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Bouhanick B, Sosner P, Brochard K, Mounier-Véhier C, Plu-Bureau G, Hascoet S, Ranchin B, Pietrement C, Martinerie L, Boivin JM, Fauvel JP, Bacchetta J. Hypertension in Children and Adolescents: A Position Statement From a Panel of Multidisciplinary Experts Coordinated by the French Society of Hypertension. Front Pediatr 2021; 9:680803. [PMID: 34307254 PMCID: PMC8292722 DOI: 10.3389/fped.2021.680803] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/09/2021] [Indexed: 11/23/2022] Open
Abstract
Hypertension is much less common in children than in adults. The group of experts decided to perform a review of the literature to draw up a position statement that could be used in everyday practice. The group rated recommendations using the GRADE approach. All children over the age of 3 years should have their blood pressure measured annually. Due to the lack of data on cardiovascular morbidity and mortality associated with blood pressure values, the definition of hypertension in children is a statistical value based on the normal distribution of blood pressure in the paediatric population, and children and adolescents are considered as having hypertension when their blood pressure is greater than or equal to the 95th percentile. Nevertheless, it is recommended to use normative blood pressure tables developed according to age, height and gender, to define hypertension. Measuring blood pressure in children can be technically challenging and several measurement methods are listed here. Regardless of the age of the child, it is recommended to carefully check for a secondary cause of hypertension as in 2/3 of cases it has a renal or cardiac origin. The care pathway and principles of the therapeutic strategy are described here.
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Affiliation(s)
- Béatrice Bouhanick
- Service d'Hypertension Artérielle et Thérapeutique, CHU Rangueil, CERPOP, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Philippe Sosner
- Centre Médico-Sportif MON STADE, Paris, France.,Hôpital Hôtel-Dieu, APHP, Centre de Diagnostic et de Thérapeutique, Paris, France.,Laboratoire MOVE (EA 6314), Université de Poitiers, Faculté des Sciences du Sport, Poitiers, France
| | - Karine Brochard
- Service de Néphrologie Médecine Interne Pédiatrique, Hôpital des Enfants, CHU Toulouse, Toulouse, France
| | - Claire Mounier-Véhier
- Institut Cœur-Poumon, Médecine Vasculaire et HTA, CHU, Université Lille, EA 2694 - Santé Publique: Epidémiologie et Qualité des Soins Lille, Lille, France
| | - Geneviève Plu-Bureau
- Unité de Gynécologie Médicale, AP-HP, Hôpital Port-Royal, Université de Paris, Paris, France
| | - Sébastien Hascoet
- Pôle des Cardiopathies Congénitales du Nouveau-Né à L'adulte - Centre Constitutif Cardiopathies Congénitales Complexes M3C, Groupe Hospitalier Paris Saint-Joseph, Hôpital Marie-Lannelongue, Inserm U999, Université Paris-Saclay, Le Plessis-Robinson, France
| | - Bruno Ranchin
- Centre de Référence des Maladies Rénales Rares, Service de Néphrologie Rhumatologie et Dermatologie Pédiatriques, Filières Maladies Rares ORKID et ERK-Net, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Bron, France.,Faculté de Médecine Lyon Est, Université Lyon 1, Lyon, France
| | | | - Laetitia Martinerie
- Centre de Reference des Maladies Rares de la Croissance et du Développement, Université de Paris, Endocrinologie et Diabétologie Pédiatrique, AP-HP, Hôpital Robert-Debré, Paris, France
| | - Jean Marc Boivin
- Département de Médecine Générale, Université de Lorraine, Inserm CIC-P Pierre Drouin Vandœuvre-Lès-Nancy, Vandœuvre-lès-Nancy, France
| | - Jean Pierre Fauvel
- Service de Néphrologie Hospices Civils, Hôpital Edouard Herriot, Lyon, France.,UMR CNRS 5558, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Justine Bacchetta
- Centre de Référence des Maladies Rénales Rares, Service de Néphrologie Rhumatologie et Dermatologie Pédiatriques, Filières Maladies Rares ORKID et ERK-Net, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Bron, France.,Faculté de Médecine Lyon Est, Université Lyon 1, Lyon, France
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Madika AL, Mounier-Véhier C. [Gender inequalities for cardiovascular diseases]. Rev Prat 2019; 69:373-376. [PMID: 31626484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Cardiovascular diseases are the primary cause of death in women. Cardiovascular risk is specific and often underestimated in women. At equal age, women have more cardiovascular risk factors than men. Some of them such as smoking and diabetes are associated with greater increase of cardiovascular risk and poorer prognosis in women as compared to men. In addition, women have a specific hormonal risk linked to contraception, pregnancy and menopause. Prevention, screening and diagnosis are generally implemented both at later stages and less frequently than in men because of particularities in clinical presentation, and treatments are not optimal in women. All these specificities must be considered for an optimized evaluation of cardiovascular risk and an improvement of management in women.
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Affiliation(s)
- Anne-Laure Madika
- CHU Lille, Institut cœur poumon, médecine vasculaire et hypertension artérielle, Lille, France - Univ. Lille, EA 2694 - Santé
| | - Claire Mounier-Véhier
- CHU Lille, Institut cœur poumon, médecine vasculaire et hypertension artérielle, Lille, France - Univ. Lille, EA 2694 - Santé
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Azizi M, Pereira H, Hamdidouche I, Gosse P, Monge M, Bobrie G, Delsart P, Mounier-Véhier C, Courand PY, Lantelme P, Denolle T, Dourmap-Collas C, Girerd X, Michel Halimi J, Zannad F, Ormezzano O, Vaïsse B, Herpin D, Ribstein J, Chamontin B, Mourad JJ, Ferrari E, Plouin PF, Jullien V, Sapoval M, Chatellier G, Amar L, Lorthioir A, Pagny JY, Claisse G, Midulla M, Dauphin R, Fauvel J, Rouvière O, Cremer A, Grenier N, Lebras Y, Trillaud H, Heautot J, Larralde A, Paillard F, Cluzel P, Rosenbaum D, Alison D, Claudon M, Popovic B, Rossignol P, Baguet J, Thony F, Bartoli J, Drouineau J, Sosner P, Tasu J, Velasco S, Vernhet-Kovacsik H, Bouhanick B, Rousseau H, Le Jeune S, Lopez-Sublet M, Bellmann L, Esnault V, Baguet J, Vernhet-Kovacsik H, Durand-Zaleski I, Beregi (chair) J, Lièvre M, Persu A. Adherence to Antihypertensive Treatment and the Blood Pressure–Lowering Effects of Renal Denervation in the Renal Denervation for Hypertension (DENERHTN) Trial. Circulation 2016; 134:847-57. [DOI: 10.1161/circulationaha.116.022922] [Citation(s) in RCA: 119] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 07/29/2016] [Indexed: 12/20/2022]
Abstract
Background:
The DENERHTN trial (Renal Denervation for Hypertension) confirmed the blood pressure–lowering efficacy of renal denervation added to a standardized stepped-care antihypertensive treatment for resistant hypertension at 6 months. We report the influence of adherence to antihypertensive treatment on blood pressure control.
Methods:
One hundred six patients with hypertension resistant to 4 weeks of treatment with indapamide 1.5 mg/d, ramipril 10 mg/d (or irbesartan 300 mg/d), and amlodipine 10 mg/d were randomly assigned to renal denervation plus standardized stepped-care antihypertensive treatment, or the same antihypertensive treatment alone. For standardized stepped-care antihypertensive treatment, spironolactone 25 mg/d, bisoprolol 10 mg/d, prazosin 5 mg/d, and rilmenidine 1 mg/d were sequentially added at monthly visits if home blood pressure was ≥135/85 mm Hg after randomization. We assessed adherence to antihypertensive treatment at 6 months by drug screening in urine/plasma samples from 85 patients.
Results:
The numbers of fully adherent (20/40 versus 21/45), partially nonadherent (13/40 versus 20/45), or completely nonadherent patients (7/40 versus 4/45) to antihypertensive treatment were not different in the renal denervation and the control groups, respectively (
P
=0.3605). The difference in the change in daytime ambulatory systolic blood pressure from baseline to 6 months between the 2 groups was –6.7 mm Hg (
P
=0.0461) in fully adherent and –7.8 mm Hg (
P
=0.0996) in nonadherent (partially nonadherent plus completely nonadherent) patients. The between-patient variability of daytime ambulatory systolic blood pressure was greater for nonadherent than for fully adherent patients.
Conclusions:
In the DENERHTN trial, the prevalence of nonadherence to antihypertensive drugs at 6 months was high (≈50%) but not different in the renal denervation and control groups. Regardless of adherence to treatment, renal denervation plus standardized stepped-care antihypertensive treatment resulted in a greater decrease in blood pressure than standardized stepped-care antihypertensive treatment alone.
Clinical Trial Registration:
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT01570777.
