1
|
Azizi M, Sharp ASP, Fisher NDL, Weber MA, Lobo MD, Daemen J, Lurz P, Mahfoud F, Schmieder RE, Basile J, Bloch MJ, Saxena M, Wang Y, Sanghvi K, Jenkins JS, Devireddy C, Rader F, Gosse P, Claude L, Augustin DA, McClure CK, Kirtane AJ. Patient-Level Pooled Analysis of Endovascular Ultrasound Renal Denervation or a Sham Procedure 6 Months After Medication Escalation: The RADIANCE Clinical Trial Program. Circulation 2024; 149:747-759. [PMID: 37883784 DOI: 10.1161/circulationaha.123.066941] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 10/24/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND The randomized, sham-controlled RADIANCE-HTN (A Study of the Recor Medical Paradise System in Clinical Hypertension) SOLO, RADIANCE-HTN TRIO, and RADIANCE II (A Study of the Recor Medical Paradise System in Stage II Hypertension) trials independently met their primary end point of a greater reduction in daytime ambulatory systolic blood pressure (SBP) 2 months after ultrasound renal denervation (uRDN) in patients with hypertension. To characterize the longer-term effectiveness and safety of uRDN versus sham at 6 months, after the blinded addition of antihypertensive treatments (AHTs), we pooled individual patient data across these 3 similarly designed trials. METHODS Patients with mild to moderate hypertension who were not on AHT or with hypertension resistant to a standardized combination triple AHT were randomized to uRDN (n=293) versus sham (n=213); they were to remain off of added AHT throughout 2 months of follow-up unless specified blood pressure (BP) criteria were exceeded. In each trial, if monthly home BP was ≥135/85 mm Hg from 2 to 5 months, standardized AHT was sequentially added to target home BP <135/85 mm Hg under blinding to initial treatment assignment. Six-month outcomes included baseline- and AHT-adjusted change in daytime ambulatory, home, and office SBP; change in AHT; and safety. Linear mixed regression models using all BP measurements and change in AHT from baseline through 6 months were used. RESULTS Patients (70% men) were 54.1±9.3 years of age with a baseline daytime ambulatory/home/office SBP of 150.5±9.8/151.0±12.4/155.5±14.4 mm Hg, respectively. From 2 to 6 months, BP decreased in both groups with AHT titration, but fewer uRDN patients were prescribed AHT (P=0.004), and fewer additional AHT were prescribed to uRDN patients versus sham patients (P=0.001). Whereas the unadjusted between-group difference in daytime ambulatory SBP was similar at 6 months, the baseline and medication-adjusted between-group difference at 6 months was -3.0 mm Hg (95% CI, -5.7, -0.2; P=0.033), in favor of uRDN+AHT. For home and office SBP, the adjusted between-group differences in favor of uRDN+AHT over 6 months were -5.4 mm Hg (-6.8, -4.0; P<0.001) and -5.2 mm Hg (-7.1, -3.3; P<0.001), respectively. There was no heterogeneity between trials. Safety outcomes were few and did not differ between groups. CONCLUSIONS This individual patient-data analysis of 506 patients included in the RADIANCE trials demonstrates the maintenance of BP-lowering efficacy of uRDN versus sham at 6 months, with fewer added AHTs. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifiers: NCT02649426 and NCT03614260.
Collapse
Affiliation(s)
- Michel Azizi
- Université Paris Cité, France (M.A.)
- AP-HP, Hôpital Européen Georges-Pompidou, Hypertension Department and DMU CARTE, Paris, France (M.A.)
- INSERM, Paris, France (M.A.)
| | - Andrew S P Sharp
- University Hospital of Wales and Cardiff University, Cardiff, UK (A.S.P.S.)
| | | | - Michael A Weber
- Division of Cardiovascular Medicine, State University of New York, Downstate Medical Center, New York (M.A.W., M.S.)
| | - Melvin D Lobo
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, UK (M.D.L.)
| | - Joost Daemen
- Department of Cardiology, Erasmus University Medical Center Rotterdam, the Netherlands (J.D.)
| | - Philipp Lurz
- Zentrum für Kardiologie, Universitätsmedizin Mainz, Germany (P.L.)
| | - Felix Mahfoud
- Klinik für Innere Medizin III, Saarland University Hospital, Homburg/Saar, Germany (F.M.)
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge (F.M.)
| | - Roland E Schmieder
- Nephrology and Hypertension, University Hospital Erlangen, Friedrich Alexander University, Erlangen, Germany (R.E.S.)
| | - Jan Basile
- Division of Cardiovascular Medicine, Medical University of South Carolina, Ralph H. Johnson VA Medical Center, Charleston (J.B.)
| | - Michael J Bloch
- Department of Medicine, University of Nevada School of Medicine, Vascular Care, Renown Institute of Heart and Vascular Health, Reno (M.J.B.)
| | - Manish Saxena
- Division of Cardiovascular Medicine, State University of New York, Downstate Medical Center, New York (M.A.W., M.S.)
| | - Yale Wang
- Minneapolis Heart Institute, Abbott Northwestern Hospital, MN (Y.W.)
| | | | | | - Chandan Devireddy
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (C.D.)
| | - Florian Rader
- Cedars-Sinai Heart Institute, Los Angeles, CA (F.R.)
| | | | - Lisa Claude
- Recor Medical, Inc., Palo Alto, CA (L.C., D.A.A.)
| | | | | | - Ajay J Kirtane
- Columbia University Irving Medical Center/New York-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, NY (A.J.K.)
| |
Collapse
|
2
|
Gosse P, Boulestreau R, Doublet J, Gaudissard J, Cremer A. Arterial stiffness (from monitoring of Qkd interval) predict the occurrence of cardiovascular events and total mortality. J Hum Hypertens 2023; 37:907-912. [PMID: 36581680 DOI: 10.1038/s41371-022-00797-4] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 11/25/2022] [Accepted: 12/20/2022] [Indexed: 12/30/2022]
Abstract
Arterial stiffness, most often assessed with carotido-femoral pulse wave velocity predicts cardiovascular events but its use in clinical practice remains limited. The 24 h ambulatory monitoring of Blood pressure and timing of Korotkoff sounds (QKD interval) allows an automatic assessment of arterial stiffness and is an independent predictor of cardiovascular events in hypertensive patients. The long term follow up of our cohort of hypertensive patients gave us the opportunity to test the consequences of increased arterial stiffness on the incidence of all causes deaths and to define the populations who could benefit of this measurement beyond risk scores. The sample includes 930 patients (502 males, age 53 ± 13 years, baseline risk SCORE2-OP = 6.70 ± 4.97%) with an average follow up of 12.11 ± 7.4 years (0.3-30). In this population 169 cardiovascular events and 155 deaths were recorded. SCORE2-OP, 24 h Systolic Blood Pressure and arterial stiffness (QKDh) as a continuous or discontinuous variable (normal or reduced) were significantly and independently linked to the occurrence of cardiovascular events or all cause deaths in multivariate Cox model. ROC curves analysis show that measuring arterial stiffness with QKD method offers the best predictive value in patients with low or very low risk scores.
Collapse
Affiliation(s)
- Philippe Gosse
- Hypertension unit, University hospital of Bordeaux, Bordeaux, France.
| | | | - Julien Doublet
- Hypertension unit, University hospital of Bordeaux, Bordeaux, France
| | - Julie Gaudissard
- Hypertension unit, University hospital of Bordeaux, Bordeaux, France
| | - Antoine Cremer
- Hypertension unit, University hospital of Bordeaux, Bordeaux, France
| |
Collapse
|
3
|
Gosse P, Sentilhes L, Boulestreau R, Doublet J, Gaudissard J, Azizi M, Cremer A. Endovascular ultrasound renal denervation to lower blood pressure in young hypertensive women planning pregnancy: study protocol for a multicentre randomised, blinded and sham controlled proof of concept study. BMJ Open 2023; 13:e071164. [PMID: 37775290 PMCID: PMC10546167 DOI: 10.1136/bmjopen-2022-071164] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 09/08/2023] [Indexed: 10/01/2023] Open
Abstract
INTRODUCTION A major issue confronting clinicians treating hypertension in pregnancy is the limited number of pharmacological options. Endovascular catheter-based renal denervation (RDN) is a new method to lower blood pressure (BP) in patients with hypertension by reducing the activity of the renal sympathetic nervous system. Drugs that affect this system are safe in pregnant women. So there is reasonable evidence that RDN performed before pregnancy should not have deleterious effects for the fetus. Because the efficacy of RDN may be greater in younger patients and in women, we may expect a larger proportion of BP normalisation in young hypertensive women, but this remains to be proven. Our primary objective is to quantify the proportion of BP normalisation with RDN in this population. METHODS AND ANALYSIS WHY-RDN is a multicentre randomised sham-controlled trial conducted in six French hypertension centres that will include 80 women with essential hypertension treated or untreated, who are planning a pregnancy in the next 2 years and will be randomly assigned to RDN or classic renal arteriography and sham RDN in a ratio of 1:1. The primary outcome is the normalisation of 24-hour BP (<130/80 mm Hg) at 2-month post procedure off treatment. Sample size is calculated with the following assumptions: 5% one-sided significance level (α), 80% power (1-β), expected responder rates of 24% and 3% in the treatment and control group, respectively. Secondary outcomes include the absence of adverse outcomes for a future pregnancy, the variations of BP in ambulatory and home BP measurements and the evaluation of treatment prescribed. ETHICS AND DISSEMINATION WHY-RDN has been approved by the French Ethics Committee (Tours, Region Centre, Ouest 1- number 2021T1-28 HPS). This project is being carried out in accordance with national and international guidelines. The findings of this study will be disseminated by publication. TRIAL REGISTRATION NUMBER ClinicalTrials.gov, NCT05563337.
