Intervenções educativas e medicamentosas para controle pressórico em transplantados renais baseadas no uso da monitorização ambulatorial da pressão arterial
Ano de defesa: | 2022 |
---|---|
Autor(a) principal: | |
Orientador(a): | |
Banca de defesa: | |
Tipo de documento: | Dissertação |
Tipo de acesso: | Acesso aberto |
Idioma: | por |
Instituição de defesa: |
Pontifícia Universidade Católica de São Paulo
|
Programa de Pós-Graduação: |
Programa de Estudos Pós-Graduados em Educação nas Profissões da Saúde
|
Departamento: |
Faculdade de Ciências Médicas e da Saúde
|
País: |
Brasil
|
Palavras-chave em Português: | |
Palavras-chave em Inglês: | |
Área do conhecimento CNPq: | |
Link de acesso: | https://repositorio.pucsp.br/jspui/handle/handle/25997 |
Resumo: | Arterial hypertension (AH) after kidney transplant (AKT) is correlated with severe cardiovascular and renal outcomes, such as kidney function loss, decreased graft survival, and high mortality rates. Manual office blood pressure (MOBP) values of kidney transplant recipients (KTR) are usually different from those obtained by systematic methodologies like Ambulatory Blood Pressure Monitoring (ABPM). Additionally, there is a significant prevalence of nocturnal non-dipping and blood pressure, white coat hypertension (WCH), and masked hypertension (MH). The goal of the present study was to evaluate the influence of educational and therapeutic actions on blood pressure control in KTR. The evaluation was performed by comparing pre-and post-intervention MOBP and ABPM measurements of individuals from the AKT outpatient clinic of a teaching hospital. It is an experimental, observational, prospective, and interventional cohort study. We included 33 adult patients with an average age of 46.8 years, hypertensive and non-diabetic. 53.8% of the study group had received organs from deceased donors. Data collection tools included a sociodemographic and clinical survey, three routine medical appointments at 2, 4, and 6 months to collect the standardized blood pressure measurement, and a lifestyle changes (LC) program. Additionally, the drugs were adjusted according to the 24 hours ABPM results. After 6 months, the test was repeated for the 26 patients who remained in the study. A paired t-test was used to evaluate the difference between the initial and the three follow-up evaluations. The impact of LC, the perception of symptoms, and the clinical assessment were evaluated using Student's t-test for BP indicators, and Fisher's exact test was used for the remaining comparisons between categorical variables. We observed that the ambulatory evaluation presents mean values higher than those obtained by the ABPM test (p<0.05) for systolic and diastolic values. ABPM results indicated that 4 out of 10 patients had an abnormal pressure curve, with a high prevalence of WCH (46.1%), and more than 90% of the participants did not show nocturnal dipping. The association of drug adjustments and LC was the most prevalent intervention was, comprising 88% of the proposed interventions; 8% of the patients required only LC guidelines and only 4% of the participants did not require any interventional action. The ambulatory diastolic BP values significantly decreased after 6 months of follow-up (p = 0.040). However, this good result was not repeated for ABPM. Patients were more likely to follow the diet changing program (69,3%) than the physical activity program (34.6%). Dietary change was associated with a significant reduction of mean systolic BP, measured by ABPM while awake and asleep. Patients who did not change their dietary habits showed an increase in this indicator. Hence, the study allowed us to verify the high prevalence of AH, diagnose the different AH phenotypes using ABPM, and implement personalized actions addressing clinical, behavioral, and drug-related aspects. These actions proved to be effective after a 6- moths follow-up. The actions could be more effective in larger sample size and with a longer follow-up. The results show the importance of ABPM as a strategy for BP followup in KTR |
