Estudos epidemiológicos têm sugerido que a hipertensão arterial é uma doença que tem início na infância e a prematuridade, crianças nascidas com menos de 37 semanas, um possível fator associado ao desenvolvimento deste agravo. Este estudo tem por objetivo identificar a associação entre prematuridade e elevação da pressão arterial em crianças por meio de revisão sistemática da literatura. Foram selecionados artigos das bases de dados MEDLINE, LILACS e SciELO publicados no período de 1998 a 2009. Excluiu-se os que não apresentavam resumo, redigidos em idioma diferente do inglês, português e espanhol e os que não objetivavam analisar a relação entre prematuridade e hipertensão. Foram analisados 9 artigos: 5 estudos de caso-controle, 2 transversais e 2 de coorte. Prematuridade não esteve associada à elevação da pressão arterial na infância na maioria dos artigos analisados, porém, sua influência não deve ser descartada, tendo em vista a pequena produção sobre o assunto, bem como as grandes diferenças metodológicas observadas nos estudos publicados no período analisado.
OBJECTIVE:To evaluate sensitivity and specifi city of different protocols for blood pressure measurement for the diagnosis of hypertension in adults. METHODS:Cross-sectional study conducted in a non-probabilistic sample of 250 public servants of both sexes aged 35 to 74 years in Vitória, southeastern Brazil, between 2008 and 2010. The participants had their blood pressure measured using three different methods: clinic measurement, self-measured and 24-hour ambulatory measurement. They were all interviewed to obtain sociodemographic information and had their anthropometric data (weight, height, waist circumference) collected. Clinic measurement and self-measured were analyzed against the gold standard ambulatory measurement. Measures of diagnostic performance (sensitivity, specifi city, accuracy and positive and negative predictive values) were calculated. The Bland & Altman method was used to evaluate agreement between ambulatory measurement (standard deviation for daytime measurements) and self-measured (standard deviation of four measurements). A 5% signifi cance level was used for all analyses. RESULTS: Self-measured blood pressure showed higher sensitivity (S=84%, 95%CI 75;93) and overall accuracy (0.817, p<0.001) in the diagnosis of hypertension than clinic measurement (S=79%, 95%CI 73;86, and overall accuracy=0.815, p<0.001). Despite the strong correlation with daytime ambulatory measurement values (r=0.843, p<0.001), self-measured values did not show good agreement with daytime systolic ambulatory values (bias=5.82, 95%CI 4.49;7.15). Seven (2.8%) cases of white coat hypertension, 26 (10.4%) of masked hypertension and 46 (18.4%) of white-coat effect were identifi ed. CONCLUSIONS:The study shows that self-measured blood pressure has higher sensitivity than clinic measurement to identify true hypertension. The negative predictive values found confi rm the superiority of self-measured when compared to clinic in identifying truly normotensive individuals. However, clinic measurement cannot be replaced with self-measured, as it is still the most reliable method for the diagnosis of hypertension.
OBJECTIVE:To determine the reproducibility of casual arterial pressure measurement and to confi rm pressure diagnosis by monitoring of participants in the ELSA-Brasil (Estudo Longitudinal de Saúde do Adulto -Brazilian Longitudinal Study for Adult Health). METHODS:Casual blood pressure was measured with an oscilometric device. A sub-sample of participants (N = 255) from Espírito Santo state (Southeastern Brazil) was reevaluated using the same methodology following one to ten weeks and, in addition, underwent arterial blood pressure monitoring. Diagnosis of hypertension used cut off points of 140/90 mmHg for casual pressure and 130/80 mmHg for arterial blood pressure monitoring. White coat hypertension was defi ned as the presence of hypertension in casual blood pressure and normal arterial blood pressure monitoring, and converse fi ndings characterized masked hypertension. RESULTS:Data are from 230 participants that on the two occasions were free from antihypertensive medication (N 1 = 153) or under the same antihypertensive regimen (N 2 = 77). Normotension was confi rmed by arterial blood pressure monitoring in120 out of 134 participants of the N 1 group. In N 2 , blood pressure control was confi rmed by arterial blood pressure monitoring in 43 of 54 participants with controlled hypertension per casual blood pressure. Overall diagnostic concordance between casual blood pressure and arterial blood pressure monitoring was 78% (kappa = 0.44). In the N1 group, six subjects (4%) presented white coat hypertension, and 23 subjects (25%) presented with masked hypertension. CONCLUSIONS:Diagnostic concordance between casual blood pressure and arterial blood pressure monitoring was moderate. The rigorous standardization of casual blood pressure measurement adopted in the ELSA-Brasil study was able to reduce white coat hypertension. The high frequency of masked hypertension may suggest that pressure values obtained by arterial blood pressure monitoring indicate an elevated degree of stress at work.
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