MONITORIZAREA AMBULATORIE

A TENSIUNII ARTERIALE
DE LA CERCETARE LA APLICABILITATEA CLINICA

Alexandru Andritoiu
Sp. Clinic de Urgenta Militar Craiova
Sectia Medicina Interna

1961

Moto:
,, Blood pressure is a quantity with a
very large rangehypertension is
a quantitative disease,,
Sir George White Pickering
(1904-1980)

1968

Office BP vs. Out-of-Office BP

Office BP
TA de cabinet
Out-of-Office BP
ABPM
Auto-masurarea TA la domiciliu

ESH/ESC 2013

TEHNICI DE MONITORIZARE TA
Non-invazive
ABPM ambulatory
blood pressure
monitoring
HBPM home blood
pressure monitoring

Invazive
Manometrie I.A.

Metode ABPM

Metoda oscilometrica
Metoda auscultatorie
Metoda pletismografica

Protocoale de validare AAMI (1990) si BHS (1993)

SpaceLab
OMRON
Takeda
T2420

Home BP monitoring

Indicatii
FARA TRATAMENT
HTHA (WCH)
HTA borderline
HTA refractara
HTA secundara
HTA sarcina
hipoTA ortostatica
HTA episodica
Disf. autonoma

CU TRATAMENT
Eficienta terapeutica
HTA rezistenta

Giusepe Mancia

Parametrii ABPM

TA -24 h (h 7.00-7.00)
TA diurna (h 7.00-22.00)
TA nocturna (h 22.00-7.00)
TA trezire (h 5.00-8.00)
TA max
TA min
TAM
PP
ID
FC
BP load
Index hiperbar
DS

COMPONENTA TONICA
TAS, TAD, TAM, BPload
COMPONENTA PULSATILA
PP
COMPONENTA FAZICA
ID, SD-TA 24h
FC -24 ore

ESH/ESC 2013

FORME CLINICE DE HTA (ABPM)

HTA de halat alb (WC-HT)

HTA diurna
HTA nocturna
HTA sustinuta
HTA episodica
Masked hypertension

Traseu ABPM normal

HTA de halat alb (WC-HT)

Andritoiu A. Hipertensiunea de halat alb-intre normal si patologic. Infomedica, 2001:10:12-16

PREVALENTA WC-HT

Bangash F- CJASN 2009;4:656-664

HTA diurna

HTA episodica

HTA sustinuta

HTA nocturna

HTA matinala

Morning surge

Morning BP surge:
surge TAS medie in timpul celor 2 ore dupa trezire-TAS medie din timpul de 1 ora
ce include cea mai scazuta TAS din timpul somnului (Kario K 2003)
Cresterea TAS>50 mmHg si/sau TAD>20 mmHg in intervalul 6.00-10.00a.m. (Marfella R 2003)

HTA sistolica (izolata)

Masket hypertension

PREVALENTA HTA MASCATA

Bangash F - CJASN 2009;4:656-664

Masket HT-subtipuri

HTA matinala
HTA diurna
HTA nocturna

Kawano Y et al- Clin Exp Hypertens 2008;30(3):289-96

Caracteristicile pts cu Masket HT

Varsta tanara
Sex M,
Stress cotidian
Fumatori
Consumatori de alcool (seara)
Obezitate centrala
HTA ocazionala
Prehipertensivi
Pacienti cu scor mare de risc CV
Semne de afectare organe tinta cu TA normala la cabinet
Pacienti hipertensivi sub tratament

Poate precede HTA sustinuta

Lot - 46 adulti cu HTA la cabinet

Andritoiu A, 2000

HTA LA TINERI
Importanta metodei in expertiza medico-militara

Andritoiu A si colab. The significance of

high blood pressure in cardiovascular
pathology of young adults. The 4th Cong
BMMC 1999, Bucuresti
Andritoiu A.
A Monitorizarea ambulatorie a
tensiunii arteriale-aplicabilitate diagnostica si
prognostica. Rev Med Mil 1999;1107-126.

