Cohorte GEFA-HT-UY (GEnotipo, Fenotipo y Ambiente de la HiperTensión Arterial en UruguaY)
Protocolo y primeros resultados
Palabras clave:
HIPERTENSIÓN, ESTUDIOS DE COHORTES, FACTORES DE RIESGO, ENFERMEDADES CARDIOVASCULARES, ENFERMEDADES RENALES
Resumen
Introducción: la hipertensión arterial esencial es el resultado de complejas interacciones entre el genotipo, el fenotipo y el ambiente. El estudio GEFA-HT-UY busca analizar el papel de diferentes rasgos fenotípicos cardiovasculares y renales y su relación con factores genéticos y ambientales en una muestra aleatoria de una zona de Montevideo.
Material y método: estudio de cohorte poblacional, observacional y analítico que inició su diseño y programación en 2011 y la recolección de datos en abril de 2012. La muestra consiste en 150 familias (aproximadamente 450 sujetos), seleccionados de forma aleatoria entre los habitantes de un área geográfica delimitada de Montevideo. Las determinaciones basales incluyen el registro de antecedentes médicos de relevancia, medidas antropométricas, determinaciones de presión arterial en domicilio, en consultorio, automonitoreo de presión arterial y monitoreo ambulatorio de presión arterial periférico y central. Se realiza registro electrocardiográfico, ecocardiográfico y de rigidez arterial. Se recogen muestras de sangre y orina para determinaciones bioquímicas con especial énfasis en los factores de riesgo cardiovascular y de enfermedad renal crónica y la evidencia de daño de órgano blanco. Durante el seguimiento se pesquisará la incidencia de nuevos eventos cardiovasculares y renales.
Resultados: el objetivo de esta publicación es comunicar el protocolo, de todas formas se presentan los resultados de los primeros 36 sujetos que ya lo han completado.
Discusión: el seguimiento de la cohorte aportará datos relevantes y originales sobre la hipertensión arterial y su relación con el desarrollo de enfermedad cardiovascular y renal.
Citas
(1) Noboa O, Boggia J, Luzardo L, Márquez M. Hipertensión arterial y riñón. Rev Urug Cardiol 2012; 27(3):406-12.
(2) Kuznetsova T, Staessen JA, Kawecka-Jaszcz K, Babeanu S, Casiglia E, Filipovsky J, et al. Quality control of the blood pressure phenotype in the European Project on Genes in Hypertension. Blood Press Monit 2002; 7(4):215-24.
(3) European Project On Genes in Hypertension (EPOGH) Investigators, Stolarz K, Staessen JA, Kawecka-Jaszcz K, Brand E, Bianchi G, et al. Genetic variation in CYP11B2 and AT1R influences heart rate variability conditional on sodium excretion. Hypertension 2004; 44(2): 156-62.
(4) European Project on Genes in Hypertension (EPOGH) Investigators, Wojciechowska W, Staessen JA, Stolarz K, Nawrot T, Filipovský J, Tichá M, et al. Association of peripheral and central arterial wave reflections with the CYP11B2 -344C allele and sodium excretion. J Hypertens 2004; 22(12):2311-9.
(5) European Project On Genes in Hypertension (EPOGH) Investigators, Cwynar M, Staessen JA, Tichá M, Nawrot T, Citterio L, Kuznetsova T, et al. Epistatic interaction between alpha-and gamma-adducin influences peripheral and central pulse pressures in white Europeans. J Hypertens 2005; 23(5):961-9.
(6) European Project On Genes in Hypertension (EPOGH) investigators, Tikhonoff V, Staessen JA, Kuznetsova T, Thijs L, Hasenkamp S, Bäumer V, et al. SAH gene variants revisited in the European Project On Genes in Hypertension. J Hypertens 2008; 26(2):244-50.
(7) Society for Cardiological Science and Technology; British Cardiovascular Society. Clinical Guidelines by Consensus: recording a standard 12-lead electrocardiogram. An approved methodology, 2010. Disponible en: http://www.scst.org.uk/resources/consensus_guideline_for_recording_a_12_lead_ecg_Rev_072010b.pdf Consulta: abril de 2013.
