O papel da medição automatizada de pressão arterial no consultório


Pergunta clínica: No consultório, a avaliação da pressão arterial com dispositivos de medição automatizada da pressão arterial é mais fiável do que a medição habitual da pressão arterial pelo médico?

Enquadramento: Algumas normas de orientação clínica recomendam, para o diagnóstico da hipertensão em consultório, a medição repetida da pressão arterial em que idealmente o doente deverá estar calmo e confortável durante 5 minutos, seguindo-se três medições intervaladas de 1-2 minutos. Esta técnica de medição carece de condições ideais que podem não estar reunidas na prática clínica. Por outro lado, existe o problema do efeito da bata branca. De forma a ultrapassar estas limitações tem vindo a ganhar popularidade nos últimos anos a medição automatizada da pressão arterial.

Desenho do estudo: Revisão sistemática de artigos publicados e ensaios clínicos a decorrer. Critérios de inclusão: artigos com comparação entre medição automatizada de pressão arterial e outras técnicas de medição.

Resultados: 26 estudos elegíveis, para um total de 7116 pacientes. Os valores da medição automatizada de pressão arterial foram inferiores aos obtidos pela medição habitual pelo médico (cerca de 10,5mmHg pressão arterial sistólica/ 4,4mmHg pressão arterial diastólica). Não foram encontradas diferenças significativas entre os valores obtidos pela medição automatizada da pressão arterial no consultório e os valores obtidos pela monitorização ambulatória da pressão arterial (MAPA), nem em relação aos valores de auto-monitorização da pressão arterial em casa.

Conclusão: As leituras de medição automatizada de pressão arterial no consultório não diferiram significativamente da pressão arterial fora do consultório. Esta técnica pode diminuir o sobrediagnóstico limitando o efeito da bata branca.

Comentário: Estes resultados podem contribuir para uma mudança na prática clínica e na forma como avaliamos a pressão arterial no consultório. Para tal, será necessária a disponibilização de medidores automáticos da pressão arterial. Após 5 minutos de repouso do paciente, estes dispositivos fazem três medições sequenciais da pressão arterial.

Artigo original: Hypertension

Por Cláudia Silva, USF + Carandá 



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