id |
PUC_SP-1_3211fb291aa94d2634573beb6faa116c |
---|---|
oai_identifier_str |
oai:repositorio.pucsp.br:handle/25997 |
network_acronym_str |
PUC_SP-1 |
network_name_str |
Biblioteca Digital de Teses e Dissertações da PUC_SP |
repository_id_str |
|
spelling |
Rodrigues, Cibele Isaac Saadhttp://lattes.cnpq.br/7498326697611689http://lattes.cnpq.br/2585814582458704Rebelo, Rafael Naufel de Sá2022-04-27T17:49:24Z2022-04-27T17:49:24Z2022-03-14Rebelo, Rafael Naufel de Sá. Intervenções educativas e medicamentosas para controle pressórico em transplantados renais baseadas no uso da monitorização ambulatorial da pressão arterial. 2022. Dissertação (Mestrado em Educação nas Profissões da Saúde) - Programa de Estudos Pós-Graduados em Educação nas Profissões da Saúde da Pontifícia Universidade Católica de São Paulo, Sorocaba, 2022.https://repositorio.pucsp.br/jspui/handle/handle/25997Arterial hypertension (AH) after kidney transplant (AKT) is correlated with severe cardiovascular and renal outcomes, such as kidney function loss, decreased graft survival, and high mortality rates. Manual office blood pressure (MOBP) values of kidney transplant recipients (KTR) are usually different from those obtained by systematic methodologies like Ambulatory Blood Pressure Monitoring (ABPM). Additionally, there is a significant prevalence of nocturnal non-dipping and blood pressure, white coat hypertension (WCH), and masked hypertension (MH). The goal of the present study was to evaluate the influence of educational and therapeutic actions on blood pressure control in KTR. The evaluation was performed by comparing pre-and post-intervention MOBP and ABPM measurements of individuals from the AKT outpatient clinic of a teaching hospital. It is an experimental, observational, prospective, and interventional cohort study. We included 33 adult patients with an average age of 46.8 years, hypertensive and non-diabetic. 53.8% of the study group had received organs from deceased donors. Data collection tools included a sociodemographic and clinical survey, three routine medical appointments at 2, 4, and 6 months to collect the standardized blood pressure measurement, and a lifestyle changes (LC) program. Additionally, the drugs were adjusted according to the 24 hours ABPM results. After 6 months, the test was repeated for the 26 patients who remained in the study. A paired t-test was used to evaluate the difference between the initial and the three follow-up evaluations. The impact of LC, the perception of symptoms, and the clinical assessment were evaluated using Student's t-test for BP indicators, and Fisher's exact test was used for the remaining comparisons between categorical variables. We observed that the ambulatory evaluation presents mean values higher than those obtained by the ABPM test (p<0.05) for systolic and diastolic values. ABPM results indicated that 4 out of 10 patients had an abnormal pressure curve, with a high prevalence of WCH (46.1%), and more than 90% of the participants did not show nocturnal dipping. The association of drug adjustments and LC was the most prevalent intervention was, comprising 88% of the proposed interventions; 8% of the patients required only LC guidelines and only 4% of the participants did not require any interventional action. The ambulatory diastolic BP values significantly decreased after 6 months of follow-up (p = 0.040). However, this good result was not repeated for ABPM. Patients were more likely to follow the diet changing program (69,3%) than the physical activity program (34.6%). Dietary change was associated with a significant reduction of mean systolic BP, measured by ABPM while awake and asleep. Patients