Riesgo de enfermedades cardiovasculares según categorías de presión arterial en una cohorte argentina
DOI:
https://doi.org/10.31053/1853.0605.v73.n3.14812Palabras clave:
cardiovascular diseases, epidemiology, general population, high blood pressure,Resumen
Summary
Background: Hypertension is a recognized strong risk factor for cardiovascular disease. However, no data was available in our country to quantify the relationship between blood pressure and cardiovascular event.
Objective: to quantify the risk of cardiovascular events according to blood pressure categories.
Methods: A prospective epidemiological study was conducted in 1526 inhabitants from Rauch City, (Buenos Aires, Argentina) between 1997 and 2012. Subjects were classified into one of these blood-pressure categories: 1-optimal, 2-normal, 3-high-normal, 4-grade 1 hypertension, 5-grade 2 hypertension and 6-grade 3 hypertension. The first CVD event, including unstable angina pectoris, fatal and non-fatal myocardial infarction, myocardial revascularization, and fatal or non-fatal stroke, was defined as the primary endpoint. Multivariable Cox proportional-hazards regression models were used to estimate the relative risk (HR) of CVD according to base-line blood-pressure categories.
Results: In 2012, 1124 individuals (73.7% of the baseline sample), 719 women and 405 men (in 1997, aged 45±16 and 46±16 respectively) or their relatives in case of death, could be surveyed again in order to obtain information concerning incident CVD events. Cardiovascular event rates and HR values increased in a stepwise manner across the blood pressure categories (p for trend across categories <0.001 in both sex); however, in subjects aged ?55 years a j-curve phenomenon was observed, showing the lowest incidence in the high-normal category. In all categories CVD events rates were higher for men.
Conclusion: This study quantified relationships between BP and CVD starting from high-normal blood pressure in Argentina.
Resumen
Antecedentes: La hipertensión arterial es un reconocido factor de riesgo de enfermedad cardiovascular (ECV). Sin embargo, no hay información en Argentina que cuantifique la relación entre la presión arterial (PA) y ECV.
Objetivo: Cuantificar el riesgo de ECV de acuerdo a categorías de PA.
Método: Se realizó un estudio epidemiológico prospectivo en 1526 habitantes de la ciudad de Rauch (Buenos Aires, Argentina) entre octubre de 1997 y febrero de 2012. Los individuos fueron clasificados en las categorías de PA: 1-óptima, 2-normal, 3-normal-alta, 4-hipertensión grado 1, 5-hipertensión grado 2 y 6-hipertensión grado 3. Fue definido como punto final el primer evento de ECV (angina de pecho inestable, infarto fatal y no fatal, revascularización, y accidente cerebrovascular fatal y no fatal). El riesgo relativo (HR) de tener un evento fue estimado usando modelos de regresión multivariable de Cox.
Resultados: En 2012, fueron re-encuestados 1124 individuos (73,7% de la muestra basal), 719 mujeres y 405 hombres, o sus parientes en caso de muerte (edad en 1997 45±16 y 46±16 años, respectivamente). Las tasas de ECV y los HR se incrementaron para cada categoría de PA por encima de la óptima (p < 0.001 en ambos sexos); sin embargo, en sujetos mayores de 55 años se observó un fenómeno de curva en J, con la incidencia más baja en la categoría normal-alto. En todas las categorías la tasa de eventos fue mayor en hombres.
Conclusión: Este estudio demostró y cuantificó la relación entre de PA y ECV a partir de PA normal alta en una población de Argentina.
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