Hypertension artérielle et diabète...Hypertension artérielle et diabète Plan I.- Qu’est-ce que...
47
Hypertension artérielle et diabète Plan I.- Qu’est-ce que la pression artérielle ? a) ne pas confondre avec la tension nerveuse b) Pression artérielle systolique et diastolique c) Définition de l’hypertension artérielle II.- Fréquence de l’hypertension artérielle III.- L’hypertension artérielle: -maladie ? -Facteur de risque cardio-vasculaire? IV.- Causes: a) Hypertension artérielle primaire b) Hypertension artérielle secondaire V.- Hypertension et diabète: un mauvais couple! VI.- Quelques éléments de traitement a) non médicamenteux b) médicamenteux
Transcript of Hypertension artérielle et diabète...Hypertension artérielle et diabète Plan I.- Qu’est-ce que...
Hypertension artérielle et diabète
Plan
I.- Qu’est-ce que la pression artérielle ? a) ne pas confondre avec la tension nerveuse b) Pression artérielle systolique et diastolique c) Définition de l’hypertension artérielle II.- Fréquence de l’hypertension artérielle III.- L’hypertension artérielle: -maladie ? -Facteur de risque cardio-vasculaire? IV.- Causes: a) Hypertension artérielle primaire b) Hypertension artérielle secondaire V.- Hypertension et diabète: un mauvais couple! VI.- Quelques éléments de traitement a) non médicamenteux b) médicamenteux
Présentateur
Commentaires de présentation
UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. Br Med J 1998a;317:703-713. UK Prospective Diabetes Study Group. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. Br Med J 1998b;317:713-720. UK Prospective Diabetes Study Group. Study design, progress and performance. Diabetologia 1991;34:877-890. United States Renal Data System, USRDS 1999 Annual Data Report. National Institutes of Health, National Institutes of Diabetes and Digestive and Kidney Diseases. Bethesda, MD, April, 1999. U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention (CDC), National Center For Health Statistics. (Vital and health statistics, plan and operation of the third national health and nutrition and examination survey, 1988-1994). DHHS publication no. (PHS) 94-1308, series 1, No. 324-0485. Valentino VA, Wilson MD, Weart W, Bakris GL. A perspective on converting enzyme inhibitors �and calcium channel antagonists in diabetic renal disease. Arch Intern Med 1991;151:2367-2372. Velussi M, Brocco E, Frigato F, et al. Effects of cilazapril and amlodipine on kidney function in hypertensive NIDDM patients. Diabetes 1996;45:216-222. Waldherr R, Ilkenhans C, Ritz E. How frequent is glomerulonephritis in diabetes mellitus type II? Clin Neph 1992;37:271-273. Wang S-L, Head J, Stevens L, et al. Excess mortality and its relation to hypertension and proteinuria in diabetic patients. Diabetes Care 1996;19:305-311. Weidmann P, Schneider M, Bohlen L. Therapeutic efficacy of different antihypertensive drugs in human diabetic nephropathy: An updated meta-analysis. Nephrol Dial Transplant 1995;10�(suppl 9):39-45. World Health Organization. The World Health Report 1997: Conquering Suffering, Enriching Humanity. Geneva, Switzerland. 1997. Zanchetti A, Agabiti-Rosei E, Dal Palu C, et al. The verapamil in hypertension and atherosclerosis study (VHAS): results of long-term randomized treatment with either verapamil or chlorthalidone on carotid intima-media thickness. J Hypertens 1998;16:1667-1676. Zatz R, Dunn BR, Meyer TW, et al. Prevention of diabetic glomuerulopathy by pharmacological amelioration of glomerular capillary hypertension. J Clin Invest 1986;77:1925-1930.
Hypertension artérielle et diabète
Plan
I.- Qu’est-ce que la pression artérielle ? a) ne pas confondre avec la tension nerveuse b) Pression artérielle systolique et diastolique c) Définition de l’hypertension artérielle II.- Fréquence de l’hypertension artérielle III.- L’hypertension artérielle: -maladie ? -Facteur de risque cardio-vasculaire? IV.- Causes: a) Hypertension artérielle primaire b) Hypertension artérielle secondaire V.- Hypertension et diabète: un mauvais couple! VI.- Quelques éléments de traitement a) non médicamenteux b) médicamenteux
Présentateur
Commentaires de présentation
UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. Br Med J 1998a;317:703-713. UK Prospective Diabetes Study Group. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. Br Med J 1998b;317:713-720. UK Prospective Diabetes Study Group. Study design, progress and performance. Diabetologia 1991;34:877-890. United States Renal Data System, USRDS 1999 Annual Data Report. National Institutes of Health, National Institutes of Diabetes and Digestive and Kidney Diseases. Bethesda, MD, April, 1999. U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention (CDC), National Center For Health Statistics. (Vital and health statistics, plan and operation of the third national health and nutrition and examination survey, 1988-1994). DHHS publication no. (PHS) 94-1308, series 1, No. 324-0485. Valentino VA, Wilson MD, Weart W, Bakris GL. A perspective on converting enzyme inhibitors �and calcium channel antagonists in diabetic renal disease. Arch Intern Med 1991;151:2367-2372. Velussi M, Brocco E, Frigato F, et al. Effects of cilazapril and amlodipine on kidney function in hypertensive NIDDM patients. Diabetes 1996;45:216-222. Waldherr R, Ilkenhans C, Ritz E. How frequent is glomerulonephritis in diabetes mellitus type II? Clin Neph 1992;37:271-273. Wang S-L, Head J, Stevens L, et al. Excess mortality and its relation to hypertension and proteinuria in diabetic patients. Diabetes Care 1996;19:305-311. Weidmann P, Schneider M, Bohlen L. Therapeutic efficacy of different antihypertensive drugs in human diabetic nephropathy: An updated meta-analysis. Nephrol Dial Transplant 1995;10�(suppl 9):39-45. World Health Organization. The World Health Report 1997: Conquering Suffering, Enriching Humanity. Geneva, Switzerland. 1997. Zanchetti A, Agabiti-Rosei E, Dal Palu C, et al. The verapamil in hypertension and atherosclerosis study (VHAS): results of long-term randomized treatment with either verapamil or chlorthalidone on carotid intima-media thickness. J Hypertens 1998;16:1667-1676. Zatz R, Dunn BR, Meyer TW, et al. Prevention of diabetic glomuerulopathy by pharmacological amelioration of glomerular capillary hypertension. J Clin Invest 1986;77:1925-1930.
Hypertension artérielle et diabète
Le cœur à chaque contraction éjecte de 70 à 100 ml de sang dans les vaisseaux sanguins. Ainsi, à chaque contraction, on obtient un pic de pression dans le lit vasculaire qui va lentement se vider jusqu’à la contraction suivante. La pression dans les vaisseaux : au moment du pic est appelée pression artérielle systolique au moment où elle est la plus basse: pression artérielle diastolique
Qu’est-ce que la pression artérielle ?
Présentateur
Commentaires de présentation
UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. Br Med J 1998a;317:703-713. UK Prospective Diabetes Study Group. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. Br Med J 1998b;317:713-720. UK Prospective Diabetes Study Group. Study design, progress and performance. Diabetologia 1991;34:877-890. United States Renal Data System, USRDS 1999 Annual Data Report. National Institutes of Health, National Institutes of Diabetes and Digestive and Kidney Diseases. Bethesda, MD, April, 1999. U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention (CDC), National Center For Health Statistics. (Vital and health statistics, plan and operation of the third national health and nutrition and examination survey, 1988-1994). DHHS publication no. (PHS) 94-1308, series 1, No. 324-0485. Valentino VA, Wilson MD, Weart W, Bakris GL. A perspective on converting enzyme inhibitors �and calcium channel antagonists in diabetic renal disease. Arch Intern Med 1991;151:2367-2372. Velussi M, Brocco E, Frigato F, et al. Effects of cilazapril and amlodipine on kidney function in hypertensive NIDDM patients. Diabetes 1996;45:216-222. Waldherr R, Ilkenhans C, Ritz E. How frequent is glomerulonephritis in diabetes mellitus type II? Clin Neph 1992;37:271-273. Wang S-L, Head J, Stevens L, et al. Excess mortality and its relation to hypertension and proteinuria in diabetic patients. Diabetes Care 1996;19:305-311. Weidmann P, Schneider M, Bohlen L. Therapeutic efficacy of different antihypertensive drugs in human diabetic nephropathy: An updated meta-analysis. Nephrol Dial Transplant 1995;10�(suppl 9):39-45. World Health Organization. The World Health Report 1997: Conquering Suffering, Enriching Humanity. Geneva, Switzerland. 1997. Zanchetti A, Agabiti-Rosei E, Dal Palu C, et al. The verapamil in hypertension and atherosclerosis study (VHAS): results of long-term randomized treatment with either verapamil or chlorthalidone on carotid intima-media thickness. J Hypertens 1998;16:1667-1676. Zatz R, Dunn BR, Meyer TW, et al. Prevention of diabetic glomuerulopathy by pharmacological amelioration of glomerular capillary hypertension. J Clin Invest 1986;77:1925-1930.
Présentateur
Commentaires de présentation
Perico N, Remuzzi A, Sangalli F, et al. The antiproteinuric effect of angiotensin antagonism in human IgA nephropathy is potentiated by indomethacin. J Am Soc Nephrol 1998;9:2308-2317. Pinel N, Fadel B, Bilous RW, et al. Renal biopsies in 30 micro and macroalbuminuric type 2 patients. Heterogeneity of renal lesions. Diabetologia 1995;38(suppl 1):A217. Pitt B, Byington RP, Furberg CD, et al. Effect of amlodipine on the progression of atherosclerosis and the occurrence of clinical events. Circulation 2000;102:1503-1510. Pohl M, Cooper M, Ulrey J, et al. Safety and efficacy of irbesartan in hypertensive patients with type II diabetes and proteinuria. Am J Hypertens 1997;10:105A. Abstract. Pugh JA, Medina R, Ramirez, M. Comparison of the course to end-stage renal disease of type 1 (insulin-dependent) and type 2 (non-insulin-dependent) diabetic nephropathy. Diabetologia 1993;36:1094-1098. Raine AEG, Bilous RW. End-stage renal disease in NIDDM: a consequence of microangiopathy alone? Diabetologia 1996;39:1673-1675. Raine AEG. Epidemiology, development and treatment of of end-stage renal failure in type 2 (non-insulin dependent) diabetic patients in Europe. Diabetologia 1993;36:1099-1104. Ravid M, Savin H, Jutrin I, et al. Long-term stabilizing effect of angiotensin-converting enzyme inhibition on plasma creatinine and on proteinuria in normotensive type II diabetic patients. Ann Intern Med 1993;118:577-581. Reeves RA, Lin C-S, Kassler-Taub K, Pouleur H. Dose-related efficacy of irbesartan for hypertension: an integrated analysis. Hypertension 1998;31:1311-1316. Ribstein J, Picard A, Armagnac C, et al. Inhibition of the acute effects of angiotensin II by the receptor antagonist irbesartan in normotensive men. J Cardiovasc Pharmacol 2001;37:449-460. Ritz E, Stefanski A. Diabetic nephropathy in type II diabetes. Am J Kid Dis 1996;27:167-194. Rossing P, Hommel E, Smidt UM, et al. Reduction in albuminuria predicts diminished progresion in diabetic nephropathy. Kidney Int 1994;45(suppl.):S145-S149. Ruggenenti P, Gambara V, Perna A, et al. The nephropathy of non-insulin-dependent diabetes: predictors of outcome relative to diverse patterns of renal injury. J Am Soc Nephrol 1998;9:2336-2343. Savage S, Niegel NJ, Estacio RO, et al. Clinical factors associated with urinary albumin excretion in type II diabetes. Am J Kid Dis 1995;25:836-844. Schmitz A, Vaeth M. Microalbuminuria: a major risk factor in non-insulin-dependent diabetes. A 10-year follow-up study of 503 patients. Diabet Med 1988;5:126-134. Schwartz MM, Lewis EJ, Leonard-Martin T, et al. Renal pathology patterns in type II diabetes mellitus: Relationship with retinopathy. Nephrol Dial Transpl 1998;13:2547-2552. Simon TA, Gelarden T, Freitag SA, et al. Safety of irbesartan in the treatment of mild to moderate systemic hypertension. Am J Cardiol 1998;82:179-182. Staessen JA, Fagard R, Thijs L, et al. Randomized double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. Lancet 1997;350:757-764. Stamler J, Vaccaro O, Neaton JD, et al. Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in multiple risk factor intervention trial. Diabetes Care 1993;16:434-444. Stone PH, Muller JE, Hartwell T, et al. The effect of diabetes mellitus on pronosis and serial left ventricular function after acute myocardial infarction: contribution of both coronary disease and diastolic left ventricular dysfunction to the adverse prognosis. The MILIS Study Group. J Am Cardiol 1989;14:49-57. Suzuki Y, Ueno M, Hayashi H, et al. A light microscopic study of glomerulosclerosis in Japanese patients with non-insulin-dependent diabetes mellitus: the relationship between clinical and histological features. Clin Nephrol 1994;42:155-162. Tarnow L, Rossing P, Gall M-A, et al. Prevalence of arterial hypertension in diabetic patients before and after the JNC-V. Diabet Care 1994;17:1247-51. Teo KK, Burton JR, Buller CE, et al. Long-term effects of cholesterol lowering and angiotensin -converting enzyme inhibition on coronary atherosclerosis. The simvastatin/enalapril coronary atherosclerosis trial (SCAT). Circulation 2000;102:1748-1754. Tuomilehto J, Rastenyte D, Birkenhäger WH, et al. Effects of calcium-channel blockade in older patients with diabetes and systolic hypertension. N Engl J Med 1999;340:677-84.
Hypertension artérielle et diabète
Plan
I.- Qu’est-ce que la pression artérielle ? a) ne pas confondre avec la tension nerveuse b) Pression artérielle systolique et diastolique c) Définition de l’hypertension artérielle II.- Fréquence de l’hypertension artérielle III.- L’hypertension artérielle: -maladie ? -Facteur de risque cardio-vasculaire? IV.- Causes: a) Hypertension artérielle primaire b) Hypertension artérielle secondaire V.- Hypertension et diabète: un mauvais couple! VI.- Quelques éléments de traitement a) non médicamenteux b) médicamenteux
Présentateur
Commentaires de présentation
UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. Br Med J 1998a;317:703-713. UK Prospective Diabetes Study Group. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. Br Med J 1998b;317:713-720. UK Prospective Diabetes Study Group. Study design, progress and performance. Diabetologia 1991;34:877-890. United States Renal Data System, USRDS 1999 Annual Data Report. National Institutes of Health, National Institutes of Diabetes and Digestive and Kidney Diseases. Bethesda, MD, April, 1999. U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention (CDC), National Center For Health Statistics. (Vital and health statistics, plan and operation of the third national health and nutrition and examination survey, 1988-1994). DHHS publication no. (PHS) 94-1308, series 1, No. 324-0485. Valentino VA, Wilson MD, Weart W, Bakris GL. A perspective on converting enzyme inhibitors �and calcium channel antagonists in diabetic renal disease. Arch Intern Med 1991;151:2367-2372. Velussi M, Brocco E, Frigato F, et al. Effects of cilazapril and amlodipine on kidney function in hypertensive NIDDM patients. Diabetes 1996;45:216-222. Waldherr R, Ilkenhans C, Ritz E. How frequent is glomerulonephritis in diabetes mellitus type II? Clin Neph 1992;37:271-273. Wang S-L, Head J, Stevens L, et al. Excess mortality and its relation to hypertension and proteinuria in diabetic patients. Diabetes Care 1996;19:305-311. Weidmann P, Schneider M, Bohlen L. Therapeutic efficacy of different antihypertensive drugs in human diabetic nephropathy: An updated meta-analysis. Nephrol Dial Transplant 1995;10�(suppl 9):39-45. World Health Organization. The World Health Report 1997: Conquering Suffering, Enriching Humanity. Geneva, Switzerland. 1997. Zanchetti A, Agabiti-Rosei E, Dal Palu C, et al. The verapamil in hypertension and atherosclerosis study (VHAS): results of long-term randomized treatment with either verapamil or chlorthalidone on carotid intima-media thickness. J Hypertens 1998;16:1667-1676. Zatz R, Dunn BR, Meyer TW, et al. Prevention of diabetic glomuerulopathy by pharmacological amelioration of glomerular capillary hypertension. J Clin Invest 1986;77:1925-1930.