BP load
Definitie:
In 1988, the Mayo Clinic suggested the use of a BP load,
load
defined as the percentage of BP values exceeding a given
constant threshold,usually 140/90mm Hg for systolic/diastolic
BP during activity and 120/80mm Hg during resting hours.
The hyperbaric index (HBI), as a determinant of BP excess,
can be calculated as the total area of any given patients BP
above the threshold.

Stadializarea HTA dupa BP load

BP LOAD (%)
0- 5
5 - 15
15 - 25
25 - 75
75 -100

STADIU

normal

15

borderline
usoara
moderata
severa

35
20
25
5

Andritoiu A. Semnificatia parametrului BP load in evaluarea severitatii hipertensiunii.

Al 38-lea Cong Nat Cardiol 1999, Sinaia

Stadializarea HTA dupa BP load

BP load(%)

Grad

N=45

0-5

normal

10

22

6-15

borderline

12

27

16-25

usoara

11

26-75

moderata

10

22

76-100

severa

18
Andritoiu A, 2000

Valorile BP load fct tipul HTA (ABPM)

WC-HT

6.42+/-6.43

HTA episodica

10.76+/-9.85

HTA diurna

43.67+/-20.46

HTA sustinuta

77.64+/-22.79
N = 45 pacienti
Andritoiu A, 2000

Blood Pressure Load

Andritoiu A, 2000

Presiunea Pulsului (PP)

Definitie:
diferenta dintre presiunea sistolica si
presiunea diastolica: forta generata de
cord la fiecare contractie
PP: predictor de evenimente CV
mai bun decat TAS si/sau TAD izolate

TAS = 120 mmHg; TAD=80 mmHg; PP=40 mmHG

Componenta fazica - pulsatila (PP)

LOT I

LOT II

(hipertensivi)

(normali)

PP - 24 h 50,7 +/- 6,3

PP - day 51,5 +/- 6,4
PP - night 45,1 +/- 9,6

p<

50,8 +/- 4,7

NS

51,1 +/- 5,3

NS

48,9 +/- 4,0

NS

Creste semnificativ in HTA sistolica (ateromatoza Ao)

Andritoiu A, 2000

Variabilitatea TA in 24 h
variabilitatea beat-to-beat
variabilitatea measure-to-measure
Parametrul:
SD (TAS, TAD, TAM, PP)

Variabilitatea circadiana
Definitie (ID index diurn):

Dipper vs. non-Dipper

ESH/ESC 2013

Forme de dipping
Dipping absent
(HTA nocturna)

ratio>1.0

Dipping moderat

0.9<ratio<1.0

Dipping

0.8<ratio<0.9

Dipping extrem

ratio<0.8

ESH/ESC 2013

Normotensiv-Dipper

Normotensiv non-Dipper

Hermida et al. Chronobiol Int 2013

Non-Dipper

Non-Dipping

Salt sensitive hypertension

HTA secundara
Disfunctie autonoma
Diabet zaharat
Sdr. de apnee in som
Sdr. Cushing
Feocromocitom
Hiperaldosteronismul primar
Virsta avansata (HT sistolica severa)
Etnicitate (rasa Afro-Americana)
Medicamente (ciclosporina, corticosteroizi)
Insuf. renala (dializati)
Insuf. cardiaca congestiva

VARIABILITATEA CIRCADIANA

LOT I

LOT II

(hipertensivi)

(normali)

p<

ID - TAM

15,5 +/- 8,5

13,8 +/- 6,4

ns

DS .TAS-24h

15,4 +/- 3,8

11,3 +/- 2,8

0,05

Andritoiu A, 2000

RELATIA CU TOD

VALOAREA PROGNOSTICA
Cresterea TAS-24h cu 1 mmHg este asociata unei cresteri
a riscului de mortalitate cardiovasculara de 4.7% !
Studii:

Perloff et al.- JAMA 1983:249:2792-2798.

Perloff D, Sokolow M, Cowan R, Juster RP J Hypertens 1989;7(suppl):S3-S10.
Perloff D Sokolow M J Hypertens 1990 (suppl):S105-S111.
Perloff D, Sokolow M, Cowan R J Hypertens 1991 ;9 (suppl):S33-S39.