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Affiliation(s)
- Michel Azizi
- From Paris-Descartes University, France (M.A., P.-F.P., V.J., M.S., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, France (M.A., G.B., P.-F.P.); INSERM, CIC1418, Paris, France (M.A., H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Clinical Research Unit, France (H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Pharmacology, France (I.H., V.J.); Centre
| | - Helena Pereira
- From Paris-Descartes University, France (M.A., P.-F.P., V.J., M.S., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, France (M.A., G.B., P.-F.P.); INSERM, CIC1418, Paris, France (M.A., H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Clinical Research Unit, France (H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Pharmacology, France (I.H., V.J.); Centre
| | - Idir Hamdidouche
- From Paris-Descartes University, France (M.A., P.-F.P., V.J., M.S., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, France (M.A., G.B., P.-F.P.); INSERM, CIC1418, Paris, France (M.A., H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Clinical Research Unit, France (H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Pharmacology, France (I.H., V.J.); Centre
| | - Philippe Gosse
- From Paris-Descartes University, France (M.A., P.-F.P., V.J., M.S., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, France (M.A., G.B., P.-F.P.); INSERM, CIC1418, Paris, France (M.A., H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Clinical Research Unit, France (H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Pharmacology, France (I.H., V.J.); Centre
| | - Matthieu Monge
- From Paris-Descartes University, France (M.A., P.-F.P., V.J., M.S., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, France (M.A., G.B., P.-F.P.); INSERM, CIC1418, Paris, France (M.A., H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Clinical Research Unit, France (H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Pharmacology, France (I.H., V.J.); Centre
| | - Guillaume Bobrie
- From Paris-Descartes University, France (M.A., P.-F.P., V.J., M.S., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, France (M.A., G.B., P.-F.P.); INSERM, CIC1418, Paris, France (M.A., H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Clinical Research Unit, France (H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Pharmacology, France (I.H., V.J.); Centre
| | - Pascal Delsart
- From Paris-Descartes University, France (M.A., P.-F.P., V.J., M.S., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, France (M.A., G.B., P.-F.P.); INSERM, CIC1418, Paris, France (M.A., H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Clinical Research Unit, France (H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Pharmacology, France (I.H., V.J.); Centre
| | - Claire Mounier-Véhier
- From Paris-Descartes University, France (M.A., P.-F.P., V.J., M.S., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, France (M.A., G.B., P.-F.P.); INSERM, CIC1418, Paris, France (M.A., H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Clinical Research Unit, France (H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Pharmacology, France (I.H., V.J.); Centre
| | - Pierre-Yves Courand
- From Paris-Descartes University, France (M.A., P.-F.P., V.J., M.S., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, France (M.A., G.B., P.-F.P.); INSERM, CIC1418, Paris, France (M.A., H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Clinical Research Unit, France (H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Pharmacology, France (I.H., V.J.); Centre
| | - Pierre Lantelme
- From Paris-Descartes University, France (M.A., P.-F.P., V.J., M.S., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, France (M.A., G.B., P.-F.P.); INSERM, CIC1418, Paris, France (M.A., H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Clinical Research Unit, France (H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Pharmacology, France (I.H., V.J.); Centre
| | - Thierry Denolle
- From Paris-Descartes University, France (M.A., P.-F.P., V.J., M.S., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, France (M.A., G.B., P.-F.P.); INSERM, CIC1418, Paris, France (M.A., H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Clinical Research Unit, France (H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Pharmacology, France (I.H., V.J.); Centre
| | - Caroline Dourmap-Collas
- From Paris-Descartes University, France (M.A., P.-F.P., V.J., M.S., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, France (M.A., G.B., P.-F.P.); INSERM, CIC1418, Paris, France (M.A., H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Clinical Research Unit, France (H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Pharmacology, France (I.H., V.J.); Centre
| | - Xavier Girerd
- From Paris-Descartes University, France (M.A., P.-F.P., V.J., M.S., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, France (M.A., G.B., P.-F.P.); INSERM, CIC1418, Paris, France (M.A., H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Clinical Research Unit, France (H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Pharmacology, France (I.H., V.J.); Centre
| | - Jean Michel Halimi
- From Paris-Descartes University, France (M.A., P.-F.P., V.J., M.S., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, France (M.A., G.B., P.-F.P.); INSERM, CIC1418, Paris, France (M.A., H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Clinical Research Unit, France (H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Pharmacology, France (I.H., V.J.); Centre
| | - Faiez Zannad
- From Paris-Descartes University, France (M.A., P.-F.P., V.J., M.S., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, France (M.A., G.B., P.-F.P.); INSERM, CIC1418, Paris, France (M.A., H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Clinical Research Unit, France (H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Pharmacology, France (I.H., V.J.); Centre
| | - Olivier Ormezzano
- From Paris-Descartes University, France (M.A., P.-F.P., V.J., M.S., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, France (M.A., G.B., P.-F.P.); INSERM, CIC1418, Paris, France (M.A., H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Clinical Research Unit, France (H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Pharmacology, France (I.H., V.J.); Centre
| | - Bernard Vaïsse
- From Paris-Descartes University, France (M.A., P.-F.P., V.J., M.S., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, France (M.A., G.B., P.-F.P.); INSERM, CIC1418, Paris, France (M.A., H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Clinical Research Unit, France (H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Pharmacology, France (I.H., V.J.); Centre
| | - Daniel Herpin
- From Paris-Descartes University, France (M.A., P.-F.P., V.J., M.S., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, France (M.A., G.B., P.-F.P.); INSERM, CIC1418, Paris, France (M.A., H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Clinical Research Unit, France (H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Pharmacology, France (I.H., V.J.); Centre
| | - Jean Ribstein
- From Paris-Descartes University, France (M.A., P.-F.P., V.J., M.S., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, France (M.A., G.B., P.-F.P.); INSERM, CIC1418, Paris, France (M.A., H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Clinical Research Unit, France (H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Pharmacology, France (I.H., V.J.); Centre
| | - Bernard Chamontin
- From Paris-Descartes University, France (M.A., P.-F.P., V.J., M.S., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, France (M.A., G.B., P.-F.P.); INSERM, CIC1418, Paris, France (M.A., H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Clinical Research Unit, France (H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Pharmacology, France (I.H., V.J.); Centre
| | - Jean-Jacques Mourad
- From Paris-Descartes University, France (M.A., P.-F.P., V.J., M.S., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, France (M.A., G.B., P.-F.P.); INSERM, CIC1418, Paris, France (M.A., H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Clinical Research Unit, France (H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Pharmacology, France (I.H., V.J.); Centre
| | - Emile Ferrari
- From Paris-Descartes University, France (M.A., P.-F.P., V.J., M.S., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, France (M.A., G.B., P.-F.P.); INSERM, CIC1418, Paris, France (M.A., H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Clinical Research Unit, France (H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Pharmacology, France (I.H., V.J.); Centre
| | - Pierre-François Plouin
- From Paris-Descartes University, France (M.A., P.-F.P., V.J., M.S., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, France (M.A., G.B., P.-F.P.); INSERM, CIC1418, Paris, France (M.A., H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Clinical Research Unit, France (H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Pharmacology, France (I.H., V.J.); Centre
