segunda-feira, agosto 20, 2012

Aquecimento Euro 2012

P4763 : Ambulatory blood pressure monitoring is associated with subclinical atherosclerosis in normotensive spinal cord injury subjects

J.D. Garcez-Seabra (UNICAMP - State University of Campinas, Campinas /Brazil), J.R. Matos-Souza (UNICAMP - State University of Campinas, Campinas /Brazil), D. Goulart (UNICAMP - State University of Campinas, Campinas /Brazil), E. Abib (UNICAMP - State University of Campinas, Campinas /Brazil), K.R. Pithon (UNICAMP - State University of Campinas, Campinas /Brazil), A. Cliquet Junior (UNICAMP - State University of Campinas, Campinas /Brazil), W. Nadruz Junior (UNICAMP - State University of Campinas, Campinas /Brazil)

Purpose: Cardiovascular diseases are the major cause of death in subjects with chronic spinal cordy injury (SCI). Interestingly, SCI subjects present higher carotid intima-media thickness (IMT) and worse diastolic function than able-bodied individuals, independent of traditional cardiovascular risk factors. The present study investigated the relationship between carotid and echocardiographic measurements and Ambulatory Blood Pressure Monitoring (ABPM) in SCI patients.

Methods: Thirty two normotensive, nondiabetic, nonsmoker and normolipemic SCI men were enrolled (16 tetraplegic and 16 paraplegic, age 31.9±1.3 years, injury time 6.8±0.8 years) and underwent clinical, laboratory, ABPM, conventional echocardiography, tissue doppler and ultrasound carotid analysis. Data were evaluated by univariate and linear regression analyses and are presented as mean ± standard error. A p-value of less than 0.05 was considered significant.

Results: ABPM measurements in 24 hours were 108.8±1.3 X 64.1±1.3 mmHg and only 12 subjects (38%) exhibited nocturnal dipping. No participant exhibited features of autonomic dysreflexia. Univariate analysis revealed that 24-hour ABPM values correlated with carotid IMT, but not with echocardiographic or tissue doppler parameters. In this context, 24-hour diastolic BP was the variable showing the strongest correlation with IMT (r=0.54; p=0.002). Conversely, casual BP measurements, age, body mass index, serum lipid profile, glucose and C-reactive protein did not correlate with neither carotid nor cardiac measurements. Linear regression analysis adjusted for injury level and nocturnal dipping status showed that 24-hour diastolic BP was independently associated with carotid IMT (B=0.417±0.193; p=0.018).

Conclusions: These data demonstrate that subclinical atherosclerosis is directly related to ABPM values in SCI individuals, suggesting that hemodynamic stimuli may play a role in the physiopathogenesis of arterial remodeling in SCI subjects even within normal BP range.

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