Analysis of the SHARPEN Score in the Prediction of In-Hospital Mortality of Patients With Infective Endocarditis Undergoing Cardiac Surgery

Abstract Background The SHARPEN score was developed to predict in-hospital mortality in patients hospitalized for infective endocarditis (IE), undergoing or not undergoing cardiac surgery. A comparison with other available scores has not yet been carried out. Objective To evaluate the performance of the SHARPEN score in predicting in-hospital mortality in patients hospitalized for IE undergoing cardiac surgery and compare it with that of both nonspecific and IE-specific surgical scores. Methods Retrospective cohort study including all admissions of patients ≥18 years who underwent cardiac surgery due to active IE (modified Duke criteria) at a tertiary care university hospital between 2007 and 2016. The SHARPEN score was compared to the EuroSCORE, EuroSCORE II, STS-IE, PALSUSE, AEPEI, EndoSCORE and RISK-E scores. Differences P<0.05 were considered statistically significant. Results A total of 105 hospitalizations of 101 patients (mean age 57.4±14.6 years; 75.2% male) were included. The median SHARPEN score was 11 (9-13) points. The observed in-hospital mortality was 29.5%. There was no statistically significant difference in observed vs. estimated mortality (P = 0.147), with an area under the ROC curve of 0.66 (P = 0.008). In comparison with the other scores, no difference was observed in discriminative ability. The statistics of the SHARPEN score at a cutoff >10 points — positive predictive value (PPV): 38.1%, 95%CI:30.4-46.6; negative predictive value (NPV): 80.0%, 95%CI:69.8-87.4; and accuracy: 58.1%, 95%CI:48.1-67.6 — showed overlapping 95%CIs, indicating no significant difference between scores. Conclusions The SHARPEN score did not present parameters with a significant difference in relation to the other scores analyzed; despite the easy obtainment of its few variables, it has limited applicability in clinical practice, like other existing scores.

Reply to the letter "Understanding lactate and its clearance during extracorporeal membrane oxygenation for supporting refractory cardiogenic shock patients".

This is a reply to the letter titled "Understanding lactate and its clearance during extracorporeal membrane oxygenation for supporting refractory cardiogenic shock patients" by Eva Rully Kurniawati et al. In response to the concerns raised about our paper published in BMC Cardiovascular Disorders, titled "Association between serum lactate levels and mortality in patients with cardiogenic shock receiving mechanical circulatory support: a multicenter retrospective cohort study," we have addressed the confounding bias on the population included and the use of VA-ECMO and Impella CP. Furthermore, we have provided new data on the correlation of oxygen supply and lactate levels at admission of cardiogenic shock.

A multi-intervention protocol to improve sleep quality in a coronary care unit.

AIMS: Poor sleep is a frequent occurrence in the critical illness. Evaluate sleep quality and test the effect of a multi-intervention sleep care protocol in improving sleep quality in a coronary care unit (CCU). METHODS AND RESULTS: Quasi-experimental study, carried out in two phases. During the first phase, the control group (n = 58 patients) received usual care. Baseline sleep data were collected through the Richards-Campbell Sleep Questionnaire (RCSQ) and the Sleep in the Intensive Care Unit Questionnaire (SICUQ). During the second phase (n = 55 patients), a sleep care protocol was implemented. Interventions included actions to promote analgesia, reduce noise, brightness, and other general measures. Sleep data were collected again to assess the impact of these interventions. The intervention group had better scores in overall sleep depth [median (interquartile range)] [81 (65-96.7) vs. 69.7 (50-90); P = 0.046]; sleep fragmentation [90 (65-100) vs. 69 (42.2-92.7); P = 0.011]; return to sleep [90 (69.7-100) vs. 71.2 (40.7-96.5); P = 0.007]; sleep quality [85 (65-100) vs. 71.1 (49-98.1); P = 0.026]; and mean RCSQ score [83 (66-94) vs. 66.5 (45.7-87.2); P = 0.002] than the baseline group. The main barriers to sleep were pain [1 (1.0-5.5)], light [1 (1.0-5.0)], and noise [1 (1.0-5.0)]. The most rated sources of sleep-disturbing noise were heart monitor alarm [3 (1.0-5.25)], intravenous pump alarm [1.5 (1.0-5.00)]. and mechanical ventilator alarm [1 (1.0-5.0)]. All were significantly lower in the intervention group than in the baseline group. CONCLUSION: A multi-intervention protocol was feasible and effective in improving different sleep quality parameters and reducing some barriers to sleep in CCU patients.