Collapse
Affiliation(s)
- Philippe Gosse
- Department of Cardiology/Hypertension, University Hospital Centre Bordeaux, Bordeaux, France
| | - Loïc Sentilhes
- University Hospital Centre Bordeaux, Bordeaux, France
- University of Bordeaux, Bordeaux, France
| | - Romain Boulestreau
- Cardiologie/Hypertension arterielle, University Hospital Centre Bordeaux, Bordeaux, France
| | - Julien Doublet
- Cardiologie/Hypertension arterielle, University Hospital Centre Bordeaux, Bordeaux, France
| | - Julie Gaudissard
- Cardiologie/Hypertension arterielle, University Hospital Centre Bordeaux, Bordeaux, France
| | - Michel Azizi
- Department of Hypertension, Hopital Europeen Georges Pompidou, Paris, France
| | - Antoine Cremer
- Cardiologie/Hypertension arterielle, University Hospital Centre Bordeaux, Bordeaux, France
| |
Collapse
|
4
|
Gosse P, Boulestreau R, Doublet J, Laurent S, Cremer A. How to measure arterial stiffness independently of blood pressure: the QKD method. J Hypertens 2023; 41:1168-1174. [PMID: 37259777 DOI: 10.1097/hjh.0000000000003446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Arterial stiffness, an important predictor of cardiovascular event, has two components: one linked to the nonlinear elastic behaviour of the arterial wall and dependent of the blood pressure (BP) at the time of measurement, and the other linked to the structural modifications of the arterial wall as the consequences of the long-term effects of all cardiovascular risk factors, including BP. This second component is certainly the most important one and can be assessed with 24-h ambulatory monitoring of cardio-arm pulse transmission time (QKD method). METHODS The working hypothesis of this study is that QKD100-60, the value of the QKD for a 100 mmHg SBP and 60 bpm heart rate is independent of 24-h SBP in both normotensive volunteers and treated hypertensive patients, in whom the long-term influence of BP is limited, whereas QKD100-60 is not independent of 24-h SBP in untreated hypertensive patients in whom high BP was able to damage the arterial wall on the long term. So we studied the relationships of QKD100-60 with 24-h BP and heart rate together with age, sex, height in multivariate regression analysis in three groups of patients; normal, untreated and treated hypertensive patients. QKD was measured with Novacor devices. RESULTS In the normal population (n = 323, aged 29 ± 10 years) and in the treated hypertensive population (n = 425, aged 58 ± 13 years) the QKD100-60 was indeed not significantly related to 24-h SBP. In the untreated hypertensive population (n = 614, aged 51 ± 13 years) the QKD100-60 was weakly but significantly related to 24-h SBP (r = 0.249, P < 0.0001). CONCLUSION Ambulatory monitoring of QKD provides indices of arterial stiffness independent of BP level at the time of measurement and most interestingly of 24-h BP with the potential to refine risk in patients with low traditional risk scores.
Collapse
Affiliation(s)
- Philippe Gosse
- Hypertension Excellence Center, University Hospital of Bordeaux, Hopital Saint André, Bordeaux
| | - Romain Boulestreau
- Hypertension Excellence Center, University Hospital of Bordeaux, Hopital Saint André, Bordeaux
| | - Julien Doublet
- Hypertension Excellence Center, University Hospital of Bordeaux, Hopital Saint André, Bordeaux
| | | | - Antoine Cremer
- Hypertension Excellence Center, University Hospital of Bordeaux, Hopital Saint André, Bordeaux
| |
Collapse
|
5
|
Kirtane AJ, Sharp ASP, Mahfoud F, Fisher NDL, Schmieder RE, Daemen J, Lobo MD, Lurz P, Basile J, Bloch MJ, Weber MA, Saxena M, Wang Y, Sanghvi K, Jenkins JS, Devireddy C, Rader F, Gosse P, Sapoval M, Barman NC, Claude L, Augustin D, Thackeray L, Mullin CM, Azizi M. Patient-Level Pooled Analysis of Ultrasound Renal Denervation in the Sham-Controlled RADIANCE II, RADIANCE-HTN SOLO, and RADIANCE-HTN TRIO Trials. JAMA Cardiol 2023; 8:464-473. [PMID: 36853627 PMCID: PMC9975919 DOI: 10.1001/jamacardio.2023.0338] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 02/06/2023] [Indexed: 03/01/2023]
Abstract
Importance Ultrasound renal denervation (uRDN) was shown to lower blood pressure (BP) in patients with uncontrolled hypertension (HTN). Establishing the magnitude and consistency of the uRDN effect across the HTN spectrum is clinically important. Objective To characterize the effectiveness and safety of uRDN vs a sham procedure from individual patient-level pooled data across uRDN trials including either patients with mild to moderate HTN on a background of no medications or with HTN resistant to standardized triple-combination therapy. Data Sources A Study of the ReCor Medical Paradise System in Clinical Hypertension (RADIANCE-HTN SOLO and TRIO) and A Study of the ReCor Medical Paradise System in Stage II Hypertension (RADIANCE II) trials. Study Selection Trials with similar designs, standardized operational implementation (medication standardization and blinding of both patients and physicians to treatment assignment), and follow-up. Data Extraction and Synthesis Pooled analysis using individual patient-level data using linear regression models to compare uRDN with sham across the trials. Main Outcomes and Measures The primary outcome was baseline-adjusted change in 2-month daytime ambulatory systolic BP (dASBP) between groups. Results A total of 506 patients were randomized in the 3 studies (uRDN, 293; sham, 213; mean [SD] age, 54.1 [9.3]; 354 male [70.0%]). After a 1-month medication stabilization period, dASBP was similar between the groups (mean [SD], uRDN, 150.3 [9.2] mm Hg; sham, 150.8 [10.5] mm Hg). At 2 months, dASBP decreased by 8.5 mm Hg to mean (SD) 141.8 (13.8) mm Hg among patients treated with uRDN and by 2.9 mm Hg to 147.9 (14.6) mm Hg among patients treated with a sham procedure (mean difference, -5.9; 95% CI, -8.1 to -3.8 mm Hg; P < .001 in favor of uRDN). BP decreases from baseline with uRDN vs sham were consistent across trials and across BP parameters (office SBP: -10.4 mm Hg vs -3.4 mm Hg; mean difference, -6.4 mm Hg; 95% CI, -9.1 to -3.6 mm Hg; home SBP: -8.4 mm Hg vs -1.4 mm Hg; mean difference, -6.8 mm Hg; 95% CI, -8.7 to -4.9 mm Hg, respectively). The BP reductions with uRDN vs sham were consistent across prespecified subgroups. Independent predictors of a larger BP response to uRDN were higher baseline BP and heart rate and the presence of orthostatic hypertension. No differences in early safety end points were observed between groups. Conclusions and Relevance Results of this patient-level pooled analysis suggest that BP reductions with uRDN were consistent across HTN severity in sham-controlled trials designed with a 2-month primary end point to standardize medications across randomized groups. Trial Registration ClinicalTrials.gov Identifier: NCT02649426 and NCT03614260.
Collapse
Affiliation(s)
- Ajay J. Kirtane
- Columbia University Medical Center/NewYork-Presbyterian Hospital and the Cardiovascular Research Foundation, New York
- Associate Editor, JAMA Cardiology
| | - Andrew S. P. Sharp
- University Hospital of Wales and Cardiff University, Cardiff, United Kingdom
| | - Felix Mahfoud
- Klinik für Innere Medizin III, Saarland University Hospital, Homburg/Saar, Germany
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge
| | | | - Roland E. Schmieder
- Nephrology and Hypertension, University Hospital Erlangen, Friedrich Alexander University, Erlangen, Germany
| | - Joost Daemen
- Department of Cardiology, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Melvin D. Lobo
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Philipp Lurz
- Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Jan Basile
- Division of Cardiovascular Medicine, Medical University of South Carolina, Ralph H. Johnson VA Medical Center, Charleston
| | - Michael J. Bloch
- Vascular Care, Renown Institute of Heart and Vascular Health, Department of Medicine, University of Nevada School of Medicine, Reno
| | - Michael A. Weber
- Division of Cardiovascular Medicine, State University of New York, Downstate Medical Center, New York
| | - Manish Saxena
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Yale Wang
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | | | | | - Chandan Devireddy
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Florian Rader
- Cedars-Sinai Heart Institute, Los Angeles, California
| | | | - Marc Sapoval
- Université Paris Cité, Paris, France
- AP-HP, Hôpital Européen Georges-Pompidou, Hypertension Department and DMU CARTE, Paris, France
- INSERM, CIC1418, Paris, France
| | | | | | | | | | | | - Michel Azizi
- Université Paris Cité, Paris, France
- AP-HP, Hôpital Européen Georges-Pompidou, Hypertension Department and DMU CARTE, Paris, France
- INSERM, CIC1418, Paris, France
| |
Collapse
|
6
|
Boulestreau R, Lorthioir A, Persu A, Sarafidis P, Cremer A, Tharaux PL, Rubin S, Maier B, Mazighi M, Paques M, Bonnin S, Dreau H, Debeugny S, Halimi JM, Gosse P. Revisiting malignant hypertension: rationale and design of the 'HAMA cohort', on behalf of the ESH working group 'hypertension and the kidney'. J Hypertens 2023; 41:453-458. [PMID: 36719959 DOI: 10.1097/hjh.0000000000003357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Malignant hypertension has not disappeared and is associated with a poor prognosis. Yet, so far, it has received limited attention from the medical community. Guidelines are mainly based on expert consensus and low quality evidences. METHOD We set up a prospective, multicenter, observational cohort of patients with malignant hypertension. We collect at admission medical history, demographic data, ongoing treatment, clinical parameters, symptoms, care pathways, target organ status and at discharge and during follow up treatment administrated, adverse events, blood pressure level, target organ status. We aim to recruit 500 patients with malignant hypertension in 5 years, with a 5-year follow-up. Our primary objective is to assess the 5 years prognosis of these patients. DISCUSSION The HAMA (Hypertension Arterielle MAligne, meaning malignant hypertension) registry aims to describe the epidemiology and to assess the prognosis of malignant hypertension in a contemporary multidisciplinary cohort, with emphasis on the diversity of current management and care pathway among the different medical specialties. It may help improving our pathophysiological knowledge, and pave the way to update the definition of this particular form of hypertension. The multidisciplinary network developed in the wake of this project is expected to facilitate the set up therapeutic trials, laying the ground for evidence-based recommendations.
