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Abstract(s)
A hipertensão arterial, como principal fator de risco de doença cardiovascular, é considerada a principal causa de morbilidade e mortalidade a nível mundial. Desde a introdução da medição da pressão arterial, através da artéria braquial, que esta se tem mantido como uma das práticas clínicas mais amplamente usadas entre os profissionais de saúde, como importante meio de diagnóstico e de controlo do tratamento de hipertensão arterial. Contudo, evidências recentes confirmam que a pressão arterial periférica não é um substituto fidedigno da pressão arterial central a que os órgãos vitais como o coração, o cérebro e os rins estão verdadeiramente expostos. Também a nível do tratamento anti-hipertensivo, estudos revelam diferentes respostas ao nível da pressão arterial central e braquial. Da mesma forma, o papel da rigidez arterial, na patogénese da doença cardiovascular, tem assumido importância determinante, tendo sido reconhecida como um relevante fator de risco cardiovascular e lesão subclínica de órgãos alvo. Novas metodologias não invasivas, como a tonometria de aplanação da artéria radial, permitem avaliar estes parâmetros centrais, estimados pela análise da onda de pulso e pela velocidade da onda de pulso.
Face a este paradigma, os objetivos desta revisão visam aprofundar a importância da pressão central e da rigidez arterial como marcadores cardiovasculares e esclarecer o papel da pressão central na decisão diagnóstica e terapêutica, como índice de controlo no tratamento anti-hipertensivo e das doenças cardiovasculares.
Em conclusão, a pressão arterial central e a rigidez arterial são importantes índices na previsão de eventos cardiovasculares, ultrapassando o valor da pressão arterial braquial. A tonometria de aplanação surge como um promissor adjuvante na avaliação de pacientes com doenças cardiovasculares, permitindo a monitorização da condição hemodinâmica central e o diagnóstico de estágios precoces de desenvolvimento das doenças cardiovasculares. Apesar de ainda estar em investigação, se o uso de fármacos, com o objetivo de melhorar a rigidez arterial e a pressão arterial central, irá refletir-se de fato na obtenção de melhores resultados cardiovasculares, há fortes evidências que o tratamento baseado em decisões sobre a pressão central tenha melhores implicações nos diagnósticos futuros de hipertensão arterial. Dessa forma, a tonometria com a análise da onda de pulso tem indicação para complementar o estudo cardiovascular das avaliações convencionais e, assim, ser integrada na prática clínica diária, como ferramenta de diagnóstico e tratamento médico.
Hypertension, as a major risk fator for cardiovascular disease (CV), is considered as the main cause worldwide for morbidity and mortality worldwide. Since the introduction of blood pressure measuring through the brachial artery, this has remained as one of the most widely used clinical practice among health professionals as major means of both diagnosis and control of hypertension treatment. However, recent evidence confirms that peripheral blood pressure is not a reliable substitute for the central arterial pressure to which vital organs like heart, brain and kidneys are truly exposed, being therefore rather more related to injury in these target organs and future cardiovascular occurrences. Also at the level of anti-hypertensive treatment, studies show different responses at the level of central and brachial blood pressure. Likewise, the role of arterial stiffness in the pathogenesis of CV disease has been taking on a definite importance having been recognized as a relevant risk fator for CV disease and subclinical damage of target organs. New non-invasive methods, such as radial artery applanation tonometry, allow for the assessment of these central parameters as estimated by pulse wave analysis and the pulse wave speed. Given this paradigm, the objectives of this review are to look in further depth at the importance of central blood pressure and arterial stiffness as cardiovascular markers, and clarifying the role of central pressure in diagnostic and therapeutic decisions, as control index in the antihypertensive treatment. In conclusion, central arterial blood pressure and arterial stiffness are important tools in predicting cardiovascular occurrences. The central pulse pressure is a more efficient / accurate predictor of CV events rather than peripheral brachial pressure. AT emerges as a promising adjuvant for evaluating cardiovascular disease patients, allowing for monitoring central hemodynamic conditions and diagnosis of early stages of development of cardiovascular diseases, which would be impossible otherwise. Although It is still not entirely clear whether the use of drugs for improving arterial stiffness and central blood pressure will indeed reflect getting better clinical outcomes, there is strong evidence that treatment based on decisions of the central pressure has better implications for future diagnosis of hypertension. Thus, the tonometry with the pulse wave analysis is indicated in addition to the cardiovascular study of conventional evaluations and thus be integrated into daily clinical practice, as a diagnostic tool and medical treatment.
Hypertension, as a major risk fator for cardiovascular disease (CV), is considered as the main cause worldwide for morbidity and mortality worldwide. Since the introduction of blood pressure measuring through the brachial artery, this has remained as one of the most widely used clinical practice among health professionals as major means of both diagnosis and control of hypertension treatment. However, recent evidence confirms that peripheral blood pressure is not a reliable substitute for the central arterial pressure to which vital organs like heart, brain and kidneys are truly exposed, being therefore rather more related to injury in these target organs and future cardiovascular occurrences. Also at the level of anti-hypertensive treatment, studies show different responses at the level of central and brachial blood pressure. Likewise, the role of arterial stiffness in the pathogenesis of CV disease has been taking on a definite importance having been recognized as a relevant risk fator for CV disease and subclinical damage of target organs. New non-invasive methods, such as radial artery applanation tonometry, allow for the assessment of these central parameters as estimated by pulse wave analysis and the pulse wave speed. Given this paradigm, the objectives of this review are to look in further depth at the importance of central blood pressure and arterial stiffness as cardiovascular markers, and clarifying the role of central pressure in diagnostic and therapeutic decisions, as control index in the antihypertensive treatment. In conclusion, central arterial blood pressure and arterial stiffness are important tools in predicting cardiovascular occurrences. The central pulse pressure is a more efficient / accurate predictor of CV events rather than peripheral brachial pressure. AT emerges as a promising adjuvant for evaluating cardiovascular disease patients, allowing for monitoring central hemodynamic conditions and diagnosis of early stages of development of cardiovascular diseases, which would be impossible otherwise. Although It is still not entirely clear whether the use of drugs for improving arterial stiffness and central blood pressure will indeed reflect getting better clinical outcomes, there is strong evidence that treatment based on decisions of the central pressure has better implications for future diagnosis of hypertension. Thus, the tonometry with the pulse wave analysis is indicated in addition to the cardiovascular study of conventional evaluations and thus be integrated into daily clinical practice, as a diagnostic tool and medical treatment.
Description
Keywords
Análise da Onda de Pulso Pressão Arterial Central Rigidez Arterial Tonometria de Aplanação Tratamento Anti-Hipertensivo.