Effectiveness of chlorthalidone/amiloride versus losartan in patients with stage I hypertension and diabetes mellitus: results from the PREVER-treatment randomized controlled trial.

AIMS: To compare the blood pressure (BP)-lowering efficacy of a chlorthalidone/amiloride combination pill with losartan, during initial management of JNC 7 Stage I hypertension in patients with type 2 diabetes mellitus. METHODS: In an a priori subgroup analysis of a randomized, double-blind, controlled trial, volunteers aged 30-70 years, with stage I hypertension and diabetes mellitus, were randomized to 12.5/2.5 mg of chlorthalidone/amiloride (N = 47) or 50 mg of losartan (N = 50), and followed for 18 months in 21 clinical centers. If BP remained uncontrolled after three months, study medication dose was doubled, and if uncontrolled after six months, amlodipine (5 and 10 mg) and propranolol (40 and 80 mg BID) were added as open label drugs in a progressive fashion. RESULTS: Systolic BP decreased to a greater extent in participants allocated to diuretics compared to losartan (P < 0.001). After 18 months of follow-up, systolic BP was 128.4 ± 10.3 mmHg in the diuretic group versus 133.5 ± 8.0 in the losartan group (P < 0.01). In the diuretic group, 36 out of 43 participants (83.7%) had a JNC 7 normal BP, compared to 31/47 (66%) in the losartan group (P = 0.089). Serum cholesterol was higher in the diuretic arm at the end of the trial. Other biochemical parameters and reports of adverse events did not differ by treatment. CONCLUSIONS: Treatment of hypertension based on a combination of chlorthalidone and amiloride is more effective for BP lowering compared to losartan in patients with diabetes mellitus and hypertension. TRIAL REGISTRATION: Clinical trials registration number: NCT00971165.

Association between serum lactate levels and mortality in patients with cardiogenic shock receiving mechanical circulatory support: a multicenter retrospective cohort study.

BACKGROUND: To evaluate the prognostic value of peak serum lactate and lactate clearance at several time points in cardiogenic shock treated with temporary mechanical circulatory support (MCS) using veno-arterial extracorporeal membrane oxygenation (VA-ECMO) or Impella CP®. METHODS: Serum lactate and clearance were measured before MCS and at 1 h, 6 h, 12 h, and 24 h post-MCS in 43 patients at four tertiary-care centers in Southern Brazil. Prognostic value was assessed by univariable and multivariable analysis and receiver operating characteristic (ROC) curves for 30-day mortality. RESULTS: VA-ECMO was the most common MCS modality (58%). Serum lactate levels at all time points and lactate clearance after 6 h were associated with mortality on unadjusted and adjusted analyses. Lactate levels were higher in non-survivors at 6 h, 12 h, and 24 h after MCS. Serum lactate > 1.55 mmol/L at 24 h was the best single prognostic marker of 30-day mortality [area under the ROC curve = 0.81 (0.67-0.94); positive predictive value = 86%). Failure to improve serum lactate after 24 h was associated with 100% mortality. CONCLUSIONS: Serum lactate was an important prognostic biomarker in cardiogenic shock treated with temporary MCS. Serum lactate and lactate clearance at 24 h were the strongest independent predictors of short-term survival.

Analysis of Risk Scores to Predict Mortality in Patients Undergoing Cardiac Surgery for Endocarditis. / Análise de Escores de Risco para Predição de Mortalidade em Pacientes Submetidos à Cirurgia Cardíaca por Endocardite.

