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Asociación entre la variabilidad de la presión arterial (MAPA) y la hipertrofia ventricular izquierda en adultos con hipertensión arterial incidente en la cohorte Chicamocha

dc.contributor.advisorVillar Centeno, Juan Carlosspa
dc.contributor.authorOspina Galeano, Ana Maríaspa
dc.date.accessioned2020-06-26T19:59:56Z
dc.date.available2020-06-26T19:59:56Z
dc.date.issued2017
dc.identifier.urihttp://hdl.handle.net/20.500.12749/1748
dc.description.abstractAntecedentes: El monitoreo ambulatorio de presión arterial (MAPA) permite diagnosticar la hipertensión arterial (HTA). Permite también observar la variabilidad de la presión arterial sistólica (VPAS), marcador potencialmente útil en la estratificación del riesgo. Nuestro propósito fue evaluar la asociación entre VPAS e hipertrofia ventricular izquierda (HVI), un marcador establecido de riesgo. Métodos: Estudio analítico de corte transversal anidado en la cohorte CHICAMOCHA (1.645 adultos jóvenes con pruebas de tamización de bancos de sangre negativas reclutados en 2.000-2.003). Entre 2.013-2.015 los casos sospechosos de HTA y una muestra aleatoria del resto de participantes fueron referidos para MAPA y ecocardiografía transtorácica (ECOTT). Se exploró la relación entre VPAS con algunas covariables y mediante regresión logística se calcularon Odds ratios e intervalos de confianza (IC) del 95% para la prueba de hipótesis. Resultados: Se seleccionaron 288 participantes (edad media 52 años, 61% hombres) con información de MAPA y ECOTT (40 participantes sin sospecha de HTA). Se confirmó el diagnóstico de HTA en 134 casos (50.7% y 2.5% con/sin sospecha previa, respectivamente). La VPAS fue no deseable (>15 mmHg) en 53 participantes (18.4%) y similar entre los casos con o sin diagnóstico de HTA. Se identificó HVI en el 30.6% de la población, (53% versus 47% en los casos con/sin HTA, p=0.120). Se encontró una relación entre el cambio de presión arterial (CPA) desde línea de base y el grosor de la pared posterior (p=0.005) y entre la carga hipertensiva sistólica >40% y la HVI (OR ajustado 2,37; IC95% 1,35 - 4,15). Sin embargo, no se identificó asociación entre la VPAS y la HVI (OR crudo 1.34; IC95% 0,71 – 2,51, ajustado 0,98; IC95% 0,49 - 1,95). Conclusiones: Aunque este estudio validó la relación entre el cambio de presión arterial durante el seguimiento y la masa ventricular actual, no se identificó una relación entre VPAS e HVI.spa
dc.description.tableofcontentsINTRODUCCIÓN 1 1. OBJETIVOS – PREGUNTA DE INVESTIGACIÓN 3 1.1 Objetivo general: 3 1.2 Objetivos específicos: 3 1.3 Pregunta de investigación: 3 1.4 Hipótesis nula: 4 2. PLANTEAMIENTO DEL PROBLEMA 5 3. MARCO TEÓRICO Y ESTADO DE ARTE 6 3.1 Hipertensión arterial como problema de salud pública: 6 3.2 Diagnóstico de hipertensión arterial: 8 3.3 Concepto de la variabilidad de la presión arterial: 10 3.4 Hipertrofia ventricular izquierda como factor de riesgo independiente: 13 3.5 Cohorte CHICAMOCHA: “Cardiovascular Health Investigation and Collaboration to Assess the Markers and Outcomes of Chagas disease” 15 4. METODOLOGÍA PROPUESTA 17 4.1 Diseño: 17 4.2 Universo: 17 4.3 Población objeto: 17 4.4 Muestra: 17 4.5 Criterios de elegibilidad y de exclusión: 17 Criterios de elegibilidad: 17 Criterios de exclusión: 18 4.6 Variables: 18 4.7 Técnicas y procedimientos para la recolección de la información: 18 4.8 Análisis estadístico 19 4.9. Consideraciones éticas 19 5. RESULTADOS 20 6. DISCUSIÓN 29 7. CONCLUSIONES 32 8. RECOMENDACIÓNES 33 9. BIBLIOGRAFIA 34spa
dc.format.mimetypeapplication/pdfspa
dc.language.isospaspa
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/2.5/co/*
dc.titleAsociación entre la variabilidad de la presión arterial (MAPA) y la hipertrofia ventricular izquierda en adultos con hipertensión arterial incidente en la cohorte Chicamochaspa
dc.title.translatedAssociation between blood pressure variability (map) and left ventricular hypertrophy in adults with incident high blood pressure in the Chicamocha cohorteng
dc.degree.nameEspecialista en Medicina Internaspa
dc.coverageBucaramanga (Santander, Colombia)spa
dc.publisher.grantorUniversidad Autónoma de Bucaramanga UNABspa
dc.rights.localAbierto (Texto Completo)spa
dc.publisher.facultyFacultad Ciencias de la Saludspa
dc.publisher.programEspecialización en Medicina Internaspa
dc.description.degreelevelEspecializaciónspa
