Amar J, Bieler L, Salvador M, Guittard J, Chamontin B
Service de médecine interne et d'hypertension artérielle, Pavillon Turiaf, CHU Purpan, Toulouse.
Arch Mal Coeur Vaiss. 1998 Aug;91(8):985-8.
To determine the influence of ambulatory blood pressure monitoring (ABPM), carotid intima media thickness (IMT) and global cardiovascular risk on the therapeutic strategies issued from our hypertension unit.
All essential uncomplicated and never treated hypertensive patients referred to our hypertension unit between 1996 and 1997 for etiologic or target organ damage evaluation were considered eligible. We excluded diabetics and patients with renal disease who need a specific therapeutical approach. 54 patients (44.7 +/- 10.1 years) were included (40 men). All patients underwent an ABPM measurement. The right common carotid IMT measurement had been performed (0.06 +/- 09 mm). The global cardiovascular risks were assessed with the Framingham prediction chart taking into account age, sex, total cholesterol, smoking status and systolic office blood pressure. According to the therapeutic decision three groups were made up: group 1 lifestyle counselling (n = 13), group 2 single drug therapy (n = 31), and group 3 combination therapy (n = 10).
No significant difference was found in age, sex ratio, prevalence of severe hypertension, office systolic blood pressure, body mass index, global cardiovascular risk between the three groups. In contrast ABP (24 h ABP mmHg: group 1: 128.23 +/- 6.91/79.7 +/- 6.4; group 2: 140.48 +/- 9.7/97.48 +/- 8.17; group 3: 152.4 +/- 15.35/99.4 +/- 12.14 p < .0001) and IMT (group 1: 10.55 +/- .09, group 2: .59 +/- .07, group 3: .66 +/- .11 p = .02), were significantly higher in group 3 than in group 2 and in group 1. The percentage of white coat hypertensives was higher in group 1 than in group 3 (group 1: 61.5%, group 2: 3.2%, group 3: 0%). In the whole population, the higher was the global cardiovascular risk, the higher was the common carotid intima media thickness. In this study the global cardiovascular risks are not related to therapeutic decisions. Therapeutic strategies are influenced by ABP level and by the vascular remodeling which depends partly on the global cardiovascular risk.
确定动态血压监测（ABPM）、颈动脉内膜中层厚度（IMT）和总体心血管风险对我们高血压科制定的治疗策略的影响。
1996年至1997年间因病因或靶器官损害评估转诊至我们高血压科的所有原发性单纯性且未接受过治疗的高血压患者均被视为符合条件。我们排除了糖尿病患者和需要特殊治疗方法的肾病患者。纳入54例患者（44.7±10.1岁）（40名男性）。所有患者均进行了ABPM测量。已进行右侧颈总动脉IMT测量（0.06±0.09mm）。使用弗明汉预测图表评估总体心血管风险，同时考虑年龄、性别、总胆固醇、吸烟状况和诊室收缩压。根据治疗决策分为三组：第1组生活方式咨询（n = 13），第2组单药治疗（n = 31），第3组联合治疗（n = 10）。
三组在年龄、性别比、重度高血压患病率、诊室收缩压、体重指数、总体心血管风险方面均未发现显著差异。相比之下，动态血压（24小时动态血压mmHg：第1组：128.23±6.91/79.7±6.4；第2组：140.48±9.7/97.48±8.17；第3组：152.4±15.35/99.4±12.14，p <.0001）和IMT（第1组：0.55±0.09，第2组：0.59±0.07，第3组：0.66±0.11，p = 0.02），第3组显著高于第2组和第1组。第1组白大衣高血压患者的百分比高于第3组（第1组：61.5%，第2组：3.2%，第3组：0%）。在整个人群中，总体心血管风险越高，颈总动脉内膜中层厚度越高。在本研究中，总体心血管风险与治疗决策无关。治疗策略受动态血压水平和血管重塑的影响，而血管重塑部分取决于总体心血管风险。