Collapse
Affiliation(s)
- Romain Boulestreau
- European Hypertension Excellence Center, Bordeaux University Hospital
- INI CRCT Network
- INSERM, Unit 1034
| | - Aurélien Lorthioir
- Department of Hypertension, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Alexandre Persu
- Division of Cardiology, Cliniques Universitaires Saint-Luc and Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Pantelis Sarafidis
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Antoine Cremer
- European Hypertension Excellence Center, Bordeaux University Hospital
| | - Pierre-Louis Tharaux
- Paris Cardiovascular Center (PARCC), Institut de la Santé et de la Recherche Médicale (Inserm), Université Paris Cité, Paris, FranceNephrology department, Bordeaux University Hospital
| | - Sebastien Rubin
- INSERM, Unit 1034
- Service de Néphrologie, Transplantation, Dialyse et Aphérèses (S.R., C.C.), Hôpital Pellegrin, CHU de Bordeaux
| | - Benjamin Maier
- Interventional Neuroradiology Department and Biological Resources Center, Rothschild Foundation Hospital, Université Paris cité et FHU Neurovasc, Paris
| | - Mikael Mazighi
- Interventional Neuroradiology Department and Biological Resources Center, Rothschild Foundation Hospital, Université Paris cité et FHU Neurovasc, Paris
- Department of Neurology, Hopital Lariboisère, APHP Nord, inserm U1148, Paris
| | - Michel Paques
- Centre hospitalier national d'ophtalmologie des Quinze-Vingts, centre d'investigation clinique 1423, Institut de la Vision, IHU FOReSIGHT, Sorbonne université, Paris, France
| | - Sophie Bonnin
- Centre hospitalier national d'ophtalmologie des Quinze-Vingts, centre d'investigation clinique 1423, Institut de la Vision, IHU FOReSIGHT, Sorbonne université, Paris, France
| | | | | | - Jean Michel Halimi
- Service de néphrologie, centre d'excellence européen en Hypertension Artérielle, CHRU de Tours, F-CRIN INI-CRCT 10, Tours, France
| | - Philippe Gosse
- European Hypertension Excellence Center, Bordeaux University Hospital
| |
Collapse
|
7
|
Costa N, Mounie M, Gombault-Datzenko E, Boulestreau R, Cremer A, Delchier MC, Gosse P, Lagarde S, Lepage B, Molinier L, Papadopoulos P, Trillaud H, Rousseau H, Bouhanick B. Cost Analysis of Radiofrequency Ablation for Adrenal Adenoma in Patients with Primary Aldosteronism and Hypertension: Results from the ADERADHTA Pilot Study and Comparison with Surgical Adrenalectomy. Cardiovasc Intervent Radiol 2023; 46:89-97. [PMID: 36380152 DOI: 10.1007/s00270-022-03295-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 09/24/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE Primary Aldosteronism (PA) is increasingly considered as a common disease affecting up to 10% of the hypertensive population. Standard of care comprises laparoscopic total adrenalectomy but innovative treatment such as RadioFrequency Ablation (RFA) constitutes an emerging promising alternative to surgery. The main aim of this study is to analyse the cost of RFA versus surgery on aldosterone-producing adenoma patient from the French National Health Insurance (FNHI) perspective. METHODS The ADERADHTA study was a prospective pilot study aiming to evaluate both safety and efficacy of the novel use of adrenal RFA on the patients with PA. This study conducted on two French sites and enrolled adult patients, between 2016 and 2018, presenting hypertension and underwent the RFA procedure. Direct medical (inpatient and outpatient) and non-medical (transportation, daily allowance) costs were calculated over a 6-month follow-up period. Moreover, the procedure costs for the RFA were calculated from the hospital perspective. Descriptive statistics were implemented. RESULTS Analysis was done on 21 patients in RFA groups and 27 patients in the surgery group. The difference in hospital costs between the RFA and surgery groups was €3774 (RFA: €1923; Surgery: €5697 p < 0.001) in favour of RFA. Inpatient and outpatient costs over the 6-month follow-up period were estimated at €3,48 for patients who underwent RFA. The production cost of implementing the RFA procedure was estimated at €1539 from the hospital perspective. CONCLUSION Our study was the first to show that RFA is 2 to 3 times less costly than surgery. The trial is registered at ClinicalTrials.gov under the number NCT02756754.
Collapse
Affiliation(s)
- Nadège Costa
- Health Economic Unit of the University Hospital of Toulouse, 31059, Toulouse, France. .,UMR1295, INSERM Mixt INSERM UMR 1295, CERPOP-Center for Epidemiology and Population Health Research, University of Toulouse III Paul Sabatier, Toulouse, France.
| | - Michael Mounie
- Health Economic Unit of the University Hospital of Toulouse, 31059, Toulouse, France. .,UMR1295, INSERM Mixt INSERM UMR 1295, CERPOP-Center for Epidemiology and Population Health Research, University of Toulouse III Paul Sabatier, Toulouse, France.
| | - Eugénie Gombault-Datzenko
- Health Economic Unit of the University Hospital of Toulouse, 31059, Toulouse, France.,University of Toulouse III, 31330, Toulouse, France
| | - Romain Boulestreau
- Cardiology and Arterial HyperTension Department, Saint-André Hospital, University Hospital of Bordeaux, Bordeaux, France
| | - Antoine Cremer
- Cardiology and Arterial HyperTension Department, Saint-André Hospital, University Hospital of Bordeaux, Bordeaux, France
| | - Marie C Delchier
- Interventional Radiology Department, Rangueil Hospital, University Hospital of Toulouse, Toulouse, France
| | - Philippe Gosse
- Cardiology and Arterial HyperTension Department, Saint-André Hospital, University Hospital of Bordeaux, Bordeaux, France
| | - Séverine Lagarde
- Interventional Radiology Department, Rangueil Hospital, University Hospital of Toulouse, Toulouse, France
| | - Benoit Lepage
- Research Methodology Support Unit, Epidemiology and Public Health Department, University Hospital of Toulouse, Toulouse, France
| | - Laurent Molinier
- Health Economic Unit of the University Hospital of Toulouse, 31059, Toulouse, France.,UMR1295, INSERM Mixt INSERM UMR 1295, CERPOP-Center for Epidemiology and Population Health Research, University of Toulouse III Paul Sabatier, Toulouse, France.,University of Toulouse III, 31330, Toulouse, France
| | - Panteleimon Papadopoulos
- Interventional and Diagnostic Imaging Department, University Hospital of Bordeaux, Bordeaux, France
| | - Hervé Trillaud
- Interventional and Diagnostic Imaging Department, University Hospital of Bordeaux, Bordeaux, France
| | - Hervé Rousseau
- Interventional Radiology Department, Rangueil Hospital, University Hospital of Toulouse, Toulouse, France
| | - Béatrice Bouhanick
- UMR1295, INSERM Mixt INSERM UMR 1295, CERPOP-Center for Epidemiology and Population Health Research, University of Toulouse III Paul Sabatier, Toulouse, France.,University of Toulouse III, 31330, Toulouse, France.,Arterial HyperTension and Therapeutic Department, Rangueil Hospital, University Hospital of Toulouse, Toulouse, France
| |
Collapse
|
8
|
Azizi M, Mahfoud F, Weber MA, Sharp ASP, Schmieder RE, Lurz P, Lobo MD, Fisher NDL, Daemen J, Bloch MJ, Basile J, Sanghvi K, Saxena M, Gosse P, Jenkins JS, Levy T, Persu A, Kably B, Claude L, Reeve-Stoffer H, McClure C, Kirtane AJ, Mullin C, Thackeray L, Chertow G, Kahan T, Dauerman H, Ullery S, Abbott JD, Loening A, Zagoria R, Costello J, Krathan C, Lewis L, McElvarr A, Reilly J, Cash M, Williams S, Jarvis M, Fong P, Laffer C, Gainer J, Robbins M, Crook S, Maddel S, Hsi D, Martin S, Portnay E, Ducey M, Rose S, DelMastro E, Bangalore S, Williams S, Cabos S, Rodriguez Alvarez C, Todoran T, Powers E, Hodskins E, Paladugu V, Tecklenburg A, Devireddy C, Lea J, Wells B, Fiebach A, Merlin C, Rader F, Dohad S, Kim HM, Rashid M, Abraham J, Owan T, Abraham A, Lavasani I, Neilson H, Calhoun D, McElderry T, Maddox W, Oparil S, Kinder S, Radhakrishnan J, Batres C, Edwards S, Garasic J, Drachman D, Zusman R, Rosenfield K, Do D, Khuddus M, Zentko S, O'Meara J, Barb I, Foster A, Boyette A, Wang Y, Jay D, Skeik N, Schwartz R, Peterson R, Goldman JA, Goldman J, Ledley G, Katof N, Potluri S, Biedermann S, Ward J, White M, Mauri L, Sobieszczky P, Smith A, Aseltine L, Stouffer R, Hinderliter A, Pauley E, Wade T, Zidar D, Shishehbor M, Effron B, Costa M, Semenec T, Roongsritong C, Nelson P, Neumann B, Cohen D, Giri J, Neubauer R, Vo T, Chugh AR, Huang PH, Jose P, Flack J, Fishman R, Jones M, Adams T, Bajzer C, Mathur A, Jain A, Balawon A, Zongo O, Bent C, Beckett D, Lakeman N, Kennard S, D’Souza RJ, Statton S, Wilkes L, Anning C, Sayer J, Iyer SG, Robinson N, Sevillano A, Ocampo M, Gerber R, Faris M, Marshall AJ, Sinclair J, Pepper H, Davies J, Chapman N, Burak P, Carvelli P, Jadhav S, Quinn J, Rump LC, Stegbauer J, Schimmöller L, Potthoff S, Schmid C, Roeder S, Weil J, Hafer L, Agdirlioglu T, Köllner T, Böhm M, Ewen S, Kulenthiran S, Wachter A, Koch C, Fengler K, Rommel KP, Trautmann K, Petzold M, Ott C, Schmid A, Uder M, Heinritz U, Fröhlich-Endres K, Genth-Zotz S, Kämpfner D, Grawe A, Höhne J, Kaesberger B, von zur Mühlen C, Wolf D, Welzel M, Heinrichs G, Trabitzsch B, Cremer A, Trillaud H, Papadopoulos P, Maire F, Gaudissard J, Sapoval M, Livrozet M, Lorthioir A, Amar L, Paquet V, Pathak A, Honton B, Cottin M, Petit F, Lantelme P, Berge C, Courand PY, Langevin F, Delsart P, Longere B, Ledieu G, Pontana F, Sommeville C, Bertrand F, Feyz L, Zeijen V, Ruiter A, Huysken E, Blankestijn P, Voskuil M, Rittersma Z, Dolmans H, Kroon A, van Zwam W, Vranken J, de Haan. C, Renkin J, Maes F, Beauloye C, Lengelé JP, Huyberechts D, Bouvie A, Witkowski A, Januszewicz A, Kądziela J, Prejbisj A, Hering D, Ciecwierz D, Jaguszewski MJ, Owczuk R. Effects of Renal Denervation vs Sham in Resistant Hypertension After Medication Escalation: Prespecified Analysis at 6 Months of the RADIANCE-HTN TRIO Randomized Clinical Trial. JAMA Cardiol 2022; 7:1244-1252. [PMID: 36350593 PMCID: PMC9647563 DOI: 10.1001/jamacardio.2022.3904] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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: 11/10/2022]
Abstract