dc.type.driverinfo:eu-repo/semantics/masterThesis
dc.type.localTesisspa
dc.type.coarhttp://purl.org/coar/resource_type/c_bdcc
dc.subject.keywordsBlood pressureeng
dc.subject.keywordsHigh blood pressureeng
dc.subject.keywordsBlood pressureeng
dc.subject.keywordsVentricular hypertrophyeng
dc.subject.keywordsMedicineeng
dc.subject.keywordsInternal medicineeng
dc.subject.keywordsInvestigationseng
dc.subject.keywordsComplicationseng
dc.subject.keywordsPatientseng
dc.subject.keywordsPrevention and controleng
dc.subject.keywordsLeft ventricular hypertrophyeng
dc.subject.keywordsSystolic blood pressure variabilityeng
dc.identifier.instnameinstname:Universidad Autónoma de Bucaramanga - UNABspa
dc.identifier.reponamereponame:Repositorio Institucional UNABspa
dc.type.hasversioninfo:eu-repo/semantics/acceptedVersion
dc.rights.accessrightsinfo:eu-repo/semantics/openAccessspa
dc.rights.accessrightshttp://purl.org/coar/access_right/c_abf2spa
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dc.contributor.cvlachttps://scienti.minciencias.gov.co/cvlac/visualizador/generarCurriculoCv.do?cod_rh=0000068519*
dc.contributor.cvlachttps://scienti.minciencias.gov.co/cvlac/visualizador/generarCurriculoCv.do?cod_rh=0001078844*
dc.contributor.googlescholarhttps://scholar.google.es/citations?hl=es#user=nTlsWe0AAAAJ*
dc.contributor.orcidhttps://orcid.org/0000-0002-7047-7299*
dc.contributor.scopushttps://www.scopus.com/authid/detail.uri?authorId=57193835436*
dc.contributor.researchgatehttps://www.researchgate.net/profile/Juan_Villar11*
dc.subject.lembPresión arterialspa
dc.subject.lembHipertensión arterialspa
dc.subject.lembPresión sanguíneaspa
dc.subject.lembHipertrofia ventricularspa
dc.subject.lembMedicinaspa
dc.subject.lembMedicina Internaspa
dc.subject.lembInvestigacionesspa
dc.subject.lembComplicacionesspa
dc.subject.lembPacientesspa
dc.subject.lembPrevención y controlspa
dc.description.abstractenglishBackground: Ambulatory blood pressure monitoring (ABPM) allows the diagnosis of arterial hypertension (HTN). It also allows us to observe the variability of systolic blood pressure (VPAS), a potentially useful marker in risk stratification. Our purpose was to evaluate the association between VPAS and left ventricular hypertrophy (LVH), an established risk marker. Methods: Nested cross-sectional analytical study in the CHICAMOCHA cohort (1,645 young adults with negative blood bank screening tests recruited in 2000-2003). Between 2013-2015 the suspected cases of HT and a random sample of the rest of the participants were referred for ABPM and transthoracic echocardiography (ECOTT). The relationship between VPAS with some covariates was explored and Odds ratios and 95% confidence intervals (CI) were calculated using logistic regression for hypothesis testing. Results: 288 participants were selected (mean age 52 years, 61% men) with ABPM and ECOTT information (40 participants without suspicion of HT). The diagnosis of HT was confirmed in 134 cases (50.7% and 2.5% with / without prior suspicion, respectively). VPAS was undesirable (> 15 mmHg) in 53 participants (18.4%) and similar between cases with or without a diagnosis of HT. LVH was identified in 30.6% of the population (53% versus 47% in the cases with / without HT, p = 0.120). A relationship was found between the change in blood pressure (APC) from baseline and posterior wall thickness (p = 0.005) and between systolic hypertensive load> 40% and LVH (adjusted OR 2.37; 95% CI 1.35 - 4.15). However, no association was identified between ASV and LVH (crude OR 1.34; 95% CI 0.71 - 2.51, adjusted 0.98; 95% CI 0.49 - 1.95). Conclusions: Although this study validated the relationship between the change in blood pressure during follow-up and the current ventricular mass, a relationship between VPAS and LVH was not identified.eng
dc.subject.proposalHipertrofia ventricular izquierda
dc.subject.proposalVariabilidad sistólica de la presión arterial
dc.type.redcolhttp://purl.org/redcol/resource_type/TM
dc.rights.creativecommonsAtribución-NoComercial-SinDerivadas 2.5 Colombia*
dc.contributor.researchgroupGrupo de Investigación en Cardiología Preventivaspa
dc.contributor.researchgroupGrupo de Investigaciones Clínicasspa
dc.coverage.campusUNAB Campus Bucaramangaspa
dc.description.learningmodalityModalidad Presencialspa


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