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Abstract(s)
Introdução: A Hipertensão Arterial (HTA) apresenta uma elevada prevalência a nível
mundial e é um dos principais fatores de risco para desenvolvimento de doenças
cardiovasculares (DCV). É, por isso, um importante e sério problema na saúde pública da
atualidade. De acordo com dados do Instituto Nacional de Estatística, as DCV
representavam 29,9% do total de óbitos a nível nacional em 2019, e segundo a Sociedade
Portuguesa de Hipertensão estima-se que a nível da Europa 30 a 45% da população seja
hipertensa. A progressão da HTA pode levar a desfechos como as lesões de órgãos alvo
(LOA) e a morte. Por esta razão, encontrar novos métodos e relações que possam antever o
desenvolvimento de LOA causadas pela HTA torna-se crucial. Daqui nasce o foco deste
estudo: compreender o contexto epidemiológico da HTA, analisar a realidade prática da
utilização de biomarcadores no seguimento de doentes hipertensos e, como objetivo
principal, avaliar o valor prognóstico de dois marcadores inflamatórios comuns na prática
clínica, Proteína C-Reativa (PCR) e Contagem de Leucócitos (CL), na progressão da HTA.
Materiais e Métodos: Estudo observacional retrospetivo com recolha e análise de dados
relativos a 247 doentes participantes na consulta da Hipertensão do Centro Hospitalar
Universitário Cova da Beira, entre janeiro de 2017 e dezembro de 2021, por meio dos
registos clínicos e conforme os critérios de inclusão e exclusão. Foi utilizado o valor médio
de CL e PCR, os quais foram calculados através do valor registado em três momentos
distintos.
Resultados: Da amostra recolhida 51,8% são do sexo masculino e 48,2% do sexo feminino.
A idade média foi de 66,17 anos. Um aumento da CL média e PCR média foi
significativamente associado com o aumento na probabilidade de ocorrer morte ou
desenvolver LOA. Na análise logística ajustada, para o evento morte, por cada 1 mg/dL de
PCR média adicional a probabilidade de morte aumentou por 82,7% (p=0,041). Por cada
unidade de PCR média ou CL média adicional a probabilidade de desenvolvimento de LOA
aumentou por 347,4% (p=0,005) ou 89,6% (p<0,001), respetivamente. Verificou-se
também que ambos os marcadores inflamatórios têm uma associação com o
desenvolvimento de insuficiência cardíaca, hipertrofia ventricular esquerda, acidente
vascular cerebral/acidente isquémico transitório e doença renal, com exceção do enfarte
agudo do miocárdio que apenas mostrou relação com a PCR.
Conclusão: O contexto epidemiológico da amostra demonstrou-se próximo dos valores
expostos na literatura apreciada. A CL e a PCR, testes facilmente disponíveis e amplamente
utilizados na prática clínica, mostraram-se importantes peças para o estudo e o cálculo do
risco cardiovascular. Estes resultados suportam a hipótese de que a inflamação aparenta ser
um passo crucial no desenvolvimento e progressão da DCV.
