{"id":58224,"date":"2015-07-01T19:58:28","date_gmt":"2015-07-01T19:58:28","guid":{"rendered":"https:\/\/www.chronobiology.com\/blood-pressure-heart-attacks-and-chronotherapy\/"},"modified":"2024-07-18T14:42:18","modified_gmt":"2024-07-18T21:42:18","slug":"pression-art-rielle-crises-cardiaques-et-chronoth-rapie","status":"publish","type":"post","link":"https:\/\/dev.chronobiology.com\/fr\/pression-art-rielle-crises-cardiaques-et-chronoth-rapie\/","title":{"rendered":"Pression art\u00e9rielle, crises cardiaques et chronoth\u00e9rapie"},"content":{"rendered":"

Le traitement de l’hypertension art\u00e9rielle et des maladies cardiovasculaires peut constituer un d\u00e9fi pour les m\u00e9decins modernes. Malheureusement, les enjeux sont importants. Aux \u00c9tats-Unis, 720 000 personnes sont victimes d’une crise cardiaque chaque ann\u00e9e<\/a>, tandis que 60 millions de personnes souffrent d’une forme ou d’une autre de maladie cardiovasculaire. Le contr\u00f4le de la tension art\u00e9rielle est tr\u00e8s important pour maintenir un syst\u00e8me cardiovasculaire sain tout en pr\u00e9venant les crises cardiaques et les accidents vasculaires c\u00e9r\u00e9braux.<\/p>\n

Bien que de nouveaux m\u00e9dicaments miracles contre l’hypertension arrivent sur le march\u00e9 pharmaceutique presque chaque ann\u00e9e, de nombreuses personnes vivent encore avec une tension art\u00e9rielle incontr\u00f4lable et le risque \u00e9lev\u00e9 d’infarctus qui l’accompagne. Cependant, de nouvelles \u00e9tudes en chronobiologie<\/a> montrent que la chronoth\u00e9rapie, c’est-\u00e0-dire le fait de caler les th\u00e9rapies et les m\u00e9dicaments sur le rythme circadien<\/a>, pourrait constituer une nouvelle voie de traitement prometteuse.<\/p>\n

L’horloge interne de la fonction cardiovasculaire<\/h2>\n

\"Blood<\/a>Comme presque tous les syst\u00e8mes du corps humain, les fonctions cardiovasculaires<\/a> suivent une horloge de 24 heures, ou rythme circadien. Peu avant le r\u00e9veil, l’organisme commence \u00e0 augmenter les niveaux d’hormones associ\u00e9es \u00e0 l’\u00e9veil, notamment le cortisol, les cat\u00e9cholamines et l’angiotensine. Ces hormones augmentent la pression art\u00e9rielle et le rythme cardiaque, ce qui pr\u00e9pare une personne en bonne sant\u00e9 \u00e0 se r\u00e9veiller et \u00e0 commencer son activit\u00e9 quotidienne. Toutefois, chez une personne souffrant d’une maladie cardiaque, une forte augmentation de ces hormones pr\u00e9sente un risque pour la sant\u00e9. Les crises cardiaques sont plus fr\u00e9quentes le matin en raison du pic de pression art\u00e9rielle et de pouls qui en r\u00e9sulte, et les crises cardiaques du matin sont les plus susceptibles d’entra\u00eener une mort subite.<\/p>\n

La pression art\u00e9rielle augmente encore le matin lorsqu’une personne se l\u00e8ve et commence \u00e0 bouger. Le c\u0153ur est alors plus sollicit\u00e9 et doit commencer \u00e0 pomper davantage de sang pour maintenir l’apport d’oxyg\u00e8ne dans l’organisme. Les plaquettes sont \u00e9galement plus susceptibles de former des caillots le matin, ce qui augmente le risque d’accident vasculaire c\u00e9r\u00e9bral et d’autres \u00e9v\u00e9nements cardiovasculaires.<\/p>\n

Apr\u00e8s avoir atteint son maximum le matin, la tension art\u00e9rielle diminue tout au long de la journ\u00e9e et atteint son niveau le plus bas sur 24 heures entre minuit et 3 heures du matin. Les chercheurs pensent que la tension art\u00e9rielle et la fr\u00e9quence cardiaque sont r\u00e9gies dans une large mesure par le tonus sympathique<\/a>, un syst\u00e8me biologique qui agit par l’interm\u00e9diaire d’hormones telles que l’\u00e9pin\u00e9phrine et la nor\u00e9pin\u00e9phrine. Le tonus sympathique est plus \u00e9lev\u00e9 pendant la journ\u00e9e afin de maintenir le corps et l’esprit alertes et pr\u00eats \u00e0 l’activit\u00e9.<\/p>\n

