Hipertensión arterial en niños y adolescentes: ¿cómo hacemos el diagnóstico? / Arterial hypertension in children and adolescents: how do we make the diagnosis?

El rotular a un niño o adolescente de hipertenso no es una tarea fácil en la actualidad. Sabemos que el pilar para el diagnóstico de Hipertensión Arterial sigue siendo la presión arterial de consultorio; pero tenemos que tener en cuenta que, por su escasa reproducibilidad éste método tiene limitaciones. Hoy existen métodos complementarios reproducibles, validados y confiables como el Monitoreo Ambulatorio de la Presión Arterial (MAPA) y el Monitoreo Domiciliario de la Presión Arterial (MDPA) menos difundido en pediatría, que nos ayudan a llegar a un diagnostico correcto (AU)

Diagnosis of a hypertensive child or adolescent is not an easy task today. We know that the mainstay for diagnosing arterial hypertension remains the measuring of blood pressure at the office; however, it is necessary to bear in mind that, because of its low reproducibility, this method has limitations. Today there are reproducible, validated, and reliable complementary methods, such as ambulatory blood pressure monitoring (ABPM) and home blood pressure monitoring (HBPM), that are less widespread in pediatrics, which may be helpful to make an adequate diagnosis.(AU)

Comparação e correlação entre automedida, medida casual e monitorização ambulatorial da pressão arterial / Comparison and correlation between self-measured blood pressure, casual blood pressure measurement and ambulatory blood pressure monitoring / Comparación y correlación entre automedida, medida casual y monitorización ambulatoria de la presión arterial

FUNDAMENTO: A medida casual da pressão arterial (PA) pelos profissionais de saúde está sujeita a uma grande variabilidade, sendo necessário buscar novos métodos que possam superar essa limitação. OBJETIVO: Comparar e avaliar a correlação entre os níveis de PA obtidos por meio da automedida da pressão arterial (AMPA) com a medida casual e com a monitorização ambulatorial da pressão arterial (MAPA). MÉTODOS: Avaliamos hipertensos que realizaram as três metodologias de medida da PA com intervalo menor que 30 dias; as médias das pressões foram utilizadas para comparação e correlação. Foram empregados os aparelhos: OMRON 705 CP (medida casual), OMRON HEM 714 (AMPA) e SPACELABS 9002 (MAPA). RESULTADOS: Foram avaliados 32 pacientes, 50,09 por cento mulheres, idade média 59,7 (± 11,2) anos, média do IMC 26,04 (± 3,3) kg/m². Valores médios de pressão sistólica (PAS) e pressão diastólica (PAD) para a AMPA foram de 134 (± 15,71)mmHg e 79,32 (± 12,38) mmHg. Na medida casual as médias da PAS e PAD foram, respectivamente, 140,84 (± 16,15)mmHg e 85 (± 9,68) mmHg. Os valores médios da MAPA na vigília foram 130,47 (± 13,26) mmHg e 79,84 (± 9,82) mmHg para PAS e PAD, respectivamente. Na análise comparativa, a AMPA apresentou valores semelhantes aos da MAPA (p > 0,05) e diferentes da medida casual (p < 0,05). Na análise de correlação a AMPA foi superior à medida casual, considerando a MAPA como o padrão de referência nas medidas tensionais. CONCLUSÃO: A AMPA apresentou melhor comparação com a MAPA do que a medida casual e também se correlacionou melhor com a aquela, especialmente para a pressão diastólica, devendo ser considerada uma alternativa com baixo custo para o acompanhamento do paciente hipertenso.

