Effect on cardiovascular risk of an intervention by family physicians to promote physical exercise among sedentary individuals.

INTRODUCTION AND OBJECTIVES: To evaluate the effect of a program promoting physical activity (PEPAF) implemented by family physicians on cardiovascular risk reduction. METHODS: The cluster randomized clinical trial involved 56 family physicians randomly allocated to an intervention group (n=29) and a control group (n=27). Of the patients recruited, only those aged 30-74 years (1915 PEPAF and 1783 control) were included in the analysis. The intervention involved giving general advice about the benefits of physical activity to all patients and prescribed advice to a subgroup of patients (30%) who agreed to an additional consultation. Outcome measures included risk factors and cardiovascular risk assessed using the Framingham-D'Agostino scale. RESULTS: A significant decrease from baseline in systolic and diastolic blood pressure and pulse pressure was observed after 12 months in both groups (control group: -2.93 mmHg, -1.81 mmHg and -1.15 mmHg, respectively; PEPAF group: -3.35 mmHg, -1.4 mmHg, and -1.94 mmHg, respectively). The high-density lipoprotein cholesterol level increased (control group: +1.73 mg/dl; PEPAF group: +2.67 mg/dl), while the atherogenic index decreased (by 0.12 and 0.16 in the two groups, respectively), all from baseline (P< .05). Cardiovascular risk decreased by 0.68 (95% confidence interval [CI], 0.13-1.25) in the control group and 0.79 (95%CI, 0.22-1.35) in the PEPAF group. There was no significant difference in the improvement at 12 months between the groups. CONCLUSIONS: Patients' participation in the project was effective in improving control of risk factors and decreasing cardiovascular risk. No significant difference in outcome was observed between the control group and the group participating in the program promoting physical activity.

Efecto en el riesgo cardiovascular de una intervención para la promoción del ejercicio físico en sujetos sedentarios por el médico de familia / Effect on cardiovascular risk of an intervention by family physicians to promote physical exercise among sedentary individuals

Introducción y objetivos. Evaluar el efecto de un programa de promoción de la actividad física (PEPAF) realizado por médicos de familia en la disminución del riesgo cardiovascular. Métodos. Ensayo clínico por conglomerados en el que se asignó aleatoriamente a 56 médicos de familia a un grupo de intervención (n = 29) y un grupo de control (n = 27). Entre los pacientes reclutados, se analizó a los que estaban entre 30 y 74 años (1.915 PEPAF y 1.783 controles). Intervención: consejo sobre los beneficios de la actividad física a todos los pacientes y prescripción a un subgrupo que aceptó una consulta adicional (30%). Medidas: factores de riesgo y riesgo cardiovascular con la escala Framingham-D’Agostino. Resultados. A los 12 meses se observó un descenso significativo de las presiones arteriales sistólica y diastólica y la presión de pulso en los dos grupos (controles, 2,93, 1,81 y 1,15 mmHg; PEPAF, 3,35, 1,4 y 1,94 mmHg) respecto a la evaluación basal. Hubo incremento del colesterol de las lipoproteínas de alta densidad (controles, 1,73 mg/dl; PEPAF, 2,67 mg/dl) y descenso del índice aterogénico (controles, 0,12; PEPAF, 0,16) respecto al basal (p < 0,05). El riesgo cardiovascular disminuyó en el grupo control 0,68 (intervalo de confianza [IC] del 95%, 0,13-1,25) y en el PEPAF, 0,79 (IC del 95%, 0,22-1,35). No se observaron diferencias significativas en la mejoría a los 12 meses entre el grupo PEPAF y el de controles. Conclusiones. La inclusión de pacientes en el proyecto fue eficaz para mejorar el control de los factores de riesgo y reducir el riesgo cardiovascular; no se observaron diferencias entre el grupo de control y el que recibió promoción de la actividad física (AU)

