Valeur pronostique de la mesure ambulatoire de la pression artérielle chez les patients hypertendus traités
Mots-clés :
mesure ambulatoire de la pression artérielle, hypertension artérielle, pronosticRésumé
Introduction : La mesure ambulatoire de la pression artérielle (MAPA) est devenue un outil précieux pour analyser le profil de la pression artérielle (PA) du patient afin d’établir un pronostic plus précis par rapport à la PA mesurée au cabinet médical.
Objectif : Déterminer la valeur pronostique des différents paramètres de la MAPA et la survenue des événements cardiovasculaires (ECV) chez les patients hypertendus traités.
Méthodes : Nous avons mené une étude prospective et descriptive, incluant les patients hypertendus traités ayant consulté entre 2015 et 2016 et ayant eu une MAPA au cours de leur suivi. Les patients ont été suivis en ambulatoire pendant 4 ans, et nous avons recherché dans le dossier médical informatisé la survenue des ECVRésultats : Au total, 240 patients ont été inclus dans notre étude avec une prédominance masculine (57%). L’âge moyen était de 57,4±9,5 ans. Au cours des 4 années de suivi, 30 patients (12,5 %) ont présenté un événement cardiovasculaire. Le nombre total de ECV était de 32 : insuffisance cardiaque aiguë (3), syndrome coronarien aigu (15), fibrillation auriculaire (12), accident vasculaire cérébral (2). La pres-sion artérielle systolique diurne (PAS-diurne), la pression artérielle systolique nocturne (PAS-nocturne), la pression artérielle systolique sur 24 heures (PAS-24 h) et la pression pulsée sur 24 heures (PP-24 h) avaient des performances similaires pour prédire les ECV. Seule la PP-24 h (OR= 1.072 ; 95% IC : 1.019-1.128 ; p= 0.007) s’est avérée être un facteur prédictif indépendant de l’ECV. Une PP-24 heures > 55 mmHg augmentait le risque de ECV de 3,2.
Conclusion : La PP-24 h s’est avérée être un facteur prédictif indépendant de l’ECV et pourrait donc devenir une cible thérapeutique dans le traitement de l’hypertension artérielle.
Téléchargements
Références
Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. European Heart Journal. 2018;39(33):3021‑104. DOI: 10.1093/eurheartj/ehy339
Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. The Lancet. 2002;360(9349):1903‑13. DOI: 10.1016/S0140-6736(02)11911-8
Effects of different blood-pressure-lowering regimens on major cardiovascular events: results of prospectively-designed overviews of randomised trials. The Lancet. 2003;362(9395):1527‑35. DOI: 10.1016/S0140-6736(03)14739-3
Dolan E, Stanton A, Thijs L, Hinedi K, Atkins N, McClory S, et al. Superiority of Ambulatory Over Clinic Blood Pressure Measurement in Predicting Mortality: The Dublin Outcome Study. Hypertension. 2005;46(1):156‑61. DOI: 10.1161/01.HYP.0000170138.56903.7a
Kikuya M, Ohkubo T, Asayama K, Metoki H, Obara T, Saito S, et al. Ambulatory Blood Pressure and 10-Year Risk of Cardiovascular and Noncardiovascular Mortality: The Ohasama Study. Hypertension. 2005;45(2):240‑5. DOI: 10.1161/01.HYP.0000152079.04553.2c
Sega R, Facchetti R, Bombelli M, Cesana G, Corrao G, Grassi G, et al. Prognostic Value of Ambulatory and Home Blood Pressures Compared With Office Blood Pressure in the General Population: Follow-Up Results From the Pressioni Arteriose Monitorate e Loro Associazioni (PAMELA) Study. Circulation. 2005;111(14):1777‑83. DOI: 10.1161/01.CIR.0000160923.04524.5B
Hansen TW, Kikuya M, Thijs L, Björklund-Bodegård K, Kuznetsova T, Ohkubo T, et al. Prognostic superiority of daytime ambulatory over conventional blood pressure in four populations: a meta-analysis of 7030 individuals. Journal of Hypertension. 2007;25(8):1554‑64. DOI: 10.1097/HJH.0b013e3281c49da5