BACKGROUND: Risk scores are available for use in daily clinical practice, but knowing which one to choose is still fraught with uncertainty. OBJECTIVES: To assess the logistic EuroSCORE, EuroSCORE II, and the infective endocarditis (IE)-specific scores STS-IE, PALSUSE, AEPEI, EndoSCORE and RISK-E, as predictors of hospital mortality in patients undergoing cardiac surgery for active IE at a tertiary teaching hospital in Southern Brazil. METHODS: Retrospective cohort study including all patients aged ≥ 18 years who underwent cardiac surgery for active IE at the study facility from 2007-2016. The scores were assessed by calibration evaluation (observed/expected [O/E] mortality ratio) and discrimination (area under the ROC curve [AUC]). Comparison of AUC was performed by the DeLong test. A p < 0.05 was considered statistically significant. RESULTS: A total of 107 patients were included. Overall hospital mortality was 29.0% (95%CI: 20.4-37.6%). The best O/E mortality ratio was achieved by the PALSUSE score (1.01, 95%CI: 0.70-1.42), followed by the logistic EuroSCORE (1.3, 95%CI: 0.92-1.87). The logistic EuroSCORE had the highest discriminatory power (AUC 0.77), which was significantly superior to EuroSCORE II (p = 0.03), STS-IE (p = 0.03), PALSUSE (p = 0.03), AEPEI (p = 0.03), and RISK-E (p = 0.02). CONCLUSIONS: Despite the availability of recent IE-specific scores, and considering the trade-off between the indexes, the logistic EuroSCORE seemed to be the best predictor of mortality risk in our cohort, taking calibration (O/E mortality ratio: 1.3) and discrimination (AUC 0.77) into account. Local validation of IE-specific scores is needed to better assess preoperative surgical risk. (Arq Bras Cardiol. 2020; 114(3):518-524).

FUNDAMENTO: Escores de risco estão disponíveis para uso na prática clínica diária, mas saber qual deles escolher é ainda incerto. OBJETIVOS: Avaliar o EuroSCORE logístico, o EuroSCORE II e os escores específicos para endocardite infecciosa STS-IE, PALSUSE, AEPEI, EndoSCORE e RISK-E na predição de mortalidade hospitalar de pacientes submetidos à cirurgia cardíaca por endocardite ativa em um hospital terciário de ensino do sul do Brasil. MÉTODOS: Estudo de coorte retrospectivo incluindo todos os pacientes com idade ≥ 18 anos submetidos à cirurgia cardíaca por endocardite ativa no centro do estudo entre 2007 e 2016. Foram realizadas análises de calibração (razão de mortalidade observada/esperada, O/E) e de discriminação (área sob a curva ROC, ASC), sendo a comparação das ASC realizada pelo teste de DeLong. P < 0,05 foi considerado estatisticamente significativo. RESULTADOS: Foram incluídos 107 pacientes, sendo a mortalidade hospitalar de 29,0% (IC95%: 20.4-37.6%). A melhor razão de mortalidade O/E foi obtida pelo escore PALSUSE (1,01, IC95%: 0,70-1,42), seguido pelo EuroSCORE logístico (1,3, IC95%: 0,92-1,87). O EuroSCORE logístico apresentou o maior poder discriminatório (ASC 0,77), significativamente superior ao EuroSCORE II (p = 0,03), STS-IE (p = 0,03), PALSUSE (p = 0,03), AEPEI (p = 0,03) e RISK-E (p = 0,02). CONCLUSÕES: Apesar da disponibilidade dos recentes escores específicos, o EuroSCORE logístico foi o melhor preditor de mortalidade em nossa coorte, considerando-se análise de calibração (mortalidade O/E: 1,3) e de discriminação (ASC 0,77). A validação local dos escores específicos é necessária para uma melhor avaliação do risco cirúrgico. (Arq Bras Cardiol. 2020; 114(3):518-524).

Análise de Escores de Risco para Predição de Mortalidade em Pacientes Submetidos à Cirurgia Cardíaca por Endocardite / Analysis of Risk Scores to Predict Mortality in Patients Undergoing Cardiac Surgery for Endocarditis