,, Average ambulatory BP was better correlated than office BP with the degree of
target-organ damage and the presence of cardiovascular complications.
,,The patients with a low ambulatory BP, in relation to the level to the level
predicted from the office blood pressure, had a better prognostic, and were less
likely to develop clinical events over a 10-year period, than patients with higher
BP levels

VALOAREA PROGNOSTICA A DATELOR ABPM

Studiu pe 3 ani
899 pts cu HTA esentiala vs 176 normotensivi
WCH 0,45 evenimente / 100pts / an
HTA 2,59 evenimente / 100 pts / an
Normo-TA0,56 evenimente / 100 pts / an

Un traseu anormal de monitorizare TA ambulatorie a identificat 95%

dintre subiectii care aveau sa sufere un eveniment cardiovascular in
urmatorii 3,3 ani!
Valoarea predictiva negativa a ABPM = 98% !

Verdecchia P. Al XII-lea Cong Cardiol;10-14 sept 1994, Berlin

Organele tinta in HTA

HT
A

Presiunile monitorizate pe 24h se coreleaza

cu o varietate de leziuni de organ
scorul global al afectarii organelor tinta

masa VS (gradul HVS)

afectarea functiei VS
nivelul microalbuminuriei
hipertrofia peretelui arterial
distensibilitatea arterelor elastice
deteriorarea creierului (dementa vasculara)
retinopatie

Evaluarea afectarii unor tinte in HTA

(lot 800 pts)

Cuspidi C, 2001

AF. ORG. TINTA (TOD)

(ABPM - 45 hipertensivi)

Andritoiu A, 2000

Ochiul in HTA

Retina (exudate, hemoragii)

Artere/vene (Sallus)
Tromboza VCR
Ocluzia ACR
Ocluzia ACR

Relatia ABPM FO la un lot de 45 pacienti cu HTA

Hipertensiune

BP load

Grad 0/I

Grad II/III

WC-HT

6.42+/-6.43

12

Episodica

10.76+/-9.85

12

Diurna

43.67+/-20.46

Sustinuta

77.64+/-22.79

11

Andritoiu A, 2000

Relatia cu HVS (Eco)

TAS-24h si TAD 24h se coreleaza cu:

SIV+PPVS
PPVS
SIV+PPVS/DTDVS
h/r (HVS concentrica)
Masa VS
AS cu TAD-24h

Prisant LM, Carr AA. 1990

Corelatia dintre masa VS (Eco) si TAS-24h

vs TAS determinata ocazional (cabinet)
Studiu
Rowlands
Devereux
Drayer
Kleinert
Prisant
Verdecchia

TAS -24h

TAS-cab

50
100
12
93
55
253

0,60
0,50
0,81
0,26
0,50
0,48

0,51
0,24
0,55
0,22
0,33
0,38

Principalii determinanti directi ai HVS

TA medie -24 h
TAS diurna
TAS la trezire
BP load
Var. presionala

Stresul de forfecare
Stresul parietal
IMC
Virsta
Sexul
Aportul de sodiu in dieta
Factori genetici
Viscozitatea singelui
Rezistenta la insulina
Ingestia cronica de alcool
Factori neuro-hormonali (catecolamine, angiotensina, renina)

Stroke in HTA

Dipper
Non-Dipper
Dipper extrem
Dipper inversat

Kario K et al. - Hypertension 2001

Arterele in HTA

Ax carotidian

Artera brahiala

Modificarile carotidiene in HTA

Cresterea diametrului
Ingrosarea CIMT
Placi stenotice
Alterarea compliantei

Imbatrinire accelerata a axului carotidian !

100 pts hipertensivi

Dd

GROUP I

GROUP II
R-CCA L-CCA

GROUP III

R-CCA

L-CCA

R-CCA

L-CCA

5,8+/-0.8

5,6+/-0.7

6,5+/-0.7

6.7+/-0,9

8,3+/-0.3

7.7+/-0,2

0,45+/-0,2

0,44+/-0,2

0,67+/-0,2

0,65+/-0,3

0,89+/-0,3

0,93+/-0.2

(mm)
IMTh
(mm)
% Plaques

28,5%

80%

% Segnif.stenosis

22 %

14%

Mean stenosis(%)

45+/-10,7 %

38+/-9,7%

Andritoiu Al. Modificari morfologice si functionale ale arterelor carotide comune in hipertensiune
comparativ cu imbatrinirea-studiu Eco-Doppler. A II-a Conf Nat Ultrasonografie , Craiova, 1999.