Introduction and objectives. To evaluate the effect of a program promoting physical activity (PEPAF) implemented by family physicians on cardiovascular risk reduction. Methods. The cluster randomized clinical trial involved 56 family physicians randomly allocated to an intervention group (n=29) and a control group (n=27). Of the patients recruited, only those aged 30-74 years (1915 PEPAF and 1783 control) were included in the analysis. The intervention involved giving general advice about the benefits of physical activity to all patients and prescribed advice to a subgroup of patients (30%) who agreed to an additional consultation. Outcome measures included risk factors and cardiovascular risk assessed using the Framingham-D’Agostino scale. Results. A significant decrease from baseline in systolic and diastolic blood pressure and pulse pressure was observed after 12 months in both groups (control group: –2.93 mmHg, –1.81 mmHg and –1.15 mmHg, respectively; PEPAF group: –3.35 mmHg, –1.4 mmHg, and –1.94 mmHg, respectively). The high-density lipoprotein cholesterol level increased (control group: +1.73 mg/dl; PEPAF group: +2.67 mg/dl), while the atherogenic index decreased (by 0.12 and 0.16 in the two groups, respectively), all from baseline (P<.05). Cardiovascular risk decreased by 0.68 (95% confidence interval [CI], 0.13-1.25) in the control group and 0.79 (95%CI, 0.22-1.35) in the PEPAF group. There was no significant difference in the improvement at 12 months between the groups. Conclusions. Patients’ participation in the project was effective in improving control of risk factors and decreasing cardiovascular risk. No significant difference in outcome was observed between the control group and the group participating in the program promoting physical activity (AU)

Central blood pressure and pulse wave velocity: relationship to target organ damage and cardiovascular morbidity-mortality in diabetic patients or metabolic syndrome. An observational prospective study. LOD-DIABETES study protocol.

BACKGROUND: Diabetic patients show an increased prevalence of non-dipping arterial pressure pattern, target organ damage and elevated arterial stiffness. These alterations are associated with increased cardiovascular risk.The objectives of this study are the following: to evaluate the prognostic value of central arterial pressure and pulse wave velocity in relation to the incidence and outcome of target organ damage and the appearance of cardiovascular episodes (cardiovascular mortality, myocardial infarction, chest pain and stroke) in patients with type 2 diabetes mellitus or metabolic syndrome. DESIGN: This is an observational prospective study with 5 years duration, of which the first year corresponds to patient inclusion and initial evaluation, and the remaining four years to follow-up. SETTING: The study will be carried out in the urban primary care setting. STUDY POPULATION: Consecutive sampling will be used to include patients diagnosed with type 2 diabetes between 20-80 years of age. A total of 110 patients meeting all the inclusion criteria and none of the exclusion criteria will be included. MEASUREMENTS: Patient age and sex, family and personal history of cardiovascular disease, and cardiovascular risk factors. Height, weight, heart rate and abdominal circumference. Laboratory tests: hemoglobin, lipid profile, creatinine, microalbuminuria, glomerular filtration rate, blood glucose, glycosylated hemoglobin, blood insulin, fibrinogen and high sensitivity C-reactive protein. Clinical and 24-hour ambulatory (home) blood pressure monitoring and self-measured blood pressure. Common carotid artery ultrasound for the determination of mean carotid intima-media thickness. Electrocardiogram for assessing left ventricular hypertrophy. Ankle-brachial index. Retinal vascular study based on funduscopy with non-mydriatic retinography and evaluation of pulse wave morphology and pulse wave velocity using the SphygmoCor system. The medication used for diabetes, arterial hypertension and hyperlipidemia will be registered, together with antiplatelet drugs. DISCUSSION: The results of this study will help to know and quantify the prognostic value of central arterial pressure and pulse wave velocity in relation to the evolution of the subclinical target organ damage markers and the possible incidence of cardiovascular events in patients with type 2 diabetes mellitus.

Afección renal subclínica y establecida en pacientes hipertensos de nuevo diagnóstico / Subclinical and established kidney disease in recently diagnosed hypertensive patients

