SUPERIORITE DE LA MESURE DE LA PRESSION ARTERIELLE HORS CABINET

64mes Journes internationales Francophones dAngiologie - 27 Janvier 2012

Docteur Guillaume BOBRIE Service dHTA - HEGP - Paris

MESURE PERIPHERIQUE DE LA PRESSION ARTERIELLE

Toutes les tudes pidmiologiques et tous les essais thrapeutiques ont utiliss la mesure clinique de la PA.

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

EFFECT OF GENDER OF BOTH PATIENTS AND PHYSICIANS ON BP AND HR DIFFERENCES BETWEEN NURSE AND PHYSICIAN. 1062 patients (50% male, 5214 years), seen by 10 physicians (Ausc. method: 16227 / 9715 mmHg) and one nurse (Oscillo. device: 15524 / 8814 mmHg).
Sex of Physician

Male
Male patient SBP difference (mmHg) DBP difference (mmHg) HR difference -5.2 15.5 -8.2 10.6 1.7 6.5 Female patient -8.2 16.4 -8.8 11.3 1.3 5.9 -2.5 11.9 -4.1 9.8 1.6 8.6

Female
Male patient Female patient -6.3 13.9 -7.1 10.4 0.9 6.6

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

THE MISDIAGNOSIS OF HYPERTENSION. THE ROLE OF PATIENT ANXIETY

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

COMPARISON AND REPRODUCIBILITY OF 4 BLOOD PRESSURE MEASUREMENT METHODS

Standard deviation (mmHg) of the difference between 2 sets of BP measurements: 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 DBP

13.1 7.7

9.0 7.4

4.8 3.4

5.0 3.4

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

Comparison of acceptability of and preferences for different methods 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 discomfort It made me anxious 2 2 3 4 It disturbs home life 2 4 2 2 It disturbs sleep 2 5 2 2 It disturbs work 3 4 4 3 I was uncomfortable 2 5 2 2 Uncertainty I felt unsure what to do It worried me knowing BP Difficult to remeber to do it Mean item score Ranking by patient

2 2 2 2.67 1

2 2 2 3.88 4

2 2 2 3.47 2

2 2 2 3.45 3

CLASSIFICATION DE LA PA EN FONCTION DE 2 METHODES DE MESURE

MESURE CONVENTIONNELLE < 140 et 90 mmHg < 135 et NORMOTENDUS AUTOMESURE 85 mmHg CONTROLES MAPA DIURNE > 135 ou 85 mmHg HTA MASQUEE > 140 ou 90 mmHg HTA DE CONSULTATION HYPERTENDUS NON CONTROLES

ISOLATED OFFICE HYPERTENSION

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.

MASKED HYPERTENSION

16.8%

Guidelines for the Management of Arterial Hypertension. J Hypertens 2007; 25: 11051187.

Verberk WJ. Am J Hypertens 2008; 21: 969-975.

METHODOLOGIE DE LAUTOMESURE TENSIONNELLE

Deux sances de mesures tensionnelles par jour, le matin entre lever et petit-djeuner (avant la prise ventuelle des antihypertenseurs), et le soir entre le dner et le coucher. Bonnes conditions de relaxation, pas dintrt mesurer PA dans dautres circonstances.

Raliser 3 mesures chaque sance, soit 6 mesures par jour, pendant au moins 3 jours.
Enregistrer, imprimer, noter toutes les mesures faites, sans slection.

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

Imprimer, tlcharger, tltransmettre les rsultats.

MESURE DE LA PRESSION ARTERIELLE JNC 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

Relative effectiveness of clinic and home blood pressure monitoring compared with ambulatory blood pressure monitoring in diagnosis of hypertension: systematic review.
Hodgkinson J. et al. BMJ 2011;342:d3621 doi: 10.1136/bmj.d3621

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