Hypertension artérielle et diabète
Qu’est-ce que l’hypertension artérielle ?
Présentateur
Commentaires de présentation
UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. Br Med J 1998a;317:703-713. UK Prospective Diabetes Study Group. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. Br Med J 1998b;317:713-720. UK Prospective Diabetes Study Group. Study design, progress and performance. Diabetologia 1991;34:877-890. United States Renal Data System, USRDS 1999 Annual Data Report. National Institutes of Health, National Institutes of Diabetes and Digestive and Kidney Diseases. Bethesda, MD, April, 1999. U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention (CDC), National Center For Health Statistics. (Vital and health statistics, plan and operation of the third national health and nutrition and examination survey, 1988-1994). DHHS publication no. (PHS) 94-1308, series 1, No. 324-0485. Valentino VA, Wilson MD, Weart W, Bakris GL. A perspective on converting enzyme inhibitors �and calcium channel antagonists in diabetic renal disease. Arch Intern Med 1991;151:2367-2372. Velussi M, Brocco E, Frigato F, et al. Effects of cilazapril and amlodipine on kidney function in hypertensive NIDDM patients. Diabetes 1996;45:216-222. Waldherr R, Ilkenhans C, Ritz E. How frequent is glomerulonephritis in diabetes mellitus type II? Clin Neph 1992;37:271-273. Wang S-L, Head J, Stevens L, et al. Excess mortality and its relation to hypertension and proteinuria in diabetic patients. Diabetes Care 1996;19:305-311. Weidmann P, Schneider M, Bohlen L. Therapeutic efficacy of different antihypertensive drugs in human diabetic nephropathy: An updated meta-analysis. Nephrol Dial Transplant 1995;10�(suppl 9):39-45. World Health Organization. The World Health Report 1997: Conquering Suffering, Enriching Humanity. Geneva, Switzerland. 1997. Zanchetti A, Agabiti-Rosei E, Dal Palu C, et al. The verapamil in hypertension and atherosclerosis study (VHAS): results of long-term randomized treatment with either verapamil or chlorthalidone on carotid intima-media thickness. J Hypertens 1998;16:1667-1676. Zatz R, Dunn BR, Meyer TW, et al. Prevention of diabetic glomuerulopathy by pharmacological amelioration of glomerular capillary hypertension. J Clin Invest 1986;77:1925-1930.
Présentateur
Commentaires de présentation
Perico N, Remuzzi A, Sangalli F, et al. The antiproteinuric effect of angiotensin antagonism in human IgA nephropathy is potentiated by indomethacin. J Am Soc Nephrol 1998;9:2308-2317. Pinel N, Fadel B, Bilous RW, et al. Renal biopsies in 30 micro and macroalbuminuric type 2 patients. Heterogeneity of renal lesions. Diabetologia 1995;38(suppl 1):A217. Pitt B, Byington RP, Furberg CD, et al. Effect of amlodipine on the progression of atherosclerosis and the occurrence of clinical events. Circulation 2000;102:1503-1510. Pohl M, Cooper M, Ulrey J, et al. Safety and efficacy of irbesartan in hypertensive patients with type II diabetes and proteinuria. Am J Hypertens 1997;10:105A. Abstract. Pugh JA, Medina R, Ramirez, M. Comparison of the course to end-stage renal disease of type 1 (insulin-dependent) and type 2 (non-insulin-dependent) diabetic nephropathy. Diabetologia 1993;36:1094-1098. Raine AEG, Bilous RW. End-stage renal disease in NIDDM: a consequence of microangiopathy alone? Diabetologia 1996;39:1673-1675. Raine AEG. Epidemiology, development and treatment of of end-stage renal failure in type 2 (non-insulin dependent) diabetic patients in Europe. Diabetologia 1993;36:1099-1104. Ravid M, Savin H, Jutrin I, et al. Long-term stabilizing effect of angiotensin-converting enzyme inhibition on plasma creatinine and on proteinuria in normotensive type II diabetic patients. Ann Intern Med 1993;118:577-581. Reeves RA, Lin C-S, Kassler-Taub K, Pouleur H. Dose-related efficacy of irbesartan for hypertension: an integrated analysis. Hypertension 1998;31:1311-1316. Ribstein J, Picard A, Armagnac C, et al. Inhibition of the acute effects of angiotensin II by the receptor antagonist irbesartan in normotensive men. J Cardiovasc Pharmacol 2001;37:449-460. Ritz E, Stefanski A. Diabetic nephropathy in type II diabetes. Am J Kid Dis 1996;27:167-194. Rossing P, Hommel E, Smidt UM, et al. Reduction in albuminuria predicts diminished progresion in diabetic nephropathy. Kidney Int 1994;45(suppl.):S145-S149. Ruggenenti P, Gambara V, Perna A, et al. The nephropathy of non-insulin-dependent diabetes: predictors of outcome relative to diverse patterns of renal injury. J Am Soc Nephrol 1998;9:2336-2343. Savage S, Niegel NJ, Estacio RO, et al. Clinical factors associated with urinary albumin excretion in type II diabetes. Am J Kid Dis 1995;25:836-844. Schmitz A, Vaeth M. Microalbuminuria: a major risk factor in non-insulin-dependent diabetes. A 10-year follow-up study of 503 patients. Diabet Med 1988;5:126-134. Schwartz MM, Lewis EJ, Leonard-Martin T, et al. Renal pathology patterns in type II diabetes mellitus: Relationship with retinopathy. Nephrol Dial Transpl 1998;13:2547-2552. Simon TA, Gelarden T, Freitag SA, et al. Safety of irbesartan in the treatment of mild to moderate systemic hypertension. Am J Cardiol 1998;82:179-182. Staessen JA, Fagard R, Thijs L, et al. Randomized double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. Lancet 1997;350:757-764. Stamler J, Vaccaro O, Neaton JD, et al. Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in multiple risk factor intervention trial. Diabetes Care 1993;16:434-444. Stone PH, Muller JE, Hartwell T, et al. The effect of diabetes mellitus on pronosis and serial left ventricular function after acute myocardial infarction: contribution of both coronary disease and diastolic left ventricular dysfunction to the adverse prognosis. The MILIS Study Group. J Am Cardiol 1989;14:49-57. Suzuki Y, Ueno M, Hayashi H, et al. A light microscopic study of glomerulosclerosis in Japanese patients with non-insulin-dependent diabetes mellitus: the relationship between clinical and histological features. Clin Nephrol 1994;42:155-162. Tarnow L, Rossing P, Gall M-A, et al. Prevalence of arterial hypertension in diabetic patients before and after the JNC-V. Diabet Care 1994;17:1247-51. Teo KK, Burton JR, Buller CE, et al. Long-term effects of cholesterol lowering and angiotensin -converting enzyme inhibition on coronary atherosclerosis. The simvastatin/enalapril coronary atherosclerosis trial (SCAT). Circulation 2000;102:1748-1754. Tuomilehto J, Rastenyte D, Birkenhäger WH, et al. Effects of calcium-channel blockade in older patients with diabetes and systolic hypertension. N Engl J Med 1999;340:677-84.
Risque absolu = risque de base x R. relatif 1 x R. relatif 2 x …
90 80 70 60 50 40 30 20 10 0
PAD > 90 mmHg
Cholestérol > 6.4 mmol/l
Fumeurs Risque de base
RR=1.4 ER=8
RR=1.4 ER=24
RR=1.3 ER=20
RR=2.0 ER=33
D'après la Multiple Risk Factor Intervention Trial
Taux
de
mor
talit
é à
6 an
s en
o/o
o
Traitement bénéfique
Traitement néfaste
= effets secondaires du traitement
Taux de complications cardio- vasculaires
Bénéfice à traiter en fonction du niveau de la pression artérielle
A
A
A = baisse de la pression artérielle
Pression artérielle
Hommes 55 ans High risk = fumeur, intolérance au glucose, hypercholestérolémie >8 mmol/l HVG
Alderman MH. Blood pressure management: individualized treatment based on absolute risk and the potential for benefit. Ann Intern Med 1993; 119: 329-335.
Présentateur
Commentaires de présentation
Perico N, Remuzzi A, Sangalli F, et al. The antiproteinuric effect of angiotensin antagonism in human IgA nephropathy is potentiated by indomethacin. J Am Soc Nephrol 1998;9:2308-2317. Pinel N, Fadel B, Bilous RW, et al. Renal biopsies in 30 micro and macroalbuminuric type 2 patients. Heterogeneity of renal lesions. Diabetologia 1995;38(suppl 1):A217. Pitt B, Byington RP, Furberg CD, et al. Effect of amlodipine on the progression of atherosclerosis and the occurrence of clinical events. Circulation 2000;102:1503-1510. Pohl M, Cooper M, Ulrey J, et al. Safety and efficacy of irbesartan in hypertensive patients with type II diabetes and proteinuria. Am J Hypertens 1997;10:105A. Abstract. Pugh JA, Medina R, Ramirez, M. Comparison of the course to end-stage renal disease of type 1 (insulin-dependent) and type 2 (non-insulin-dependent) diabetic nephropathy. Diabetologia 1993;36:1094-1098. Raine AEG, Bilous RW. End-stage renal disease in NIDDM: a consequence of microangiopathy alone? Diabetologia 1996;39:1673-1675. Raine AEG. Epidemiology, development and treatment of of end-stage renal failure in type 2 (non-insulin dependent) diabetic patients in Europe. Diabetologia 1993;36:1099-1104. Ravid M, Savin H, Jutrin I, et al. Long-term stabilizing effect of angiotensin-converting enzyme inhibition on plasma creatinine and on proteinuria in normotensive type II diabetic patients. Ann Intern Med 1993;118:577-581. Reeves RA, Lin C-S, Kassler-Taub K, Pouleur H. Dose-related efficacy of irbesartan for hypertension: an integrated analysis. Hypertension 1998;31:1311-1316. Ribstein J, Picard A, Armagnac C, et al. Inhibition of the acute effects of angiotensin II by the receptor antagonist irbesartan in normotensive men. J Cardiovasc Pharmacol 2001;37:449-460. Ritz E, Stefanski A. Diabetic nephropathy in type II diabetes. Am J Kid Dis 1996;27:167-194. Rossing P, Hommel E, Smidt UM, et al. Reduction in albuminuria predicts diminished progresion in diabetic nephropathy. Kidney Int 1994;45(suppl.):S145-S149. Ruggenenti P, Gambara V, Perna A, et al. The nephropathy of non-insulin-dependent diabetes: predictors of outcome relative to diverse patterns of renal injury. J Am Soc Nephrol 1998;9:2336-2343. Savage S, Niegel NJ, Estacio RO, et al. Clinical factors associated with urinary albumin excretion in type II diabetes. Am J Kid Dis 1995;25:836-844. Schmitz A, Vaeth M. Microalbuminuria: a major risk factor in non-insulin-dependent diabetes. A 10-year follow-up study of 503 patients. Diabet Med 1988;5:126-134. Schwartz MM, Lewis EJ, Leonard-Martin T, et al. Renal pathology patterns in type II diabetes mellitus: Relationship with retinopathy. Nephrol Dial Transpl 1998;13:2547-2552. Simon TA, Gelarden T, Freitag SA, et al. Safety of irbesartan in the treatment of mild to moderate systemic hypertension. Am J Cardiol 1998;82:179-182. Staessen JA, Fagard R, Thijs L, et al. Randomized double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. Lancet 1997;350:757-764. Stamler J, Vaccaro O, Neaton JD, et al. Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in multiple risk factor intervention trial. Diabetes Care 1993;16:434-444. Stone PH, Muller JE, Hartwell T, et al. The effect of diabetes mellitus on pronosis and serial left ventricular function after acute myocardial infarction: contribution of both coronary disease and diastolic left ventricular dysfunction to the adverse prognosis. The MILIS Study Group. J Am Cardiol 1989;14:49-57. Suzuki Y, Ueno M, Hayashi H, et al. A light microscopic study of glomerulosclerosis in Japanese patients with non-insulin-dependent diabetes mellitus: the relationship between clinical and histological features. Clin Nephrol 1994;42:155-162. Tarnow L, Rossing P, Gall M-A, et al. Prevalence of arterial hypertension in diabetic patients before and after the JNC-V. Diabet Care 1994;17:1247-51. Teo KK, Burton JR, Buller CE, et al. Long-term effects of cholesterol lowering and angiotensin -converting enzyme inhibition on coronary atherosclerosis. The simvastatin/enalapril coronary atherosclerosis trial (SCAT). Circulation 2000;102:1748-1754. Tuomilehto J, Rastenyte D, Birkenhäger WH, et al. Effects of calcium-channel blockade in older patients with diabetes and systolic hypertension. N Engl J Med 1999;340:677-84.
Directives ESH-ESC 2007 Pression artérielle (mmHg)
Normal
120-129/80-84
Normal sup.
130-139/85-89
HTA stade 1
140-159/90-99
HTA stade 2
160-179/100-109
HTA stade 3
>180/>110
Pas d’autre FRCV Risque négligeable Risque faible Risque modéré Risque très élevé
1-2 FRCV Risque faible Risque modéré Risque modéré Risque très élevé
3 FRCV; synd. métabolique ou lésions infraclin. organes cibles
Risque modéré Risque modéré Risque élevé
Diabète Risque modéré Risque élevé
MC ou néphropathie symptomat
Risque très élevé
ESC/ESH 2007
AVC (toutes formes)
Infarctus myocardique
Angine de poitrine
Revascularisation coronaire
Insuffisance cardiaque
Néphropathie diabétique
Insuffisance rénale (> 177 mmol/l. )
Anévrisme disséquant
Mal. Artérielle symptomatique
Rétinopathie hypertensive avancée (œdème papillaire,hémorragie ou exsudat)
HVG (ECG,Echocar.,Rx thorax)
Protéinurie ou augmentation de la créatinine (106-177 mmol/l.)
Microalbuminurie Filtration glomérulaire:<60 ml/min/1.73 m2 Plaque artérioscléreuse
Rétrécissement généralisé ou focal des art. rétiniennes
Hommes plus de 55 ans
Femmes plus de 65 ans
Tabagisme
Cholestérol > 5.0 mmol/l mmol/l.
Diabète
Ant. familiaux de mal. CV
Pris en compte dans la stratifications: HDL chol.< 1 mmol/l
LDL chol. >3
Microalbuminurie dans le diabète
Intolérance au glucose
Obésité abdominale(102/88)
TG 1.7 mmol/l
Conditions cliniques associées Atteinte des organes cibles Facteurs de risque
Dr B. Jacot Des Combes, oct 2007 .
La pression artérielle idéale pour un diabétique est
que la moyenne des mesures de la pression artérielle soit
plus petite ou égale à 125 / 85 mmHg soit 12,5/8,5 cmHg
Take home message:
Définition de l’hypertension artérielle en cas de diabète
Présentateur
Commentaires de présentation
Perico N, Remuzzi A, Sangalli F, et al. The antiproteinuric effect of angiotensin antagonism in human IgA nephropathy is potentiated by indomethacin. J Am Soc Nephrol 1998;9:2308-2317. Pinel N, Fadel B, Bilous RW, et al. Renal biopsies in 30 micro and macroalbuminuric type 2 patients. Heterogeneity of renal lesions. Diabetologia 1995;38(suppl 1):A217. Pitt B, Byington RP, Furberg CD, et al. Effect of amlodipine on the progression of atherosclerosis and the occurrence of clinical events. Circulation 2000;102:1503-1510. Pohl M, Cooper M, Ulrey J, et al. Safety and efficacy of irbesartan in hypertensive patients with type II diabetes and proteinuria. Am J Hypertens 1997;10:105A. Abstract. Pugh JA, Medina R, Ramirez, M. Comparison of the course to end-stage renal disease of type 1 (insulin-dependent) and type 2 (non-insulin-dependent) diabetic nephropathy. Diabetologia 1993;36:1094-1098. Raine AEG, Bilous RW. End-stage renal disease in NIDDM: a consequence of microangiopathy alone? Diabetologia 1996;39:1673-1675. Raine AEG. Epidemiology, development and treatment of of end-stage renal failure in type 2 (non-insulin dependent) diabetic patients in Europe. Diabetologia 1993;36:1099-1104. Ravid M, Savin H, Jutrin I, et al. Long-term stabilizing effect of angiotensin-converting enzyme inhibition on plasma creatinine and on proteinuria in normotensive type II diabetic patients. Ann Intern Med 1993;118:577-581. Reeves RA, Lin C-S, Kassler-Taub K, Pouleur H. Dose-related efficacy of irbesartan for hypertension: an integrated analysis. Hypertension 1998;31:1311-1316. Ribstein J, Picard A, Armagnac C, et al. Inhibition of the acute effects of angiotensin II by the receptor antagonist irbesartan in normotensive men. J Cardiovasc Pharmacol 2001;37:449-460. Ritz E, Stefanski A. Diabetic nephropathy in type II diabetes. Am J Kid Dis 1996;27:167-194. Rossing P, Hommel E, Smidt UM, et al. Reduction in albuminuria predicts diminished progresion in diabetic nephropathy. Kidney Int 1994;45(suppl.):S145-S149. Ruggenenti P, Gambara V, Perna A, et al. The nephropathy of non-insulin-dependent diabetes: predictors of outcome relative to diverse patterns of renal injury. J Am Soc Nephrol 1998;9:2336-2343. Savage S, Niegel NJ, Estacio RO, et al. Clinical factors associated with urinary albumin excretion in type II diabetes. Am J Kid Dis 1995;25:836-844. Schmitz A, Vaeth M. Microalbuminuria: a major risk factor in non-insulin-dependent diabetes. A 10-year follow-up study of 503 patients. Diabet Med 1988;5:126-134. Schwartz MM, Lewis EJ, Leonard-Martin T, et al. Renal pathology patterns in type II diabetes mellitus: Relationship with retinopathy. Nephrol Dial Transpl 1998;13:2547-2552. Simon TA, Gelarden T, Freitag SA, et al. Safety of irbesartan in the treatment of mild to moderate systemic hypertension. Am J Cardiol 1998;82:179-182. Staessen JA, Fagard R, Thijs L, et al. Randomized double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. Lancet 1997;350:757-764. Stamler J, Vaccaro O, Neaton JD, et al. Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in multiple risk factor intervention trial. Diabetes Care 1993;16:434-444. Stone PH, Muller JE, Hartwell T, et al. The effect of diabetes mellitus on pronosis and serial left ventricular function after acute myocardial infarction: contribution of both coronary disease and diastolic left ventricular dysfunction to the adverse prognosis. The MILIS Study Group. J Am Cardiol 1989;14:49-57. Suzuki Y, Ueno M, Hayashi H, et al. A light microscopic study of glomerulosclerosis in Japanese patients with non-insulin-dependent diabetes mellitus: the relationship between clinical and histological features. Clin Nephrol 1994;42:155-162. Tarnow L, Rossing P, Gall M-A, et al. Prevalence of arterial hypertension in diabetic patients before and after the JNC-V. Diabet Care 1994;17:1247-51. Teo KK, Burton JR, Buller CE, et al. Long-term effects of cholesterol lowering and angiotensin -converting enzyme inhibition on coronary atherosclerosis. The simvastatin/enalapril coronary atherosclerosis trial (SCAT). Circulation 2000;102:1748-1754. Tuomilehto J, Rastenyte D, Birkenhäger WH, et al. Effects of calcium-channel blockade in older patients with diabetes and systolic hypertension. N Engl J Med 1999;340:677-84.
Présentateur
Commentaires de présentation
Perico N, Remuzzi A, Sangalli F, et al. The antiproteinuric effect of angiotensin antagonism in human IgA nephropathy is potentiated by indomethacin. J Am Soc Nephrol 1998;9:2308-2317. Pinel N, Fadel B, Bilous RW, et al. Renal biopsies in 30 micro and macroalbuminuric type 2 patients. Heterogeneity of renal lesions. Diabetologia 1995;38(suppl 1):A217. Pitt B, Byington RP, Furberg CD, et al. Effect of amlodipine on the progression of atherosclerosis and the occurrence of clinical events. Circulation 2000;102:1503-1510. Pohl M, Cooper M, Ulrey J, et al. Safety and efficacy of irbesartan in hypertensive patients with type II diabetes and proteinuria. Am J Hypertens 1997;10:105A. Abstract. Pugh JA, Medina R, Ramirez, M. Comparison of the course to end-stage renal disease of type 1 (insulin-dependent) and type 2 (non-insulin-dependent) diabetic nephropathy. Diabetologia 1993;36:1094-1098. Raine AEG, Bilous RW. End-stage renal disease in NIDDM: a consequence of microangiopathy alone? Diabetologia 1996;39:1673-1675. Raine AEG. Epidemiology, development and treatment of of end-stage renal failure in type 2 (non-insulin dependent) diabetic patients in Europe. Diabetologia 1993;36:1099-1104. Ravid M, Savin H, Jutrin I, et al. Long-term stabilizing effect of angiotensin-converting enzyme inhibition on plasma creatinine and on proteinuria in normotensive type II diabetic patients. Ann Intern Med 1993;118:577-581. Reeves RA, Lin C-S, Kassler-Taub K, Pouleur H. Dose-related efficacy of irbesartan for hypertension: an integrated analysis. Hypertension 1998;31:1311-1316. Ribstein J, Picard A, Armagnac C, et al. Inhibition of the acute effects of angiotensin II by the receptor antagonist irbesartan in normotensive men. J Cardiovasc Pharmacol 2001;37:449-460. Ritz E, Stefanski A. Diabetic nephropathy in type II diabetes. Am J Kid Dis 1996;27:167-194. Rossing P, Hommel E, Smidt UM, et al. Reduction in albuminuria predicts diminished progresion in diabetic nephropathy. Kidney Int 1994;45(suppl.):S145-S149. Ruggenenti P, Gambara V, Perna A, et al. The nephropathy of non-insulin-dependent diabetes: predictors of outcome relative to diverse patterns of renal injury. J Am Soc Nephrol 1998;9:2336-2343. Savage S, Niegel NJ, Estacio RO, et al. Clinical factors associated with urinary albumin excretion in type II diabetes. Am J Kid Dis 1995;25:836-844. Schmitz A, Vaeth M. Microalbuminuria: a major risk factor in non-insulin-dependent diabetes. A 10-year follow-up study of 503 patients. Diabet Med 1988;5:126-134. Schwartz MM, Lewis EJ, Leonard-Martin T, et al. Renal pathology patterns in type II diabetes mellitus: Relationship with retinopathy. Nephrol Dial Transpl 1998;13:2547-2552. Simon TA, Gelarden T, Freitag SA, et al. Safety of irbesartan in the treatment of mild to moderate systemic hypertension. Am J Cardiol 1998;82:179-182. Staessen JA, Fagard R, Thijs L, et al. Randomized double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. Lancet 1997;350:757-764. Stamler J, Vaccaro O, Neaton JD, et al. Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in multiple risk factor intervention trial. Diabetes Care 1993;16:434-444. Stone PH, Muller JE, Hartwell T, et al. The effect of diabetes mellitus on pronosis and serial left ventricular function after acute myocardial infarction: contribution of both coronary disease and diastolic left ventricular dysfunction to the adverse prognosis. The MILIS Study Group. J Am Cardiol 1989;14:49-57. Suzuki Y, Ueno M, Hayashi H, et al. A light microscopic study of glomerulosclerosis in Japanese patients with non-insulin-dependent diabetes mellitus: the relationship between clinical and histological features. Clin Nephrol 1994;42:155-162. Tarnow L, Rossing P, Gall M-A, et al. Prevalence of arterial hypertension in diabetic patients before and after the JNC-V. Diabet Care 1994;17:1247-51. Teo KK, Burton JR, Buller CE, et al. Long-term effects of cholesterol lowering and angiotensin -converting enzyme inhibition on coronary atherosclerosis. The simvastatin/enalapril coronary atherosclerosis trial (SCAT). Circulation 2000;102:1748-1754. Tuomilehto J, Rastenyte D, Birkenhäger WH, et al. Effects of calcium-channel blockade in older patients with diabetes and systolic hypertension. N Engl J Med 1999;340:677-84.
Présentateur
Commentaires de présentation
Perico N, Remuzzi A, Sangalli F, et al. The antiproteinuric effect of angiotensin antagonism in human IgA nephropathy is potentiated by indomethacin. J Am Soc Nephrol 1998;9:2308-2317. Pinel N, Fadel B, Bilous RW, et al. Renal biopsies in 30 micro and macroalbuminuric type 2 patients. Heterogeneity of renal lesions. Diabetologia 1995;38(suppl 1):A217. Pitt B, Byington RP, Furberg CD, et al. Effect of amlodipine on the progression of atherosclerosis and the occurrence of clinical events. Circulation 2000;102:1503-1510. Pohl M, Cooper M, Ulrey J, et al. Safety and efficacy of irbesartan in hypertensive patients with type II diabetes and proteinuria. Am J Hypertens 1997;10:105A. Abstract. Pugh JA, Medina R, Ramirez, M. Comparison of the course to end-stage renal disease of type 1 (insulin-dependent) and type 2 (non-insulin-dependent) diabetic nephropathy. Diabetologia 1993;36:1094-1098. Raine AEG, Bilous RW. End-stage renal disease in NIDDM: a consequence of microangiopathy alone? Diabetologia 1996;39:1673-1675. Raine AEG. Epidemiology, development and treatment of of end-stage renal failure in type 2 (non-insulin dependent) diabetic patients in Europe. Diabetologia 1993;36:1099-1104. Ravid M, Savin H, Jutrin I, et al. Long-term stabilizing effect of angiotensin-converting enzyme inhibition on plasma creatinine and on proteinuria in normotensive type II diabetic patients. Ann Intern Med 1993;118:577-581. Reeves RA, Lin C-S, Kassler-Taub K, Pouleur H. Dose-related efficacy of irbesartan for hypertension: an integrated analysis. Hypertension 1998;31:1311-1316. Ribstein J, Picard A, Armagnac C, et al. Inhibition of the acute effects of angiotensin II by the receptor antagonist irbesartan in normotensive men. J Cardiovasc Pharmacol 2001;37:449-460. Ritz E, Stefanski A. Diabetic nephropathy in type II diabetes. Am J Kid Dis 1996;27:167-194. Rossing P, Hommel E, Smidt UM, et al. Reduction in albuminuria predicts diminished progresion in diabetic nephropathy. Kidney Int 1994;45(suppl.):S145-S149. Ruggenenti P, Gambara V, Perna A, et al. The nephropathy of non-insulin-dependent diabetes: predictors of outcome relative to diverse patterns of renal injury. J Am Soc Nephrol 1998;9:2336-2343. Savage S, Niegel NJ, Estacio RO, et al. Clinical factors associated with urinary albumin excretion in type II diabetes. Am J Kid Dis 1995;25:836-844. Schmitz A, Vaeth M. Microalbuminuria: a major risk factor in non-insulin-dependent diabetes. A 10-year follow-up study of 503 patients. Diabet Med 1988;5:126-134. Schwartz MM, Lewis EJ, Leonard-Martin T, et al. Renal pathology patterns in type II diabetes mellitus: Relationship with retinopathy. Nephrol Dial Transpl 1998;13:2547-2552. Simon TA, Gelarden T, Freitag SA, et al. Safety of irbesartan in the treatment of mild to moderate systemic hypertension. Am J Cardiol 1998;82:179-182. Staessen JA, Fagard R, Thijs L, et al. Randomized double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. Lancet 1997;350:757-764. Stamler J, Vaccaro O, Neaton JD, et al. Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in multiple risk factor intervention trial. Diabetes Care 1993;16:434-444. Stone PH, Muller JE, Hartwell T, et al. The effect of diabetes mellitus on pronosis and serial left ventricular function after acute myocardial infarction: contribution of both coronary disease and diastolic left ventricular dysfunction to the adverse prognosis. The MILIS Study Group. J Am Cardiol 1989;14:49-57. Suzuki Y, Ueno M, Hayashi H, et al. A light microscopic study of glomerulosclerosis in Japanese patients with non-insulin-dependent diabetes mellitus: the relationship between clinical and histological features. Clin Nephrol 1994;42:155-162. Tarnow L, Rossing P, Gall M-A, et al. Prevalence of arterial hypertension in diabetic patients before and after the JNC-V. Diabet Care 1994;17:1247-51. Teo KK, Burton JR, Buller CE, et al. Long-term effects of cholesterol lowering and angiotensin -converting enzyme inhibition on coronary atherosclerosis. The simvastatin/enalapril coronary atherosclerosis trial (SCAT). Circulation 2000;102:1748-1754. Tuomilehto J, Rastenyte D, Birkenhäger WH, et al. Effects of calcium-channel blockade in older patients with diabetes and systolic hypertension. N Engl J Med 1999;340:677-84.
Hypertension artérielle et diabète
Plan
I.- Qu’est-ce que la pression artérielle ? a) ne pas confondre avec la tension nerveuse b) Pression artérielle systolique et diastolique c) Définition de l’hypertension artérielle II.- Fréquence de l’hypertension artérielle III.- L’hypertension artérielle: -maladie ? -Facteur de risque cardio-vasculaire? IV.- Causes: a) Hypertension artérielle primaire b) Hypertension artérielle secondaire V.- Hypertension et diabète: un mauvais couple! VI.- Quelques éléments de traitement a) non médicamenteux b) médicamenteux
Présentateur
Commentaires de présentation
UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. Br Med J 1998a;317:703-713. UK Prospective Diabetes Study Group. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. Br Med J 1998b;317:713-720. UK Prospective Diabetes Study Group. Study design, progress and performance. Diabetologia 1991;34:877-890. United States Renal Data System, USRDS 1999 Annual Data Report. National Institutes of Health, National Institutes of Diabetes and Digestive and Kidney Diseases. Bethesda, MD, April, 1999. U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention (CDC), National Center For Health Statistics. (Vital and health statistics, plan and operation of the third national health and nutrition and examination survey, 1988-1994). DHHS publication no. (PHS) 94-1308, series 1, No. 324-0485. Valentino VA, Wilson MD, Weart W, Bakris GL. A perspective on converting enzyme inhibitors �and calcium channel antagonists in diabetic renal disease. Arch Intern Med 1991;151:2367-2372. Velussi M, Brocco E, Frigato F, et al. Effects of cilazapril and amlodipine on kidney function in hypertensive NIDDM patients. Diabetes 1996;45:216-222. Waldherr R, Ilkenhans C, Ritz E. How frequent is glomerulonephritis in diabetes mellitus type II? Clin Neph 1992;37:271-273. Wang S-L, Head J, Stevens L, et al. Excess mortality and its relation to hypertension and proteinuria in diabetic patients. Diabetes Care 1996;19:305-311. Weidmann P, Schneider M, Bohlen L. Therapeutic efficacy of different antihypertensive drugs in human diabetic nephropathy: An updated meta-analysis. Nephrol Dial Transplant 1995;10�(suppl 9):39-45. World Health Organization. The World Health Report 1997: Conquering Suffering, Enriching Humanity. Geneva, Switzerland. 1997. Zanchetti A, Agabiti-Rosei E, Dal Palu C, et al. The verapamil in hypertension and atherosclerosis study (VHAS): results of long-term randomized treatment with either verapamil or chlorthalidone on carotid intima-media thickness. J Hypertens 1998;16:1667-1676. Zatz R, Dunn BR, Meyer TW, et al. Prevention of diabetic glomuerulopathy by pharmacological amelioration of glomerular capillary hypertension. J Clin Invest 1986;77:1925-1930.
