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Abstract
OBJECTIF
Le contrôle de la pression artérielle (PA) est un défi en hémodialyse. L’objectif de cette étude était d’évaluer le niveau du contrôle tensionnel avec trois méthodes de mesure de la PA chez l’hémodialysé chronique.
METHODES
Cette étude transversale d’Avril à Juillet 2014 s’est déroulée au Centre Hospitalier et Universitaire de Yaoundé. Etait inclus tout adulte hémodialysé chronique ayant un diagnostic médical d’hypertension artérielle (HTA). Il subissait une évaluation de la PA en pré- et post-dialyse, et pendant 48heures par la mesure ambulatoire de la PA (MAPA) et l’automesure.
RESULTATS
Nous avons inclus 19 patients d’âge moyen de 51±12,54 ans d’une durée moyenne de l’HTA et de la dialyse de 102,53±13,83 mois et 38,89±12,71 mois respectivement. L’HTA (31,6%) et les glomérulonéphrites chroniques (26,3%) étaient les principales néphropathies. Sept (36,8%) patients ne prenaient aucun traitement antihypertenseur. Le contrôle tensionnel optimal variait de 5,3 à 57,9% selon les méthodes de mesure. Il était plus faible avec la MAPA (5,3% et 26,3% respectivement les jours sans et de dialyse), suivi de l’automesure (47,4%) et de la mesure en dialyse (31,6% et 57,9% en pré- et post-dialyse). L’automesure interdialytique avait la meilleure sensibilité, spécificité et valeur prédictive positive comparée à la MAPA interdialytique. Le jeune âge, la courte durée en dialyse et de l’HTA, et la présence des troubles minéralo-osseux étaient associés au contrôle non optimal de la PA.
CONCLUSION
Le niveau de contrôle tensionnel est bas indépendamment de la méthode utilisée. L’automesure interdialytique est l’alternative de choix à la MAPA dans notre contexte.
Article Details
References
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- Barri YM. Hypertension and kidney disease: a deadly connection. Curr Hypertens Rep. 2008 Feb;10(1):39-45.
- Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, Jr., et al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003 Dec;42(6):1206-52.
- Mann JF, Gerstein HC, Pogue J, Bosch J, Yusuf S. Renal insufficiency as a predictor of cardiovascular outcomes and the impact of ramipril: the HOPE randomized trial. Ann Intern Med. 2001 Apr 17;134(8):629-36.
- Levin NW, Kotanko P, Eckardt KU, Kasiske BL, Chazot C, Cheung AK, et al. Blood pressure in chronic kidney disease stage 5D-report from a Kidney Disease: Improving Global Outcomes controversies conference. Kidney Int. 2010 Feb;77(4):273-84.
- Agarwal R, Peixoto AJ, Santos SF, Zoccali C. Out-of-office blood pressure monitoring in chronic kidney disease. Blood Press Monit. 2009 Feb;14(1):2-11.
- Zoccali C, Mallamaci F, Tripepi G, Benedetto FA, Cottini E, Giacone G, et al. Prediction of left ventricular geometry by clinic, pre-dialysis and 24-h ambulatory BP monitoring in hemodialysis patients: CREED investigators. J Hypertens. 1999 Dec;17(12 Pt 1):1751-8.
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References
Agarwal R, Nissenson AR, Batlle D, Coyne DW, Trout JR, Warnock DG. Prevalence, treatment, and control of hypertension in chronic hemodialysis patients in the United States. Am J Med. 2003 Sep;115(4):291-7.
Barri YM. Hypertension and kidney disease: a deadly connection. Curr Hypertens Rep. 2008 Feb;10(1):39-45.
Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, Jr., et al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003 Dec;42(6):1206-52.
Mann JF, Gerstein HC, Pogue J, Bosch J, Yusuf S. Renal insufficiency as a predictor of cardiovascular outcomes and the impact of ramipril: the HOPE randomized trial. Ann Intern Med. 2001 Apr 17;134(8):629-36.