BACKGROUND: Casual blood pressure (BP) measurement by healthcare professionals is subject to great variability and new methods are necessary to overcome this limitation. OBJECTIVE: To compare and assess the correlation between the BP levels obtained by self-measured BP (SMBP), casual BP measurement and ambulatory blood pressure monitoring (ABPM). METHODS: We assessed hypertensive individuals submitted to the three methods of BP measurement at an interval < 30 days; the BP means were used for comparison and correlation. The following devices were used: OMRON 705 CP (casual measurement), OMRON HEM 714 (SMBP) and SPACELABS 9002 (ABPM). RESULTS: A total of 32 patients were assessed, of which 50.09 percent were females, with a mean age of 59.7 (± 11.2), BMI mean of 26.04 (± 3.3) kg/m². Mean systolic (SBP) and diastolic blood pressure (DBP) for SMBP were 134 (± 15.71) mmHg and 79.32 (± 12.38) mmHg. The casual measurement means of SBP and DBP were, respectively, 140.84 (± 16.15) mmHg and 85 (± 9.68) mmHg. The mean values of ABPM during the wakefulness period were 130.47 (± 13.26) mmHg and 79.84 (± 9.82) mmHg for SBP and DBP, respectively. At the comparative analysis, the SMBP had similar results to those obtained at ABPM (p > 0.05) and different from the casual measurement (p < 0.05). At the analysis of correlation, SMBP values were higher than the casual measurements, considering ABPM as the reference standard in BP measurements. CONCLUSION: SMBP showed a better correlation with ABPM than the casual measurement and was also better correlated with the latter, especially regarding the DBP and should be considered as a low-cost alternative for the follow-up of the hypertensive patient.

FUNDAMENTO: La medida casual de la presión arterial (PA), por los profesionales de la salud está sujeta a una gran variabilidad, siendo necesario buscar nuevos métodos que puedan superar esa limitación. OBJETIVO: Comparar y evaluar la correlación entre los niveles de PA obtenidos por medio de la automedida de la presión arterial (AMPA) con la medida casual y con la monitorización ambulatoria de la presión arterial (MAPA). MÉTODOS: Evaluamos hipertensos que realizaron las tres metodologías de medida de la PA con un intervalo menor que 30 días. Los promedios de las presiones fueron utilizados para la comparación y la correlación. Fueron usados los aparatos: OMRON 705 CP (medida casual), OMRON HEM 714 (AMPA) y SPACELABS 9002 (MAPA). RESULTADOS: Se evaluaron 32 pacientes, 50,09 por ciento mujeres, edad promedio 59,7(± 11,2) años, promedio del IMC 26,04 (± 3,3) kg/m². Los valores promedios de presión sistólica (PAS) y presión diastólica (PAD) para la AMPA fueron de 134 (± 15,71) mmHg y 79,32(± 12,38) mmHg. En la medida casual los promedios de la PAS y PAD fueron, respectivamente, 140,84 (± 16,15) mmHg y 85 (± 9,68) mmHg. Los valores promedios de la MAPA en la vigilia fueron 130,47 (± 13,26) mmHg y 79,84 (± 9,82) mmHg para PAS y PAD, respectivamente. En el análisis comparativo, la AMPA tuvo valores similares a los de la MAPA (p > 0,05) y diferentes de la medida casual (p < 0,05). En el análisis de correlación la AMPA fue superior a la medida casual, considerando la MAPA como el estándar de referencia en las medidas tensionales. CONCLUSIÓN: La AMPA presentó una mejor comparación con la MAPA que la medida casual y también se correlacionó mejor con aquella, especialmente para la presión diastólica, debiendo ser considerada como una alternativa con bajo coste para el seguimiento del paciente hipertenso.

A comparison between sphygmomanometer-based and ambulatory blood pressure monitoring in acute salt loading and depletion protocol

