Hypertension artérielle

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Urgence hypertensive

Pression artérielle élevée et dommage d'organe/dysfonction associée

Recommandations

  • For adults with a hypertensive emergency and a compelling condition (such as aortic dissection, severe preeclampsia or eclampsia, or pheochromocytoma crisis), systolic blood pressure should be reduced to less than 140 mm Hg during the first hour and to less than 120 mm Hg in aortic dissection.
  • For adults with a hypertensive emergency but without a compelling condition, systolic blood pressure should be reduced by no more than 25% within the first hour; then, if stable, to 160/100 mm Hg within the next 2 to 6 hours; and then cautiously to normal during the following 24 to 48 hours.[1]

Hypertension essentielle

Définition

tableau ici avec cibles tensionnelles

Traitement

  • Modifications non médicamenteuses (arrêt du tabac, perte de poids avec cible BMI <25, diète DASH avec apports en potassium, ...)
  • Première ligne médicamenteuse: diurétique thiazidique (hydrochlorothiazide), chlortalidone
    • Alternative: Loop diuretics are preferred in patients with symptomatic heart failure or CKD with an estimated GFR <30 mL/min/1.73 m2. Potassium-sparing diuretics, such as aldosterone receptor antagonists (spironolactone or eplerenone) or epithelial sodium channel blockers (amiloride), are weaker diuretics. These are often used in liver cirrhosis, heart failure, or resistant hypertension.
  • The 2017 ACC/AHA BP guideline recommends combination therapy with two first-line antihypertensive drugs of different classes for adults with stage 2 hypertension and an average BP of 20/10 mm Hg above their BP target (typically ≥150/90 mm Hg).
  • Thérapies adjonctives:
    • β-blockers for post–myocardial infarction or heart failure
    • aldosterone receptor blockers for heart failure
    • loop diuretics for advanced CKD

Références

Lien: https://medicalforum.ch/fr/article/doi/fms.2019.08308