(8) Council on High Blood Pressure Research Professional and Public Education Subcommittee, American Heart Association, Pickering TG, Hall JE, Appel LJ, Falkner BE, Graves JW, Hill MN, et al. Recommendations for blood pressure measurement in humans: an AHA scientific statement from the Council on High Blood Pressure Research Professional and Public Education Subcommittee. J Clin Hypertens (Greenwich) 2005; 7(2):102-9.
(9) Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research, 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. Hypertension 2005; 45(1):142-61.
(10) Chen CH, Ting CT, Nussbacher A, Nevo E, Kass DA, Pak P, et al. Validation of carotid artery tonometry as a means of estimating augmentation index of ascending aortic pressure. Hypertension 1996; 27(2):168-75.
(11) Chen CH, Nevo E, Fetics B, Pak PH, Yin FC, Maughan WL, et al. Estimation of central aortic pressure waveform by mathematical transformation of radial tonometry pressure. Validation of generalized transfer function. Circulation 1997; 95(7):1827-36.
(12) Pauca AL, O'Rourke MF, Kon ND. Prospective evaluation of a method for estimating ascending aortic pressure from the radial artery pressure waveform. Hypertension 2001; 38(4):932-7.
(13) Wassertheurer S, Kropf J, Weber T, van der Giet M, Baulmann J, Ammer M, et al. A new oscillometric method for pulse wave analysis: comparison with a common tonometric method. J Hum Hypertens 2010; 24(8):498-504.
(14) Weber T, Wassertheurer S, Rammer M, Maurer E, Hametner B, Mayer CC, et al. Validation of a brachial cuff-based method for estimating central systolic blood pressure. Hypertension 2011; 58(5):825-32.
(15) Chirinos JA, Segers P. Noninvasive evaluation of left ventricular afterload: part 2: arterial pressure-flow and pressure-volume relations in humans. Hypertension 2010; 56(4):563-70.
(16) Wassertheurer S, Mayer C, Breitenecker F. Modeling arterial and left ventricular coupling for non-invasive measurements. Simul Model Pract Theory 2008; 16(8):988-97.
(17) American Society of Echocardiography, Gottdiener JS, Bednarz J, Devereux R, Gardin J, Klein A, Manning WJ, et al. American Society of Echocardiography recommendations for use of echocardiography in clinical trials. J Am Soc Echocardiogr 2004; 17(10):1086-119.
(18) CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration),Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med 2009; 150(9):604-12.
(19) Jaffe M. Über den Niederschlag, welchen Pikrinsäure in normalem Harn erzeugt und über eine neue Reaction des Kreatinins. Z Physiol Chem 1886; 10:391-400.
(20) Bowers LD, Wong ET. Kinetic serum creatinine assays. II. A critical evaluation and review. Clin Chem 1980; 26(5):555-61.
(21) Peake M, Whiting M. Measurement of serum creatinine-current status and future goals. Clin Biochem Rev 2006; 27(4):173-84.
(22) Mosteller RD. Simplified calculation of body-surface area. N Engl J Med 1987; 317(17):1098.
(23) Rule AD, Bergstralh EJ, Slezak JM, Bergert J, Larson TS. Glomerular filtration rate estimated by cystatin C among different clinical presentations. Kidney Int 2006; 69(2):399-405.
(24) Tidman M, Sjöström P, Jones I. A Comparison of GFR estimating formulae based upon s-cystatin C and s-creatinine and a combination of the two. Nephrol Dial Transplant 2008; 23(1):154-60.
(25) Sociedad Uruguaya de Cardiología, Comité de Hipertensión Arterial, Bianchi M, Fernández Cean JM, Carbonell ME, Bermúdez C, Manfredi JA, Folle LE. Encuesta epidemiológica de hipertensión arterial en Montevideo: prevalencia, factores de riesgo, plan de seguimiento. Rev Méd Urug 1994; 10(2):113-20.
(26) Schettini C, Bianchi M, Nieto F, Sandoya E, Senra H. Ambulatory blood pressure: normality and comparison with other measurements. Hypertension Working Group. Hypertension 1999; 34(4 Pt 2):818-25.
(27) Uruguay. Ministerio de Salud Pública. Dirección General de Salud. División Epidemiología. 1a Encuesta Nacional de Factores de Riesgo de Enfermedades Crónicas no Trasmisibles. Montevideo: MSP, 2006.