Resumo Fundamento Escores de risco estão disponíveis para uso na prática clínica diária, mas saber qual deles escolher é ainda incerto. Objetivos Avaliar o EuroSCORE logístico, o EuroSCORE II e os escores específicos para endocardite infecciosa STS-IE, PALSUSE, AEPEI, EndoSCORE e RISK-E na predição de mortalidade hospitalar de pacientes submetidos à cirurgia cardíaca por endocardite ativa em um hospital terciário de ensino do sul do Brasil. Métodos Estudo de coorte retrospectivo incluindo todos os pacientes com idade ≥ 18 anos submetidos à cirurgia cardíaca por endocardite ativa no centro do estudo entre 2007 e 2016. Foram realizadas análises de calibração (razão de mortalidade observada/esperada, O/E) e de discriminação (área sob a curva ROC, ASC), sendo a comparação das ASC realizada pelo teste de DeLong. P < 0,05 foi considerado estatisticamente significativo Resultados Foram incluídos 107 pacientes, sendo a mortalidade hospitalar de 29,0% (IC95%: 20.4-37.6%). A melhor razão de mortalidade O/E foi obtida pelo escore PALSUSE (1,01, IC95%: 0,70-1,42), seguido pelo EuroSCORE logístico (1,3, IC95%: 0,92-1,87). O EuroSCORE logístico apresentou o maior poder discriminatório (ASC 0,77), significativamente superior ao EuroSCORE II (p = 0,03), STS-IE (p = 0,03), PALSUSE (p = 0,03), AEPEI (p = 0,03) e RISK-E (p = 0,02). Conclusões Apesar da disponibilidade dos recentes escores específicos, o EuroSCORE logístico foi o melhor preditor de mortalidade em nossa coorte, considerando-se análise de calibração (mortalidade O/E: 1,3) e de discriminação (ASC 0,77). A validação local dos escores específicos é necessária para uma melhor avaliação do risco cirúrgico. (Arq Bras Cardiol. 2020; 114(3):518-524)

Abstract Background Risk scores are available for use in daily clinical practice, but knowing which one to choose is still fraught with uncertainty. Objectives To assess the logistic EuroSCORE, EuroSCORE II, and the infective endocarditis (IE)-specific scores STS-IE, PALSUSE, AEPEI, EndoSCORE and RISK-E, as predictors of hospital mortality in patients undergoing cardiac surgery for active IE at a tertiary teaching hospital in Southern Brazil. Methods Retrospective cohort study including all patients aged ≥ 18 years who underwent cardiac surgery for active IE at the study facility from 2007-2016. The scores were assessed by calibration evaluation (observed/expected [O/E] mortality ratio) and discrimination (area under the ROC curve [AUC]). Comparison of AUC was performed by the DeLong test. A p < 0.05 was considered statistically significant. Results A total of 107 patients were included. Overall hospital mortality was 29.0% (95%CI: 20.4-37.6%). The best O/E mortality ratio was achieved by the PALSUSE score (1.01, 95%CI: 0.70-1.42), followed by the logistic EuroSCORE (1.3, 95%CI: 0.92-1.87). The logistic EuroSCORE had the highest discriminatory power (AUC 0.77), which was significantly superior to EuroSCORE II (p = 0.03), STS-IE (p = 0.03), PALSUSE (p = 0.03), AEPEI (p = 0.03), and RISK-E (p = 0.02). Conclusions Despite the availability of recent IE-specific scores, and considering the trade-off between the indexes, the logistic EuroSCORE seemed to be the best predictor of mortality risk in our cohort, taking calibration (O/E mortality ratio: 1.3) and discrimination (AUC 0.77) into account. Local validation of IE-specific scores is needed to better assess preoperative surgical risk. (Arq Bras Cardiol. 2020; 114(3):518-524)

Effect of motivational interviewing in hypertensive patients (MIdNIgHT): study protocol for a randomized controlled trial.

BACKGROUND: Only one-third of hypertensive patients achieve and maintain blood-pressure control. This is attributed to low treatment adherence and has a negative impact on clinical outcomes. Adherence is multidimensional and involves aspects both related to patient characteristics and to the chronic nature of the disease. In this context, motivational interviewing has been proposed as an approach to foster patients' motivations to change their behavior for the benefit of their own health, thus providing more lasting behavioral changes. DESIGN AND METHODS: Single-center, parallel, randomized controlled trial with outcome-assessor blinding. This study will select adult patients (n = 120) diagnosed with hypertension who receive regular follow-up in a specialized outpatient clinic. Patients will be randomly allocated across two groups: the intervention group will have appointments focused on motivational interviewing, while the control group will have traditional appointments. Patients will be monitored face-to-face, once monthly for six months. The primary outcomes will be a reduction of at least 8 mmHg in systolic blood pressure and changes in mean blood pressure measured by 24-h ambulatory blood pressure monitoring. Secondary outcomes include improvement of adherence to a low-sodium diet, adherence to self-care behaviors, regular use of antihypertensive medications, increase or maintenance of physical activity, weight reduction, evaluation of changes in daytime sleepiness, and cessation of smoking. DISCUSSION: This study shows an intervention strategy that will be tested and, if effective, warrant replication in monitoring of other chronic diseases. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02892929 . Registered on 24 August 2016.

