RESUMO
BACKGROUND: Carotid intima-media thickness (cIMT) has been suggested as a further tool for risk function charts. The aim of this study was to describethe relationship between cIMT and cardiovascular risk (CVR) estimation according to Framingham-REGICOR and SCORE equations. METHODS: Observational, cross-sectional cohort study from 362 hypertensive subjects. Demographic and clinical information were collected as well as laboratory, ultrasonographic and CVR estimation by the Framingham-REGICOR and SCORE functions. Statistical analysis was performed using SPSS software (version 20,0). To analyze the data, statistical tests such as Chi-square, T-test, ANOVA, and Pearson correlation coefficient were used. RESULTS: According to both functions, differences on mean cIMT were found between low CVR group and intermediate to high groups. No differences were found between intermediate and high risk groups (cIMT: 0,73mm low risk patients vs. 0,89 or 0,88mm respectively according to SCORE function and cIMT: 0,73 vs. 0,85 or 0,87mm respectively according to Framingham-REGICOR function). cIMT correlated positively with CVR estimation according to both SCORE (r=0,421; P<.01), and Framingham-REGICOR functions (r=0,363; P<.01). CONCLUSIONS: cIMT correlates positively with CVR estimated by SCORE and Framingham-REGICOR functions. cIMT in those subjects at intermediate risk is similar to those at high risk. Our findings highlight the importance of carotid ultrasound in identifying silent target-organ damage in those patients at intermediate CVR.
Assuntos
Doenças Cardiovasculares/epidemiologia , Espessura Intima-Media Carotídea , Hipertensão , Artérias Carótidas , Distribuição de Qui-Quadrado , Estudos de Coortes , Estudos Transversais , Humanos , Medição de Risco , Fatores de RiscoRESUMO
OBJECTIVE: To assess predictive value of the cardiovascular prognosis by comparing the two most used formulas for the estimation of glomerular filtration rate in hypertensive patients. MATERIAL AND METHODS: A retrospective cohort study was designed that included 405 patients diagnosed with essential hypertension. The patients were referred from Primary Care to the Hypertension and Vascular Risk Unit between January 1, 1998 and August 31, 1999. Blood pressure measurements, blood and urine analysis, and echocardiography were simultaneously performed. They were followed up for 12.5 years (mean [± IQR]: 10.61 [± 3.11] years) and 174 events were recorded. RESULTS: The study included 405 patients (53.8% women), with a mean age of 55.5 years. The estimated glomerular filtration rate according to the MDRD and CKD-EPI equations was 73.9±2.6 mL/min/1.73m(2) and 76.9±2.2 mL/min/1.73m(2), respectively. The prevalence of chronic kidney disease was 31.6% and 23.9%, respectively. Using the CKD-EPI equation led to the re-classification of 22.9% of patients. The incidence rate ratio (IRR [95%CI] for chronic kidney disease identified by the MDRD equation was 2.4 [1.8-3.3], and for the CKD-EPI calculation it was 2.5 [1.8 to 3.3]). CONCLUSIONS: Both equations estimate similar magnitudes of renal function, although the CKD-EPI equation has less false positives, and both have similar prognostic values in patients at high cardiovascular risk as well those at low risk.
Assuntos
Doenças Cardiovasculares/diagnóstico , Taxa de Filtração Glomerular , Hipertensão/fisiopatologia , Insuficiência Renal Crônica/diagnóstico , Estudos de Coortes , Hipertensão Essencial , Feminino , Seguimentos , Humanos , Testes de Função Renal , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prevalência , Prognóstico , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/fisiopatologia , Estudos Retrospectivos , Fatores de RiscoRESUMO
Antecedentes y objetivos: Son múltiples los estudios que avalan el papel pronóstico que han mostrado tanto la presión arterial (PA) ambulatoria como la hipertrofia ventricular izquierda (HVI) en el paciente hipertenso. Por ello, nos planteamos evaluar la correlación existente entre determinados parámetros de la PA ambulatoria y la masa ventricular izquierda (MVI) medida por ecocardiografía, en una muestra de pacientes hipertensos. Material y métodos Se diseñó un estudio transversal retrospectivo, que incluyó a 405 pacientes (53,8% mujeres), con una edad media de 55,5 años, diagnosticados de HTA esencial, remitidos a la Unidad de HTA y Riesgo Vascular, desde atención primaria, entre el 1 de enero de 1998 y el 31 de agosto de 1999. En todos los casos se realizó una evaluación clínica y biológica (según protocolo estandarizado), estudio ecocardiográfico y MAPA de 24 h (monitor Space Labs 90207).Resultados La MAPA demostró un mal control de la HTA en 320 pacientes (79%); la profundidad de la PA sistólica fue del 10,6 ± 0,9%. La prevalencia de perfil dipper fue del 43,8%, del dipper-extremo 13,4%, del no dipper 30,2% y del riser 12,6%. Se identificó a 248 pacientes (61,23%) con HVI. El aumento de la PA ambulatoria nocturna se asoció con un incremento de la MVI (p < 0,0001) y se objetivó una correlación estadísticamente significativa y negativa entre la disminución de la profundidad de la PA y el incremento del índice de MVI (p < 0,0001).Conclusión El incremento de la MVI se asocia con HTA nocturna y disminución de la profundidad nocturna de la PA (AU)
Background and objectives: Multiple studies support the prognostic role of both ambulatory blood pressure (BP) monitoring and left ventricular hypertrophy (LVH) in patients with hypertension. Consequently, we evaluated the correlation between certain ambulatory BP monitoring parameters and left ventricular mass (LVM) measured by echocardiography in a sample of hypertensive patients. Material and methods: A cross sectional, retrospective study was performed in 405 patients(53.8% women; mean age, 55.5 years), diagnosed with essential hypertension and referred to the Hypertension and Vascular Risk Unit by their primary care centers between 1 January,1998 and 31 August, 1999. All patients underwent clinical and biological evaluation (using a standardized protocol), echocardiography, and 24-hour ambulatory BP monitoring (SaceLabs90207).Results: Ambulatory BP monitoring revealed poor BP control in 320 patients (79%); the meandip in systolic BP was 10.6 ± 0.9%. The dipper pattern was observed in 43.8%, the extreme dipper pattern in 13.4%, the non-dipper pattern in 30.2%, and the riser pattern in 12.6%. Left ventricular hypertrophy was identified in 248 patients (61.23%). An increase in ambulatory nocturnal BP was associated with an increase in LVM (p < 0.0001) and a statistically significant negative correlation was observed between the drop in BP and the increase in LVM (P<.0001).Conclusion: An increase in LVM was associated with nocturnal hypertension and a decrease in the nocturnal drop in BP (AU)