(28) Kannel WB, Schwartz MJ, McNamara PM. Blood pressure and risk of coronary heart disease: the Framingham Study. 1969. Chest 2009; 136(5 Suppl):e23.
(29) International Database on Ambulatory blood pressure monitoring in relation to Cardiovascular Outcomes (IDACO) investigators, Boggia J, Li Y, Thijs L, Hansen TW, Kikuya M, Björklund-Bodegård K, et al. Prognostic accuracy of day versus night ambulatory blood pressure: a cohort study. Lancet 2007; 370(9594):1219-29.
(30) Willum-Hansen T, Staessen JA, Torp-Pedersen C, Rasmussen S, Thijs L, Ibsen H, et al. Prognostic value of aortic pulse wave velocity as index of arterial stiffness in the general population. Circulation 2006; 113(5):664-70.
(31) CAFE Investigators; Anglo-Scandinavian Cardiac Outcomes Trial Investigators; CAFE Steering Committee and Writing Committee, Williams B, Lacy PS, Thom SM, Cruickshank K, Stanton A, Collier D, et al. Differential impact of blood pressure-lowering drugs on central aortic pressure and clinical outcomes: principal results of the Conduit Artery Function Evaluation (CAFE) study. Circulation 2006; 113(9):1213-25.
(32) European Network for Non-invasive Investigation of Large Arteries, Laurent S, Cockcroft J, Van Bortel L, Boutouyrie P, Giannattasio C, Hayoz D, et al. Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J 2006; 27(21):2588-605.
(33) European Project on Genes in Hypertension (EPOGH) Investigators, Wojciechowska W, Staessen JA, Nawrot T, Cwynar M, Seidlerová J, Stolarz K, et al. Reference values in white Europeans for the arterial pulse wave recorded by means of the SphygmoCor device. Hypertens Res 2006; 29(7):475-83.
(34) Reference Values for Arterial Stiffness' Collaboration. Determinants of pulse wave velocity in healthy people and in the presence of cardiovascular risk factors: 'establishing normal and reference values'. Eur Heart J 2010; 31(19):2338-50.
(35) Farro I, Bia D, Zócalo Y, Torrado J, Farro F, Florio L, et al. Pulse wave velocity as marker of preclinical arterial disease: reference levels in a uruguayan population considering wave detection algorithms, path lengths, aging, and blood pressure. Int J Hypertens 2012; 2012:169359.
(36) O'Rourke MF, Adji A. Basis for use of central blood pressure measurement in office clinical practice. J Am Soc Hypertens 2008; 2(1):28-38.
(37) Luzardo L, Lujambio I, Sottolano M, da Rosa A, Thijs L, Noboa O, et al. 24-h ambulatory recording of aortic pulse wave velocity and central systolic augmentation: a feasibility study. Hypertens Res 2012; 35(10):980-7.
(2) Kuznetsova T, Staessen JA, Kawecka-Jaszcz K, Babeanu S, Casiglia E, Filipovsky J, et al. Quality control of the blood pressure phenotype in the European Project on Genes in Hypertension. Blood Press Monit 2002; 7(4):215-24.
(3) European Project On Genes in Hypertension (EPOGH) Investigators, Stolarz K, Staessen JA, Kawecka-Jaszcz K, Brand E, Bianchi G, et al. Genetic variation in CYP11B2 and AT1R influences heart rate variability conditional on sodium excretion. Hypertension 2004; 44(2): 156-62.
(4) European Project on Genes in Hypertension (EPOGH) Investigators, Wojciechowska W, Staessen JA, Stolarz K, Nawrot T, Filipovský J, Tichá M, et al. Association of peripheral and central arterial wave reflections with the CYP11B2 -344C allele and sodium excretion. J Hypertens 2004; 22(12):2311-9.
(5) European Project On Genes in Hypertension (EPOGH) Investigators, Cwynar M, Staessen JA, Tichá M, Nawrot T, Citterio L, Kuznetsova T, et al. Epistatic interaction between alpha-and gamma-adducin influences peripheral and central pulse pressures in white Europeans. J Hypertens 2005; 23(5):961-9.
