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Abstract
Objectifs. Le but de cette étude était de déterminer la prévalence de l’hypotension orthostatique (HO) chez les hypertendus traités à l’hôpital de Tombouctou, et rechercher ses facteurs favorisants. Méthodes. Il s’est agi d’une étude prospective transversale menée du 1er janvier 2020 au 31 décembre 2022 au service de médecine générale de l’hôpital de Tombouctou incluant des patients régulièrement traités pour hypertension artérielle. La pression artérielle et la fréquence cardiaque étaient mesurées en décubitus dorsal puis immédiatement en orthostatisme (1ère et 3ème minutes). Résultats. Sur une population de 526 patients hypertendus traités, 78 cas d’HO (14,8%) ont été observés dont 53 (65,4 %) étaient symptomatiques. Il s’agissait de 246 femmes (47,8%) et de 280 hommes (52,2%). L’âge moyen des hypertendus était de 56,2 ans ± 11,2 avec des extrêmes de 22 ans et de 91 ans. Les patients ayant présenté une HO avaient un âge moyen plus élevé : 66 ans contre 56 ans chez les autres (p= 0,01). L’HO était plus fréquente chez les patients traités par antihypertenseurs centraux, les patients ayant présenté un accident vasculaire cérébral, les diabétiques, les obèses. Conclusion. L’hypotension orthostatique est fréquente chez les hypertendus. Il faut la rechercher systématiquement chez tous les hypertendus, surtout mal contrôlés car elle peut être non seulement un facteur de mauvaise observance thérapeutique, mais aussi un facteur de risque cardiovasculaire indépendant.
ABSTRACT
Objective. The aim of this study was to determine the prevalence of orthostatic hypotension (HO) in hypertensive patients treated at the Tombouctou hospital, and to find its contributing factors. Methods. This was a prospective cross-sectional study conducted from January 1st, 2020 to December 31st, 2022 at the General Medicine Department of Tombouctou Hospital including patients regularly treated for arterial hypertension. Blood pressure and heart rate were measured in supine position then immediately in orthostatism (1st and 3rd minutes). Results. Out of a population of 526 treated hypertensive patients, 78 cases of HO (14.8%) were observed, of which 53 (65.4%) were symptomatic. These were 246 women (47.8%) and 280 men (52.2%). The average age of hypertensives was 56.2 years ± 11.2 with extremes of 22 years and 91 years. Patients presenting with HO had a significantly higher mean age: 66 years versus 56 years in the others (p= 0.01). HO was more common in patients treated with central antihypertensives, patients who had had a stroke, diabetics, obese. Conclusion. Orthostatic hypotension is common in hypertensives. It must be systematically sought in all hypertensives, especially poorly controlled, because it can be not only a factor of poor therapeutic compliance, but also an independent cardiovascular risk factor.
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References
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- The consensus committee of the American autonomic society and the American academy of neurology. Consensus statement on the definition of orthostatic hypertension, pure autonomic failure and multiple system atrophy. Neurology. 1996 May; 46 (5):1470.
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References
RÉFÉRENCES
The consensus committee of the American autonomic society and the American academy of neurology. Consensus statement on the definition of orthostatic hypertension, pure autonomic failure and multiple system atrophy. Neurology. 1996 May; 46 (5):1470.
Low PA. Prevalence of orthostatic hypotension. Clin Auton Res. 2008 Mar; 18 (Suppl 1):8–13
Saez T, Suarez C, Sierra MJ, Llamas C, Jimenez R, Vega S. Orthostatic hypotension in the aged and its association with antihypertensive treatment. Med Clin (Barc) 2000; 114(14):525–9.
Gonzalez VL, Dominguez Rollan R, Fernandez Ruiz M, Josa Fernandez B, Ruiz Izquierdo F, Zabalo Amezqueta A, Munoz Cacho P. Prevalence of orthostatic hypotension in elderly hypertensive patients in primary care. Aten Primaria. 2001;28(3):151–7.
Leftheriotis G, Fortrat JO, Dupuis JM, Victor J. Syncopes inexpliquées. La lettre du neurologue. 2001;1:9–11.
Bletry O. Aspects étiologiques des hypotensions orthostatiques. Rev Med Interne. 1992 Nov; 13 (6):430–7.
Mathias CJ, Kimber JR. Postural hypotension: causes, clinical features, investigation and management. Ann Rev Med. 1999; 50: 317–336.
Federowski A, Stavenow L, Hedblad B, Berglund G, Nilsson PM, Melander O. Consequences of orthostatic blood pressure variability in middle aged men (The Malmo Preventive Project) J Hypertens. 2010; 28(3):551–9.
Kamaruzzaman S, Watt H, Carson C, Ebrahim S. The association between orthostatic hypotension and medication use in the British Women’s Heart and Health Study. Age Ageing. 2010 Jan; 39(1):51–6.
Rose KM, Marsha LE, Biga RL, Couper D J, Light KC, Sharrett A R. Orthostatic hypotension predicts mortality in middle-aged adults The atherosclerosis risk in communities (ARIC) study. Circulation. 2006 Aug 15; 114(7):630–6.
Rose KM, Tyroler HA, Nardo CJ, Arnett DK, Light KC, Rosamond W. Orthostatic hypotension and the incidence of coronary heart disease: the atherosclerosis risk in communities study. Am J Hypertens. 2000 Jun; 13(6 Pt 1):571–8.
Eigenbrodt ML, Rose KM, Couper DJ, Couper DJ, Arnett DK, Smith R, Jones D. Orthostatic Hypotension as a risk factor for stroke: the Atherosclerosis Risk in Communities (ARIC) Study, 1987–1996. Stroke. 2000 Oct; 31(10):2307–13.
Kong KH, Chuo AM. Incidence and outcome of orthostatic hypotension in stroke patients undergoing rehabilitation. Arch Phys Med Rehabil. 2003 Apr;84(4):559–62.