abpm-ambulatory bp monitoring
TRANSCRIPT
![Page 1: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/1.jpg)
MONITORIZAREA AMBULATORIE A TENSIUNII ARTERIALE
DE LA CERCETARE LA APLICABILITATEA CLINICA
Alexandru AndritoiuAlexandru AndritoiuSp. Clinic de Urgenta Militar Craiova
Sectia Medicina Interna
![Page 2: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/2.jpg)
Moto:
,, Blood pressure is a quantity with a very large range…hypertension is a quantitative disease,,
Sir George White Pickering
(1904-1980)
1968
1961
![Page 3: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/3.jpg)
Office BP vs. Out-of-Office BPOffice BP vs. Out-of-Office BP
• Office BPOffice BP TA de cabinet
• Out-of-Office BPOut-of-Office BPABPM Auto-masurarea TA la domiciliu
ESH/ESC 2013
![Page 4: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/4.jpg)
TEHNICI DE MONITORIZARE TATEHNICI DE MONITORIZARE TA
Non-invaziveNon-invazive• ABPM ambulatory
blood pressure monitoring
• HBPM home blood pressure monitoring
InvaziveInvazive• Manometrie I.A.
![Page 5: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/5.jpg)
Metode ABPMMetode ABPM
• Metoda oscilometrica
• Metoda auscultatorie
• Metoda pletismografica
Protocoale de validare AAMI (1990) si BHS (1993)
![Page 6: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/6.jpg)
SpaceLabOMRONTakedaT2420
![Page 7: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/7.jpg)
Home BP monitoringHome BP monitoring
![Page 8: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/8.jpg)
IndicatiiIndicatii
FARA TRATAMENT• HTHA (WCH)• HTA borderline• HTA refractara• HTA secundara• HTA sarcina• hipoTA ortostatica• HTA episodica• Disf. autonoma
CU TRATAMENT• Eficienta terapeutica• HTA rezistenta
![Page 9: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/9.jpg)
![Page 10: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/10.jpg)
Giusepe Mancia
![Page 11: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/11.jpg)
![Page 12: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/12.jpg)
Parametrii ABPMParametrii ABPM
TA -24 h (h 7.00-7.00)TA diurna (h 7.00-22.00)TA nocturna (h 22.00-7.00)TA trezire (h 5.00-8.00)TA maxTA minTAMPPIDFCBP load Index hiperbarDS
![Page 13: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/13.jpg)
COMPONENTA TONICA
TAS, TAD, TAM, BPload
COMPONENTA PULSATILA
PP
COMPONENTA FAZICA
ID, SD-TA 24h
FC -24 ore
![Page 14: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/14.jpg)
ESH/ESC 2013
![Page 15: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/15.jpg)
![Page 16: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/16.jpg)
FORME CLINICE DE HTA (ABPM)FORME CLINICE DE HTA (ABPM)
• HTA de halat alb (WC-HT)
• HTA diurna
• HTA nocturna
• HTA sustinuta
• HTA episodica
• Masked hypertension
![Page 17: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/17.jpg)
Traseu ABPM normalTraseu ABPM normal
![Page 18: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/18.jpg)
HTA de halat alb (WC-HT)HTA de halat alb (WC-HT)
Andritoiu A. Hipertensiunea de halat alb-intre normal si patologic. Infomedica, 2001:10:12-16
![Page 19: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/19.jpg)
PREVALENTA WC-HTPREVALENTA WC-HT
Bangash F- CJASN 2009;4:656-664
![Page 20: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/20.jpg)
HTA diurnaHTA diurna
![Page 21: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/21.jpg)
HTA episodicaHTA episodica
![Page 22: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/22.jpg)
HTA sustinutaHTA sustinuta
![Page 23: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/23.jpg)
HTA nocturnaHTA nocturna
![Page 24: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/24.jpg)
HTA matinalaHTA matinala
![Page 25: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/25.jpg)
Morning surgeMorning surge
Morning BP surgeMorning BP surge: TAS medie in timpul celor 2 ore dupa trezire-TAS medie din timpul de 1 ora ce include cea mai scazuta TAS din timpul somnului (Kario K 2003)
Cresterea TAS>50 mmHg si/sau TAD>20 mmHg in intervalul 6.00-10.00a.m. (Marfella R 2003)
![Page 26: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/26.jpg)
HTA sistolica (izolata)HTA sistolica (izolata)
![Page 27: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/27.jpg)
Masket hypertension Masket hypertension
![Page 28: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/28.jpg)
PREVALENTA HTA MASCATA PREVALENTA HTA MASCATA
Bangash F - CJASN 2009;4:656-664
![Page 29: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/29.jpg)
Masket HT-subtipuriMasket HT-subtipuri
• HTA matinala
• HTA diurna
• HTA nocturna
Kawano Y et al- Clin Exp Hypertens 2008;30(3):289-96
![Page 30: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/30.jpg)
CaCaracteristicracteristicileile pts cu Masket HTpts cu Masket HT
• Varsta tanara• Sex M, • Stress cotidian• Fumatori • Consumatori de alcool (seara)• Obezitate centrala• HTA ocazionala• Prehipertensivi• Pacienti cu scor mare de risc CV• Semne de afectare organe tinta cu TA normala la
cabinet• Pacienti hipertensivi sub tratament
Poate precede HTA sustinutaPoate precede HTA sustinuta
![Page 31: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/31.jpg)
Lot - 46 adulti cu HTA la cabinet
40%
25%
15%
20%
WCH episodica diurna sustinuta
Andritoiu A, 2000
![Page 32: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/32.jpg)
HTA LA TINERIHTA LA TINERI
Andritoiu AAndritoiu A si colab. The significance of high blood pressure in cardiovascular pathology of young adults. The 4th Cong BMMC 1999, Bucuresti
Andritoiu AAndritoiu A. Monitorizarea ambulatorie a tensiunii arteriale-aplicabilitate diagnostica si prognostica. Rev Med Mil 1999;1107-126.
