Análisis de la variabilidad de la presión arterial mediante la automedida de la presión arterial en Navarra / Analysis of the variability of blood pressure by self-measurement of blood pressure in Navarra

Objetivos. Dada la gran utilización del método diagnóstico que es la automedida de presión arterial (AMPA) y existiendo escasa clarificación sobre la variabilidad diurna y sobre el número de determinaciones de PA a realizar mediante AMPA se realizó este estudio. Método. Se seleccionó una muestra de 1.136 personas (población total, 2.084), aleatoria y estratificada por edad y sexo, de 25 a 64 años. Se excluyeron a los diagnosticados de hipertensión arterial (HTA). En la recogida de datos en consulta (C) se determinó la PA tres veces mediante el esfigmomanómetro de mercurio (Hg) en las dos primeras y mediante el aparato automático Omron 705 CP (ap autom) en la tercera. Se registró la frecuencia cardíaca (FC), la talla y el peso. Para la recogida de datos en el domicilio (D) se les instruyó en el manejo del ap autom y se les pidió que obtuviesen 9 mediciones de PA, tres por la mañana (M), tres por la tarde (T) y tres por la noche (N) durante tres días laborables (L) y uno festivo (F). Se aplicó la "t" de Student de medias pareadas y ANOVA monofactorial. Resultados. Las mediciones de PA (mmHg) en C y D se obtuvieron en 734 participantes. De ellos, 185 con una PA en C >= 140/90. Las medias de presión sistólica/presión diastólica (PS/PD) en C con el Hg fueron: 123,5 ± 15,1/76,4 ± 10,3 y 122,4 ± 14,4/75,5 ± 10 y con el ap autom de 123 ± 16,1/73,7 ± 10,3. La media de PS/PD en el D de toda la muestra fue: 115 ± 14,3/69,2 ± 9 y en el grupo con PA en C < 140/90, la media de PS fue 111 ± 12,2 y de PD 66,8 ± 7,6. La media de FC en la C fue de 70,3 ± 10,4 (pulsaciones/minuto). La media de FC en el D de toda la muestra fue 67,9 ± 9,7 y en el grupo con PA < 140/90 en C fue de 67 ± 9,6. Al comparar la PA de la C y del D existieron diferencias significativas entre las determinaciones en C en relación con las del D (M, T o N) en los días L y F (p < 0,05); siendo superior la PA en C. La FC fue también diferente en la C y en el D, siendo superior en C que en el D. Al analizar las tres tomas de la M de cada día se observó que existía una diferencia significativa de la PA tanto en la primera toma que se realizaba por la M, por la T y por la N del primer día en relación con la segunda y la tercera tomas del mismo día (p < 0,05). Respecto a la FC se observaron diferencias significativas entre la primera toma de la M en comparación con la segunda y la tercera tomas de la M del primer día (p < 0,05). Al comparar la PA de la M, la T y la N de los días L se observó que existían diferencias significativas entre las tomas de la M y la N (p < 0,05). Al comparar el día L y el F no existieron diferencias significativas de PS entre las M (p = 0,998) y las T (p = 0,934) del día L y F, pero sí existieron diferencias entre PS de las N (p < 0,05). La PD no presentó diferencias significativas por las T (p = 0,268), pero sí entre las M y las N (p < 0,05). Conclusiones. 1) Se demuestra una gran variabilidad entre las diferentes tomas de PA y se mantiene el ritmo circadiano, y 2) se recomienda realizar tres determinaciones por la M, tres por la T y tres por la N durante tres días, debiendo eliminar sólo la primera determinación del primer día