Distributia topografia a placilor ATS-CAR

GROUP II
CCA-middle
CCA-bulb
ICA
ECA
TOTAL

3
4
5
2
12

GROUP III
5
10
11
6
32

Andritoiu Al. Modificari morfologice si functionale ale arterelor carotide comune in hipertensiune
comparativ cu imbatrinirea-studiu Eco-Doppler. A II-a Conf Nat Ultrasonografie , Craiova, 1999.

Modificarile a. brahiale in HTA

Se coreleaza cu parametrii ABPM-24h si la trezire !

Cresterea in diametru/arie
Modificarea profilului spectral
Alterarea vasodilatatiei
- dependenta de endoteliu (Ach)
- independenta de endoteliu (NTG)

Andritoiu A, 2000

Profil spectral a. brahiala

(largire spectrala)

Rinichiul in HTA
Microalbuminurie (30-300 mg/24 h)
microalbuminurie de efort
proteinurie
valoare predictiva poz. ptr evenimente CV subsecvente
Metode de determinare
RIA/nefelometrie laser
Dipstick +2

CONSECINTE
Nefroangioscleroza
Insuficienta renala cr.
Cr. ser > 1,5 mg/dl
Cl. Cr < 60 ml/min

SCORUL AFECTARII ORGANELOR TINTA

Ex. FO:
Std I . 1p.
Std.II. 2p.
Std. III3p.
Prezenta HVS..3p.
Disfunctia VS diastolica (E/A <1) ..2p.
Ecografia carotidiana:
Diametrul >6.5 mm.1p.
CIMT > 1mm...1p.
Placi .2p.
A. Brahiala (largire spectrala)1p.
Ex urina (albuminurie).2p.
SCOR Max. = 15p.
Andritoiu A, 2000

TOD - SCOR MEDIU

DIURNA vs SUSTINUTA vs WC-HT

6p
3.71p

1.33p

Andritoiu A, 2000

CORELATII Scor TOD vs

TAS
TAD
TAM
SBP load
DBP load
FC

R= 0.87
R= 0.72
R= 0.80
R= 0.74
R= 0.61
R= 0.23

PARAMETRII MONITORIZARII
TENSIONALE LA TREZIRE SI
AFECTAREA ORGANELOR TINTA
IN HTA
Andritoiu A. Al 41 Cong Nat Cardiol 2002, Sinaia

Relatia scor-TOD si parametrii ABPM la trezire

(lot 45 pacienti HT)
TAS

R= 0.87

TAD

R= 0.72

TAM

R= 0.80

SBP load

R= 0.74

DBP load

R= 0.61

FC

R= 0.23
Andritoiu A, 2002

MONITORIZAREA TA IN SARCINA

Hypertension in pregnancy, as diagnosed by ABPM, is

superior to the ofce measurement of BP in predicting
outcomes

ABPM in sarcina
Recomandata de:
de
Soc. Elvetiana de Hipertensiune
Soc. Franceza de Hipertensiune
Nerecomandata de:
de
Marea Britanie, SUA, Germania, Brazilia

Valorile normale (ABPM) in sarcina

Sapt.
TA diurna

9-17

18-22

26-30

>30

130/77

132/79

133/81

135/86
(Brown MA et colab. 1998)

Trim I

Trim II

Trim III

TA-24h

110/70

116/74

125/80

TA diurna

113/69

119/78

126/83

TA nocturna

100/71

113/73

111/78

(Gheorman V, Andritoiu A, Raca N 2002)