Importance Although early trials of endovascular renal denervation (RDN) for patients with resistant hypertension (RHTN) reported inconsistent results, ultrasound RDN (uRDN) was found to decrease blood pressure (BP) vs sham at 2 months in patients with RHTN taking stable background medications in the Study of the ReCor Medical Paradise System in Clinical Hypertension (RADIANCE-HTN TRIO) trial. Objectives To report the prespecified analysis of the persistence of the BP effects and safety of uRDN vs sham at 6 months in conjunction with escalating antihypertensive medications. Design, Setting, and Participants This randomized, sham-controlled, clinical trial with outcome assessors and patients blinded to treatment assignment, enrolled patients from March 11, 2016, to March 13, 2020. This was an international, multicenter study conducted in the US and Europe. Participants with daytime ambulatory BP of 135/85 mm Hg or higher after 4 weeks of single-pill triple-combination treatment (angiotensin-receptor blocker, calcium channel blocker, and thiazide diuretic) with estimated glomerular filtration rate (eGFR) of 40 mL/min/1.73 m2 or greater were randomly assigned to uRDN or sham with medications unchanged through 2 months. From 2 to 5 months, if monthly home BP was 135/85 mm Hg or higher, standardized stepped-care antihypertensive treatment starting with aldosterone antagonists was initiated under blinding to treatment assignment. Interventions uRDN vs sham procedure in conjunction with added medications to target BP control. Main Outcomes and Measures Six-month change in medications, change in daytime ambulatory systolic BP, change in home systolic BP adjusted for baseline BP and medications, and safety. Results A total of 65 of 69 participants in the uRDN group and 64 of 67 participants in the sham group (mean [SD] age, 52.4 [8.3] years; 104 male [80.6%]) with a mean (SD) eGFR of 81.5 (22.8) mL/min/1.73 m2 had 6-month daytime ambulatory BP measurements. Fewer medications were added in the uRDN group (mean [SD], 0.7 [1.0] medications) vs sham (mean [SD], 1.1 [1.1] medications; P = .045) and fewer patients in the uRDN group received aldosterone antagonists at 6 months (26 of 65 [40.0%] vs 39 of 64 [60.9%]; P = .02). Despite less intensive standardized stepped-care antihypertensive treatment, mean (SD) daytime ambulatory BP at 6 months was 138.3 (15.1) mm Hg with uRDN vs 139.0 (14.3) mm Hg with sham (additional decreases of -2.4 [16.6] vs -7.0 [16.7] mm Hg from month 2, respectively), whereas home SBP was lowered to a greater extent with uRDN by 4.3 mm Hg (95% CI, 0.5-8.1 mm Hg; P = .03) in a mixed model adjusting for baseline and number of medications. Adverse events were infrequent and similar between groups. Conclusions and Relevance In this study, in patients with RHTN initially randomly assigned to uRDN or a sham procedure and who had persistent elevation of BP at 2 months after the procedure, standardized stepped-care antihypertensive treatment escalation resulted in similar BP reduction in both groups at 6 months, with fewer additional medications required in the uRDN group. Trial Registration ClinicalTrials.gov Identifier: NCT02649426.
Collapse
Affiliation(s)
- Michel Azizi
- Université Paris Cité, F-75006 Paris, France,Assistance Publique–Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Hypertension Department and DMU CARTE, F-75015 Paris, France,INSERM, CIC1418, F-75015 Paris, France
| | - Felix Mahfoud
- Klinik für Innere Medizin III, Saarland University Hospital, Homburg/Saar, Germany,Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge
| | - Michael A. Weber
- Division of Cardiovascular Medicine, State University of New York, Downstate Medical Center, New York
| | - Andrew S. P. Sharp
- University Hospital of Wales, Cardiff and University of Exeter, Exeter, United Kingdom
| | - Roland E. Schmieder
- Nephrology and Hypertension, University Hospital Erlangen, Friedrich Alexander University, Erlangen, Germany
| | - Philipp Lurz
- Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Melvin D. Lobo
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | | | - Joost Daemen
- Erasmus MC, University Medical Center Rotterdam, Department of Cardiology, Rotterdam, the Netherlands
| | - Michael J. Bloch
- Department of Medicine, University of Nevada School of Medicine, Vascular Care, Renown Institute of Heart and Vascular Health, Reno
| | - Jan Basile
- Division of Cardiovascular Medicine, Medical University of South Carolina, Ralph H. Johnson VA Medical Center, Charleston
| | | | - Manish Saxena
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | | | | | - Terry Levy
- Royal Bournemouth Hospital, Dorset, United Kingdom
| | - Alexandre Persu
- Division of Cardiology, Cliniques Universitaires Saint-Luc and Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Benjamin Kably
- Assistance Publique–Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Department of Pharmacology, Paris, France
| | | | | | | | - Ajay J. Kirtane
- Columbia University Medical Center/New York-Presbyterian Hospital and the Cardiovascular Research Foundation, New York
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Danny Do
- for the RADIANCE-HTN Investigators
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jay Giri
- for the RADIANCE-HTN Investigators
| | | | - Thu Vo
- for the RADIANCE-HTN Investigators
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Bloch M, Kirtane A, Mahfoud F, Azizi M, Basile J, Daemen J, Saxena M, Gosse P, Sanghvi K, Schmieder R. TCT-212 Twenty-Four Month Results in Patients With Resistant Hypertension After Endovascular Ultrasound Renal Denervation in the RADIANCE-HTN TRIO Trial. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.08.250] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
10
|
Boulestreau R, Lucas L, Cremer A, Doublet J, Rubin S, Sibon I, Gosse P. NEUROLOGICALLY ASYMPTOMATIC PATIENTS FREQUENTLY PRESENT CEREBRAL INJURIES DURING MALIGNANT HYPERTENSION: A MRI STUDY. J Hypertens 2022. [DOI: 10.1097/01.hjh.0000836852.84410.d6] [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]
|
11
|
Weber T, Amar J, de Backer T, Burkard T, van der Giet M, Gosse P, Januszewicz A, Kahan T, Mancia G, Mayer CC, Muiesan ML, Stergiou GS, Tsioufis K, Vaisse B, Kreutz R. Covid-19 associated reduction in hypertension-related diagnostic and therapeutic procedures in Excellence Centers of the European Society of Hypertension. Blood Press 2022; 31:71-79. [DOI: 10.1080/08037051.2022.2060182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Thomas Weber
- Cardiology Department, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Jaques Amar
- Department of Hypertension, Toulouse University Hospital, Toulouse, France
| | - Tine de Backer
- Cardiovascular Center, Heymans Institute of Clinical Pharmacology, University Hospital Gent, Gent, Belgium
| | - Thilo Burkard
- Medical Outpatient Department and Hypertension Clinic, University Hospital Basel, Basel, Switzerland
| | - Marcus van der Giet
- Hypertension Centre Berlin, Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Philippe Gosse
- Unité Hypertension Artérielle, University of Bordeaux, Bordeaux, France
| | | | - Thomas Kahan
- Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden
| | | | - Christopher C. Mayer
- Health and Bioresources Division, Austrian Institute of Technology, Vienna, Austria
| | - Maria Lorenza Muiesan
- Department of Clinical and Experimental Sciences, Centro per la Prevenzione e Cura dell’ipertensione Arteriosa, University of Brescia and ASST Spedali Civili, Brescia, Italy
| | - George S. Stergiou
- Third Department of Medicine, Sotiria Hospital, Hypertension Center STRIDE-7, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Tsioufis
- 1st Cardiology Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - Bernard Vaisse
- Service de Rythmologie et d’Hypertension, Pôle Cardiovasculaire et Thoracique, Marseille, France
| | - Reinhold Kreutz
- Hypertension Centre Berlin, Charite Universitatsmedizin Berlin, Berlin, Germany
| | | |
Collapse
|
12
|
Fisher NDL, Kirtane AJ, Daemen J, Rader F, Lobo MD, Saxena M, Abraham J, Schmieder RE, Sharp ASP, Gosse P, Claude L, Song Y, Azizi M. Plasma renin and aldosterone concentrations related to endovascular ultrasound renal denervation in the RADIANCE-HTN SOLO trial. J Hypertens 2022; 40:221-228. [PMID: 34433763 DOI: 10.1097/hjh.0000000000002994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 10/20/2022]
Abstract
OBJECTIVE The RADIANCE-HTN SOLO trial demonstrated a greater reduction in daytime ambulatory SBP at 2 months by endovascular ultrasound renal denervation than sham procedure. We hypothesized that plasma renin and aldosterone concentrations would be associated with the SBP response to renal denervation. METHODS Hypertensive patients were randomized to renal denervation (n = 74) or sham (n = 72) after a 4-week washout of antihypertensive medications. In a 53-patient subset, 2-month and 6-month plasma renin and aldosterone concentration were measured. Dietary sodium was not controlled. RESULTS Mean age of the 29 treatment and 24 sham patients was 54 years; 62% were men; 17% black. Daytime ambulatory SBP fell in the denervation but not the sham group at 2 months (-7.8 ± 10.7 vs. -0.1 ± 10.1 mmHg; P = 0.048). Baseline plasma renin and aldosterone concentrations were in the low-normal range, did not change significantly at 2 months in either group and did not predict response to renal denervation. At 6 months, after the addition of antihypertensive medications, there was a significant rise in renin in the sham but not the denervation group. CONCLUSION Although renal denervation but not sham resulted in a decrease in daytime ambulatory SBP at 2 months, renin and aldosterone concentrations did neither predict the BP response to renal denervation; nor did they fall after denervation. A rise in renin at 6 months in the sham group likely represents confounding from antihypertensive medications. Whether the BP-lowering effect of renal denervation depends on reducing local intrarenal renin release requires further study.
