De nouvelles directives, tant américaines qu’européennes, ont vu le jour en 2003 pour tenter d’améliorer la prise en charge de l’hypertension artérielle. Le traitement de l’hypertension
repose maintenant davantage sur l’appréciation du risque cardio-vasculaire global que sur le niveau de pression artérielle sensu stricto. On sera ainsi parfois amené à prescrire des médicaments antihypertenseurs chez des sujets se trouvant dans le groupe à PA normale haute pour autant que leur risque cardio-vasculaire à 10 ans soit > 20 %. A l’inverse, chez un
patient hypertendu, mais de grade 1 ou 2 et à risque faible, il sera conseillé d’attendre plusieurs mois avant d’instaurer un traitement médicamenteux actif sur la PA. Dans tous les cas, les règles hygiéno-diététiques devront être expliquées et appliquées individuellement. La cible tensionnelle à atteindre sera < 140/90 mmHg pour les risques faibles et < 130/80 mmHg pour les risques élevés. Pour y arriver, il faudra souvent recourir à des associations de molécules, contenant un diurétique à faible dose. Il est d’ailleurs maintenant proposé, d’emblée, en première ligne, le choix entre une monothérapie ou une thérapie combinée à faible dose. Une approche globale des facteurs de risque est capitale. Le patient sera revu souvent au début et constamment encouragé; son traitement sera adapté en fonction des résultats obtenus, de façon à atteindre le niveau de risque le plus bas possible.
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[en] New American and European guidelines have been released in 2003, the purpose of which is to improve the management of arterial hypertension. The decision to treat high blood pressure now mainly relies on the individual cardiovascular risk rather than on the sole blood pressure level. Thus, antihypertensive drugs could be proposed even to normotensive individuals, provided they have a high cardiovascular risk (> 20% at 10 years). On the other hand, grade 1 or 2 hypertensive patients, if their baseline cardiovascular risk is low, will be prescribed antihypertensive drugs only after 3 to 6 months of follow-up. In all cases, individualized non pharmacological means must always be proposed and their use stimulated. The target blood pressure under treatment will be < 140/90 mmHg when the cardiovascular risk is low or moderate, but < 130/80 mmHg when high risk exists. To reach this target, a drug combination is very often necessary, and it frequently includes a low dose of diuretic. To-day, the option of using a low dose biotherapy as an alternative to monotherapy is even proposed as first step antihypertensive treatment. After initiation of treatment, the patient must be regularly followed up and stimulated to decrease his cardiovascular risk to the lowest possible level, following an inclusive approach.
Disciplines :
Urology & nephrology Human health sciences: Multidisciplinary, general & others
Author, co-author :
Krzesinski, Jean-Marie ; Université de Liège - ULiège > Département des sciences cliniques > Néphrologie
Language :
French
Title :
Nouvelles directives americaines et europeennes en 2003 pour la prise en charge de l'hypertension arterielle
Alternative titles :
[en] New American and European 2003 Guidelines for the Management of Arterial Hypertension
Publication date :
September 2003
Journal title :
Revue Médicale de Liège
ISSN :
0370-629X
eISSN :
2566-1566
Publisher :
Université de Liège. Revue Médicale de Liège, Liège, Belgium
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