(6) European Project On Genes in Hypertension (EPOGH) investigators, Tikhonoff V, Staessen JA, Kuznetsova T, Thijs L, Hasenkamp S, Bäumer V, et al. SAH gene variants revisited in the European Project On Genes in Hypertension. J Hypertens 2008; 26(2):244-50.
(7) Society for Cardiological Science and Technology; British Cardiovascular Society. Clinical Guidelines by Consensus: recording a standard 12-lead electrocardiogram. An approved methodology, 2010. Disponible en: http://www.scst.org.uk/resources/consensus_guideline_for_recording_a_12_lead_ecg_Rev_072010b.pdf Consulta: abril de 2013.
(8) Council on High Blood Pressure Research Professional and Public Education Subcommittee, American Heart Association, Pickering TG, Hall JE, Appel LJ, Falkner BE, Graves JW, Hill MN, et al. Recommendations for blood pressure measurement in humans: an AHA scientific statement from the Council on High Blood Pressure Research Professional and Public Education Subcommittee. J Clin Hypertens (Greenwich) 2005; 7(2):102-9.
(9) Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research, 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. Hypertension 2005; 45(1):142-61.
(10) Chen CH, Ting CT, Nussbacher A, Nevo E, Kass DA, Pak P, et al. Validation of carotid artery tonometry as a means of estimating augmentation index of ascending aortic pressure. Hypertension 1996; 27(2):168-75.
(11) Chen CH, Nevo E, Fetics B, Pak PH, Yin FC, Maughan WL, et al. Estimation of central aortic pressure waveform by mathematical transformation of radial tonometry pressure. Validation of generalized transfer function. Circulation 1997; 95(7):1827-36.
(12) Pauca AL, O'Rourke MF, Kon ND. Prospective evaluation of a method for estimating ascending aortic pressure from the radial artery pressure waveform. Hypertension 2001; 38(4):932-7.
(13) Wassertheurer S, Kropf J, Weber T, van der Giet M, Baulmann J, Ammer M, et al. A new oscillometric method for pulse wave analysis: comparison with a common tonometric method. J Hum Hypertens 2010; 24(8):498-504.
(14) Weber T, Wassertheurer S, Rammer M, Maurer E, Hametner B, Mayer CC, et al. Validation of a brachial cuff-based method for estimating central systolic blood pressure. Hypertension 2011; 58(5):825-32.
(15) Chirinos JA, Segers P. Noninvasive evaluation of left ventricular afterload: part 2: arterial pressure-flow and pressure-volume relations in humans. Hypertension 2010; 56(4):563-70.
(16) Wassertheurer S, Mayer C, Breitenecker F. Modeling arterial and left ventricular coupling for non-invasive measurements. Simul Model Pract Theory 2008; 16(8):988-97.
(17) American Society of Echocardiography, Gottdiener JS, Bednarz J, Devereux R, Gardin J, Klein A, Manning WJ, et al. American Society of Echocardiography recommendations for use of echocardiography in clinical trials. J Am Soc Echocardiogr 2004; 17(10):1086-119.
(18) CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration),Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med 2009; 150(9):604-12.
(19) Jaffe M. Über den Niederschlag, welchen Pikrinsäure in normalem Harn erzeugt und über eine neue Reaction des Kreatinins. Z Physiol Chem 1886; 10:391-400.
(20) Bowers LD, Wong ET. Kinetic serum creatinine assays. II. A critical evaluation and review. Clin Chem 1980; 26(5):555-61.
(21) Peake M, Whiting M. Measurement of serum creatinine-current status and future goals. Clin Biochem Rev 2006; 27(4):173-84.
(22) Mosteller RD. Simplified calculation of body-surface area. N Engl J Med 1987; 317(17):1098.
(23) Rule AD, Bergstralh EJ, Slezak JM, Bergert J, Larson TS. Glomerular filtration rate estimated by cystatin C among different clinical presentations. Kidney Int 2006; 69(2):399-405.
(24) Tidman M, Sjöström P, Jones I. A Comparison of GFR estimating formulae based upon s-cystatin C and s-creatinine and a combination of the two. Nephrol Dial Transplant 2008; 23(1):154-60.
