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Efecto de la enfermedad renal sobre el monitoreo ambulatorio de la presión arterial;
Effect of Renal Disease on Ambulatory Blood Pressure Monitoring

Creators:Sarcona, Eugenia, Díaz, Mónica
2015-05-07

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En la actualidad la enfermedad renal crónica (ERC) se ha convertido en un problema creciente para la salud pública debido al progresivo aumento de su prevalencia y a los costos económicos que esto acarrea, no solo por el aumento de los casos de diálisis o trasplante renal sino por su estrecha relación con la enfermedad cardiovascular. De hecho, los pacientes con enfermedad renal son más susceptibles de presentar complicaciones cardiovasculares que de progresar a enfermedad renal terminal. Actualmente la insuficiencia renal crónica (IRC) es considerada un factor de riesgo para el desarrollo de enfermedad cardiovascular (1).   Mas del 11% de la población general adulta de los EUA presenta deterioro de la función renal (FR), de los cuales aproximadamente el 40% tiene un filtrado glomerular (FG) menor a 60 ml/min/1.73m2 (2). Australia (3), Japón (4) y Europa (5) muestran una prevalencia de insuficiencia renal (IR) entre el 6 y el 11%. Esto se acentúa entre los individuos de mayor riesgo, como son los pacientes hipertensos y/o diabéticos, en quienes la prevalencia de IR llega al 50-60% (6). En América Latina en general y en nuestro país en particular no existen datos globales de prevalencia de IR, aunque siendo aquí la prevalencia de hipertensión arterial (HTA) y diabetes mellitus tipo 2 (DM2) –principales contribuyentes para la aparición de IR-  similar a la de los países arriba mencionados, se podría suponer que aquí la prevalencia de IR es similar a la del resto del mundo. En un estudio realizado en pacientes hipertensos que concurrieron a un servicio de Hipertensión Arterial de la ciudad de Buenos Aires (7) se evidenció la presencia de IR en el 19.6% de la población estudiada.   Existe una muy estrecha relación entre HTA e IR. Por un lado la HTA es muy frecuente  en los pacientes con ERC, entre el 60-100% de estos pacientes presentan HTA (8). Por el otro  la IR  constituye la causa más  frecuente de HTA secundaria (9). La HTA es a la vez el más conspicuo entre los factores modificables para progresión de ERC (10). De esta manera la interrelación entre HTA y enfermedad renal constituye un verdadero círculo perjudicial tanto para el  riñón como para el sistema cardiovascular. Existe numerosa evidencia de que los valores de presión arterial (PA) obtenidos por monitoreo ambulatorio de la presión arterial de 24 horas (MAPA) se correlacionan mas con daño de órgano blanco que las presiones obtenidas en consultorio (11), lo que convierte al MAPA en un mejor predictor de eventos cardiovasculares. Estudios recientes han determinado que la presencia de patrón non dipper (PND), el aumento de la presión de pulso en el MAPA (PP) (12), y el aumento de la variabilidad (13) son variables asociadas a alto riesgo cardiovascular (RCV). De acuerdo con la información disponible la mayoría de los estudios que identifican las características del MAPA en los pacientes con ERC fueron realizados en pacientes con enfermedad renal terminal, en diálisis / transplante o bien en pacientes con glomerulopatías específicas.  Sin embargo, prácticamente no hay estudios que muestren las características del MAPA en los pacientes con IR secundaria a DM2 y/o HTA

Background: Chronic renal disease is a growing public health problem, not only for its progression to end-stage renal failurebut for its close association with cardiovascular disease, especially hypertension. Currently, there is scarce information onambulatory blood pressure monitoring (ABPM) in hypertensive patients with renal failure.Objective: The aim of this study was to assess ABPM pulse pressure, circadian rhythm and blood pressure variability in apopulation of hypertensive patients with renal failure.Methods: A cross-sectional study evaluated 123 consecutive ABPM performed in a Hypertension Service. The glomerularfiltration rate was estimated using the abridged formula from the “Modification of diet in renal disease” (MDRD) study.Results: A total of 123 hypertensive patients were evaluated (age 66±7.5 years, 56% men), whose glomerular filtration ratewas 64.5±19.4 ml/min/1.73m2. Thirty-seven percent of patients presented with renal failure with a glomerular filtrationrate of 45±12.5 ml/min/1.73m2 vs. 76±11.9 ml/min/1.73m2 in patients without renal failure. Fifty-five hypertensive patients(44%) had elevated pulse pressure: 28 (60.9%) with renal failure vs. 27 (35%) without renal failure (p&lt;0.005). After adjustingfor different variables, this difference remained significant. No differences were found in blood pressure variability or in thepresence of non-dipper pattern.Conclusions: The main ABPM characteristic in hypertensive patients with renal failure was a significant increase of pulsepressure. There was no greater prevalence of non-dipper pattern or increased blood pressure variability, as classically describedfor the general population of renal disease patients.

Metadatos destacados

Colecciones
Argentine Journal of Cardiology

Editor

Sociedad Argentina de Cardiología

Fuente

Revista Argentina de Cardiología; Vol 83, No 2 (2015); 124-129, Argentine Journal of Cardiology; Vol 83, No 2 (2015); 124-129

Citación

Sarcona, Eugenia y Díaz, Mónica, “Efecto de la enfermedad renal sobre el monitoreo ambulatorio de la presión arterial,” Archivo PPCT, consulta 2 de abril de 2026, http://archivoppct.caicyt.gov.ar/items/show/8860.

Dublin Core

Materia

Autor

Sarcona, Eugenia
Díaz, Mónica

Fuente

Revista Argentina de Cardiología; Vol 83, No 2 (2015); 124-129
Argentine Journal of Cardiology; Vol 83, No 2 (2015); 124-129

Editor

Sociedad Argentina de Cardiología

Fecha

2015-05-07

Derechos

Los que firman al pié, certificamos que tenemos total responsabilidad por la conducción de este estudio y por el diseño y la interpretación de los datos. Nosotros escribimos el manuscrito y somos responsables por la decisión acerca del mismo. Cada uno de nosotros cumple la definición de autor como se afirma en el Comité Internacional de Editores de Revistas Médicas (International Committee of Medical Journal Editors, ver www.icmje.org). Nosotros hemos visto y aprobado el manuscrito final. Ni el artículo, ni ninguna parte esencial del mismo, incluido las tablas y las figuras, será publicado o admitido para arbitrar a otra parte antes de aparecer en la Revista.También notificamos haber leído la sección “conflicto de intereses”, y revelaríamos cualquiera que existiera. Dejamos constancia que si nuestro artículo se publicara en la RAC, cederíamos los derechos (copyright) a la Revista.Los documentos publicados en esta revista están bajo la licencia Creative Commons Atribución-NoComercial-Compartir-Igual 2.5 Argentina.
Those signing below certify that we have full responsibility for the conduction of this study and for the design and interpretation of the information. We wrote the manuscript and are responsible for its decision. Each of us fulfills the definition of authorship as stated by the International Committee of Medical Journal Editors ( www.icmje.org). We have signed and approved the final manuscript. Neither the manuscript, nor any essential part thereof, including tables and figures, will be published or accepted for refereeing elsewhere before being published in the Journal. We have also read the "Conflict of Interest" section and would disclose any existing. We state that if our manuscript is published in the RAC, we shall transfer the copyright to the Journal.

Formato

Idioma

spa
eng

Tipo

info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion