Diferentes métodos de medida da pressão arterial em adolescentes e sua correlação com perfil metabólico e aspectos ecocardiográficos
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2013-10-04
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Universidade Federal de Goiás
Resumo
Introduction: Blood pressure (BP) varies according to physiological and
environmental stimulations and the office BP measurement, most utilized
method, does not include this variation. Multiple measurement methods such
as ambulatory BP monitoring (ABPM) and home BP monitoring (HBPM) have
aided in the attempt of attaining higher diagnosis and prognosis accuracy.
The knowledge of BP alterations in adolescents and their implications for
target organs are even more limited, and these methods provide good
perspectives regarding sustained hypertension and also more unusual types
such as white-coat hypertension (WCHT). Objectives: To assess BP in
adolescents through office measurement, HBPM, ABPM and test the
agreement among these methods. To compare and investigate the
correlation of blood pressure measurements with the metabolic profile and
echocardiographic aspects between normotensives, patients with sustained
HT and with WCHT. Method: the selection included adolescents from a
representative sample (n=1025) aged 12 to 18, from Goiânia, Brazil, with
office BP and/or home measurement percentile >90 and also a group of
normotensives, according to normality values proposed by 4th Task Force.
BP was measured twice in separate periods, considering the second
measurements’ mean. HBPM (06 days, duplicated measures in the morning
and in the evening, regarding the minimum of 12). The selected teenagers
performed ABPM and were allocated in the following groups: sustained HT
(percentage 95 in office measurement, HBPM and ABPM); WCHT
(percentage 95 in office measurement, <90 HBPM and ABPM) and
normotensives (percentage <90 in the three methods). Semi-automatic
machines, OMRON, HEM-705CP (office and HBPM) and Spacelabs, 90207
(ABPM). Statistical analysis: Pearson’s chi-square, Kolmogorov Smirnov,
paired Student’s-t test, Bland-Altman, Mountain Plots, ANOVA One Way with
Bonferroni correction and Pearson’s coefficient. Considered significant:
p<0.05. Results: in total samples (n=133), values of office measurement
(SBP:127.3±13,8; DBP:74.4±9.5 mmHg); HBPM (SBP:120.3±12.6
DBP:69.4±7.7mmHg) and daytime ABPM (SBP:121.5±9.8; DBP:
70.2±6.6mmHg). Bland-Altman’s graphs show good agreement between
HBPM and daytime ABPM. In the comparison of metabolic and
echocardiographic aspects, being 65 adolescents evaluated, which 10 had
HT, 22 had WCHT and 33 normotensives. BMI: HT (28.5±6.3), WCHT
(22.1±3.7) and normotensives (20.7±3.5 kg/m2); HOMA-IR: HT (2.8±1.8),
WCHT (2.6±1.2) and normotensives (1.8±1.1); Fasting glycaemia: HT
(83.1±8.8), WCHT (88.7±8.7) and normotensives (83.2±6.7 cm); Total
cholesterol: HT (183.1±57.8), WCHT (165.1±32.8) and normotensives
(150.7±23.4mg/dL); Triglycerides: HT (156.6±107.1), WCHT (98.2±47.9) and
normotensives (63.3±19.8 mg/dL); Left ventricular mass index (LVMI): HT
(62.4±12.1), WCHT (51.1±12.1) and normotensives (53.6±13.0 g/m2).
Differences found: LVMI (HT and WCHT, p=0.026); LV mass (HT and
normotensives, p=0.006; HT and WCHT, p=0.014); fasting glycaemia (WCHT
and normotensives, p=0.034); total cholesterol (HT and normotensives,
p=0.029); triglycerides (HT and normotensives, p<0.001; HT and WCHT,
Abstract xvi
p=0.012). Conclusion: Office measurements must be used as screening
method in adolescents with BP measurements above normal and the values
must be confirmed through ABPM or HBPM. Sustained hypertension already
harms the metabolic and cardiovascular health of teenagers and WCHP
seems to be an intermediate situation, nevertheless, it deserves attention
due to its metabolic risk.
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PÓVOA, Thaís Rolim. Diferentes métodos de medida da pressão arterial em adolescentes e sua correlação com perfil metabólico e aspectos ecocardiográficos. 2013. 135 f. Tese (Doutorado em em Ciências da Saúde)–Universidade Federal de Goiás, Goiânia, 2013.