Fundamento y objetivo: Estimar la prevalencia de afectación renal en pacientes hipertensos de nuevo diagnóstico e identificar los factores relacionados con esta afectación renal. Pacientes y métodos: Estudio transversal de 425 hipertensos de reciente diagnóstico en atención primaria. La afectación renal se ha valorado con la creatinina, índice albumina/ creatinina y tasa de filtrado glomerular (TFG). Los factores de riesgo cardiovascular, la lesión orgánica subclínica y la enfermedad cardiovascular se analizaron según los criterios de la Guía Europea de Hipertensión de 2007. Resultados: Edad media de 58,96 (DE: 12,73) años, el 63,3% eran varones. Encontramos dislipidemia en el 80%, obesidad abdominal en el 49% y síndrome metabólico en el 36%. Presentaron creatinina elevada el 3,3%, TFG disminuida el 9,6%, afectación renal oculta el 6,4%, oligoalbuminuria el 7,5% y nefropatía el 2,4%. Los hipertensos con afectación renal (17,88%) tenían mayor edad, presión arterial sistólica más elevada, mayor porcentaje de síndrome metabólico, íntima-media de carótida e índice tobillo/brazo patológico, así como mayor proporción de enfermedad cardiovascular. Las variables asociadas a la afectación renal fueron la presencia de síndrome metabólico (OR=11,12) y el índice tobillo/brazo patológico (OR=17,55). Las variables asociadas a creatinina elevada fueron sexo, índice tobillo/brazo patológico y síndrome metabólico; las variables asociadas a TFG disminuida fueron edad, sexo, índice tobillo/brazo patológico, síndrome metabólico e índice de masa corporal, y la variable asociada al índice albumina/creatinina elevado fue la diabetes mellitus. Conclusión: Se detecta afectación renal aproximadamente en 2 de cada 10 hipertensos cuando, además de la creatinina sérica, realizamos índice albumina/creatinina y TFG. El síndrome metabólico y el índice tobillo/brazo patológico son los principales indicadores de afectación renal (AU)

Background and objective:To estimate renal disease in recently diagnosed hypertensive patients, and to identify factors related to renal disease. Patients and methods: Cross-sectional study, with 425 hypertensive patients recently diagnosed in primary health care; renal disease was estimated with serum creatinine, albumin/creatinine index and glomerular filtration rate (GFR). We analyzed cardiovascular risk factors (CRF), subclinical organ injury and cardiovascular disease following the criteria of the 2007 European Guide of Hypertension. Results: Average age: 58,96±12,73 years old, 63,3% male. We found dyslipemia in 80%, abdominal obesity in 49% and metabolic syndrome in 36% patients. These patients showed increased serum creatinine 3,3%, a reduction in GFR 9,6%, hidden renal disease 6,4%, microalbuminuria 7,5% and nephropathy 2,4%. Hypertensive patients with renal disease (17,88%) were older, with higher systolic pressure, higher incidence of metabolic syndrome, abnormal carotid intima-media thickness and ankle-arm index, and presence of cardiovascular disease. Variables associated with renal disease were metabolic syndrome (odds ratio =11,12) and ankle-arm index (odds ratio =17,55). Variables related to creatinina were sex, ankle-arm index and metabolic syndrome; variables related to GFR were sex, age, ankle-arm index, metabolic syndrome and body mass index (BMI); variables related with albumin/creatinine index included diabetes mellitus. Conclusions: Renal disease is detected in about 2 out of 10 hypertensive patients, when, besides serum creatinina, we analyze albumin/creatinine index and GFR. Metabolic syndrome and ankle-arm index are the main variables associated with renal disease (AU)

[Subclinical and established kidney disease in recently diagnosed hypertensive patients]. / Afección renal subclínica y establecida en pacientes hipertensos de nuevo diagnóstico.

BACKGROUND AND OBJECTIVE: To estimate renal disease in recently diagnosed hypertensive patients, and to identify factors related to renal disease. PATIENTS AND METHODS: Cross-sectional study, with 425 hypertensive patients recently diagnosed in primary health care; renal disease was estimated with serum creatinine, albumin/creatinine index and glomerular filtration rate (GFR). We analyzed cardiovascular risk factors (CRF), subclinical organ injury and cardiovascular disease following the criteria of the 2007 European Guide of Hypertension. RESULTS: Average age: 58,96 +/- 12,73 years old, 63,3% male. We found dyslipemia in 80%, abdominal obesity in 49% and metabolic syndrome in 36% patients. These patients showed increased serum creatinine 3,3%, a reduction in GFR 9,6%, hidden renal disease 6,4%, microalbuminuria 7,5% and nephropathy 2,4%. Hypertensive patients with renal disease (17,88%) were older, with higher systolic pressure, higher incidence of metabolic syndrome, abnormal carotid intima-media thickness and ankle-arm index, and presence of cardiovascular disease. Variables associated with renal disease were metabolic syndrome (odds ratio = 11,12) and ankle-arm index (odds ratio = 17,55). Variables related to creatinina were sex, ankle-arm index and metabolic syndrome; variables related to GFR were sex, age, ankle-arm index, metabolic syndrome and body mass index (BMI); variables related with albumin/creatinine index included diabetes mellitus. CONCLUSIONS: Renal disease is detected in about 2 out of 10 hypertensive patients, when, besides serum creatinina, we analyze albumin/creatinine index and GFR. Metabolic syndrome and ankle-arm index are the main variables associated with renal disease.

