Valeur pronostique de la mesure ambulatoire de la pression artérielle chez les patients hypertendus traités

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Publiée juil. 11, 2023
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Vol. 101 No 2 (2023): Revue Fev. 2023

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Saoussen Antit
University of Tunis El Manar, Faculty of Medicine of Tunis, Security Forces Hospital of Marsa, Cardiology Department, Tunisia
Ridha Fekih
Department of Nephrology, Dialysis, and Transplantation - Sahloul University Hospital, Sousse, Tunisia.
Cyrine Antit
Department of Nephrology, Dialysis, and Transplantation - Sahloul University Hospital, Sousse, Tunisia.
Marwa Abdelhedi
Department of Nephrology, Dialysis, and Transplantation - Sahloul University Hospital, Sousse, Tunisia.
Elhem Boussabeh
Department of Nephrology, Dialysis, and Transplantation - Sahloul University Hospital, Sousse, TunisiaDepartment of Nephrology, Dialysis, and Transplantation - Sahloul University Hospital, Sousse, Tunisia
Lilia Zakhama
- Department of Nephrology, Dialysis, and Transplantation - Sahloul University Hospital, Sousse, Tunisia.

Résumé

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.

Mots-clés :

mesure ambulatoire de la pression artérielle, hypertension artérielle, pronostic

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Ce travail est disponible sous licence Creative Commons Attribution - Pas d'Utilisation Commerciale - Pas de Modification 4.0 International.

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