C-reactive protein and blood pressure variability in type 2 hypertensive diabetic patients.

OBJECTIVE: Increased blood pressure (BP) variability and inflammation are included among the factors recognized as potential predictors of cardiovascular events in type 2 diabetes and hypertension. This study aimed to evaluate whether C-reactive protein (CRP) is associated with increased BP variability in diabetic-hypertensive patients. PATIENTS AND METHODS: We carried out a cross-sectional study with 285 diabetic-hypertensive patients, evaluating laboratory characteristics and 24-h ambulatory BP monitoring. SD, coefficient of variation (CV%), time-rate index of 24-h systolic BP (SBP), and 24-h BP patterns were evaluated. Pearson's χ-test, Student's t-test, and the Mann-Whitney test were used to compare the groups. Groups were defined by CRP of up to 3 mg/l (low) and more than 3 mg/l (high). RESULTS: The age of the patients was 59 (54-62) years; 101 (35%) were men. There was an increase in office SBP [137 (127-148) vs. 145 (130-157) mmHg] and DBP [79 (73-86) vs. 82 (76-91) mmHg] in the high CRP group. Blood pressure variability indexes were not different among groups [SD: 11.2 (9-15) vs. 12.2 (10-15) mmHg; CV%: 8.6 (7-11) vs. 9.4 (7-12); time rate: 0.55±0.12 vs.12.2 (10-15) mmHg/min]. In addition, BMI (29.3±3.8 vs. 30.9±3.6 kg/m), total cholesterol [166 (148-190) vs. 177 (156-210) mg/dl], and HbA1c [7.5% (6.6-8.9) vs.8.3% (7.1-9.9)] were higher in the high CRP group. CONCLUSION: In patients with diabetes and hypertension, higher CRP levels are linked to cardiometabolic derangements, although they are not associated with increased BP variability.

Early Manipulation of Arterial Blood Pressure in Acute Ischemic Stroke (MAPAS): Results of a Randomized Controlled Trial.

INTRODUCTION: There is uncertainty over the optimal level of systolic blood pressure (SBP) in the setting of acute ischemic stroke (AIS). The aim of this study was to determine the efficacy of the early manipulation of SBP in non-thrombolised patients. The key hypothesis under investigation was that clinical outcomes vary across ranges of SBP in AIS. METHODS: 218 patients were randomized within 12 h of AIS to maintain the SBP during 24 h within three ranges: Group 1 140-160 mmHg, Group 2 161-180 mmHg or Group 3 181-200 mmHg. Vasoactive drugs and fluids were used to achieve these targets. Good outcome was defined as a modified Rankin score 0-2 at 90-days. RESULTS: The median SBP in the three groups in 24 h was: 153 mmHg, 163 mmHg, and 178 mmHg, respectively, P < 0.0001. Good clinical outcome did not differ among the different groups (51% vs 52% vs 39%, P = 0.27). Symptomatic intracranial hemorrhage (SICH) was more frequent in the higher SBP range (1% vs 2.7% vs 9.1%, P = 0.048) with similar mortality rates. No patient had acute neurological deterioration related to the SBP reduction in the first 24 h. In our logistic regression analysis, the odds of having good clinical outcome was higher in Group 2 (OR 2.83) after adjusting for important confounders. Regardless of the assigned group, the probability of good outcome was 47% in patients who were manipulated to increase the BP, 42% to decrease and 62% in non-manipulated (P = 0.1). Adverse effects were limited to Group 2 (4%) and Group 3 (7.6%) and were associated with the use of norepinephrine (P = 0.05). CONCLUSIONS: Good outcome in 90 days was not significantly different among the 3 blood pressure ranges. After logistic regression analysis, the odds of having good outcome was greater in Group 2 (SBP 161-180 mmHg). SICH occurred more frequently in Group 3 (181-200 mmHg).