who did not change their dietary habits showed an increase in this indicator. Hence, the study allowed us to verify the high prevalence of AH, diagnose the different AH phenotypes using ABPM, and implement personalized actions addressing clinical, behavioral, and drug-related aspects. These actions proved to be effective after a 6- moths follow-up. The actions could be more effective in larger sample size and with a longer follow-up. The results show the importance of ABPM as a strategy for BP followup in KTRHipertensão arterial (HA) no pós-transplante renal (TXR) se correlaciona com piores desfechos cardiovasculares e renais, com perda de função renal, diminuição da sobrevida do enxerto e maior mortalidade. Receptores de TXR apresentam valores discrepantes de pressão arterial (PA) quando ela é obtida em consultório ou por metodologias sistematizadas como a Monitorização Ambulatorial da PA (MAPA), com prevalências significantes de ausência de descenso noturno ou hipertensão noturna, hipertensão do avental branco (HAAB) e hipertensão mascarada (HAM). O objetivo do presente estudo foi comparar as medidas de PA de consultório e da MAPA pré e pós-intervenção após medidas educativas e terapêuticas para controle pressórico de transplantados renais provenientes do ambulatório de TXR de um hospital de ensino. Trata-se de estudo quantitativo, observacional, de coorte prospectivo e interventivo. Foram incluídos 33 pacientes adultos, 46,8 anos de média de idade, hipertensos, não diabéticos, sendo 53,8% com órgãos de doadores falecidos. Os instrumentos de coleta de dados foram um questionário sociodemográfico e clínico; e consultas de rotina, com 2, 4 e 6 meses, para realização da medida sistematizada da PA de consultório, prescrição de mudanças no estilo de vida (MEV), além de ajustes medicamentosos de acordo com a MAPA de 24 horas. Ao final de 6 meses, o exame foi repetido nos 26 pacientes que permaneceram no estudo. O teste t de Student pareado foi aplicado para verificar a possível diferença entre a avaliação inicial e demais avaliações. O impacto das MEV, percepção de sintomas e avaliação médica foram avaliados por meio de teste t de Student para indicadores de PA e exato de Fisher para demais comparações entre variáveis categóricas. Observou-se que, para valores sistólicos e diastólicos, a avaliação ambulatorial apresenta valores médios superiores aos resultados obtidos pelo exame de MAPA (p<0,05), pois indicavam que 4 em cada 10 pacientes exibiam curva pressórica anormal, com alta prevalência de HAAB (46,1%), e mais de 90% dos participantes do estudo não apresentaram descenso noturno no período basal. As mudanças relacionadas a ajustes de medicação associadas a MEV foram as mais prevalentes, correspondendo à 88% das intervenções propostas, 8% necessitaram somente de orientações quanto a MEV, e apenas 4% dos participantes não necessitaram de medidas interventivas. Em comparação com os valores de PA diastólica ambulatorial na avaliação inicial, observou-se redução significativa desse indicador 6 meses após o início do seguimento (p = 0,040), mas não se obteve o mesmo resultado com a MAPA. Houve maior adesão à proposição de alteração da dieta (69,3%) em relação à atividade física (34,6%). A alteração da dieta esteve associada com redução média significante das PA sistólicas médias, em vigília e no sono pela MAPA, enquanto pessoas que não readequaram hábitos alimentares apresentaram aumento destes indicadores. Assim, foi possível verificar a alta prevalência de HA, diagnosticar os diferentes fenótipos de HA pela MAPA e implementar medidas de tratamento clínico comportamental e medicamentoso individualizado, que se mostraram eficazes após 6 meses de seguimento e, possivelmente ainda mais significantes com maiores tamanho amostral e tempo de seguimento, demonstrando a importância da MAPA como ferramenta de acompanhamento da PA em