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Master Thesis

Efficacité du traitement de l'hypertension artérielle précoce au sevrage des vasopresseurs après un choc septique au sein d'une cohorte rétrospective

Abstract : Background: the onset of hypertension after withdrawal of vasopressor following septic shock is poorly described in intensive care but appears to be frequent, early and associated with better outcome. The main objective of this study was to analyse the efficacy of antihypertensive treatments prescribed to intensive care patients and their prognosis. Patients and method: retrospective cohort including patients admitted for septic shock in two resuscitations at Bordeaux University Hospital between 2016 and 2019 with a diagnosis of hypertension defined by the introduction of an intravenous antihypertensive maintained at least 24 hours or by a 24-hour average blood pressure greater than 140mmHg (systolic) or 90mmHg (diastolic) occurring within 7 days of norepinephrine withdrawal. Results: two hundred and thirty-eight patients were included in the analysis, of which 141 (68%) were treated with an antihypertensive drug (α1-adrenoceptor antagonist (urapidil), calcium channel blockers (nicardipine) or their combination in 33%, 31% and 22% of cases respectively). Only 46 (28%) of the patients had their blood pressure controlled on the third day after the onset of hypertension. No difference in efficacy or tolerance was found between nicardipine and urapidil. There was no difference in renal events between treated and untreated patients, but major cardiovascular events were more frequent among treated patients (26% vs 8%, P=0.001). Conclusion: hypertension following septic shock is a common phenomenon after norepinephrine withdrawal. Blood pressure control is rarely achieved with comparable inefficacy of nicardipine and urapidil, even in combination. The short-term outcome of treated patients was similar to that of untreated patients, without any benefit found for any type of antihypertensive drug commonly used in the ICU. The value of a strategy to control blood pressure after septic shock in intensive care remains to be defined.
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Submitted on : Wednesday, September 23, 2020 - 1:02:27 PM
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  • HAL Id : dumas-02946703, version 1



Younes El Boustani. Efficacité du traitement de l'hypertension artérielle précoce au sevrage des vasopresseurs après un choc septique au sein d'une cohorte rétrospective. Sciences du Vivant [q-bio]. 2020. ⟨dumas-02946703⟩



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