Assuntos
Hipertensão , Brasil , Humanos , Hipertensão/diagnóstico , Hipertensão/prevenção & controleRESUMO
ABSTRACT: The aim of this study is to compare spironolactone versus clonidine as the fourth drug in patients with resistant hypertension in a multicenter, randomized trial. Medical therapy adherence was checked by pill counting. Patients with resistant hypertension (no office and ambulatory blood pressure [BP] monitoring control, despite treatment with 3 drugs, including a diuretic, for 12 weeks) were randomized to an additional 12-week treatment with spironolactone (12.5-50 mg QD) or clonidine (0.1-0.3 mg BID). The primary end point was BP control during office (<140/90 mm Hg) and 24-h ambulatory (<130/80 mm Hg) BP monitoring. Secondary end points included BP control from each method and absolute BP reduction. From 1597 patients recruited, 11.7% (187 patients) fulfilled the resistant hypertension criteria. Compared with the spironolactone group (n=95), the clonidine group (n=92) presented similar rates of achieving the primary end point (20.5% versus 20.8%, respectively; relative risk, 1.01 [0.55-1.88]; P=1.00). Secondary end point analysis showed similar office BP (33.3% versus 29.3%) and ambulatory BP monitoring (44% versus 46.2%) control for spironolactone and clonidine, respectively. However, spironolactone promoted greater decrease in 24-h systolic and diastolic BP and diastolic daytime ambulatory BP than clonidine. Per-protocol analysis (limited to patients with ≥80% adherence to spironolactone/clonidine treatment) showed similar results regarding the primary end point. In conclusion, clonidine was not superior to spironolactone in true resistant hypertensive patients, but the overall BP control was low (≈21%). Considering easier posology and greater decrease in secondary end points, spironolactone is preferable for the fourth-drug therapy.
Assuntos
Espironolactona , Clonidina , Tratamento Farmacológico , HipertensãoRESUMO
The aim of this study is to compare spironolactone versus clonidine as the fourth drug in patients with resistant hypertension in a multicenter, randomized trial. Medical therapy adherence was checked by pill counting. Patients with resistant hypertension (no office and ambulatory blood pressure [BP] monitoring control, despite treatment with 3 drugs, including a diuretic, for 12 weeks) were randomized to an additional 12-week treatment with spironolactone (12.5-50 mg QD) or clonidine (0.1-0.3 mg BID). The primary end point was BP control during office (<140/90 mm Hg) and 24-h ambulatory (<130/80 mm Hg) BP monitoring. Secondary end points included BP control from each method and absolute BP reduction. From 1597 patients recruited, 11.7% (187 patients) fulfilled the resistant hypertension criteria. Compared with the spironolactone group (n=95), the clonidine group (n=92) presented similar rates of achieving the primary end point (20.5% versus 20.8%, respectively; relative risk, 1.01 [0.55-1.88]; P=1.00). Secondary end point analysis showed similar office BP (33.3% versus 29.3%) and ambulatory BP monitoring (44% versus 46.2%) control for spironolactone and clonidine, respectively. However, spironolactone promoted greater decrease in 24-h systolic and diastolic BP and diastolic daytime ambulatory BP than clonidine. Per-protocol analysis (limited to patients with ≥80% adherence to spironolactone/clonidine treatment) showed similar results regarding the primary end point. In conclusion, clonidine was not superior to spironolactone in true resistant hypertensive patients, but the overall BP control was low (≈21%). Considering easier posology and greater decrease in secondary end points, spironolactone is preferable for the fourth-drug therapy. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01643434.
