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Previous issue date: 2013-10-04 / Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq / 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. / Introdução: A pressão arterial (PA) varia em razão de estímulos fisiológicos
e ambientais e a medida casual, método mais utilizado, não abrange esta
variação. Métodos de múltiplas medidas como a Monitorização Ambulatorial
da PA (MAPA) e a Monitorização Residencial da PA (MRPA) têm contribuído
na busca por maior precisão ao diagnóstico e prognóstico. O conhecimento
das alterações da PA em adolescentes e suas implicações para os órgãos
alvo é ainda mais limitado e estes métodos abrem boas perspectivas, em
relação à hipertensão sustentada e também a tipos menos comuns como a
hipertensão do jaleco branco (HAJB). Objetivos: avaliar a PA em
adolescentes pela medida casual, MRPA e MAPA e testar a concordância
entre os métodos. Comparar e investigar a correlação dos valores
pressóricos com perfil metabólico e aspectos ecocardiográficos entre
sujeitos normotensos, com HA sustentada e HAJB. Método: a partir de
amostra (n=1025) representativa dos adolescentes de 12 a 18 anos
incompletos de Goiânia, Goiás, Brasil, foram selecionados aqueles com PA
casual e/ou residencial com percentil >90 e ainda um grupo de normotensos,
segundo os valores de normalidade propostos pela Fourth Task Force. PA
casual aferida duas vezes em dois momentos distintos, e considerada a
média das segundas medidas. MRPA (06 dias, medidas duplicadas no
período matutino e noturno; considerado o mínimo de 12). Os adolescentes
realizaram a MAPA e foram alocados nos grupos: HA sustentada (percentil
95 na casual, MRPA e MAPA); HAJB (percentil 95 na casual, <90 na
MRPA e MAPA) e normotensos (percentis <90 nos três métodos).
Aparelhos semiautomáticos, OMRON, HEM-705CP (casual e MRPA) e o
Spacelabs, 90207 (MAPA). Análise estatística: Qui-quadrado de Pearson,
Kolmogorov Smirnov, t-student pareado, Estratégia de Bland Altman,
Mountain Plots, ANOVA One Way com correção de Bonferroni e coeficiente
de Pearson. Significante: p<0,05. Resultados: na amostra total (n=133),
valores da medida casual (PAS:127,3±13,8; PAD:74,4±9,5 mmHg); MRPA
(PAS:120,3±12,6; PAD:69,4±7,7mmHg) e MAPA-diurna (PAS:121,5±9,8;
PAD: 70,2±6,6mmHg). Os gráficos de Bland Altman mostraram boa
concordância entre MRPA e MAPA-diurna. Na comparação dos aspectos
metabólicos e ecocardiográficos, avaliados 65 adolescentes, sendo 10 com
HA, 22 com HAJB e 33 normotensos. IMC: HA (28,5±6,3), HAJB (22,1±3,7)
e normotensos (20,7±3,5 kg/m2); HOMA-IR: HA (2,8±1,8), HAJB (2,6±1,2) e
normotensos (1,8±1,1); Glicemia de jejum: HA (83,1±8,8), HAJB (88,7±8,7) e
normotensos (83,2±6,7 cm); Colesterol total: HA (183,1±57,8), HAJB
(165,1±32,8) e normotensos (150,7±23,4mg/dL); Triglicérides: HA
(156,6±107,1), HAJB (98,2±47,9) e normotensos (63,3±19,8 mg/dL); Índice
de massa de ventrículo esquerdo (IMVE): HA (62,4±12,1), HAJB (51,1±12,1)
e normotensos (53,6±13,0 g/m2). Diferenças encontradas: IMVE (HA e
HAJB, p=0,026); massa de VE (HA e normotensos, p=0,006; HA e HAJB,
p=0,014); glicemia de jejum (HAJB e normotensos, p=0,034); colesterol total
(HA e normotensos, p=0,029); triglicérides (HA e normotensos, p<0,001; HA
e HAJB, p=0,012). Conclusão: A medida casual deve ser usada como
triagem em adolescentes com PA acima dos valores de normalidade e os
Resumo xiv
valores devem ser confirmados pela MAPA ou MRPA. A hipertensão
sustentada já começa gerar prejuízos à saúde metabólica e cardiovascular
de adolescentes e a HAJB parece ser uma situação intermediária, mas
requer atenção por oferecer risco metabólico.
| Identifer | oai:union.ndltd.org:IBICT/oai:repositorio.bc.ufg.br:tede/4278 |
| Date | 04 October 2013 |
| Creators | Póvoa, Thaís Inacio Rolim |
| Contributors | Jardim, Paulo César Brandão Veiga, Sousa, Ana Luiza Lima, Jardim, Paulo César Brandão Veiga, Brandão, Andréa Araújo, Pereira, Edna Regina Silva, Souza, Weimar Kunz Sebba Barroso de, Costa, Paulo Sérgio Sucasas da |
| Publisher | Universidade Federal de Goiás, Programa de Pós-graduação em Ciências da Saúde (FM), UFG, Brasil, Faculdade de Medicina - FM (RG) |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/doctoralThesis |
| Format | application/pdf |
| Source | reponame:Biblioteca Digital de Teses e Dissertações da UFG, instname:Universidade Federal de Goiás, instacron:UFG |
| Rights | http://creativecommons.org/licenses/by-nc-nd/4.0/, info:eu-repo/semantics/openAccess |
| Relation | -1006864312617745310, 600, 600, 600, 600, 1545772475950486338, 7337577453819502453, -2555911436985713659 |
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