Contrôle de la pression artérielle : ce que nous apportent ... HTA nouvea… ·...
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Contrôle de la pression artérielle : ce que nous apportent les essais récents P r Xavier Girerd Pôle Cœur Métabolisme Unité de Prévention des Maladies Cardiovasculaires Groupe Hospitalier Universitaire Pitié-Salpêtrière [email protected] Agadir, 21 mai 2016
Transcript of Contrôle de la pression artérielle : ce que nous apportent ... HTA nouvea… ·...
Contrôle de la pression
artérielle : ce que nous
apportent les essais récents
Pr Xavier Girerd
Pôle Cœur Métabolisme
Unité de Prévention des Maladies Cardiovasculaires
Groupe Hospitalier Universitaire Pitié-Salpêtrière
Agadir, 21 mai 2016
Les essais récents avec une
baisse de la pression
artérielle
published on November 9, 2015, at NEJM.org.
Participants
published on November 9, 2015, at NEJM.org.
Participants were required to meet all the following criteria: an age
of at least 50 years, a systolic blood pressure of 130 to 180 mm Hg,
and an increased risk of cardiovascular events.
Blood pressure characteristics
published on November 9, 2015, at NEJM.org.
Efficacy on SBP in the intensive treatment group is obtained
with the addition of 1 antihypertensive drug on the drug list
The SPRINT Research Group* published on November 9, 2015, at NEJM.org.
1.8
2.8
Cardiovascular prevention is demonstrated
after 1 year in favor of intensive treatment
The SPRINT Research Group* published on November 9, 2015, at NEJM.org.
Heart failure and death from any cause is
prevented in intensive treatment group
The numbers needed to treat to prevent a primary outcome event, death from any
cause, and death from cardiovascular causes during the median 3.26 years of the trial
were 61, 90, and 172, respectively.
The SPRINT Research Group* published on November 9, 2015, at NEJM.org.
Stroke is not significantly prevented in
intensive treatment group
The SPRINT Research Group* published on November 9, 2015, at NEJM.org.
At 1 year, the mean SBP was 121.4 mm Hg in the intensive-treatment group and
136.2 mm Hg in the standard-treatment group, for an average difference of 14.8 mm
Hg. The mean DBP at 1 year was 68.7 mm Hg in the intensive- treatment group and
76.3 mm Hg in the standard-treatment group for an average difference of 7.6 mm Hg.
J Hypertens 25:959–964 Q 2007
-1.8 per 1000
-20 mmHg
Chaque mmHg compte !
J Hypertens 25:959–964 Q 2007
-0.5 per 1000
-20 mmHg
Chaque mmHg pour une PA basse
compte moins!
-50
-40
-30
-20
-10
0
PROGRESS
Single
PROGRESS
Asso
PROFESS SPRINT
SBP change (mmHg) DBP change (mmHg) Stroke prevention (%)
Blood pressure and stroke prevention in
PROGRESS - PROFESS - SPRINT
PROFESS
144/84
inclusion
PROGRESS
147/86
inclusion
SPRINT
139/78
inclusion
PRoFESS NEJM 2008;359. SPRINT NEJM.org Nov 9, 2015 PROGRESS Lancet 2001;284:465-471.
Intensive treatment contained tri-therapies
or more for 56% of patients
The SPRINT Research Group* published on November 9, 2015, at NEJM.org.
56.2%
64.4%
« Lorsque vous avez à la consultation un
hypertendu âgé de plus de 50 ans (et pouvant
avoir plus de 75 ans), traité par une bithérapie, et
dont la PAS est à 140 mmHg (moyenne de 3
mesures obtenues avec un tensiomètre
électronique après 5 minutes de repos en position
assise), vous pouvez ajouter un médicament
antihypertenseur à votre prescription.»
«Traiter plus intensément 90 hypertendus
pendant 3,2 ans évite 1 décès».
Ce que SPRINT nous enseigne
The SPRINT Research Group* published on November 9, 2015, at NEJM.org.
Causes of Death
The SPRINT Research Group* published on November 9, 2015, at NEJM.org.