Assuntos
Pressão Sanguínea/efeitos dos fármacos , Clonidina , Hipertensão , Espironolactona , Adulto , Idoso , Anti-Hipertensivos/administração & dosagem , Anti-Hipertensivos/efeitos adversos , Anti-Hipertensivos/classificação , Monitorização Ambulatorial da Pressão Arterial/métodos , Clonidina/administração & dosagem , Clonidina/efeitos adversos , Monitoramento de Medicamentos/métodos , Resistência a Medicamentos , Quimioterapia Combinada/métodos , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Hipertensão/fisiopatologia , Masculino , Adesão à Medicação , Pessoa de Meia-Idade , Espironolactona/administração & dosagem , Espironolactona/efeitos adversos , Resultado do TratamentoRESUMO
BACKGROUND:: Lack of adherence to pharmacological treatment is one of the main causes of low control rates in hypertension. OBJECTIVE:: To verify treatment adherence and associated factors, as well as blood pressure (BP) control in participants of the Resistant Hypertension Optimal Treatment (ReHOT) clinical trial. METHOD:: Cross-sectional study including all 109 patients who had completed the ReHOT for at least 6 months. We excluded those participants who failed to respond to the new recruitment after three phone contact attempts. We evaluated the BP control by ambulatory BP monitoring (ABPM; controlled levels: 24-hour systolic and diastolic BP < 130 x 80 mmHg) and analyzed the patients' treatment adherence using the Morisky Medication Adherence Scale (MMAS) questionnaire validated by Bloch, Melo, and Nogueira (2008). The statistical analysis was performed with the software IBM SPSS statistics 21.0. We tested the normality of the data distribution with kurtosis and skewness. The variables tested in the study are presented with descriptive statistics. Comparisons between treatment adherence and other variables were performed with Student's t test for independent variables and Pearson's chi-square or Fisher's exact test. To conduct analyses among patients considering adherence to treatment and BP control, we created four groups: G0, G1, G2, and G3. We considered a 5% significance level in all tests. RESULTS:: During the ReHOT, 80% of the patients had good BP control and treatment adherence. Of 96 patients reevaluated in the present study, only 52.1% had controlled hypertension when assessed by ABPM, while 31.3% were considered adherent by the MMAS. Regarding other ABPM measures, we observed an absence of a nocturnal dip in 64.6% of the patients and a white-coat effect and false BP control in 23% and 12.5%, respectively. Patients' education level showed a trend towards being a determinant factor associated with lack of adherence (p = 0.05). Resistant hypertension and number of medications were significantly associated with BP control assessed by ABPM (p = 0.009 and p = 0.001, respectively). Resistant hypertension was also significantly associated with group G0 (patients with no control or adherence, p = 0.012). CONCLUSION:: There was a decrease in BP control and adherence measured by the MMAS after participation of at least 6 months in the ReHOT clinical trial. FUNDAMENTO:: A falta de adesão ao tratamento medicamentoso da hipertensão arterial sistêmica (HAS) é uma das principais causas das baixas taxas de controle da doença. OBJETIVO:: Verificar a adesão e fatores relacionados a ela, além do controle pressórico de pacientes que participaram do ensaio clínico Resistant Hypertension Optimal Treatment (ReHOT). MÉTODO:: Estudo transversal que incluiu todos os 109 pacientes que concluíram o ReHOT há pelo menos 6 meses. Foram excluídos aqueles que não responderam ao novo recrutamento após três tentativas de contato telefônico. Foi realizada avaliação do controle pressórico através de monitorização ambulatorial da pressão arterial (MAPA; PA controlada: pressão arterial [PA] sistólica e diastólica de 24 horas < 130 x 80 mmHg) e avaliação da adesão através de respostas ao questionário Morisky Medication Adherence Scale (MMAS) validado por Bloch, Melo e Nogueira (2008). A análise estatística foi realizada com o programa IBM SPSS statistics 21.0. Para verificar a normalidade da distribuição dos dados, utilizamos testes de curtose e assimetria. As variáveis relacionadas ao objeto de estudo são apresentadas por meio de estatística descritiva. Comparações entre a adesão ao tratamento e demais variáveis foi realizada com o teste t de Student para variáveis independentes e teste do qui-quadrado de Pearson ou exato de Fisher. Para a análise entre pacientes considerando a adesão ao tratamento e controle da PA, foram criados quatro grupos: G0, G1, G2 e G3. Em todos os testes estatísticos consideramos um nível de significância de 5%. RESULTADOS:: Durante o ReHOT, 80% dos pacientes apresentaram controle pressórico e adesão ao tratamento. Do total de 96 pacientes reavaliados, apenas 52,1% foram identificados como tendo HAS controlada através da avaliação da MAPA e 31,3% apresentaram adesão pelo MMAS. Quando consideradas outras medidas da MAPA, verificou-se que 64,6% dos pacientes não apresentavam descenso noturno e 23% e 12,5% apresentavam efeito do avental branco e falso controle da PA, respectivamente. A escolaridade apresentou tendência a ser um fator determinante de falta de adesão (p = 0,05). O número de medicamentos e a HAS resistente (HAR) tiveram uma relação significativa com o controle da PA medida por MAPA (p = 0,009 e p = 0,001, respectivamente). A HAR teve relação significativa com o grupo G0 (sem controle e sem adesão, p = 0,012). CONCLUSÃO:: Houve redução do controle da PA e da adesão pelo MMAS após pelo menos 6 meses de participação no ensaio clínico ReHOT.
