Monitoramento ambulatorial da pressão arterial: variabilidade da pressão, descenso da frequência cardíaca ao sono e risco de eventos fatais na doença renal crônica

• Autor(a) principal: Marchi, Daniel [UNESP]
• Data de Publicação: 2014
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: Repositório Institucional da UNESP
• Texto Completo: http://hdl.handle.net/11449/108800
• topic: Pressão arterial - Medição; Batimento cardíaco; Insuficiencia renal cronica; Estudos longitudinais; Pressão arterial - Measurement

Introduction: More than half of the deaths in patients with chronic kidney disease (CKD) are attributed to cardiovascular disease. Blood pressure control (BP ) is considered a main strategy in reducing morbidity and mortality in chronic renal population. Ambulatory blood pressure monitoring (ABPM ) has been shown to be higher to office BP in defining prognosis and outcome in all stages of CKD. Some data of ABPM, such as blood pressure variability ( BPV ) and the attenuation of heart rate decrease (HRa) while sleeping were observed as risk factors for overall and cardiovascular mortality in hypertensive population, but no studies on CKD population who evaluated BPV and HRa decrease while sleeping measured by ABPM. The objectives of this study were to evaluate the prognostic impact of the BPV and the decrease of HR while sleeping obtained by ABPM in individuals with chronic kidney disease. Patients and methods : An observational, longitudinal and retrospective study which involved the analysis of 251 ABPM examinations in individuals with CKD at Hospital das Clinicas, Faculty of Medicine of Botucatu followed by a median of 34 months. Results: When comparing patients with fatal outcomes from cardiovascular causes and from all causes, with those who did not present outcomes, there is an age and prevalence of more advanced stages of CKD. Even after adjusting for CKD stage, age and PP in wakefulness, the lowest decrease of HRa while sleeping ( HR : 0.925 , 95% CI : 0.865 to 0.991 , p = 0.026 ) was independent predictor of cardiovascular mortality. The results showed no independent association between BPV, measured by the standard deviation of the pressure with mortality. Conclusion: BPV to ABPM did not show independent prognostic impact in multivariate analysis, however, the decrease of HRa while sleeping was a good marker of cardiovascular mortality in CKD, even after adjustment for misconfusion factors. The short follow-up time and ...