[Efficacy of an educational intervention group on changes in lifestyles in hypertensive patients in primary care: a randomized clinical trial]. / Eficacia de una intervención educativa grupal sobre cambios en los estilos de vida en hipertensos en atención primaria: un ensayo clínico aleatorio.

BACKGROUND: Healthy lifestyles are associated with less risk of cardiovascular disease. The aim of this study is to evaluate the effectiveness of a group educational strategy in lifestyle changes, as well as the control of risk factors and cardiovascular risk in hypertensive patients. METHODS: Randomized clinical trial carried out in Primary Care. 101 hypertensive patients were selected by random sampling, aged 35-74; 51 patients were randomized to the intervention group (IG) (aged: 64,5+/-9,7, 56% women) and other 50 to the control group(CG)(aged: 65,4+/-8,4, 68% women). We performed a basal evaluation and an educational intervention on lifestyles, six sessions during one year, and final-point evaluation. Effect of intervention was evaluated through of cardiovascular risk (Framingham), blood pressure, lipid profile, waist circumference, body mass index (BMI), nutrient consumption, physical exercise (7-PAR day) and quality of life(SF-36). RESULTS: Basal blood pressure was 136,8/82,7 mmHg IG and 139,3/79,3 CG, cardiovascular risk was 11,1% y 12,3% respectively. Systolic blood pressure decreased 5,6+/-19,6 (p=0,07) IG and 7,1+/-16,3 mmHg (p=0,004) GC, and diastolic decreased 3,9+/-10,8 (p=0,02) and 2,7+/-11,5 mmHg (p=0,10) respectively. BMI decreased 0,3+/-1,6 points IG (p=0,17) and increased 0,1+/-1,5 CG (p=0,81). Coronary risk decreased 0,8+/-6,5 points IG and increased 0,2+/- 6,8 CG; effect of intervention was a reduction in 1 point (CI95%-3,9/1,9)(p=0,48). Calories ingestion decreased 42,8+/-1141,2 Kcal/day p=0,14) IG and 278,9+/-1115,9(p=0,62) CG. Physical exercise increased in both groups: 3,6+/-19 IG (p=0,20) and 3,9+/-14,9 mets/hour/week CG (p=0,07). CONCLUSIONS: There was a higher decline of cardiovascular risk in the intervention group than control group, we did not find statistically significant differences between both groups in parameters evaluated.

Pulse pressure and nocturnal fall in blood pressure are predictors of vascular, cardiac and renal target organ damage in hypertensive patients (LOD-RISK study).

