Asociación entre el comportamiento non-dipper de la presión arterial y las fracciones del calcio sérico en pacientes hipertensos con disfunción renal crónica leve a moderada
Resumen
Objetivos: determinar asociación entre calcio total sérico y calcio iónico, con las determinaciones del MAPA en pacientes hipertensos en estadios 1-3 de enfermedad renal crónica. Material y métodos: se incluyeron 231 pacientes hipertensos. Resultados: En non dippers la prevalencia de Clcr <60 mL/min/1,73 m2 fue mayor que en dippers (p < 0,02). El análisis de covarianza mostró que en estadío 3 de K/DOQI el Cat fue menor en non dippers que en dippers (9,03 ± 0,66 vs 9,41 ± 1 mg/dL, p<0,02). En non dippers hubo correlaciones significativas entre Cai y PAS 24 hs (r = 0,21, p < 0,03), PAS diurna 24 hs.(r=0,21, p<0,03) y PP 24 hs (r = 0,23; p < 0,02). Los non dippers tuvieron una mayor prevalencia del tercilo mas elevado de PP 24 horas que dippers. Los pacientes con Clcr ≥60 mL/min/1,73 m2 tienen menor riesgo de presentar comportamiento non dipper que pacientes con Clcr<60 mL/min/1,73 m2 (OR 2,445, IC 95% 1,398-4,277, p < 0,002). Conclusiones: los hipertensos en estadío 3 de K/DOQI tienen una mayor alteración de ritmo circadiano de PA que aquéllos en estadíos 1-2. La alta prevalencia de non dipper en estadio 3 K/DOQI sugiere que aun en disfunción renal moderada este patrón circadiano es común. Se puede especular que el Cai tiene un rol en patogénesis de alteración en descenso fisiológico nocturno de PA. El aumento de rigidez arterial puede ser un mecanismo significativo por el que comportamiento non dipper ejerce su influencia deletérea sobre evolución cardiovascular y renal de pacientes con ERC.
Citas
National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002;39(2 Suppl 1):S1-266.
Levey AS, Coresh J, Balk E, Kausz AT, Levin A, Steffes MW, et al. National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Ann Intern Med. 2003;139(2):137-47.
Anavekar NS, McMurray JJ, Velazquez EJ, Solomon SD, Kober L, Rouleau JL, et al. Relation between renal dysfunction and cardiovascular outcomes after myocardial infarction. N Engl J Med. 2004;351(13):1285-95.
Smith GL, Lichtman JH, Bracken MB, Shlipak MG, Phillips CO, DiCapua P, et al. Renal impairment and outcomes in heart failure: systematic review and meta-analysis. J Am Coll Cardiol. 2006;47(10):1987-96.
Rahman M, Pressel S, Davis BR, Nwachuku C, Wright JT Jr, Whelton PK, et al. Cardiovascular outcomes in high-risk hypertensive patients stratified by baseline glomerular filtration rate. Ann Intern Med. 2006;144(3):172-80.
Bakris GL, Ritz E; World Kidney Day Steering Committee. The message for World Kidney Day 2009: hypertension and kidney disease, a marriage that should be prevented. J Hypertens. 2009;27(3):666-9.
Drawz PE, Rosenthal N, Babineau DC, Rahman M. Nighttime hospital blood pressure, a predictor of death, ESRD, and decline in GFR. Ren Fail. 2010;32(9):1036-43.
Pogue V, Rahman M, Lipkowitz M, Toto R, Miller E, Faulkner M, Rostand S, et al. Disparate estimates of hypertension control from ambulatory and clinic blood pressure measurements in hypertensive kidney disease. Hypertension. 2009;53(1):20-7.
Andersen MJ, Khawandi W, Agarwal R. Home blood pressure monitoring in CKD. Am J Kidney Dis. 2005;45(6):994-1001.
Jorde R, Sundsfjord J, Fitzgerald P, Bønaa KH. Serum calcium and cardiovascular risk factors and diseases: the Tromsø study. Hypertension. 1999;34(3):484-90.
Lind L, Skarfors E, Berglund L, Lithell H, Ljunghall S. Serum calcium: a new, independent, prospective risk factor for myocardial infarction in middle-aged men followed for 18 years. J Clin Epidemiol. 1997;50(8):967-73.
Paini A, Boutouyrie P, Calvet D, Tropeano AI, Laloux B, Laurent S. Carotid and aortic stiffness: determinants of discrepancies. Hypertension. 2006;47(3):371-6.
Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults--The Evidence Report. National Institutes of Health. Obes Res. 1998;6(Suppl 2):51S-209S.
Levey A, Greene T, Kusek J, Beck G. A simplified equation to predict glomerular filtration rate from serum creatinine. J Am Soc Nephrol. 2000;11:155A.
O'Brien E, Sheridan J, O'Malley K. Dippers and non-dippers. Lancet. 1988;2(8607):397.
O'Brien E. Dipping comes of age: the importance of nocturnal blood pressure. Hypertension. 2009;53(3):446-7.
