2015, Number 1
Pronostic value of the central aortic systolic pressure measured with the analysis of pulse wave en patients with acute coronary syndrome and systemic hypertension
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Language: Spanish
References: 20
Page: 16-27
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ABSTRACT
Introduction: In Mexico, ischemic heart disease is a major cause of death and representing 18% of all deaths per year, approximately 45% of these patients have arterial hypertension and 20% have less control of their figures tension. The CASP measurement by analysis of the pulse wave is associated with more adverse than the single blood pressure measurement events. At present there are no studies on the subject, in patients diagnosed with ACS. Objective: To evaluate the prognosis of measuring the Central Aortic Systolic Pressure by radial CASP as a risk factor in hypertensive patients with ACS. Material and methods: This is a cohort study in patients admitted to the Inpatient Units, diagnosed with ACS according to international criteria (ACC/AHA/ESC) who underwent measurement of CASP by analyzing pulse wave and Augmentation Index (RAI) using BPro device in patients with and without arterial hypertension. CASP and RAI was measured using a scale expected by age and gender two groups according to the normality of the CASP, cardiovascular events (death, re-infarction, cerebrovascular events, functional class and need new hospitalizations were identified ) were evaluated during hospitalization and one-month follow-up. Results: We included 150 patients in the study, 105 hypertensive patients (group A) and 45 non-hypertensive patients (group B) and 50 controls (group C). The average age of the patients was 62.6 years, 78% male gender, other risk factors were distributed as follows: 52% smoking, diabetes, dyslipidemia 39.8 and 42%. The mean baseline heart rate was 73 bpm. A statistically significant difference in the numbers of diastolic blood pressure (73 with 78 mmHg, p = 0.014) was found. The average value of the CASP for each group was 102.5 ± 10.1 mmHg in controls, 107.8 ± 16.1 mmHg in normotensive and 118 ± 14.7 mmHg in hypertensive, with a significant difference (p ‹ 0.0001). 53% of hypertensive patients had an abnormal CASP with respect to age and gender compared to normotensive subjects (35%) and healthy controls (22%). The incidence of MACE at 7 and 30 days was higher in the hypertensive group (p ‹ 0.0001). Patients with abnormal CASP regardless of whether or not hypertension had a higher rate of adverse events during hospitalization (RR 2.7, 95% CI 1.38-5.45, p = 0.003) and at 30 days follow-up (RR 2.11, 95% CI 1.1 -4.2, p = 0.018). Conclusions: The arterial hypertension is a risk factor for developing a CASP outside the normal range for age and gender compared with non-hypertensive patients and healthy controls. Our findings demonstrate for the first time in Mexico that measuring central aortic systolic pressure calculated by the radial CASP can be used as an independent predictor of major cardiovascular events 7 and 30 days in patients with ACS, which we consider to be assessed in these patients.REFERENCES
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Iñiguez K, Borrayo G, Almeida E, Madrid A, Isordia I, Jáuregui R et al. Correlación entre la presión central aórtica medida a través del análisis de onda de pulso radial y la presión sistólica a nivel de la raíz de la aorta en paciente sometidos a cateterismo cardiaco. Rev Mex Cardiol. 2010; 21 (4): 161-215.