Valor pronòstic del monitoratge ambulatori de pressió arterial (MAPA) de 24 hores sobre la incidència d’esdeveniments i mort d’origen cardiovascular en pacients en prevenció primària cardiovascular: MAPA-RISC

Abstract

Ambulatory blood pressure (BP), obtained through 24-hour ambulatory blood pressure monitoring (ABPM), has been associated with greater predictive power of cardiovascular risk than conventional clinical BP. Several calculators exist to estimate cardiovascular risk using clinical BP, but to our knowledge, there is no predictive model of cardiovascular risk that uses ambulatory pressures and other parameters provided by ABPM._x000D_ This study is addressed to patients at primaryprevention of cardiovascular disease, and is based on ABPM obtained parameters, determining their prognostic value. A risk estimation algorithm for cardiovascular morbidity and mortality, including coronary heart disease, cerebrovascular disease, hospital admission for heart failure, and symptomatic peripheral arteriopathy or with revascularization or amputation, has been created and validated._x000D_ An ambispective, multicentre cohort study has been designed, carried out at Primary Care area and Hypertension Units in Catalonia. Data about ABPM, clinical measures of BP and HR, and comorbidities of each patient were obtained from the CARDIORISC registry of the Spanish Society of Hypertension. All patients aged 18 years or older, with a first baseline visit and a valid MAP performed between 2009 and 2014, and without previous cardiovascular disease, were included. It includes all patients aged 18 or over at primary prevention of cardiovascular disease, with a first baseline visit and a valid ABPM, performed between 2009 and 2014. The data have been completed with clinical information and incidence of cardiovascular events obtained from the Information System for the Development of Research in Primary Care (SIDIAP). Cardiovascular events were monitored until December 2018. Survival and Cox proportional hazards analyses were carried out._x000D_ Finally, 3907 patients were included. The average age of the sample is 58 years (standard deviation (SD) 13.8) and 53.1% are men. Median follow-up time is 6.68 years (interquartile range 5.00-8.49). The parameters provided by the 24-hour ABPM are predictors of cardiovascular morbidity and mortality, being the 24-hour ambulatory pulse pressure mean the one with the greatest predictive power, as for each standard deviation that it increases, the cardiovascular event or mortality risk increases by 83% (hazard ratio: 1.83 [95% confidence interval: 1.71-1.96]). In descending order, they follow as the night-period systolic blood pressure mean with a 56% risk (1.56 [1.45-1.68]), the mean standard deviation of the day-period systolic blood pressure with a 52% risk (1.52 [1.40-1.66]), the 24-hour-period systolic blood pressure mean with 44% risk (1.44 [1.33-1.56]), night-day ratio with 38% risk (1.38 [1.27-1.49]), the mean SD of nighttime systolic blood pressure with 37% risk (1.37 [1.25-1.49]), daytime systolic blood pressure mean with 36% risk (1.36 [1.25-1.48]), and the mean SD of 24-hour-period systolic blood pressure with a 31% risk (1.31 [1.20-1.43]). Finally, a 5-year risk predictive model was created that includes the most significant and clinically relevant variables, to calculate cardiovascular event or death risk in patients between 18 to 96 years of age at primary prevention of cardiovascular disease_x000D_ Therefore, ABPM parameters are associated with the occurrence of cardiovascular events or death in patients at primary prevention of cardiovascular disease. This project adds the improvement of the estimation of cardiovascular prognosis with the novelty of incorporating ABPM obtained values to the already used conventional risk factors.

Date of Award	13 Dec 2024
Original language	Catalan
Supervisor	Ernest Vinyoles Bargalló (Director) & Nuria Soldevila Bacardit (Director)