Efectividad de una intervención terapéutica en hipertensos con mal control por monitorización ambulatoria de la presión arterial

Abstract

Objective To evaluate the effectiveness of a therapeutic reinforcement in deficiently controlled blood pressure (BP) patients by using ambulatory BP monitoring (ABPM). Design Descriptive, observational and interventional study. Setting Urban primary care center. Subjects Subjects in whom an ABPM was performed from 2004–06. Intervention To intensify antihypertensive treatment in poorly controlled patients in the initial ABPM (average 24 hours BP ≥130/80 mmHg) and performing of a second ABPM later. Main measurements Age, gender, cardiovascular risk factors, antihypertensive treatment, average BP at the office and by ABPM, circadian pattern, intervention type. Statistical analysis of the variables through SPSS-12 program. Results 107 patients were included, with an average of 60±14 years and slight predominance of women (53%). Antihypertensive drugs were taken in 71% of cases, the most frequently prescribed being diuretics (50%). A total of 42 patients were classified as being poorly controlled (39%). Intensification of treatment was performed in 36 of them (86%), addition of drugs being the most common attitude (48%). The post-intervention ABPM was performed in 27 patients (64%), who, starting from averages of 24 hours BP of 142/75±10/9 mmHg in the first monitoring, achieved statistically significant reductions (p≤0.005) in the average values from 24 hours (−11/5 mmHg), daytime (−11/5 mmHg) and systolic nighttime (−10 mmHg) BP values. Conclusion Intensifying antihypertensive treatment is effectiveness to reduce average BP values in poorly controlled patients by ABPM, objectively shown in a subsequent ABPM.