INTRODUCTION: Ambulatory blood pressure monitors have been used in salt loading and depletion protocols. However, the agreement between measurements made using ambulatory blood pressure monitors and those made with the sphygmomanometer has not been evaluated. OBJECTIVE: The objective of this study was to compare the concordance of the two methods of blood pressure measurements in protocols of acute salt loading and depletion. METHOD: Systolic blood pressure was measured using a sphygmomanometer at the completion of salt infusion (2 L NaCl 0.9 percent, 4 h) and salt depletion (furosemide, 120mg/day, p.o.) in 18 volunteers. Using the Pearson correlation coefficient (ρ), these readings were compared with the mean systolic blood pressure measured using the ambulatory blood pressure monitoring device during the following periods: 4 h of saline infusion and 12 h of salt depletion; 4 h of saline infusion and the last 6 h of salt depletion; 12 h of salt loading and the last 6 h of depletion; 12 h of salt loading and 12 h of depletion. Salt sensitivity was defined by a difference in the systolic blood pressure between salt loading and salt depletion greater than 10 mmHg when measured with the sphygmomanometer, and the Kappa analysis of concordance (K) was used with a significance level of P<0.05. RESULTS: Only the blood pressure readings obtained using the ambulatory blood pressure device during 4 h of intravenous NaCl and during 12 h of salt depletion showed a high correlation with the variation in the systolic blood pressure measured by the sphygmomanometer, with a full agreement with the salt sensitivity classification (p = 0.71; P = 0.001 and K=1). CONCLUSION: In acute salt loading and depletion protocols, an ambulatory blood pressure monitoring device should be used to record the blood pressure during the 4-h interval of salt infusion and 12-h interval of salt depletion.

The smoothness of blood pressure control of ramipril in essential hypertensive Thai patients evaluation by 24-hour ambulatory blood pressure monitoring.

OBJECTIVE: Evaluate the efficacy of ramipril 2.5 and 5 mg once daily on the degree and homogeneity of 24-hour blood pressure reduction in essential hypertensive Thai patients. MATERIAL AND METHOD: Nineteen male subjects, aged 30 to 60 years, with newly diagnosed essential hypertension were evaluated using the 24-hour ambulatory blood pressure (24-h ABP) measurement. RESULTS: Twelve subjects responded and/or normalized with ramipril once daily, where the office and 24-h ABP were decreased significantly from baseline (p < 0.01). The percentage and magnitude of 24-h SBP/DBP loads after treatment were significantly decreased from 92 +/- 9.7/91 +/- 15.9 to 67 +/- 23.8/65 +/- 27.6 (p < 0.01) and from 23 +/- 10.6/16 +/- 5.3 mmHg to 17 +/- 10.3/10 +/- 4.8 mmHg ( p < 0.05). Trough to peak ratio for SBP/DBP was 0.59/0.52 (overall estimated) and 0.68 +/- 0.23/0.52 +/- 0.22 (individual estimated), while the smoothness index was 0.89/1.03. CONCLUSION: Ramipril 2.5 and 5 mg once daily exerted the smooth 24-hour blood pressure reduction in essential hypertensive Thai patients.

Avaliação do monitor de medida de pressão arterial 0mron 705-CP para uso em adolescentes e adultos jovens / Evaluation of the Omron 705-CP blood pressure measuring device for use in adolescents and young adults

OBJETIVO: Avaliar o monitor OMRON 705-CP de medida de pressão arterial em adolescentes e adultos jovens. MÉTODOS: De acordo com o protocolo da British Hypertension Society e da Association for the Advancement of Medical Instrumentation, realizamos a validação do aparelho em 60 adolescentes. O monitor foi conectado em Y com a coluna de mercúrio e foram realizadas 4 medidas consecutivas e simultâneas, analisadas as independentes e calculadas as diferenças médias entre as pressões e o desvio padrão dessas diferenças. Os resultados foram analisados de acordo com o sistema de grau do protocolo utilizado. RESULTADOS: Foram avaliadas 240 medidas. A idade média dos pacientes foi 16,3 anos. Quando comparada a medida realizada pela coluna de mercúrio com o aparelho houve uma diferença < 15 mmHg em 97,9 por cento das medidas sistólicas e 98,8 por cento das diastólicas; uma diferença < 10 mmHg em 86,3 por cento das medidas sistólicas e 90,4 por cento das diastólicas, classificada como grau A; uma diferença < 5 mmHg em 59,1 por cento das medidas sistólicas e 67 por cento das medidas diastólicas, considerada pela classificação entre A/B. A diferença média e o desvio padrão dessa diferença na pressão sistólica foi de 2,91±6,42 mmHg e para a diastólica de 1,16±5,79 mmHg. CONCLUSAO: O monitor OMRON 705-CP mostrou-se válido para medidas de pressão arterial de adolescentes segundo o protocolo empregado.