Características del ritmo circadiano de la presión arterial y la presión de pulso en pacientes con insuficiencia renal
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2021
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Graduados
Resumen
Antecedentes: la enfermedad renal crónica produce una alteración, bien caracterizada de los ritmos circadianos, incluidos los de la presión arterial. La ausencia de caída de la presión arterial
durante el sueño puede tener implicaciones en la respuesta terapéutica.
Objetivo: Establecer las características del ritmo circadiano de la presión arterial y la presión de pulso en pacientes con insuficiencia renal
Metodología: se realizó un reporte de casos que incluyo 33 pacientes con enfermedad renal crónica atendidos en el hospital General del IESS Ceibos Norte en la ciudad de Guayaquil, Ecuador, en los cuales se monitorizados presión arterial sistólica, diastólica y de pulso. Se seleccionaron pacientes con MAPA, sin antecedentes de trasplante renal, que no presentaron
hipertensión arterial maligna.
Resultados: La PAS promedio a las 24 horas 147,5 ± 9.5 mmHg, en el día de 147.9 ± 10.2 mmHg, en la noche de 129.1 ± 7.6 mmHg. La PAD promedio en las 24 horas fue de 80.5 ± 7.6 mmHg, en el día fue de 81 ± 7.3 mmHg y en la noche de 70.24 ± 7.9 mmHg con tendencia al alza sostenida pero leve. El promedio de la presión de pulso fue de 67.3 ± 6.7 mmHg con tendencia es bastante uniforme en meseta (Gráfico 2).
Conclusiones: Las características de la presión arterial sistólica, diastólica y la presión de pulso se mantienen durante el día en cifras tensionales altas que deben ser consideradas de hipertensión, pero en la noche los valores describen una presión que cae a valores que pueden considerarse de normalidad.
Background: chronic kidney disease produces a well-characterized alteration of circadian rhythms, including blood pressure. The absence of a drop in blood pressure during sleep may have implications for the therapeutic response. Objective: To establish the characteristics of the circadian rhythm of blood pressure and pulse pressure in patients with kidney failure. Methodology: a case report was made that included 33 patients with chronic kidney disease treated at the General Hospital of the IESS Ceibos Norte in the city of Guayaquil, Ecuador, in which systolic, diastolic and pulse blood pressure were monitored. Patients with ABPM, without a history of kidney transplantation, who did not present malignant arterial hypertension were selected. Results: Average SBP at 24 hours 147.5 ± 9.5 mmHg, 147.9 ± 10.2 mmHg in the day, 129.1 ± 7.6 mmHg at night. The mean DBP in the 24 hours was 80.5 ± 7.6 mmHg, in the daytime it was 81 ± 7.3 mmHg and at night it was 70.24 ± 7.9 mmHg with a sustained but slight upward trend. The mean pulse pressure was 67.3 ± 6.7 mmHg with a tendency to be quite uniform in plateau (Graph 2). Conclusions: The characteristics of systolic and diastolic blood pressure and pulse pressure remain during the day at high blood pressure figures that should be considered hypertensive, but at night the values describe a pressure that falls to values that can be considered normal.
Background: chronic kidney disease produces a well-characterized alteration of circadian rhythms, including blood pressure. The absence of a drop in blood pressure during sleep may have implications for the therapeutic response. Objective: To establish the characteristics of the circadian rhythm of blood pressure and pulse pressure in patients with kidney failure. Methodology: a case report was made that included 33 patients with chronic kidney disease treated at the General Hospital of the IESS Ceibos Norte in the city of Guayaquil, Ecuador, in which systolic, diastolic and pulse blood pressure were monitored. Patients with ABPM, without a history of kidney transplantation, who did not present malignant arterial hypertension were selected. Results: Average SBP at 24 hours 147.5 ± 9.5 mmHg, 147.9 ± 10.2 mmHg in the day, 129.1 ± 7.6 mmHg at night. The mean DBP in the 24 hours was 80.5 ± 7.6 mmHg, in the daytime it was 81 ± 7.3 mmHg and at night it was 70.24 ± 7.9 mmHg with a sustained but slight upward trend. The mean pulse pressure was 67.3 ± 6.7 mmHg with a tendency to be quite uniform in plateau (Graph 2). Conclusions: The characteristics of systolic and diastolic blood pressure and pulse pressure remain during the day at high blood pressure figures that should be considered hypertensive, but at night the values describe a pressure that falls to values that can be considered normal.
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RITMO CIRCADIANO, PRESION ARTERIAL, PRESION DE PULSO, INSUFICIENCIA RENAL, HOSPITAL IESS LOS CEIBOS, CANTON GUAYAQUIL, ECUADOR