(25) Sociedad Uruguaya de Cardiología, Comité de Hipertensión Arterial, Bianchi M, Fernández Cean JM, Carbonell ME, Bermúdez C, Manfredi JA, Folle LE. Encuesta epidemiológica de hipertensión arterial en Montevideo: prevalencia, factores de riesgo, plan de seguimiento. Rev Méd Urug 1994; 10(2):113-20.
(26) Schettini C, Bianchi M, Nieto F, Sandoya E, Senra H. Ambulatory blood pressure: normality and comparison with other measurements. Hypertension Working Group. Hypertension 1999; 34(4 Pt 2):818-25.
(27) Uruguay. Ministerio de Salud Pública. Dirección General de Salud. División Epidemiología. 1a Encuesta Nacional de Factores de Riesgo de Enfermedades Crónicas no Trasmisibles. Montevideo: MSP, 2006.
(28) Kannel WB, Schwartz MJ, McNamara PM. Blood pressure and risk of coronary heart disease: the Framingham Study. 1969. Chest 2009; 136(5 Suppl):e23.
(29) International Database on Ambulatory blood pressure monitoring in relation to Cardiovascular Outcomes (IDACO) investigators, Boggia J, Li Y, Thijs L, Hansen TW, Kikuya M, Björklund-Bodegård K, et al. Prognostic accuracy of day versus night ambulatory blood pressure: a cohort study. Lancet 2007; 370(9594):1219-29.
(30) Willum-Hansen T, Staessen JA, Torp-Pedersen C, Rasmussen S, Thijs L, Ibsen H, et al. Prognostic value of aortic pulse wave velocity as index of arterial stiffness in the general population. Circulation 2006; 113(5):664-70.
(31) CAFE Investigators; Anglo-Scandinavian Cardiac Outcomes Trial Investigators; CAFE Steering Committee and Writing Committee, Williams B, Lacy PS, Thom SM, Cruickshank K, Stanton A, Collier D, et al. Differential impact of blood pressure-lowering drugs on central aortic pressure and clinical outcomes: principal results of the Conduit Artery Function Evaluation (CAFE) study. Circulation 2006; 113(9):1213-25.
(32) European Network for Non-invasive Investigation of Large Arteries, Laurent S, Cockcroft J, Van Bortel L, Boutouyrie P, Giannattasio C, Hayoz D, et al. Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J 2006; 27(21):2588-605.
(33) European Project on Genes in Hypertension (EPOGH) Investigators, Wojciechowska W, Staessen JA, Nawrot T, Cwynar M, Seidlerová J, Stolarz K, et al. Reference values in white Europeans for the arterial pulse wave recorded by means of the SphygmoCor device. Hypertens Res 2006; 29(7):475-83.
(34) Reference Values for Arterial Stiffness' Collaboration. Determinants of pulse wave velocity in healthy people and in the presence of cardiovascular risk factors: 'establishing normal and reference values'. Eur Heart J 2010; 31(19):2338-50.
(35) Farro I, Bia D, Zócalo Y, Torrado J, Farro F, Florio L, et al. Pulse wave velocity as marker of preclinical arterial disease: reference levels in a uruguayan population considering wave detection algorithms, path lengths, aging, and blood pressure. Int J Hypertens 2012; 2012:169359.
(36) O'Rourke MF, Adji A. Basis for use of central blood pressure measurement in office clinical practice. J Am Soc Hypertens 2008; 2(1):28-38.
(37) Luzardo L, Lujambio I, Sottolano M, da Rosa A, Thijs L, Noboa O, et al. 24-h ambulatory recording of aortic pulse wave velocity and central systolic augmentation: a feasibility study. Hypertens Res 2012; 35(10):980-7.
Publicado
2013-06-30
Cómo citar
1.
Luzardo L, Lujambio I, Sottolano M, Da Rosa A, Robaina S, Arce F, Márquez M, Agorrody V, Américo C, Garau M, Krul N, Ríos AC, Florio L, Olascoaga A, Noboa Óscar, Staessen JA, Boggia J. Cohorte GEFA-HT-UY (GEnotipo, Fenotipo y Ambiente de la HiperTensión Arterial en UruguaY). Rev. Méd. Urug. [Internet]. 30 de junio de 2013 [citado 28 de diciembre de 2024];29(2):103-1. Disponible en: http://www2.rmu.org.uy/ojsrmu311/index.php/rmu/article/view/287
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