Arquivos Brasileiros de Cardiologia (Apr 2010)
Pressão arterial de 24 horas em mulheres idosas normotensas e com hipertensão do avental branco Presión arterial de 24 horas en mujeres mayores normotensas y con hipertensión de la bata blanca 24-hour blood pressure in normotensive elderly women and elderly women with white-coat hypertension
Abstract
FUNDAMENTO: Mudanças no comportamento do ritmo circadiano podem ser deletérias, levando à lesão de órgãos-alvo, o que sugere ser de importante significado prognóstico e, eventualmente, podem também demandar intervenção terapêutica. OBJETIVO: Descrever e comparar os ritmos circadianos de pressão arterial (PA) entre mulheres idosas normotensas e portadoras de hipertensão do avental branco (HAB). MÉTODOS: Estudo transversal em uma amostra de 36 pacientes, com idades entre 60-83 anos, submetidas à monitorização ambulatorial de pressão arterial (MAPA) durante 24 horas. Dezenove idosas normotensas e 17 com HAB foram comparadas quanto à queda noturna e variabilidade de PA, ascensão matinal da PAS, pressão de pulso, hipotensão pós-prandial e correlação de médias de PA de 24 horas. Na análise estatística, utilizou-se o teste t de Student, teste do qui-quadrado, teste exato de Fisher e teste de correlação linear de Pearson. RESULTADOS: As idosas com HAB apresentaram níveis mais elevados de PAS do que as normotensas, entre 8-12 horas (133 ± 8,0 mmHg vs 123 ± 9,0 mmHg, respectivamente, p FUNDAMENTO: Cambios en el comportamiento del ritmo circadiano pueden ser perjudiciales, conduciendo a la lesión de órganos blanco, lo que sugiere ser de importante significado pronóstico y, eventualmente, pueden también demandar intervención terapéutica. OBJETIVO: Describir y comparar los ritmos circadianos de presión arterial (PA) entre mujeres mayores normotensas y portadoras de hipertensión de la bata blanca (HABB). MÉTODOS: Estudio transversal en una muestra de 36 pacientes, con edades entre 60-83 años, sometidas a monitoreo ambulatorio de presión arterial (MAPA) durante 24 horas. 19 mujeres mayores normotensas y 17 con HABB fueron comparadas con relación a la caída nocturna y variabilidad de la PA, ascenso matinal de la PAS, presión de pulso, hipotensión postprandial y correlación de promedios de PA de 24 horas. En el análisis estadístico, se utilizó el test t de Student, el test de chi-cuadrado, el test exacto de Fisher y el test de correlación lineal de Pearson. RESULTADOS: Las mujeres mayores con HABB presentaron niveles más elevados de PAS que las normotensas, entre 8-12 horas (133 ± 8,0 mmHg vs 123 ± 9,0 mmHg, respectivamente, p BACKGROUND: Changes in the behavior of the circadian rhythm can be deleterious, leading to target-organ damage, which suggests that they can have a prognostic significance and, eventually, can also demand therapeutic intervention. OBJECTIVE: To describe and compare the circadian rhythms of blood pressure (BP) in normotensive elderly women and in those with white-coat hypertension (WCH). METHODS: A cross-sectional study was carried out in sample of 36 patients, aged 60-83 years, submitted to ambulatory blood pressure monitoring (ABPM) for a period of 24 hours. Nineteen normotensive elderly women and 17 with WHC were compared regarding the nocturnal dipping and the BP variability, morning increase in systolic blood pressure (SBP), pulse pressure, post-prandial hypotension and correlation of 24-hour BP means. The statistical analysis used the Student's t test, Chi-square test, Fisher's exact test and Pearson's linear correlation. RESULTS: The elderly women with WCH presented higher levels of SBP than the normotensive ones, between 8 am-12 pm (133 ± 8.0 mmHg vs 123 ± 9.0 mmHg, respectively, p < 0.001). The BP variability was higher in the WCH group only during the wakefulness period (between 7 am-11 pm, p = 0.02). A positive correlation was observed between the BMI and the SBP means at night, only in the elderly women with WCH (r = 0.578; p = 0.015 and r = 0.488; p = 0.055, respectively). CONCLUSION: The elderly women with WCH presented higher SBP and diastolic blood pressure (DBP) means during the wakefulness period. In the early hours of the morning, the elderly women with WCH presented significantly higher SBP means.