Serious adverse events of hypotension, syncope, electrolyte
abnormalities, and acute kidney injury or acute
renal failure, but not injurious falls or bradycardia,
occurred more frequently in the intensive treatment group
The SPRINT Research Group* published on November 9, 2015, at NEJM.org.
April 2, 2016, at NEJM.org.
Blood-Pressure Lowering in Intermediate Risk
Persons without Cardiovascular Disease (HOPE 3)
April 2, 2016, at NEJM.org.
Blood-Pressure Lowering in Intermediate Risk
Persons without Cardiovascular Disease (HOPE 3)
April 2, 2016, at NEJM.org.
Blood-Pressure Lowering in Intermediate Risk
Persons without Cardiovascular Disease (HOPE 3)
April 2, 2016, at NEJM.org.
Blood-Pressure Lowering in Intermediate Risk
Persons without Cardiovascular Disease (HOPE 3)
April 2, 2016, at NEJM.org.
Blood-Pressure Lowering in Intermediate Risk
Persons without Cardiovascular Disease (HOPE 3)
April 2, 2016, at NEJM.org.
Blood-Pressure Lowering in Intermediate Risk
Persons without Cardiovascular Disease (HOPE 3)
April 2, 2016, at NEJM.org.
La méta-analyse de Zanchetti
apporte une aide à la
compréhension du bénéfice
d’une baisse supplémentaire
de la pression artérielle
1. Overview, meta-analyses, and meta-regression analyses of randomized trials. J Hypertension 2014, 32:2285–2295
2. Effects at different baseline and achieved blood pressure levels - overview and meta-analyses of randomized trials.
J Hypertension 2014, 32:2296–2304
3. Effects in patients at different levels of cardiovascular risk - overview and meta-analyses of randomized trials.
J Hypertension 2014, 32:2305–2314
4. Effects of various classes of antihypertensive drugs - overview and meta-analyses. J Hypertension 2015, 33:195–
211
5 Effects of various classes of antihypertensive drugs – head to head comparisons of various classes of
antihypertensives drugs. J Hypertension 2015, 33:1321–1341
6. Effects of blood pressure-lowering treatment. Prevention of heart failure and new-onset heart failure – meta-
analyses of randomized trials. J Hypertension 2016, 34: 373-384
7. Effects of blood pressure lowering on outcome incidence in hypertension: Effects of more vs. less intensive blood
pressure lowering and different achieved blood pressure levels – updated overview and meta-analyses of randomized
trials. J Hypertension 2016, 34:613-22.
Effects of blood pressure lowering on outcome
incidence in hypertension Costas Thomopoulos, Gianfranco Parati, Alberto Zanchetti
Characteristics of the patients in the trials of more vs. less
intense blood pressure lowering included in the meta-analysis
J Hypertension 2016, 34:613-22.
Effects of more vs. less intense BP-lowering on stroke, heart
failure and cardiovascular death calculated as SBP reductions
from baseline -17mmHg for less and -25mmHg for more
intense lowering
J Hypertension 2016, 34:613-22.
Relative and absolute risk reduction of various outcomes in
trials comparing more intense with less intense BP lowering
J Hypertension 2016, 34:613-22.
Effects of BP lowering in trials of active treatment vs. placebo and more vs. less
intense treatment (considered together), stratified in three strata with mean SBP
achieved by active or more intense treatment vs. mean SBP achieved in the
placebo or less intense treatment
J Hypertension 2016, 34:613-22.
Les visites au cabinet médical doivent être mensuelles,
jusqu'à l'obtention de l'objectif tensionnel.
L'objectif tensionnel est d'obtenir une PAS comprise entre
130 et 139 mm Hg et une PAD < 90 mm Hg, y compris chez
les diabétiques et les patients avec maladies rénales.
L'objectif tensionnel sera confirmé par une mesure de la PA
en dehors du cabinet médical.
Après 80 ans, l’objectif est d’obtenir une PAS < 150 mm Hg,
sans hypotension orthostatique.
Presse Med. 2013;42(5):819–25.