Pickering TG, Kario K. Nocturnal non-dipping: what does it augur? Curr Opin Nephrol Hypertens. 2001;10(5):611-6.
Bulpitt CJ, Hodes C, Everitt MG. The relationship between blood pressure and biochemical risk factors in a general population. Br J Prev Soc Med. 1976;30(3):158-62.
Brickman AS, Nyby MD, von Hungen K, Eggena P, Tuck ML. Calcitropic hormones, platelet calcium, and blood pressure in essential hypertension. Hypertension. 1990;16(5):515-22.
Lind L, Jakobsson S, Lithell H, Wengle B, Ljunghall S. Relation of serum calcium concentration to metabolic risk factors for cardiovascular disease. BMJ. 1988;297(6654):960-3.
Schutte R, Huisman HW, Schutte AE, Malan NT, van Rooyen JM, Fourie CM, et al. Serum calcium revisited: associations with 24-h ambulatory blood pressure and cardiovascular reactivity in Africans. Hypertens Res. 2010;33(7):688-94.
Buckley BM, Smith SC, Beevers M, Beevers DG, McKiernan MJ. Lack of evidence of low ionized calcium levels in systemic hypertension. Am J Cardiol. 1987;59(8):878-80.
Phillips AN, Shaper AG. Serum calcium and blood pressure. J Hum Hypertens. 1991;5(6):479-84.
Kesteloot H, Geboers J. Calcium and blood pressure. Lancet. 1982;1(8276):813-5.
Fogh-Andersen N, Hedegaard L, Thode J, Siggaard-Andersen O. Sex-dependent relation between ionized calcium in serum and blood pressure. Clin Chem. 1984;30(1):116-8.
Vargas CM, Obisesan T, Gillum RF. Association of serum albumin concentration, serum ionized calcium concentration, and blood pressure in the Third National Health and Nutrition Examination Survey. J Clin Epidemiol. 1998;51(9):739-46.
Kuriyama H, Ito Y, Suzuki H, Kitamura K, Itoh T. Factors modifying contraction-relaxation cycle in vascular smooth muscles. Am J Physiol. 1982;243(5):H641-62.
Oshima T, Young EW. Systemic and cellular calcium metabolism and hypertension. Semin Nephrol. 1995;15(6):496-503.
Dean WL. Role of platelet plasma membrane Ca-ATPase in health and disease. World J Biol Chem. 2010;1(9):265-70.
Redon J, Plancha E, Swift PA, Pons S, Muñoz J, Martinez F. Nocturnal blood pressure and progression to end-stage renal disease or death in nondiabetic chronic kidney disease stages 3 and 4. J Hypertens. 2010;28(3):602-7.
Davidson MB, Hix JK, Vidt DG, Brotman DJ. Association of impaired diurnal blood pressure variation with a subsequent decline in glomerular filtration rate. Arch Intern Med. 2006;166(8):846-52.
Agarwal R, Andersen MJ. Prognostic importance of ambulatory blood pressure recordings in patients with chronic kidney disease. Kidney Int. 2006;69(7):1175-80.
Palmas W, Pickering T, Teresi J, Schwartz JE, Eguchi K, Field L, et al. Nocturnal blood pressure elevation predicts progression of albuminuria in elderly people with type 2 diabetes. J Clin Hypertens (Greenwich). 2008;10(1):12-20.
Levin A, Thompson CR, Ethier J, Carlisle EJ, Tobe S, Mendelssohn D, et al. Left ventricular mass index increase in early renal disease: impact of decline in hemoglobin. Am J Kidney Dis. 1999;34(1):125-34.
Arulkumaran N, Diwakar R, Tahir Z, Mohamed M, Kaski JC, Banerjee D. Pulse pressure and progression of chronic kidney disease. J Nephrol. 2010;23(2):189-93.
Wang MC, Tsai WC, Chen JY, Huang JJ. Stepwise increase in arterial stiffness corresponding with the stages of chronic kidney disease. Am J Kidney Dis. 2005;45(3):494-501.
Briet M, Bozec E, Laurent S, Fassot C, London GM, Jacquot C, et al. Arterial stiffness and enlargement in mild-to-moderate chronic kidney disease. Kidney Int. 2006;69(2):350-7.
Verdecchia P, Schillaci G, Reboldi G, Franklin SS, Porcellati C. Different prognostic impact of 24-hour mean blood pressure and pulse pressure on stroke and coronary artery disease in essential hypertension. Circulation. 2001;103(21):2579-84.
Vaccarino V, Berger AK, Abramson J, Black HR, Setaro JF, Davey JA, et al. Pulse pressure and risk of cardiovascular events in the systolic hypertension in the elderly program. Am J Cardiol. 2001;88(9):980-6.
Blacher J, Staessen JA, Girerd X, Gasowski J, Thijs L, Liu L, et al. Pulse pressure not mean pressure determines cardiovascular risk in older hypertensive patients. Arch Intern Med. 2000;160(8):1085-9.