Importanta metodei in expertiza medico-militaraImportanta metodei in expertiza medico-militara
![Page 33: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/33.jpg)
BP loadBP load
Definitie:
In 1988, the Mayo ClinicMayo Clinic suggested the use of a BP loadBP load,defined as the percentage of BP values exceeding a given constant threshold,usually 140/90mm Hg for systolic/diastolic BP during activity and 120/80mm Hg during resting hours.
The hyperbaric index (HBI),hyperbaric index (HBI), as a determinant of BP excess, can be calculated as the total area of any given patient’s BPabove the threshold.
![Page 34: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/34.jpg)
Stadializarea HTA dupa BP loadStadializarea HTA dupa BP load
BP LOAD (%) STADIU % BP LOAD (%) STADIU %
0 - 5 normal 15
5 - 15 borderline 35
15 - 25 usoara 20
25 - 75 moderata 25
75 -100 severa 5Andritoiu A. Semnificatia parametrului BP load in evaluarea severitatii hipertensiunii.
Al 38-lea Cong Nat Cardiol 1999, Sinaia
![Page 35: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/35.jpg)
Stadializarea HTA dupa BP loadStadializarea HTA dupa BP load
BP load(%)BP load(%) GradGrad N=45N=45 %%
0-5 normal 10 22
6-15 borderline 12 27
16-25 usoara 5 11
26-75 moderata 10 22
76-100 severa 8 18
Andritoiu A, 2000
![Page 36: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/36.jpg)
Valorile BP load fct tipul HTA (ABPM)Valorile BP load fct tipul HTA (ABPM)
WC-HTWC-HT 6.42+/-6.43
HTA episodicaHTA episodica 10.76+/-9.85
HTA diurnaHTA diurna 43.67+/-20.46
HTA sustinutaHTA sustinuta 77.64+/-22.79
Andritoiu A, 2000
N = 45 pacienti
![Page 37: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/37.jpg)
Blood Pressure LoadBlood Pressure Load
2,1 +/- 3,3
27,2 +/- 25,8
0 5 10 15 20 25 30
n -TA
HTA
HTA
n -TA
Andritoiu A, 2000
![Page 38: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/38.jpg)
![Page 39: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/39.jpg)
![Page 40: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/40.jpg)
Presiunea Pulsului (PP)Presiunea Pulsului (PP)
Definitie:
diferenta dintre presiunea sistolica si presiunea diastolica: forta generata de cord la fiecare contractie
TAS = 120 mmHg; TAD=80 mmHg; PP=40 mmHG
PP: predictor de evenimente CV mai bun decat TAS si/sau TAD izolate
![Page 41: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/41.jpg)
Componenta fazica - pulsatila (PP)Componenta fazica - pulsatila (PP)
LOT I LOT II p< (hipertensivi) (normali)
PP - 24 h 50,7 +/- 6,3 50,8 +/- 4,7 NS
PP - day 51,5 +/- 6,4 51,1 +/- 5,3 NS
PP - night 45,1 +/- 9,6 48,9 +/- 4,0 NS
Andritoiu A, 2000
Creste semnificativ in HTA sistolica (ateromatoza Ao)
![Page 42: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/42.jpg)
Variabilitatea TA in 24 hVariabilitatea TA in 24 h
• variabilitatea beat-to-beat
• variabilitatea measure-to-measure
Parametrul:
SD (TAS, TAD, TAM, PP)
![Page 43: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/43.jpg)
Variabilitatea circadianaVariabilitatea circadiana
• Definitie (ID index diurn):
Dipper vs. non-Dipper
ESH/ESC 2013
![Page 44: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/44.jpg)
Forme de dippingForme de dipping
Dipping absent
(HTA nocturna)
ratio>1.0
Dipping moderat 0.9<ratio<1.0
Dipping 0.8<ratio<0.9
Dipping extrem ratio<0.8
ESH/ESC 2013
![Page 45: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/45.jpg)
![Page 46: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/46.jpg)
Normotensiv-DipperNormotensiv-Dipper
![Page 47: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/47.jpg)
Normotensiv non-DipperNormotensiv non-Dipper
Hermida et al. Chronobiol Int 2013
![Page 48: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/48.jpg)
![Page 49: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/49.jpg)
![Page 50: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/50.jpg)
Non-DipperNon-Dipper
![Page 51: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/51.jpg)
Non-DippingNon-Dipping
• Salt sensitive hypertension• HTA secundara• Disfunctie autonoma• Diabet zaharat• Sdr. de apnee in som• Sdr. Cushing• Feocromocitom• Hiperaldosteronismul primar• Virsta avansata (HT sistolica severa)• Etnicitate (rasa Afro-Americana)• Medicamente (ciclosporina, corticosteroizi)• Insuf. renala (dializati)• Insuf. cardiaca congestiva
![Page 52: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/52.jpg)
![Page 53: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/53.jpg)
LOT I LOT II p<
(hipertensivi) (normali)
ID - TAM 15,5 +/- 8,5 13,8 +/- 6,4 ns
DS .TAS-24h 15,4 +/- 3,8 11,3 +/- 2,8 0,05
Andritoiu A, 2000
VARIABILITATEAVARIABILITATEA CIRCADIANACIRCADIANA
![Page 54: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/54.jpg)
RELATIA CU TOD
![Page 55: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/55.jpg)
VALOAREA PROGNOSTICAVALOAREA PROGNOSTICA
Cresterea TAS-24h cu 1 mmHg este asociata unei cresteri a riscului de mortalitate cardiovasculara de 4.7% !
