Mise à jour sur la prise en charge de l’hypertension en 2023
Résumé
L’hypertension est la pathologie la plus couramment prise en charge dans le cadre des soins primaires. Il s’agit d’un facteur de risque puissant, mais modifiable, de maladie cardiovasculaire (MCV) et de mortalité prématurée. Actuellement, environ 25 % des adultes canadiens ont reçu un diagnostic d’hypertension. Cependant, la communauté mondiale éprouve des difficultés à optimiser la prise en charge de l’hypertension; on estime qu’au moins 23 % des individus dans le monde ont eu une prise en charge efficace de l’hypertension. En outre, si les cliniciens étaient en mesure d’identifier ces cas et d’intervenir de manière adéquate, nous pourrions éviter 10,8 millions de décès par an. Cette statistique est extrêmement pertinente pour les praticiens canadiens, car nos données canadiennes les plus récentes suggèrent que 34 % des adultes souffrant d’hypertension n’atteignent pas la pression artérielle (PA) cible en raison d’un traitement insuffisant ou d’une méconnaissance de la situation.
Le sous-traitement de l’hypertension est complexe. Il existe un certain nombre de facteurs structurels et environnementaux liés au risque CV, et il est de plus en plus admis que si nous voulons réduire efficacement le risque CV, nous devons reconnaître le rôle important que jouent les déterminants sociaux dans le développement des facteurs de risque, notamment l’hypertension, le tabagisme, l’obésité et le diabète.
Les lignes directrices cliniques concernant l’hypertension peuvent involontairement contribuer aux défis que nous observons dans le monde en matière de prise en charge de l’hypertension. De nombreuses lignes directrices sont disponibles pour informer les cliniciens sur la manière de fournir des soins de soutien aux personnes souffrant d’hypertension, et la discordance entre les lignes directrices et la granularité des lignes directrices rendent la mise en œuvre difficile. Bien qu’il y ait des disparités entre les lignes directrices, ainsi que des différences concernant la nomenclature de l’hypertension, il y a un accord unanime sur le fait qu’une mesure précise de la PA, des seuils d’intervention basés sur le risque, des approches simplifiées de la pharmacothérapie et des soins bien structurés sont les fondements d’une prise en charge efficace de l’hypertension.
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