transplantados renaisporPontifícia Universidade Católica de São PauloPrograma de Estudos Pós-Graduados em Educação nas Profissões da SaúdePUC-SPBrasilFaculdade de Ciências Médicas e da SaúdeCNPQ::CIENCIAS DA SAUDETransplante de RimHipertensãoEducação de pacientes como assuntoMonitorização ambulatorial da pressão arterialConduta do tratamento medicamentoso/EDEstilo de vida saudávelKidney transplantationHypertensionPatient education as a topicAmbulatory blood pressure monitoringMedication/ED treatment managementHealthy lifestyleIntervenções educativas e medicamentosas para controle pressórico em transplantados renais baseadas no uso da monitorização ambulatorial da pressão arterialEducational and drug interventions for blood pressure control in kidney transplant recipients based on ambulatory blood pressure monitoringinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/masterThesisinfo:eu-repo/semantics/openAccessreponame:Biblioteca Digital de Teses e Dissertações da PUC_SPinstname:Pontifícia Universidade Católica de São Paulo (PUC-SP)instacron:PUC_SPORIGINALRafael Naufel de Sa Rebelo.pdfapplication/pdf2340083https://repositorio.pucsp.br/xmlui/bitstream/handle/25997/1/Rafael%20Naufel%20de%20Sa%20Rebelo.pdf37f428edbe507a8012cb48bc2f327d39MD51TEXTRafael Naufel de Sa Rebelo.pdf.txtRafael Naufel de Sa Rebelo.pdf.txtExtracted texttext/plain119168https://repositorio.pucsp.br/xmlui/bitstream/handle/25997/2/Rafael%20Naufel%20de%20Sa%20Rebelo.pdf.txt171b1887997e5c1c76cf447a363caed9MD52THUMBNAILRafael Naufel de Sa Rebelo.pdf.jpgRafael Naufel de Sa Rebelo.pdf.jpgGenerated Thumbnailimage/jpeg1302https://repositorio.pucsp.br/xmlui/bitstream/handle/25997/3/Rafael%20Naufel%20de%20Sa%20Rebelo.pdf.jpga092e15a5449b9ca0349977eb63d680cMD53handle/259972022-04-28 12:11:25.084oai:repositorio.pucsp.br:handle/25997Biblioteca Digital de Teses e Dissertaçõeshttps://sapientia.pucsp.br/https://sapientia.pucsp.br/oai/requestbngkatende@pucsp.br||rapassi@pucsp.bropendoar:2022-04-28T15:11:25Biblioteca Digital de Teses e Dissertações da PUC_SP - Pontifícia Universidade Católica de São Paulo (PUC-SP)false |
dc.title.pt_BR.fl_str_mv |
Intervenções educativas e medicamentosas para controle pressórico em transplantados renais baseadas no uso da monitorização ambulatorial da pressão arterial |
dc.title.alternative.en_US.fl_str_mv |
Educational and drug interventions for blood pressure control in kidney transplant recipients based on ambulatory blood pressure monitoring |
title |
Intervenções educativas e medicamentosas para controle pressórico em transplantados renais baseadas no uso da monitorização ambulatorial da pressão arterial |
spellingShingle |
Intervenções educativas e medicamentosas para controle pressórico em transplantados renais baseadas no uso da monitorização ambulatorial da pressão arterial Rebelo, Rafael Naufel de Sá CNPQ::CIENCIAS DA SAUDE Transplante de Rim Hipertensão Educação de pacientes como assunto Monitorização ambulatorial da pressão arterial Conduta do tratamento medicamentoso/ED Estilo de vida saudável Kidney transplantation Hypertension Patient education as a topic Ambulatory blood pressure monitoring Medication/ED treatment management Healthy lifestyle |
title_short |
Intervenções educativas e medicamentosas para controle pressórico em transplantados renais baseadas no uso da monitorização ambulatorial da pressão arterial |
title_full |
Intervenções educativas e medicamentosas para controle pressórico em transplantados renais baseadas no uso da monitorização ambulatorial da pressão arterial |
title_fullStr |
Intervenções educativas e medicamentosas para controle pressórico em transplantados renais baseadas no uso da monitorização ambulatorial da pressão arterial |
title_full_unstemmed |
Intervenções educativas e medicamentosas para controle pressórico em transplantados renais baseadas no uso da monitorização ambulatorial da pressão arterial |