OBJECTIVES: To analyse the relationship between various parameters derived from ambulatory blood pressure monitoring (ABPM) and vascular, cardiac and renal target organ damage. METHODS: A cross-sectional, descriptive study. It included 353 patients with short-term or recently diagnosed hypertension. PRIMARY MEASUREMENTS: ABPM, carotid intima-media thickness (IMT), Cornell voltage-duration product (Cornell VDP), glomerular filtration rate and albumin/creatinine ratio to assess vascular, cardiac and renal damage. RESULTS: Two hundred and twenty-three patients (63.2%) were males, aged 56.12+/-11.21 years. The nocturnal fall in blood pressure was 11.33+/-8.41, with a dipper pattern in 49.0% (173), nondipper in 30.3% (107), extreme dipper in 12.7% (45) and riser in 7.9% (28). The IMT was lower in the extreme dipper (0.716+/-0.096 mm) and better in the riser pattern (0.794+/-0.122 mm) (P<0.05). The Cornell VDP and albumin/creatinine ratio were higher in the riser pattern (1818.94+/-1798.63 mm/ms and 140.78+/-366.38 mg/g, respectively) than in the other patterns. In the multivariate analysis after adjusting for age, sex and antihypertensive treatment, with IMT as dependent variable the 24-h pulse pressure (beta = 0.003), with Cornell VDP the rest pulse pressure (beta = 12.04), and with the albumin/creatinine ratio the percentage of nocturnal fall in systolic blood pressure (beta = -3.59), the rest heart rate (beta = 1.83) and the standard deviation of 24-h systolic blood pressure (beta = 5.30) remain within the equation. CONCLUSION: The estimated pulse pressure with ABPM is a predictor of vascular and cardiac organ damage. The nocturnal fall and the standard deviation in 24-h systolic blood pressure measured with the ABPM is a predictor of renal damage.

Eficacia d euna intervención educativa grupal sobre cambios en los estilos de vida de Hipertensos en Atención Primaria: Un ensayo Clínico Aleatorio / Effycacy of an Educational Intervention Group on Changes in Lifestyles in Hypertensive Patients in Primary Care: A Randomized Clinical Trial

Fundamentos: Los estilos de vida saludables se relacionan con un menor riesgo de enfermedades cardiovasculares. El objetivo del estudio es evaluar la eficacia de una estrategia educativa grupal en la modificación de estilos de vida, control de factores de riesgo y riesgo cardiovascular (RCV) en personas hipertensas.Método: Ensayo clínico aleatorio en Atención Primaria. Se seleccionaron por muestreo aleatorio 101 personas hipertensas de 35 a 74 años, randomizando 51 al grupo de intervención (GI)(64,5±9,7 años, 56% mujeres) y 50 al control (GC) (65,4±8,4 años, 68% mujeres). Se realizó una evaluación basal, una intervención educativa grupal sobre cambios de estilos de vida (seis sesiones durante un año) y una evaluación final. El efecto de la intervención se evaluó con RCV (Framingham), presión arterial(PA), perfil lipídico, perímetro de cintura, índice de masa corporal(IMC), consumo de nutrientes con encuesta validada, ejercicio físico con 7-PAR Day y calidad de vida con SF-36.Resultados: PA basal 136,8/82,7 mmHg en GI y 139,3/79,3 mmHg y en GC, RCV:11,1% (GI) y 12,3% (GC). La PA sistólica descendió 5,6±19,6 mmHg (p=0,07) en GI, y 7,1±16, mmHg (p=0,004) en GC, la diastólica 3,9±10,8 (p=0,02), y 2,7±11, mmHg (p=0,10) respectivamente. El IMC descendió 0,3±1,6 puntos en GI(p=0,17), y aumentó 0,1±1,5 en GC(p=0,81). El RCV descendió 0,8±6,5 puntos en GI y aumentó 0,2±6,8 en GC, el efecto de la intervención fue un descenso de 1 punto (IC95%:3,9-1,9) (p=0,48). La ingesta disminuyó en GI: 42,8±1141,2 Kcal/día(p=0,14), y en GC: 278,9±1115,9 (p=0,62). El ejercicio (mets/hora/semana) aumentó en ambos, 3,6±19 en GI(p=0,20) y 3,9±14,9 en GC(p=0,07).Conclusión: Encontramos mayor descenso del riesgo cardiovascular en el grupo de intervención, sin existir diferencias estadísticamente significativas en los parámetros evaluados entre ambos grupos (AU)