Studii:• Perloff et al.- JAMA 1983:249:2792-2798.• Perloff D, Sokolow M, Cowan R, Juster RP – J Hypertens 1989;7(suppl):S3-S10.• Perloff D Sokolow M – J Hypertens 1990 (suppl):S105-S111.• Perloff D, Sokolow M, Cowan R – J Hypertens 1991 ;9 (suppl):S33-S39.
,, Average ambulatory BP was better correlated than office BP with the degree of ,, Average ambulatory BP was better correlated than office BP with the degree of target-organ damage and the presence of cardiovascular complications”.target-organ damage and the presence of cardiovascular complications”.
,,The patients with a low ambulatory BP, in relation to the level to the level ,,The patients with a low ambulatory BP, in relation to the level to the level predicted from the office blood pressure, had a better prognostic, and were less predicted from the office blood pressure, had a better prognostic, and were less likely to develop clinical events over a 10-year period, than patients with higher likely to develop clinical events over a 10-year period, than patients with higher BP levels”BP levels”
![Page 56: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/56.jpg)
VALOAREA PROGNOSTICA A DATELOR ABPM
Studiu pe 3 ani
899 pts cu HTA esentiala vs 176 normotensivi
WCH ……………0,45 evenimente / 100pts / an
HTA ……………2,59 evenimente / 100 pts / an
Normo-TA………0,56 evenimente / 100 pts / an
• Un traseu anormal de monitorizare TA ambulatorie a identificat 95% dintre subiectii care aveau sa sufere un eveniment cardiovascular in urmatorii 3,3 ani!
• Valoarea predictiva negativa a ABPM = 98% !
Verdecchia P. Al XII-lea Cong Cardiol;10-14 sept 1994, Berlin
![Page 57: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/57.jpg)
![Page 58: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/58.jpg)
Organele tinta in HTAOrganele tinta in HTA
HTA
![Page 59: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/59.jpg)
Presiunile monitorizate pe 24h se coreleaza cu o varietate de leziuni de organ
• scorul global al afectarii organelor tintascorul global al afectarii organelor tinta• masa VS (gradul HVS)• afectarea functiei VS• nivelul microalbuminuriei• hipertrofia peretelui arterial• distensibilitatea arterelor elastice• deteriorarea creierului (dementa vasculara)• retinopatie
![Page 60: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/60.jpg)
Evaluarea afectarii unor tinte in HTA (lot 800 pts)
78%
43%
22%
14%
FO I / I I Placa ASC HVS Mi Alb
Cuspidi C, 2001
![Page 61: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/61.jpg)
AF. ORG. TINTA (TOD) AF. ORG. TINTA (TOD) (ABPM - 45 hipertensivi)(ABPM - 45 hipertensivi)
0
2
4
6
8
10
12
14
FO HVS E/A<1 CAR AB ALB
Andritoiu A, 2000
![Page 62: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/62.jpg)
Ochiul in HTAOchiul in HTA
• Retina (exudate, hemoragii)• Artere/vene (Sallus)• Tromboza VCR• Ocluzia ACR
Ocluzia ACR
![Page 63: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/63.jpg)
Relatia ABPM – FO la un lot de 45 pacienti cu HTA
Hipertensiune BP load Grad 0/I Grad II/III
WC-HT 6.42+/-6.43 12 0
Episodica 10.76+/-9.85 12 0
Diurna 43.67+/-20.46 2 4
Sustinuta 77.64+/-22.79 3 11
Andritoiu A, 2000
![Page 64: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/64.jpg)
Relatia cu HVS (Eco)Relatia cu HVS (Eco)
TAS-24h si TAD 24h se coreleaza cu:
• SIV+PPVS• PPVS• SIV+PPVS/DTDVS• h/r (HVS concentrica)• Masa VS• AS – cu TAD-24h
Prisant LM, Carr AA. 1990
![Page 65: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/65.jpg)
Corelatia dintre masa VS (Eco) si TAS-24h vs TAS determinata ocazional (cabinet)
Studiu n TAS -24h TAS-cab Rowlands 50 0,60 0,51
