The importance of blood pressure variability has grown exponentially over the past two to three years. In this review, we aim to discuss the reasons underlying this increasing interest. First, we describe the different methods used to assess blood pressure variability, including very short-term (beat-to-beat), short-term (24-hour ambulatory blood pressure monitoring), mid-term (home self-measurements), and long-term (visit-to-visit measurements), as well as the mathematical indices used to quantify it. We then address the clinical relevance of blood pressure variability. First, increased variability is more prevalent in several health conditions not necessarily related to vascular disease, such as mental illness, severity of COVID-19 infection, bone fractures, and various forms of cognitive impairment. Second, blood pressure variability appears to be involved in the progression from prehypertensive states to established hypertension and, once hypertension is present, in the development of target organ damage. It has also been associated with an increased risk of gestational hypertension, preeclampsia, and adverse neonatal outcomes. Furthermore, blood pressure variability, even independently of mean arterial blood pressure, influences the development, prognosis, and complications of coronary and cerebrovascular disease. Finally, we discuss evidence suggesting that blood pressure variability is associated with both vascular and all-cause mortality.
Introducción La heparina de bajo peso molecular (HBPM) es el tratamiento anticoagulante de elección para el tratamiento de la enfermedad tromboembólica venosa (ETV) durante la gestación y la lactancia. Los antagonistas de vitamina K (AVK) están contraindicados durante las semanas seis a 12 por relacionarse con una embriopatía específica y en el tercer trimestre por el riesgo hemorrágico. Los anticoagulantes orales de acción directa (ACOD) están contraindicados en el embarazo y la lactancia por riesgo de malformaciones prenatales. Técnicas de reperfusión, como la fibrinólisis sistémica o la trombectomía mecánica, se reservan para casos de embolia pulmonar (EP) con inestabilidad hemodinámica. Métodos y resultados Este documento de consenso, elaborado por las Sociedades Españolas de Medicina Interna (SEMI), de Radiología Médica (SERAM), de Radiología Vascular e Intervencionista (SERVEI) y Sociedad Española de Ginecología y Obstetricia (SEGO), realiza una revisión exhaustiva de la evidencia más reciente sobre el tratamiento de la ETV en la paciente gestante y actualiza las recomendaciones.
