Cardiovasculaire Geneeskunde.nl

Ambulante bloeddrukmeting: groot potentieel voor CV preventie bij vrouwen

Nieuws - Feb. 3, 2011

Achtergrond:
Er zijn weinig studies bekend naar sekse-specifieke verschillen in de associatie tussen cardiovasculaire uitkomsten en bloeddrukmeting gebaseerd op ambulante bloeddrukmonitoring.

Onderzoek:
Bij 9357 personen werden conventionele en ambulante bloeddruk gemeten en vragenlijsten afgenomen betreffende hun medische voorgeschiedenis en leefstijlfactoren.

Methode:
Meta-analyse van 11 verschillende populaties uit de International Database on Ambulatory BP Monitoring in Relation to Cardiovascular Outcomes (IDACO). De 11 centra bevinden zich in Europa, Latijns-America en Azië. Multivariabele-gecorrigeerde harzard ratios werden berekend,  voor associaties tussen cardiovasculaire uitkomsten en systolische bloeddruk.

Resultaten:
Gedurende een follow-up duur van 11,2 jaar overleden 1245 deelnemers, van wie 472 vanwege een cardiovasculaire oorzaak. Bij zowel mannen als vrouwen voorspelde de systolische bloeddruk de cardiovasculaire uitkomst, onafhankelijk van het type bloeddrukbehandeling. Vrouwen hadden een lager risico in vergelijking met mannen (p<0,001 op sterfte en CV events). Echter de associatie tussen alle CV events met de 24-uursbloeddruk én de relatie tussen totale mortaliteit, alle cardiovasculaire, cerebrovasculaire en cardiale events met de nachtelijke bloeddruk was significant sterker bij vrouwen.

Conclusies:
De proportie van CV events welke potentieel voorkomen zouden kunnen worden is groter bij vrouwen in vergelijking met mannen, voor alle CV events coor zowel de relatie met 24-uursbloeddruk als de nachtelijke bloeddruk.

1. Boggia et al. Hypertension 2011

Lees onderstaand het volledige artikel.

"Enormous" opportunity to cut CV events in women, by lowering BP
JANUARY 27, 2011 Montevideo, Uruguay - Reducing blood pressure by a given amount prevents more cardiovascular events in women than in men, according to a new meta-analysis of individual data on more than 9000 subjects. The study is the first to examine sex-specific differences in the association between outcome and BP based on ambulatory monitoring, say Dr José Boggia (Universidad de la República, Montevideo, Uruguay) and colleagues in their paper published online in Hypertension.Although the results show that the absolute risk of events is lower in women than in men, the proportion of preventable cardiovascular events is 30% to 100% higher in females than in males, they state. There is enormous potential for prevention by BP-lowering treatment in women," according to senior author Dr Jan A Staessen (University of Leuven, Belgium). "We show that the relationship between BP and individual complications is steeper in women than in men, so for a given, say 15-mm-Hg reduction in BP, you prevent a larger percentage of events in women; this is a missed opportunity because most doctors do not realize this." Relation of CV events with 24-hour BP steeper in women than men Boggia et al constructed the International Database on Ambulatory BP Monitoring in Relation to Cardiovascular Outcomes (IDACO), which currently includes prospective studies from 11 centers across Europe, Asia, and Latin America.

They performed conventional and ambulatory BP measurements in 9357 subjects (mean age 52.8 years, 47% women) and also administered questionnaires to obtain information on medical history and smoking and drinking habits. Body-mass index was calculated and serum cholesterol and blood glucose were measured. They computed standardized, multivariable-adjusted hazard ratios for associations between outcome and systolic BP. During the course of 11.2 years of follow-up, 1245 participants died, 472 of cardiovascular causes. In women and men alike, systolic BP predicted outcome, irrespective of the type of BP management. Women compared with men were at lower risk (hazard ratios for death and all CV events 0.66 and 0.62, respectively; p<0.001). However, the relation of all CV events with 24-hour BP (p=0.020) and the relation of total mortality(p=0.023) and all cardiovascular (p=0.0013), cerebrovascular (p=0.045), and cardiac (p=0.034) events with nighttime BP were steeper in women than in men. Consequently, per a one-standard-deviation decrease, the proportion of potentially preventable events was higher in women than in men for all CV events (35.9% vs 24.2%) in relation to 24-hour systolic BP and for all-cause mortality (23.1% vs 12.3%) and cardiovascular (35.1% vs 19.4%), cerebrovascular (38.3% vs 25.9%), and cardiac (31.0% vs 16.0%) events in relation to systolic nighttime BP. The lower absolute risk in women should not be used as an excuse for therapeutic laxity, the researchers say.

"Our results reveal a vast and largely unused potential for cardiovascular prevention by BP-lowering treatment in women. Women and their healthcare providers should . . . request a wider use of ambulatory BP measurement to diagnose and take control of BP. This approach will help women live a longer life with higher quality."Staessen adds that the results "are applicable to all age groups," noting that the age range in thestudy was 20 to 80 years and that the findings were consistent across all geographic areas, "so this is truly a global message."(Source: Heartwire)

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