120127 drphilippesosner mesuresambulatoiresdepa

507 views

Published on

MAPA et HTA

Published in: Health & Medicine
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
507
On SlideShare
0
From Embeds
0
Number of Embeds
3
Actions
Shares
0
Downloads
6
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

120127 drphilippesosner mesuresambulatoiresdepa

  1. 1. European Society of Hypertension Excellence CentreMesures ambulatoires de la pressionartérielle : - MAPA des 24h - AutomesuresPhilippe Sosner, Cardiologie, Centre de prévention (CPMCV)DIU HTA, Poitiers, le 27 janvier 2012
  2. 2. Office BP measurementGuidelines Committee. 2007 Guidelines for the Management of Arterial Hypertension: The Task Force for theManagement of Arterial Hypertension of the ESH and of the ESC. Journal of Hypertension 2007; 25: 1105-87.
  3. 3. Office BP thresholdsGuidelines Committee. 2007 Guidelines for the Management of Arterial Hypertension: The Task Force for theManagement of Arterial Hypertension of the ESH and of the ESC. Journal of Hypertension 2007; 25: 1105-87.
  4. 4. Limits of office BPJ Hypertens. 2008;26:1505-26.
  5. 5. Masked HT: prevalencePickering TG, Eguchi K, Kario K. Masked hypertension: a review. Hypertens Res. 2007;30:479-88.
  6. 6. Masked HT: consequences Prevalence: 16.8% (13.0-20.5%), 7% in children, 19% in adults, no significant differences between Home-BPM (21.1%) and 24h-ABPM (16.8%) (p=0.42). Consequences / LVH:  Normotensive: 98 g/m²  Masked HT: 110 g/m²  Hypertensive patients: 109 g/m² Verberk WJ, Kessels AG, de Leeuw PW. Prevalence, causes, and consequences of masked hypertension: a meta- analysis. Am J Hypertens. 2008;21:969-75.
  7. 7. Intérêt de la MAPA des 24hWith permission from Herpin D.
  8. 8. BP thresholds (mm Hg)for definition of hypertension SBP DBPOffice or clinic 140 9024-hour 125 – 130 80Day 130 – 135 85Night 120 70Home 130 – 135 85Guidelines Committee. 2007 Guidelines for the Management of Arterial Hypertension: The Task Force for theManagement of Arterial Hypertension of the ESH and of the ESC. Journal of Hypertension 2007; 25: 1105-87.
  9. 9. Intérêt de la MAPA des 24hWith permission from Herpin D.
  10. 10. Effet blouse-blancheWith permission from Herpin D.
  11. 11. Non-dipperInversion du rythme nycthéméralWith permission from Herpin D.
  12. 12. Pourcentage de diabétiques non-dipperDiabète type 1 Diabète type 2 LURBE E et al. J Hypertension 2001;19:1421-28. EQUILUZ-BRUCK S et al. Am J Hypertens 1996;9:1139-43.
  13. 13. Non-dipperReproductibilitéWith permission from Herpin D.
  14. 14. HTA paroxystique :PhéochromocytomeWith permission from Herpin D.
  15. 15. Valeur pronostique de la MAPAOhkubo T. et al, J. Hypertens., 1997
  16. 16. Valeur pronostique de la MAPAD’après Verdecchia, Hypertension 1994
  17. 17. Survie des diabétiqueset altérations du rythme tensionnelSTURROCK NDC et al. Diabet Med 2000;17:360-4.
  18. 18. ESH/ESC 200724h-ABPMGuidelines Committee. 2007 Guidelines for the Management of Arterial Hypertension: The Task Force for theManagement of Arterial Hypertension of the ESH and of the ESC. Journal of Hypertension 2007; 25: 1105-87.
  19. 19. ESH/ESC 2007HBPMGuidelines Committee. 2007 Guidelines for the Management of Arterial Hypertension: The Task Force for theManagement of Arterial Hypertension of the ESH and of the ESC. Journal of Hypertension 2007; 25: 1105-87.
  20. 20. AHA/ASH/PCNA 2008Pickering TG, Miller NH, Ogedegbe G, Krakoff LR, Artinian NT, Goff D; American Heart Association; American Society of ,Hypertension; Preventive Cardiovascular Nurses Association. Call to action on use and reimbursement for home blood pressuremonitoring: executive summary: a joint scientific statement from the American Heart Association, American Society OfHypertension, and Preventive Cardiovascular Nurses Association. Hypertension. 2008;52:1-9.