Objectives. This study was conducted given the great use of the diagnostic method that is the self-measurements of blood pressure (SMBP) and there being scarce clarification on the daytime variability and the number of BP determinations to be conducted by SMBP. Method. A sample of 1,136 persons (total population, 2,084) was chosen. It was randomized and stratified by age and gender, from 25 to 64 years. Those diagnosed of HBP were excluded. PB was determined three times in the consultation (C) data collection. This was done by mercury sphygmomanometer (Hg) in the first two and by automatic Omron 705 CP apparatus (ap autom) in the third. Heart rate (HR), height and weight were recorded. For home (H) data collection, they were instructed in the management of the ap autom and were asked to obtain 9 BP measurements, three in the morning (M), three in the afternoon (A) and three at night (NO) for three work (W) days and one holiday (H). The Student's "t" test of paired means and monofactorial ANOVA were administered. Results. The blood pressure measurements (mmHg) in C and H were obtained in 734 participants. Of them, 185 had a BP C >= 140/90. SP/DP means in the C with the Hg were 123.5 ± 15.1/76.4 ± 10.3 and 122.4 ± 14.4/75.5 ± 10 and with the ap autom, 123 ± 16.1/73.7 ± 10.3. The mean SP /DP at H of all the sample was 115 ± 14.3/69.2 ± 9 and in the group with BP at C < 140/90, the mean SP was 111 ± 12.2 and DP, 66.8 ± 7.6. Mean HR in the C was 70.3 ± 10.4 (beats/minute). Mean HR at H of all the sample was 67.9 ± 9.7 and in the group with BP < 140/90 in C it was 67 ± 9.6. When the BP of the C was compared with that of the H, there were significant differences between the measurements in C in relationship with those in H (M, A or N) on the days of W and H (p < 0.05); the BP being greater in C. The HR was also different in the C and H, it being greater in the C than in the H. When the three measurements of the M of each day were analyzed, it was observed that there was a significant different of BP both in the first done in the M, the A and N of the first day in relationship with the 2nd and 3rd measurements of the same day (p < 0.05). Regarding the HR, significant differences were observed between the 1st measurement of the M in comparison with the 2nd and 3rd measurements of the M of the first day (p < 0.05). When the BP of the M, A and N of the W days were compared, it was observed that there were significant differences between the measurements of the M and N (p < 0.05). When the W and H day were compared, there were no significant differences of SP between M (p = 0.998) and A (p = 0.934) of the W and H day. However, there were differences between SP of the N (p < 0.05). The DP did not have significant differences in the A (p = 0.268), but did between the M and N (p < 0.05). Conclusions. 1) A large variability is shown between the different BP measurements and the circadian rhythm is maintained, and 2) it is recommended to make three measurements in the M, three in the A and three at N for three days, and only the 1st measurement of the first day should be eliminated

Supportive care after active periodontal treatment: a review.

This review concerns the most significant questions regarding supportive (maintenance) care after active periodontal treatment: the effectiveness and ideal frequency of maintenance appointments, the adequacy of the supportive therapy according to patient needs, the possible alternatives to currently accepted protocols, and the relative value of personal oral hygiene in the overall context of supportive care. Periodontal diseases are infections with a high potential for recurrence, progressive loss of attachment and eventually, tooth loss. Current therapies for periodontal diseases are highly predictable in arresting disease activity. Supportive periodontal care has been shown to be very effective in maintaining support when adapted to each particular case. Nevertheless, current maintenance therapies may be unsuccessful in preventing further loss of attachment in a small number of sites for some patients. Tests aiming at bacterial identification and the subgingival application of antimicrobials may be helpful in the management of such cases, however the practical value in a specific setting is not known. There is growing evidence of the fundamental role of personal oral hygiene in supportive periodontal care. In cases with rapid and severe periodontal destruction and where local and/or systemic risk factors are present, personal oral hygiene becomes a key factor in the long-term preservation of periodontal support.

Guided tissue regeneration in severe periodontal defects in anterior teeth. Case reports.

Four consecutive chronic, severe periodontal bone defects in anterior teeth were treated by guided tissue regeneration, using a polytetrafluoroethylene periodontal membrane. The root surface was not specifically conditioned, and osseous grafts were not used. However the membrane was manipulated so that space under it was maintained. This was accomplished by painting the outer surface of the membrane with butyl-cyanoacrylate, so that it became rigid. The membranes were removed after 4 weeks and a bone-like tissue was found in all cases. The clinical results suggest that there was a relationship between the amount and quality of the new tissue and the volumetric characteristics of the available space.

How to integrate prevention into a successful practice.

Research in the last three decades has shown the infectious nature of dental caries and periodontal diseases, and the feasibility of their prevention. This well established, albeit incomplete, knowledge has the potential to entirely change the way in which most dental practices are now operating. This change should ideally turn the traditional treatment-oriented practice into a different type in which the main emphasis is placed on preventive care. This goal can be achieved in most dental offices if the dentist follows some simple rules and guidelines which are currently accepted as effective measures to prevent oral diseases. Finally, personal data is presented suggesting that such preventive measures can be successfully implemented in a private practice.

Effects of gingival curettage when performed 1 month after root instrumentation. A biometric evaluation.

The purpose of the present study was to evaluate biometrically the periodontal response to gingival curettage. 15 subjects having suprabony pockets were selected. Gingival Index (GI) was initially determined for the selected teeth. Measurements of probing depth, and the distance from the free gingival margin to the cemento-enamel junction were also taken at that time, as well as immediately after scaling and root planing of the selected teeth. 4 weeks after scaling and root planing, the clinical parameters were recorded. A split mouth design was used to select 2 quadrants of the mouth in which gingival curettage was to be performed. Immediately after, experimental measurements were again recorded. 5 weeks after gingival curettage, gingival inflammation, probing depth and the location of the free gingival margin were recorded for the last time. All data were analyzed statistically. It was shown that gingival inflammation, the distance from the free gingival margin to the cemento-enamel junction, and the probing depth were reduced after 4 and 9 weeks. The level of clinical attachment improved after 9 weeks. All these changes were statistically significant. These results were observed after scaling and root planing, as well as after scaling, root planing and gingival curettage. No differences were found between both treatment modalities in any of the parameters analyzed. Gingival curettage did not improve the condition of the periodontal tissues more significantly than scaling and root planing.