MESURE PERIPHERIQUE DE LAPRESSION ARTERIELLE

7/30/2019 MESURE PERIPHERIQUE DE LAPRESSION ARTERIELLE

1/13

SUPERIORITE DE LA MESURE DE LA PRESSIONARTERIELLE HORS CABINET

Docteur Guillaume BOBRIE

Service dHTA - HEGP - Paris

64mesJournes internationales Francophones dAngiologie - 27 Janvier 2012


2/13

MESURE PERIPHERIQUE DE LAPRESSION ARTERIELLE

Toutes les tudes pidmiologiques et tous les essais

thrapeutiques ont utiliss la mesure clinique de la PA.


3/13

VARIABILITE TENSIONNELLE

Variabilit respiratoire Variabilit cyclique courte (chmorcepteur)

Variabilit cyclique moyenne (tonus sympathique)

Rythme circadien

Variabilit saisonnire

Position

Stimulation mentale

Activit physique Alimentation : baisse tensionnelle post-prandiale

Toxique : nicotine, cocane,

Variabilit pharmacologique


4/13

La Batide-Alanore A et al. J Hypertens 2000; 18: 391-398.

1062 patients (50% male, 52

14 years), seen by 10 physicians (Ausc.method: 16227 / 9715 mmHg) and one nurse (Oscillo. device: 15524

/ 8814 mmHg).

Sex of Physician

Male Female

Male patient Female patient Male patient Female patientSBP difference (mmHg) -5.2 15.5 -8.2 16.4 -2.5 11.9 -6.3 13.9

DBP difference (mmHg) -8.2 10.6 -8.8 11.3 -4.1 9.8 -7.1 10.4

HR difference 1.7 6.5 1.3 5.9 1.6 8.6 0.9 6.6

EFFECT OF GENDER OF BOTH PATIENTS AND PHYSICIANS ONBP AND HR DIFFERENCES BETWEEN NURSE AND PHYSICIAN.

The nursephysician difference was greater in patients seen by the 4

professors than in those examined by the six other physicians for SBP

(8.016.6 versus 4.514.2 mmHg, p=0.0002) and DBP (8.711.0 versus

7.210.7 mmHg, p=0.027).


5/13

THE MISDIAGNOSIS OF HYPERTENSION.THE ROLE OF PATIENT ANXIETY

Ogedegbe G. Arch Intern Med. 2008; 168: 2459-2465.


6/13

Denolle T. Arch Mal Coeur Vaiss. 1995; 88: 1165-70.

COMPARISON AND REPRODUCIBILITY OF 4 BLOOD PRESSUREMEASUREMENT METHODS

Standard deviation (mmHg) of the difference between 2 sets of BPmeasurements: 2 office measurements with mercury manometer (n = 2); 2 automatics records during visit (n = 10); 2 24h-ambulatory recordings (n = 88);

2 periods of 5 days of home self BP-measurement (n = 30).

Office(Hg manometer)

Automatic(ColinBP8800)

ABPM(Dyasis 300R Novacor)

HBPM(Oscillomat)

SBP 13.1 9.0 4.8 5.0

DBP 7.7 7.4 3.4 3.4


7/13

Comparison of acceptability of and preferences for differentmethods of measuring BP in primary care.

Little et al. BMJ 2002; 325: 258-9.

Rating (median) of different methods of measuring BP (1 to 7)Home Ambulatory Nurse Doctor(n=153) (n=156) (n=153) (n=152)

Disturbance and discomfortIt made me anxious 2 2 3 4It disturbs home life 2 4 2 2

It disturbs sleep 2 5 2 2It disturbs work 3 4 4 3I was uncomfortable 2 5 2 2

UncertaintyI felt unsure what to do 2 2 2 2

It worried me knowing BP 2 2 2 2Difficult to remeber to do it 2 2 2 2

Mean item score 2.67 3.88 3.47 3.45

Ranking by patient 1 4 2 3


8/13


9/13

Regardless of the terminology,evidence is now available that

isolated office hypertension may

be present in about 15% of the

general population and that it

may account for a noticeable

fraction (one third or more) of

individuals in whom hypertension

is diagnosed.

16.8%

Verberk WJ. Am J Hypertens 2008; 21: 969-975.Guidelines for the Management of Arterial Hypertension.J Hypertens 2007; 25: 11051187.

ISOLATED OFFICEHYPERTENSION

MASKED HYPERTENSION


10/13

Deux sances de mesures tensionnelles par jour, le matin entrelever et petit-djeuner (avant la prise ventuelle desantihypertenseurs), et le soir entre le dner et le coucher.

Bonnes conditions de relaxation, pas dintrt mesurer PA dansdautres circonstances.

Raliser 3 mesures chaque sance, soit 6 mesures par jour,pendant au moins 3 jours.

Enregistrer, imprimer, noter toutes les mesures faites, sansslection.

Calcul de la moyenne (hors mesures du premier jour).

Imprimer, tlcharger, tltransmettre les rsultats.

METHODOLOGIE DE LAUTOMESURE TENSIONNELLE


11/13

MESURE DE LA PRESSION ARTERIELLEJNC VI - 1997 (2)

MAPA- Programmation mesurer toutes les 15 30 minutes- Normales : jour < 135/85 mmHg

nuit < 120/75 mmHg

- Cycle nycthmral- Meilleure corrlation avec atteinte des organes cibles- tudes pronostiques limites- Utiles pour :

* Dpister lHTA blouse blanche * Comprendre les symptmes d hypotension* Affirmer les pousses tensionnelles

- Ne pas utiliser en routine


12/13

Relative effectiveness of clinic and home blood pressure monitoringcompared with ambulatory blood pressure monitoring in diagnosis of

hypertension: systematic review.Hodgkinson J. et al. BMJ 2011;342:d3621 doi: 10.1136/bmj.d3621


13/13

Everything you always wanted to knowabout self blood pressure measurement,but were afraid to ask is on line

http://www.automesure.com

Documents

MESURE PERIPHERIQUE DE LAPRESSION ARTERIELLE