Hypertension artérielle et diabète
Présentateur
Commentaires de présentation
UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. Br Med J 1998a;317:703-713. UK Prospective Diabetes Study Group. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. Br Med J 1998b;317:713-720. UK Prospective Diabetes Study Group. Study design, progress and performance. Diabetologia 1991;34:877-890. United States Renal Data System, USRDS 1999 Annual Data Report. National Institutes of Health, National Institutes of Diabetes and Digestive and Kidney Diseases. Bethesda, MD, April, 1999. U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention (CDC), National Center For Health Statistics. (Vital and health statistics, plan and operation of the third national health and nutrition and examination survey, 1988-1994). DHHS publication no. (PHS) 94-1308, series 1, No. 324-0485. Valentino VA, Wilson MD, Weart W, Bakris GL. A perspective on converting enzyme inhibitors �and calcium channel antagonists in diabetic renal disease. Arch Intern Med 1991;151:2367-2372. Velussi M, Brocco E, Frigato F, et al. Effects of cilazapril and amlodipine on kidney function in hypertensive NIDDM patients. Diabetes 1996;45:216-222. Waldherr R, Ilkenhans C, Ritz E. How frequent is glomerulonephritis in diabetes mellitus type II? Clin Neph 1992;37:271-273. Wang S-L, Head J, Stevens L, et al. Excess mortality and its relation to hypertension and proteinuria in diabetic patients. Diabetes Care 1996;19:305-311. Weidmann P, Schneider M, Bohlen L. Therapeutic efficacy of different antihypertensive drugs in human diabetic nephropathy: An updated meta-analysis. Nephrol Dial Transplant 1995;10�(suppl 9):39-45. World Health Organization. The World Health Report 1997: Conquering Suffering, Enriching Humanity. Geneva, Switzerland. 1997. Zanchetti A, Agabiti-Rosei E, Dal Palu C, et al. The verapamil in hypertension and atherosclerosis study (VHAS): results of long-term randomized treatment with either verapamil or chlorthalidone on carotid intima-media thickness. J Hypertens 1998;16:1667-1676. Zatz R, Dunn BR, Meyer TW, et al. Prevention of diabetic glomuerulopathy by pharmacological amelioration of glomerular capillary hypertension. J Clin Invest 1986;77:1925-1930.
Hypertension artérielle et diabète
Globalement: 5% des enfants : principalement hypertensions artérielles secondaires 15% des adultes entre 20 et 65 ans 50 % des adultes âgés de plus de 65 ans
Présentateur
Commentaires de présentation
UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. Br Med J 1998a;317:703-713. UK Prospective Diabetes Study Group. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. Br Med J 1998b;317:713-720. UK Prospective Diabetes Study Group. Study design, progress and performance. Diabetologia 1991;34:877-890. United States Renal Data System, USRDS 1999 Annual Data Report. National Institutes of Health, National Institutes of Diabetes and Digestive and Kidney Diseases. Bethesda, MD, April, 1999. U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention (CDC), National Center For Health Statistics. (Vital and health statistics, plan and operation of the third national health and nutrition and examination survey, 1988-1994). DHHS publication no. (PHS) 94-1308, series 1, No. 324-0485. Valentino VA, Wilson MD, Weart W, Bakris GL. A perspective on converting enzyme inhibitors �and calcium channel antagonists in diabetic renal disease. Arch Intern Med 1991;151:2367-2372. Velussi M, Brocco E, Frigato F, et al. Effects of cilazapril and amlodipine on kidney function in hypertensive NIDDM patients. Diabetes 1996;45:216-222. Waldherr R, Ilkenhans C, Ritz E. How frequent is glomerulonephritis in diabetes mellitus type II? Clin Neph 1992;37:271-273. Wang S-L, Head J, Stevens L, et al. Excess mortality and its relation to hypertension and proteinuria in diabetic patients. Diabetes Care 1996;19:305-311. Weidmann P, Schneider M, Bohlen L. Therapeutic efficacy of different antihypertensive drugs in human diabetic nephropathy: An updated meta-analysis. Nephrol Dial Transplant 1995;10�(suppl 9):39-45. World Health Organization. The World Health Report 1997: Conquering Suffering, Enriching Humanity. Geneva, Switzerland. 1997. Zanchetti A, Agabiti-Rosei E, Dal Palu C, et al. The verapamil in hypertension and atherosclerosis study (VHAS): results of long-term randomized treatment with either verapamil or chlorthalidone on carotid intima-media thickness. J Hypertens 1998;16:1667-1676. Zatz R, Dunn BR, Meyer TW, et al. Prevention of diabetic glomuerulopathy by pharmacological amelioration of glomerular capillary hypertension. J Clin Invest 1986;77:1925-1930.
Prevalence of Hypertension in Type 2 Diabetes
Prevalence of hypertension
(%)
0
50
100
Normoalbuminuria (UAE ≤ 30 mg/day)
Microalbuminuria (UAE 30-300 mg/day) Macroalbuminuria (UAE ≥ 300 mg/day)
All patients
Tarnow L et al. Diabetes Care 1994;17:1247-1251.
Hypertension defined as ≥140/90 mm Hg. UAE = urinary albumin excretion
71
90 93
80
n=323 n=151 n=75 n=549
Présentateur
Commentaires de présentation
Hypertension is very common among patients with diabetes, especially diabetic patients with evidence of renal disease. Hypertension is very common among patients with diabetes, with a prevalence approximately twice that of the nondiabetic population, and may precede the onset of diabetes.1,2 The prevalence of hypertension is further increased in patients with type 2 diabetes and renal disease, as manifested by elevated urinary albumin excretion rates, compared with patients with type 2 diabetes and no evidence of renal involvement. A study including a cohort of 549 patients with type 2 diabetes (mean age 60 years) identified a high prevalence of hypertension, on the basis of an average blood pressure (BP) 140/90 mm Hg during a 3-year follow-up period.3 Eighty percent of the patients were classified as hypertensive, ranging from 71% of patients with normal urinary albumin excretion (UAE 30 mg/day) to 93% in patients with macroalbuminuria (UAE 300 mg/day). Only 41% of the patients were receiving antihypertensive treatment. Even in treated patients, 92% of those with normoalbuminuria, 92% of those with microalbuminuria (UAE 30-300 mg/day), and 88% of those with macroalbuminuria were uncontrolled, with a BP 140/90 mm Hg. Average BP was 163/90, 165/88, and 161/92 mm Hg in the 3 groups, respectively, despite antihypertensive therapy. 1 Epstein and Sowers, 1992. 2 American Diabetes Association, 2001. 3 Tarnow et al, 1994.
Prevalence of Hypertension in Type 1 Diabetes
Rare au moment du diagnostic, mais elle se développe dans les 10 à 12 ans suivant le diagnostic pour atteindre une prévalence aussi élevée que dans le diabète de type II
Présentateur
Commentaires de présentation
Hypertension is very common among patients with diabetes, especially diabetic patients with evidence of renal disease. Hypertension is very common among patients with diabetes, with a prevalence approximately twice that of the nondiabetic population, and may precede the onset of diabetes.1,2 The prevalence of hypertension is further increased in patients with type 2 diabetes and renal disease, as manifested by elevated urinary albumin excretion rates, compared with patients with type 2 diabetes and no evidence of renal involvement. A study including a cohort of 549 patients with type 2 diabetes (mean age 60 years) identified a high prevalence of hypertension, on the basis of an average blood pressure (BP) 140/90 mm Hg during a 3-year follow-up period.3 Eighty percent of the patients were classified as hypertensive, ranging from 71% of patients with normal urinary albumin excretion (UAE 30 mg/day) to 93% in patients with macroalbuminuria (UAE 300 mg/day). Only 41% of the patients were receiving antihypertensive treatment. Even in treated patients, 92% of those with normoalbuminuria, 92% of those with microalbuminuria (UAE 30-300 mg/day), and 88% of those with macroalbuminuria were uncontrolled, with a BP 140/90 mm Hg. Average BP was 163/90, 165/88, and 161/92 mm Hg in the 3 groups, respectively, despite antihypertensive therapy. 1 Epstein and Sowers, 1992. 2 American Diabetes Association, 2001. 3 Tarnow et al, 1994.
Hypertension artérielle et diabète
Plan
I.- Qu’est-ce que la pression artérielle ? a) ne pas confondre avec la tension nerveuse b) Pression artérielle systolique et diastolique c) Définition de l’hypertension artérielle II.- Fréquence de l’hypertension artérielle III.- L’hypertension artérielle: -maladie ? -Facteur de risque cardio-vasculaire? IV.- Causes: a) Hypertension artérielle primaire b) Hypertension artérielle secondaire V.- Hypertension et diabète: un mauvais couple! VI.- Quelques éléments de traitement a) non médicamenteux b) médicamenteux
Présentateur
Commentaires de présentation
UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. Br Med J 1998a;317:703-713. UK Prospective Diabetes Study Group. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. Br Med J 1998b;317:713-720. UK Prospective Diabetes Study Group. Study design, progress and performance. Diabetologia 1991;34:877-890. United States Renal Data System, USRDS 1999 Annual Data Report. National Institutes of Health, National Institutes of Diabetes and Digestive and Kidney Diseases. Bethesda, MD, April, 1999. U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention (CDC), National Center For Health Statistics. (Vital and health statistics, plan and operation of the third national health and nutrition and examination survey, 1988-1994). DHHS publication no. (PHS) 94-1308, series 1, No. 324-0485. Valentino VA, Wilson MD, Weart W, Bakris GL. A perspective on converting enzyme inhibitors �and calcium channel antagonists in diabetic renal disease. Arch Intern Med 1991;151:2367-2372. Velussi M, Brocco E, Frigato F, et al. Effects of cilazapril and amlodipine on kidney function in hypertensive NIDDM patients. Diabetes 1996;45:216-222. Waldherr R, Ilkenhans C, Ritz E. How frequent is glomerulonephritis in diabetes mellitus type II? Clin Neph 1992;37:271-273. Wang S-L, Head J, Stevens L, et al. Excess mortality and its relation to hypertension and proteinuria in diabetic patients. Diabetes Care 1996;19:305-311. Weidmann P, Schneider M, Bohlen L. Therapeutic efficacy of different antihypertensive drugs in human diabetic nephropathy: An updated meta-analysis. Nephrol Dial Transplant 1995;10�(suppl 9):39-45. World Health Organization. The World Health Report 1997: Conquering Suffering, Enriching Humanity. Geneva, Switzerland. 1997. Zanchetti A, Agabiti-Rosei E, Dal Palu C, et al. The verapamil in hypertension and atherosclerosis study (VHAS): results of long-term randomized treatment with either verapamil or chlorthalidone on carotid intima-media thickness. J Hypertens 1998;16:1667-1676. Zatz R, Dunn BR, Meyer TW, et al. Prevention of diabetic glomuerulopathy by pharmacological amelioration of glomerular capillary hypertension. J Clin Invest 1986;77:1925-1930.
L’hypertension artérielle, est asymptomatique et
est une « tueuse silencieuse »
Take home message:
Semblable aux termites, elle ronge le bâtiment, pratiquement sans signe jusqu’à ce qu’il s’écroule.
Hypertension artérielle et diabète
Présentateur
Commentaires de présentation
UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. Br Med J 1998a;317:703-713. UK Prospective Diabetes Study Group. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. Br Med J 1998b;317:713-720. UK Prospective Diabetes Study Group. Study design, progress and performance. Diabetologia 1991;34:877-890. United States Renal Data System, USRDS 1999 Annual Data Report. National Institutes of Health, National Institutes of Diabetes and Digestive and Kidney Diseases. Bethesda, MD, April, 1999. U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention (CDC), National Center For Health Statistics. (Vital and health statistics, plan and operation of the third national health and nutrition and examination survey, 1988-1994). DHHS publication no. (PHS) 94-1308, series 1, No. 324-0485. Valentino VA, Wilson MD, Weart W, Bakris GL. A perspective on converting enzyme inhibitors �and calcium channel antagonists in diabetic renal disease. Arch Intern Med 1991;151:2367-2372. Velussi M, Brocco E, Frigato F, et al. Effects of cilazapril and amlodipine on kidney function in hypertensive NIDDM patients. Diabetes 1996;45:216-222. Waldherr R, Ilkenhans C, Ritz E. How frequent is glomerulonephritis in diabetes mellitus type II? Clin Neph 1992;37:271-273. Wang S-L, Head J, Stevens L, et al. Excess mortality and its relation to hypertension and proteinuria in diabetic patients. Diabetes Care 1996;19:305-311. Weidmann P, Schneider M, Bohlen L. Therapeutic efficacy of different antihypertensive drugs in human diabetic nephropathy: An updated meta-analysis. Nephrol Dial Transplant 1995;10�(suppl 9):39-45. World Health Organization. The World Health Report 1997: Conquering Suffering, Enriching Humanity. Geneva, Switzerland. 1997. Zanchetti A, Agabiti-Rosei E, Dal Palu C, et al. The verapamil in hypertension and atherosclerosis study (VHAS): results of long-term randomized treatment with either verapamil or chlorthalidone on carotid intima-media thickness. J Hypertens 1998;16:1667-1676. Zatz R, Dunn BR, Meyer TW, et al. Prevention of diabetic glomuerulopathy by pharmacological amelioration of glomerular capillary hypertension. J Clin Invest 1986;77:1925-1930.
Hypertension artérielle et diabète
Plan
I.- Qu’est-ce que la pression artérielle ? a) ne pas confondre avec la tension nerveuse b) Pression artérielle systolique et diastolique c) Définition de l’hypertension artérielle II.- Fréquence de l’hypertension artérielle III.- L’hypertension artérielle: -maladie ? -Facteur de risque cardio-vasculaire? IV.- Causes: a) Hypertension artérielle primaire b) Hypertension artérielle secondaire V.- Hypertension et diabète: un mauvais couple! VI.- Quelques éléments de traitement a) non médicamenteux b) médicamenteux
Présentateur
Commentaires de présentation
UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. Br Med J 1998a;317:703-713. UK Prospective Diabetes Study Group. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. Br Med J 1998b;317:713-720. UK Prospective Diabetes Study Group. Study design, progress and performance. Diabetologia 1991;34:877-890. United States Renal Data System, USRDS 1999 Annual Data Report. National Institutes of Health, National Institutes of Diabetes and Digestive and Kidney Diseases. Bethesda, MD, April, 1999. U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention (CDC), National Center For Health Statistics. (Vital and health statistics, plan and operation of the third national health and nutrition and examination survey, 1988-1994). DHHS publication no. (PHS) 94-1308, series 1, No. 324-0485. Valentino VA, Wilson MD, Weart W, Bakris GL. A perspective on converting enzyme inhibitors �and calcium channel antagonists in diabetic renal disease. Arch Intern Med 1991;151:2367-2372. Velussi M, Brocco E, Frigato F, et al. Effects of cilazapril and amlodipine on kidney function in hypertensive NIDDM patients. Diabetes 1996;45:216-222. Waldherr R, Ilkenhans C, Ritz E. How frequent is glomerulonephritis in diabetes mellitus type II? Clin Neph 1992;37:271-273. Wang S-L, Head J, Stevens L, et al. Excess mortality and its relation to hypertension and proteinuria in diabetic patients. Diabetes Care 1996;19:305-311. Weidmann P, Schneider M, Bohlen L. Therapeutic efficacy of different antihypertensive drugs in human diabetic nephropathy: An updated meta-analysis. Nephrol Dial Transplant 1995;10�(suppl 9):39-45. World Health Organization. The World Health Report 1997: Conquering Suffering, Enriching Humanity. Geneva, Switzerland. 1997. Zanchetti A, Agabiti-Rosei E, Dal Palu C, et al. The verapamil in hypertension and atherosclerosis study (VHAS): results of long-term randomized treatment with either verapamil or chlorthalidone on carotid intima-media thickness. J Hypertens 1998;16:1667-1676. Zatz R, Dunn BR, Meyer TW, et al. Prevention of diabetic glomuerulopathy by pharmacological amelioration of glomerular capillary hypertension. J Clin Invest 1986;77:1925-1930.