title_sort |
Intervenções educativas e medicamentosas para controle pressórico em transplantados renais baseadas no uso da monitorização ambulatorial da pressão arterial |
author |
Rebelo, Rafael Naufel de Sá |
author_facet |
Rebelo, Rafael Naufel de Sá |
author_role |
author |
dc.contributor.advisor1.fl_str_mv |
Rodrigues, Cibele Isaac Saad |
dc.contributor.advisor1Lattes.fl_str_mv |
http://lattes.cnpq.br/7498326697611689 |
dc.contributor.authorLattes.fl_str_mv |
http://lattes.cnpq.br/2585814582458704 |
dc.contributor.author.fl_str_mv |
Rebelo, Rafael Naufel de Sá |
contributor_str_mv |
Rodrigues, Cibele Isaac Saad |
dc.subject.cnpq.fl_str_mv |
CNPQ::CIENCIAS DA SAUDE |
topic |
CNPQ::CIENCIAS DA SAUDE Transplante de Rim Hipertensão Educação de pacientes como assunto Monitorização ambulatorial da pressão arterial Conduta do tratamento medicamentoso/ED Estilo de vida saudável Kidney transplantation Hypertension Patient education as a topic Ambulatory blood pressure monitoring Medication/ED treatment management Healthy lifestyle |
dc.subject.por.fl_str_mv |
Transplante de Rim Hipertensão Educação de pacientes como assunto Monitorização ambulatorial da pressão arterial Conduta do tratamento medicamentoso/ED Estilo de vida saudável |
dc.subject.eng.fl_str_mv |
Kidney transplantation Hypertension Patient education as a topic Ambulatory blood pressure monitoring Medication/ED treatment management Healthy lifestyle |
description |
Arterial hypertension (AH) after kidney transplant (AKT) is correlated with severe cardiovascular and renal outcomes, such as kidney function loss, decreased graft survival, and high mortality rates. Manual office blood pressure (MOBP) values of kidney transplant recipients (KTR) are usually different from those obtained by systematic methodologies like Ambulatory Blood Pressure Monitoring (ABPM). Additionally, there is a significant prevalence of nocturnal non-dipping and blood pressure, white coat hypertension (WCH), and masked hypertension (MH). The goal of the present study was to evaluate the influence of educational and therapeutic actions on blood pressure control in KTR. The evaluation was performed by comparing pre-and post-intervention MOBP and ABPM measurements of individuals from the AKT outpatient clinic of a teaching hospital. It is an experimental, observational, prospective, and interventional cohort study. We included 33 adult patients with an average age of 46.8 years, hypertensive and non-diabetic. 53.8% of the study group had received organs from deceased donors. Data collection tools included a sociodemographic and clinical survey, three routine medical appointments at 2, 4, and 6 months to collect the standardized blood pressure measurement, and a lifestyle changes (LC) program. Additionally, the drugs were adjusted according to the 24 hours ABPM results. After 6 months, the test was repeated for the 26 patients who remained in the study. A paired t-test was used to evaluate the difference between the initial and the three follow-up evaluations. The impact of LC, the perception of symptoms, and the clinical assessment were evaluated using Student's t-test for BP indicators, and Fisher's exact test was used for the remaining comparisons between categorical variables. We observed that the ambulatory evaluation presents mean values higher than those obtained by the ABPM test (p<0.05) for systolic and diastolic values. ABPM results indicated that 4 out of 10 patients had an abnormal pressure curve, with a high prevalence of WCH (46.1%), and more than 90% of the participants did not show nocturnal dipping. The association of drug adjustments and LC was the most prevalent intervention was, comprising 88% of the proposed interventions; 8% of the patients required only LC guidelines and only 4% of the participants did not require any interventional action. The ambulatory