Influence de la variabilité de la pression artérielle en consultation sur le diagnostic du contrôle tensionnel chez des hypertendus traités

Abstract

ObjectiveTo evaluate the variability in blood pressure observed during office visit in treated hypertensive patients and its consequences on the diagnosis of controlled hypertension. MethodThe medical records of 144 subjects seen consecutively in a hypertension excellence center were extracted from a computerized medical database including hypertension subjects treated and followed-up for at least one year. BP measured with an automatic device (four consecutives measurements at 2min intervals) where compared to BP values of home BP performed in the previous week's visit. Thresholds were 140/90mmHg for office BP and 135/85mmHg for HBP. ResultsThe population has the following characteristics: age 62 years with 26% over 70 years, treated with a monotherapy (33%), bitherapy (35%), triple therapy (17%), quadri-therapy or more (8%). A white coat effect SBP above 20mmHg was noted in 32% of patients when BP at 2min is taken and in 2% when BP at 8min is taken (P<0.01). After 8min, a masked effect is noted in 16% for SBP above 20mmHg and in 44% for DBP above 10mmHg. White coat hypertension or masked hypertension was noted in 40% or 16% respectively (BP 2min) and in 5% or 29% (BP 8min) in treated hypertensive. ConclusionIn treated hypertensive, office BP measured by an automatic device shows significant variability. When the BP is taken with an automatic device, measures taken after 8minutes of rest avoid the misleading effects of white coat effect, but the masked hypertension is present in nearly one third of the subjects. The use of AMT for monitoring hypertensive patients is the best way to monitor treatment efficacy.