Collapse
Affiliation(s)
- Naomi D L Fisher
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ajay J Kirtane
- Columbia University Medical Center/New York-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York, USA
| | - Joost Daemen
- Erasmus MC, Department of Cardiology, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Florian Rader
- Cedars-Sinai Heart Institute, Los Angeles, California, USA
| | - Melvin D Lobo
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Manish Saxena
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, UK
| | | | - Roland E Schmieder
- Nephrology and Hypertension, University Hospital Erlangen, Friedrich Alexander University, Erlangen, Germany
| | - Andrew S P Sharp
- University Hospital of Wales, Cardiff and University of Exeter, Exeter, UK
| | | | | | - Yang Song
- Baim Institute for Clinical Research, Boston, Massachusetts, USA
| | - Michel Azizi
- Université de Paris
- AP-HP, Hôpital Européen Georges-Pompidou, Hypertension Department and DMU CARTE
- INSERM, CIC1418, Paris, France
| |
Collapse
|
13
|
Bustin A, Sridi S, Gravinay P, Legghe B, Gosse P, Ouattara A, Rozé H, Coste P, Gerbaud E, Desclaux A, Boyer A, Prevel R, Gruson D, Bonnet F, Issa N, Montaudon M, Laurent F, Stuber M, Camou F, Cochet H. High-resolution Free-breathing late gadolinium enhancement Cardiovascular magnetic resonance to diagnose myocardial injuries following COVID-19 infection. Eur J Radiol 2021; 144:109960. [PMID: 34600236 PMCID: PMC8450147 DOI: 10.1016/j.ejrad.2021.109960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/30/2021] [Accepted: 09/15/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE High-resolution free-breathing late gadolinium enhancement (HR-LGE) was shown valuable for the diagnosis of acute coronary syndromes with non-obstructed coronary arteries. The method may be useful to detect COVID-related myocardial injuries but is hampered by prolonged acquisition times. We aimed to introduce an accelerated HR-LGE technique for the diagnosis of COVID-related myocardial injuries. METHOD An undersampled navigator-gated HR-LGE (acquired resolution of 1.25 mm3) sequence combined with advanced patch-based low-rank reconstruction was developed and validated in a phantom and in 23 patients with structural heart disease (test cohort; 15 men; 55 ± 16 years). Twenty patients with laboratory-confirmed COVID-19 infection associated with troponin rise (COVID cohort; 15 men; 46 ± 24 years) prospectively underwent cardiovascular magnetic resonance (CMR) with the proposed sequence in our center. Image sharpness, quality, signal intensity differences and diagnostic value of free-breathing HR-LGE were compared against conventional breath-held low-resolution LGE (LR-LGE, voxel size 1.8x1.4x6mm). RESULTS Structures sharpness in the phantom showed no differences with the fully sampled image up to an undersampling factor of x3.8 (P > 0.5). In patients (N = 43), this acceleration allowed for acquisition times of 7min21s ± 1min12s at 1.25 mm3 resolution. Compared with LR-LGE, HR-LGE showed higher image quality (P = 0.03) and comparable signal intensity differences (P > 0.5). In patients with structural heart disease, all LGE-positive segments on LR-LGE were also detected on HR-LGE (80/391) with 21 additional enhanced segments visible only on HR-LGE (101/391, P < 0.001). In 4 patients with COVID-19 history, HR-LGE was definitely positive while LR-LGE was either definitely negative (1 microinfarction and 1 myocarditis) or inconclusive (2 myocarditis). CONCLUSIONS Undersampled free-breathing isotropic HR-LGE can detect additional areas of late enhancement as compared to conventional breath-held LR-LGE. In patients with history of COVID-19 infection associated with troponin rise, the method allows for detailed characterization of myocardial injuries in acceptable scan times and without the need for repeated breath holds.
Collapse
Affiliation(s)
- Aurélien Bustin
- Department of Cardiovascular Imaging, Groupe Hospitalier Sud, CHU Bordeaux, Pessac, France; IHU LIRYC, Electrophysiology and Heart Modeling Institute, Université de Bordeaux - INSERM U1045, Avenue du Haut Lévêque, Pessac, France; Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
| | - Soumaya Sridi
- Department of Cardiovascular Imaging, Groupe Hospitalier Sud, CHU Bordeaux, Pessac, France
| | - Pierre Gravinay
- Cardiac Intensive Care Unit, Hôpital St André, CHU Bordeaux, Bordeaux, France
| | - Benoit Legghe
- Department of Cardiovascular Imaging, Groupe Hospitalier Sud, CHU Bordeaux, Pessac, France
| | - Philippe Gosse
- Cardiac Intensive Care Unit, Hôpital St André, CHU Bordeaux, Bordeaux, France
| | - Alexandre Ouattara
- Department of Anaesthesia and Critical Care, Groupe Hospitalier Sud, CHU Bordeaux, Pessac, France
| | - Hadrien Rozé
- Department of Anaesthesia and Critical Care, Groupe Hospitalier Sud, CHU Bordeaux, Pessac, France
| | - Pierre Coste
- Cardiac Intensive Care Unit, Groupe Hospitalier Sud, CHU de Bordeaux, Pessac, France
| | - Edouard Gerbaud
- Cardiac Intensive Care Unit, Groupe Hospitalier Sud, CHU de Bordeaux, Pessac, France
| | - Arnaud Desclaux
- Infectious disease Unit, Hôpital Pellegrin, CHU Bordeaux, Bordeaux, France
| | - Alexandre Boyer
- Medical Intensive Care Unit, Hôpital Pellegrin, CHU Bordeaux, Bordeaux, France
| | - Renaud Prevel
- Medical Intensive Care Unit, Hôpital Pellegrin, CHU Bordeaux, Bordeaux, France
| | - Didier Gruson
- Medical Intensive Care Unit, Hôpital Pellegrin, CHU Bordeaux, Bordeaux, France
| | - Fabrice Bonnet
- Infectious Disease Unit, Hôpital St André, CHU Bordeaux, Bordeaux, France
| | - Nahema Issa
- Intensive Care Unit, Hôpital St André, CHU Bordeaux, Bordeaux, France
| | - Michel Montaudon
- Department of Cardiovascular Imaging, Groupe Hospitalier Sud, CHU Bordeaux, Pessac, France
| | - François Laurent
- Department of Cardiovascular Imaging, Groupe Hospitalier Sud, CHU Bordeaux, Pessac, France
| | - Matthias Stuber
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Université de Bordeaux - INSERM U1045, Avenue du Haut Lévêque, Pessac, France; Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; CIBM Center for Biomedical Imaging, Lausanne, Switzerland
| | - Fabrice Camou
- Intensive Care Unit, Hôpital St André, CHU Bordeaux, Bordeaux, France
| | - Hubert Cochet
- Department of Cardiovascular Imaging, Groupe Hospitalier Sud, CHU Bordeaux, Pessac, France; IHU LIRYC, Electrophysiology and Heart Modeling Institute, Université de Bordeaux - INSERM U1045, Avenue du Haut Lévêque, Pessac, France
| |
Collapse
|
14
|
Parati G, Stergiou GS, Bilo G, Kollias A, Pengo M, Ochoa JE, Agarwal R, Asayama K, Asmar R, Burnier M, De La Sierra A, Giannattasio C, Gosse P, Head G, Hoshide S, Imai Y, Kario K, Li Y, Manios E, Mant J, McManus RJ, Mengden T, Mihailidou AS, Muntner P, Myers M, Niiranen T, Ntineri A, O’Brien E, Octavio JA, Ohkubo T, Omboni S, Padfield P, Palatini P, Pellegrini D, Postel-Vinay N, Ramirez AJ, Sharman JE, Shennan A, Silva E, Topouchian J, Torlasco C, Wang JG, Weber MA, Whelton PK, White WB, Mancia G. Home blood pressure monitoring: methodology, clinical relevance and practical application: a 2021 position paper by the Working Group on Blood Pressure Monitoring and Cardiovascular Variability of the European Society of Hypertension. J Hypertens 2021; 39:1742-1767. [PMID: 34269334 PMCID: PMC9904446 DOI: 10.1097/hjh.0000000000002922] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [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: 05/18/2021] [Accepted: 05/23/2021] [Indexed: 02/06/2023]
Abstract
The present paper provides an update of previous recommendations on Home Blood Pressure Monitoring from the European Society of Hypertension (ESH) Working Group on Blood Pressure Monitoring and Cardiovascular Variability sequentially published in years 2000, 2008 and 2010. This update has taken into account new evidence in this field, including a recent statement by the American Heart association, as well as technological developments, which have occurred over the past 20 years. The present document has been developed by the same ESH Working Group with inputs from an international team of experts, and has been endorsed by the ESH.