Devereux 100 0,50 0,24
Drayer 12 0,81 0,55
Kleinert 93 0,26 0,22
Prisant 55 0,50 0,33
Verdecchia 253 0,48 0,38
![Page 66: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/66.jpg)
Principalii determinanti directi ai HVSPrincipalii determinanti directi ai HVS
• TA medie -24 h• TAS diurna• TAS la trezire• BP load• Var. presionala
• Stresul de forfecare • Stresul parietal• IMC• Virsta• Sexul• Aportul de sodiu in dieta• Factori genetici• Viscozitatea singelui• Rezistenta la insulina• Ingestia cronica de alcool• Factori neuro-hormonali (catecolamine, angiotensina, renina)
![Page 67: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/67.jpg)
Stroke in HTAStroke in HTA
• DipperDipper• Non-DipperNon-Dipper• Dipper extremDipper extrem• Dipper inversatDipper inversat
Kario K et al. - Hypertension 2001
![Page 68: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/68.jpg)
Arterele in HTAArterele in HTA
Ax carotidian Artera brahiala
![Page 69: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/69.jpg)
Modificarile carotidiene in HTAModificarile carotidiene in HTA
• Cresterea diametruluiCresterea diametrului• Ingrosarea CIMTIngrosarea CIMT• Placi stenoticePlaci stenotice
Alterarea complianteiAlterarea compliantei
Imbatrinire accelerata a axului carotidian !
![Page 70: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/70.jpg)
100 pts hipertensivi
•
GROUP I GROUP II GROUP III
R-CCA L-CCA R-CCA L-CCA R-CCA L-CCA
Dd 5,8+/-0.8 5,6+/-0.7 6,5+/-0.7 6.7+/-0,9 8,3+/-0.3 7.7+/-0,2
(mm)
IMTh 0,45+/-0,2 0,44+/-0,2 0,67+/-0,2 0,65+/-0,3 0,89+/-0,3 0,93+/-0.2
(mm)
% Plaques 28,5% 80%
% Segnif.stenosis 22 % 14%
Mean stenosis(%) 45+/-10,7 % 38+/-9,7%
Andritoiu Al. Modificari morfologice si functionale ale arterelor carotide comune in hipertensiune comparativ cu imbatrinirea-studiu Eco-Doppler. A II-a Conf Nat Ultrasonografie , Craiova, 1999.
![Page 71: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/71.jpg)
GROUP II GROUP III
CCA-middle 3 5
CCA-bulb 4 10
ICA 5 11
ECA 2 6
TOTAL 12 32
Distributia topografia a placilor ATS-CAR
Andritoiu Al. Modificari morfologice si functionale ale arterelor carotide comune in hipertensiune
comparativ cu imbatrinirea-studiu Eco-Doppler. A II-a Conf Nat Ultrasonografie , Craiova, 1999.
![Page 72: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/72.jpg)
Modificarile a. brahiale in HTAModificarile a. brahiale in HTA
• Cresterea in diametru/arie• Modificarea profilului spectral• Alterarea vasodilatatiei - dependenta de endoteliu (Ach) - independenta de endoteliu (NTG)
Se coreleaza cu parametrii ABPM-24h si la trezire !
Andritoiu A, 2000
![Page 73: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/73.jpg)
Profil spectral – a. brahiala (largire spectrala)
![Page 74: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/74.jpg)
Rinichiul in HTARinichiul in HTA
• Microalbuminurie (30-300 mg/24 h) • microalbuminurie de efort• proteinurievaloare predictiva poz. ptr evenimente CV subsecvente Metode de determinare RIA/nefelometrie laser Dipstick +2
CONSECINTE• Nefroangioscleroza• Insuficienta renala cr. Cr. ser > 1,5 mg/dl Cl. Cr < 60 ml/min
![Page 75: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/75.jpg)
SCORUL AFECTARII ORGANELOR TINTASCORUL AFECTARII ORGANELOR TINTA
• Ex. FO: Std I ……………………………………. 1p. Std.II……………………………………. 2p. Std. III……………………………………3p.• Prezenta HVS…………………………………..3p.• Disfunctia VS diastolica (E/A <1) …………..2p.• Ecografia carotidiana: Diametrul >6.5 mm……………………….1p. CIMT > 1mm………………..…………….1p. Placi ……………………………………….2p.• A. Brahiala (largire spectrala)…………………1p.• Ex urina (albuminurie)………………………….2p. SCOR Max. = 15p.