| | - Vincent Jullien
- From Paris-Descartes University, France (M.A., P.-F.P., V.J., M.S., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, France (M.A., G.B., P.-F.P.); INSERM, CIC1418, Paris, France (M.A., H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Clinical Research Unit, France (H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Pharmacology, France (I.H., V.J.); Centre
| | - Marc Sapoval
- From Paris-Descartes University, France (M.A., P.-F.P., V.J., M.S., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, France (M.A., G.B., P.-F.P.); INSERM, CIC1418, Paris, France (M.A., H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Clinical Research Unit, France (H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Pharmacology, France (I.H., V.J.); Centre
| | - Gilles Chatellier
- From Paris-Descartes University, France (M.A., P.-F.P., V.J., M.S., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, France (M.A., G.B., P.-F.P.); INSERM, CIC1418, Paris, France (M.A., H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Clinical Research Unit, France (H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Pharmacology, France (I.H., V.J.); Centre
| | - L. Amar
- Hôpital Européen Georges Pompidou, Paris (31/28)
| | - A. Lorthioir
- Hôpital Européen Georges Pompidou, Paris (31/28)
| | - J.-Y. Pagny
- Hôpital Européen Georges Pompidou, Paris (31/28)
| | | | | | - R. Dauphin
- Hôpital de la Croix Rousse and Hôpital Edouard Herriot, Lyon (14/13)
| | - J.P. Fauvel
- Hôpital de la Croix Rousse and Hôpital Edouard Herriot, Lyon (14/13)
| | - O. Rouvière
- Hôpital de la Croix Rousse and Hôpital Edouard Herriot, Lyon (14/13)
| | - A. Cremer
- Hôpital Saint André and Hôpital Pellegrin, Bordeaux (14/13)
| | - N. Grenier
- Hôpital Saint André and Hôpital Pellegrin, Bordeaux (14/13)
| | - Y. Lebras
- Hôpital Saint André and Hôpital Pellegrin, Bordeaux (14/13)
| | - H. Trillaud
- Hôpital Saint André and Hôpital Pellegrin, Bordeaux (14/13)
| | - J.F. Heautot
- Hôpital Arthur Gardiner, Dinard and CHU Rennes (12/12)
| | - A. Larralde
- Hôpital Arthur Gardiner, Dinard and CHU Rennes (12/12)
| | - F. Paillard
- Hôpital Arthur Gardiner, Dinard and CHU Rennes (12/12)
| | - P. Cluzel
- Hôpital de la Pitié Salpétrière, Paris (6/5)
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Amar L, Baguet JP, Bardet S, Chaffanjon P, Chamontin B, Douillard C, Durieux P, Girerd X, Gosse P, Hernigou A, Herpin D, Houillier P, Jeunemaitre X, Joffre F, Kraimps JL, Lefebvre H, Ménégaux F, Mounier-Véhier C, Nussberger J, Pagny JY, Pechère A, Plouin PF, Reznik Y, Steichen O, Tabarin A, Zennaro MC, Zinzindohoue F, Chabre O. SFE/SFHTA/AFCE primary aldosteronism consensus: Introduction and handbook. Ann Endocrinol (Paris) 2016; 77:179-86. [PMID: 27315757 DOI: 10.1016/j.ando.2016.05.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 05/09/2016] [Indexed: 10/21/2022]
Abstract
The French Endocrinology Society (SFE) French Hypertension Society (SFHTA) and Francophone Endocrine Surgery Association (AFCE) have drawn up recommendations for the management of primary aldosteronism (PA), based on an analysis of the literature by 27 experts in 7 work-groups. PA is suspected in case of hypertension associated with one of the following characteristics: severity, resistance, associated hypokalemia, disproportionate target organ lesions, or adrenal incidentaloma with hypertension or hypokalemia. Diagnosis is founded on aldosterone/renin ratio (ARR) measured under standardized conditions. Diagnostic thresholds are expressed according to the measurement units employed. Diagnosis is established for suprathreshold ARR associated with aldosterone concentrations >550pmol/L (200pg/mL) on 2 measurements, and rejected for aldosterone concentration<240pmol/L (90pg/mL) and/or subthreshold ARR. The diagnostic threshold applied is different if certain medication cannot be interrupted. In intermediate situations, dynamic testing is performed. Genetic forms of PA are screened for in young subjects and/or in case of familial history. The patient should be informed of the results expected from medical and surgical treatment of PA before exploration for lateralization is proposed. Lateralization is explored by adrenal vein sampling (AVS), except in patients under 35 years of age with unilateral adenoma on imaging. If PA proves to be lateralized, unilateral adrenalectomy may be performed, with adaptation of medical treatment pre- and postoperatively. If PA is non-lateralized or the patient refuses surgery, spironolactone is administered as first-line treatment, replaced by amiloride, eplerenone or calcium-channel blockers if insufficiently effective or poorly tolerated.
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Affiliation(s)
- Laurence Amar
- Université Paris Descartes, Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Unité D'hypertension Artérielle, 75098 Paris Cedex 15, France
| | - Jean Philippe Baguet
- Service de Cardiologie, centre d'excellence en hypertension, Clinique Mutualiste de Grenoble, 38028 Grenoble, France
| | - Stéphane Bardet
- Centre François Baclesse, Service de Médecine Nucléaire, 3, Avenue du Général-Harris, 14076 Caen cedex 05, France
| | - Philippe Chaffanjon
- CHU Grenoble-Alpes, Département de Chirurgie Thoracique, Vasculaire et Endocrinienne, 38700 La Tronche, France; Université Grenoble Alpes, LADAF-Laboratoire d'Anatomie Des Alpes Françaises, UFR de Médecine, 38700 La Tronche, France
| | - Bernard Chamontin
- Centre Hospitalo-Universitaire Rangueil, Service de Médecine Interne et d'Hypertension Artérielle, 31059 Toulouse, France
| | - Claire Douillard
- Service d'endocrinologie et des maladies métaboliques, Centre Hospitalier Régional Universitaire de Lille, 59037 Lille, France
| | - Pierre Durieux
- Santé Publique et Informatique Médicale, Hôpital Européen Georges Pompidou, 20, Rue Leblanc, 75908 Paris cedex 15, France; Centre Cochrane Français, Université Paris Descartes, Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris, 75098 Paris France
| | - Xaxier Girerd
- Pôle Cœur Métabolisme, Unité de Prévention Cardiovasculaire, Groupe Hospitalier Universitaire Pitié-Salpêtrière, 83, bld de l'Hôpital, 75013 Paris, France
| | - Philippe Gosse
- Service de Cardiologie/Hypertension CHU Bordeaux, 33076 Bordeaux, France
| | - Anne Hernigou
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Unité d'Hypertension, 20, Rue Leblanc, 75908 Paris cedex 15, France
| | - Daniel Herpin
- Service de Cardiologie, Centre Hospitalier Universitaire de Poitiers, 86021 Poitiers, France
| | - Pascal Houillier
- Département des maladies rénales et métaboliques, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, 75015 Paris, France
| | - Xavier Jeunemaitre
- INSERM, UMRS_970, Paris Cardiovascular Research Center, Université Paris Descartes, Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Génétique, 75098 Paris, France
| | - Francis Joffre
- Centre Hospitalo-Universitaire Rangueil, Département de Radiologie, 31059 Toulouse, France
| | - Jean-Louis Kraimps
- CHU Poitiers, Hôpital Jean Bernard, Chirurgie Générale et Endocrinienne, Université de Poitiers, Faculté de Médecine, 86000 Poitiers, France
| | - Hervé Lefebvre
- Service d'endocrinologie, Centre Hospitalier Universitaire, 76031 Rouen, France
| | - Fabrice Ménégaux
- Sorbonne Universités, UPMC Univ Paris 06, Faculté de Médecine, 75006 Paris, France; AP-HP, Pitié Salpétrière, Service de Chirurgie Digestive et Viscérale, 75013 Paris, France
| | - Claire Mounier-Véhier
- Service de Médecine Vasculaire et Hypertension Artérielle, Centre Hospitalier Universitaire de Lille, 59037 Lille, France
| | - Juerg Nussberger
- Service de Médecine Interne (unité vasculaire et d'hypertension), Centre Hospitalier Universitaire de Lausanne, 1011 Lausanne, Switzerland
| | - Jean-Yves Pagny
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Département de Radiologie, 20, Rue Leblanc, 75908 Paris cedex 15, France
| | - Antoinette Pechère
- Unité d'Hypertension, Hopital Universitaire de Genève, 1205 Geneve, Switzerland
| | - Pierre-François Plouin
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Unité d'Hypertension, 20, Rue Leblanc, 75908 Paris cedex 15, France
| | - Yves Reznik
- Service d'Endocrinologie et Maladies Métaboliques, CHU Côte de Nacre, 14033 Caen Cedex, France
| | - Olivier Steichen
- AP-HP, hôpital Tenon, Service de Médecine Interne, 75020 Paris, France
| | - Antoine Tabarin
- Service d'Endocrinologie, Hôpital Haut Lévêque, CHU de Bordeaux, Avenue de Magellan, 33600 Pessac, France
| | - Maria-Christina Zennaro
- INSERM, UMRS_970, Paris Cardiovascular Research Center, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Génétique, 75098 Paris, France
| | - Franck Zinzindohoue
- Sorbonne Paris Cité, Université Paris Descartes, Faculté de Médecine, 75006 Paris, France
| | - Olivier Chabre
- AP-HP, HEGP, Service de Chirurgie Digestive, Générale et Cancérologique, 75015 Paris, France; Endocrinologie, Pavillon des Ecrins, Centre Hospitalier Universitaire de Grenoble, CS 10217, 38043 Grenoble Cedex 9, France.
