Descenso nocturno de la presión arterial: factores determinantes y relación con daño orgánico secundario a hipertensión / Night-time drop in blood pressure: determining factors and relationship with organic damage as a side-effect of hypertension

Objetivos. Evaluar el descenso nocturno de la presión arterial en los pacientes con hipertensión ligera y determinar su posible relación con la presencia de daño en órganos diana. Diseño. Estudio transversal. Emplazamiento. Ocho centros de salud urbanos. Pacientes. Cuatrocientos dieciocho pacientes adultos con hipertensión arterial ligera-moderada. Intervenciones. a) Lectura de la presión arterial en 3 visitas; b) monitorización ambulatoria de la presión durante 24 horas; c) ecocardiografía (en 219 pacientes), y d) determinación de albuminuria (en 134 pacientes). Se definió como descenso nocturno de presión arterial la diferencia entre las presiones ambulatorias diurna y nocturna, y como descenso relativo al porcentaje de descenso de la presión nocturna respecto de la diurna. Resultados. El descenso nocturno de las presiones sistólica y diastólica fue de 13,6 (10,7) y 12,1 (8,6) mmHg, respectivamente. Los factores predictores del descenso nocturno de PA (por ciento) fueron, en sentido directo, la presión arterial ambulatoria diurna (p < 0,05) y el sexo femenino (p < 0,05) y, en sentido inverso, la edad (p < 0,05). No se observó asociación entre el descenso nocturno de presión arterial y la masa del ventrículo izquierdo. Solamente en mujeres se observó una relación independiente, en sentido inverso, entre el descenso nocturno de presión arterial y la excreción urinaria de albúmina (p < 0,05). Conclusiones. El descenso nocturno relativo ( por ciento) de la presión arterial es mayor en las mujeres que en los varones, disminuye con la edad y depende de la presión ambulatoria diurna. En las mujeres, un menor descenso nocturno de la presión arterial se asocia a mayor daño orgánico (AU)

[Nocturnal drop of arterial blood pressure: determinant factors and relationship with organic damage secondary to hypertension]. / Descenso nocturno de la presión arterial: factores determinantes y relación con daño orgánico secundario a hipertensión.

OBJECTIVES: To evaluate the night-time drop in blood pressure in patients with light hypertension and to determine its possible relationship with damage in key organs. DESIGN: Cross-sectional study. SETTING: Eight urban health centres. PATIENTS: Four hundred and eighteen adults with light-moderate hypertension. INTERVENTIONS: a) Blood pressure reading on three visits; b) ambulatory monitoring of pressure for 24 hours; c) echocardiograph (in 219 patients); d) albuminuria determination (in 134 patients). A night-time drop in blood pressure was defined as the difference between day and night ambulatory pressures; and relative drop, as the night-time pressure drop as a percentage of the day-time pressure. RESULTS: Night-time drop in systolic and diastolic pressures was 13.6 (10.7) and 12.1 (8.6) mmHg, respectively. The predictive factors of night-time drop in blood pressure were, directly, daily ambulatory blood pressure (p < 0.05) and female gender (p < 0.05) and, inversely, age (p < 0.05). No association was observed between night-time drop in blood pressure and left ventricular mass. Only in women was an independent relationship found, inversely, between night-time drop in blood pressure and urinary excretion of albumin (p < 0.05). CONCLUSIONS: Relative night-time drop in blood pressure is greater in women than in men, diminishes with age and depends on the day-time ambulatory pressure. In women a minor night-time drop in blood pressure is associated with greater organic damage.

[A prospective study of programmed nursing consultation in an urban health center]. / Estudio prospectivo de la consulta programada de enfermería en un centro de salud urbano.

A study of the programmed nurse clinic in a health center was carried out to evaluate its different health care activities, the time consumed in them, the type of patients cared for, and the mechanism of organization of the clinic. A remarkable finding was a high number of daily appointments (11.8 persons), with an excellent rate of compliance with the appointment (89.3%). It was found that most of the diseases cared for in the nurse clinic were those most commonly managed with a protocol design in primary care: hypertension (34.1%), diabetes (6.9%), hyperlipoproteinemia (9%) and obesity (12.8%). Other parameters were evaluated, such as mean time per visit, which was predominantly between five and ten minutes, or activities during the visits, with a clear predominance of the clinical protocols. There was a remarkably high efficiency of the nursing staff, with a low rate of referral to the medical clinic (6.9%). We conclude that nurse clinics play an important role in the health centers, as the only possible mechanism to guarantee the correct fulfillment of the different programs. This requires a definite constant physical space for a given minimal period of time of about 2 hours per day.