Effect of metformin on blood pressure in patients with hypertension: a randomized clinical trial.

OBJECTIVE: Part of the beneficial effects of metformin on the prevention of cardiovascular events in diabetes can be attributed to pleiotropic effects, including a blood pressure (BP)-lowering effect. In a double-blind parallel clinical trial (NCT02072382), the effect of metformin on BP evaluated by ambulatory blood pressure monitoring (ABPM) was measured. METHODS: Ninety-seven patients with hypertension, but without diabetes mellitus, were randomized to receive 850-1700 mg of metformin (n = 48) or placebo (n = 49). Clinical, laboratory, and ABPM data were collected at the baseline and after 8 weeks of follow-up. RESULTS: The sample consisted mainly of White overweight women. There was no difference in BP reduction measured by ABPM between both groups. There was no effect in BP measured in the different periods of ABP monitoring and office BP. Additionally, fasting plasma glucose, lipids, and C-reactive protein remained unchanged during the trial. There was a significant reduction in waist circumference with metformin (95.1 ± 10.4 to 89.3 ± 27.4 cm; p = 0.02). CONCLUSION: In the present trial, metformin did not reduce BP, measured by ABP monitoring, in hypertensive patients without diabetes.

Partial anomalous pulmonary venous connection in a 72-year-old woman: A case report.

Partial Anomalous Pulmonary Venous Connection is a congenital abnormality characterized by drainage of one or more, but not all, pulmonary veins to the right atrium or to one of the systemic veins. This pathology has low prevalence, although it probably is underestimated and is rarely diagnosed in adults. This report describes a case of a 72-year-old woman with long-term worsening shortness of breath and elevated pulmonary artery systolic pressure in which Partial Anomalous Pulmonary Venous Connection was occasionally diagnosed through imaging methods.

Correlation between Very Short and Short-Term Blood Pressure Variability in Diabetic-Hypertensive and Healthy Subjects.

BACKGROUND: Blood pressure (BP) variability can be evaluated by 24-hour ambulatory BP monitoring (24h-ABPM), but its concordance with results from finger BP measurement (FBPM) has not been established yet. OBJECTIVE: The aim of this study was to compare parameters of short-term (24h-ABPM) with very short-term BP variability (FBPM) in healthy (C) and diabetic-hypertensive (DH) subjects. METHODS: Cross-sectional study with 51 DH subjects and 12 C subjects who underwent 24h-ABPM [extracting time-rate, standard deviation (SD), coefficient of variation (CV)] and short-term beat-to-beat recording at rest and after standing-up maneuvers [FBPM, extracting BP and heart rate (HR) variability parameters in the frequency domain, autoregressive spectral analysis]. Spearman correlation coefficient was used to correlate BP and HR variability parameters obtained from both FBPM and 24h-ABPM (divided into daytime, nighttime, and total). Statistical significance was set at p < 0.05. RESULTS: There was a circadian variation of BP levels in C and DH groups; systolic BP and time-rate were higher in DH subjects in all periods evaluated. In C subjects, high positive correlations were shown between time-rate index (24h-ABPM) and LF component of short-term variability (FBPM, total, R = 0.591, p = 0.043); standard deviation (24h-ABPM) with LF component BPV (FBPM, total, R = 0.608, p = 0.036), coefficient of variation (24h-ABPM) with total BPV (FBPM, daytime, -0.585, p = 0.046) and alpha index (FBPM, daytime, -0.592, p = 0.043), time rate (24h-ABPM) and delta LF/HF (FBPM, total, R = 0.636, p = 0.026; daytime R = 0,857, p < 0.001). Records obtained from DH showed weak positive correlations. CONCLUSIONS: Indices obtained from 24h-ABPM (total, daytime) reflect BP and HR variability evaluated by FBPM in healthy individuals. This does not apply for DH subjects.

