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Lors du passage en orthostatisme, la PAS s'élève significativement (p<0,05)
après le lever et reste en plateau jusqu'à la 6ème minute. la PAD s'élève
significativement au lever mais retrouve le niveau de repos à la 6 ème
minute. La FC s'élève significativement après une minute d'orthostatisme,
puis elle chute significativement à partir de la 3 ème minute où elle
reste en plateau.
Conclusion
Cette étude confirme que connaître la
position des patients lors des mesures de MAPA peut être un atout supplémentaire
dans l'interprétation de ces examens; les chiffres présentés peuvent
servir de référence pour les sujets normotendus. Il importe maintenant
de valider cette approche en recherche clinique : étude des sujets dysautonomiques,
étude du comportement des anti-hypertenseurs sur l'orthostatisme.
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Ambulatory
blood pressure variation in normotensive subjects in relation to the
sitting or standing position
Jean-Michel Mallion,
Sandrine Mouret, Jean-Philippe Baguet, Anne Martre, Jean-Louis Quesada,
Regis De Gaudemaris
Objective
To evaluate the physiological variations in arterial blood pressure in
normotensive subjects during activity and in relation to the sitting
or lying position.
Methods
The subjects were 30 healthy volunteers who
were normotensive and receiving no treatment. Blood pressure was measured
using the validated monitor Diasys Integra (NOVACOR SA, Rueil-Malmaison,
France) with an integral position sensor. Blood pressure was recorded
every 15 min over a 24 h period, additional measurements being made
in the first, third and sixth minutes after standing up.
Results
During the active period (1000-2000 h), 53%
of the measures were made in the standing position. Over this period,
the values of systolic blood pressure (SBP), diastolic blood pressure
(DBF) and heart rate were significantly elevated in the standing position
in comparison to the sitting position. The difference was of the order
of 5 mmHg for the SBP, 3.5 mmHg for the DBF and 9 beats/min for the
heart rate. The SBP, DBF and heart rate measured in the first, third
and sixth minutes after standing up were not significantly different.
Conclusion When measuring the blood pressure and heart rate in ambulatory
patients, it seems justified to evaluate the patient's position during
monitoring in order to achieve a better reproducibility and also to
uncover any problems of blood pressure control with positional change,
as could exist in patients with autonomic dysfunction. This might also
aid in evaluating antihypertensive treatment and also any deleterious
hypotensive effects. Blood Press Monit 5:169-173 © 2000 Lippincott Williams
& Wilkins.
Blood Pressure Monitoring 2000, 5:169-173
Keywords: ambulatory blood pressure, setting, standing, healthy volunteers,
clinical application
Department of Internal Medicine and Cardiology, Grenoble University
Hospital, Grenoble, France
Correspondence and requests for reprints to Jean-Michel Mallion, Grenoble
University Hospital, BP217-38043 Grenoble Cedex 9, France
Received 12 January 2000 Revised 14 May 2000 Accepted 10 May 2000
1359-5237 © 2000 Lippincott Will
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The determination of ambulatory blood pressure in very elderly hypertensives: effect of lying or sleeping in the day
E. Pinto, C.J.Bulpitt, N.Beckett, R.Peters, W.Banya, c.Nachev, V.Gergova, S.Nedogoda, L.Thijs, J.A.Staessen, C.Rajkumar. On behalf of the HYVET Investigators. Imperial College London, UK, Hospital St Anna, Sophia, Bulgaria, Hospital Alexandrovska, Sophia, Bulgaria, Volgograd Medical, Academy, Volgograd, Russia, University of Leuven, Belgium.
Background
This is the fist study in very elderly hypertensives to report ambulatory blood pressure measurements in relation to the patient's position during day time.
Objective
To determine ambulatory blood pressure in very elderly hypertensives (aged 80 years or more) and to report results according to body position, lying or sitting/standing.
Design and methods
This study is a side-project of the Hypertension in the Very Elderly Trial (HYVET). HYVET aims to investigate the effect of active treatment on outcom in hypertensive patients aged 80 years or more. ABPM (ambulatory blood pressure monitoring) is carried out annually using the Diasys Integra II monitor (Novacor, France). Daytime measurements were taken every half-hour from 10 am to 8 pm. This monitor also records the patient's position (lying or sitting/standing) simultaneously with each BP measurement.
