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Prevalence des differents phenotypes d’hypertension arterielle apres une pre-eclampsie

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Defense Thèse de doctorat : Univ. Genève, 2017 - Méd. 10846 - 2017/05/05
Abstract La pré-éclampsie (PE) est un trouble hypertensif gravidique qui touche 3-5% des grossesses. Elle s’associe à un risque d’hypertension artérielle (HTA) 4 fois supérieur à la population générale. L’objectif de cette étude prospective contrôlée est d’évaluer la prévalence des différents phénotypes d’hypertension par la mesure de la pression artérielle de 24 heures (MAPA) dans le post-partum. Des MAPA sur 24 heures ont été effectuées 6-12 semaines après l’accouchement, chez 115 femmes ayant fait une PE et 41 femmes ayant eu une grossesse normale. Les valeurs de MAPA diurne et nocturne étaient significativement plus élevées après une PE. Cinquante % des patientes avec PE présentaient une HTA persistante, 17.9% une HTA de la blouse blanche, 11.6% une HTA masquée et 62.3% étaient non-dippers. La MAPA après une PE permet l’identification des patientes à risque cardiovasculaire élevé et l’implémentation précoce de mesures préventives.
Abstract Preeclampsia is associated with increased cardiovascular and renal risk. The aim of this prospective cohort study was to characterize the early postpartum blood pressure (BP) profile after preeclampsia. We enrolled 115 women with preeclampsia and 41 women with a normal pregnancy in a prospective cohort study. At 6 to 12 week postpartum, we assessed the prevalence of different hypertensive phenotypes using 24-hour ambulatory BP monitoring (ABPM), as well as the risk of salt sensitivity and the variability of BP derived from ABPM parameters. Among patients with preeclampsia, 57.4% were still hypertensive at the office. Daytime ABP was significantly higher in the preeclampsia group (118.9±15.0/83.2±10.4 mm Hg) than in controls (104.8±7.9/71.6±5.3 mm Hg; P<0.01). Differences between groups were similar for nocturnal BP values. Fifty percent of preeclampsia women remained hypertensive on ABPM in the postpartum, of whom 24.3% were still under antihypertensive treatment; 17.9% displayed a white-coat hypertension and 11.6% had masked hypertension. In controls, 2.8% had white-coat hypertension; none had masked hypertension or needed hypertensive treatment. The prevalence of nondippers was similar 59.8% in the preeclampsia group versus 51.4% in controls. High-risk class of salt sensitivity of BP was increased in preeclampsia women (48.6%) compared with controls (17.1%); P<0.01. In conclusion, ABPM 6 to 12 weeks after delivery reveals a high rate of sustained ambulatory, nocturnal, and masked hypertension after preeclampsia. This finding may help identify women who should be included in a postpartum cardiovascular risk management program.
Keywords Blood pressureMasked hypertensionPostpartum periodPreeclampsiaPregnancy
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URN: urn:nbn:ch:unige-1010636
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DITISHEIM, Agnès. Prevalence des differents phenotypes d’hypertension arterielle apres une pre-eclampsie. Université de Genève. Thèse, 2017. https://archive-ouverte.unige.ch/unige:101063

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Deposited on : 2018-01-03

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