Utilidad de la automedida de la presión arterial en el control del paciente hipertenso

Objetivo

La automedida de la presión arterial (AMPA) ha sido estudiada como método de diagnóstico y verificación del control del hipertenso, pero muchos hipertensos la utilizan amenudo sin indicación médica como control habitual. Nos proponemos estudiar la utilidad de un programa de automedida para el control deun grupo de hipertensos comparándolo con el control habitual en la consulta.

Mediciones y resultados

Realizamos un estudio experimental en Atención Primaria. Se incluyeron 109 pacientes, 52 en el grupo de intervención (GI), que fue instruido para la automedida, entregándosele a cada paciente un monitor validado y calibrado, y 57 en el de control. Se realizó una monitorización ambulatoria de presión arterial (MAPA) de 24 horas al comienzo y a los 6 meses, y se midieron otros factores de riesgo cardiovascular, el consumo de fármacos antihipertensivos y el índice de bienestar psicológico.

El 59 % fueron mujeres y el 41 % hombres, con una edad media de 58,38 años. Las medias de las presiones arterial sistólica y diastólica de la monitorización total y diurna han descendido a los 6 meses, pero no se detectan diferencias significativas entre los grupos. El consumo de fármacos es menor en el GI, y mayor su bienestar psicológico, sin que estas diferencias alcancen significación ni a nivel bivariante ni multivariante. La pertenencia al grupo intervención o control no se asocia de forma significativa con el descenso de la presión arterial.

Conclusiones

El control de la hipertensión mediante un programa de automedida como el estudiado no difiere del alcanzado con la atención ordinaria en consulta. Estudios posteriores deberán constatar si la tendencia apreciada a los 6 meses hacia un mayor bienestar y menor consumo de fármacos se confirma.

Background

The self-measurement of blood pressure has been evaluated as a means of diagnosis and evaluation in the control of hypertension. However, many hypertensive patients often use self-measurement as a regular control without having been indicated to do so by a physician. We propose to evaluate a program of self-measurement of blood pressure among a group of hypertensive patients and compare it to regular clinical control.

Measurements and results

An experimental primary care study was undertaken. It included 109 patients, 52 of which were in an intervention group (IG) who were instructed in self-measurement of blood pressureand were each given monitors which were both validated and calibrated. The other 57 patients comprised the control group. A 24-hour ambulatory blood pressure monitoring was done at the beginning of the study and again at 6 months. Also measured were other cardiovascular risk factors, the taking of antihypertensive drugs and degree of psychological well-being. Fifty-nine per cent were women and 41% were men, with an average age of 58.38 years old. Average systolic and diastolic values for both 24-hour and diurnal monitoring haddecreased at 6 months, but no significant differences were observed between the groups. Drug use in the intervention group has become less and their psychological well-being is better. However, these differences were not statistically significant when using either a bivariant or multivariant analysis. Being part of one group or the other had no significant effect on decrease in blood pressure.

Conclusions

A program involving the self- measurement ofblood pressure, such as the onewe have studied, used as a tool for the control of hypertension is no more effective than one involving ordinary clinical measurement. Further studieswould be needed to demonstrate if the perceived trend towards better well-being and lesser drug use is true.