Correlation between Very Short and Short-Term Blood Pressure Variability in Diabetic-Hypertensive and Healthy Subjects / Correlação entre a Variabilidade da Pressão Arterial de Muito Curto Prazo e Curto Prazo em Indivíduos Diabéticos-Hipertensos e Saudáveis

Abstract Background: Blood pressure (BP) variability can be evaluated by 24-hour ambulatory BP monitoring (24h-ABPM), but its concordance with results from finger BP measurement (FBPM) has not been established yet. Objective: The aim of this study was to compare parameters of short-term (24h-ABPM) with very short-term BP variability (FBPM) in healthy (C) and diabetic-hypertensive (DH) subjects. Methods: Cross-sectional study with 51 DH subjects and 12 C subjects who underwent 24h-ABPM [extracting time-rate, standard deviation (SD), coefficient of variation (CV)] and short-term beat-to-beat recording at rest and after standing-up maneuvers [FBPM, extracting BP and heart rate (HR) variability parameters in the frequency domain, autoregressive spectral analysis]. Spearman correlation coefficient was used to correlate BP and HR variability parameters obtained from both FBPM and 24h-ABPM (divided into daytime, nighttime, and total). Statistical significance was set at p < 0.05. Results: There was a circadian variation of BP levels in C and DH groups; systolic BP and time-rate were higher in DH subjects in all periods evaluated. In C subjects, high positive correlations were shown between time-rate index (24h-ABPM) and LF component of short-term variability (FBPM, total, R = 0.591, p = 0.043); standard deviation (24h-ABPM) with LF component BPV (FBPM, total, R = 0.608, p = 0.036), coefficient of variation (24h-ABPM) with total BPV (FBPM, daytime, -0.585, p = 0.046) and alpha index (FBPM, daytime, -0.592, p = 0.043), time rate (24h-ABPM) and delta LF/HF (FBPM, total, R = 0.636, p = 0.026; daytime R = 0,857, p < 0.001). Records obtained from DH showed weak positive correlations. Conclusions: Indices obtained from 24h-ABPM (total, daytime) reflect BP and HR variability evaluated by FBPM in healthy individuals. This does not apply for DH subjects.

Resumo Fundamento: A variabilidade da pressão arterial (PA) pode ser avaliada por meio da monitorização ambulatorial da PA em 24 horas (MAPA-24h), mas sua concordância com os resultados da medição da PA digital (MPAD) ainda não foi estabelecida. Objetivo: O objetivo deste estudo foi comparar os parâmetros da variabilidade a curto prazo (MAPA-24h) com a variabilidade da PA a muito curto prazo (MPAD) em sujeitos saudáveis (C) e diabéticos-hipertensos (DH). Métodos: Estudo transversal com 51 sujeitos DH e 12 sujeitos C que se submeteram a MAPA-24h [extraindo time rate, desvio padrão (SD) e coeficiente de variação (CV)] e registro batimento-a-batimento em repouso e após manobra de manobra de ortostatismo ativo [MPAD, extraindo parâmetros de variabilidade da PA e da frequência cardíaca (FC) no domínio da frequência, análise espectral por modelagem autoregressiva]. O coeficiente de correlação de postos de Spearman foi utilizado para correlacionar os parâmetros de variabilidade de PA e FC obtidos tanto da MPAD quanto da MAPA-24h (dividida em dia, noite e total). A significância estatística foi estabelecida em p < 0.05. Resultados: Houve uma variação circadiana dos níveis de PA nos grupos C e DH; A PA sistólica e a taxa de tempo foram maiores em indivíduos DH em todos os períodos avaliados. Em indivíduos C, foram apresentadas altas correlações positivas entre o índice de taxa de tempo (MAPA-24h) e o componente de baixa frequência (LF, do inglês low frequency) da variabilidade de curto prazo (MPAD, total, R = 0,591, p = 0,043); desvio padrão (MAPA-24h) com o componente de LF VPA (MPAD, total, R = 0,608, p = 0,036), coeficiente de variação (24h-ABPM) com VPA total (MPAD, dia, -0,585, p = 0,046) e índice alfa (MPAD, dia, -0,592, p = 0,043), taxa de tempo (MAPA-24h) e delta LF/HF (MPAD, total, R = 0,636, p = 0,026; dia R = 0,857, p < 0,001). Os registros obtidos dos pacientes DH apresentaram correlações positivas fracas. Conclusões: Os índices obtidos a partir da MAPA-24h (total, durante o dia) refletem a variabilidade da PA e da FC avaliada pela MPAD em indivíduos saudáveis, o que não se aplica a indivíduos DH.