¿Será suficiente el Estudio SPRINT para revisar las guías de hipertensión arterial?

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Alfredo Wassermann

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.

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1.
Wassermann A. ¿Será suficiente el Estudio SPRINT para revisar las guías de hipertensión arterial?. Rev Nefrol Dial Traspl. [Internet]. 16 de octubre de 2018 [citado 20 de octubre de 2021];38(3):206-17. Disponible en: https://www.revistarenal.org.ar/index.php/rndt/article/view/359
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1) SPRINT Research Group, Wright JT Jr, Williamson JD, Whelton PK, Snyder JK, Sink KM, et al. A Randomized Trial of Intensive versus Standard Blood-Pressure Control. N Engl J Med. 2015;373(22):2103-16. Errata: N Engl J Med. 2017;377(25):2506.

2) Rocco MV, Sink KM, Lovato LC, Wolfgram DF, Wiegmann TB, Wall BM, et al. Effects of Intensive Blood Pressure Treatment on Acute Kidney Injury Events in the Systolic Blood Pressure Intervention Trial (SPRINT). Am J Kidney Dis. 2018;71(3):352-61.

3) Kidney Disease: Improving Global Outcomes (KDIGO) Chronic Kidney Disease Work Group. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int Suppl. 2013;3(1):1-150.

4) Soliman EZ, Ambrosius WT, Cushman WC, Zhang ZM, Bates JT, Neyra JA, et al. Effect of Intensive Blood Pressure Lowering on Left Ventricular Hypertrophy in Patients With Hypertension: SPRINT (Systolic Blood Pressure Intervention Trial). Circulation. 2017;136(5):440-50.

5) Upadhya B, Rocco M, Lewis CE, Oparil S, Lovato LC, Cushman WC, et al. Effect of Intensive Blood Pressure Treatment on Heart Failure Events in the Systolic Blood Pressure Reduction Intervention Trial. Circ Heart Fail. 2017;10(4). pii: e003613.

6) Shapiro BP, Ambrosius WT, Blackshear JL, Cushman WC, Whelton PK, Oparil S, et al. Impact of Intensive Versus Standard Blood Pressure Management by Tertiles of Blood Pressure in SPRINT (Systolic Blood Pressure Intervention Trial). Hypertension. 2018;71(6):1064-74.

7) Williamson JD, Supiano MA, Applegate WB, Berlowitz DR, Campbell RC, Chertow GM, et al. Intensive vs Standard Blood Pressure Control and Cardiovascular Disease Outcomes in Adults Aged ≥75 Years: A Randomized Clinical Trial. JAMA. 2016;315(24):2673-82.

8) Rocco MV, Sink KM, Lovato LC, Wolfgram DF, Wiegmann TB, Wall BM, et al. Effects of Intensive Blood Pressure Treatment on Acute Kidney Injury Events in the Systolic Blood Pressure Intervention Trial (SPRINT). Am J Kidney Dis. 2018;71(3):352-61.

9) Beddhu S, Chertow GM, Cheung AK, Cushman WC, Rahman M, Greene T, et al. Influence of Baseline Diastolic Blood Pressure on Effects of Intensive Compared With Standard Blood Pressure Control. Circulation. 2018;137(2):134-43.

10) Krishnaswami A, Kim DH, McCulloch CE, Forman DE, Maurer MS, Alexander KP, et al. Individual and Joint Effects of Pulse Pressure and Blood Pressure Treatment Intensity on Serious Adverse Events in the SPRINT Trial. Am J Med. 2018: S0002-9343(18)30516-3.

11) Chobanian AV. SPRINT Results in Older Patients: How Low to Go? JAMA. 2016;315(24):2669-70.

12) Del Pinto R, Pietropaoli D, Ferri C. Diastolic blood pressure and risk profile in renal and cardiovascular diseases. Results from the SPRINT trial. J Am Soc Hypertens. 2018;12(7):513-23.e3.

13) Cheung AK, Rahman M, Reboussin DM, Craven TE, Greene T, Kimmel PL, et al. Effects of Intensive BP Control in CKD. J Am Soc Nephrol. 2017;28(9):2812-23.

14) Beddhu S, Rocco MV, Toto R, Craven TE, Greene T, Bhatt U, et al. Effects of Intensive Systolic Blood Pressure Control on Kidney and Cardiovascular Outcomes in Persons Without Kidney Disease: A Secondary Analysis of a Randomized Trial. Ann Intern Med. 2017;167(6):375-83.

15) Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018;71(19):2199-269.

16) Pickering G. Hypertension. Definitions, natural histories and consequences. Am J Med. 1972;52(5):570-83.

17) Kjeldsen SE, Mancia G. The Un-Observed Automated Office Blood Pressure Measurement Technique Used in the SPRINT Study Points to a Standard Target Office Systolic Blood Pressure <140 mm Hg. Curr Hypertens Rep. 2017;19(1):3.

18) Johnson KC, Whelton PK, Cushman WC, Cutler JA, Evans GW, Snyder JK, et al. Blood Pressure Measurement in SPRINT (Systolic Blood Pressure Intervention Trial). Hypertension. 2018;71(5):848-57.