Assuntos
Anti-Hipertensivos/uso terapêutico , Monitorização Ambulatorial da Pressão Arterial/métodos , Pressão Sanguínea/efeitos dos fármacos , Hipertensão/tratamento farmacológico , Adesão à Medicação , Adulto , Idoso , Estudos de Coortes , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e QuestionáriosRESUMO
Abstract Background: Lack of adherence to pharmacological treatment is one of the main causes of low control rates in hypertension. Objective: To verify treatment adherence and associated factors, as well as blood pressure (BP) control in participants of the Resistant Hypertension Optimal Treatment (ReHOT) clinical trial. Method: Cross-sectional study including all 109 patients who had completed the ReHOT for at least 6 months. We excluded those participants who failed to respond to the new recruitment after three phone contact attempts. We evaluated the BP control by ambulatory BP monitoring (ABPM; controlled levels: 24-hour systolic and diastolic BP < 130 x 80 mmHg) and analyzed the patients' treatment adherence using the Morisky Medication Adherence Scale (MMAS) questionnaire validated by Bloch, Melo, and Nogueira (2008). The statistical analysis was performed with the software IBM SPSS statistics 21.0. We tested the normality of the data distribution with kurtosis and skewness. The variables tested in the study are presented with descriptive statistics. Comparisons between treatment adherence and other variables were performed with Student's t test for independent variables and Pearson's chi-square or Fisher's exact test. To conduct analyses among patients considering adherence to treatment and BP control, we created four groups: G0, G1, G2, and G3. We considered a 5% significance level in all tests. Results: During the ReHOT, 80% of the patients had good BP control and treatment adherence. Of 96 patients reevaluated in the present study, only 52.1% had controlled hypertension when assessed by ABPM, while 31.3% were considered adherent by the MMAS. Regarding other ABPM measures, we observed an absence of a nocturnal dip in 64.6% of the patients and a white-coat effect and false BP control in 23% and 12.5%, respectively. Patients' education level showed a trend towards being a determinant factor associated with lack of adherence (p = 0.05). Resistant hypertension and number of medications were significantly associated with BP control assessed by ABPM (p = 0.009 and p = 0.001, respectively). Resistant hypertension was also significantly associated with group G0 (patients with no control or adherence, p = 0.012). Conclusion: There was a decrease in BP control and adherence measured by the MMAS after participation of at least 6 months in the ReHOT clinical trial.
Resumo Fundamento: A falta de adesão ao tratamento medicamentoso da hipertensão arterial sistêmica (HAS) é uma das principais causas das baixas taxas de controle da doença. Objetivo: Verificar a adesão e fatores relacionados a ela, além do controle pressórico de pacientes que participaram do ensaio clínico Resistant Hypertension Optimal Treatment (ReHOT). Método: Estudo transversal que incluiu todos os 109 pacientes que concluíram o ReHOT há pelo menos 6 meses. Foram excluídos aqueles que não responderam ao novo recrutamento após três tentativas de contato telefônico. Foi realizada avaliação do controle pressórico através de monitorização ambulatorial da pressão arterial (MAPA; PA controlada: pressão arterial [PA] sistólica e diastólica de 24 horas < 130 x 80 mmHg) e avaliação da adesão através de respostas ao questionário Morisky Medication Adherence Scale (MMAS) validado por Bloch, Melo e Nogueira (2008). A análise estatística foi realizada com o programa IBM SPSS statistics 21.0. Para verificar a normalidade da distribuição dos dados, utilizamos testes de curtose e assimetria. As variáveis relacionadas ao objeto de estudo são apresentadas por meio de estatística descritiva. Comparações entre a adesão ao tratamento e demais variáveis foi realizada com o teste t de Student para variáveis independentes e teste do