Collapse
Affiliation(s)
- Gianfranco Parati
- Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Department of Cardiovascular Neural and Metabolic Sciences
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - George S. Stergiou
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Grzegorz Bilo
- Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Department of Cardiovascular Neural and Metabolic Sciences
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Anastasios Kollias
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Martino Pengo
- Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Department of Cardiovascular Neural and Metabolic Sciences
| | - Juan Eugenio Ochoa
- Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Department of Cardiovascular Neural and Metabolic Sciences
| | - Rajiv Agarwal
- Division of Nephrology, Department of Medicine, Indiana University School of Medicine and Richard L. Roudebush Veterans Administration Medical Center, Indianapolis, Indiana, USA
| | - Kei Asayama
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
- Tohoku Institute for the Management of Blood Pressure, Sendai, Japan
| | | | - Michel Burnier
- Service of Nephrology and Hypertension, University Hospital, Lausanne, Switzerland
| | - Alejandro De La Sierra
- Hypertension Unit, Department of Internal Medicine, Hospital Mútua Terrassa, University of Barcelona, Barcelona, Spain
| | - Cristina Giannattasio
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Cardiology IV, ‘A. De Gasperis” Department, ASTT GOM Niguarda Ca’ Granda
| | - Philippe Gosse
- Cardiology/Hypertension Unit Saint André Hospital. University Hospital of Borfeaux, France
| | - Geoffrey Head
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Satoshi Hoshide
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Yutaka Imai
- Tohoku Institute for the Management of Blood Pressure, Sendai, Japan
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Yan Li
- Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Efstathios Manios
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Alexandra Hospital, Athens, Greece
| | - Jonathan Mant
- Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge, UK
| | - Richard J. McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Thomas Mengden
- Kerckhoff Clinic, Rehabilitation, ESH Excellence Centre, Bad Nauheim, Germany
| | - Anastasia S. Mihailidou
- Department of Cardiology and Kolling Institute, Royal North Shore Hospital, St Leonards Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Paul Muntner
- Hypertension Research Center, Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Martin Myers
- Schulich Heart Program, Sunnybrook Health Sciences Centre and Department of Medicine, University of Toronto, Toronto, Canada
| | - Teemu Niiranen
- Department of Medicine, Turku University Hospital and University of Turku
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Angeliki Ntineri
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Eoin O’Brien
- The Conway Institute, University College Dublin, Dublin, Ireland
| | - José Andres Octavio
- Experimental Cardiology, Department of Tropical Medicine Institute, Universidad Central de Venezuela, Venezuela
| | - Takayoshi Ohkubo
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
- Tohoku Institute for the Management of Blood Pressure, Sendai, Japan
| | - Stefano Omboni
- Clinical Research Unit, Italian Institute of Telemedicine, Varese, Italy
- Department of Cardiology, Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Paul Padfield
- Department of Medical Sciences, University of Edinburgh, Edinburgh, UK
| | - Paolo Palatini
- Studium Patavinum, Department of Medicine. University of Padova, Padua
| | - Dario Pellegrini
- Cardiovascular Department, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Agustin J. Ramirez
- Arterial Hypertension and Metabolic Unit, University Hospital, Fundacion Favaloro, Argentina
| | - James E. Sharman
- Menzies Institute for Medical Research, College of Health and Medicine, University of Tasmania, Hobart, Australia
| | - Andrew Shennan
- Department of Women and Children's Health, School of Life Course Sciences, FoLSM, Kings College London, UK
| | - Egle Silva
- Research Institute of Cardiovascular Diseases of the University of Zulia, Venezuelan Foundation of Arterial Hypertension. Maracaibo, Venezuela
| | - Jirar Topouchian
- Diagnosis and Therapeutic Center, Paris-Descartes University, AP-HP, Hotel Dieu, Paris, France
| | - Camilla Torlasco
- Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Department of Cardiovascular Neural and Metabolic Sciences
| | - Ji Guang Wang
- Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Michael A. Weber
- Division of Cardiovascular Medicine, Downstate College of Medicine, State University of New York, Brooklyn, New York, USA
| | - Paul K. Whelton
- Department of Epidemiology, Tulane University, School of Public Health and Tropical Medicine, New Orleans, Lousiana
| | - William B. White
- Cardiology Center, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | | |
Collapse
|
15
|
Laurent S, Chatellier G, Azizi M, Calvet D, Choukroun G, Danchin N, Delsart P, Girerd X, Gosse P, Khettab H, London G, Mourad JJ, Pannier B, Pereira H, Stephan D, Valensi P, Cunha P, Narkiewicz K, Bruno RM, Boutouyrie P. SPARTE Study: Normalization of Arterial Stiffness and Cardiovascular Events in Patients With Hypertension at Medium to Very High Risk. Hypertension 2021; 78:983-995. [PMID: 34455813 PMCID: PMC8415523 DOI: 10.1161/hypertensionaha.121.17579] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Supplemental Digital Content is available in the text. The SPARTE study (Strategy for Preventing cardiovascular and renal events based on ARTErial stiffness; URL: https://www.clinicaltrials.gov; Unique identifier: NCT02617238) is a multicenter open-label randomized controlled trial with blinded end point evaluation, undertaken at 25 French research centers in university hospitals. Patients with primary hypertension were randomly assigned (1:1) to a therapeutic strategy targeting the normalization of carotid-femoral pulse wave velocity (PWV) measured every 6 months (PWV group, n=264) versus a classical therapeutic strategy only implementing the European Guidelines for Hypertension Treatment (conventional group, n=272). In the PWV group, the therapeutic strategy used preferably a combination of ACE (angiotensin-converting enzyme) inhibitor or angiotensin receptor blocker and calcium channel blockers, as well as maximal recommended doses of ACE inhibitors and angiotensin receptor blockers. The primary outcome was a combined end point including particularly stroke and coronary events. Secondary outcomes included the time-course changes in brachial office blood pressure (BP), ambulatory BP, PWV, and treatments. After a median follow-up of 48.3 months, there was no significant between-group difference in primary outcome (hazard ratio, 0.74 [95% CI, 0.40–1.38], P=0.35). In the PWV group, combinations of renin-angiotensin-system blockers and calcium channel blockers were prescribed at higher dosage (P=0.028), office and ambulatory systolic blood pressure and diastolic blood pressure decreased more (P<0.001 and P<0.01, respectively), and PWV increased less (P=0.0003) than in the conventional group. The SPARTE study lacked sufficient statistical power to demonstrate its primary outcome. However, it demonstrated that a PWV-driven treatment for hypertension enables to further reduce office and ambulatory systolic blood pressure and diastolic blood pressure and prevent vascular aging in patients with hypertension at medium-to-very-high risk, compared with strict application of guidelines.
Collapse
Affiliation(s)
- Stephane Laurent
- From the Université de Paris, France (S.L., G. Chatellier, M.A., N.D., R.-M.B., P.B.).,Assistance-Publique Hopitaux de Paris, Georges Pompidou European Hospital, Paris, France (S.L., G. Chatellier, M.A., N.D., H.K., R.-M.B., P.B.)
| | - Gilles Chatellier
- From the Université de Paris, France (S.L., G. Chatellier, M.A., N.D., R.-M.B., P.B.).,Assistance-Publique Hopitaux de Paris, Georges Pompidou European Hospital, Paris, France (S.L., G. Chatellier, M.A., N.D., H.K., R.-M.B., P.B.).,Clinical Research Unit, INSERM U970, Paris (G. Chatellier, H.P.)
| | - Michel Azizi
- From the Université de Paris, France (S.L., G. Chatellier, M.A., N.D., R.-M.B., P.B.).,Assistance-Publique Hopitaux de Paris, Georges Pompidou European Hospital, Paris, France (S.L., G. Chatellier, M.A., N.D., H.K., R.-M.B., P.B.).,Hypertension Department and DMU CARTE, Paris, France (M.A.).,INSERM, CIC1418, Paris, France (M.A.)
| | - David Calvet
- Neurology department, GHU Paris Psychiatrie Neurosciences, Sainte-Anne Hospital (D.C.).,INSERM UMR 1266, FHU NeuroVasc, Paris, France (D.C.)
| | - Gabriel Choukroun
- Nephrology Dialysis Transplantation Department, CHU Amiens, France (G. Choukroun).,MP3CV Research Unit, University Picardie Jules Verne, France (G. Choukroun)
| | - Nicolas Danchin
- From the Université de Paris, France (S.L., G. Chatellier, M.A., N.D., R.-M.B., P.B.).,Assistance-Publique Hopitaux de Paris, Georges Pompidou European Hospital, Paris, France (S.L., G. Chatellier, M.A., N.D., H.K., R.-M.B., P.B.).,Cardiology Department, Georges Pompidou Hospital, Paris, France (N.D.)
| | | | - Xavier Girerd
- ICAN, Sorbonne University, Assistance-Publique Hopitaux de Paris, Paris, France (X.G.)
| | - Philippe Gosse
- Cardiology Department, Saint Andre Hospital, CHU Bordeaux, France (P.G.)
| | - Hakim Khettab
- Assistance-Publique Hopitaux de Paris, Georges Pompidou European Hospital, Paris, France (S.L., G. Chatellier, M.A., N.D., H.K., R.-M.B., P.B.).,INSERM U970, Cardiovascular Research Center - PARCC, Paris, France (H.K., R.-M.B., P.B.)
| | - Gerard London
- Department of Nephrology, Manhes Hospital, Fleury Merogis, France(G.L.)
| | | | - Bruno Pannier
- Department of Internal Medicine, Manhes Hospital, Fleury Merogis, France (B.P.)
| | - Helena Pereira
- Clinical Research Unit, INSERM U970, Paris (G. Chatellier, H.P.)
| | - Dominique Stephan
- University of Strasbourg, France (D.S.).,UMR 1260, INSERM-University of Strasbourg, France (D.S.)
