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Num tema muito controverso, com conclusões e resultados díspares em diferentes estudos e alguns estudos ainda em curso, a hipertensão noturna pode ser definida como a média de pressão arterial noturna sistólica superior a 120 mmHg e/ou média de pressão arterial noturna diastólica superior a 70 mmHg. Este diagnóstico só é possível através da realização da Monitorização Ambulatória da Pressão Arterial. A hipertensão noturna, quando acompanhada com hipertensão diurna, é definida como Hipertensão Sustentada ou persistente, por outro lado, se apenas existir hipertensão noturna, verifica-se a presença de Hipertensão Arterial Noturna Isolada.
A Hipertensão Arterial Noturna está associada de forma clara e inequívoca a lesão de órgão alvo e ao aumento do risco cardiovascular. Dado que se define por valores absolutos de pressões arteriais e ser reprodutível através de MAPA, ao contrário das definições clássicas e arcaicas do estado dipping, parece ser um preditor fidedigno do prognóstico dos pacientes.
Existem diversos mecanismos que estão na origem desta entidade patológica, nomeadamente, disfunção do sistema nervoso autónomo com hiperatividade do sistema nervoso simpático e inibição do sistema nervoso parassimpático, alterações no metabolismo do sódio, disfunção endotelial e inflamação vascular e sistémica. Os mesmos mecanismos fisiopatológicos estão na base de doenças cardiovasculares, cerebrovasculares, diabetes mellitus, síndrome da apneia obstrutiva do sono e doença renal crónica, patologias que acompanham frequentemente a Hipertensão arterial Noturna.
Os benefícios associados ao tratamento da Hipertensão arterial noturna ainda não são claros, porém pensa-se que redução da pressão arterial noturna diminua a lesão de órgão alvo associada e o risco cardiovascular. O controlo da pressão arterial deve ser feito ao longo das 24 horas, logo, a cronoterapia (adaptação do ritmo circadiano e fisiopatológico à farmacocinética e farmacodinâmica dos anti-hipertensores) surge como um conceito fundamental e aplicável. Serão necessários ainda mais estudos e investigações para avaliar a forma de tratamento e os benefícios reais do tratamento desta entidade.
In a very controversial subject, with different conclusions and results in many studies and with some studies still in progress, we can already define nocturnal hypertension as the mean systolic nocturnal blood pressure higher than 120 mmHg and/or mean diastolic nocturnal blood pressure higher than 70 mmHg. This diagnosis is only possible through the performance of Ambulatory Blood Pressure Monitoring. The Nocturnal Hypertension when accompanied with diurnal hypertension is defined as Sustained or Persistent Hypertension, otherwise if there is only nocturnal hypertension, we are dealing with Isolated Nocturnal Hypertension. Nocturnal Hypertension is clearly and unequivocally associated with target organ damage and increased cardiovascular risk. Moreover it is defined by absolute values of arterial pressures so it can be reproducible through ABPM, unlike classic and archaic definitions of dipping, and it seems to be a reliable predictor o factual prognosis of patients. There are several mechanisms that are in the origin of this pathology like the dysfunction of autonomic nervous system with a hyper activity of the sympatic nervous system and an inhibition of parassympathic nervous system, changes in sodium metabolism, endothelial dysfunction and vascular/ systemic inflammation. The same pathophysiological mechanisms are the base of cardiovascular diseases, cerebrovascular diseases, diabetes mellitus, obstructive sleep apnea syndrome and chronic kidney disease, pathologies that often accompany nocturnal hypertension. The treatment and benefits of nocturnal hypertension is still nuclear, but lowering nocturnal blood pressure decrease associated target organ damage and cardiovascular risk. Control of blood pressure should be done over the course of 24 hours and therefore chronotherapy (adaptation of the circadian and pathophysiolocal rhythm to the pharmacokinetic and pharmacodynamics of antihypertensives) appears as a fundamental and applicable concept. Further studies and investigations will be needed to assess the form and treatment and the real benefits of treating this entity.
In a very controversial subject, with different conclusions and results in many studies and with some studies still in progress, we can already define nocturnal hypertension as the mean systolic nocturnal blood pressure higher than 120 mmHg and/or mean diastolic nocturnal blood pressure higher than 70 mmHg. This diagnosis is only possible through the performance of Ambulatory Blood Pressure Monitoring. The Nocturnal Hypertension when accompanied with diurnal hypertension is defined as Sustained or Persistent Hypertension, otherwise if there is only nocturnal hypertension, we are dealing with Isolated Nocturnal Hypertension. Nocturnal Hypertension is clearly and unequivocally associated with target organ damage and increased cardiovascular risk. Moreover it is defined by absolute values of arterial pressures so it can be reproducible through ABPM, unlike classic and archaic definitions of dipping, and it seems to be a reliable predictor o factual prognosis of patients. There are several mechanisms that are in the origin of this pathology like the dysfunction of autonomic nervous system with a hyper activity of the sympatic nervous system and an inhibition of parassympathic nervous system, changes in sodium metabolism, endothelial dysfunction and vascular/ systemic inflammation. The same pathophysiological mechanisms are the base of cardiovascular diseases, cerebrovascular diseases, diabetes mellitus, obstructive sleep apnea syndrome and chronic kidney disease, pathologies that often accompany nocturnal hypertension. The treatment and benefits of nocturnal hypertension is still nuclear, but lowering nocturnal blood pressure decrease associated target organ damage and cardiovascular risk. Control of blood pressure should be done over the course of 24 hours and therefore chronotherapy (adaptation of the circadian and pathophysiolocal rhythm to the pharmacokinetic and pharmacodynamics of antihypertensives) appears as a fundamental and applicable concept. Further studies and investigations will be needed to assess the form and treatment and the real benefits of treating this entity.
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Keywords
Cronoterapia Dipping e Não Dipping Hipertensão Arterial Hipertensão Noturna Hipertensão Noturna Isolada Pressão Arterial Noturna