Background: Healthy lifestyles are associated with less risk of cardiovascular disease. The aim of this study is to evaluate the effectiveness of a group educational strategy in lifestyle changes, as well as the control of risk factors and cardiovascular risk in hypertensive patients.Methods: Randomized clinical trial carried out in Primary Care. 101 hypertensive patients were selected by random sampling, aged 35-74; 51 patients were randomized to the intervention group (IG) (aged: 64,5±9,7, 56% women) and other 50 to the control group(CG)(aged: 65,4±8,4, 68% women). We performed a basal evaluation and an educational intervention on lifestyles, six sessions during one year, and final-point evaluation. Effect of intervention was evaluated through of cardiovascular risk (Framingham), blood pressure, lipid profile, waist circumference, body mass index (BMI), nutrient consumption, physical exercise (7-PAR day) and quality of life(SF-36).Results: Basal blood pressure was 136,8/82,7 mmHg IG and 139,3/79,3 CG, cardiovascular risk was 11,1% y 12,3% respectively. Systolic blood pressure decreased 5,6±19,6 (p=0,07) IG and 7,1±16,3 mmHg (p=0,004) GC, and diastolic decreased 3,9±10,8 (p=0,02) and 2,7±11,5 mmHg (p=0,10) respectively. BMI decreased 0,3±1,6 points IG (p=0,17) and increased 0,1±1,5 CG (p=0,81). Coronary risk decreased 0,8±6,5 points IG and increased 0,2± 6,8 CG; effect of intervention was a reduction in 1 point (CI95%-3,9÷1,9)(p=0,48). Calories ingestion decreased 42,8±1141,2 Kcal/day p=0,14) IG and 278,9±1115,9(p=0,62) CG. Physical exercise increased in both groups: 3,6±19 IG (p=0,20) and 3,9±14,9 mets/hour/week CG (p=0,07).Conclusions: There was a higher decline of cardiovascular risk in the intervention group than control group, we did not find statistically significant differences between both groups in parameters evaluated (AU)

Therapeutic implications of selecting the SCORE (European) versus the D'AGOSTINO (American) risk charts for cardiovascular risk assessment in hypertensive patients.

BACKGROUND: No comparisons have been made of scales estimating cardiovascular mortality and overall cardiovascular morbidity and mortality. The study objectives were to assess the agreement between the Framingham-D'Agostino cardiovascular risk (CVR) scale and the chart currently recommended in Europe (SCORE) with regard to identification of patients with high CVR, and to describe the discrepancies between them and the attendant implications for the treatment of hypertension and hyperlipidaemia. METHODS: A total of 474 hypertensive patients aged 40-65 years monitored in primary care were enrolled into the study. CVR was assessed using the Framingham-D'Agostino scale, which estimates the overall cardiovascular morbidity and mortality risk, and the SCORE chart, which estimates the cardiovascular mortality risk. Cardiovascular risk was considered to be high for values > or = 20% and > or = 5% according to the Framingham-D'Agostino and SCORE charts respectively. Kappa statistics was estimated for agreement in classification of patients with high CVR. The therapeutic recommendations in the 2007 European Guidelines on Cardiovascular Disease Prevention were followed. RESULTS: Mean patient age was 54.1 (SD 7.3), and 58.4% were males. A high CVR was found in 17.5% using the SCORE chart (25.3% males, 6.6% females) and in 32.7% using the D'Agostino method (56.9% males, 12,7% females). Kappa coefficient was 0.52, and increased to 0.68 when the high CVR threshold was established at 29% according to D'Agostino. Hypertensive patients with high SCORE and non-high D'Agostino (1.7%) were characterized by an older age, diabetes, and a lower atherogenic index, while the opposite situation (16.9%) was associated to males, hyperlipidaemia, and a higher atherogenic index. Variables with a greater weight in discrepancies were sex and smoking. A 32.0% according to SCORE and 33.5% according to D'Agostino would be candidates to receive antihypertensive treatment, and 15.8% and 27.3% respectively to receive lipid-lowering treatment. CONCLUSION: A moderate to high agreement was found. SCORE may underestimate risk in males with an unfavourable lipid profile, and D'Agostino in diabetics with a lower atherogenic risk. Use of the D'Agostino scale implies treating more patients with lipid-lowering and antihypertensive drugs as compared to SCORE.