Profilul circadian al TAS, TAD, TAM, FC

in sarcina

Hermida RC, Hypertension 2001;38:746

Valorile medii
pe fiecare trimestru de sarcina
Parametru
ABPM

TRIM I

TRIM II

TRIM III

99.5+/-5.5

104.1+/-6

108.7+/-8.2

TAD 24 h

66.3+/-2.2

67.8+/-3

70.3+/-5.3

TAM 24 ore

77.8+/-9.7

79.6+/-10.2

86.8+/-12.4

TAS diurna

101.3+/-5.8

106.3+/-6

111.7+/-7.2

TAD diurna

66.8+/-1.2

69.3+/-4

72+/-5.6

TAM diurna

79.6+/-5.6

82.6+/-6.6

88.4+/-6.7

TAS nocturna

95.3+/-2.3

99+/-6.8

100.5+/-5.5

TAD nocturna

62.8+/-3.9

65.3+/-4

66.7+/-5.4

TAM nocturna

76.8+/-5.2

77.3+/-4.5

79.2+/-5.6

TAS 24 h

Andritoiu A, Raca N, Gheorman V.- Metode noi in predictia preeclampsiei. Ed. Info, Craiova, 2007.

Limita cut-off
Parametru
ABPM

TRIM I

TRIM II

TRIM III

TA 24 h

110.5/70

116/74

125/80

TA diurna

113/69

119/78

126/83

TA nocturna

100/71

113/73

111/78

Andritoiu A, 2006

PP presiunea pulsului
(TAS-TAD)
Parametru
ABPM

TRIM I

TRIM II

TRIM III

33.5+/-5.5

36.1+/-6

38.5+/-8.2

PP diurn

33.3+/-5.8

36.3+/-6

40.2+/-7.2

PP nocturn

33.3+/-2.3

34.2+/-6

33.5+/-5.5

PP 24 ore

Andritoiu A, 2006

Sarcina de presiune
(BP load)

Parametrul
ABPM

TRIM I

TRIM II

TRIM III

SBP load

3.2+/-0.05

6.2+/-0.05

7.5+/-0.02

DBP load

3.3+/-0.08

4.6.+/-0.06

5.5+/-0.03

Andritoiu A, 2006

Frequency distribution of maximum BP load from normotensive pregnant women (top)

and women with a final diagnosis of gestational hypertension or preeclampsia (bottom)
sampled in different trimesters of pregnancy.

Hermida R C - Hypertension 2001;38:723-729

Parametrii ABPM
intervalul de trezire (h 5.00-8.00 am)

Parametru
ABPM

TRIM I

TRIM II

TRIM III

TAS

103.5 +/-12.2

106.6+/-11.3

114.5+/-10.9

TAD

69+/- 11.3

72+/- 13.6

76+/-13.2

TAM

78.6 +/-3.2

83 +/-3.3

88 +/-3.6

FC

72.6+/-8.9

86.6+/-11.2

86.7+/-10.2

Andritoiu A, 2006

Relatia TA clinica -TA ambulatorie

Normal Probability Plot

Normal Probability Plot

196

Variables
TAS CAB
TAS DIURNA

176

124

Variables
TAD DIURNA
TAD CAB

114
104

156

94
136

84

116

74

96

64
0.1

20

50
percentage

TAS

80

95

99

99.9

0.1

20

50

80

95

99

99.9

percentage

TAD

Andritoiu A, 2006

Subgrupuri de risc

WC-HT
HTG
PE
NORM

Andritoiu A, 2006

Parametrii presionali

Diferente semnificative statistic s-au observat intre subgrupul PE si

subgrupurile NORM si WCH (p <0.001), cit si intre subgrupul PE si
subgrupul HTG (p=0.01).
Andritoiu A, 2006

TAM-24 ore

Diferente s-au inregistrat intre subgrupul PE si subgrupurile NORM si

WCH (p<0.001), inclusiv intre PE si HTG (p = 0.004).
Andritoiu A, 2006

TA diurna si TA nocturna in cele 4 subgrupuri

Diferente statistice s-au remarcat

intre subgrupul PE si NORM, WCH
(p<0.001), inclusiv intre PE si HTG
(p=0.01).

