{"id":50651,"date":"2023-09-22T14:13:32","date_gmt":"2023-09-22T18:13:32","guid":{"rendered":"https:\/\/hypertension.ca\/traitement-de-lhypertension-associee-au-diabete-sucre\/"},"modified":"2023-10-10T12:19:43","modified_gmt":"2023-10-10T16:19:43","slug":"traitement-de-lhypertension-associee-au-diabete-sucre","status":"publish","type":"page","link":"https:\/\/hypertension.idlwebclients.com\/fr\/lignes-directrices\/prevention-et-traitement\/traitement-de-lhypertension-associee-au-diabete-sucre\/","title":{"rendered":"Traitement de l\u2019hypertension associ\u00e9e au diab\u00e8te sucr\u00e9"},"content":{"rendered":"<div id=\"modal-ready\"><section class=\"l-section wpb_row us_custom_5c31ec89 event-banner-section height_medium width_full\"><div class=\"l-section-h i-cf\"><div class=\"g-cols vc_row via_flex valign_top type_default stacking_default\"><div class=\"vc_col-sm-12 wpb_column vc_column_container\"><div class=\"vc_column-inner us_custom_461a6918\"><div class=\"wpb_wrapper\"><div class=\"w-image img-w-100 align_center\"><div class=\"w-image-h\"><img fetchpriority=\"high\" decoding=\"async\" width=\"1440\" height=\"252\" src=\"https:\/\/hypertension.idlwebclients.com\/wp-content\/uploads\/2023\/04\/HC-Guidelines-Credits-Page.jpg\" class=\"attachment-full size-full\" alt=\"\" srcset=\"https:\/\/hypertension.idlwebclients.com\/wp-content\/uploads\/2023\/04\/HC-Guidelines-Credits-Page.jpg 1440w, https:\/\/hypertension.idlwebclients.com\/wp-content\/uploads\/2023\/04\/HC-Guidelines-Credits-Page-300x53.jpg 300w, https:\/\/hypertension.idlwebclients.com\/wp-content\/uploads\/2023\/04\/HC-Guidelines-Credits-Page-1024x179.jpg 1024w, https:\/\/hypertension.idlwebclients.com\/wp-content\/uploads\/2023\/04\/HC-Guidelines-Credits-Page-200x35.jpg 200w, https:\/\/hypertension.idlwebclients.com\/wp-content\/uploads\/2023\/04\/HC-Guidelines-Credits-Page-600x105.jpg 600w, https:\/\/hypertension.idlwebclients.com\/wp-content\/uploads\/2023\/04\/HC-Guidelines-Credits-Page-1000x175.jpg 1000w, https:\/\/hypertension.idlwebclients.com\/wp-content\/uploads\/2023\/04\/HC-Guidelines-Credits-Page-500x88.jpg 500w, https:\/\/hypertension.idlwebclients.com\/wp-content\/uploads\/2023\/04\/HC-Guidelines-Credits-Page-700x123.jpg 700w\" sizes=\"(max-width: 1440px) 100vw, 1440px\" \/><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/section><section class=\"l-section wpb_row height_medium\"><div class=\"l-section-h i-cf\"><div class=\"g-cols vc_row via_flex valign_top type_default stacking_default\"><div class=\"vc_col-sm-12 wpb_column vc_column_container\"><div class=\"vc_column-inner\"><div class=\"wpb_wrapper\"><h1 class=\"w-post-elm post_title us_custom_83a03b96 title-underline small-underline has_text_color entry-title color_link_inherit\">Traitement de l\u2019hypertension associ\u00e9e au diab\u00e8te sucr\u00e9<\/h1><\/div><\/div><\/div><\/div><\/div><\/section><section class=\"l-section wpb_row us_custom_887a049b height_medium\"><div class=\"l-section-h i-cf\"><div class=\"g-cols vc_row via_flex valign_top type_default stacking_default\"><div class=\"vc_col-sm-12 wpb_column vc_column_container\"><div class=\"vc_column-inner\"><div class=\"wpb_wrapper\"><div class=\"wpb_text_column sub-title\"><div class=\"wpb_wrapper\"><h2>Recommandations<\/h2>\n<\/div><\/div>[vc_empty_space height=\u00a0\u00bb20px\u00a0\u00bb]<div class=\"wpb_text_column\"><div class=\"wpb_wrapper\"><ul>\n<li>Les personnes atteintes de diab\u00e8te sucr\u00e9 doivent \u00eatre trait\u00e9es pour atteindre une PAS de < 130\u00a0mmHg (grade C) et une PAD de < 80\u00a0mmHg (grade A; ces taux cibles de PA sont les m\u00eames que les seuils de traitement de la PA).