Results
Results of 50 patients with 3 or more readings in both the lying and sitting/standing position (mean age 84 +/- 3.7 yeards s.d.) who were in the placebo phase or already randomised to either active or placebo treatment in eight participating centres. Daytime SBP was 128.1 +/- 15 mmHg. When values for only sitting/standing patients were used SBP was133.6 +/- 17 mmHg. For measurements during the day when the patients were lying down SBP decreased to 118.7 +/- 17 mmHg (p<0.001). Daytime DBP was 76.6 +/- 10 mmHg, sitting/standing-day time 81.1 +/- 12 mmHg and lying down 69.0 +/- 9 mmHg (p<0.001). The HR values were 75.6 +/- 9 beats/min, 79 +/- 10 beats/min sitting/standing and 70.2 +/- 9 beats/min lying down (p<0.0001).
Conclusion
The lower pressures when lying are thouyght to be due to sleeping or resting. In very elderly patients, it is important to account for body position in the interpretation of the day time ambulatory blood pressure recordings.
J. Hypertens., 2004, 22:S22, P1.7
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Effect of position on the ambulatory measurement of QKd interval in very elderly hypertensives
E. Pinto, C.J.Bulpitt, N.Beckett, R.Peters, W.Banya, C.Nachev, D.L.Dumitrascu, R.Antikainen, V.Stoyanovsky, M.Comsa, F.Dockery, J.A.Staessen, C.Rajkumar. On behalf of the HYVET Investigators. Imperial College London, UK, Hospital St Anna, Sophia, Bulgaria, UMF Cluj Napoca, Cluj Romania, Oulu City Hospital, oulu, Finland, National Multiprofile Transport Hospital, Sophia Bulgaria, Cabinet Medical Comsa Marius, Fagaras, Romania, University of Leuven, Belgium.
Background
Arterial compliance is know to decrease with age and conditions such as hypertension. No studies, however, have reported the effect of position on the ambulatory measurement of arterial compliance.
Objective
To determine the effetc of the body position on arterial compliance in very elderly hypertensives by measuring ambulatory QKD intervals during daytime.
Design and Methods
This study is a side-project of the Hypertension in the Very Elderly Trial (Hyvet). HYVET aims to investigate the effect of active treatment on outcome in hypertensive patients aged 80 years or more. The measurement of the QKD interval (Q wave (ECG) to Korotkoff Diastole sound) interval over a 24hr period is carried out annually using the Diasys Integra II monitor (Novacor, France). Daytime measurements were taken every half-hour from 10am to 8 pm. This monitor also records the patient's position (lying or sitting/standing) simultaneously with each BP measurement.
Results
Results of 37 patients (age 84 +/- 4 years, mean +/- s.d.) with 3 or more readings in both the lying and sitting/standing position who were in the placebo run-in phase or already randomised to either active or placebo treatment in eight participating centres were analysed in this study. The daytime QKD interval (10 am to 8 pm) was 180.7 +/- 19 ms (178.7 +/- 20 ms sitting/standing versus 182.6 +/- 21 ms lying, NS). SBP was 133 +/- 13 mmHg and HR 78 +/- 11 beats/min sitting/standing and 117 +/- 15 mmHg and 70 +/- 10beat/min lying. Adjusted for systolic blood pressure (100 mmHg) and heart rate (60 beats/min), the QKD100-60 for daytime was 200 +/- 9 ms. The QKD100-60 for lying position was 196 +/- 10 ms and for standing was 205 +/- 8 ms (p=0.0001).
Conclusions
We conclude that QKD interval is not affected by position unless corrected for systolic blood pressure and heart rate.
J.Hypertens., 2004, 22:S115, P1.340
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Blood pressure surge on rising
P. Gosse, R. Lasserre, C. Minifié, P. Lemetayer, J. Clementy
Hôpital Saint-André, Bordeaux, France
Objective
Since cardiovascular complications tend to occur more often in the morning, it is tempting to link to the surge in BP on rising. This was verified in a cohort of hypertensive patients (HT).
Design and Methods
We performed 24h ABPM along with a measurement of BP on rising (either manually or automatically from the device coupled with a position sensor) in 507 untreated HT. Left ventricular mass (LVM) was measured with echo at baseline. HT were the treated and followed by their GP and news were obtained at regular intervals (mean follow-up = 92 +/- 36 months). Surge in BP was the difference between measurement triggered in the minute following rising and the last measurement within the 30' before.
Results
Rising led to a mean increase of 14 mmHg in SBP and a 13 bpm increase in HR without significant correlation between the two. The increase in SBP on rising was linked with the overall variability in SBP (standard deviation, p<0.001), but independent of the mean 24h SBP. It was associated with LVM at baseline (linear regression, p<0.05) and an increased risk of future cardiovascular complications (Cox model, p<0.01) independently of age and average 24h SBP.
Conclusions
SBP surge on rising was associated with LVH and an increased risk of cardiovascular complications independently of age and average 24h SBP.
J.Hypertens., 2004, 22:1113-1118
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