Diferente statistice s-au remarcat intre

subgrupurile PE si NORM si WCH (p<0.001)
cit si intre PE si HTG (p =0.01).
Andritoiu A, 2006

WC-HT
hipertensiunea de halat alb
AU

ACM

A OFT

WCH

NORM

WCH

NORM

WCH

NORM

IP

0.78

0.76

0.88

0.87

1.15

1.18

IR

0.55

0.53

0.58

0.57

0.67

0.66

S/D

2.3

2.2

2.2

2.2

2.8

2.7

Andritoiu A, 2006

HTG
hipertensiune gestationala
AU

ACM

A OFT

HTG

NORM

HTG

NORM

HTG

NORM

IP

1.11

0.76

0.94

0.87

1.02

1.18

IR

0.63

0.53

0.59

0.57

0.65

0.66

S/D

2.6

2.2

2.4

2.2

2.9

2.7

Andritoiu A, 2006

PE - preeclampsie
AU

ACM

A OFT

PE

NORM

PE

NORM

PE

NORM

IP

1.74

0.76

0.83

0.87

1.01

1.18

IR

0.75

0.53

0.58

0.67

0.61

0.66

S/D

3.75

2.2

2.2

2.2

2.5

2.7

Andritoiu A, 2006

Andritoiu A, 2006

NORM
AU

ACM

A OFT

REF

NORM

REF

NORM

REF

NORM

IP

0.78

0.76

0.94

0.87

1.24

1.18

IR

0.55

0.53

0.59

0.57

0.72

0.66

S/D

2.3

2.2

2.5

2.2

2.9

2.7

Andritoiu A, 2006

Corelatiile stabilite intre parametrii determinati prin

ABPM si PE
in grupul cu risc crescut

Parametru ABPM

r=

p<

TAS-24 ore

0.68

0.001

TAD-24 ore

0.72

0.001

TAM -24 ore

0.71

0.001

TAS diurna

0.69

0.001

TAD diurna

0.72

0.001

TAS nocturna

0.63

0.001

TAD nocturna

0.70

0.001

FC-24 ore

-0.24

NS

Andritoiu A, 2006

TAM-24 ore >100 mmHg

Sb %

66.66

Sp %

89.28

VP(+) %

50

VP(-) %

94.33

AC %

86

RR

10
Andritoiu A, 2006

PROFILUL CIRCADIAN AL HTA

Sb%
Sp%

55.55
96.42

VP(+) %

71.42

VP(-) %
AC %
RR

93.1
90.77
10.44

Corelatia dintre profilul non-dipper si rata aparitiei PE

r = 0.71; p<0.001
Andritoiu A, 2006

Scorul de risc preeclamptic

Variabila

Punctaj

Clinic
Cel pu\in un factor derisc (diabet, primiparitate,
varsta =>35 ani, antec. PE sau fat mort)

1 p.

TAD cabinet =>100 mmHg

1p

Doppler
IR-a uterina >0.6

1p.

S/D a. uterina >2.4

1p.

Notch grad 1, 2, 3,

1p, 2p, 3p.

Notch bilateral

x 2 p.

Notch absent

0p.

IR <0.5 aa. cerebrale materne

1 p.

ABPM
TAM-24 ore >100 mmHg

TAD nocturna > 75 mmHg

Profil non-dipper

Scor maxim de risc

14

Andritoiu A, 2006

Plot of Fitted Model

PE = -0.0938699 + 0.0736661*SCOR
1
0.8

PE

0.6
0.4
0.2
0
0

12

15

SCOR

Andritoiu A, 2006

CRONOFARMACOLOGIA
HIPERTENSIUNII ARTERIALE

Ceasul biologic - master clock

Complex de gene
Arie speciala in cortex
Nc. suprachiasmatic
Locus ceruleus

Rolul SN autonom - baroreflexe

Melatonina-mesager endogen

The cardiovascular system is highly organised in time

Lemmer B. - Pharmacol Ther 2006

TA
FC
RVP
DC
Hh vasoactivi

CA, SRAA, Et-1, AMPc

Definitii
Chronobiologia stiinta preocupata de mecanismele
biologice ale bolilor in relatie cu o structura temporala;
Chronoterapia (cronofarmacologia): disciplina ce
studiaza efectul farmacologic al medicamentelor in relatie
cu comportamnetul bolii pe o anume perioada de timp.
Cronofarmacokinetica
Cronofarmacodinamia

Cronofarmacokinetica
Absorbtia
Distributia
Secretiile gastro-dd
Golirea gastrica
Metabolizarea
Eliminarea renala

Cronofarmacodinamie
Efecte diferite pe
intervalul 24 ore
Momentul
administrarii poate
modifica rap.
doza/concentratie

Cronotoxicitate

Cronoterapia
hipertensiunii arteriale

Concepte

Homeostazic

Mediul intern ramine constant

Cronobiologic
Cum tratam ?