<\/li>\n<li>Chez les personnes atteintes d\u2019une maladie cardiovasculaire ou r\u00e9nale, y compris de microalbuminurie, ou pr\u00e9sentant des facteurs de risque cardiovasculaire en plus du diab\u00e8te et de l\u2019hypertension, un inhibiteur de ECA ou un ARA est recommand\u00e9 comme traitement initial (grade A).<\/li>\n<li>Pour les personnes atteintes de diab\u00e8te et d\u2019hypertension qui ne sont pas incluses dans d\u2019autres recommandations de cette section, les choix appropri\u00e9s comprennent (en ordre alphab\u00e9tique)\u00a0: Inhibiteurs de ECA (grade A), ARA (grade B), BCC dihydropyridine (grade A) et diur\u00e9tiques de type thiazide\/thiazide (grade A).<\/li>\n<li>Si la PA cible n\u2019est pas atteinte avec la dose standard en monoth\u00e9rapie, un traitement antihypertenseur suppl\u00e9mentaire doit \u00eatre utilis\u00e9. Chez les personnes chez qui un traitement d\u2019association avec un inhibiteur de l\u2019ECA est envisag\u00e9, un BCC dihydropyridine est pr\u00e9f\u00e9rable \u00e0 un diur\u00e9tique de type thiazide\/thiazide (grade A).<\/li>\n<\/ul>\n<\/div><\/div>[vc_empty_space height=\u00a0\u00bb30px\u00a0\u00bb]<div class=\"wpb_text_column sub-title\"><div class=\"wpb_wrapper\"><h2>Hypertension en cas de maladie r\u00e9nale chronique<\/h2>\n<\/div><\/div>[vc_empty_space height=\u00a0\u00bb20px\u00a0\u00bb][vc_custom_heading text=\u00a0\u00bbNouvelles recommandations pour 2020&Prime; font_container=\u00a0\u00bbtag:h4|text_align:left\u00a0\u00bb use_theme_fonts=\u00a0\u00bbyes\u00a0\u00bb css=\u00a0\u00bb%7B%22default%22%3A%7B%22color%22%3A%22_content_primary%22%2C%22font-size%22%3A%2218px%22%2C%22font-weight%22%3A%22700%22%7D%7D\u00a0\u00bb]<div class=\"wpb_text_column\"><div class=\"wpb_wrapper\"><ul>\n<li>Personnaliser les valeurs cibles de PA chez les patients atteints d\u2019une maladie r\u00e9nale chronique. Envisager des cibles intensives (PAS < 120\u00a0mmHg) chez les patients appropri\u00e9s.<\/li>\n<\/ul>\n<p>Chez les patients non diab\u00e9tiques atteints de maladie r\u00e9nale chronique qui r\u00e9pondent aux crit\u00e8res d\u2019inclusion de l\u2019essai d\u2019intervention systolique sur la pression art\u00e9rielle (SPRINT; \u00e2g\u00e9s de plus de 50\u00a0ans, pr\u00e9sentant un risque cardiovasculaire \u00e9lev\u00e9 avec une PAS de 130 \u00e0 180\u00a0mmHg; tableau 6)71, nous appuyons une PAS cible de &lt; 120 mm Hg. There was no evidence of hetero-geneity of effect across prespecified subgroups; therefore, the benefits observed in the intervention group as a whole should also be experienced by those with nondiabetic kidney disease. However, it should also be acknowledged that SPRINT only enrolled 2646 participants with a GFR &lt; 60 mL\/min\/1.73 m2 of an intended 4600, so the evaluation of heterogeneity of ef-fects might be