8.9 mmHg. Orthostatic hypotension was present in 31.7% of the elderly patients studied. In the AMBP, the average awake blood pressure was 127.1±6.5 x 69.1±8.5 mmHg, while the average during sleep was 122.8 ± 17.3 x 62.9 ± 10.4 mmHg. Twelve cardiovascular events occurred (6 coronary and 6 cerebrovascular). To analyze the variables obtained in the office and the AMBP variables associated with cardiovascular events, the sample was divided into one group with events and a group without. In the group with events, the prevalence of previous stroke was significantly higher (33.3% vs. 7.0%, p=0.016). The cardiovascular risk factors were similar in both groups. Also, there was no difference between the groups in relation to the classes of antihypertensive drugs. In the multivariate analysis, daytime systolic pressure load and previous stroke were the independent variables for the occurrence of cardiovascular events. A logistical regression model was carried out, adjusted with the stroke variables and daytime systolic pressure load and a cut-off point of 35%, the following odds ratios and confidence intervals were obtained: stroke (OR: 7.669; IC: 1.629-36.098; p = 0.009) and daytime systolic pressure load (OR: 6.752; IC: 1.750; IC: 26.051; p = 0.005), sensitivity 66.7%, specificity 75.4%, negative predictive value 95.6% and accuracy 74.6%. Conclusion: Daytime systolic pressure load higher than 35% was a strong predictor of cardiovascular events in controlled hypertensive octogenarians, particularly when associated with previous stroke

ASSUNTO(S)

blood pressure monitoring ambulatory prognóstico hypertension idade com mais de 80 anos monitorização ambulatorial da pressão arterial prognosis hipertensão arterial aged 80 and over

ACESSO AO ARTIGO

Documentos Relacionados