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Azizi M, Sapoval M, Gosse P, Monge M, Bobrie G, Delsart P, Midulla M, Mounier-Véhier C, Courand PY, Lantelme P, Denolle T, Dourmap-Collas C, Trillaud H, Pereira H, Plouin PF, Chatellier G. Optimum and stepped care standardised antihypertensive treatment with or without renal denervation for resistant hypertension (DENERHTN): a multicentre, open-label, randomised controlled trial. Lancet 2015; 385:1957-65. [PMID: 25631070 DOI: 10.1016/s0140-6736(14)61942-5] [Citation(s) in RCA: 368] [Impact Index Per Article: 40.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Conflicting blood pressure-lowering effects of catheter-based renal artery denervation have been reported in patients with resistant hypertension. We compared the ambulatory blood pressure-lowering efficacy and safety of radiofrequency-based renal denervation added to a standardised stepped-care antihypertensive treatment (SSAHT) with the same SSAHT alone in patients with resistant hypertension. METHODS The Renal Denervation for Hypertension (DENERHTN) trial was a prospective, open-label randomised controlled trial with blinded endpoint evaluation in patients with resistant hypertension, done in 15 French tertiary care centres specialised in hypertension management. Eligible patients aged 18-75 years received indapamide 1·5 mg, ramipril 10 mg (or irbesartan 300 mg), and amlodipine 10 mg daily for 4 weeks to confirm treatment resistance by ambulatory blood pressure monitoring before randomisation. Patients were then randomly assigned (1:1) to receive either renal denervation plus an SSAHT regimen (renal denervation group) or the same SSAHT alone (control group). The randomisation sequence was generated by computer, and stratified by centres. For SSAHT, after randomisation, spironolactone 25 mg per day, bisoprolol 10 mg per day, prazosin 5 mg per day, and rilmenidine 1 mg per day were sequentially added from months two to five in both groups if home blood pressure was more than or equal to 135/85 mm Hg. The primary endpoint was the mean change in daytime systolic blood pressure from baseline to 6 months as assessed by ambulatory blood pressure monitoring. The primary endpoint was analysed blindly. The safety outcomes were the incidence of acute adverse events of the renal denervation procedure and the change in estimated glomerular filtration rate from baseline to 6 months. This trial is registered with ClinicalTrials.gov, number NCT01570777. FINDINGS Between May 22, 2012, and Oct 14, 2013, 1416 patients were screened for eligibility, 106 of those were randomly assigned to treatment (53 patients in each group, intention-to-treat population) and 101 analysed because of patients with missing endpoints (48 in the renal denervation group, 53 in the control group, modified intention-to-treat population). The mean change in daytime ambulatory systolic blood pressure at 6 months was -15·8 mm Hg (95% CI -19·7 to -11·9) in the renal denervation group and -9·9 mm Hg (-13·6 to -6·2) in the group receiving SSAHT alone, a baseline-adjusted difference of -5·9 mm Hg (-11·3 to -0·5; p=0·0329). The number of antihypertensive drugs and drug-adherence at 6 months were similar between the two groups. Three minor renal denervation-related adverse events were noted (lumbar pain in two patients and mild groin haematoma in one patient). A mild and similar decrease in estimated glomerular filtration rate from baseline to 6 months was observed in both groups. INTERPRETATION In patients with well defined resistant hypertension, renal denervation plus an SSAHT decreases ambulatory blood pressure more than the same SSAHT alone at 6 months. This additional blood pressure lowering effect may contribute to a reduction in cardiovascular morbidity if maintained in the long term after renal denervation. FUNDING French Ministry of Health.
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Affiliation(s)
- Michel Azizi
- Paris-Descartes University, Paris, France; Hypertension Unit, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigations Cliniques 1418, Paris, France.
| | - Marc Sapoval
- Paris-Descartes University, Paris, France; Vascular and Oncological Interventional Radiology Department, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Philippe Gosse
- Cardiology/Hypertension Department, Centre Hospitalier Universitaire de Bordeaux Hôpital Saint André, Bordeaux, France
| | - Matthieu Monge
- Hypertension Unit, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Guillaume Bobrie
- Hypertension Unit, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Pascal Delsart
- Centre Hospitalier Régional Universitaire de Lille, Hôpital Cardiologique, Médecine Vasculaire et HTA Lille, France
| | - Marco Midulla
- Centre Hospitalier Régional Universitaire de Lille, Hôpital Cardiologique, Radiologie et Imagerie Cardiaque et Vasculaire, Lille, France
| | - Claire Mounier-Véhier
- Centre Hospitalier Régional Universitaire de Lille, Hôpital Cardiologique, Médecine Vasculaire et HTA Lille, France
| | - Pierre-Yves Courand
- Hôpital Croix-Rousse, Cardiology Department, European Society of Hypertension Excellence Centre, Hospices Civils de Lyon, Lyon, France
| | - Pierre Lantelme
- Hôpital Croix-Rousse, Cardiology Department, European Society of Hypertension Excellence Centre, Hospices Civils de Lyon, Lyon, France; Génomique Fonctionnelle de l'Hypertension Artérielle, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Thierry Denolle
- Hôpital Arthur Gardiner, Centre d'Excellence en HTA Rennes-Dinard, Dinard, France
| | - Caroline Dourmap-Collas
- Centre Hospitalier Universitaire de Rennes, Service de Cardiologie et Maladies Vasculaires, Rennes, France
| | - Hervé Trillaud
- Centre Hospitalier Universitaire de Bordeaux, Hôpital Saint André, Service d'Imagerie Diagnostique et Interventionnelle, Bordeaux, France
| | - Helena Pereira
- Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigations Cliniques 1418, Paris, France
| | - Pierre-François Plouin
- Paris-Descartes University, Paris, France; Hypertension Unit, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Gilles Chatellier
- Paris-Descartes University, Paris, France; Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigations Cliniques 1418, Paris, France
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Ducher M, Mounier-Véhier C, Lantelme P, Vaisse B, Baguet JP, Fauvel JP. Reliability of a Bayesian network to predict an elevated aldosterone-to-renin ratio. Arch Cardiovasc Dis 2015; 108:293-9. [DOI: 10.1016/j.acvd.2014.09.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 09/04/2014] [Indexed: 01/21/2023]
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Mounier-Véhier C, Magnier A, Delsart P, Fayolle P, Noel A, Tegere C, Vernet N, Mortelecque E, Devos P. [Assessment of educational benefits in 73 hypertensive patients by telephone survey at distance of HTA Vasc educational program]. Ann Cardiol Angeiol (Paris) 2013; 62:204-209. [PMID: 23759734 DOI: 10.1016/j.ancard.2013.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Accepted: 04/01/2013] [Indexed: 06/02/2023]
Abstract
UNLABELLED HTA Vasc offers an approved educational program for hypertensive patients at high cardiovascular risk (CVR). METHOD A telephone survey (December 2011-July 2012) evaluated the benefits of different workshops "my treatment", "my blood pressure" and "my nutrition", more than 6 months after the end of the program. The follow-up data (TS) were compared to inclusion data (T0) and to final data (TF) in 73 hypertensive patients. RESULTS The follow-up period was 6 to 31 months. The number of hypertensive controlled patients [blood pressure (BP)<140/90 mmHg] increased from 55.4% to 75.4% (P=0.0158) in TF, which remained over time. The practice of physical activity increased from 47.9% (T0) to 79.5% (TS) (P=0.001). The follow-up period of 18 months or more was associated with a tendency to weight gain (P=0.0059) and with a decline in physical activity [89.7% (<18 months) to 67.5% (≥ 18 months) (P=0.0198)]. The practice of self-measurement BP increased from 41.1% (T0) to 71.2% (TS) (P<0.0001); knowledge of the "rule of three" increased from 6.8% (T0) to 74% (TS) (P<0.0001). CONCLUSION An educational support contributes to a better long-term BP control. The motivation for lifestyle rules decreases with time. The implementation of a structured motivational follow-up could maintain the lifestyle motivation at these CVR patients.
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Affiliation(s)
- C Mounier-Véhier
- Médecine vasculaire et HTA, CHRU de Lille, 2, avenue Oscar-Lambret, 59037 Lille, France.
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Ducher M, Mounier-Véhier C, Baguet JP, Tartière JM, Sosner P, Régnier-Le Coz S, Perez L, Fourcade J, Jabourek O, Lejeune S, Stolz A, Fauvel JP. Aldosterone-to-renin ratio for diagnosing aldosterone-producing adenoma: a multicentre study. Arch Cardiovasc Dis 2012. [PMID: 23199617 DOI: 10.1016/j.acvd.2012.07.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Biological diagnostic criteria for diagnosing aldosterone-producing adenoma (APA) are not well-established. AIM The aim of the study was to establish the best biological predictors of APA. METHODS A prospective register was implemented in 17 secondary or tertiary hypertension centres. The inclusion criterion was one of the following: onset of hypertension before 40 years of age; history of hypokalaemia; drug-resistant hypertension (resistant to three drugs); or spironolactone efficiency on BP. RESULTS Among the 338 collected cases, 192 patients had two aldosterone-to-renin ratio (ARR) determinations (after 1 hour supine and at least 1 hour upright) on the same occasion. Twenty-five patients (8.2%) had biological hyperaldosteronism and an adrenal adenoma identified by computed tomography. APA was histologically confirmed in all 12 patients who underwent surgery. Histologically proven APAs were used as the 'gold standard' in receiver operating characteristic (ROC) curve analysis. ARRs were computed with a minimum renin value set at 5 ng/L to avoid misclassification of so-called 'low-renin hypertension'. To predict an APA, the ARR area under the ROC curve was 0.93. A supine ARR cut-off value of 32ng/ng provided the highest sum of sensitivity (92%) plus specificity (92%). On the basis of an ARR≥32 ng/ng in the supine and/or upright position, sensitivity reached 100%. CONCLUSION The proposed cut-off value of 32 ng/ng for ARR (minimum renin value set at 5 ng/L) in one of two determinations had 100% sensitivity and 72% specificity with 20% positive and 100% negative predictive values for diagnosing APA.