underpowered. In patients with adult polycystic kidney disease, an SBP &lt; 110mm Hg should be targeted on the basis of the HALT Progression of Polycystic Kidney Disease (HALT-PKD) trial,72 which showed a slower increase in total kidney volume, a greater decline in left ventricular mass index, and a greater reduction in urinary albumin excretion compared with standard BP control. The in-clusion and exclusion criteria for the SPRINT trial likely captured primarily patients with hypertension-related chronic kidney disease. Consequently, there is currently insufficient evidence to support a target SBP as per the SPRINT trial in nondiabetic chronic kidney disease patients who meet the exclusion criteria for the SPRINT trial (eg, patients with advanced chronic kidney disease [eGFR &lt; 20 mL\/min\/1.73 m2], proteinuria &gt; 1\u00a0g\/j, une maladie r\u00e9nale polykystique chez l\u2019adulte, une glom\u00e9rulon\u00e9phrite et ceux qui sont institutionnalis\u00e9s et\/ou fragiles).<\/p>\n<p>Une r\u00e9duction suppl\u00e9mentaire de la PAS cible peut \u00eatre personnalis\u00e9e \u00e0 la discr\u00e9tion du m\u00e9decin traitant, compte tenu de la maladie r\u00e9nale, des comorbidit\u00e9s et de l\u2019\u00e2ge sp\u00e9cifiques du patient. De plus, Hypertension Canada recommande que les bienfaits et les \u00e9v\u00e9nements ind\u00e9sirables potentiels li\u00e9s aux cibles de PAS plus faibles soient discut\u00e9s avec chaque patient et que les d\u00e9cisions th\u00e9rapeutiques soient partag\u00e9es.<\/p>\n<\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/section>\n<\/div>","protected":false},"excerpt":{"rendered":"Traitement de l\u2019hypertension associ\u00e9e au diab\u00e8te sucr\u00e9 Recommandations [vc_empty_space height=\"20px\"] Les personnes atteintes de diab\u00e8te sucr\u00e9 doivent \u00eatre trait\u00e9es pour atteindre une PAS de < 130\u00a0mmHg (grade C) et une PAD de < 80\u00a0mmHg (grade A; ces taux cibles de PA sont les m\u00eames que les seuils de traitement de la PA). Chez les personnes...","protected":false},"author":4209,"featured_media":0,"parent":50665,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-50651","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/hypertension.idlwebclients.com\/fr\/wp-json\/wp\/v2\/pages\/50651","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/hypertension.idlwebclients.com\/fr\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/hypertension.idlwebclients.com\/fr\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/hypertension.idlwebclients.com\/fr\/wp-json\/wp\/v2\/users\/4209"}],"replies":[{"embeddable":true,"href":"https:\/\/hypertension.idlwebclients.com\/fr\/wp-json\/wp\/v2\/comments?post=50651"}],"version-history":[{"count":5,"href":"https:\/\/hypertension.idlwebclients.com\/fr\/wp-json\/wp\/v2\/pages\/50651\/revisions"}],"predecessor-version":[{"id":50781,"href":"https:\/\/hypertension.idlwebclients.com\/fr\/wp-json\/wp\/v2\/pages\/50651\/revisions\/50781"}],"up":[{"embeddable":true,"href":"https:\/\/hypertension.idlwebclients.com\/fr\/wp-json\/wp\/v2\/pages\/50665"}],"wp:attachment":[{"href":"https:\/\/hypertension.idlwebclients.com\/fr\/wp-json\/wp\/v2\/media?parent=50651"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}