| | - Paul Valensi
- Unit of Endocrinology-Diabetology-Nutrition, Assistance-Publique Hopitaux de Paris, Jean Verdier Hospital, University Sorbonne Paris Cite, Bondy, France (P.V.)
| | - Pedro Cunha
- Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Internal Medicine Department, Guimaraes, Portugal (P.C.).,Life and Health Research Institute (ICVS/3B's), Minho University, Portugal (P.C.)
| | - Krzysztof Narkiewicz
- Department of Hypertension and Diabetology, Faculty of Medicine, Medical University of Gdansk, Debinki, Gdansk, Poland (K.N.)
| | - Rosa-Maria Bruno
- From the Université de Paris, France (S.L., G. Chatellier, M.A., N.D., R.-M.B., P.B.).,Assistance-Publique Hopitaux de Paris, Georges Pompidou European Hospital, Paris, France (S.L., G. Chatellier, M.A., N.D., H.K., R.-M.B., P.B.).,INSERM U970, Cardiovascular Research Center - PARCC, Paris, France (H.K., R.-M.B., P.B.)
| | - Pierre Boutouyrie
- From the Université de Paris, France (S.L., G. Chatellier, M.A., N.D., R.-M.B., P.B.).,Assistance-Publique Hopitaux de Paris, Georges Pompidou European Hospital, Paris, France (S.L., G. Chatellier, M.A., N.D., H.K., R.-M.B., P.B.).,INSERM U970, Cardiovascular Research Center - PARCC, Paris, France (H.K., R.-M.B., P.B.)
| | | |
Collapse
|
16
|
Azizi M, Daemen J, Lobo MD, Mahfoud F, Sharp ASP, Schmieder RE, Wang Y, Saxena M, Lurz P, Sayer J, Bloch MJ, Basile J, Weber MA, Rump LC, Levy T, Sapoval M, Sanghvi K, Rader F, Fisher NDL, Gosse P, Abraham J, Claude L, Barman NC, McClure CK, Liu Y, Kirtane AJ. 12-Month Results From the Unblinded Phase of the RADIANCE-HTN SOLO Trial of Ultrasound Renal Denervation. JACC Cardiovasc Interv 2021; 13:2922-2933. [PMID: 33357531 DOI: 10.1016/j.jcin.2020.09.054] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/04/2020] [Accepted: 09/08/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVES This study reports the 12-month results of the RADIANCE-HTN (A Study of the ReCor Medical Paradise System in Clinical Hypertension) SOLO trial following unblinding of patients at 6 months. BACKGROUND The blood pressure (BP)-lowering efficacy and safety of endovascular ultrasound renal denervation (RDN) in the absence (2 months) and presence (6 months) of antihypertensive medications were previously reported. METHODS Patients with daytime ambulatory BP ≥135/85 mm Hg after 4 weeks off medication were randomized to RDN (n = 74) or sham (n = 72) and maintained off medication for 2 months. A standardized medication escalation protocol was instituted between 2 and 5 months (blinded phase). Between 6 and 12 months (unblinded phase), patients received antihypertensive medications at physicians' discretion. Outcomes at 12 months included medication burden, change in daytime ambulatory systolic BP (dASBP) and office or home systolic BP (SBP), visit-to-visit variability in SBP, and safety. RESULTS Sixty-five of 74 RDN patients and 67 of 72 sham patients had 12-month dASBP measurements. The proportion of patients on ≥2 medications (27.7% vs. 44.8%; p = 0.041), the number of medications (0 vs. 1.4; p = 0.015), and defined daily dose (1.4 vs. 2.2; p = 0.007) were less with RDN versus sham. The decrease in dASBP from baseline in the RDN group (-16.5 ± 12.9 mm Hg) remained stable at 12 months. The RDN versus sham adjusted difference at 12 months was -2.3 mm Hg (95% confidence interval [CI]: -5.9 to 1.3 mm Hg; p = 0.201) for dASBP, -6.3 mm Hg (95% CI: -11.1 to -1.5 mm Hg; p = 0.010) for office SBP, and -3.4 mm Hg (95% CI: -6.9 to 0.1 mm Hg; p = 0.062) for home SBP. Visit-to-visit variability in SBP was smaller in the RDN group. No renal artery injury was detected on computed tomographic or magnetic resonance angiography. CONCLUSIONS Despite unblinding, the BP-lowering effect of RDN was maintained at 12 months with fewer prescribed medications compared with sham.
Collapse
Affiliation(s)
- Michel Azizi
- Université de Paris, Paris, France; AP-HP, Hôpital Européen Georges-Pompidou, Hypertension Department and DMU CARTE, Paris, France; INSERM, CIC1418, Paris, France.
| | - Joost Daemen
- Erasmus Medical Center, University Medical Center Rotterdam, Department of Cardiology, Rotterdam, the Netherlands
| | - Melvin D Lobo
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Felix Mahfoud
- Klinik für Innere Medizin III, Saarland University Hospital, Homburg/Saar, Germany; Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Andrew S P Sharp
- University Hospital of Wales, Cardiff and University of Exeter, Exeter, United Kingdom
| | - Roland E Schmieder
- Nephrology and Hypertension, University Hospital Erlangen, Friedrich Alexander University, Erlangen, Germany
| | - Yale Wang
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Manish Saxena
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Philipp Lurz
- Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Jeremy Sayer
- The Essex Cardiothoracic Centre, Essex, United Kingdom
| | - Michael J Bloch
- Department of Medicine, University of Nevada School of Medicine, Vascular Care, Renown Institute of Heart and Vascular Health, Reno, Nevada, USA
| | - Jan Basile
- Seinsheimer Cardiovascular Health Program, Medical University of South Carolina, Ralph H. Johnson VA Medical Center, Charleston, South Carolina, USA
| | - Michael A Weber
- Division of Cardiovascular Medicine, State University of New York, Downstate Medical Center, New York, New York, USA
| | - Lars C Rump
- University Clinic Dusseldorf, Dusseldorf, Germany
| | - Terry Levy
- Royal Bournemouth Hospital, Dorset, United Kingdom
| | - Marc Sapoval
- Université de Paris, Paris, France; AP-HP, Hôpital Européen Georges-Pompidou, Hypertension Department and DMU CARTE, Paris, France; INSERM, CIC1418, Paris, France
| | - Kintur Sanghvi
- Deborah Heart & Lung Center, Brown Mills, New Jersey, USA
| | - Florian Rader
- Cedars-Sinai Heart Institute, Los Angeles, California, USA
| | | | | | | | | | | | | | - Yuyin Liu
- The Baim Institute for Clinical Research, Boston, Massachusetts, USA
| | - Ajay J Kirtane
- Columbia University Medical Center/NewYork-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York, USA
| | | |
Collapse
|
17
|
Azizi M, Sanghvi K, Saxena M, Gosse P, Reilly JP, Levy T, Rump LC, Persu A, Basile J, Bloch MJ, Daemen J, Lobo MD, Mahfoud F, Schmieder RE, Sharp ASP, Weber MA, Sapoval M, Fong P, Pathak A, Lantelme P, Hsi D, Bangalore S, Witkowski A, Weil J, Kably B, Barman NC, Reeve-Stoffer H, Coleman L, McClure CK, Kirtane AJ. Ultrasound renal denervation for hypertension resistant to a triple medication pill (RADIANCE-HTN TRIO): a randomised, multicentre, single-blind, sham-controlled trial. Lancet 2021; 397:2476-2486. [PMID: 34010611 DOI: 10.1016/s0140-6736(21)00788-1] [Citation(s) in RCA: 149] [Impact Index Per Article: 49.7] [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] [Received: 03/16/2021] [Revised: 03/24/2021] [Accepted: 03/26/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Endovascular renal denervation reduces blood pressure in patients with mild-to-moderate hypertension, but its efficacy in patients with true resistant hypertension has not been shown. We aimed to assess the efficacy and safety of endovascular ultrasound renal denervation in patients with hypertension resistant to three or more antihypertensive medications. METHODS In a randomised, international, multicentre, single-blind, sham-controlled trial done at 28 tertiary centres in the USA and 25 in Europe, we included patients aged 18-75 years with office blood pressure of at least 140/90 mm Hg despite three or more antihypertensive medications including a diuretic. Eligible patients were switched to a once daily, fixed-dose, single-pill combination of a calcium channel blocker, an angiotensin receptor blocker, and a thiazide diuretic. After 4 weeks of standardised therapy, patients with daytime ambulatory blood pressure of at least 135/85 mm Hg were randomly assigned (1:1) by computer (stratified by centres) to ultrasound renal denervation or a sham procedure. Patients and outcome assessors were masked to randomisation. Addition of antihypertensive medications was allowed if specified blood pressure thresholds were exceeded. The primary endpoint was the change in daytime ambulatory systolic blood pressure at 2 months in the intention-to-treat population. Safety was also assessed in the intention-to-treat population. This study is registered with ClinicalTrials.gov, NCT02649426. FINDINGS Between March 11, 2016, and March 13, 2020, 989 participants were enrolled and 136 were randomly assigned to renal denervation (n=69) or a sham procedure (n=67). Full adherence to the combination medications at 2 months among patients with urine samples was similar in both groups (42 [82%] of 51 in the renal denervation group vs 47 [82%] of 57 in the sham procedure group; p=0·99). Renal denervation reduced daytime ambulatory systolic blood pressure more than the sham procedure (-8·0 mm Hg [IQR -16·4 to 0·0] vs -3·0 mm Hg [-10·3 to 1·8]; median between-group difference -4·5 mm Hg [95% CI -8·5 to -0·3]; adjusted p=0·022); the median between-group difference was -5·8 mm Hg (95% CI -9·7 to -1·6; adjusted p=0·0051) among patients with complete ambulatory blood pressure data. There were no differences in safety outcomes between the two groups. INTERPRETATION Compared with a sham procedure, ultrasound renal denervation reduced blood pressure at 2 months in patients with hypertension resistant to a standardised triple combination pill. If the blood pressure lowering effect and safety of renal denervation are maintained in the long term, renal denervation might be an alternative to the addition of further antihypertensive medications in patients with resistant hypertension. FUNDING ReCor Medical.