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Ennezat PV, Maréchaux S, Six-Carpentier M, Pinçon C, Sediri I, Delsart P, Gras M, Mounier-Véhier C, Gautier C, Montaigne D, Jude B, Asseman P, Le Jemtel TH. Renal resistance index and its prognostic significance in patients with heart failure with preserved ejection fraction. Nephrol Dial Transplant 2011; 26:3908-13. [PMID: 21421591 DOI: 10.1093/ndt/gfr116] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Functional renal impairment is a common feature of heart failure with preserved ejection fraction (HFpEF). The link between functional renal impairment and HFpEF remains incompletely understood. With hypertension and diabetes as frequent co-morbidities, patients with HFpEF are at risk of developing intra-renal vascular hemodynamic alterations that may lead to functional renal impairment and impact on prognosis. METHODS Renal resistive index (RRI) was non-invasively determined by Doppler ultrasonic examination in 90 HFpEF patients and 90 age- and sex-matched hypertensive patients without evidence of heart failure (HF) who served as controls. Clinical, laboratory and cardiac echocardiography data were obtained in HFpEF patients and controls. To investigate its possible clinical relevance, RRI was evaluated as a prognostic index of all-cause mortality and hospitalization for HF. RESULTS Mean RRI was substantially greater in HFpEF patients than in controls (P < 0.0001), while mean blood pressure, glomerular filtration rate, hemoglobin and serum protein levels were significantly lower in HFpEF patients than in controls. On multivariable analysis, mean RRI was independently associated with HFpEF. In addition, increased mean RRI was an independent predictor of poor outcome [hazard ratio = 1.06 95% confidence interval (1.01-1.10), P = 0.007] and remained significantly associated with the outcome after adjustment for univariate predictors that included low mean blood pressure, low hemoglobin concentration and low glomerular filtration rate. Conclusion. Patients with HFpEF exhibit intra-renal vascular hemodynamic alterations. The severity of intra-renal vascular hemodynamic alterations correlates with a poor outcome.
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Midulla M, Martinelli T, Goyault G, Lions C, Abboud G, Koussa M, Mounier-Véhier C, Beregi JP. T-stenting with small protrusion technique (TAP-stenting) for stenosed aortoiliac bifurcations with small abdominal aortas: an alternative to the classic kissing stents technique. J Endovasc Ther 2010; 17:642-51. [PMID: 20939724 DOI: 10.1583/10-3052.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To report the feasibility and midterm results of aortic bifurcation reconstruction in patients with small abdominal aortas using commercially available stents applied in a modified T-stenting technique adapted from coronary angioplasty. METHODS Twenty-three patients (16 men; mean age 52.4 years) with lower limb ischemia (Fontaine stage IIb or III) and distal abdominal aortas <14 mm in diameter were treated for 39 common iliac artery and 16 aortic stenotic lesions involving the aortic bifurcation. A large, self-expanding stent was implanted from the lower aorta to one iliac branch, followed by deployment of a balloon-expandable stent in the contralateral iliac artery such that its proximal edge protruded a few millimeters through the struts of the self-expanding stent into the aorta [TAP (T And Protrude)-stenting technique]. Follow-up clinical, Doppler ultrasound, and computed tomography examinations were scheduled for each patient. RESULTS Angiographic success was obtained in all 23 patients, who received 23 self-expanding aortomonoiliac stents (mean diameter 13.5 mm) and 22 balloon-expandable stents (mean diameter 8.14 mm) in the contralateral iliac branch. No complications were reported. At a mean 16.3-month follow-up (range 2-60), clinical and ankle-brachial index (0.6±0.2 at baseline versus 1.04±0.1, p<0.01) improvement was observed in all patients. All stents were patent (patency rate 100%). Two late technical failures of the contralateral stent were observed (incomplete dilation requiring angioplasty and incomplete protrusion without any hemodynamic impact). CONCLUSION The TAP-stenting technique adapted to the aortoiliac bifurcation appears to be feasible, with satisfactory early and midterm patency rates in patients with small abdominal aortas. Larger series with longer follow-up times are necessary.
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Affiliation(s)
- Marco Midulla
- Department of Cardiovascular Imaging and Radiology, Hôpital Cardiologique, CHRU de Lille, France
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11
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Ennezat PV, Lefetz Y, Maréchaux S, Six-Carpentier M, Deklunder G, Montaigne D, Bauchart JJ, Mounier-Véhier C, Jude B, Nevière R, Bauters C, Asseman P, de Groote P, Lejemtel TH. Left ventricular abnormal response during dynamic exercise in patients with heart failure and preserved left ventricular ejection fraction at rest. J Card Fail 2008; 14:475-80. [PMID: 18672195 DOI: 10.1016/j.cardfail.2008.02.012] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2007] [Revised: 02/01/2008] [Accepted: 02/25/2008] [Indexed: 11/15/2022]
Abstract
BACKGROUND The mechanisms that contribute to limit functional capacity are incompletely understood in patients with preserved resting ejection fraction (HFpREF). We assessed left ventricular (LV) systolic response to dynamic exercise in patients with HFpREF and in patients with similar comorbidities to HFpREF patients but without history or evidence of heart failure. METHODS AND RESULTS Twenty-five HFpREF patients in steady-state clinical condition without significant coronary artery disease and 25 hypertensive controls underwent exercise echocardiography. At rest, systolic pulmonary artery pressure, left atrial area, E/A and E/e' ratios were greater in patients with HFpREF than in control patients, whereas peak systolic mitral annular velocity was lower in HFpREF patients. The exercise-induced changes in LVEF, forward stroke volume, and cardiac output were significantly lower in HFpREF compared with control patients (-4 +/- 8 vs. +6 +/- 6 %, P = .001; -4 +/- 9 vs. +10 +/- 10 mL, P < .0001, and 1.6 +/- 1.2 vs. 3.5 +/- 1.8 L/min, P < .0001, respectively). Exercise-induced changes in effective arterial elastance significantly differed in HFpREF and control patients (0.5 +/- 0.6 vs. -0.2 +/- 0.5 mm Hg/mL, P < .0001). In addition, 7 of the 25 HFpREF patients developed functional mitral regurgitation during exercise and none in controls. CONCLUSIONS When compared with patients with similar comorbidities but without history or evidence of heart failure, patients with HFpREF experience greater arterial stiffening and thereby a deterioration of global LV systolic performance during dynamic exercise.
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Affiliation(s)
- Pierre V Ennezat
- Division of Cardiology, Centre Hospitalier Régional et Universitaire de Lille, and EA 2693, Université de Lille II, Faculté de Médecine, Lille, France
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Ormezzano O, Poirier O, Mallion JM, Nicaud V, Amar J, Chamontin B, Mounier-Véhier C, François P, Cambien F, Baguet JP. A polymorphism in the endothelin-A receptor gene is linked to baroreflex sensitivity. J Hypertens 2005; 23:2019-26. [PMID: 16208144 DOI: 10.1097/01.hjh.0000184748.49189.36] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The baroreflex plays an essential role in regulating the cardiovascular system. However, very few studies have focused on the links between genetic polymorphisms and baroreflex sensitivity (BRS). METHODS A total of 146 hypertensive individuals who had never been treated, and 105 healthy individuals (controls) were included in the study. The genotypes of 17 polymorphisms of 11 genes involved in the regulation of the cardiovascular system were studied. BRS was measured using a sequence method: BRS was evaluated as the slope of spontaneous increases [systolic blood pressure (SBP)+/reflex response (RR)+] or decreases (SBP-/RR-) in SBP and pulse interval by recording blood pressure (BP) continuously for 20 min. RESULTS Following univariate analysis, the genetic polymorphism of endothelin receptor A EDNRA/C+1222T was found to be significantly correlated with the BRS (SBP-/RR-) level in both populations. In normotensive subjects, mean BRS values (SBP-/RR-) were 11.93 +/- 3.69 ms/mmHg in EDNRA CC homozygotes, 9.94 +/- 2.97 ms/mmHg in CT heterozygotes and 9.51 +/- 3.16 ms/mmHg in TT homozygotes (P = 0.01). In hypertensive subjects, mean BRS values (SBP-/RR-) were 9.26 +/- 3.59 ms/mmHg in EDNRA CC homozygotes, 9.03 +/- 4.14 ms/mmHg in CT heterozygotes and 6.60 +/- 2.42 ms/mmHg in TT homozygotes (P = 0.01). After adjustment for age, sex, SBP and diastolic blood pressure and body mass index, the EDNRA/C+1222T polymorphism remained significantly correlated with BRS in both normotensive (P = 0.01) and hypertensive (P = 0.01) subjects. CONCLUSIONS These results suggest that the endothelin system may be involved in the regulation of BRS in humans. In particular, the T allele of the EDNRA/C+1222T polymorphism is associated with a reduction in BRS in both healthy and hypertensive subjects.
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Affiliation(s)
- Olivier Ormezzano
- Service de Cardiologie et Hypertension Artérielle, Grenoble, France.