Andritoiu A, 2000
![Page 76: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/76.jpg)
TOD - SCOR MEDIUDIURNA vs SUSTINUTA vs WC-HT
0
1
2
3
4
5
6
DIURNA SUSTINUTA WCH
3.71p
6p
1.33p
Andritoiu A, 2000
![Page 77: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/77.jpg)
CORELATII Scor TOD vs…
TASTAS R= 0.87
TADTAD R= 0.72
TAMTAM R= 0.80
SBP loadSBP load R= 0.74
DBP loadDBP load R= 0.61
FC R= 0.23
![Page 78: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/78.jpg)
PARAMETRII MONITORIZARII TENSIONALE LA TREZIRE SI
AFECTAREA ORGANELOR TINTA IN HTA
Andritoiu A. Al 41 Cong Nat Cardiol 2002, Sinaia
![Page 79: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/79.jpg)
Relatia scor-TOD si parametrii ABPM la trezire (lot 45 pacienti HT)
TASTAS R= 0.87
TADTAD R= 0.72
TAMTAM R= 0.80
SBP loadSBP load R= 0.74
DBP loadDBP load R= 0.61
FC FC R= 0.23
Andritoiu A, 2002
![Page 80: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/80.jpg)
MONITORIZAREA TA IN SARCINA
![Page 81: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/81.jpg)
![Page 82: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/82.jpg)
Hypertension in pregnancy, as diagnosed by ABPM, is superior to the office measurement of BP in predicting outcomes
![Page 83: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/83.jpg)
ABPM in sarcina
Recomandata deRecomandata de:
Soc. Elvetiana de Hipertensiune
Soc. Franceza de Hipertensiune
Nerecomandata deNerecomandata de:
Marea Britanie, SUA, Germania, Brazilia
![Page 84: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/84.jpg)
Valorile normale (ABPM) in sarcina
Sapt. 9-17 18-22 26-30 >30
TA diurna 130/77 132/79 133/81 135/86
(Brown MA et colab. 1998)
Trim I Trim II Trim III
TA-24h 110/70 116/74 125/80
TA diurna 113/69 119/78 126/83
TA nocturna 100/71 113/73 111/78
(Gheorman V, Andritoiu A, Raca N 2002)
![Page 85: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/85.jpg)
Profilul circadian al TAS, TAD, TAM, FC in sarcina
Hermida RC, Hypertension 2001;38:746
![Page 86: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/86.jpg)
Valorile medii pe fiecare trimestru de sarcina
ParametruParametruABPMABPM TRIM ITRIM I TRIM IITRIM II TRIM IIITRIM III
TAS 24 h 99.5+/-5.5 104.1+/-6 108.7+/-8.2
TAD 24 h 66.3+/-2.2 67.8+/-3 70.3+/-5.3
TAM 24 ore 77.8+/-9.7 79.6+/-10.2 86.8+/-12.4
TAS diurna 101.3+/-5.8 106.3+/-6 111.7+/-7.2
TAD diurna 66.8+/-1.2 69.3+/-4 72+/-5.6
TAM diurna 79.6+/-5.6 82.6+/-6.6 88.4+/-6.7
TAS nocturna 95.3+/-2.3 99+/-6.8 100.5+/-5.5
TAD nocturna 62.8+/-3.9 65.3+/-4 66.7+/-5.4
TAM nocturna 76.8+/-5.2 77.3+/-4.5 79.2+/-5.6
Andritoiu A, Raca N, Gheorman V.- Metode noi in predictia preeclampsiei. Ed. Info, Craiova, 2007.
![Page 87: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/87.jpg)
Limita cut-off
Parametru ABPM
TRIM I TRIM II TRIM III
TA – 24 h 110.5/70 116/74 125/80
TA diurna 113/69 119/78 126/83
TA nocturna 100/71 113/73 111/78
110.5116
125
70 7480
0
20
40
60
80
100
120
140
TRIM I TRIM II TRIM III
TAS TAD
Andritoiu A, 2006
![Page 88: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/88.jpg)
PP – presiunea pulsuluiPP – presiunea pulsului(TAS-TAD)(TAS-TAD)
ParametruABPM
TRIM I TRIM II TRIM III
PP 24 ore 33.5+/-5.5 36.1+/-6 38.5+/-8.2
PP diurn 33.3+/-5.8 36.3+/-6 40.2+/-7.2
PP nocturn 33.3+/-2.3 34.2+/-6 33.5+/-5.533.5
36.1
38.5
30
32
34
36
38
40
42
TRIM. I TRIM. II TRIM. III
virsta sarcinii
PP
-24
ore
Andritoiu A, 2006
![Page 89: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/89.jpg)
Sarcina de presiune(BP load)
ParametrulABPM
TRIM I TRIM II TRIM III
SBP load 3.2+/-0.05 6.2+/-0.05 7.5+/-0.02
DBP load 3.3+/-0.08 4.6.+/-0.06 5.5+/-0.03
Andritoiu A, 2006
![Page 90: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/90.jpg)
Frequency distribution of maximum BP load from normotensive pregnant women (top) and women with a final diagnosis of gestational hypertension or preeclampsia (bottom)
sampled in different trimesters of pregnancy.
