Ritmo circadiano y presión arterial en pacientes con monitorización ambulatoria de la presión arterial y su relación con el riesgo de evento cardiovascular / Circadian rhythm and blood pressure in patients with ambulatory blood pressure monitoring and its relationship with the risk of cardiovascular events

Introducción: Las enfermedades cardiovasculares son el conjunto de afecciones que más muertes produce globalmente, siendo la hipertensión arterial uno de los principales factores de riesgo. En este sentido, la monitorización de la presión arterial ambulatoria (MAPA) permite detectar los diferentes cambios de presión arterial a lo largo de 24h, denominados patrones circadianos: dipper, no dipper,riser o dipper extremo. Existe una posible asociación entre los diferentes patrones y el riesgo cardiovascular. En este estudio se pretende comparar el riesgo cardiovascular usando las escalas validadas REGICOR y SCORE en los pacientes con diferentes patrones circadianos usando la MAPA. Material y métodos: Estudio retrospectivo de pacientes hipertensos con registro MAPA entre 2015 y 2021 en Alcázar de San Juan y Madridejos. Se recogieron variables sociodemográficas, clínicas, antecedentes (hipertensión arterial, IMC, comorbilidades, hábitos de tabaquismo), analíticas, escalas REGICOR y SCORE, y ritmos circadianos. Resultados: Se han incluido un total de 269 pacientes (el 46,5% mujeres, 64,3±12,6 años), de los cuales un 38,3% presentaron patrón dipper, 10% dipper extremo, 33,1% no dipper y un 18,6% riser. Los pacientes con patrón riser tuvieron una puntuación significativamente mayor en las escalas REGICOR y SCORE (34 y 68%, respectivamente). Se observó una correlación significativa entre ambas escalas (rho Spearman: 0,589; p<0,001), aunque con baja concordancia (kappa de 0,348 [IC 95% 0,271-0,425]).Conclusión: La MAPA se ha convertido en una herramienta útil en el diagnóstico y tratamiento de la hipertensión arterial. Adicionalmente, conocer los patrones circadianos de estos pacientes podría favorecer el seguimiento y la elección del tratamiento adecuado.(AU)

Introduction: Cardiovascular diseases are the group of diseases that cause most deaths worldwide, being arterial hypertension the modifiable risk factor that mostly predisposes to other cardiovascular diseases development. In this regard, ambulatory blood pressure monitoring (ABPM) lets to detect the different changes in blood pressure throughout 24h, known as circadian patterns (dipper, non-dipper, riser or extreme dipper). There may be an association between these patterns and cardiovascular risk, so this study aims to compare cardiovascular risk using the 2 validated scales REGICOR and SCORE in patients with different circadian patterns using ABMP. Material and methods: Retrospective study of hypertensive patients with ABMP registered between 2015 and 2021 in Alcázar de San Juan and Madridejos. Data were collected from clinical history (arterial hypertension, BMI, comorbidities, and smoking habits) and ABPM records, as well as sociodemographic and analytical variables, cardiovascular risk scales (REGICOR and SCORE) and circadian rhythm variables (dipper, extreme dipper, non-dipper and rise pattern). Results: Two hundred and sixty-nine patients (46.5% female, 64.3±12.6 years old) were included. There were 38.3% with dipper pattern, 10% extreme dipper, 33.1% non-dipper and 18.6% riser. Patients with riser pattern showed higher score on the REGICOR and SCORE scales (34 and 68%, respectively). A significant correlation was established between both scales (Spearman rho: 0.589; p<0.001), but with poor concordance (kappa=0.348 [95% CI 0.271–0.425]). Conclusion: ABMP has turned into a very useful tool in the diagnosis and treatment of arterial hypertension. In addition, the circadian patterns of these patients may correlate to the choice of an adequate treatment and correct follow-up.(AU)

[Circadian rhythm and blood pressure in patients with ambulatory blood pressure monitoring and its relationship with the risk of cardiovascular events]. / Ritmo circadiano y presión arterial en pacientes con monitorización ambulatoria de la presión arterial y su relación con el riesgo de evento cardiovascular.

INTRODUCTION: Cardiovascular diseases are the group of diseases that cause most deaths worldwide, being arterial hypertension the modifiable risk factor that mostly predisposes to other cardiovascular diseases development. In this regard, ambulatory blood pressure monitoring (ABPM) lets to detect the different changes in blood pressure throughout 24h, known as circadian patterns (dipper, non-dipper, riser or extreme dipper). There may be an association between these patterns and cardiovascular risk, so this study aims to compare cardiovascular risk using the 2 validated scales REGICOR and SCORE in patients with different circadian patterns using ABMP. MATERIAL AND METHODS: Retrospective study of hypertensive patients with ABMP registered between 2015 and 2021 in Alcázar de San Juan and Madridejos. Data were collected from clinical history (arterial hypertension, BMI, comorbidities, and smoking habits) and ABPM records, as well as sociodemographic and analytical variables, cardiovascular risk scales (REGICOR and SCORE) and circadian rhythm variables (dipper, extreme dipper, non-dipper and rise pattern). RESULTS: Two hundred and sixty-nine patients (46.5% female, 64.3±12.6 years old) were included. There were 38.3% with dipper pattern, 10% extreme dipper, 33.1% non-dipper and 18.6% riser. Patients with riser pattern showed higher score on the REGICOR and SCORE scales (34 and 68%, respectively). A significant correlation was established between both scales (Spearman rho: 0.589; p<0.001), but with poor concordance (kappa=0.348 [95% CI 0.271-0.425]). CONCLUSION: ABMP has turned into a very useful tool in the diagnosis and treatment of arterial hypertension. In addition, the circadian patterns of these patients may correlate to the choice of an adequate treatment and correct follow-up.