Hypertension artérielle et diabète
Environ le 95 % de toutes les hypertension artérielles sont dues à des prédispositions génétiques qui vont se révéler si : - excès de sel (NaCl) - excès de poids - manque d’activité physique Environ 5% sont dues à des affections telles que: - insuffisance rénale - obstruction des artères rénales - diverses maladies endocriniennes
Présentateur
Commentaires de présentation
UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. Br Med J 1998a;317:703-713. UK Prospective Diabetes Study Group. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. Br Med J 1998b;317:713-720. UK Prospective Diabetes Study Group. Study design, progress and performance. Diabetologia 1991;34:877-890. United States Renal Data System, USRDS 1999 Annual Data Report. National Institutes of Health, National Institutes of Diabetes and Digestive and Kidney Diseases. Bethesda, MD, April, 1999. U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention (CDC), National Center For Health Statistics. (Vital and health statistics, plan and operation of the third national health and nutrition and examination survey, 1988-1994). DHHS publication no. (PHS) 94-1308, series 1, No. 324-0485. Valentino VA, Wilson MD, Weart W, Bakris GL. A perspective on converting enzyme inhibitors �and calcium channel antagonists in diabetic renal disease. Arch Intern Med 1991;151:2367-2372. Velussi M, Brocco E, Frigato F, et al. Effects of cilazapril and amlodipine on kidney function in hypertensive NIDDM patients. Diabetes 1996;45:216-222. Waldherr R, Ilkenhans C, Ritz E. How frequent is glomerulonephritis in diabetes mellitus type II? Clin Neph 1992;37:271-273. Wang S-L, Head J, Stevens L, et al. Excess mortality and its relation to hypertension and proteinuria in diabetic patients. Diabetes Care 1996;19:305-311. Weidmann P, Schneider M, Bohlen L. Therapeutic efficacy of different antihypertensive drugs in human diabetic nephropathy: An updated meta-analysis. Nephrol Dial Transplant 1995;10�(suppl 9):39-45. World Health Organization. The World Health Report 1997: Conquering Suffering, Enriching Humanity. Geneva, Switzerland. 1997. Zanchetti A, Agabiti-Rosei E, Dal Palu C, et al. The verapamil in hypertension and atherosclerosis study (VHAS): results of long-term randomized treatment with either verapamil or chlorthalidone on carotid intima-media thickness. J Hypertens 1998;16:1667-1676. Zatz R, Dunn BR, Meyer TW, et al. Prevention of diabetic glomuerulopathy by pharmacological amelioration of glomerular capillary hypertension. J Clin Invest 1986;77:1925-1930.
Hypertension artérielle et diabète
• les HTA secondaires:
o rénales
o Hyperaldostéronisme:
• Rénovasculaire
• hypeminéralocorticisme
primaire
o Autres formes endocriniennes:
• Hyper- et Hypothyroïdie
• Acromégalie
• Cushing
• Hyperparathyroïdisme
o Syndrome d’apnée du sommeil
o Hypertension intra-crânienne
o Alcoolisme
o Etats anxio-dépressif
Présentateur
Commentaires de présentation
UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. Br Med J 1998a;317:703-713. UK Prospective Diabetes Study Group. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. Br Med J 1998b;317:713-720. UK Prospective Diabetes Study Group. Study design, progress and performance. Diabetologia 1991;34:877-890. United States Renal Data System, USRDS 1999 Annual Data Report. National Institutes of Health, National Institutes of Diabetes and Digestive and Kidney Diseases. Bethesda, MD, April, 1999. U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention (CDC), National Center For Health Statistics. (Vital and health statistics, plan and operation of the third national health and nutrition and examination survey, 1988-1994). DHHS publication no. (PHS) 94-1308, series 1, No. 324-0485. Valentino VA, Wilson MD, Weart W, Bakris GL. A perspective on converting enzyme inhibitors �and calcium channel antagonists in diabetic renal disease. Arch Intern Med 1991;151:2367-2372. Velussi M, Brocco E, Frigato F, et al. Effects of cilazapril and amlodipine on kidney function in hypertensive NIDDM patients. Diabetes 1996;45:216-222. Waldherr R, Ilkenhans C, Ritz E. How frequent is glomerulonephritis in diabetes mellitus type II? Clin Neph 1992;37:271-273. Wang S-L, Head J, Stevens L, et al. Excess mortality and its relation to hypertension and proteinuria in diabetic patients. Diabetes Care 1996;19:305-311. Weidmann P, Schneider M, Bohlen L. Therapeutic efficacy of different antihypertensive drugs in human diabetic nephropathy: An updated meta-analysis. Nephrol Dial Transplant 1995;10�(suppl 9):39-45. World Health Organization. The World Health Report 1997: Conquering Suffering, Enriching Humanity. Geneva, Switzerland. 1997. Zanchetti A, Agabiti-Rosei E, Dal Palu C, et al. The verapamil in hypertension and atherosclerosis study (VHAS): results of long-term randomized treatment with either verapamil or chlorthalidone on carotid intima-media thickness. J Hypertens 1998;16:1667-1676. Zatz R, Dunn BR, Meyer TW, et al. Prevention of diabetic glomuerulopathy by pharmacological amelioration of glomerular capillary hypertension. J Clin Invest 1986;77:1925-1930.
Hypertension artérielle et diabète
Plan
I.- Qu’est-ce que la pression artérielle ? a) ne pas confondre avec la tension nerveuse b) Pression artérielle systolique et diastolique c) Définition de l’hypertension artérielle II.- Fréquence de l’hypertension artérielle III.- L’hypertension artérielle: -maladie ? -Facteur de risque cardio-vasculaire? IV.- Causes: a) Hypertension artérielle primaire b) Hypertension artérielle secondaire V.- Hypertension et diabète: un mauvais couple! VI.- Quelques éléments de traitement a) non médicamenteux b) médicamenteux
Présentateur
Commentaires de présentation
UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. Br Med J 1998a;317:703-713. UK Prospective Diabetes Study Group. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. Br Med J 1998b;317:713-720. UK Prospective Diabetes Study Group. Study design, progress and performance. Diabetologia 1991;34:877-890. United States Renal Data System, USRDS 1999 Annual Data Report. National Institutes of Health, National Institutes of Diabetes and Digestive and Kidney Diseases. Bethesda, MD, April, 1999. U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention (CDC), National Center For Health Statistics. (Vital and health statistics, plan and operation of the third national health and nutrition and examination survey, 1988-1994). DHHS publication no. (PHS) 94-1308, series 1, No. 324-0485. Valentino VA, Wilson MD, Weart W, Bakris GL. A perspective on converting enzyme inhibitors �and calcium channel antagonists in diabetic renal disease. Arch Intern Med 1991;151:2367-2372. Velussi M, Brocco E, Frigato F, et al. Effects of cilazapril and amlodipine on kidney function in hypertensive NIDDM patients. Diabetes 1996;45:216-222. Waldherr R, Ilkenhans C, Ritz E. How frequent is glomerulonephritis in diabetes mellitus type II? Clin Neph 1992;37:271-273. Wang S-L, Head J, Stevens L, et al. Excess mortality and its relation to hypertension and proteinuria in diabetic patients. Diabetes Care 1996;19:305-311. Weidmann P, Schneider M, Bohlen L. Therapeutic efficacy of different antihypertensive drugs in human diabetic nephropathy: An updated meta-analysis. Nephrol Dial Transplant 1995;10�(suppl 9):39-45. World Health Organization. The World Health Report 1997: Conquering Suffering, Enriching Humanity. Geneva, Switzerland. 1997. Zanchetti A, Agabiti-Rosei E, Dal Palu C, et al. The verapamil in hypertension and atherosclerosis study (VHAS): results of long-term randomized treatment with either verapamil or chlorthalidone on carotid intima-media thickness. J Hypertens 1998;16:1667-1676. Zatz R, Dunn BR, Meyer TW, et al. Prevention of diabetic glomuerulopathy by pharmacological amelioration of glomerular capillary hypertension. J Clin Invest 1986;77:1925-1930.
Hypertension artérielle et diabète
Association of Systolic BP and Cardiovascular Death in Type 2 Diabetes
250
225
200
175
150
125
100
75
50
0
25
< 120 120–139
140–159 160–179
180–199 ≥ 200
Systolic blood pressure (mm Hg)
Cardiovascular mortality
rate/10,000 person-yr
Nondiabetic
Diabetic
Stamler J et al. Diabetes Care 1993;16:434-444.
Présentateur
Commentaires de présentation
UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. Br Med J 1998a;317:703-713. UK Prospective Diabetes Study Group. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. Br Med J 1998b;317:713-720. UK Prospective Diabetes Study Group. Study design, progress and performance. Diabetologia 1991;34:877-890. United States Renal Data System, USRDS 1999 Annual Data Report. National Institutes of Health, National Institutes of Diabetes and Digestive and Kidney Diseases. Bethesda, MD, April, 1999. U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention (CDC), National Center For Health Statistics. (Vital and health statistics, plan and operation of the third national health and nutrition and examination survey, 1988-1994). DHHS publication no. (PHS) 94-1308, series 1, No. 324-0485. Valentino VA, Wilson MD, Weart W, Bakris GL. A perspective on converting enzyme inhibitors �and calcium channel antagonists in diabetic renal disease. Arch Intern Med 1991;151:2367-2372. Velussi M, Brocco E, Frigato F, et al. Effects of cilazapril and amlodipine on kidney function in hypertensive NIDDM patients. Diabetes 1996;45:216-222. Waldherr R, Ilkenhans C, Ritz E. How frequent is glomerulonephritis in diabetes mellitus type II? Clin Neph 1992;37:271-273. Wang S-L, Head J, Stevens L, et al. Excess mortality and its relation to hypertension and proteinuria in diabetic patients. Diabetes Care 1996;19:305-311. Weidmann P, Schneider M, Bohlen L. Therapeutic efficacy of different antihypertensive drugs in human diabetic nephropathy: An updated meta-analysis. Nephrol Dial Transplant 1995;10�(suppl 9):39-45. World Health Organization. The World Health Report 1997: Conquering Suffering, Enriching Humanity. Geneva, Switzerland. 1997. Zanchetti A, Agabiti-Rosei E, Dal Palu C, et al. The verapamil in hypertension and atherosclerosis study (VHAS): results of long-term randomized treatment with either verapamil or chlorthalidone on carotid intima-media thickness. J Hypertens 1998;16:1667-1676. Zatz R, Dunn BR, Meyer TW, et al. Prevention of diabetic glomuerulopathy by pharmacological amelioration of glomerular capillary hypertension. J Clin Invest 1986;77:1925-1930.
Hypertension artérielle et diabète
Plan
I.- Qu’est-ce que la pression artérielle ? a) ne pas confondre avec la tension nerveuse b) Pression artérielle systolique et diastolique c) Définition de l’hypertension artérielle II.- Fréquence de l’hypertension artérielle III.- L’hypertension artérielle: -maladie ? -Facteur de risque cardio-vasculaire? IV.- Causes: a) Hypertension artérielle primaire b) Hypertension artérielle secondaire V.- Hypertension et diabète: un mauvais couple! VI.- Quelques éléments de traitement a) non médicamenteux b) médicamenteux
Présentateur
Commentaires de présentation
UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. Br Med J 1998a;317:703-713. UK Prospective Diabetes Study Group. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. Br Med J 1998b;317:713-720. UK Prospective Diabetes Study Group. Study design, progress and performance. Diabetologia 1991;34:877-890. United States Renal Data System, USRDS 1999 Annual Data Report. National Institutes of Health, National Institutes of Diabetes and Digestive and Kidney Diseases. Bethesda, MD, April, 1999. U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention (CDC), National Center For Health Statistics. (Vital and health statistics, plan and operation of the third national health and nutrition and examination survey, 1988-1994). DHHS publication no. (PHS) 94-1308, series 1, No. 324-0485. Valentino VA, Wilson MD, Weart W, Bakris GL. A perspective on converting enzyme inhibitors �and calcium channel antagonists in diabetic renal disease. Arch Intern Med 1991;151:2367-2372. Velussi M, Brocco E, Frigato F, et al. Effects of cilazapril and amlodipine on kidney function in hypertensive NIDDM patients. Diabetes 1996;45:216-222. Waldherr R, Ilkenhans C, Ritz E. How frequent is glomerulonephritis in diabetes mellitus type II? Clin Neph 1992;37:271-273. Wang S-L, Head J, Stevens L, et al. Excess mortality and its relation to hypertension and proteinuria in diabetic patients. Diabetes Care 1996;19:305-311. Weidmann P, Schneider M, Bohlen L. Therapeutic efficacy of different antihypertensive drugs in human diabetic nephropathy: An updated meta-analysis. Nephrol Dial Transplant 1995;10�(suppl 9):39-45. World Health Organization. The World Health Report 1997: Conquering Suffering, Enriching Humanity. Geneva, Switzerland. 1997. Zanchetti A, Agabiti-Rosei E, Dal Palu C, et al. The verapamil in hypertension and atherosclerosis study (VHAS): results of long-term randomized treatment with either verapamil or chlorthalidone on carotid intima-media thickness. J Hypertens 1998;16:1667-1676. Zatz R, Dunn BR, Meyer TW, et al. Prevention of diabetic glomuerulopathy by pharmacological amelioration of glomerular capillary hypertension. J Clin Invest 1986;77:1925-1930.
Hypertension artérielle et diabète
Dicton populaire:
On a l’âge de ses artères
Présentateur
Commentaires de présentation
UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. Br Med J 1998a;317:703-713. UK Prospective Diabetes Study Group. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. Br Med J 1998b;317:713-720. UK Prospective Diabetes Study Group. Study design, progress and performance. Diabetologia 1991;34:877-890. United States Renal Data System, USRDS 1999 Annual Data Report. National Institutes of Health, National Institutes of Diabetes and Digestive and Kidney Diseases. Bethesda, MD, April, 1999. U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention (CDC), National Center For Health Statistics. (Vital and health statistics, plan and operation of the third national health and nutrition and examination survey, 1988-1994). DHHS publication no. (PHS) 94-1308, series 1, No. 324-0485. Valentino VA, Wilson MD, Weart W, Bakris GL. A perspective on converting enzyme inhibitors �and calcium channel antagonists in diabetic renal disease. Arch Intern Med 1991;151:2367-2372. Velussi M, Brocco E, Frigato F, et al. Effects of cilazapril and amlodipine on kidney function in hypertensive NIDDM patients. Diabetes 1996;45:216-222. Waldherr R, Ilkenhans C, Ritz E. How frequent is glomerulonephritis in diabetes mellitus type II? Clin Neph 1992;37:271-273. Wang S-L, Head J, Stevens L, et al. Excess mortality and its relation to hypertension and proteinuria in diabetic patients. Diabetes Care 1996;19:305-311. Weidmann P, Schneider M, Bohlen L. Therapeutic efficacy of different antihypertensive drugs in human diabetic nephropathy: An updated meta-analysis. Nephrol Dial Transplant 1995;10�(suppl 9):39-45. World Health Organization. The World Health Report 1997: Conquering Suffering, Enriching Humanity. Geneva, Switzerland. 1997. Zanchetti A, Agabiti-Rosei E, Dal Palu C, et al. The verapamil in hypertension and atherosclerosis study (VHAS): results of long-term randomized treatment with either verapamil or chlorthalidone on carotid intima-media thickness. J Hypertens 1998;16:1667-1676. Zatz R, Dunn BR, Meyer TW, et al. Prevention of diabetic glomuerulopathy by pharmacological amelioration of glomerular capillary hypertension. J Clin Invest 1986;77:1925-1930.