Presión arterial clínica y ambulatoria y su relación con el grosor íntima-media de carótida (LOD-RISK Study) / Outpatient blood pressure monitoring and its relationship with carotid intima-media thickness (LOD-RISK study )

Objetivo. Evaluar la relación entre la presión arterial y el perfil circadiano y el grosor de la íntima media de la carótida. Metodología. Estudio descriptivo transversal. Se evaluó a 284 pacientes con hipertensión en atención primaria, de los cuales el 62% eran varones, y tenían una edad media de 57,86 años. Mediciones: edad, sexo, presión arterial clínica, presión de pulso, monitorización ambulatoria de presión arterial y patrón circadiano. Se calculó el aumento del grosor de la capa íntima-media (GIM) de la carótida mediante ecografía con protocolo de 12 medidas, utilizando el grosor medio y máximo. Se considera patológico si el GMI medio > 0,9 mm o hay presencia de placas según la Guía Europea de Hipertensión de 2007. Resultados. La presión arterial clínica fue de 138,7/75,01 mmHg y la presión de pulso 50,6 mmHg. La presión arterial de 24 h fue de 122,9/76,3 mmHg; en actividad, 126,7/79,7 mmHg, y en descanso, 112,8/67 mmHg. El descenso nocturno fue del 10,8% en la presión arterial sistólica y del 15,8% en la diastólica, y la presión de pulso de 24 h fue de 46,7 mmHg en actividad, 46,9 mmHg, y en descanso, 45,8 mmHg. El 46,5% de los pacientes presenta patrón dipper; el 35,9%, non-dipper; el 10,9%, extreme dipper, y el 6,7%, riser. El GIM medio fue de 0,765 mm y el GIM máximo, 0,943 mm. Cuarenta y seis (16,2%) pacientes tenían GIM medio > 0,9 mm o placas. En el patrón riser, el GIM fue de 0,831 mm; en non-dipper, de 0,765 mm; en dipper, de 0,762 mm, y en extreme dipper, de 0,738 mm (p < 0,05).Encontramos correlación positiva (p < 0,05) entre GIM medio y máximo con presión arterial sistólica clínica (r = 0,27), presión de pulso (r = 0,38), presión arterial sistólica de 24 h (r = 0,26), en actividad (r = 0,24) y descanso (r = 0,28) y negativa con presión arterial díastólica de 24 h (r = –0,18) y en actividad (r = –0,21). Conclusiones. El GIM de carótida se correlaciona positivamente con la presión arterial sistólica y la presión de pulso, tanto clínica como ambulatoria, y negativamente con la presión arterial diastólica ambulatoria y con el descenso nocturno de la presión arterial. El patrón riser está asociado con GIM mayor y extreme dipper menor (AU)

Objective. To assess relationships between blood pressure and circadian pattern and carotid intima-media thickness (IMT). Methods. Cross-sectional study. We included 284 hypertensive patients evaluated in primary care. Men 62%, aged 57.86 years. Measurements: Age, sex, office blood pressure, pulse pressure, ambulatory monitoring blood pressure and circadian pattern. Intima-media thickness (IMT) by ultrasound with protocol of 12 measurements, using mean maximum values. It is considered pathological if IMT > 0.9 mm or presence of plaques in accordance with European hypertension guidelines 2007. Results. Office blood pressure was 138.7/75.01 mmHg and pulse pressure 50.6 mmHg. Blood pressure 24 hours was 122.9/76.3, in activity: 126.7/79.7 and at rest: 112.8/67 mmHg. Systolic decrease in blood pressure was 10.8% and diastolic 15.8%. pulse pressure 24 hours was 46.7 mmHg, in activity 46.9 mmHg and at rest 45.8 mmHg. Circadian pattern was: 46.5% dipper, 35.9% non-dipper, 10,9% extreme dipper and 6.7% riser. IMT mean value was 0.765 mm and mean maximum 0.943 mm. A total of 46 (16.2%) patients had IMT > 0.9 mm or plaque. IMT in riser was 0.831mm, non-dipper 0.765, dipper 0.762 and extreme dipper 0.738 mm (p < 9.05). We found a positive correlation (p < 9.05) between mean and maximum IMT with Office blood pressure (r = 0.27), pulse pressure (r = 0.38), systolic blood pressure 24 hours (r = 0.26), day (r = 0.24), night (r = 0.28) and a negative correlation with diastolic blood pressure 24 hours and daytime (r = –0.18, r = –0.21). Conclusions. Carotid intima-media thickness correlates positively with clinic and ambulatory systolic blood pressure and pulse pressure and negatively with diastolic blood pressure and decrease in night blood pressure. Riser pattern is associated with intima-media thickness higher and extreme dipper lower (AU)