qui-quadrado de Pearson ou exato de Fisher. Para a análise entre pacientes considerando a adesão ao tratamento e controle da PA, foram criados quatro grupos: G0, G1, G2 e G3. Em todos os testes estatísticos consideramos um nível de significância de 5%. Resultados: Durante o ReHOT, 80% dos pacientes apresentaram controle pressórico e adesão ao tratamento. Do total de 96 pacientes reavaliados, apenas 52,1% foram identificados como tendo HAS controlada através da avaliação da MAPA e 31,3% apresentaram adesão pelo MMAS. Quando consideradas outras medidas da MAPA, verificou-se que 64,6% dos pacientes não apresentavam descenso noturno e 23% e 12,5% apresentavam efeito do avental branco e falso controle da PA, respectivamente. A escolaridade apresentou tendência a ser um fator determinante de falta de adesão (p = 0,05). O número de medicamentos e a HAS resistente (HAR) tiveram uma relação significativa com o controle da PA medida por MAPA (p = 0,009 e p = 0,001, respectivamente). A HAR teve relação significativa com o grupo G0 (sem controle e sem adesão, p = 0,012). Conclusão: Houve redução do controle da PA e da adesão pelo MMAS após pelo menos 6 meses de participação no ensaio clínico ReHOT.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Pressão Sanguínea/efeitos dos fármacos , Monitorização Ambulatorial da Pressão Arterial/métodos , Adesão à Medicação , Hipertensão/tratamento farmacológico , Anti-Hipertensivos/uso terapêutico , Estudos Transversais , Inquéritos e Questionários , Estudos de CoortesRESUMO
BACKGROUND: Although there is strong evidence of the benefits of antihypertensive treatment, the high prevalence of this important cardiovascular risk factor and its complications, as well as the low control rates of hypertension observed in many studies justify the investigation of these relationships in population studies. The objective was to investigate the ratio of cardiovascular disease mortality between hypertensives (non-treated, controlled and uncontrolled) and non-hypertensives in a cohort of a population sample of adults living in Ilha do Governador, Rio de Janeiro state, Brazil, who were classified in a survey conducted in 1991 and 1992 and whose death certificates were sought 19 years later. METHODS: A cohort study was performed on probabilistic linkage between data from an epidemiological study of hypertension performed in Ilha do Governador, in Rio de Janeiro, Brazil (1991 to 1992) and data from the Mortality Information System of Rio de Janeiro (1991 to 2009). The survey aimed to estimate the prevalence of hypertension and other cardiovascular risk factors in 1,270 adults aged 20 years or older selected through a probabilistic sampling of households at three economic levels (low, middle and high income). We performed a probabilistic record linkage of these databases and estimated the risk of cardiovascular death using Kaplan-Meier method to plot survival curves and Cox proportional hazards models comparing hypertensive subjects all together, and by hypertension subgroups: untreated, controlled, and uncontrolled hypertensives with non-hypertensive ones. RESULTS: A total of 170 deaths occurred, of which 31.2 % attributed to cardiovascular causes. The hazard ratio for cardiovascular death was 6.1 times higher (95 % CI 2.7 - 13.7) in uncontrolled hypertensive patients relative to non-hypertensive patients. The hazard ratios for untreated hypertensive and controlled hypertensive patients were 2.7 times (95 % CI 1.1 - 6.3) and 2.1 times (95 % CI 0.38 - 11.5) higher than for normotensive patients, respectively. CONCLUSION: The present study demonstrated a higher cardiovascular death risk among hypertensive than among non-hypertensive ones that is not associated uniquely to treatment, because uncontrolled hypertensives demonstrated a greater risk than untreated ones. Although the subgroups of hypertensive individuals were susceptible to changes in their classification over the 19 years of the study, the baseline classification was consistent with a worse prognosis in these individuals.