Hypertension artérielle et diabète
Les traitements antihypertenseurs ralentissent le vieillissement artérielle et sont ainsi une véritable fontaine de jouvence
Présentateur
Commentaires de présentation
UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. Br Med J 1998a;317:703-713. UK Prospective Diabetes Study Group. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. Br Med J 1998b;317:713-720. UK Prospective Diabetes Study Group. Study design, progress and performance. Diabetologia 1991;34:877-890. United States Renal Data System, USRDS 1999 Annual Data Report. National Institutes of Health, National Institutes of Diabetes and Digestive and Kidney Diseases. Bethesda, MD, April, 1999. U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention (CDC), National Center For Health Statistics. (Vital and health statistics, plan and operation of the third national health and nutrition and examination survey, 1988-1994). DHHS publication no. (PHS) 94-1308, series 1, No. 324-0485. Valentino VA, Wilson MD, Weart W, Bakris GL. A perspective on converting enzyme inhibitors �and calcium channel antagonists in diabetic renal disease. Arch Intern Med 1991;151:2367-2372. Velussi M, Brocco E, Frigato F, et al. Effects of cilazapril and amlodipine on kidney function in hypertensive NIDDM patients. Diabetes 1996;45:216-222. Waldherr R, Ilkenhans C, Ritz E. How frequent is glomerulonephritis in diabetes mellitus type II? Clin Neph 1992;37:271-273. Wang S-L, Head J, Stevens L, et al. Excess mortality and its relation to hypertension and proteinuria in diabetic patients. Diabetes Care 1996;19:305-311. Weidmann P, Schneider M, Bohlen L. Therapeutic efficacy of different antihypertensive drugs in human diabetic nephropathy: An updated meta-analysis. Nephrol Dial Transplant 1995;10�(suppl 9):39-45. World Health Organization. The World Health Report 1997: Conquering Suffering, Enriching Humanity. Geneva, Switzerland. 1997. Zanchetti A, Agabiti-Rosei E, Dal Palu C, et al. The verapamil in hypertension and atherosclerosis study (VHAS): results of long-term randomized treatment with either verapamil or chlorthalidone on carotid intima-media thickness. J Hypertens 1998;16:1667-1676. Zatz R, Dunn BR, Meyer TW, et al. Prevention of diabetic glomuerulopathy by pharmacological amelioration of glomerular capillary hypertension. J Clin Invest 1986;77:1925-1930.
Hypertension artérielle et diabète
Plan
I.- Qu’est-ce que la pression artérielle ? a) ne pas confondre avec la tension nerveuse b) Pression artérielle systolique et diastolique c) Définition de l’hypertension artérielle II.- Fréquence de l’hypertension artérielle III.- L’hypertension artérielle: -maladie ? -Facteur de risque cardio-vasculaire? IV.- Causes: a) Hypertension artérielle primaire b) Hypertension artérielle secondaire V.- Hypertension et diabète: un mauvais couple! VI.- Quelques éléments de traitement a) non médicamenteux b) médicamenteux
Présentateur
Commentaires de présentation
UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. Br Med J 1998a;317:703-713. UK Prospective Diabetes Study Group. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. Br Med J 1998b;317:713-720. UK Prospective Diabetes Study Group. Study design, progress and performance. Diabetologia 1991;34:877-890. United States Renal Data System, USRDS 1999 Annual Data Report. National Institutes of Health, National Institutes of Diabetes and Digestive and Kidney Diseases. Bethesda, MD, April, 1999. U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention (CDC), National Center For Health Statistics. (Vital and health statistics, plan and operation of the third national health and nutrition and examination survey, 1988-1994). DHHS publication no. (PHS) 94-1308, series 1, No. 324-0485. Valentino VA, Wilson MD, Weart W, Bakris GL. A perspective on converting enzyme inhibitors �and calcium channel antagonists in diabetic renal disease. Arch Intern Med 1991;151:2367-2372. Velussi M, Brocco E, Frigato F, et al. Effects of cilazapril and amlodipine on kidney function in hypertensive NIDDM patients. Diabetes 1996;45:216-222. Waldherr R, Ilkenhans C, Ritz E. How frequent is glomerulonephritis in diabetes mellitus type II? Clin Neph 1992;37:271-273. Wang S-L, Head J, Stevens L, et al. Excess mortality and its relation to hypertension and proteinuria in diabetic patients. Diabetes Care 1996;19:305-311. Weidmann P, Schneider M, Bohlen L. Therapeutic efficacy of different antihypertensive drugs in human diabetic nephropathy: An updated meta-analysis. Nephrol Dial Transplant 1995;10�(suppl 9):39-45. World Health Organization. The World Health Report 1997: Conquering Suffering, Enriching Humanity. Geneva, Switzerland. 1997. Zanchetti A, Agabiti-Rosei E, Dal Palu C, et al. The verapamil in hypertension and atherosclerosis study (VHAS): results of long-term randomized treatment with either verapamil or chlorthalidone on carotid intima-media thickness. J Hypertens 1998;16:1667-1676. Zatz R, Dunn BR, Meyer TW, et al. Prevention of diabetic glomuerulopathy by pharmacological amelioration of glomerular capillary hypertension. J Clin Invest 1986;77:1925-1930.
Hypertension artérielle et diabète
Des faits:
Entre 2 et 3 g. de sel suffisent par jour
En Suisse la consommation de sel moyenne est de 12 g.
En diminuant à 6 g. par jour on pourrait éviter en Suisse 1’700 attaques cérébrales 2’575 infarctus myocardiques
Présentateur
Commentaires de présentation
UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. Br Med J 1998a;317:703-713. UK Prospective Diabetes Study Group. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. Br Med J 1998b;317:713-720. UK Prospective Diabetes Study Group. Study design, progress and performance. Diabetologia 1991;34:877-890. United States Renal Data System, USRDS 1999 Annual Data Report. National Institutes of Health, National Institutes of Diabetes and Digestive and Kidney Diseases. Bethesda, MD, April, 1999. U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention (CDC), National Center For Health Statistics. (Vital and health statistics, plan and operation of the third national health and nutrition and examination survey, 1988-1994). DHHS publication no. (PHS) 94-1308, series 1, No. 324-0485. Valentino VA, Wilson MD, Weart W, Bakris GL. A perspective on converting enzyme inhibitors �and calcium channel antagonists in diabetic renal disease. Arch Intern Med 1991;151:2367-2372. Velussi M, Brocco E, Frigato F, et al. Effects of cilazapril and amlodipine on kidney function in hypertensive NIDDM patients. Diabetes 1996;45:216-222. Waldherr R, Ilkenhans C, Ritz E. How frequent is glomerulonephritis in diabetes mellitus type II? Clin Neph 1992;37:271-273. Wang S-L, Head J, Stevens L, et al. Excess mortality and its relation to hypertension and proteinuria in diabetic patients. Diabetes Care 1996;19:305-311. Weidmann P, Schneider M, Bohlen L. Therapeutic efficacy of different antihypertensive drugs in human diabetic nephropathy: An updated meta-analysis. Nephrol Dial Transplant 1995;10�(suppl 9):39-45. World Health Organization. The World Health Report 1997: Conquering Suffering, Enriching Humanity. Geneva, Switzerland. 1997. Zanchetti A, Agabiti-Rosei E, Dal Palu C, et al. The verapamil in hypertension and atherosclerosis study (VHAS): results of long-term randomized treatment with either verapamil or chlorthalidone on carotid intima-media thickness. J Hypertens 1998;16:1667-1676. Zatz R, Dunn BR, Meyer TW, et al. Prevention of diabetic glomuerulopathy by pharmacological amelioration of glomerular capillary hypertension. J Clin Invest 1986;77:1925-1930.
Hypertension artérielle et diabète
Présentateur
Commentaires de présentation
Perico N, Remuzzi A, Sangalli F, et al. The antiproteinuric effect of angiotensin antagonism in human IgA nephropathy is potentiated by indomethacin. J Am Soc Nephrol 1998;9:2308-2317. Pinel N, Fadel B, Bilous RW, et al. Renal biopsies in 30 micro and macroalbuminuric type 2 patients. Heterogeneity of renal lesions. Diabetologia 1995;38(suppl 1):A217. Pitt B, Byington RP, Furberg CD, et al. Effect of amlodipine on the progression of atherosclerosis and the occurrence of clinical events. Circulation 2000;102:1503-1510. Pohl M, Cooper M, Ulrey J, et al. Safety and efficacy of irbesartan in hypertensive patients with type II diabetes and proteinuria. Am J Hypertens 1997;10:105A. Abstract. Pugh JA, Medina R, Ramirez, M. Comparison of the course to end-stage renal disease of type 1 (insulin-dependent) and type 2 (non-insulin-dependent) diabetic nephropathy. Diabetologia 1993;36:1094-1098. Raine AEG, Bilous RW. End-stage renal disease in NIDDM: a consequence of microangiopathy alone? Diabetologia 1996;39:1673-1675. Raine AEG. Epidemiology, development and treatment of of end-stage renal failure in type 2 (non-insulin dependent) diabetic patients in Europe. Diabetologia 1993;36:1099-1104. Ravid M, Savin H, Jutrin I, et al. Long-term stabilizing effect of angiotensin-converting enzyme inhibition on plasma creatinine and on proteinuria in normotensive type II diabetic patients. Ann Intern Med 1993;118:577-581. Reeves RA, Lin C-S, Kassler-Taub K, Pouleur H. Dose-related efficacy of irbesartan for hypertension: an integrated analysis. Hypertension 1998;31:1311-1316. Ribstein J, Picard A, Armagnac C, et al. Inhibition of the acute effects of angiotensin II by the receptor antagonist irbesartan in normotensive men. J Cardiovasc Pharmacol 2001;37:449-460. Ritz E, Stefanski A. Diabetic nephropathy in type II diabetes. Am J Kid Dis 1996;27:167-194. Rossing P, Hommel E, Smidt UM, et al. Reduction in albuminuria predicts diminished progresion in diabetic nephropathy. Kidney Int 1994;45(suppl.):S145-S149. Ruggenenti P, Gambara V, Perna A, et al. The nephropathy of non-insulin-dependent diabetes: predictors of outcome relative to diverse patterns of renal injury. J Am Soc Nephrol 1998;9:2336-2343. Savage S, Niegel NJ, Estacio RO, et al. Clinical factors associated with urinary albumin excretion in type II diabetes. Am J Kid Dis 1995;25:836-844. Schmitz A, Vaeth M. Microalbuminuria: a major risk factor in non-insulin-dependent diabetes. A 10-year follow-up study of 503 patients. Diabet Med 1988;5:126-134. Schwartz MM, Lewis EJ, Leonard-Martin T, et al. Renal pathology patterns in type II diabetes mellitus: Relationship with retinopathy. Nephrol Dial Transpl 1998;13:2547-2552. Simon TA, Gelarden T, Freitag SA, et al. Safety of irbesartan in the treatment of mild to moderate systemic hypertension. Am J Cardiol 1998;82:179-182. Staessen JA, Fagard R, Thijs L, et al. Randomized double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. Lancet 1997;350:757-764. Stamler J, Vaccaro O, Neaton JD, et al. Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in multiple risk factor intervention trial. Diabetes Care 1993;16:434-444. Stone PH, Muller JE, Hartwell T, et al. The effect of diabetes mellitus on pronosis and serial left ventricular function after acute myocardial infarction: contribution of both coronary disease and diastolic left ventricular dysfunction to the adverse prognosis. The MILIS Study Group. J Am Cardiol 1989;14:49-57. Suzuki Y, Ueno M, Hayashi H, et al. A light microscopic study of glomerulosclerosis in Japanese patients with non-insulin-dependent diabetes mellitus: the relationship between clinical and histological features. Clin Nephrol 1994;42:155-162. Tarnow L, Rossing P, Gall M-A, et al. Prevalence of arterial hypertension in diabetic patients before and after the JNC-V. Diabet Care 1994;17:1247-51. Teo KK, Burton JR, Buller CE, et al. Long-term effects of cholesterol lowering and angiotensin -converting enzyme inhibition on coronary atherosclerosis. The simvastatin/enalapril coronary atherosclerosis trial (SCAT). Circulation 2000;102:1748-1754. Tuomilehto J, Rastenyte D, Birkenhäger WH, et al. Effects of calcium-channel blockade in older patients with diabetes and systolic hypertension. N Engl J Med 1999;340:677-84.
Hypertension artérielle et diabète
Présentateur
Commentaires de présentation
UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. Br Med J 1998a;317:703-713. UK Prospective Diabetes Study Group. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. Br Med J 1998b;317:713-720. UK Prospective Diabetes Study Group. Study design, progress and performance. Diabetologia 1991;34:877-890. United States Renal Data System, USRDS 1999 Annual Data Report. National Institutes of Health, National Institutes of Diabetes and Digestive and Kidney Diseases. Bethesda, MD, April, 1999. U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention (CDC), National Center For Health Statistics. (Vital and health statistics, plan and operation of the third national health and nutrition and examination survey, 1988-1994). DHHS publication no. (PHS) 94-1308, series 1, No. 324-0485. Valentino VA, Wilson MD, Weart W, Bakris GL. A perspective on converting enzyme inhibitors �and calcium channel antagonists in diabetic renal disease. Arch Intern Med 1991;151:2367-2372. Velussi M, Brocco E, Frigato F, et al. Effects of cilazapril and amlodipine on kidney function in hypertensive NIDDM patients. Diabetes 1996;45:216-222. Waldherr R, Ilkenhans C, Ritz E. How frequent is glomerulonephritis in diabetes mellitus type II? Clin Neph 1992;37:271-273. Wang S-L, Head J, Stevens L, et al. Excess mortality and its relation to hypertension and proteinuria in diabetic patients. Diabetes Care 1996;19:305-311. Weidmann P, Schneider M, Bohlen L. Therapeutic efficacy of different antihypertensive drugs in human diabetic nephropathy: An updated meta-analysis. Nephrol Dial Transplant 1995;10�(suppl 9):39-45. World Health Organization. The World Health Report 1997: Conquering Suffering, Enriching Humanity. Geneva, Switzerland. 1997. Zanchetti A, Agabiti-Rosei E, Dal Palu C, et al. The verapamil in hypertension and atherosclerosis study (VHAS): results of long-term randomized treatment with either verapamil or chlorthalidone on carotid intima-media thickness. J Hypertens 1998;16:1667-1676. Zatz R, Dunn BR, Meyer TW, et al. Prevention of diabetic glomuerulopathy by pharmacological amelioration of glomerular capillary hypertension. J Clin Invest 1986;77:1925-1930.
Hypertension artérielle et diabète
Moore LL et al. Arch Intern Med 2005; 165:1298-1303.
Cohort Risk reduction (%)
Relative risk 95% CI
Age 30–49 22 0.78 0.60–1.03
Age 50–65 26 0.74 0.56–0.97
Relative risk reduction for incident hypertension associated with sustained weight loss of ≥1.8 kg: The Framingham Study
Présentateur
Commentaires de présentation
UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. Br Med J 1998a;317:703-713. UK Prospective Diabetes Study Group. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. Br Med J 1998b;317:713-720. UK Prospective Diabetes Study Group. Study design, progress and performance. Diabetologia 1991;34:877-890. United States Renal Data System, USRDS 1999 Annual Data Report. National Institutes of Health, National Institutes of Diabetes and Digestive and Kidney Diseases. Bethesda, MD, April, 1999. U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention (CDC), National Center For Health Statistics. (Vital and health statistics, plan and operation of the third national health and nutrition and examination survey, 1988-1994). DHHS publication no. (PHS) 94-1308, series 1, No. 324-0485. Valentino VA, Wilson MD, Weart W, Bakris GL. A perspective on converting enzyme inhibitors �and calcium channel antagonists in diabetic renal disease. Arch Intern Med 1991;151:2367-2372. Velussi M, Brocco E, Frigato F, et al. Effects of cilazapril and amlodipine on kidney function in hypertensive NIDDM patients. Diabetes 1996;45:216-222. Waldherr R, Ilkenhans C, Ritz E. How frequent is glomerulonephritis in diabetes mellitus type II? Clin Neph 1992;37:271-273. Wang S-L, Head J, Stevens L, et al. Excess mortality and its relation to hypertension and proteinuria in diabetic patients. Diabetes Care 1996;19:305-311. Weidmann P, Schneider M, Bohlen L. Therapeutic efficacy of different antihypertensive drugs in human diabetic nephropathy: An updated meta-analysis. Nephrol Dial Transplant 1995;10�(suppl 9):39-45. World Health Organization. The World Health Report 1997: Conquering Suffering, Enriching Humanity. Geneva, Switzerland. 1997. Zanchetti A, Agabiti-Rosei E, Dal Palu C, et al. The verapamil in hypertension and atherosclerosis study (VHAS): results of long-term randomized treatment with either verapamil or chlorthalidone on carotid intima-media thickness. J Hypertens 1998;16:1667-1676. Zatz R, Dunn BR, Meyer TW, et al. Prevention of diabetic glomuerulopathy by pharmacological amelioration of glomerular capillary hypertension. J Clin Invest 1986;77:1925-1930.