Hermida R C - Hypertension 2001;38:723-729
![Page 91: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/91.jpg)
Parametrii ABPM Parametrii ABPM intervalul de trezire (h 5.00-8.00 am)
Parametru ABPM
TRIM I TRIM II TRIM III
TAS 103.5 +/-12.2 106.6+/-11.3 114.5+/-10.9
TAD 69+/- 11.3 72+/- 13.6 76+/-13.2
TAM 78.6 +/-3.2 83 +/-3.3 88 +/-3.6
FC 72.6+/-8.9 86.6+/-11.2 86.7+/-10.2
Andritoiu A, 2006
![Page 92: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/92.jpg)
Relatia TA clinica -TA ambulatorie
Normal Probability Plot
0.1 1 5 20 50 80 95 99 99.9
percentage
96
116
136
156
176
196 VariablesTAS CAB
TAS DIURNA
Normal Probability Plot
0.1 1 5 20 50 80 95 99 99.9
percentage
64
74
84
94
104
114
124 VariablesTAD DIURNATAD CAB
Andritoiu A, 2006
TAS TAD
![Page 93: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/93.jpg)
Subgrupuri de risc
• WC-HT
• HTG
• PE
• NORM13
35
8 9
0
5
10
15
20
25
30
35
40
NORM WCH HTG PE
Andritoiu A, 2006
![Page 94: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/94.jpg)
Parametrii presionali
TA cabinet @n cele 4 subgrupe
0
20
40
60
80
100
120
140
160
180
NORM WCH HTG PE
subgrup
mm
Hg
TAS cab
TAD cab
TA - 24 ore @n cele 4 subgrupuri
0
20
40
60
80
100
120
140
160
NORM WCH HTG PE
subgrup
mm
Hg
TAS 24 ore
TAD 24 ore
Diferente semnificative statistic s-au observat intre subgrupul PE si subgrupurile NORM si WCH (p <0.001), cit si intre subgrupul PE si subgrupul HTG (p=0.01).
Andritoiu A, 2006
![Page 95: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/95.jpg)
TAM-24 ore
TAM - 24 ore @n cele 4 subgrupuri
0
20
40
60
80
100
120
NORM WCH HTG PE
subgrup
mm
Hg
TAM -24 ore
Diferente s-au inregistrat intre subgrupul PE si subgrupurile NORM si WCH (p<0.001), inclusiv intre PE si HTG (p = 0.004).
Andritoiu A, 2006
![Page 96: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/96.jpg)
TA diurn[ @n cele 4 subgrupuri
0
20
40
60
80
100
120
140
160
NORM WCH HTG PE
subgrup
mm
Hg
TAS diurna
TAD diurna
TA nocturn[ @n cele 4 subgrupuri
0
20
40
60
80
100
120
140
NORM WCH HTG PE
subgrup
mm
Hg
TAS nocturna
TAD nocturna
TA diurna si TA nocturna in cele 4 subgrupuri
Diferente statistice s-au remarcat intre subgrupul PE si NORM, WCH (p<0.001), inclusiv intre PE si HTG (p=0.01).
Diferente statistice s-au remarcat intre subgrupurile PE si NORM si WCH (p<0.001) cit si intre PE si HTG (p =0.01).
Andritoiu A, 2006
![Page 97: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/97.jpg)
WC-HThipertensiunea de halat alb
Parametrii ABPMWCH vs NORM
020406080
100120140160180
TAS
CAB
TAD
CAB
TAS 24
H
TAD 24
H
TAM 24
H
TAS
DIURN
TAD
DIURN
TAS
NOCT
TAD
NOCT
mm
Hg
WCH NORM
AU ACM A OFT
WCH NORM WCH NORM WCH NORM
IP 0.78 0.76 0.88 0.87 1.15 1.18
IR 0.55 0.53 0.58 0.57 0.67 0.66
S/D 2.3 2.2 2.2 2.2 2.8 2.7
76
78
80
82
84
86
88
WCH NORM
bpm
FC - 24 oreWCH vs NORM
Andritoiu A, 2006
![Page 98: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/98.jpg)
HTGhipertensiune gestationala
Parametrii ABPMHTG vs NORM
020406080
100120140160180
TAS
CAB
TAD
CAB
TAS 24
H
TAD 24
H
TAM 24
H
TAS
DIURN
TAD
DIURN
TAS
NOCT
TAD
NOCT
mm
Hg
HTG NORM
0102030405060708090
100
HTG NORM
bpm
FC - 24 oreHTG vs NORM
AU ACM A OFT
HTG NORM HTG NORM HTG NORM
IP 1.11 0.76 0.94 0.87 1.02 1.18
IR 0.63 0.53 0.59 0.57 0.65 0.66
S/D 2.6 2.2 2.4 2.2 2.9 2.7
Andritoiu A, 2006
![Page 99: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/99.jpg)
PE - preeclampsie
Parametrii ABPMPE vs NORM
020406080
100120140160180
TAS
CAB
TAD
CAB
TAS 24
H
TAD 24
H
TAM 24
H
TAS
DIURN
TAD
DIURN
TAS
NOCT
TAD
NOCT
mm
Hg
PE NORM
Distribu\ia valorilor TA @n subgrupul PE
