Avaliação da pressão arterial no ambulatório - Revisão baseada na evidência

Abstract

Objectives: To assess the evidence for the usefulness of self-measurement of blood pressure (SMBP) and ambulatory blood pressure monitoring (ABPM) as part of the evaluation and follow-up of hypertensive individuals in the prognosis of cardiovascular disease, blood pressure control and cost-effectiveness compared with isolated office blood pressure monitoring (OBPM) and to assess the prognostic value of daytime and night time blood pressure (BP), and the day/night blood pressure ratio, as measured by ABPM. Data Sources: Medline and Evidence-Based Medicine databases. Review methods:A survey of clinical guidelines, systematic reviews, meta-analysis, clinical trials and observational studies, published between January 2000 and May 2011 was performed using the MeSH term “Blood Pressure Monitoring, Ambulatory” and the key words “Self Blood Pressure Monitoring” and “Home Blood Pressure Monitoring”. The SORT scale of the American Family Physician was applied to grade the evidence. Conclusions: Thirty eight articles were selected for analysis. These included four clinical practice guidelines, two systematic reviews, nine meta-analysis, 19 clinical trials and four observational studies. Each of the ambulatory blood pressure measurements studied provides a reduction in the white coat effect, with not only a stronger association with cardiovascular events, but also a higher degree of control of blood pressure. Ambulatory evaluation of blood pressure also reduces costs through the reduction in the costs of medication and other treatments. For each of the ambulatory blood pressure measurement techniques studied, there is evidence that their use can provide a more accurate diagnostic and prognostic evaluation (strength of recommendation A for ABPM and strength of recommendation B for SBPM). These methods may result in better control of blood pressure in the hypertensive patient (strength of recommendation A for both ABPM and SBPM). Ambulatory measurement may also reduce costs (strength of recommendation B for both ABPM and SBPM).