Hypertension artérielle et diabète
Moore LL et al. Arch Intern Med 2005; 165:1298-1303.
Cohort Risk reduction (%)
Relative risk 95% CI
Age 30–49 28 0.72 0.49–1.05
Age 50–65 47 0.63 0.42–0.95
Relative risk reduction for incident hypertension associated with weight loss of ≥6.8 kg: The Framingham Study
Présentateur
Commentaires de présentation
UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. Br Med J 1998a;317:703-713. UK Prospective Diabetes Study Group. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. Br Med J 1998b;317:713-720. UK Prospective Diabetes Study Group. Study design, progress and performance. Diabetologia 1991;34:877-890. United States Renal Data System, USRDS 1999 Annual Data Report. National Institutes of Health, National Institutes of Diabetes and Digestive and Kidney Diseases. Bethesda, MD, April, 1999. U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention (CDC), National Center For Health Statistics. (Vital and health statistics, plan and operation of the third national health and nutrition and examination survey, 1988-1994). DHHS publication no. (PHS) 94-1308, series 1, No. 324-0485. Valentino VA, Wilson MD, Weart W, Bakris GL. A perspective on converting enzyme inhibitors �and calcium channel antagonists in diabetic renal disease. Arch Intern Med 1991;151:2367-2372. Velussi M, Brocco E, Frigato F, et al. Effects of cilazapril and amlodipine on kidney function in hypertensive NIDDM patients. Diabetes 1996;45:216-222. Waldherr R, Ilkenhans C, Ritz E. How frequent is glomerulonephritis in diabetes mellitus type II? Clin Neph 1992;37:271-273. Wang S-L, Head J, Stevens L, et al. Excess mortality and its relation to hypertension and proteinuria in diabetic patients. Diabetes Care 1996;19:305-311. Weidmann P, Schneider M, Bohlen L. Therapeutic efficacy of different antihypertensive drugs in human diabetic nephropathy: An updated meta-analysis. Nephrol Dial Transplant 1995;10�(suppl 9):39-45. World Health Organization. The World Health Report 1997: Conquering Suffering, Enriching Humanity. Geneva, Switzerland. 1997. Zanchetti A, Agabiti-Rosei E, Dal Palu C, et al. The verapamil in hypertension and atherosclerosis study (VHAS): results of long-term randomized treatment with either verapamil or chlorthalidone on carotid intima-media thickness. J Hypertens 1998;16:1667-1676. Zatz R, Dunn BR, Meyer TW, et al. Prevention of diabetic glomuerulopathy by pharmacological amelioration of glomerular capillary hypertension. J Clin Invest 1986;77:1925-1930.
Hypertension artérielle et diabète
A bon entendeur SALUT !
Présentateur
Commentaires de présentation
UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. Br Med J 1998a;317:703-713. UK Prospective Diabetes Study Group. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. Br Med J 1998b;317:713-720. UK Prospective Diabetes Study Group. Study design, progress and performance. Diabetologia 1991;34:877-890. United States Renal Data System, USRDS 1999 Annual Data Report. National Institutes of Health, National Institutes of Diabetes and Digestive and Kidney Diseases. Bethesda, MD, April, 1999. U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention (CDC), National Center For Health Statistics. (Vital and health statistics, plan and operation of the third national health and nutrition and examination survey, 1988-1994). DHHS publication no. (PHS) 94-1308, series 1, No. 324-0485. Valentino VA, Wilson MD, Weart W, Bakris GL. A perspective on converting enzyme inhibitors �and calcium channel antagonists in diabetic renal disease. Arch Intern Med 1991;151:2367-2372. Velussi M, Brocco E, Frigato F, et al. Effects of cilazapril and amlodipine on kidney function in hypertensive NIDDM patients. Diabetes 1996;45:216-222. Waldherr R, Ilkenhans C, Ritz E. How frequent is glomerulonephritis in diabetes mellitus type II? Clin Neph 1992;37:271-273. Wang S-L, Head J, Stevens L, et al. Excess mortality and its relation to hypertension and proteinuria in diabetic patients. Diabetes Care 1996;19:305-311. Weidmann P, Schneider M, Bohlen L. Therapeutic efficacy of different antihypertensive drugs in human diabetic nephropathy: An updated meta-analysis. Nephrol Dial Transplant 1995;10�(suppl 9):39-45. World Health Organization. The World Health Report 1997: Conquering Suffering, Enriching Humanity. Geneva, Switzerland. 1997. Zanchetti A, Agabiti-Rosei E, Dal Palu C, et al. The verapamil in hypertension and atherosclerosis study (VHAS): results of long-term randomized treatment with either verapamil or chlorthalidone on carotid intima-media thickness. J Hypertens 1998;16:1667-1676. Zatz R, Dunn BR, Meyer TW, et al. Prevention of diabetic glomuerulopathy by pharmacological amelioration of glomerular capillary hypertension. J Clin Invest 1986;77:1925-1930.
Hypertension artérielle et diabète
Soit environ 10 % de plus de survivant à 75 ans
Courbe de survie pour personnes de 50 ans selon le degré d’activité physique
Présentateur
Commentaires de présentation
UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. Br Med J 1998a;317:703-713. UK Prospective Diabetes Study Group. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. Br Med J 1998b;317:713-720. UK Prospective Diabetes Study Group. Study design, progress and performance. Diabetologia 1991;34:877-890. United States Renal Data System, USRDS 1999 Annual Data Report. National Institutes of Health, National Institutes of Diabetes and Digestive and Kidney Diseases. Bethesda, MD, April, 1999. U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention (CDC), National Center For Health Statistics. (Vital and health statistics, plan and operation of the third national health and nutrition and examination survey, 1988-1994). DHHS publication no. (PHS) 94-1308, series 1, No. 324-0485. Valentino VA, Wilson MD, Weart W, Bakris GL. A perspective on converting enzyme inhibitors �and calcium channel antagonists in diabetic renal disease. Arch Intern Med 1991;151:2367-2372. Velussi M, Brocco E, Frigato F, et al. Effects of cilazapril and amlodipine on kidney function in hypertensive NIDDM patients. Diabetes 1996;45:216-222. Waldherr R, Ilkenhans C, Ritz E. How frequent is glomerulonephritis in diabetes mellitus type II? Clin Neph 1992;37:271-273. Wang S-L, Head J, Stevens L, et al. Excess mortality and its relation to hypertension and proteinuria in diabetic patients. Diabetes Care 1996;19:305-311. Weidmann P, Schneider M, Bohlen L. Therapeutic efficacy of different antihypertensive drugs in human diabetic nephropathy: An updated meta-analysis. Nephrol Dial Transplant 1995;10�(suppl 9):39-45. World Health Organization. The World Health Report 1997: Conquering Suffering, Enriching Humanity. Geneva, Switzerland. 1997. Zanchetti A, Agabiti-Rosei E, Dal Palu C, et al. The verapamil in hypertension and atherosclerosis study (VHAS): results of long-term randomized treatment with either verapamil or chlorthalidone on carotid intima-media thickness. J Hypertens 1998;16:1667-1676. Zatz R, Dunn BR, Meyer TW, et al. Prevention of diabetic glomuerulopathy by pharmacological amelioration of glomerular capillary hypertension. J Clin Invest 1986;77:1925-1930.
Hypertension artérielle et diabète
Présentateur
Commentaires de présentation
Perico N, Remuzzi A, Sangalli F, et al. The antiproteinuric effect of angiotensin antagonism in human IgA nephropathy is potentiated by indomethacin. J Am Soc Nephrol 1998;9:2308-2317. Pinel N, Fadel B, Bilous RW, et al. Renal biopsies in 30 micro and macroalbuminuric type 2 patients. Heterogeneity of renal lesions. Diabetologia 1995;38(suppl 1):A217. Pitt B, Byington RP, Furberg CD, et al. Effect of amlodipine on the progression of atherosclerosis and the occurrence of clinical events. Circulation 2000;102:1503-1510. Pohl M, Cooper M, Ulrey J, et al. Safety and efficacy of irbesartan in hypertensive patients with type II diabetes and proteinuria. Am J Hypertens 1997;10:105A. Abstract. Pugh JA, Medina R, Ramirez, M. Comparison of the course to end-stage renal disease of type 1 (insulin-dependent) and type 2 (non-insulin-dependent) diabetic nephropathy. Diabetologia 1993;36:1094-1098. Raine AEG, Bilous RW. End-stage renal disease in NIDDM: a consequence of microangiopathy alone? Diabetologia 1996;39:1673-1675. Raine AEG. Epidemiology, development and treatment of of end-stage renal failure in type 2 (non-insulin dependent) diabetic patients in Europe. Diabetologia 1993;36:1099-1104. Ravid M, Savin H, Jutrin I, et al. Long-term stabilizing effect of angiotensin-converting enzyme inhibition on plasma creatinine and on proteinuria in normotensive type II diabetic patients. Ann Intern Med 1993;118:577-581. Reeves RA, Lin C-S, Kassler-Taub K, Pouleur H. Dose-related efficacy of irbesartan for hypertension: an integrated analysis. Hypertension 1998;31:1311-1316. Ribstein J, Picard A, Armagnac C, et al. Inhibition of the acute effects of angiotensin II by the receptor antagonist irbesartan in normotensive men. J Cardiovasc Pharmacol 2001;37:449-460. Ritz E, Stefanski A. Diabetic nephropathy in type II diabetes. Am J Kid Dis 1996;27:167-194. Rossing P, Hommel E, Smidt UM, et al. Reduction in albuminuria predicts diminished progresion in diabetic nephropathy. Kidney Int 1994;45(suppl.):S145-S149. Ruggenenti P, Gambara V, Perna A, et al. The nephropathy of non-insulin-dependent diabetes: predictors of outcome relative to diverse patterns of renal injury. J Am Soc Nephrol 1998;9:2336-2343. Savage S, Niegel NJ, Estacio RO, et al. Clinical factors associated with urinary albumin excretion in type II diabetes. Am J Kid Dis 1995;25:836-844. Schmitz A, Vaeth M. Microalbuminuria: a major risk factor in non-insulin-dependent diabetes. A 10-year follow-up study of 503 patients. Diabet Med 1988;5:126-134. Schwartz MM, Lewis EJ, Leonard-Martin T, et al. Renal pathology patterns in type II diabetes mellitus: Relationship with retinopathy. Nephrol Dial Transpl 1998;13:2547-2552. Simon TA, Gelarden T, Freitag SA, et al. Safety of irbesartan in the treatment of mild to moderate systemic hypertension. Am J Cardiol 1998;82:179-182. Staessen JA, Fagard R, Thijs L, et al. Randomized double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. Lancet 1997;350:757-764. Stamler J, Vaccaro O, Neaton JD, et al. Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in multiple risk factor intervention trial. Diabetes Care 1993;16:434-444. Stone PH, Muller JE, Hartwell T, et al. The effect of diabetes mellitus on pronosis and serial left ventricular function after acute myocardial infarction: contribution of both coronary disease and diastolic left ventricular dysfunction to the adverse prognosis. The MILIS Study Group. J Am Cardiol 1989;14:49-57. Suzuki Y, Ueno M, Hayashi H, et al. A light microscopic study of glomerulosclerosis in Japanese patients with non-insulin-dependent diabetes mellitus: the relationship between clinical and histological features. Clin Nephrol 1994;42:155-162. Tarnow L, Rossing P, Gall M-A, et al. Prevalence of arterial hypertension in diabetic patients before and after the JNC-V. Diabet Care 1994;17:1247-51. Teo KK, Burton JR, Buller CE, et al. Long-term effects of cholesterol lowering and angiotensin -converting enzyme inhibition on coronary atherosclerosis. The simvastatin/enalapril coronary atherosclerosis trial (SCAT). Circulation 2000;102:1748-1754. Tuomilehto J, Rastenyte D, Birkenhäger WH, et al. Effects of calcium-channel blockade in older patients with diabetes and systolic hypertension. N Engl J Med 1999;340:677-84.
Hypertension artérielle et diabète
Présentateur
Commentaires de présentation
Perico N, Remuzzi A, Sangalli F, et al. The antiproteinuric effect of angiotensin antagonism in human IgA nephropathy is potentiated by indomethacin. J Am Soc Nephrol 1998;9:2308-2317. Pinel N, Fadel B, Bilous RW, et al. Renal biopsies in 30 micro and macroalbuminuric type 2 patients. Heterogeneity of renal lesions. Diabetologia 1995;38(suppl 1):A217. Pitt B, Byington RP, Furberg CD, et al. Effect of amlodipine on the progression of atherosclerosis and the occurrence of clinical events. Circulation 2000;102:1503-1510. Pohl M, Cooper M, Ulrey J, et al. Safety and efficacy of irbesartan in hypertensive patients with type II diabetes and proteinuria. Am J Hypertens 1997;10:105A. Abstract. Pugh JA, Medina R, Ramirez, M. Comparison of the course to end-stage renal disease of type 1 (insulin-dependent) and type 2 (non-insulin-dependent) diabetic nephropathy. Diabetologia 1993;36:1094-1098. Raine AEG, Bilous RW. End-stage renal disease in NIDDM: a consequence of microangiopathy alone? Diabetologia 1996;39:1673-1675. Raine AEG. Epidemiology, development and treatment of of end-stage renal failure in type 2 (non-insulin dependent) diabetic patients in Europe. Diabetologia 1993;36:1099-1104. Ravid M, Savin H, Jutrin I, et al. Long-term stabilizing effect of angiotensin-converting enzyme inhibition on plasma creatinine and on proteinuria in normotensive type II diabetic patients. Ann Intern Med 1993;118:577-581. Reeves RA, Lin C-S, Kassler-Taub K, Pouleur H. Dose-related efficacy of irbesartan for hypertension: an integrated analysis. Hypertension 1998;31:1311-1316. Ribstein J, Picard A, Armagnac C, et al. Inhibition of the acute effects of angiotensin II by the receptor antagonist irbesartan in normotensive men. J Cardiovasc Pharmacol 2001;37:449-460. Ritz E, Stefanski A. Diabetic nephropathy in type II diabetes. Am J Kid Dis 1996;27:167-194. Rossing P, Hommel E, Smidt UM, et al. Reduction in albuminuria predicts diminished progresion in diabetic nephropathy. Kidney Int 1994;45(suppl.):S145-S149. Ruggenenti P, Gambara V, Perna A, et al. The nephropathy of non-insulin-dependent diabetes: predictors of outcome relative to diverse patterns of renal injury. J Am Soc Nephrol 1998;9:2336-2343. Savage S, Niegel NJ, Estacio RO, et al. Clinical factors associated with urinary albumin excretion in type II diabetes. Am J Kid Dis 1995;25:836-844. Schmitz A, Vaeth M. Microalbuminuria: a major risk factor in non-insulin-dependent diabetes. A 10-year follow-up study of 503 patients. Diabet Med 1988;5:126-134. Schwartz MM, Lewis EJ, Leonard-Martin T, et al. Renal pathology patterns in type II diabetes mellitus: Relationship with retinopathy. Nephrol Dial Transpl 1998;13:2547-2552. Simon TA, Gelarden T, Freitag SA, et al. Safety of irbesartan in the treatment of mild to moderate systemic hypertension. Am J Cardiol 1998;82:179-182. Staessen JA, Fagard R, Thijs L, et al. Randomized double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. Lancet 1997;350:757-764. Stamler J, Vaccaro O, Neaton JD, et al. Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in multiple risk factor intervention trial. Diabetes Care 1993;16:434-444. Stone PH, Muller JE, Hartwell T, et al. The effect of diabetes mellitus on pronosis and serial left ventricular function after acute myocardial infarction: contribution of both coronary disease and diastolic left ventricular dysfunction to the adverse prognosis. The MILIS Study Group. J Am Cardiol 1989;14:49-57. Suzuki Y, Ueno M, Hayashi H, et al. A light microscopic study of glomerulosclerosis in Japanese patients with non-insulin-dependent diabetes mellitus: the relationship between clinical and histological features. Clin Nephrol 1994;42:155-162. Tarnow L, Rossing P, Gall M-A, et al. Prevalence of arterial hypertension in diabetic patients before and after the JNC-V. Diabet Care 1994;17:1247-51. Teo KK, Burton JR, Buller CE, et al. Long-term effects of cholesterol lowering and angiotensin -converting enzyme inhibition on coronary atherosclerosis. The simvastatin/enalapril coronary atherosclerosis trial (SCAT). Circulation 2000;102:1748-1754. Tuomilehto J, Rastenyte D, Birkenhäger WH, et al. Effects of calcium-channel blockade in older patients with diabetes and systolic hypertension. N Engl J Med 1999;340:677-84.