Introduction: Arterial Hypertension (HT) has a high prevalence worldwide and is one of the main risk factors for the development of cardiovascular diseases (CVD). It is, therefore, an important and serious problem in public health today. According to data from the Instituto Nacional de Estatística [National Institute of Statistics], CVDs accounted for 29.9% of total deaths nationwide in 2019, and according to the Sociedade Portuguesa de Hipertensão [Portuguese Society of Hypertension], it is estimated that 30 to 45% of the population in Europe is hypertensive. HT progression can lead to outcomes such as hypertension-mediated organ damage (HMOD) and death. For this reason, finding new methods and relationships that can predict the development of HMOD caused by HT becomes crucial. Hence the focus of this study: to understand the epidemiological context of hypertension, to analyse the practical reality of the use of biomarkers in the follow-up of hypertensive patients and, as the main objective, to evaluate the prognostic value of two inflammatory markers common in clinical practice, C-Reactive Protein (CRP) and WBC Count (WBC), in the progression of hypertension. Materials and Methods: Retrospective observational study with collection and analysis of data from 247 patients participating in the Hypertension consultation at Centro Hospitalar Universitário Cova da Beira [Cova da Beira Hospital and University Center], between January 2017 and December 2021, through clinical records and according to the inclusion criteria and exclusion. It was used the mean value of CL and CRP, which were calculated through the value recorded at three different moments. Results: Of the collected sample, 51.8% are male and 48.2% are female. The mean age was 66.17 years. An increase in mean WBC and mean CRP was significantly associated with an increase in the likelihood of death or developing HMOD. In the adjusted logistic analysis, for the death event, for each additional 1 mg/dL of mean CRP the probability of death increased by 82.7% (p=0.041). For each additional mean CRP or mean WBC unit the probability of developing HMOD increased by 347.4% (p=0.005) or 89.6% (p<0.001), respectively. Both inflammatory markers were also found to be associated with the development of heart failure, left ventricular hypertrophy, stroke/transient ischemic attack and kidney disease, with the exception of acute myocardial infarction which only showed a relationship with CRP. Conclusion: The epidemiological context of the sample proved to be close to the values exposed in the literature. WBC and CRP, tests that are easily available and widely used in clinical practice, have proved to be important parts for the study and calculation of cardiovascular risk. These results support the hypothesis that inflammation appears to be a crucial step in the development and progression of CVD.
Introduction: Arterial Hypertension (HT) has a high prevalence worldwide and is one of the main risk factors for the development of cardiovascular diseases (CVD). It is, therefore, an important and serious problem in public health today. According to data from the Instituto Nacional de Estatística [National Institute of Statistics], CVDs accounted for 29.9% of total deaths nationwide in 2019, and according to the Sociedade Portuguesa de Hipertensão [Portuguese Society of Hypertension], it is estimated that 30 to 45% of the population in Europe is hypertensive. HT progression can lead to outcomes such as hypertension-mediated organ damage (HMOD) and death. For this reason, finding new methods and relationships that can predict the development of HMOD caused by HT becomes crucial. Hence the focus of this study: to understand the epidemiological context of hypertension, to analyse the practical reality of the use of biomarkers in the follow-up of hypertensive patients and, as the main objective, to evaluate the prognostic value of two inflammatory markers common in clinical practice, C-Reactive Protein (CRP) and WBC Count (WBC), in the progression of hypertension. Materials and Methods: Retrospective observational study with collection and analysis of data from 247 patients participating in the Hypertension consultation at Centro Hospitalar Universitário Cova da Beira [Cova da Beira Hospital and University Center], between January 2017 and December 2021, through clinical records and according to the inclusion criteria and exclusion. It was used the mean value of CL and CRP, which were calculated through the value recorded at three different moments. Results: Of the collected sample, 51.8% are male and 48.2% are female. The mean age was 66.17 years. An increase in mean WBC and mean CRP was significantly associated with an increase in the likelihood of death or developing HMOD. In the adjusted logistic analysis, for the death event, for each additional 1 mg/dL of mean CRP the probability of death increased by 82.7% (p=0.041). For each additional mean CRP or mean WBC unit the probability of developing HMOD increased by 347.4% (p=0.005) or 89.6% (p<0.001), respectively. Both inflammatory markers were also found to be associated with the development of heart failure, left ventricular hypertrophy, stroke/transient ischemic attack and kidney disease, with the exception of acute myocardial infarction which only showed a relationship with CRP. Conclusion: The epidemiological context of the sample proved to be close to the values exposed in the literature. WBC and CRP, tests that are easily available and widely used in clinical practice, have proved to be important parts for the study and calculation of cardiovascular risk. These results support the hypothesis that inflammation appears to be a crucial step in the development and progression of CVD.
Description
Keywords
Contagem de Leucócitos Doenças Cardiovasculares Hipertensão Arterial Lesão de Órgão Alvo Marcadoresinflamatórios Pcr