La mesure ambulatoire de la pression artérielle (MAPA) chez les diabétiques

Ambulatory blood pressure monitoring (ABPM) permits to better appreciate blood pressure (BP) patterns in usual life conditions, to determine its nycthemeral variability and to rule out a « white coat » effect. Ambulatory BP recordings are lower than in the clinic, but differ during day- and nighttimes. A blunted nocturnal BP decreases defined a "non dipper" subject by contrast to "dipper" normal subjects. This phenomenon, unlikely to be insignificant, increases pressor load, has unfavourable consequences on target organs and seems to be related to a cardiovascular autonomic neuropathy. BP in diabetics is characterised also by an increase in BP variability, which contrast with a decreased heart rate variability. Finally, ABPM permits to verify the treatment efficacy and represents, together with BP self-monitoring, a highly useful tool in diabetology.