Clement DL, De Buyzere ML, De Bacquer DA, de Leeuw PW, Duprez DA, Fagard RH, et al. Prognostic Value of Ambulatory Blood-Pressure Recordings in Patients with Treated Hypertension. N Engl J Med. 2003;348(24):2407‑15. DOI: 10.1056/NEJMoa022273
Verdecchia P, Porcellati C, Schillaci G, Borgioni C, Ciucci A, Battistelli M, et al. Ambulatory blood pressure. An independent predictor of prognosis in essential hypertension. Hypertension. 1994;24(6):793‑801. DOI: 10.1161/01.HYP.24.6.793
Boggia J, Li Y, Thijs L, Hansen TW, Kikuya M, Björklund-Bodegård K, et al. Prognostic accuracy of day versus night ambulatory blood pressure: a cohort study. The Lancet. 2007;370(9594):1219‑29. DOI: 10.1016/S0140-6736(07)61538-4
Ben-Dov IZ, Kark JD, Ben-Ishay D, Mekler J, Ben-Arie L, Bursztyn M. Predictors of All-Cause Mortality in Clinical Ambulatory Monitoring: Unique Aspects of Blood Pressure During Sleep. Hypertension. 2007;49(6):1235‑41. DOI: 10.1161/HYPERTENSIONAHA.107.087262
Fagard RH, Celis H, Thijs L, Staessen JA, Clement DL, De Buyzere ML, et al. Daytime and Nighttime Blood Pressure as Predictors of Death and Cause-Specific Cardiovascular Events in Hypertension. Hypertension. 2008;51(1):55‑61. DOI: 10.1161/HYPERTENSIONAHA.107.100727
Redon J, Campos C, Narciso ML, Rodicio JL, Pascual JM, Ruilope LM. Prognostic Value of Ambulatory Blood Pressure Monitoring in Refractory Hypertension: A Prospective Study. Hypertension. 1998;31(2):712‑8. DOI: 10.1161/01.HYP.31.2.712
Dolan E, Stanton AV, Thom S, Caulfield M, Atkins N, McInnes G, et al. Ambulatory blood pressure monitoring predicts cardiovascular events in treated hypertensive patients – an Anglo-Scandinavian cardiac outcomes trial substudy. Journal of Hypertension. 2009;27(4):876‑85. DOI: 10.1097/HJH.0b013e328322cd62
Lempiäinen PA, Ylitalo A, Huikuri H, Kesäniemi YA, Ukkola OH. Nighttime ambulatory pulse pressure predicts cardiovascular and all‐cause mortality among middle‐aged participants in the 21‐year follow‐up. J Clin Hypertens. 2021;23(8):1547‑55. DOI: 10.1111/jch.14317
Tadic M, Quarti-Trevano F, Bombelli M, Facchetti R, Cuspidi C, Mancia G, et al. The importance of pulse pressure on cardiovascular risk and total mortality in the general population: Is sex relevant? J Clin Hypertens. 2018;20(6):1001‑7. DOI: 10.1111/jch.13300
Franklin SS, Gustin W, Wong ND, Larson MG, Weber MA, Kannel WB, et al. Hemodynamic Patterns of Age-Related Changes in Blood Pressure: The Framingham Heart Study. Circulation. 1997;96(1):308‑15. DOI: 10.1161/01.CIR.96.1.308
Khattar RS, Swales JD, Dore C, Senior R, Lahiri A. Effect of Aging on the Prognostic Significance of Ambulatory Systolic, Diastolic, and Pulse Pressure in Essential Hypertension. Circulation. 2001;104(7):783‑9. DOI: 10.1161/hc3201.094227
Wing LMH, Chowdhury EK, Reid ChristopherM, Beilin LJ, Brown MA. Night-time ambulatory blood pressure is the best pretreatment blood pressure predictor of 11-year mortality in treated older hypertensives. Blood Pressure Monitoring. 2018;23(5):237‑43. DOI: 10.1097/MBP.0000000000000331
Staessen J. Ambulatory pulse pressure aspredictor of outcome in older patients with systolic hypertension. American Journal of Hypertension. 2002;15(10):835‑43. DOI: 10.1016/S0895-7061(02)02987-4
Kanoun F, Alaya NB, Idriss S, Sayem N, Chihaoui M, Harzallah F, et al. Appréciation du profil tensionnel par mesure ambulatoire de la pression artérielle chez les diabétiques hypertendus traités. LA TUNISIE MEDICALE. 2010;88.