Assuntos
Anti-Hipertensivos/uso terapêutico , Doenças Cardiovasculares/tratamento farmacológico , Doenças Cardiovasculares/mortalidade , Adulto , Anti-Hipertensivos/administração & dosagem , Pressão Sanguínea , Brasil/epidemiologia , Doenças Cardiovasculares/epidemiologia , Estudos de Coortes , Bases de Dados Factuais , Atestado de Óbito , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/epidemiologia , Incidência , Masculino , Pessoa de Meia-Idade , Prevalência , Modelos de Riscos Proporcionais , Fatores de Risco , Fatores SocioeconômicosAssuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Dieta Mediterrânea , Hipertensão/terapiaAssuntos
Anti-Hipertensivos/administração & dosagem , Hipertensão/tratamento farmacológico , Guias de Prática Clínica como Assunto , Sociedades Médicas , Pressão Sanguínea/efeitos dos fármacos , Brasil , Transtornos Cerebrovasculares/complicações , Doença das Coronárias/complicações , Quimioterapia Combinada/métodos , Humanos , Insuficiência Renal Crônica/tratamento farmacológico , Fatores de Risco , Resultado do TratamentoAssuntos
Hipertensão Mascarada/diagnóstico , Hipertensão Mascarada/terapia , Pré-Hipertensão/diagnóstico , Pré-Hipertensão/terapia , Hipertensão do Jaleco Branco/diagnóstico , Hipertensão do Jaleco Branco/terapia , Monitorização Ambulatorial da Pressão Arterial , Brasil/epidemiologia , Feminino , Humanos , Masculino , Hipertensão Mascarada/epidemiologia , Guias de Prática Clínica como Assunto , Pré-Hipertensão/epidemiologia , Prognóstico , Fatores de Risco , Sociedades Médicas , Hipertensão do Jaleco Branco/epidemiologiaAssuntos
Humanos , Masculino , Feminino , Hipertensão Mascarada/diagnóstico , Hipertensão Mascarada/terapia , Pré-Hipertensão/diagnóstico , Pré-Hipertensão/terapia , Hipertensão do Jaleco Branco/diagnóstico , Hipertensão do Jaleco Branco/terapia , Monitorização Ambulatorial da Pressão Arterial , Brasil/epidemiologia , Hipertensão Mascarada/epidemiologia , Guias de Prática Clínica como Assunto , Pré-Hipertensão/epidemiologia , Prognóstico , Fatores de Risco , Sociedades Médicas , Hipertensão do Jaleco Branco/epidemiologiaAssuntos
Humanos , Anti-Hipertensivos/administração & dosagem , Hipertensão/tratamento farmacológico , Guias de Prática Clínica como Assunto , Sociedades Médicas , Brasil , Pressão Sanguínea/efeitos dos fármacos , Transtornos Cerebrovasculares/complicações , Doença das Coronárias/complicações , Quimioterapia Combinada/métodos , Fatores de Risco , Insuficiência Renal Crônica/tratamento farmacológico , Resultado do TratamentoRESUMO
The prevalence of resistant hypertension (ReHy) is not well established. Furthermore, diuretics, angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers, and calcium channel blockers are largely used as the first 3-drug combinations for treating ReHy. However, the fourth drug to be added to the triple regimen is still controversial and guided by empirical choices. We sought (1) to determine the prevalence of ReHy in patients with stage II hypertension; (2) to compare the effects of spironolactone vs clonidine, when added to the triple regimen; and (3) to evaluate the role of measuring sympathetic and renin-angiotensin-aldosterone activities in predicting blood pressure response to spironolactone or clonidine. The Resistant Hypertension Optimal Treatment (ReHOT) study (ClinicalTrials.gov NCT01643434) is a prospective, multicenter, randomized trial comprising 26 sites in Brazil. In step 1, 2000 patients will be treated according to hypertension guidelines for 12 weeks, to detect the prevalence of ReHy. Medical therapy adherence will be checked by pill count monitoring. In step 2, patients with confirmed ReHy will be randomized to an open label 3-month treatment with spironolactone (titrating dose, 12.5-50 mg once daily) or clonidine (titrating dose, 0.1-0.3 mg twice daily). The primary endpoint is the effective control of blood pressure after a 12-week randomized period of treatment. The ReHOT study will disseminate results about the prevalence of ReHy in stage II hypertension and the comparison of spironolactone vs clonidine for blood pressure control in patients with ReHy under 3-drug standard regimen.