Levin NW, Kotanko P, Eckardt KU, Kasiske BL, Chazot C, Cheung AK, et al. Blood pressure in chronic kidney disease stage 5D-report from a Kidney Disease: Improving Global Outcomes controversies conference. Kidney Int. 2010 Feb;77(4):273-84.
Agarwal R, Peixoto AJ, Santos SF, Zoccali C. Out-of-office blood pressure monitoring in chronic kidney disease. Blood Press Monit. 2009 Feb;14(1):2-11.
Zoccali C, Mallamaci F, Tripepi G, Benedetto FA, Cottini E, Giacone G, et al. Prediction of left ventricular geometry by clinic, pre-dialysis and 24-h ambulatory BP monitoring in hemodialysis patients: CREED investigators. J Hypertens. 1999 Dec;17(12 Pt 1):1751-8.
Agarwal R, Peixoto AJ, Santos SF, Zoccali C. Pre- and postdialysis blood pressures are imprecise estimates of interdialytic ambulatory blood pressure. Clin J Am Soc Nephrol. 2006 May;1(3):389-98.
Zager PG, Nikolic J, Brown RH, Campbell MA, Hunt WC, Peterson D, et al. "U" curve association of blood pressure and mortality in hemodialysis patients. Medical Directors of Dialysis Clinic, Inc. Kidney Int. 1998 Aug;54(2):561-9.
Zoccali C. Arterial pressure components and cardiovascular risk in end-stage renal disease. Nephrol Dial Transplant. 2003 Feb;18(2):249-52.
Alborzi P, Patel N, Agarwal R. Home blood pressures are of greater prognostic value than hemodialysis unit recordings. Clin J Am Soc Nephrol. 2007 Nov;2(6):1228-34.
K/DOQI clinical practice guidelines for cardiovascular disease in dialysis patients. Am J Kidney Dis. 2005 Apr;45(4 Suppl 3):S1-153.
Chalmers J, MacMahon S, Mancia G, Whitworth J, Beilin L, Hansson L, et al. 1999 World Health Organization-International Society of Hypertension Guidelines for the management of hypertension. Guidelines sub-committee of the World Health Organization. Clin Exp Hypertens. 1999 Jul-Aug;21(5-6):1009-60.
Dolan E, Stanton A, Thijs L, Hinedi K, Atkins N, McClory S, et al. Superiority of ambulatory over clinic blood pressure measurement in predicting mortality: the Dublin outcome study. Hypertension. 2005 Jul;46(1):156-61.
Kikuya M, Ohkubo T, Asayama K, Metoki H, Obara T, Saito S, et al. Ambulatory blood pressure and 10-year risk of cardiovascular and noncardiovascular mortality: the Ohasama study. Hypertension. 2005 Feb;45(2):240-5.
Sega R, Facchetti R, Bombelli M, Cesana G, Corrao G, Grassi G, et al. Prognostic value of ambulatory and home blood pressures compared with office blood pressure in the general population: follow-up results from the Pressioni Arteriose Monitorate e Loro Associazioni (PAMELA) study. Circulation. 2005 Apr 12;111(14):1777-83.
Fagard RH, Staessen JA, Thijs L, Bulpitt CJ, Clement D, de Leeuw PW, et al. Relationship between ambulatory blood pressure and follow-up clinic blood pressure in elderly patients with systolic hypertension. J Hypertens. 2004 Jan;22(1):81-7.
The World Bank. Cameroon; http://data.worldbank.org/country/cameroon (Accessed date 30th October 2015).
Kaze FF, Kengne AP, Choukem SP, Dzudie A, Halle MP, Dehayem MY, et al. Dialysis in Cameroon. Am J Kidney Dis. 2008 Jun;51(6):1072-4; author reply 4.
Kaze FF, Kengne AP, Mambap AT, Halle MP, Mbanya D, Ashuntantang G. Anemia in patients on chronic hemodialysis in Cameroon: prevalence, characteristics and management in low resources setting. Afr Health Sci. 2015 Mar;15(1):253-60.