diastolic BP values significantly decreased after 6 months of follow-up (p = 0.040). However, this good result was not repeated for ABPM. Patients were more likely to follow the diet changing program (69,3%) than the physical activity program (34.6%). Dietary change was associated with a significant reduction of mean systolic BP, measured by ABPM while awake and asleep. Patients who did not change their dietary habits showed an increase in this indicator. Hence, the study allowed us to verify the high prevalence of AH, diagnose the different AH phenotypes using ABPM, and implement personalized actions addressing clinical, behavioral, and drug-related aspects. These actions proved to be effective after a 6- moths follow-up. The actions could be more effective in larger sample size and with a longer follow-up. The results show the importance of ABPM as a strategy for BP followup in KTR |
publishDate |
2022 |
dc.date.accessioned.fl_str_mv |
2022-04-27T17:49:24Z |
dc.date.available.fl_str_mv |
2022-04-27T17:49:24Z |
dc.date.issued.fl_str_mv |
2022-03-14 |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/masterThesis |
format |
masterThesis |
status_str |
publishedVersion |
dc.identifier.citation.fl_str_mv |
Rebelo, Rafael Naufel de Sá. Intervenções educativas e medicamentosas para controle pressórico em transplantados renais baseadas no uso da monitorização ambulatorial da pressão arterial. 2022. Dissertação (Mestrado em Educação nas Profissões da Saúde) - Programa de Estudos Pós-Graduados em Educação nas Profissões da Saúde da Pontifícia Universidade Católica de São Paulo, Sorocaba, 2022. |
dc.identifier.uri.fl_str_mv |
https://repositorio.pucsp.br/jspui/handle/handle/25997 |
identifier_str_mv |
Rebelo, Rafael Naufel de Sá. Intervenções educativas e medicamentosas para controle pressórico em transplantados renais baseadas no uso da monitorização ambulatorial da pressão arterial. 2022. Dissertação (Mestrado em Educação nas Profissões da Saúde) - Programa de Estudos Pós-Graduados em Educação nas Profissões da Saúde da Pontifícia Universidade Católica de São Paulo, Sorocaba, 2022. |
url |
https://repositorio.pucsp.br/jspui/handle/handle/25997 |
dc.language.iso.fl_str_mv |
por |
language |
por |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.publisher.none.fl_str_mv |
Pontifícia Universidade Católica de São Paulo |
dc.publisher.program.fl_str_mv |
Programa de Estudos Pós-Graduados em Educação nas Profissões da Saúde |
dc.publisher.initials.fl_str_mv |
PUC-SP |
dc.publisher.country.fl_str_mv |
Brasil |
dc.publisher.department.fl_str_mv |
Faculdade de Ciências Médicas e da Saúde |
publisher.none.fl_str_mv |
Pontifícia Universidade Católica de São Paulo |
dc.source.none.fl_str_mv |
reponame:Biblioteca Digital de Teses e Dissertações da PUC_SP instname:Pontifícia Universidade Católica de São Paulo (PUC-SP) instacron:PUC_SP |
instname_str |
Pontifícia Universidade Católica de São Paulo (PUC-SP) |
instacron_str |
PUC_SP |
institution |
PUC_SP |
reponame_str |
Biblioteca Digital de Teses e Dissertações da PUC_SP |
collection |
Biblioteca Digital de Teses e Dissertações da PUC_SP |
bitstream.url.fl_str_mv |
https://repositorio.pucsp.br/xmlui/bitstream/handle/25997/1/Rafael%20Naufel%20de%20Sa%20Rebelo.pdf https://repositorio.pucsp.br/xmlui/bitstream/handle/25997/2/Rafael%20Naufel%20de%20Sa%20Rebelo.pdf.txt https://repositorio.pucsp.br/xmlui/bitstream/handle/25997/3/Rafael%20Naufel%20de%20Sa%20Rebelo.pdf.jpg |
bitstream.checksum.fl_str_mv |
37f428edbe507a8012cb48bc2f327d39 171b1887997e5c1c76cf447a363caed9 a092e15a5449b9ca0349977eb63d680c |
bitstream.checksumAlgorithm.fl_str_mv |
MD5 MD5 MD5 |
repository.name.fl_str_mv |
Biblioteca Digital de Teses e Dissertações da PUC_SP - Pontifícia Universidade Católica de São Paulo (PUC-SP) |
repository.mail.fl_str_mv |
bngkatende@pucsp.br||rapassi@pucsp.br |
_version_ |
1793424105372909568 |