  21. 21. ESH 2008Parati G, Stergiou GS, Asmar R, Bilo G, de Leeuw P, Imai Y, Kario K, Lurbe E, Manolis A, Mengden T, OBrien E, Ohkubo T,Padfield P, Palatini P, Pickering T, Redon J, Revera M, Ruilope LM, Shennan A, Staessen JA, Tisler A, Waeber B, Zanchetti A,Mancia G; ESH Working Group on Blood Pressure Monitoring. European Society of Hypertension guidelines for bloodpressure monitoring at home: a summary report of the Second International Consensus Conference on Home Blood PressureMonitoring. J Hypertens. 2008;26:1505-26.
  22. 22. Devices for HBPM: selection andvalidationJ Hypertens. 2008;26:1505-26.
  23. 23. User proceduresJ Hypertens. 2008;26:1505-26.
  24. 24. BP cuff bladder dimensions © Current MedicineJ Hypertens. 2008;26:1505-26.
  25. 25. French recommandations www.automesure.com normale < 135/85
  26. 26. 24h-ABPM / Home-BPM
  27. 27. Indications de l’automesure J Hypertens. 2008;26:1505-26.
  28. 28. Guidelines Committee. 2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management ofArterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Journalof Hypertension 2007; 25: 1105-87.
  29. 29. Recommandations ESH 2008 J Hypertens. 2008;26:1505-26.
  30. 30. Recommandations ESH 2008 J Hypertens. 2008;26:1505-26.
  31. 31. Chez l’enfant J Hypertens. 2008;26:1505-26.
  32. 32. Chez la femme enceinte J Hypertens. 2008;26:1505-26.
  33. 33. HBPM-related unresolved issues in specialpopulationsJ Hypertens. 2008;26:1505-26.
  34. 34. Dans les essais cliniques J Hypertens. 2008;26:1505-26.
  35. 35. Advantages and disadvantages of automatedoscillometric BP devicesJ Hypertens. 2008;26:1505-26.
  36. 36. Avantages de l’automesure J Hypertens. 2008;26:1505-26.
  37. 37. Utilisation des appareils d’automesureen France en 2004Mourad JJ, Herpin D, Postel-Vinay N, Vaïsse B, Poncelet P, Mallion JM, Murino M, Girerd X. Utilisation des appareilsd’automesure tensionnelle en France en 2004. Arch Mal Coeur Vaiss. 2005;98:779-82.
  38. 38. Home-BPM prognostic valuePickering TG, Miller NH, Ogedegbe G, Krakoff LR, Artinian NT, Goff D; American Heart Association; American Society ofHypertension; Preventive Cardiovascular Nurses Association. Call to action on use and reimbursement for home blood pressuremonitoring: executive summary: a joint scientific statement from the American Heart Association, American Society OfHypertension, and Preventive Cardiovascular Nurses Association. Hypertension. 2008;52:1-9.
  39. 39. Limites de l’automesure J Hypertens. 2008;26:1505-26.
  40. 40. Comparison of 24h-ABPM and HBPM
  41. 41. J Hypertens.2008;26:1505-26.
  42. 42. Choix de la méthode-visée diagnostique-Situations cliniques Informations Choix AutomesureHTA limite – légère HTA ? MAPA Sévérité ? CliniqueHTA sévère Retentissement ? MAPA Poussée ?HTA paroxystique MAPA Sévérité ? AutomesureHTA gravidique HTA ? Cycle circadien MAPAPA variable - Amplitude ? MAPAdysautonomie Sévérité ?Surveillance HTA blouse Évolution vers une HTA Automesureblanche vraie ?
  43. 43. Choix de la méthode-évaluation thérapeutique-Situations cliniques Informations ChoixHTA traitée Symptôme  variation MAPAsymptomatique de PA ? AutomesurePathologies associées Équilibre optimal ? MAPA AutomesureHTA résistante Résistance vraie ? MAPA Variations et durée AutomesureÉquilibre tensionnel d’action ? MAPA Profil tensionnel MAPAAptitude à l’effort équilibré ? Profil tensionnel d’effort Élévation tensionnelle MAPADissection aortique contrôlée ? Profil tensionnel d’effort
  44. 44. Conclusion Méthode validée de mesure de PA :  Automatique > auscultatoire  Ambulatoire : MAPA des 24h ou AMT (bras > poignet), pour diagnostiquer/confirmer puis suivre une HTA Résultats : www.comitehta.org/  Valeurs normales :  < 140/90 mm Hg = mesure clinique  < 135/85 mm Hg = AMT, MAPA diurne  < 130/80 mm Hg = MAPA des 24h  < 120/70 mm Hg = MAPA nocturne

×