Hypertension artérielle et diabète
Plan
I.- Qu’est-ce que la pression artérielle ? a) ne pas confondre avec la tension nerveuse b) Pression artérielle systolique et diastolique c) Définition de l’hypertension artérielle II.- Fréquence de l’hypertension artérielle III.- L’hypertension artérielle: -maladie ? -Facteur de risque cardio-vasculaire? IV.- Causes: a) Hypertension artérielle primaire b) Hypertension artérielle secondaire V.- Hypertension et diabète: un mauvais couple! VI.- Quelques éléments de traitement a) non médicamenteux b) médicamenteux
Présentateur
Commentaires de présentation
UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. Br Med J 1998a;317:703-713. UK Prospective Diabetes Study Group. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. Br Med J 1998b;317:713-720. UK Prospective Diabetes Study Group. Study design, progress and performance. Diabetologia 1991;34:877-890. United States Renal Data System, USRDS 1999 Annual Data Report. National Institutes of Health, National Institutes of Diabetes and Digestive and Kidney Diseases. Bethesda, MD, April, 1999. U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention (CDC), National Center For Health Statistics. (Vital and health statistics, plan and operation of the third national health and nutrition and examination survey, 1988-1994). DHHS publication no. (PHS) 94-1308, series 1, No. 324-0485. Valentino VA, Wilson MD, Weart W, Bakris GL. A perspective on converting enzyme inhibitors �and calcium channel antagonists in diabetic renal disease. Arch Intern Med 1991;151:2367-2372. Velussi M, Brocco E, Frigato F, et al. Effects of cilazapril and amlodipine on kidney function in hypertensive NIDDM patients. Diabetes 1996;45:216-222. Waldherr R, Ilkenhans C, Ritz E. How frequent is glomerulonephritis in diabetes mellitus type II? Clin Neph 1992;37:271-273. Wang S-L, Head J, Stevens L, et al. Excess mortality and its relation to hypertension and proteinuria in diabetic patients. Diabetes Care 1996;19:305-311. Weidmann P, Schneider M, Bohlen L. Therapeutic efficacy of different antihypertensive drugs in human diabetic nephropathy: An updated meta-analysis. Nephrol Dial Transplant 1995;10�(suppl 9):39-45. World Health Organization. The World Health Report 1997: Conquering Suffering, Enriching Humanity. Geneva, Switzerland. 1997. Zanchetti A, Agabiti-Rosei E, Dal Palu C, et al. The verapamil in hypertension and atherosclerosis study (VHAS): results of long-term randomized treatment with either verapamil or chlorthalidone on carotid intima-media thickness. J Hypertens 1998;16:1667-1676. Zatz R, Dunn BR, Meyer TW, et al. Prevention of diabetic glomuerulopathy by pharmacological amelioration of glomerular capillary hypertension. J Clin Invest 1986;77:1925-1930.
Hypertension artérielle et diabète
UKPDS - Sujets et méthode
1148 patients
Age moyen 56 ans
PA moyenne 160/94 mmHg
758 randomisés dans groupe de contrôle stricte de la PA(<150/85 mmHg)
390 dans groupe moins contrôlé (<180/105)
Follow-up moyen : 8.4 ans
Présentateur
Commentaires de présentation
UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. Br Med J 1998a;317:703-713. UK Prospective Diabetes Study Group. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. Br Med J 1998b;317:713-720. UK Prospective Diabetes Study Group. Study design, progress and performance. Diabetologia 1991;34:877-890. United States Renal Data System, USRDS 1999 Annual Data Report. National Institutes of Health, National Institutes of Diabetes and Digestive and Kidney Diseases. Bethesda, MD, April, 1999. U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention (CDC), National Center For Health Statistics. (Vital and health statistics, plan and operation of the third national health and nutrition and examination survey, 1988-1994). DHHS publication no. (PHS) 94-1308, series 1, No. 324-0485. Valentino VA, Wilson MD, Weart W, Bakris GL. A perspective on converting enzyme inhibitors �and calcium channel antagonists in diabetic renal disease. Arch Intern Med 1991;151:2367-2372. Velussi M, Brocco E, Frigato F, et al. Effects of cilazapril and amlodipine on kidney function in hypertensive NIDDM patients. Diabetes 1996;45:216-222. Waldherr R, Ilkenhans C, Ritz E. How frequent is glomerulonephritis in diabetes mellitus type II? Clin Neph 1992;37:271-273. Wang S-L, Head J, Stevens L, et al. Excess mortality and its relation to hypertension and proteinuria in diabetic patients. Diabetes Care 1996;19:305-311. Weidmann P, Schneider M, Bohlen L. Therapeutic efficacy of different antihypertensive drugs in human diabetic nephropathy: An updated meta-analysis. Nephrol Dial Transplant 1995;10�(suppl 9):39-45. World Health Organization. The World Health Report 1997: Conquering Suffering, Enriching Humanity. Geneva, Switzerland. 1997. Zanchetti A, Agabiti-Rosei E, Dal Palu C, et al. The verapamil in hypertension and atherosclerosis study (VHAS): results of long-term randomized treatment with either verapamil or chlorthalidone on carotid intima-media thickness. J Hypertens 1998;16:1667-1676. Zatz R, Dunn BR, Meyer TW, et al. Prevention of diabetic glomuerulopathy by pharmacological amelioration of glomerular capillary hypertension. J Clin Invest 1986;77:1925-1930.
Hypertension artérielle et diabète
UKPDS-Principaux résultats (1)
Groupe A = contrôle stricte < 150/85
Groupe B = contrôle - stricte < 180/105 56%<150/85
Gr. A:PA moyenne 144/82 96%<180/105 37%<150/85
Gr. B: PA moyenne 154/87 91%<180/105
Présentateur
Commentaires de présentation
UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. Br Med J 1998a;317:703-713. UK Prospective Diabetes Study Group. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. Br Med J 1998b;317:713-720. UK Prospective Diabetes Study Group. Study design, progress and performance. Diabetologia 1991;34:877-890. United States Renal Data System, USRDS 1999 Annual Data Report. National Institutes of Health, National Institutes of Diabetes and Digestive and Kidney Diseases. Bethesda, MD, April, 1999. U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention (CDC), National Center For Health Statistics. (Vital and health statistics, plan and operation of the third national health and nutrition and examination survey, 1988-1994). DHHS publication no. (PHS) 94-1308, series 1, No. 324-0485. Valentino VA, Wilson MD, Weart W, Bakris GL. A perspective on converting enzyme inhibitors �and calcium channel antagonists in diabetic renal disease. Arch Intern Med 1991;151:2367-2372. Velussi M, Brocco E, Frigato F, et al. Effects of cilazapril and amlodipine on kidney function in hypertensive NIDDM patients. Diabetes 1996;45:216-222. Waldherr R, Ilkenhans C, Ritz E. How frequent is glomerulonephritis in diabetes mellitus type II? Clin Neph 1992;37:271-273. Wang S-L, Head J, Stevens L, et al. Excess mortality and its relation to hypertension and proteinuria in diabetic patients. Diabetes Care 1996;19:305-311. Weidmann P, Schneider M, Bohlen L. Therapeutic efficacy of different antihypertensive drugs in human diabetic nephropathy: An updated meta-analysis. Nephrol Dial Transplant 1995;10�(suppl 9):39-45. World Health Organization. The World Health Report 1997: Conquering Suffering, Enriching Humanity. Geneva, Switzerland. 1997. Zanchetti A, Agabiti-Rosei E, Dal Palu C, et al. The verapamil in hypertension and atherosclerosis study (VHAS): results of long-term randomized treatment with either verapamil or chlorthalidone on carotid intima-media thickness. J Hypertens 1998;16:1667-1676. Zatz R, Dunn BR, Meyer TW, et al. Prevention of diabetic glomuerulopathy by pharmacological amelioration of glomerular capillary hypertension. J Clin Invest 1986;77:1925-1930.
Hypertension artérielle et diabète
UKPDS-Principaux résultats (2)
de 44 % des AVC
de 34 % des atteintes macrovasulaires*.
de 37 % des atteintes microvasculaires**
*:AVC+Infarctus+morts subites+amputations **:rétinopathie, albuminurie
Présentateur
Commentaires de présentation
UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. Br Med J 1998a;317:703-713. UK Prospective Diabetes Study Group. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. Br Med J 1998b;317:713-720. UK Prospective Diabetes Study Group. Study design, progress and performance. Diabetologia 1991;34:877-890. United States Renal Data System, USRDS 1999 Annual Data Report. National Institutes of Health, National Institutes of Diabetes and Digestive and Kidney Diseases. Bethesda, MD, April, 1999. U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention (CDC), National Center For Health Statistics. (Vital and health statistics, plan and operation of the third national health and nutrition and examination survey, 1988-1994). DHHS publication no. (PHS) 94-1308, series 1, No. 324-0485. Valentino VA, Wilson MD, Weart W, Bakris GL. A perspective on converting enzyme inhibitors �and calcium channel antagonists in diabetic renal disease. Arch Intern Med 1991;151:2367-2372. Velussi M, Brocco E, Frigato F, et al. Effects of cilazapril and amlodipine on kidney function in hypertensive NIDDM patients. Diabetes 1996;45:216-222. Waldherr R, Ilkenhans C, Ritz E. How frequent is glomerulonephritis in diabetes mellitus type II? Clin Neph 1992;37:271-273. Wang S-L, Head J, Stevens L, et al. Excess mortality and its relation to hypertension and proteinuria in diabetic patients. Diabetes Care 1996;19:305-311. Weidmann P, Schneider M, Bohlen L. Therapeutic efficacy of different antihypertensive drugs in human diabetic nephropathy: An updated meta-analysis. Nephrol Dial Transplant 1995;10�(suppl 9):39-45. World Health Organization. The World Health Report 1997: Conquering Suffering, Enriching Humanity. Geneva, Switzerland. 1997. Zanchetti A, Agabiti-Rosei E, Dal Palu C, et al. The verapamil in hypertension and atherosclerosis study (VHAS): results of long-term randomized treatment with either verapamil or chlorthalidone on carotid intima-media thickness. J Hypertens 1998;16:1667-1676. Zatz R, Dunn BR, Meyer TW, et al. Prevention of diabetic glomuerulopathy by pharmacological amelioration of glomerular capillary hypertension. J Clin Invest 1986;77:1925-1930.
Hypertension artérielle et diabète
UKPDS-Principaux résultats (3)
Entre les Gr A et Gr B il existe une de :
– 56 % des insuffisances cardiaques
– 35% des photocoagulations rétiniennes
Présentateur
Commentaires de présentation
UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. Br Med J 1998a;317:703-713. UK Prospective Diabetes Study Group. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. Br Med J 1998b;317:713-720. UK Prospective Diabetes Study Group. Study design, progress and performance. Diabetologia 1991;34:877-890. United States Renal Data System, USRDS 1999 Annual Data Report. National Institutes of Health, National Institutes of Diabetes and Digestive and Kidney Diseases. Bethesda, MD, April, 1999. U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention (CDC), National Center For Health Statistics. (Vital and health statistics, plan and operation of the third national health and nutrition and examination survey, 1988-1994). DHHS publication no. (PHS) 94-1308, series 1, No. 324-0485. Valentino VA, Wilson MD, Weart W, Bakris GL. A perspective on converting enzyme inhibitors �and calcium channel antagonists in diabetic renal disease. Arch Intern Med 1991;151:2367-2372. Velussi M, Brocco E, Frigato F, et al. Effects of cilazapril and amlodipine on kidney function in hypertensive NIDDM patients. Diabetes 1996;45:216-222. Waldherr R, Ilkenhans C, Ritz E. How frequent is glomerulonephritis in diabetes mellitus type II? Clin Neph 1992;37:271-273. Wang S-L, Head J, Stevens L, et al. Excess mortality and its relation to hypertension and proteinuria in diabetic patients. Diabetes Care 1996;19:305-311. Weidmann P, Schneider M, Bohlen L. Therapeutic efficacy of different antihypertensive drugs in human diabetic nephropathy: An updated meta-analysis. Nephrol Dial Transplant 1995;10�(suppl 9):39-45. World Health Organization. The World Health Report 1997: Conquering Suffering, Enriching Humanity. Geneva, Switzerland. 1997. Zanchetti A, Agabiti-Rosei E, Dal Palu C, et al. The verapamil in hypertension and atherosclerosis study (VHAS): results of long-term randomized treatment with either verapamil or chlorthalidone on carotid intima-media thickness. J Hypertens 1998;16:1667-1676. Zatz R, Dunn BR, Meyer TW, et al. Prevention of diabetic glomuerulopathy by pharmacological amelioration of glomerular capillary hypertension. J Clin Invest 1986;77:1925-1930.
Hypertension artérielle et diabète
Présentateur
Commentaires de présentation
UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. Br Med J 1998a;317:703-713. UK Prospective Diabetes Study Group. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. Br Med J 1998b;317:713-720. UK Prospective Diabetes Study Group. Study design, progress and performance. Diabetologia 1991;34:877-890. United States Renal Data System, USRDS 1999 Annual Data Report. National Institutes of Health, National Institutes of Diabetes and Digestive and Kidney Diseases. Bethesda, MD, April, 1999. U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention (CDC), National Center For Health Statistics. (Vital and health statistics, plan and operation of the third national health and nutrition and examination survey, 1988-1994). DHHS publication no. (PHS) 94-1308, series 1, No. 324-0485. Valentino VA, Wilson MD, Weart W, Bakris GL. A perspective on converting enzyme inhibitors �and calcium channel antagonists in diabetic renal disease. Arch Intern Med 1991;151:2367-2372. Velussi M, Brocco E, Frigato F, et al. Effects of cilazapril and amlodipine on kidney function in hypertensive NIDDM patients. Diabetes 1996;45:216-222. Waldherr R, Ilkenhans C, Ritz E. How frequent is glomerulonephritis in diabetes mellitus type II? Clin Neph 1992;37:271-273. Wang S-L, Head J, Stevens L, et al. Excess mortality and its relation to hypertension and proteinuria in diabetic patients. Diabetes Care 1996;19:305-311. Weidmann P, Schneider M, Bohlen L. Therapeutic efficacy of different antihypertensive drugs in human diabetic nephropathy: An updated meta-analysis. Nephrol Dial Transplant 1995;10�(suppl 9):39-45. World Health Organization. The World Health Report 1997: Conquering Suffering, Enriching Humanity. Geneva, Switzerland. 1997. Zanchetti A, Agabiti-Rosei E, Dal Palu C, et al. The verapamil in hypertension and atherosclerosis study (VHAS): results of long-term randomized treatment with either verapamil or chlorthalidone on carotid intima-media thickness. J Hypertens 1998;16:1667-1676. Zatz R, Dunn BR, Meyer TW, et al. Prevention of diabetic glomuerulopathy by pharmacological amelioration of glomerular capillary hypertension. J Clin Invest 1986;77:1925-1930.