Assuntos
Agonistas de Receptores Adrenérgicos alfa 2/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Clonidina/uso terapêutico , Resistência a Medicamentos , Hipertensão/tratamento farmacológico , Antagonistas de Receptores de Mineralocorticoides/uso terapêutico , Projetos de Pesquisa , Espironolactona/uso terapêutico , Idoso , Bloqueadores do Receptor Tipo 1 de Angiotensina II/uso terapêutico , Brasil/epidemiologia , Bloqueadores dos Canais de Cálcio/uso terapêutico , Protocolos Clínicos , Diuréticos/uso terapêutico , Descoberta de Drogas , Quimioterapia Combinada , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Masculino , Adesão à Medicação , Pessoa de Meia-Idade , Prevalência , Fatores de Tempo , Resultado do TratamentoRESUMO
Background and objective: White coat effect (WCE) (i.e., the difference between office blood pressure [OBP] and awake ambulatory blood pressure monitoring [ABPM]) may be present in hypertensive individuals. The relationship between occurrence of WCE and target organ damage (TOD) has not yet been assessed in true resistant hypertension (RHTN). Patients and methods: RHTN patients were divided into two groups: RHTN with WCE (WCE, n=66) and RHTN without WCE (non-WCE, n=61). All patients were submitted to OBP measurement, ABPM, echocardiography and renal function evaluation in three visits. Results: No differences were observed between the WCE and non-WCE groups regarding age, body mass index or gender. OBP were 169.8±15.8/95.1±14.0 (WCE) and 161.9±9.0/90.1±10.4mmHg (non-WCE), ABPM=143.0±12.8/86.1±9.9 (WCE) and 146.1±13.6/85.1±14.9mmHg (non-WCE). No statistical differences were observed between WCE and non-WCE subgroups with respect to left ventricular mass index (LVMI) (WCE=131±4.7; non-WCE=125±2.9g/m2), creatinine clearance (WCE=78±4.7; non-WCE=80±3.6ml/min/m2) and microalbuminuria (MA) (WCE=44±8.4; non-WCE=49±6.8mg/g Cr). Conclusions: This finding may suggest that WCE is not associated with additional increase of TOD in true RHTN subjects (AU)
Fundamento y objetivo: El efecto de bata blanca (EBB), es considerado cuando la diferencia entre la PAS/PAD medida en consulta médica y aquella obtenida por monitorización ambulatoria de la presión arterial (MAPA) y puede estar presente durante la consulta médica en pacientes con hipertensión arterial resistente (HTA-R). La relación entre la presencia del efecto bata blanca y daños en órganos diana aún no ha sido evaluada en individuos con HTA-R verdadera. Pacientes y método: En este estudio, sesenta y seis pacientes con HTA-R verdadera presentaron EBB y otros 61 no lo hicieron. A todos los sujetos se les practicó una monitorización ambulatoria de la presión arterial durante 24 horas (MAPA). La afectación de órganos diana se determinó mediante la realización de ecocardiograma y evaluación de la función renal. Resultados: Los valores de PAS y PAD en consulta médica fueron: 169,8±15,8/95,1±14,0 (pacientes con EBB) y 161,9±9,0/90,1±10,4mmHg (pacientes sin EBB), respectivamente y mediante MAPA los valores promedios de PAS y PAD de 24 horas fueron: 143,0±12,8/86,1±9,9 (pacientes con EBB) y 146,1±13,6/85,1±14,9 mmHg (pacientes sin EBB), respectivamente. No se observaron diferencias significativas entre los pacientes con o sin EBB con respecto al índice de masa ventricular izquierda (con EBB=131±4,7; sin EBB=125±2,9g/m2), aclaramiento de creatinina (con EBB=78±4,7; sin EBB=80±3,6ml/min/m2) y microalbuminuria (con EBB=44±8,4; sin EBB=49±6,8mg/g Cr). Conclusiones: Este hallazgo sugiere que el EBB no se asocia a incremento adicional de daños en órganos diana en pacientes con HTA-R verdadera (AU)
Assuntos
Humanos , Hipertensão do Jaleco Branco/epidemiologia , Hipertensão/fisiopatologia , Determinação da Pressão Arterial/métodos , Insuficiência Renal Crônica/epidemiologia , Insuficiência Cardíaca/epidemiologiaRESUMO
BACKGROUND AND OBJECTIVE: White coat effect (WCE) (i.e., the difference between office blood pressure [OBP] and awake ambulatory blood pressure monitoring [ABPM]) may be present in hypertensive individuals. The relationship between occurrence of WCE and target organ damage (TOD) has not yet been assessed in true resistant hypertension (RHTN). PATIENTS AND METHODS: RHTN patients were divided into two groups: RHTN with WCE (WCE, n=66) and RHTN without WCE (non-WCE, n=61). All patients were submitted to OBP measurement, ABPM, echocardiography and renal function evaluation in three visits. RESULTS: No differences were observed between the WCE and non-WCE groups regarding age, body mass index or gender. OBP were 169.8±15.8/95.1±14.0 (WCE) and 161.9±9.0/90.1±10.4mmHg (non-WCE), ABPM=143.0±12.8/86.1±9.9 (WCE) and 146.1±13.6/85.1±14.9mmHg (non-WCE). No statistical differences were observed between WCE and non-WCE subgroups with respect to left ventricular mass index (LVMI) (WCE=131±4.7; non-WCE=125±2.9g/m(2)), creatinine clearance (WCE=78±4.7; non-WCE=80±3.6ml/min/m(2)) and microalbuminuria (MA) (WCE=44±8.4; non-WCE=49±6.8mg/g Cr). CONCLUSIONS: This finding may suggest that WCE is not associated with additional increase of TOD in true RHTN subjects.