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Becker F, Boissel JP, Boissier C, Bounameaux H, Camelot G, Constans J, Duboc D, Favre JP, Hayoz D, Jego P, Lacroix P, Magne JL, Mounier-Véhier C, Quéré I, Stephan D. [Intermittent claudications]. J Mal Vasc 2005; 30:4S13-28. [PMID: 16208210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- F Becker
- Médecine Vasculaire, Université de Franche-Comté, CHU, Besançon
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Becker F, Boissel J, Boissier C, Bounameaux H, Camelot G, Constans J, Duboc D, Favre J, Hayoz D, Jego P, Lacroix P, Magne J, Mounier-Véhier C, Quéré I, Stephan D. Les claudications intermittentes. ACTA ACUST UNITED AC 2005. [DOI: 10.1016/s0398-0499(05)83839-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Gaxotte V, Laurens B, Haulon S, Lions C, Mounier-Véhier C, Beregi JP. Multicenter trial of the Jostent balloon-expandable stent-graft in renal and iliac artery lesions. J Endovasc Ther 2003; 10:361-5. [PMID: 12877624 DOI: 10.1177/152660280301000231] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To report the results of a multicenter feasibility study of the Jostent balloon-expandable stent-graft in the treatment of renal and iliac artery lesions. METHODS Twenty-three patients (17 men; mean age 62 years, range 38-80) with lesions in the renal (n=12) or iliac arteries (n=12) were enrolled in 6 centers over a 1-year period. Preprocedural computed tomography (CT) and angiography were performed in all patients. The Jostent device was implanted in the 24 arteries to treat 11 in-stent stenoses, 2 arterial ruptures, 2 aneurysms, 2 dissections, 2 ulcerated stenoses, and 5 chronic occlusions. Follow-up included color duplex ultrasound examination on the day after the procedure and at 6 months; patients with renal artery stent-grafts were also evaluated with CT angiography. RESULTS Twenty-seven stent-grafts were deployed successfully in the 24 (100%) arteries. Seven (30%) patients required adjunctive procedures to address 1 acute in-stent thrombosis, 2 dissections, and 4 in-stent residual stenoses. At 6-month follow-up, 2 (8.3%) restenoses occurred in the renal arteries; these were treated successfully using balloon angioplasty. CONCLUSIONS These data suggest that a balloon-expandable stent-graft may be safe and useful in patients with selected peripheral indications.
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Affiliation(s)
- Virginia Gaxotte
- Department of Vascular Radiology, Hôpital Cardiologique, CHRU de Lille, France
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Gaxotte V, Laurens B, Haulon S, Lions C, Mounier-Véhier C, Beregi JP. Multicenter Trial of the Jostent Balloon-Expandable Stent-Graft in Renal and Iliac Artery Lesions. J Endovasc Ther 2003. [DOI: 10.1583/1545-1550(2003)010<0361:mtotjb>2.0.co;2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Mounier-Véhier C, Haulon S, Lions C, Devos P, Jaboureck O, Willoteaux S, Carré A, Beregi JP. Renal Atrophy in Atherosclerotic Renovascular Disease:Gradual Changes 6 Months After Successful Angioplasty. J Endovasc Ther 2002. [DOI: 10.1583/1545-1550(2002)009<0863:raiard>2.0.co;2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Mounier-Véhier C, Haulon S, Lions C, Devos P, Jaboureck O, Willoteaux S, Carré A, Beregi JP. Renal atrophy in atherosclerotic renovascular disease: gradual changes 6 months after successful angioplasty. J Endovasc Ther 2002; 9:863-72. [PMID: 12546589 DOI: 10.1177/152660280200900621] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess renal morphology using spiral computed tomographic angiography (CTA) before and 6 months after angioplasty of unilateral atherosclerotic renal artery stenosis (RAS). METHODS Spiral CTA scans from 14 hypertensive patients (7 men; mean age 57.4 +/- 13.1 years) with significant RAS were performed before and 6 months after angioplasty; renal length, mean cortical thickness (MCT), cortical area (CA), and medullary length (ML) were measured from the axial slices in the 14 contralateral and 14 poststenotic then revascularized kidneys. Blood pressure, creatinine clearance, and number of antihypertensive drugs were analyzed. RESULTS At 6 months, the systolic blood pressure was significantly reduced (p=0.007), but the number of antihypertensive drugs and the creatinine clearance did not change significantly. Most morphological parameters before and after angioplasty were different in the contralateral versus poststenotic kidneys (renal length, p=0.01; MCT, p=0.01; ML, p=0.03; CA, p=0.008). After angioplasty, there was an 11% drop in cortical atrophy associated with a mean 4-mm increase in medullary length in the poststenotic/revascularized kidneys. The contralateral kidneys exhibited corticomedullary thinning after angioplasty. CONCLUSIONS In atherosclerotic renal disease, cortical thinning could be a useful timesaving marker to assess the significance of the lesion and to evaluate associated distal lesions. The favorable blood pressure outcome supports the existence of reversible ischemic lesions, particularly in the medulla. Angioplasty appears to be useful for the poststenotic kidney, according to the morphological study.
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Affiliation(s)
- Claire Mounier-Véhier
- Services de Médecine Interne et HTA, Hôpital Cardiologique, CHRU, Lille Cedex, France.
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Mounier-Véhier C, Jaboureck O, Emeriau JP, Bernaud C, Clerson P, Carre A. Randomized, comparative, double-blind study of amlodipine vs. nicardipine as a treatment of isolated systolic hypertension in the elderly. Fundam Clin Pharmacol 2002; 16:537-44. [PMID: 12685513 DOI: 10.1046/j.1472-8206.2002.00129.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A 90-day, multicenter, randomized, double-blind, parallel-group study was conducted to compare the efficacy of amlodipine (once a day) with nicardipine (two to three times a day), in the treatment of isolated systolic hypertension (ISH) in the elderly. Patients (n = 133) aged > or = 60 years, with ISH were randomized to receive either amlodipine 5 mg/day, or nicardipine 60 mg/day (titrated if necessary to 10 mg/day and 100 mg/day, respectively) for 90 days. Efficacy was assessed by measuring office blood pressure (BP), and 24-h ambulatory blood pressure monitoring (ABPM). The two treatments substantially and comparably reduced office systolic blood pressure (SBP) and pulse pressure (PP), and also produced a slight decrease in diastolic blood pressure (DBP). Amlodipine reduced SBP, as assessed by ABPM, to a significantly greater extent than nicardipine. Both treatments were well-tolerated. The sustained effect of amlodipine, compared with nicardipine, was reflected in its significantly greater antihypertensive activity, particularly during the nocturnal period, as assessed by ABPM. The study demonstrates that once a day dose of amlodipine is an effective antihypertensive treatment for elderly ISH patients.
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Mounier-Véhier C, Haulon S, Devos P, Lions C, Jaboureck O, Gaxotte V, Carré A, Beregi JP. Renal atrophy outcome after revascularization in fibromuscular dysplasia disease. J Endovasc Ther 2002; 9:605-13. [PMID: 12431144 DOI: 10.1177/152660280200900510] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To assess clinical, biological, and kidney parameters before and 6 months after revascularization of renal artery stenosis due to fibromuscular dysplasia (FMD). METHODS Twenty hypertensive patients (18 women; mean age 48.7 +/- 15.4 years) with unilateral de novo FMD stenosis were studied before and 6 months after revascularization (balloon angioplasty 19; bypass surgery 1). Blood pressure and creatinine clearance were measured, and renal length, cortical thickness, cortical area (CA), and medullary length (ML) were evaluated by spiral computed tomographic angiography (CTA) in 20 poststenotic and 20 contralateral kidneys. RESULTS Six months after revascularization, the systolic and diastolic blood pressures decreased by 19 mmHg and 10 mmHg, respectively (p=0.02), the number of antihypertensive drugs decreased by 1 (p=0.01), but the increase in creatinine clearance was not significant. At baseline, the poststenotic kidneys were significantly more atrophied than the contralateral normal kidney (ML in normal kidney 89 +/- 9 mm versus 81 +/- 10 mm in poststenotic kidney, p<0.001; CA in normal kidney 824 +/- 149 mm(2) versus 703 +/- 156 mm(2) in poststenotic kidney, p<0.01), which persisted at 6 months (ML in normal kidney 89 +/- 10 versus 80 +/- 11 in poststenotic kidney, p<0.001; CA in normal kidney 807 +/- 145 mm(2) versus 696 +/- 157 mm(2) in poststenotic kidney, p<0.01). Renal length was still within normal range in all kidneys, and the morphological parameters remained stable after revascularization. CONCLUSIONS We demonstrated significant cortical/medullary atrophy in poststenotic kidneys compared to contralateral normal kidneys. Despite intraparenchymal disease, clinical outcome was favorable after revascularization. Cortical/medullary thinning appears to be an early marker of renal ischemia that could support revascularization in FMD disease.
