Avaliação de diferentes definições dos fenótipos de hipertensão em portadores de doença renal crônica: estudo de coorte
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Data
2023-02-16
Autores
Gonçalves, Alessandra Bonilha
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Universidade Estadual Paulista (Unesp)
Resumo
O objetivo do presente estudo foi comparar a acurácia de diferentes definições dos fenótipos de hipertensão em portadores de doença renal crônica não dialítica para predizer eventos adversos. Trata-se de coorte longitudinal de todos os pacientes com DRC que realizaram MAPA no período de abril de 2004 a fevereiro de 2012 no Serviço de MAPA da UNESP e seguidos até dezembro de 2021. Foi avaliado se a definição mais ampla e atual dos fenótipos de hipertensão (PA de consultório normal com PA em vigília ≥135x85 mmHg, ou PA em 24 h ≥130x80mmHg ou PA ao sono ≥ 120x70 mmHg para hipertensão mascarada ou vice-versa para Jaleco Branco) pode identificar com mais acurácia o risco de desfechos duros do que a definição tradicional desses fenótipos (PA de consultório normal com PA ≥ 135x85mmHg na MAPA em vigília para mascarada ou vice-versa para Jaleco Branco). Foram analisados os desfechos mortalidade por todas as causas, mortalidade de causa cardiovascular e evento renal (falência renal ou dobrar a creatinina). As curvas de sobrevivência foram comparadas pela análise de Cox. Foram analisados 367 pacientes, incluindo 161 homens (44%), com idade de 60 ± 16,0 anos. O tempo de seguimento foi de 1 a 199 meses e a mediana de 109 meses. Na análise univariada, o critério tradicional conseguiu discriminar a evolução para morte de causa cardiovascular entre hipertensão arterial mascarada não controlada e hipertensão arterial controlada, com Hazard Ratio (HR): 3,49 (IC 95%: 1,14 – 10,68; p=0,03). O critério tradicional conseguiu discriminar a evolução para evento renal entre hipertensão arterial do avental branco não controlada e hipertensão arterial sustentada não controlada, com HR: 0,30 (IC 95%: 0,11 – 0,82; p=0,02). As demais curvas de sobrevivência não apresentaram diferença estatística. Na análise múltipla com ajuste para diabetes e tabagismo, que foram as características clínicas mais relevantes que apresentaram desbalanço entre os grupos, o critério tradicional foi capaz de identificar os desfechos de mortalidade por todas as causas HR: 0,39 (IC95%: 0,17-0,90); p=0,03 e desfechos renais HR: 0,22 (IC95%: 0,07-0,70; p=0,01) entre hipertensão arterial do avental branco não controlada e hipertensão arterial sustentada não controlada. Portanto, de maneira geral, o critério tradicional teve uma performance melhor do que o critério atual para diferenciar os desfechos dos diferentes fenótipos de hipertensão nos portadores de DRC não dialíticos.
The purpose of the present study was to compare the accuracy of different definitions to hypertension phenotypes in non-dialytic chronic kidney disease patients to predict adverse events. This is a longitudinal cohort of all patients with CKD who underwent ABPM from April 2004 to February 2012 at the ABPM Service of UNESP and followed up to December 2021. We evaluated whether the broader and current definition of hypertension phenotypes (normal office BP with waking BP ≥ 135x85 mmHg, or 24-h BP ≥ 130x80mmHg or sleep BP ≥ 120x70 mmHg for masked hypertension, or vice versa for White Coat) can more accurately identify the risk of hard outcomes than the traditional definition of these phenotypes (normal office BP with BP ≥ 135x85mmHg on ABPM from waking to masked or vice versa for White Coat). The outcomes of all-cause mortality, cardiovascular mortality and renal events (kidney failure or creatinine doubling) were analyzed. Survival curves were compared by Cox analysis. A total of 367 patients were analyzed, including 161 men (44%), aged 60 ± 16.0 years. The followup time ranged from 1 to 199 months and the median was 109 months. In the univariate analysis, the traditional criterion was able to discriminate the evolution to death from cardiovascular causes between uncontrolled and controlled arterial hypertension, with Hazard Ratio (HR): 3.49 (IC 95%: 1.14 – 10.68; p=0.03). The traditional criterion was able to discriminate the progression to a renal event between uncontrolled white-coat arterial hypertension and uncontrolled sustained arterial hypertension, with HR: 0.30 (IC 95%: 0.11 – 0.82; p=0.02). The other survival curves showed no statistical significant difference. In the multiple analysis with adjustment for diabetes and smoking, which were the most relevant clinical characteristics that showed imbalance between the groups, the traditional criterion was able to identify the outcomes of all-cause mortality with HR: 0.39 (IC95%: 0.17-0.90; p=0.03) and renal outcomes with HR: 0.22 (IC95%: 0.07-0.70; p=0.01) between uncontrolled white-coat hypertension and uncontrolled sustained arterial hypertension. Therefore, in general, the traditional criterion performed better than the current criterion to differentiate the outcomes of different hypertension phenotypes in non-dialysis CKD patients.
The purpose of the present study was to compare the accuracy of different definitions to hypertension phenotypes in non-dialytic chronic kidney disease patients to predict adverse events. This is a longitudinal cohort of all patients with CKD who underwent ABPM from April 2004 to February 2012 at the ABPM Service of UNESP and followed up to December 2021. We evaluated whether the broader and current definition of hypertension phenotypes (normal office BP with waking BP ≥ 135x85 mmHg, or 24-h BP ≥ 130x80mmHg or sleep BP ≥ 120x70 mmHg for masked hypertension, or vice versa for White Coat) can more accurately identify the risk of hard outcomes than the traditional definition of these phenotypes (normal office BP with BP ≥ 135x85mmHg on ABPM from waking to masked or vice versa for White Coat). The outcomes of all-cause mortality, cardiovascular mortality and renal events (kidney failure or creatinine doubling) were analyzed. Survival curves were compared by Cox analysis. A total of 367 patients were analyzed, including 161 men (44%), aged 60 ± 16.0 years. The followup time ranged from 1 to 199 months and the median was 109 months. In the univariate analysis, the traditional criterion was able to discriminate the evolution to death from cardiovascular causes between uncontrolled and controlled arterial hypertension, with Hazard Ratio (HR): 3.49 (IC 95%: 1.14 – 10.68; p=0.03). The traditional criterion was able to discriminate the progression to a renal event between uncontrolled white-coat arterial hypertension and uncontrolled sustained arterial hypertension, with HR: 0.30 (IC 95%: 0.11 – 0.82; p=0.02). The other survival curves showed no statistical significant difference. In the multiple analysis with adjustment for diabetes and smoking, which were the most relevant clinical characteristics that showed imbalance between the groups, the traditional criterion was able to identify the outcomes of all-cause mortality with HR: 0.39 (IC95%: 0.17-0.90; p=0.03) and renal outcomes with HR: 0.22 (IC95%: 0.07-0.70; p=0.01) between uncontrolled white-coat hypertension and uncontrolled sustained arterial hypertension. Therefore, in general, the traditional criterion performed better than the current criterion to differentiate the outcomes of different hypertension phenotypes in non-dialysis CKD patients.
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Palavras-chave
Insuficiência renal crônica, Hipertensão do jaleco branco, Monitorização ambulatorial da pressão arterial, Hipertensão mascarada