SUJET AGE
PROPOSITIONS POUR LE PRATICIEN
PATIENTS VALEURS CIBLES-TRAITEMENTS
Patients âgés de 65 ans à 79 ans sans comorbidités PA< 140/90 mmHg Patients âgés de 65 ans à 79 ans avec comordidités, faible
espérance de vie
130 < PAS < 160 mmHg
Patients présentant une coronaropathie PAS < 140mmHg
65 < PAD < 90 mmHg Patients très âgés de 80 ans et plus 130 < PAS < 160 mmHg
65 < PAD < 90 mmHg
Patients de peau noire PA< 140/90 mmHg si sujets âgés
130 < PAS < 160 mmHg si sujets très âgés pas d'IEC ni d'Ara 2
Patients diabétiques PA<140/90 mmHg
si protéinurie : IEC ou Ara 2
Patients avec Insuffisance rénale PA< 140/90 mmHg
CONCLUSION
Le traitement de l'hypertension artérielle permet de réduire l'incidence des accidents vasculaires cérébraux, des insuffisances cardiaques, des infarctus du myocarde et des néphropathies hypertensives. Les valeurs seuils de pression artérielle doivent être adaptées en fonction de chaque cas particulier. La valeur seuil de pression artérielle chez les patients de 65 à 79 ans reste 140/90 mmHg mais doit être adaptée aux comorbidités et à l'espérance de vie. Chez les patients de plus de 80 ans, la valeur cible de la systolique s'établit entre 130 et 160 mmHg et doit être adaptée en cas de coronaropathie (pression artérielle diastolique supérieure à 65 mmHg). Chez tous les patients, co-morbidités ainsi qu'espérance de vie doivent être pris en compte. Une hypotension orthostatique ainsi que les effets iatrogènes des traitements doivent être systématiquement recherchés. Le traitement médicamenteux fait ressortir 4 classes de médicaments : inhibiteur calcique, thiazidique, inhibiteur de l'enzyme de conversion et antagoniste des récepteurs à l'angiotensine 2. Le choix se fera en fonction des comordibités.
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