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  • Publication
    Accès libre
    Différences induites par la définition des périodes diurnes et nocturnes sur la pression artérielle et le dipping lors d’une mesure ambulatoire de la pression artérielle
    (2012)
    Muller, M.-E.
    ;
    Bochud, M.
    ;
    Pruijm, M.
    ;
    ;
    Burnier, Michel
    ;
    Wuerzner, G.
    La mesure ambulatoire de la pression artérielle (MAPA) est devenue un outil indispensable dans le diagnostic et le contrôle de la pression artérielle (PA). Il n’existe cependant aucun consensus concernant la définition des périodes diurnes ou nocturnes lors des MAPA.
    But de l’étude
    Comparer les valeurs de PA diurnes et nocturnes et la baisse nocturne de la PA (dipping) définies par un actigraphe et par la position du corps aux valeurs calculées sur des périodes fixées arbitrairement.
    Patients et méthodes
    Enregistrement simultané de la MAPA, des périodes de sommeil et de la position du corps (débout/allongé) par un actigraphe (SenseWear Armband®) chez des patients référés pour une MAPA. Les résultats obtenus par l’actigraphe (sommeil et position) étaient comparés aux résultats obtenus par une période de jour (07 h 00–22 h 00) et de nuit (22 h 00–07 h 00) fixées arbitrairement.
    Resultats
    Les données de 103 patients, dont plus de la moitié étaient traités pour une hypertension, ont été analysées. Par rapport aux périodes fixées arbitrairement, les PA nocturnes étaient plus basses (PA systolique : 2,08 ± 4,50 mmHg ; PA diastolique : 1,84 ± 2,99 mmHg, p < 0,05) et le dipping était plus marqué (PA systolique : 1,54 ± 3,76 % ; PA diastolique : 2,27 ± 3,48 %, p < 0,05) lorsque la période nocturne était définie par l’actigraphe. Les valeurs en position debout étaient supérieures (PA systolique : 1,07 ± 2,81 mmHg ; PA diastolique : 1,34 ± 2,50 mmHg) aux valeurs diurnes de la période diurne fixée.
    Conclusion
    La PA diurne et nocturne ainsi que le dipping sont influencés par la méthode utilisée pour définir l’intervalle nocturne. Le choix d’une méthode par rapport à une autre dépendra de la valeur pronostique de chaque méthode sur des évènements cardiovasculaires., Ambulatory blood pressure monitoring (ABPM) has become indispensable for the diagnosis and control of hypertension. However, no consensus exists on how daytime and nighttime periods should be defined.
    Objective
    To compare daytime and nighttime blood pressure (BP) defined by an actigraph and by body position with BP resulting from arbitrary daytime and nighttime periods.
    Patients and method
    ABPM, sleeping periods and body position were recorded simultaneously using an actigraph (SenseWear Armband®) in patients referred for ABPM. BP results obtained with the actigraph (sleep and position) were compared to the results obtained with fixed daytime (7 a.m.–10 p.m.) and nighttime (10 p.m.–7 a.m.) periods.
    Results
    Data from 103 participants were available. More than half of them were taking antihypertensive drugs. Nocturnal BP was lower (systolic BP: 2.08 ± 4.50 mmHg; diastolic BP: 1.84 ± 2.99 mmHg, P < 0.05) and dipping was more marked (systolic BP: 1.54 ± 3.76%; diastolic BP: 2.27 ± 3.48%, P < 0.05) when nighttime was defined with the actigraph. Standing BP was higher (systolic BP 1.07 ± 2.81 mmHg; diastolic BP: 1.34 ± 2.50 mmHg) than daytime BP defined by a fixed period.
    Conclusion
    Diurnal BP, nocturnal BP and dipping are influenced by the definition of daytime and nighttime periods. Studies evaluating the prognostic value of each method are needed to clarify which definition should be used.
  • Publication
    Accès libre
    Is there a risk of orthostatic hypotension associated with antihypertensive therapy in geriatric inpatients?
    (2012)
    Coutaz, M.
    ;
    ;
    Morisod, J.
    Objectives
    To determine the risk of orthostatic hypotension (OH) due to antihypertensive therapy in a geriatric inpatient population.
    Subjects and methods< br> This observational cohort study included 388 patients (mean age 80.7, 68.5% female) hospitalized in a geriatric clinic. OH risk was evaluated by orthostatic testing (OT), with manual measurement of blood pressure after 30 minutes supine (T0), and after 1 (T1), 3 (T3), and 5 (T5) minutes after rising in a vertical position. OH was defined by a ≥ 20 mmHg decrease in systolic blood pressure and/or a ≥ 10 mmHg decrease in diastolic blood pressure.
    Results
    Age ≥ 80 years, history of falls and prescribed medication (antihypertensive, hypotensive, or both), were not significantly associated with OH or with OT positivity at any time point. The multivariate analysis showed that OH risk in T1 was 2.34 times higher than in T3 and T5 (confidence interval [1.49–3.68], P < 0.001). Presenting symptoms during OT increased the risk of obtaining a positive result by 3.67 times (confidence interval [1.52–8.87], P = 0.004). With each increase in one mini-mental state examination (MMS) point, a 9.9% decrease of OT positivity was observed (odds ratio = 0.907, confidence interval [0,84–0,98], P = 0.016).
    Conclusion
    The prescription of antihypertensive drugs was not significantly associated with the risk of OH in this geriatric inpatient population. OH screening in patients with cognitive impairment is critical, as with each decrease in one MMS point, OH risk increased by almost 10%.