Zhang Z, Gu X, Tang Z, Guan S, Liu H, Wu X, et al. Associations of blood pressure components with risks of cardiovascular events and all-cause death in a Chinese population: A Prospective Study. The Journal of Clinical Hypertension. 2022;24(7):825‑37. DOI: 10.1111/jch.14529
Goff DC, Lloyd-Jones DM, Bennett G, Coady S, D’Agostino RB, Gibbons R, et al. 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129(25_suppl_2). DOI: 10.1161/01.cir.0000437741.48606.98
Selvaraj S, Steg PhG, Elbez Y, Sorbets E, Feldman LJ, Eagle KA, et al. Pulse Pressure and Risk for Cardiovascular Events in Patients With Atherothrombosis. Journal of the American College of Cardiology. 2016;67(4):392‑403. DOI: 10.1016/j.jacc.2015.10.084
Myers MG, Kaczorowski J, Paterson JM, Dolovich L, Tu K. Thresholds for Diagnosing Hypertension Based on Automated Office Blood Pressure Measurements and Cardiovascular Risk. Hypertension. 2015;66(3):489‑95. DOI: 10.1161/HYPERTENSIONAHA.115.05782
Flint AC, Conell C, Ren X, Banki NM, Chan SL, Rao VA, et al. Effect of Systolic and Diastolic Blood Pressure on Cardiovascular Outcomes. N Engl J Med. 2019;381(3):243‑51. DOI: 10.1056/NEJMoa1803180
Williams B, Lindholm LH, Sever P. Systolic pressure is all that matters. The Lancet. 2008;371(9631):2219‑21. DOI: 10.1016/S0140-6736(08)60804-1
McEvoy JW, Daya N, Rahman F, Hoogeveen RC, Blumenthal RS, Shah AM, et al. Association of Isolated Diastolic Hypertension as Defined by the 2017 ACC/AHA Blood Pressure Guideline With Incident Cardiovascular Outcomes. JAMA. 2020;323(4):329. DOI: 10.1001/jama.2019.21402
Carlsson AC, Johansson S-E, Theobald H, Wändell PE. Blood pressure measures and their predictive ability of cardiovascular mortality: a 26-year follow-up. Blood Pressure Monitoring. 2013;18(2):72‑7. DOI: 10.1097/MBP.0b013e32835ea233
Powell TM, Glynn RJ, Buring JE, Creager MA, Ridker PM, Pradhan AD. The relative importance of systolic versus diastolic blood pressure control and incident symptomatic peripheral artery disease in women. Vasc Med. 2011;16(4):239‑46. DOI: 10.1177/1358863X11413166
Wei F-F, Li Y, Zhang L, Xu T-Y, Ding F-H, Staessen JA, et al. Association of Target Organ Damage With 24-Hour Systolic and Diastolic Blood Pressure Levels and Hypertension Subtypes in Untreated Chinese. Hypertension. 2014;63(2):222‑8. DOI: 10.1161/HYPERTENSIONAHA.113.01940
Roman MJ, Devereux RB, Kizer JR, Okin PM, Lee ET, Wang W, et al. High Central Pulse Pressure Is Independently Associated With Adverse Cardiovascular Outcome. Journal of the American College of Cardiology. 2009;54(18):1730‑4. DOI: 10.1016/j.jacc.2009.05.070
Anderson RJ, Bahn GD, Emanuele NV, Marks JB, Duckworth WC, for the VADT Study Group. Blood Pressure and Pulse Pressure Effects on Renal Outcomes in the Veterans Affairs Diabetes Trial (VADT). Diabetes Care. 2014;37(10):2782‑8. DOI: 10.2337/dc14-0284
The SPRINT Research Group. A Randomized Trial of Intensive versus Standard Blood-Pressure Control. N Engl J Med. 2015;373(22):2103‑16. DOI: 10.1056/NEJMoa1511939
Franklin SS, Larson MG, Khan SA, Wong ND, Leip EP, Kannel WB, et al. Does the Relation of Blood Pressure to Coronary Heart Disease Risk Change With Aging?: The Framingham Heart Study. Circulation. 2001;103(9):1245‑9. DOI: 10.1161/01.CIR.103.9.1245
Williams C, Kingwell BA, Burke K, McPherson J, Dart AM. Folic acid supplementation for 3 wk reduces pulse pressure and large artery stiffness independent of MTHFR genotype. The American Journal of Clinical Nutrition. 2005;82(1):26‑31. DOI: 10.1093/ajcn/82.1.26
Fichiers supplémentaires
Publiée
Numéro
Rubrique
Licence
Merci de créditer les auteurs lors de toute citation : La Tunisie Médicale (2022)
Ce travail est disponible sous licence Creative Commons Attribution - Pas d'Utilisation Commerciale - Pas de Modification 4.0 International.