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Mounier-Véhier C, Haulon S, Devos P, Lions C, Jaboureck O, Gaxotte V, Carré A, Beregi JP. Renal Atrophy Outcome After Revascularization in Fibromuscular Dysplasia Disease. J Endovasc Ther 2002. [DOI: 10.1583/1545-1550(2002)009<0605:raoari>2.0.co;2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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22
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Haulon S, Mounier-Véhier C, Gaxotte V, Koussa M, Lions C, Haouari BA, Beregi JP. Percutaneous reconstruction of the aortoiliac bifurcation with the "kissing stents" technique: long-term follow-up in 106 patients. J Endovasc Ther 2002; 9:363-8. [PMID: 12096953 DOI: 10.1177/152660280200900317] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate the long-term results using the kissing stents technique for treatment of occlusive disease involving the aortoiliac bifurcation. METHODS One hundred six patients (97 men; mean age 52.5 +/- 10.2 years, range 33-78) were treated with the kissing stents technique for bilateral aortoiliac stenosis (55, 51.9%), unilateral occlusion of the common iliac artery (CIA) with contralateral stenosis (47, 44.3%), and bilateral CIA occlusion (4, 3.8%). Clinical examination and duplex scans were performed prior to discharge and at 1, 6, and 12 months, followed by yearly examinations thereafter. RESULTS Bilateral stent implantation was successful in all patients. No major procedure-related complications were observed. Self-expanding stents were deployed in 62 (58.5%) patients and balloon-expandable devices in 44 (41.5%). Fifteen (7.1%) hematomas were observed at the 212 access sites. Mean follow-up was 30.1 +/- 11.1 months (range 12-137). Duplex imaging diagnosed significant (>50%) restenosis in 15 (14.8%) of 101 patients and reocclusion in 4 (4%); 17 (89.5%) of these patients had recurrent symptoms and all were retreated (endovascular procedure in 18 and an aortobifemoral bypass in 1). Primary and secondary cumulative patency rates at 36 months were 79.4% and 97.7%, respectively. Balloon-expandable stents had a nonsignificantly higher patency rate compared to self-expanding stents. CONCLUSIONS Based on our experience, aortoiliac endovascular reconstruction with the kissing stents technique is a safe and effective procedure, representing an alternative to conventional surgery in selected patients.
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Affiliation(s)
- Stéphan Haulon
- Department of Vascular Surgery, Hôpital Cardiologique, CHRU de Lille, 59038 Lille Cedex, France
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23
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Haulon S, Mounier-Véhier C, Gaxotte V, Koussa M, Lions C, Haouari BA, Beregi JP. Percutaneous Reconstruction of the Aortoiliac Bifurcation With the “Kissing Stents” Technique:Long-term Follow-up in 106 Patients. J Endovasc Ther 2002. [DOI: 10.1583/1545-1550(2002)009<0363:protab>2.0.co;2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Mounier-Véhier C, Clerson P, Laude D, Elkohen M, Poncelet P, Goullard L. [Assessment of acute blood pressure variability during a stress test]. Ann Cardiol Angeiol (Paris) 2002; 51:69-75. [PMID: 12471685 DOI: 10.1016/s0003-3928(02)00071-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- C Mounier-Véhier
- Service de médecine interne et HTA, hôpital cardiologique, CHRU de Lille, France
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Galland E, Lequeuche B, Mounier-Véhier C, Carré A, Goullard L. [Post-embolic chronic pulmonary heart disease: a case report]. Ann Cardiol Angeiol (Paris) 2000; 49:21-6. [PMID: 12555317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
Echocardiography and pulmonary scintigraphy demonstrated post-embolic chronic cor pulmonale in a six-year-old woman presenting with dyspnoea. The patient's symptoms deteriorated during subsequent thromboembolic episodes, despite treatment consisting of oral anticoagulants and diuretics. After discussing the pathophysiology and diagnostic methods, the authors emphasize the limits of medical treatment of post-embolic chronic cor pulmonale and the value of two surgical treatments: thromboendarterectomy and lung transplantation. They also recall the precise selection criteria for lung transplantation.
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Affiliation(s)
- E Galland
- Service de médecine interne, HTA, hôpital cardiologique, boulevard du professeur Jules-Leclercq, 59037 Lille, France
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Equine O, Bérégi JP, Mounier-Véhier C, Gautier C, Desmoucelles F, Carré A. [Anatomic results of the endoluminal revascularization of renal arterial stenoses. A retrospective study of 113 patients]. Arch Mal Coeur Vaiss 1999; 92:1009-13. [PMID: 10486656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
The aim of the study was to evaluate the anatomic results of percutaneous transluminal renal angioplasty in a population of 113 hypertensive patients (66 men, mean age 63 years) who had a significant renal artery stenosis (atheromatous in 105 patients and fibrodysplastic in the eight others). Conventional angioplasty was performed in 89 arteries, and stent implantation in 46 cases. Stenting was associated with a better immediate result than simple angioplasty for atheromatous stenoses (rate of residual stenosis < 30% = 93.5% and 71.2% respectively, p < 0.003). Technical success for angioplasty of atheromatous stenoses was achieved in 73.8% of procedures involving non ostial lesions and 51.6% for ostial stenoses (p = 0.05). Restenosis was detected 6.3 +/- 0.3 months later (by echodoppler and/or helical computed tomography angiography) in 9.1% of cases after stent implantation and in 47% after simple angioplasty (p = 0.00017). The presence of a residual stenosis < 30% immediately after revascularization was associated with a significantly (26.4% versus 50%, p = 0.044) lower rate of restenosis. In conclusion, this study confirms the utility of percutaneous transluminal renal angioplasty for treatment of renovascular hypertension, particularly with the utilisation of stents for atheromatous and ostial stenoses.
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Affiliation(s)
- O Equine
- Service de médecine interne et HTA, hôpital cardiologique, CHRU, Lille
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27
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Equine O, Mounier-Véhier C, Devos P, Bérégi JP, Deklunder G, Carré A. [Clinical results of angioplasty of the renal arteries in renovascular arterial hypertension. A retrospective study in 113 patients]. Arch Mal Coeur Vaiss 1999; 92:1015-21. [PMID: 10486657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
The aim of the study was to evaluate the clinical results of percutaneous transluminal renal angioplasty in a population of 113 consecutive hypertensive patients who underwent endoluminal revascularization for angiographically significant renal artery stenosis. Retrospective analysis of the case records of 104 patients showed that systolic blood pressure (SBP) and diastolic blood pressure (DBP) decreased significantly 6 months after angioplasty (-20.9 mmHg and -8.4 mmHg respectively; p = 0.0001). This decrease was maintained until 19.8 months after the procedure. In cases with suboptimal revascularization (persistence of a residual stenosis more than 30%), only the SBP decreased significantly at 6 months (from 177 mmHg to 156.1 mmHg; p = 0.0061); when DBP decreased from 91.4 mmHg to 86.1 mmHg (NS) at 6 months, and fell to 80.9 mmHg (p = 0.026) at 19.8 months (after the performance of a second transluminal angioplasty for 41% patients of this group due to restenosis). Twenty-nine patients presented a restenosis of the renal artery 6 months after the initial procedure. In this group, only SBP decreased significantly at 6.1 months and at 18.7 months (from 171.9 mmHg to 156.1 mmHg and 146.5 mmHg respectively; p = 0.0064 and p = 0.0001). DBP decreased significantly only at 18.7 months (-12.6 mmHg; p = 0.0001), after a second renal angioplasty in 23 patients (79%). In the 60 patients without restenosis at 6 months, SBP and DBP decreased significantly at 6.1 and 18.7 months. No significant variation of creatinine levels was observed. These results confirm the utility of percutaneous transluminal renal angioplasty for the treatment of renovascular hypertension.
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Affiliation(s)
- O Equine
- Service de médecine interne et HTA, hôpital cardiologique, CHRU, Lille
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28
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Equine O, Bérégi JP, Mounier-Véhier C, Gautier C, Desmoucelles F, Carré A. [Importance of the echo-doppler and helical angioscanner of the renal arteries in the management of renovascular diseases. Results of a retrospective study in 113 patients]. Arch Mal Coeur Vaiss 1999; 92:1043-5. [PMID: 10486662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
The aim of this study was to determine the sensitivity and specificity of two non invasive methods for the diagnosis of renal artery stenosis, compared with renal angiography. Retrospective analysis of 113 hypertensive patients who underwent renal angiography permitted us to evaluate the results of echo-Doppler (n = 53) and helical computed tomography angiography (n = 50). Regarding echo-Doppler, sensitivity and specificity were 0.75 and 0.86 respectively (40 true positives/53 stenoses, and negative result in 38/44 normal arteries). Regarding helical CT angiography, these values were 0.94 and 0.95 respectively (positive result in 45/48 stenoses, and 41 true negatives/43 normal arteries). These results suggest that echo-Doppler and helical CT angiography are two reliable methods for the diagnosis of renal artery stenosis. Thus, renal angiography could be reserved for patients who may require percutaneous transluminal renal angioplasty.
