Actualizaciones en HTA FEBRERO 2022

Novedades en Hipertensión Arterial y Riesgo Vascular: Febrero 2022
El día 24 de Febrero tendrá lugar en el Auditorio del Hospital Moisès Broggi de Sant Joan Despi, La Jornada bianual sobre Actualización en Riesgo vascular – Estas jornadas se viene llevando a cabo dese del año 2013, de forma bianual, y con sede alternativa en el Complex Hospitalari Moisés Broggi, y en el Hospital Universitario de Bellvitge.  Se presenta tema de actualidad en Diabetes, Hipertensión arterial y lípidos, y resolución multidisciplinar de casos clínicos complejos en riesgo vascular. La Jornada está acreditada, y permite la asistencia por la mañana o bien por la tarde, dado que el programa integro ser repite mañana y tarde.
Entre las publicaciones de mayor relevancia en el campo de la Hipertensión arterial queremos 2 excelentes estudios publicado en Hypertension:
1/ Cardoso CRL,Salles GF. Prognostic Value of Changes in Aortic Stiffness for Cardiovascular Outcomes and Mortality in Resistant Hypertension: a Cohort Study. (Hypertension. 2022;79:447–456. DOI: 10.1161/HYPERTENSIONAHA.121.18498.)
ABSTRACT: The prognostic importance of changes in aortic stiffness for the occurrence of adverse cardiovascular outcomes and mortality has never been investigated in patients with resistant hypertension. We aimed to evaluate it in a prospective cohort of 442 resistant hypertension individuals. Changes in aortic stiffness were assessed by 2 carotid-femoral pulse wave velocity (CF-PWV) measurements performed over a median time interval of 4.7 years. Multivariate Cox analysis examined the associations between changes in CF-PWV (evaluated as continuous variables and categorized into quartiles and as increased/persistently high or reduced/persistently low) and the occurrence of total cardiovascular events (CVEs), major adverse CVEs, and cardiovascular/all-cause mortalities. During a median follow-up of 4.1 years after the second CFPWV measurement, there were 49 total CVEs (42 major adverse CVEs) and 53 all-cause deaths (32 cardiovascular). As continuous variables, increments in absolute and relative changes in CF-PWV were associated with higher risks of CVEs and major adverse CVEs occurrence, but not of mortality. Divided into quartiles of CF-PWV changes, risks increased in the third and fourth quartile subgroups in relation to the reference first quartile subgroup (those with greatest CF-PWV reductions) for all outcomes. Patients who either increased or persisted with high CF-PWV had excess risks of cardiovascular morbidity/ mortality, with hazard ratios ranging from 2.7 to 3.0, in relation to those who reduced or persisted with low CF-PWV values.
In conclusion, reducing or preventing progression of aortic stiffness was associated with significant cardiovascular protection in patients with resistant hypertension, suggesting that it may be an additional clinical target of antihypertensive treatment.
Comentario:
En este estudio se presentan los datos de un estudio prospectivo llevado a cabo en 442 sujetos con hipertensión arterial resistente, seguidos durante 4,7 años y se muestra el valor pronóstico de los cambios en la rigidez arterial valorados mediante la velocidad de la onda del pulso carotideo-femoral. La velocidad de la onda del pulso (VOP) es la velocidad con que la onda del pulso viaja a lo largo de un segmento arterial determinado y se considera el estándar para la investigación no invasiva de la rigidez arterial. Cuando más rígida es la arteria, mayor es la VOP.  En la actualidad, basado en la amplia experiencia de su utilización en grandes poblaciones, el método de referencia seria la medida de la VOP carotideo-femoral mediante tonometría de aplanamiento, o bien por Doppler, dada la ventaja de la localización superficial de ambas arterias. Las Guías Europeas de las Sociedad Europea de Cardiología (ESC) y de la Sociedad Europea de Hipertensión (ESH)   consideran que un valor VOP superior a 10 m /s es una estimación conservadora de alteraciones de la función aórtica.
Los resultados de este estudio, en un amplio grupo de pacientes hipertensos de alto riesgo, han mostrado que los sujetos con incremento o persistencia de una VOP elevada presentan un incremento importante en el riesgo de desarrollar complicaciones cardiovasculares en relación a loa hipertensos que logran reducir o mantener normal la VOP.
2/ Wojciechowska V , Januszewicz A, Drożdż T, Rojek M, Bączalska J, Terlecki M et al. Blood Pressure and Arterial Stiffness in Association With Aircraft Noise Exposure: Long-Term Observation and Potential Effect of COVID-19 Lockdown.
ABSTRACT: In a cross-sectional analysis of a case-control study in 2015, we revealed the association between increased arterial stiffness (pulse wave velocity) and aircraft noise exposure. In June 2020, we evaluated the long-term effects, and the impact of a sudden decline in noise exposure during the coronavirus disease 2019 (COVID-19) lockdown, on blood pressure and pulse wave velocity, comparing 74 participants exposed to long-term day-evening-night aircraft noise level >60 dB and 75 unexposed individuals. During the 5-year follow-up, the prevalence of hypertension increased in the exposed (42% versus 59%, P=0.048) but not in the unexposed group. The decline in noise exposure since April 2020 was accompanied with a significant decrease of noise annoyance, 24-hour systolic (121.2 versus 117.9 mmHg; P=0.034) and diastolic (75.1 versus 72.0 mmHg; P=0.003) blood pressure, and pulse wave velocity (10.2 versus 8.8 m/s; P=0.001) in the exposed group. Less profound decreases of these parameters were noticed in the unexposed group. Significant between group differences were observed for declines in office and night-time diastolic blood pressure and pulse wave velocity. Importantly, the difference in the reduction of pulse wave velocity between exposed and unexposed participants remained significant after adjustment for covariates (−1.49 versus −0.35 m/s; P=0.017). The observed difference in insomnia prevalence between exposed and unexposed individuals at baseline was no more significant at follow-up. Thus, long-term aircraft noise exposure may increase the prevalence of hypertension and accelerate arterial stiffening. However, even short-term noise reduction, as experienced during the COVID-19 lockdown, may reverse those unfavorable effects. (Hypertension. 2022;78:325–334. DOI: 10.1161/ HYPERTENSIONAHA.121.17704.)
Comentario:  La contaminación acústica es un factor de riesgo emergente, como han mostrado diversos estudios llevados a cabo en los últimos años. En este estudio se muestra como la reducción en la contaminación acústica secundaria al tráfico aéreo, observada desde abril de 2020 debido al pandemia se tradujo en una mejoría en la presión arterial y en la rigidez arterial en lo sujetos no expuestos. Sería deseable mantener esa mejoría en la contaminación acústica,   ya sean en el tráfico aéreo como en otros ámbitos, una vez que se superemos la pandemia.