Diferentes métodos de medida da pressão arterial em adolescentes e sua correlação com perfil metabólico e aspectos ecocardiográficos

• Ano de defesa: 2013
• Autor(a) principal: Póvoa, Thaís Inacio Rolim
• Orientador(a): Jardim, Paulo César Brandão Veiga
• Banca de defesa: Jardim, Paulo César Brandão Veiga, Brandão, Andréa Araújo, Pereira, Edna Regina Silva, Souza, Weimar Kunz Sebba Barroso de, Costa, Paulo Sérgio Sucasas da
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de Goiás
• Programa de Pós-Graduação: Programa de Pós-graduação em Ciências da Saúde (FM)
• Departamento: Faculdade de Medicina - FM (RG)
• País: Brasil
• Palavras-chave em Português: Adolescentes; Pressão arterial; Hipertensão arterial; Perfil metabólico; Ecodopplercardiograma
• Palavras-chave em Inglês: Adolescents; Blood pressure; Hypertension; Metabolic profile; Echodopplercardiogram
• Área do conhecimento CNPq: MEDICINA::ANATOMIA PATOLOGICA E PATOLOGIA CLINICA
• Link de acesso: http://repositorio.bc.ufg.br/tede/handle/tede/4278

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.