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Affiliation(s)
- O Equine
- Service de médecine interne et hypertension artérielle, hôpital cardiologique, CHRU, Lille
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29
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Equine O, Mounier-Véhier C, Devos P, Bérégi JP, Deklunder G, Carre A. Clinical results of percutaneous transluminal renal angioplasty in 113 hypertensive patients. J Hypertens 1999. [DOI: 10.1097/00004872-199917060-00035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Mounier-Véhier C, Valat-Rigot AS, Devos P, Carré A. [Modifications of heart rate and blood pressure during pregnancy]. Ann Cardiol Angeiol (Paris) 1998; 47:429-37. [PMID: 9772964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
The pathophysiology of pre-eclampsia, disease of the endothelium, placental ischaemia, and its consequences on blood pressure and heart rate variations are described. The methods of evaluation of heart rate and blood pressure during pregnancy, outpatient visit clinical measurement, self-measurement, ambulatory measurement, "Finapres", electrocardiogram and Holter ECG are reviewed; the practical implications of the nocturnal fall of vagal tone with tachycardia, demonstrated during pre-eclampsia, are discussed.
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Mounier-Véhier C, Lequeuche B, Carré A. [Heart rate and lipids]. Ann Cardiol Angeiol (Paris) 1998; 47:425-8. [PMID: 9772963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Heart rate (HR) appears to be an independent marker of cardiovascular risk, based on certain epidemiological data. Several studies have tried to establish a predictive cutt-off value. Many studies have observed the existence of a positive and independent correlation between HR and triglyycerides, VLDL, and a negative correlation between HR and HDL cholesterol. The recommended techniques for HR measurement, pathophysiological hypotheses, and clinical implications are discussed.
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Abstract
Both white coat effect (the tendency of blood pressure to rise during a medical visit) and talking effect were analyzed in 42 patients with essential hypertension. Blood pressure was measured during the clinic visit and over the subsequent 24-hour ambulatory period, with the physician performing 49 +/- 4 measurements for each patient. Three silent periods and two talking periods (stress and relaxation) were randomly allocated in a crossover design and studied, using analysis of variance. During the initial 11-minute silent period, systolic/diastolic blood pressures increased by 6 mm Hg/5 mm Hg. During the subsequent talking periods, these variations were significantly greater: +22 mm Hg/+17 mm Hg. Measures of systolic/diastolic blood pressure were higher during stressful talking than during relaxed talking. The talking and its emotional contents seemed to explain 70% of the white coat phenomenon. To minimize the white coat phenomenon in the clinic, physicians, nurses, and clinicians are advised to measure blood pressure during an initial period of silence.
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Affiliation(s)
- C Le Pailleur
- Clinique Cardiologique, Hôpital Necker, Paris, France
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33
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Elkohen M, Clerson P, Mounier-Véhier C, Gressin V, Humbert R, Carré A. [Effects of bisoprolol and ramipril on short-term variability of systolic blood pressure during mental stress test: spectrum analysis]. Arch Mal Coeur Vaiss 1995; 88:1075-80. [PMID: 8572849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
UNLABELLED The mid frequency component (MFC = 66-128 mHz) of blood pressure is an index of sympathetic vascular control. To investigate the effect of bisoprolol (B) and ramipril (R) treatment (TT) on the short-term variability of systolic blood pressure (SBP) diastolic blood pressure (DPB) and heart rate (HR) reactivity during mental stress, we studied 54 mild essential untreated hypertensive patients (24 men, 45 +/- 9.6 years, BP > 160/90 mmHg after a 15-days placebo run-in period) who were randomly assigned to double blind treatment (B: 10 mg/day: n = 28 and R: 5 mg/day: n = 26). A Stroop Word Color Conflict Test (SWCCT) was performed before and after 2 months of treatment. Hemodynamic parameters (BP and HR) were measured by a non invasive device (Finapres 2300E, Ohmeda-Maurepas) and underwent spectral analysis (SBP: mmHg.Hz-1/2, HR: beats/min.Hz-1/2, Anapres 1.2, Notocord-Orgametrie Systems, Igny-Lille) at rest and during SWCCT. The sympathetic vascular activity was assessed by calculating the area of the mid-frequency component (MFC = 66-128 Hz). RESULTS [table: see text] CONCLUSION The absolute variations in sympathetic activity during SWCCT as demonstrated by analysis of MFC of SBP and HR is not affected by chronic ramipril treatment, whereas bisoprolol attenuates sympathetic reactivity during SWCCT.
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Affiliation(s)
- M Elkohen
- Service de médecine interne et HTA, Hôpital cardiologique, CHRU de Lille
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Clerson P, Elkohen M, Mounier-Véhier C, Humbert R, Jouvent R, Prost PL, Carré A. [Stress, blood pressure reactivity and arterial hypertension: not an unambiguous relation]. Arch Mal Coeur Vaiss 1994; 87:1097-101. [PMID: 7755467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
UNLABELLED In order to determine the different ways the hypertensives' blood pressure would react during mental stress, 49 patients, 27 women and 22 men, were submitted at the Stroop Word Colour Conflict Test. Their haemodynamic parameters were recorded by finger photoplethysmography (Finapres device), with equidistant sampling (2 Hz). Temporal and spectral analysis showed evidence of: a quick and short elevation of BP and HR and a greater variability of SBP, as shown by the increase of the MF (66-128 mHZ) module. Patients can be divided into 3 clusters according to the reactivity of SBP. Group I (N, mean +/- sigma) 13, + 32.7 +/- 8 mmHg; group II 24, + 10.3 +/- 6; group III 12, -10.2 +/- 7. They were comparable on anxiety level and on any demographic and clinical feature. In group III, the higher NA at rest, the bigger the fall of SBP when stressed. The cognitive efficiency of these patients is increased by stress. Spectral analysis: Mid frequency (66-128 mHz) components are markedly higher in group III, before, during and after SWCCT showing a higher sympathetic tonus. CONCLUSION The reactivity of BP is not homogeneous. One fourth of our patients showed a decrease of SBP during the cognitive treatment stage of the test without showing a decrease of sympathetic tone. Anxiety level is not predictive of BP's response.
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Mounier-Véhier C, Poncelet P, Fouquoire B, Petetin N, Vanceulebroecke K, Carré A. [Is scheduled hospitalization over a specific period still justified in hypertension?]. Arch Mal Coeur Vaiss 1993; 86:1181-5. [PMID: 8129525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
To general practitioners' request, a 36-hour scheduled hospitalization over a determined period (SHDP) was set up to assess the effects and the etiology of the arterial hypertensions they had detected and to propose an appropriate treatment. From November 1988 to December 1990, 277 patients (156 male/121 female) with mean age of 44.7 +/- 14.5 were thus hospitalized over a determined period. All of them underwent 24-hour semi-ambulatory blood pressure monitoring (Bard Sentron) by using the oscillometric method, which permits to measure mean blood pressure (MBP) instead of calculating it. This 24-hour MBP was on average of 108.5 +/- 16.2 mmHg and not significantly different from daytime MBP (111 +/- 16.3 mmHg). Figures of MBP superior to 105 mmHg confirmed permanent HBP (High Blood Pressure). On the 277 patients, 46 (16%) had a normal MBP, 67 (24%) had a "borderline" MBP (between 96 and 105 mmHg). A severe HBP (MBP > 125 mmHg) found in 66 cases (23%) was confirmed by visceral impairment. Left ventricular hypertrophy (LVH) was detected in 12 cases (4.3%) on the chest radiograph, in 24 cases (8.6%) on the ECG and in 75 cases (27%) on the echocardiogram. The etiological assessment revealed 10 cases (3.61%) of secondary hypertension with 3 reno-vascular HBP and 2 Conn's adenomas. Eventually, therapeutic abstention was recommended in 57 patients (20.5%) though 20 of them had previously received antihypertensive therapy. All in all, SHDP permits a more accurate determination of the consequences and severity of HBP. The small number of secondary HBP reflects the proportion found in practice.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- C Mounier-Véhier
- Service de médecine interne et hypertension artérielle, hôpital cardiologique, CHRU de Lille
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Carré A, Petetin N, Debruères S, Mounier-Véhier C, Poncelet P. [Predictive criteria of left ventricular hypertrophy given by ambulatory monitoring of blood pressure in hypertension of the elderly]. Arch Mal Coeur Vaiss 1991; 84:1149-51. [PMID: 1835357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Eighty-nine patients over 65 years of age, with mild to moderate hypertension, underwent ambulatory blood pressure monitoring during 1988 and 45 of them also underwent echocardiography. Concentric left ventricular hypertrophy was diagnosed in 9 patients (20%) and criteria predictive of this complication were looked for in the results of the ambulatory pressure monitoring. The most predictive factors seemed to be: nocturnal systolic blood pressure (the average of the systolic values recorded between 22 h and 6 h); the percentage of excessive nocturnal values (values over 120/80 during the same nocturnal period); the loss of diurnal rythm with absence of the clearcut difference between the daytime and nocturnal blood pressure value; increased differential pressure, a sign of reduced arterial compliance. These notions, based on ambulatory blood pressure recordings, have diagnostic and prognostic implications (need for echocardiography) and important therapeutic consequences (drugs reducing LHV and improving arterial compliance).
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Affiliation(s)
- A Carré
- Service de médecine interne et d'hypertension artérielle, hôpital Cardiologique, Lille
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