Mesure ambulatoire de la pression artérielle sur 24 heures
Treatment of hypertension to reduce cardiovascular events (heart attack or stroke) and death needs careful consideration in people with PAD. If the blood pressure is lower in the legs compared to the arms (ABI of less than 1.0) this indicates blocked arteries in the legs (or PAD). When blood pressure is consistently high it can lead to complications such as a heart attack (myocardial infarction) or stroke. PAD is diagnosed when the blood supply to the legs is restricted causing pain and cramping that limits walking (intermittent claudication). The evidence from randomised controlled trials (RCTs) examining the risks and benefits of various anti-hypertensive drugs on measures of PAD is lacking. ↑ a et b (en) GBD 2016 Alcohol Collaborators, « Alcohol use and burden for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016 », The Lancet, Elsevier, vol. Cochrane Database of Systematic Reviews 2013, Issue 12. Art. No.: CD003075. State of the art lecture»։ The studies were not combined due to the variation of comparisons and the outcomes presented.
Quelle Tension Artérielle à 70 Ans ?
However, lack of data specifically examining outcomes in hypertensive PAD patients should not detract from the overwhelming evidence on the benefit of treating hypertension and lowering blood pressure. We identified eight RCTs with a total of 3610 people with symptomatic PAD where participants were randomised to receive an anti-hypertensive treatment for at least one month or placebo or no treatment. One trial with 1725 participants showed that the angiotensin converting enzyme (ACE) inhibitor ramipril was effective in reducing the number of cardiovascular events by 28% compared to placebo. 36) MWD was improved at 12 months in the angiotensin-II receptor antagonist telmisartan group compared to the placebo group but there were no significant differences in ABI or arterial wall thickness. Four studies compared an anti-hypertensive treatment with placebo and four studies compared two anti-hypertensive treatments with each other. », Morbidity and Mortality Weekly Report, vol.
163) found no significant differences in intermittent or absolute claudication distance, ABI, all-cause mortality or non-fatal cardiovascular events after 24 weeks of treatment in the beta-adrenoreceptor blocker nebivolol group and the HCTZ group. A study comparing two beta-adrenoreceptor blockers, nebivolol and metoprolol, found no clear differences in intermittent or absolute claudication distance, ABI, all-cause mortality or revascularisation after 36 weeks of treatment. This is hardening of the arteries which is caused by deposits of fat, cholesterol and other substances inside the blood vessels. In patients undergoing peripheral arterial angioplasty (a procedure to open narrowed or blocked blood vessels) the results from a trial with 96 participants suggested that the calcium channel blocker verapamil reduced restenosis (new blockage of the artery) at six months. Magnesium et hypertension . PAD can progress to pain at rest and critical limb ischaemia (sudden lack of blood flow to a limb caused by a blood clot or fatty deposit blockage) that requires revascularisation (restoring the blood flow by opening up the blocked blood vessel) or amputation.
The evidence on the use of various anti-hypertensive drugs in people with PAD is poor so that it is not known whether significant benefits or risks accrue. The CHEP Evidence-Based Recommendations Task Force (Figure 1 shows how the task force fits within the CHEP organizational chart) consists of 15 subcommittees with topic-specific content experts (Table 2). To recognize the public health risk posed by the underdiagnosis and undertreatment of hypertension in Canada, the Evidence-Based Recommendations Task Force aims to improve awareness, management and control of hypertension by providing updated recommendations. Posez le coude sur une table.