0
20
40
60
80
100
120
140
160
180
1 2 3 4 5 6 7 8 9
nr. paciente
mm
Hg
TAS 24 H
TAD 24 H
0102030405060708090
100
HTG NORM
bpm
FC - 24 orePE vs NORM
AU ACM A OFT
PE NORM PE NORM PE NORM
IP 1.74 0.76 0.83 0.87 1.01 1.18
IR 0.75 0.53 0.58 0.67 0.61 0.66
S/D 3.75 2.2 2.2 2.2 2.5 2.7
Andritoiu A, 2006
![Page 100: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/100.jpg)
Andritoiu A, 2006
![Page 101: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/101.jpg)
NORMNORM
Parametrii presionaliNORM vs REF
0
20
40
60
80
100
120
140
TASCAB
TADCAB
TAS24H
TAD24H
TAM24H
TASDIURN
TADDIURN
TASNOCT
TADNOCT
TAMNOCT
mm
Hg
NORM
REF
FC - 24 oreNORM vs REF
25
35
45
55
65
75
85
95
NORM REF
bp
m
AU ACM A OFT
REF NORM REF NORM REF NORM
IP 0.78 0.76 0.94 0.87 1.24 1.18
IR 0.55 0.53 0.59 0.57 0.72 0.66
S/D 2.3 2.2 2.5 2.2 2.9 2.7
Andritoiu A, 2006
![Page 102: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/102.jpg)
Corelatiile stabilite intre parametrii determinati prin ABPM si PE
in grupul cu risc crescut
Parametru ABPM r = p<
TAS-24 ore 0.68 0.001
TAD-24 ore 0.72 0.001
TAM -24 ore 0.71 0.001
TAS diurna 0.69 0.001
TAD diurna 0.72 0.001
TAS nocturna 0.63 0.001
TAD nocturna 0.70 0.001
FC-24 ore -0.24 NS
Andritoiu A, 2006
![Page 103: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/103.jpg)
TAM-24 ore >100 mmHg
Sb %Sb % 66.66
Sp %Sp % 89.28
VP(+) %VP(+) % 50
VP(-) %VP(-) % 94.33
AC %AC % 86
RRRR 10
Andritoiu A, 2006
![Page 104: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/104.jpg)
PROFILUL CIRCADIAN AL HTA
Corelatia dintre profilul non-dipper si rata aparitiei PE r = 0.71; p<0.001
Sb%Sb% 55.55
Sp%Sp% 96.42
VP(+) %VP(+) % 71.42
VP(-) %VP(-) % 93.1
AC %AC % 90.77
RRRR 10.44
Andritoiu A, 2006
![Page 105: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/105.jpg)
Scorul de risc preeclampticScorul de risc preeclamptic
VariabilaVariabila PunctajPunctaj
ClinicCel pu\in un factor derisc (diabet, primiparitate, varsta =>35 ani, antec. PE sau fat mort)
1 p.
TAD cabinet =>100 mmHg 1p
DopplerIR-a uterina >0.6 1p.
S/D a. uterina >2.4 1p.
Notch grad 1, 2, 3, 1p, 2p, 3p.
Notch bilateral x 2 p.
Notch absent 0p.
IR <0.5 aa. cerebrale materne 1 p.
ABPMTAM-24 ore >100 mmHg 1
TAD nocturna > 75 mmHg 1
Profil non-dipper 1
Scor maxim de risc 14
Andritoiu A, 2006
![Page 106: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/106.jpg)
1.61 1.17
4.87
11.55
0
2
4
6
8
10
12
puncte
NORM WCH HTG PE
SCOR DE RISC PREECLAMPTIC
Plot of Fitted Model
PE = -0.0938699 + 0.0736661*SCOR
0 3 6 9 12 15SCOR
0
0.2
0.4
0.6
0.8
1
PE
Andritoiu A, 2006
![Page 107: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/107.jpg)
CRONOFARMACOLOGIA HIPERTENSIUNII ARTERIALE
![Page 108: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/108.jpg)
Ceasul biologic - master clockCeasul biologic - master clock
• Complex de gene• Arie speciala in
cortex• Nc. suprachiasmatic• Locus ceruleus
Rolul SN autonom - baroreflexe Melatonina-mesager endogen
![Page 109: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/109.jpg)
The cardiovascular system is highly organised in time Lemmer B. - Pharmacol Ther 2006
• TA
• FC
• RVP
• DC
• Hh vasoactivi
CA, SRAA, Et-1, AMPc
![Page 110: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/110.jpg)
DefinitiiDefinitii
• Chronobiologia –stiinta preocupata de mecanismele biologice ale bolilor in relatie cu o structura temporala;
• Chronoterapia (cronofarmacologia): disciplina ce studiaza efectul farmacologic al medicamentelor in relatie cu comportamnetul bolii pe o anume perioada de timp.
