¿Será suficiente el Estudio SPRINT para revisar las guías de hipertensión arterial?
Resumen
El Estudio de Intervención sobre la Presión Arterial Sistólica (SPRINT: The Systolic Blood Pressure Intervention Trial) evaluó si el objetivo terapéutico de llevar la presión arterial sistólica (PAS) a <120 mm Hg podría reducir los eventos cardiovasculares (ECV) comparado con el objetivo <140 mm Hg. El estudio estuvo promovido y financiado por varias áreas del Instituto Nacional de la Salud de Estados Unidos y con la colaboración de la Administración de Veteranos de Estados Unidos. Los resultados mostraron beneficios en el grupo con tratamiento intensivo con reducción en la incidencia de eventos cardiovasculares y mortalidad que excedían el incremento de eventos adversos, tanto en la población total como en los participantes con enfermedad renal crónica. Los subestudios en participantes con hipertrofia ventricular izquierda, diastólicas bajas, deterioro cognitivo y calidad de vida mostraron resultados similares. Varios estudios epidemiológicos muestran que un 30% del riesgo cardiovascular ocurre en personas cuya PAS está entre 115 y 140 mm Hg. Estas características influyeron para que las nuevas guías elaboradas por varias sociedades científicas de Estados Unidos modificaran la clasificación de los niveles de presión arterial y las recomendaciones terapéuticas, generando una controversia que aún continúa. Esta revisión describe algunos conceptos que consideramos relevantes para el enfoque individual del paciente, remarcando la necesidad de obtener: a) registros confiables y reproducibles de la presión arterial y, b) mejorar el cuidado de las personas que tienen niveles de presión arterial, indicando incremento del riesgo cardiovascular independientemente de la clasificación adoptada para los niveles de la presión arterial.
Citas
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