19) Bauer F, Seibert FS, Rohn B, Bauer KAR, Rolshoven E, Babel N, et al. Attended Versus Unattended Blood Pressure Measurement in a Real Life Setting. Hypertension. 2018;71(2):243-9.

20) Stamler J, Stamler R, Neaton JD. Blood pressure, systolic and diastolic, and cardiovascular risks. US population data. Arch Intern Med. 1993;153(5):598-615.

21) Pickering TG, Hall JE, Appel LJ, Falkner BE, Graves J, Hill MN, et al. Recommendations for blood pressure measurement in humans and experimental animals: part 1: blood pressure measurement in humans: a statement for professionals from the Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research. Circulation. 2005;111(5):697-716.

22) Handler J. The importance of accurate blood pressure measurement. Perm J. 2009;13(3):51-4.

23) Campbell NR, Myers MG, McKay DW. Is usual measurement of blood pressure meaningful? Blood Press Monit. 1999;4(2):71-6.

24) Siete consejos simples para obtener una lectura de la presión arterial precisa [Internet]. Chicago, Ill.: American Medical Association, 2017. Disponible en: https://targetbp.org/wp-content/uploads/2017/11/Measuring_Blood_Pressure_In-Office_Spanish.pdf [citado: 15/07/2018 ].

25) Stergiou G, Kollias A, Parati G, O’Brien E. Office Blood Pressure Measurement: The Weak Cornerstone of Hypertension Diagnosis. Hypertension. 2018;71(5):813-5.

26) Drawz PE, Ix JH. BP Measurement in Clinical Practice: Time to SPRINT to Guideline-Recommended Protocols. J Am Soc Nephrol. 2018;29(2):383-8.

27) Agarwal R. Implications of Blood Pressure Measurement Technique for Implementation of Systolic Blood Pressure Intervention Trial (SPRINT). J Am Heart Assoc. 2017;6(2):e004536.

28) Moss AJ, Scott G. Characteristics of persons with hypertension. United States, 1974. Vital Health Stat 10. 1978;(121):1-76.

29) World Health Organization. Hypertension and Coronary Heart Disease: Classification and Criteria for Epidemiological Studies. First Report of the Expert Committee on Cardiovascular Diseases and Hypertension. WHO Technical Report Series No. 168. Ann Intern Med. 1960;53(1):238-9.

30) Kaplan NM, Ronald GV, Flynn JT. Kaplan’s clinical hypertension. 11th ed. Philadelphia: Wolters & Kluwer, 2015. 461 p.

31) Evans JG, Rose G. Hypertension. Br Med Bull. 1971;27(1):37-42.

32) World Health Organization. Hypertension control. World Health Organ Tech Rep Ser. 1996;862:1-83.

33) Lewington S, Clarke R, Qizilbash N, Peto R, Collins R; Prospective Studies Collaboration. Agespecific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002;360(9349):1903-13.

34) Forouzanfar MH, Liu P, Roth GA, Ng M, Biryukov S, Marczak L, et al. Global Burden of Hypertension and Systolic Blood Pressure of at Least 110 to 115 mm Hg, 1990-2015. JAMA. 2017;317(2):165-82.

35) Farquhar JW, Fortmann SP, Flora JA, Taylor CB, Haskell WL, Williams PT, et al. Effects of communitywide education on cardiovascular disease risk factors. The Stanford Five-City Project. JAMA. 1990;264(3):359-65.

36) Vartiainen E, Laatikainen T, Peltonen M, Juolevi A, Männistö S, Sundvall J, et al. Thirty-five-year trends in cardiovascular risk factors in Finland. Int J Epidemiol. 2010;39(2):504-18.

37) Musini VM, Gueyffier F, Puil L, Salzwedel DM, Wright JM. Pharmacotherapy for hypertension in adults aged 18 to 59 years. Cochrane Database Syst Rev. 2017;8:CD008276.

38) Leitschuh M, Cupples LA, Kannel W, Gagnon D, Chobanian A. High-normal blood pressure progression to hypertension in the Framingham Heart Study. Hypertension. 1991;17(1):22-7.

39) Vasan RS, Larson MG, Leip EP, Evans JC, O’Donnell CJ, Kannel WB, et al. Impact of high-normal blood pressure on the risk of cardiovascular disease. N Engl J Med. 2001;345(18):1291-7.

40) Pencina MJ, D’Agostino RB Sr, Larson MG, Massaro JM, Vasan RS. Predicting the 30-year risk of cardiovascular disease: the framingham heart study. Circulation. 2009;119(24):3078-84.

41) Puska P, Vartiainen E, Laatikainen T, Jousilahti P, Paavola M. The North Karelia Project: from North Karelia to National Action [Internet].
Helsinki: National Institute for Health and Welfare, North Karelia Project Foundation, 2009. 309 p. Disponible en: https://www.julkari.fi/bitstream/
handle/10024/80109/731beafd-b544-42b2-b853-baa87db6a046.pdf [citado: 15/07/2018].

42) ACCORD Study Group, Cushman WC, Evans GW, Byington RP, Goff DC Jr, Grimm RH Jr, et al. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med. 2010;362(17):1575-85.