Variatii (cicluri)
circadiene

Cand tratam ?

Obiectivele cronoterapiei in HTA

concentratii mai mari atunci cind este mai multa

nevoie (e.x: perioada post-trezire) si mai mici cind
nevoile sunt mai reduse (e.g., in intervalul de
somn nocturn)

Normalizarea valorilor TA pe intreg intervalul circadian

Reducerea riscului cardio-vascular
Imbunatatirea/normalizarea profilului circadian al TA (dipper)
Morning versus evening dosing of a once-daily agent !

Studii
Morning vs evening dosing
ACE inhibitors
quinapril, enalapril, benazepril, perindopril
BRA
valsartan
Beta-blockers
Atenolol, propranolol MR
Calcium channel blockers
Depinde de formularea farmaceutica
nifedipine-GITS
Instant vs ER
amlodipine
isradipine
nitrendipine
ditizem
verapamil COER

The impact of dosing time on the response to

antihypertensive therapy

circadian patterns were generally unchanged

when comparing morning vs evening
administration of a variety of
antihypertensive agents
nocturnal medication dosing generally
reduced asleep BP more than morning
dosing

Lemmer B. Blood Press Monit 1999;1:161-169.

Morning vs Evening dosing

Control TA diurn vs. nocturn

Prestance (5/5)

Non-control

Non-control TA nocturna

IECA

Non-control

Ce ne rezerva viitorul ....

trialuri clinice comparative ptr. a evalua
efectele antihipertensivelor
homeostatice vs cronoterapeutice pe
end-pointurile clinice ( imbunatatirea
controlului TA, QOL, ischemiei
miocardice si performantelor
miocardice)

Presedinte
Conf. Horia Balan

ABPM ACCURACY (1381 readings)

Andritoiu A , 2003

Studii personale
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.

Andritoiu A si colab. Monitorizarea automata pe 24 h a tensiunii arteriale. Studiu pe 20

pacienti tineri hipertensivi comparativ cu normalul. Al 37 Cong Nat Cardiol, 1998, Sinaia
Andritoiu A si colab. Parametrii de presiune arteriala evaluati prin computerizare automata
24h la un grup de pacienti cu hipertensiune arteriala. Al 37-lea Cong Nat Cardiol 1998, Sinaia
Andritoiu A si colab. Monitorizarea automata 24h a tensiunii arteriale (ABPM). A 3-a Conf Nat
Semiol Med 1998, Craiova
Andritoiu A. Semnificatia diagnostica si prognostica a monitorizarii ambulatorii a tensiunii
arteriale. Infomedica 1999;8:2-9.
Andritoiu A. Semnificatia parametrului BP load in evaluarea severitatii hipertensiunii. Al 38-lea
Cong Nat Cardiol 1999, Sinaia
Andritoiu A si colab. The significance of high blood pressure in cardiovascular pathology of
young adults. The 4th Cong BMMC 1999, Bucuresti
Andritoiu A. Monitorizarea ambulatorie a tensiunii arteriale-aplicabilitate diagnostica si
prognostica. Rev Med Mil 1999;1107-126.
Andritoiu A. Hipertensiunea de halat alb - intre normal si patologic. Infomedica 2001;10:12-16.
Andritoiu A. Complianta terapeutica in managementul hipertensiunii arteriale. Rev Med Mil
2001;2:195-206.
Andritoiu A. Parametrii monitorizarii tensionale la trezire si afectarea organelor tinta in HTA. Al
41-lea Cong Nat Cardiol 2002, Sinaia
Andritoiu A. Monitorizarea ambulatorie a TA relatia cu afectarea organelor tinta in HTA. Al
41-lea Cong Nat Cardiol 2002, Sinaia
Raca N, Gheorman V, Andritoiu A. Parametrii ABPM in sarcina normala. Al 2-lea Cong Nat
Obst-Ginecologie, 2002, Bucuresti

2004