• Cronofarmacokinetica• Cronofarmacodinamia
![Page 111: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/111.jpg)
Cronofarmacokinetica• Absorbtia• Distributia• Secretiile gastro-dd• Golirea gastrica • Metabolizarea• Eliminarea renala
Cronofarmacodinamie • Efecte diferite pe
intervalul 24 ore• Momentul
administrarii poate modifica rap. doza/concentratie
Cronotoxicitate
![Page 112: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/112.jpg)
Cronoterapia Cronoterapia hipertensiunii arterialehipertensiunii arteriale
![Page 113: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/113.jpg)
ConcepteConcepte
Homeostazic• Mediul intern ramine
constant Cronobiologic• Variatii (cicluri)
circadieneCum tratam ?
Cand tratam ?
![Page 114: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/114.jpg)
Obiectivele cronoterapiei in HTAObiectivele cronoterapiei in HTA
concentratii mai mari atunci cind este mai multa nevoie (e.x: perioada post-trezire) si mai mici cind nevoile sunt mai reduse (e.g., in intervalul de somn nocturn)
• Normalizarea valorilor TA pe intreg intervalul circadian• Reducerea riscului cardio-vascular• Imbunatatirea/normalizarea profilului circadian al TA (dipper)
Morning versus evening dosing of a once-daily agent !
![Page 115: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/115.jpg)
StudiiStudii
ACE inhibitors• quinapril, enalapril, benazepril, perindopril
BRA• valsartan
Beta-blockers • Atenolol, propranolol MR
Calcium channel blockers • nifedipine-GITS • amlodipine• isradipine• nitrendipine• ditizem• verapamil COER
Morning vs evening dosing
Depinde de formularea farmaceuticaInstant vs ER
![Page 116: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/116.jpg)
• circadian patterns were generally unchanged when comparing morning vs evening administration of a variety of antihypertensive agents
• nocturnal medication dosing generally reduced asleep BP more than morning dosing
Lemmer B. Blood Press Monit 1999;1:161-169.
The impact of dosing time on the response to
antihypertensive therapy
![Page 117: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/117.jpg)
Morning vs Evening dosingMorning vs Evening dosing
![Page 118: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/118.jpg)
Control TA diurn vs. nocturnControl TA diurn vs. nocturn
Prestance (5/5)Prestance (5/5) Non-control
![Page 119: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/119.jpg)
Non-control TA nocturnaNon-control TA nocturna
IECA Non-control
![Page 120: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/120.jpg)
Ce ne rezerva viitorul ....
trialuri clinice comparative ptr. a evalua efectele antihipertensivelor homeostatice vs cronoterapeutice pe end-pointurile clinice ( imbunatatirea controlului TA, QOL, ischemiei miocardice si performantelor miocardice)
![Page 121: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/121.jpg)
![Page 122: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/122.jpg)
PresedintePresedinteConf. Horia Balan
![Page 123: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/123.jpg)
ABPM ACCURACY (1381 readings)
83%
17%
Andritoiu A , 2003
![Page 124: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/124.jpg)
Studii personale
1. Andritoiu A si colab. Monitorizarea automata pe 24 h a tensiunii arteriale. Studiu pe 20 pacienti tineri hipertensivi comparativ cu normalul. Al 37 Cong Nat Cardiol, 1998, Sinaia
2. Andritoiu A si colab. Parametrii de presiune arteriala evaluati prin computerizare automata 24h la un grup de pacienti cu hipertensiune arteriala. Al 37-lea Cong Nat Cardiol 1998, Sinaia
3. Andritoiu A si colab. Monitorizarea automata 24h a tensiunii arteriale (ABPM). A 3-a Conf Nat Semiol Med 1998, Craiova
4. Andritoiu A. Semnificatia diagnostica si prognostica a monitorizarii ambulatorii a tensiunii arteriale. Infomedica 1999;8:2-9.
5. Andritoiu A. Semnificatia parametrului BP load in evaluarea severitatii hipertensiunii. Al 38-lea Cong Nat Cardiol 1999, Sinaia
6. Andritoiu A si colab. The significance of high blood pressure in cardiovascular pathology of young adults. The 4th Cong BMMC 1999, Bucuresti
7. Andritoiu A. Monitorizarea ambulatorie a tensiunii arteriale-aplicabilitate diagnostica si prognostica. Rev Med Mil 1999;1107-126.
8. Andritoiu A. Hipertensiunea de halat alb - intre normal si patologic. Infomedica 2001;10:12-16.
9. Andritoiu A. Complianta terapeutica in managementul hipertensiunii arteriale. Rev Med Mil 2001;2:195-206.
10. Andritoiu A. Parametrii monitorizarii tensionale la trezire si afectarea organelor tinta in HTA. Al 41-lea Cong Nat Cardiol 2002, Sinaia
11. Andritoiu A. Monitorizarea ambulatorie a TA – relatia cu afectarea organelor tinta in HTA. Al 41-lea Cong Nat Cardiol 2002, Sinaia
12. Raca N, Gheorman V, Andritoiu A. Parametrii ABPM in sarcina normala. Al 2-lea Cong Nat Obst-Ginecologie, 2002, Bucuresti
![Page 125: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/125.jpg)
![Page 126: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/126.jpg)
2004
![Page 127: ABPM-AMBULATORY BP MONITORING](https://reader036.vdocuments.us/reader036/viewer/2022081508/556272e7d8b42a0d398b4796/html5/thumbnails/127.jpg)