Personnes qui s’endorment et personnes qui ne s’endorment pas<\/h2>\n

En \u00e9tudiant la rythmicit\u00e9 des crises cardiaques et de la pression art\u00e9rielle, les chercheurs en biologie circadienne se sont rapidement rendu compte que leurs patients suivaient l’un des deux sch\u00e9mas quotidiens. Ces deux groupes de patients ont \u00e9t\u00e9 appel\u00e9s \u00ab\u00a0dippers\u00a0\u00bb et \u00ab\u00a0non dippers\u00a0\u00bb. Les dippers ont une pression art\u00e9rielle nocturne inf\u00e9rieure d’au moins 10 % \u00e0 leur pression art\u00e9rielle diurne, tandis que les non-dippers pr\u00e9sentent une baisse beaucoup plus faible. Cette diff\u00e9rence est importante car les non-dippers ont un risque plus \u00e9lev\u00e9 de mourir d’un \u00e9v\u00e9nement cardiovasculaire, ce qui sugg\u00e8re qu’un rythme circadien normal est important pour la sant\u00e9 cardiaque et la pr\u00e9vention des maladies. Les non-dippers pr\u00e9sentent un risque particuli\u00e8rement \u00e9lev\u00e9 de crise cardiaque nocturne.<\/p>\n

Chronoth\u00e9rapie : Application des nouvelles connaissances<\/h2>\n

\"Blood<\/a>La chronoth\u00e9rapie des m\u00e9dicaments contre la tension art\u00e9rielle et d’autres traitements<\/a> des maladies cardiovasculaires peut offrir un espoir aux personnes dont l’hypertension est difficile \u00e0 contr\u00f4ler. Plusieurs \u00e9tudes chronobiologiques r\u00e9centes sugg\u00e8rent que les effets des m\u00e9dicaments peuvent \u00eatre maximis\u00e9s et les effets secondaires minimis\u00e9s en les prenant \u00e0 certains moments de la journ\u00e9e<\/a>. Par exemple, les antagonistes des r\u00e9cepteurs b\u00eata-adr\u00e9nergiques, connus sous le nom de b\u00eata-bloquants, r\u00e9duisent consid\u00e9rablement la pression art\u00e9rielle pendant la journ\u00e9e, mais ont peu d’effet sur la pression art\u00e9rielle pendant la nuit. Ils constituent donc un bon choix pour les patients qui font de l’hypertension diurne, mais les patients qui ne font pas d’hypertension diurne peuvent avoir besoin d’un autre m\u00e9dicament pour traiter l’hypertension nocturne.<\/p>\n

Les inhibiteurs calciques, un autre m\u00e9dicament courant contre l’hypertension, pr\u00e9sentent une biodisponibilit\u00e9 r\u00e9duite lorsqu’ils sont administr\u00e9s le soir. Malgr\u00e9 cela, certains m\u00e9dicaments de cette classe aident \u00e0 r\u00e9duire la tension art\u00e9rielle nocturne chez les non-dippers. Deux m\u00e9dicaments permettent m\u00eame aux non-dippers de retrouver le rythme normal de la pression art\u00e9rielle d’un dipper, ce qui peut r\u00e9duire les risques de mort subite.<\/p>\n

Les inhibiteurs de l’ECA sont pris une fois par jour, mais les personnes qui ne sont pas dippers constatent une baisse drastique de la pression art\u00e9rielle lorsqu’elles les prennent le soir plut\u00f4t que le matin. Le fait de prendre ce m\u00e9dicament au bon moment peut permettre d’\u00e9viter un grand nombre d’infarctus du myocarde observ\u00e9s chez les non-dippers en fin de journ\u00e9e.<\/p>\n

Le rythme circadien d’une personne, y compris le fait qu’elle soit dipper ou non dipper, peut faire une \u00e9norme diff\u00e9rence dans les traitements et les moments les plus efficaces. De nombreuses vies pourraient \u00eatre sauv\u00e9es par de simples tests visant \u00e0 d\u00e9terminer comment la pression art\u00e9rielle d’un patient \u00e9volue la nuit, puis par l’application d’une chronoth\u00e9rapie en fonction du type de patient. Ces nouvelles d\u00e9couvertes sont porteuses d’espoir pour les personnes qui luttent contre l’hypertension, ainsi que pour l’\u00e9quipe m\u00e9dicale qui tente de les aider.<\/p><\/p>\n","protected":false},"excerpt":{"rendered":"

Le traitement de l’hypertension art\u00e9rielle et des maladies cardiovasculaires peut constituer un d\u00e9fi pour les m\u00e9decins modernes. Malheureusement, les enjeux sont importants. Aux \u00c9tats-Unis, 720 000 personnes sont victimes d’une crise cardiaque chaque ann\u00e9e, tandis que 60 millions de personnes souffrent d’une forme ou d’une autre de maladie cardiovasculaire. Le contr\u00f4le de la tension art\u00e9rielle […]<\/p>\n","protected":false},"author":15,"featured_media":23508,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_genesis_hide_title":false,"_genesis_hide_breadcrumbs":false,"_genesis_hide_singular_image":false,"_genesis_hide_footer_widgets":false,"_genesis_custom_body_class":"","_genesis_custom_post_class":"","_genesis_layout":"","footnotes":""},"categories":[245,249],"tags":[],"class_list":{"0":"post-58224","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-chronotype-fr","8":"category-sante-du-coeur","9":"entry"},"acf":[],"yoast_head":"\nPression art\u00e9rielle, crises cardiaques et chronoth\u00e9rapie – Chronobiology.com<\/title>\n<meta name=\"description\" content=\"While new wonder drugs for hypertension hit the pharmaceutical market almost every year, many people still live with uncontrollably high blood pressure and the accompanying high risk of heart attack. 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