Novedades en hipertensión arterial y riesgo vascular: Febrero-Marzo2024

Los próximos días 31 de mayo-3 de Junio de 2024 tendrá lugar el “ 33rd Meeting of the European Society of Hypertension (ESH) en Berlín.

Publicaciones recientes de interés en hipertensión arterial:

 

1/ Mena L, Mengual JJ, García-Sánchez SM, Avellaneda-Gómez C, Font MA, Montull C, Castrillo L, Blanch P, Castellanos P, Lleixa M, Martín-Baranera M, Armario P, Gómez-Choco M.  Relationship of arterial stiffness and baseline vascular burden with new lacunes and microbleeds: A longitudinal cohort study

 

Abstract

Introduction: Arterial stiffness may have a significant impact on the development of cerebral small vessel disease (cSVD).

Patients and methods: We obtained pulse wave velocity (24-h PWV) by means of ambulatory blood pressure monitoring (ABPM) in patients with a recent small subcortical infarct (RSSI). Patients with known cardiac or arterial embolic sources were excluded. Lacunes, microbleeds, white matter hyperintensities and enlarged perivascular spaces at baseline were assessed in a brain MRI and included in a cSVD score. A follow-up MRI was obtained 2 years later and assessed for the appearance of new lacunes or microbleeds. We constructed both unadjusted and adjusted models, and subsequently selected the optimal models based on the area under the curve (AUC) of the predicted probabilities.

Results: Ninety-two patients (mean age 67.04 years, 69.6% men) were evaluated and 25 had new lacunes or microbleeds during follow-up. There was a strong correlation between 24-h PWV and age (r = 0.942, p < 0.001). cSVD was associated with new lacunes or microbleeds when adjusted by age, 24-h PWV, NT-proBNP and hypercholesterolemia (OR 2.453, CI95% 1.381–4.358). The models exhibiting the highest discrimination, as indicated by their area under the curve (AUC) values, were as follows: 1 (AUC 0.854) – Age, cSVD score, 24-h PWV, Hypercholesterolemia; 2 (AUC 0.852) – cSVD score, 24-h PWV, Hypercholesterolemia; and 3 (AUC 0.843) – Age, cSVD score, Hypercholesterolemia.

Conclusions: cSVD score is a stronger predictor for cSVD progression than age or hemodynamic parameters in patients with a RSSI.

 

Comentario:

En este estudio prospectivo se incluyó una cohorte de pacientes con un episodio de ictus lacunar reciente, ingresados en el Hospital Universitario Moisès Broggi entre Noviembre de 2017 hasta Julio de 2019, seguidos durante 2 años. La edad media de los pacientes incluidos fue de 67,04 años, 69,6% varones.

El objetivo principal fue evaluar si los parámetros hemodinámicos relacionados con la rigidez arterial se asociaron con la progresión de la enfermedad cerebral de vaso pequeño (cerebral small vessel dissease: cSVD), particularmente con el desarrollo

de nuevas lagunas o microhemorragias.

La principal conclusión del estudio es que la puntuación (score) de CSVD fue un  predictor más potente de aparición de nuevas lesiones cerebrovasculares por progresión de la CSVD que la edad y la VOP-24h. Estos resultados apoyan el concepto actual de la relevancia de lograr un control adecuado de la PA en la edad media de la vida, para poder prevenir la aparición) de lesiones cerebrovasculares de vaso pequeño (en la mayoría de casos silentes), que son un predictor potente de recurrencia de ictus, y de alteración cognitiva vascular futura.

 

2/ Pregnancy—An Ideal Period to Identify Women at Risk for Chronic Hypertension

Charakida M, Wright A, Magee LA, Syngelaki A, von Daldelszen P, Akolekar R et al. Pregnancy—An Ideal Period to Identify Women at Risk for Chronic Hypertension

Hypertension 2024;81:311-318

 

Abstract

 

BACKGROUND: Cardiovascular disease is the leading cause of mortality in women. Pregnancy is an ideal period to implement cardiovascular prevention strategies as women seek medical help. We aimed to develop a predictive model to identify women at increased risk for chronic hypertension (CH) based on information collected in the index pregnancy. METHODS: Cohort of 26 511 women seen in 2 consecutive pregnancies. Included were women without CH, with information on maternal characteristics and blood pressure at 11 to 13 weeks’ gestation, and the development of preeclampsia or gestational hypertension (GH) in the index pregnancy. Logistic regression models were fitted for the prediction of the development of future CH by the 20th week of the subsequent pregnancy. The performance of screening and risk calibration of the model were assessed.

RESULTS: In this study 1560 (5.9%) women developed preeclampsia or GH (index pregnancy), and 215 (0.8%) developed future CH, with a median of 3.0 years later. Predictors of development of future CH were maternal age, weight, and blood pressure; Black and South Asian ethnicity; family history of preeclampsia; parity; and development of preeclampsia or GH. Preeclampsia or GH detected 52.1% (45.2%–58.9%) of future CH. At a screen-positive rate of 10%, a model including maternal characteristics, early pregnancy blood pressure, and development of preeclampsia or GH detected 73.5% (67.1–79.3) of future CH.

CONCLUSIONS: Early pregnancy maternal characteristics, blood pressure, and development of preeclampsia or GH identify three-fourths of women at risk for future CH. Our results offer an important preventative strategy for identifying women at increased risk of future CH, which is applicable worldwide.

 

Comentario:

 

Es bien conocido que entre un 5-10% de los embarazaros se asocia a trastornos hipertensivos (HTA gestacional o preeclampsia), las cuales se presentan a partir de la semana 20 de gestación. El tratamiento final es el parto, por tanto cuanto más tarde ser presenten estas complicaciones, mejor será el pronóstico.

 

Pero lo que es relevante en esta publicación como otras muchas previas sobre el mismo tópico, es recordar que incluso en los casos que se normotensan durante los primeros días o primeras  semanas ( la mayoría de casos sin HTA crónica previa), el riesgo de HTA futura y el aumento del riesgo de padecer eventos cardiovasculares es notablemente superior al que presentan las mujeres normotensas, por lo que una vez dadas de alta por el obstetra se debe hacer un  seguimiento de sus cifras de PA y de los otros factores de riesgo vascular, para prevenir adecuadamente complicaciones cardiovasculares futuras.