Screening and Monitoring for Arterial Hypertension: Putting the Patient at the Center of Care.

Why should you care about high blood pressure (HTA)? ?

has been proven. decrease in blood pressure lead to hypertensive patients :

  • a Risk reduction:
    • cerebrovascular accident;
    • dementia;
    • heart failure;
    • myocardial infarction;
    • cardiovascular death;
  • Delays end-stage chronic renal failure.

But today Management of high blood pressure is suboptimal in France, 20 % Patience Known hypertension is untreated.

further See note sheet Management of arterial hypertension in adults » Developed by the Higher Medical Service (HAS) and the French Society of Hypertension (SFHTA).

The level of knowledge and understanding of hypertensive disease remains fairly low. This is an obstacle to therapeutic adherence and management of hypertension (1,2).

in France, prevention, sieving and the Supported that is Mainly performed by general practitionerswhich corresponds to the current recommendation.

general practitioner : Essential Actor

General practitioners are key players in care hypertensive, he measures regularly to measure a patient’s blood pressure :

  • Early detection of the onset of hypertension ;
  • Monitor changes in blood pressure values ​​in hypertensive patients.

Improving early detection and monitoring of hypertension to extend life expectancy

A sphygmomanometer is preferred when measuring a patient’s blood pressure (BP) in the clinic. electronic sphygmomanometer in a verified arm repeated measurements During consultation (at least two consecutive measurements). It is recommended that this measurement be repeated in consultation. diagnose and the continued of high blood pressure.

Other than that :

  • cuff is Fits around your wrist.LPA should be measured During the first visit to both arms after that Arm with highest measurement ;
  • Measurements should be performed on the patient sitting or lyingrest for at least 3-5 minutes. in the calm and silent ;
  • During initial measurement and follow-up: a Orthostatic hypotension Desired 1 minute and 3 minutes later at least Standing position (Mainly diabetic patients, patients with Parkinson’s disease or the elderly) element of Cardiovascular disease morbidity and mortality And of autumnseconds.

To be careful : timeOrthostatic hypotension is Systolic blood pressure (PAS) is at least 20 mmHg and/or Systolic blood pressure (PAD) is at least 10 mmHg occurring within 3 minutes of standing.

Self blood pressure measurement to confirm diagnosis and ensure follow-up outside the clinic

Self-monitoring of blood pressure (AMT) performed outside the healthcare facility and at the patient’s home enables:

  • Confirmation of the diagnosis of hypertension ;
  • Monitor hypertensive disease progression.

outside the clinic, Check for high blood pressure By AMT or Ambulatory Blood Pressure Measurement (MAPA) – Systolic blood pressure (SBP) ≥ 135 mm Hg or diastolic blood pressure (PAD) ≥ 85 mm Hg.

Mapa provides additional information in certain situations (Investigation of blood pressure fluctuation Suspected significant, nocturnal hypotension or autonomic imbalance, etc.),AMT promotes engagement in patient care.

Physicians are aware of some restrictions (atrial fibrillation, pregnant women, excessive anxiety, children).

why Self-measurement in addition to clinic measurements?

AMT is a way to involve patients in the overall management of their disease, improve blood pressure control, and potentially improve treatment compliance.

Advantages of self-measurement:

  • Reduced variability : Clinic readings are highly variable (physiological blood pressure fluctuations) ;
  • Eliminate errors May result from measuring equipment used in the clinic or lack of rest required for proper latching ;
  • detection of “ high blood pressure ” Also “ masked hypertension (see box below) ;
  • A better predictor of cardiovascular morbidity and mortality than clinic measurements.

high blood pressure white coat vs masked hypertension

“HTA lab coat” : Hypertension noted on examination associated with normal blood pressure out of clinic. It is responsible for approximately one-third of hypertensive diagnoses and in nonhypertensive patients (those at high risk of developing persistent hypertension during follow-up but not at high risk of developing complications of hypertension). It has caused the initiation of useless drug treatment. monitoring without treatment) as well as overtreatment of known hypertension.

“Masked hypertension” : Normal blood pressure in the clinic, abnormal outside the clinic, of unknown cause. related to 15 Percentage of patients still undiagnosed in the clinic and 30 Therefore, the proportion of treated hypertensive patients is not well controlled. The incidence of masked hypertension increases with age and is seen more frequently in patients with cardiovascular risk factors who are subject to increased cardiovascular risk.

Which patient?

Education must take place with patients and their entourage.

initial diagnosis

It should be placed before starting treatment. Confirm the diagnosis (“Hypertension detected” white blouse suspicion of “,” Masked HTA ”) except in hypertensive emergencies.

Monitoring hypertension during treatment

people followed for high blood pressure Patients should be able to benefit from AMT to enhance their adherence to treatment.

How ?

interest is to make Repetition measures blood pressure, normal living conditions. We recommend using Sphygmomanometer with upper arm cuffwrist sphygmomanometers are subject to more user error.

Blood pressure self-monitoring conditions

  • Rest for about 5 minutes before starting.
  • put the device on the table.
  • Do not talk or move during the measurement.
  • Always select the same arm to perform measurements.
  • Follow rule 3.
    • 3 measures in the morning (before breakfast and taking medicine);
    • 3 measurements at 1-2 minute intervals in the evening.
    • 3 consecutive days (usually before medical consultation).
  • Adopt the correct position: Sit, forearms on the table, elbows bent, armbands at heart level.
  • Record results in self-monitoring: systolic blood pressure, heart rate.

The Important Role of General Practitioners

general practitioner is :

  • Training in AMT practice ;
  • Promote and educate AMT patients re-evaluate Where To adapt Antihypertensive therapy (avoid unnecessary initiation or intensification of therapy and therapy inertia).

Please refer to the memo sheet “Blood pressure measurement outside the clinic” (PDF) for daily medical care.

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