Collapse
Affiliation(s)
- Michel Azizi
- Université de Paris, Paris, France; Hypertension Department and DMU CARTE, AP-HP Hôpital Européen Georges-Pompidou, Paris, France; INSERM, CIC1418, Paris, France.
| | | | - Manish Saxena
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, UK
| | | | - John P Reilly
- Ochsner Heart and Vascular Institute, New Orleans, LA, USA
| | - Terry Levy
- Royal Bournemouth Hospital, Bournemouth, UK
| | - Lars C Rump
- University Clinic Dusseldorf, Dusseldorf, Germany
| | - Alexandre Persu
- Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium; Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Jan Basile
- Seinsheimer Cardiovascular Health Program, Medical University of South Carolina, Ralph H Johnson VA Medical Center, Charleston, SC, USA
| | - Michael J Bloch
- Department of Medicine, University of Nevada School of Medicine, Vascular Care, Renown Institute of Heart and Vascular Health, Reno, NV, USA
| | - Joost Daemen
- Erasmus MC, Department of Cardiology, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Melvin D Lobo
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Felix Mahfoud
- Klinik für Innere Medizin III, Saarland University Hospital, Homburg/Saar, Germany; Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Roland E Schmieder
- Nephrology and Hypertension, University Hospital Erlangen, Friedrich Alexander University, Erlangen, Germany
| | - Andrew S P Sharp
- Cardiology Department, University Hospital of Wales, Cardiff, UK; NIHR Clinical Research Facility, University of Exeter, Exeter, UK
| | - Michael A Weber
- Division of Cardiovascular Medicine, State University of New York, Downstate Medical Center, New York, NY, USA
| | - Marc Sapoval
- Université de Paris, Paris, France; Hypertension Department and DMU CARTE, AP-HP Hôpital Européen Georges-Pompidou, Paris, France
| | - Pete Fong
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Atul Pathak
- Department of Cardiovascular Medicine, Princess Grace Hospital, Monaco; UMR UT3 CNRS 5288, University of Toulouse, Toulouse, France
| | | | - David Hsi
- Stamford Hospital, Stamford, CT, USA
| | | | | | | | - Benjamin Kably
- Université de Paris, Paris, France; AP-HP Hôpital Européen Georges-Pompidou, Pharmacology Unit and DMU CARTE, Paris, France
| | | | | | | | | | - Ajay J Kirtane
- Columbia University Medical Center/New York-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, NY, USA
| |
Collapse
|
18
|
Saxena M, Schmieder RE, Kirtane AJ, Mahfoud F, Daemen J, Basile J, Lurz P, Gosse P, Sanghvi K, Fisher NDL, Rump LC, Pathak A, Blankestijn PJ, Mathur A, Wang Y, Weber MA, Sharp ASP, Bloch MJ, Barman NC, Claude L, Song Y, Azizi M, Lobo MD. Predictors of blood pressure response to ultrasound renal denervation in the RADIANCE-HTN SOLO study. J Hum Hypertens 2021; 36:629-639. [PMID: 34031548 PMCID: PMC9287166 DOI: 10.1038/s41371-021-00547-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 04/09/2021] [Accepted: 04/23/2021] [Indexed: 02/03/2023]
Abstract
The blood pressure (BP) lowering response to renal denervation (RDN) remains variable with about one-third of patients not responding to ultrasound or radiofrequency RDN. Identification of predictors of the BP response to RDN is needed to optimize patient selection for this therapy. This is a post-hoc analysis of the RADIANCE-HTN SOLO study. BP response to RDN was measured by the change in daytime ambulatory systolic blood pressure (dASBP) at 2 months post procedure. Univariate regression was used initially to assess potential predictors of outcome followed by multivariate regression analysis. In the univariate analysis, predictors of response to RDN were higher baseline daytime ambulatory diastolic blood pressure (dADBP), the use of antihypertensive medications at screening, and presence of orthostatic hypertension (OHTN) whilst the presence of untreated accessory arteries was a negative predictor of response. Multivariate analysis determined that dADBP and use of antihypertensive medications were predictors of response to RDN with a trend for OHTN to predict response. Obese females also appeared to be better responders to RDN in an interaction model. RDN is more effective in patients with elevated baseline dADBP and those with OHTN, suggesting increased peripheral vascular resistance secondary to heightened sympathetic tone. These assessments are easy to perform in clinical setting and may help in phenotyping patients who will respond better to RDN.
Collapse
Affiliation(s)
- Manish Saxena
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, UK.
| | - Roland E Schmieder
- Nephrology and Hypertension, University Hospital Erlangen, Friedrich Alexander University, Erlangen, Germany
| | - Ajay J Kirtane
- Columbia University Medical Center/New York-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, NY, USA
| | - Felix Mahfoud
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA.,Klinik für Innere Medizin III, Saarland University Hospital, Homburg/Saar, Germany
| | - Joost Daemen
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, NL, The Netherlands
| | - Jan Basile
- Seinsheimer Cardiovascular Health Program, Medical University of South Carolina, Ralph H Johnson VA Medical Center, Charleston, SC, USA
| | - Philipp Lurz
- Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | | | | | | | - Lars C Rump
- University Clinic Dusseldorf, Dusseldorf, Germany
| | - Atul Pathak
- Department of Cardiovascular Medicine, Princess Grace Hospital, Monaco, Monaco
| | | | - Anthony Mathur
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Yale Wang
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Michael A Weber
- Division of Cardiovascular Medicine, State University of New York, Downstate Medical Center, New York, NY, USA
| | - Andrew S P Sharp
- University Hospital of Wales, Cardiff, UK.,University of Exeter, Exeter, UK
| | - Michael J Bloch
- Department of Medicine, University of Nevada School of Medicine, Vascular Care, Renown Institute of Heart and Vascular Health, Reno, NV, USA
| | | | | | - Yang Song
- Baim Institute for Clinical Research, Boston, MA, USA
| | - Michel Azizi
- Université de Paris, Paris, France.,Hypertension Department and DMU CARTE, AP-HP, Hôpital Européen Georges-Pompidou, Paris, France.,INSERM, CIC1418, Paris, France
| | - Melvin D Lobo
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, UK
| |
Collapse
|
19
|
Cremer A, Boutouyrie P, Laurent S, Gosse P, Tzourio C. Orthostatic hypotension: a marker of blood pressure variability and arterial stiffness: a cross-sectional study on an elderly population: the 3-City study. J Hypertens 2021; 38:1103-1109. [PMID: 32371800 DOI: 10.1097/hjh.0000000000002374] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Orthostatic hypotension, blood pressure (BP) variability, and arterial stiffness are three markers of cardiovascular risk beyond the average BP. However, the relationships between these three parameters are not well known. AIM To examine the relationships between orthostatic hypotension, BP variability, and arterial stiffness. METHODS AND RESULTS In the Three-City study, a sample of 1151 elderly participants (mean age = 80 ± 3 years) was screened for orthostatic hypotension, undertook home BP and pulse wave velocity (PWV) measurements. We performed logistic regression analyses to look at the associations between orthostatic hypotension and both day-to-day (D-to-D) BP variability quartiles and PWV quartiles. Orthostatic hypotension was detected in 210 participants who were more likely to be hypertensive, exhibit higher BP variability and have increased arterial stiffness. In the multivariate logistic regression analysis, the frequency of orthostatic hypotension increased by 20% with every quartile of D-to-D SBP variability and by 20% with every quartile of PWV. PWV and D-to-D BP variability were not associated. In stratified analysis, the use of beta-blocker changes these relationships: orthostatic hypotension was not associated to PWV anymore but its association with D-to-D SBP variability was apparently stronger. CONCLUSION In this large sample of elderly individuals, orthostatic hypotension was independently associated with both BP variability and PWV. BP variability being more indicative of a baroreflex dysfunction and PWV being a marker of vascular ageing, these two components would participate to the orthostatic hypotension mechanisms.
Collapse
Affiliation(s)
- Antoine Cremer
- Department of Cardiology and Hypertension, Bordeaux University Hospital.,University Bordeaux, Inserm, Bordeaux Population HealthResearch Center, UMR 1219.,CHU de Bordeaux, Pole de sante publique, Service d'information medicale, Bordeaux
| | - Pierre Boutouyrie
- Université Paris Descartes Sorbonne Paris-Cité.,Assistance Publique Hôpitaux de Paris, Hôpital Georges Pompidou.,Institut National de la Santé et de la Recherche Médicale U 970, Paris, France
| | - Stéphane Laurent
- Université Paris Descartes Sorbonne Paris-Cité.,Assistance Publique Hôpitaux de Paris, Hôpital Georges Pompidou.,Institut National de la Santé et de la Recherche Médicale U 970, Paris, France
| | - Philippe Gosse
- Department of Cardiology and Hypertension, Bordeaux University Hospital
| | - Christophe Tzourio
- University Bordeaux, Inserm, Bordeaux Population HealthResearch Center, UMR 1219.,CHU de Bordeaux, Pole de sante publique, Service d'information medicale, Bordeaux
| |
Collapse
|
20
|
Gosse P, Doublet J, Gaudissard J, Boulestreau R, Cremer A. Long-term evolution of ambulatory blood pressure and cardiovascular events in hypertensive patients. J Hum Hypertens 2021; 36:517-523. [PMID: 33931738 DOI: 10.1038/s41371-021-00538-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/19/2021] [Accepted: 04/06/2021] [Indexed: 11/09/2022]
Abstract
Ambulatory blood pressure monitoring (ABPM) is now considered the gold standard to evaluate BP, and predicts related cardiovascular risk. However, no study has reported the association of long-term changes in ABPM with the incidence of cardiovascular events, therefore the objective of this work. We included patients from the Bordeaux cohort of hypertensive patients, who had undergone at least two ABPM; the first was performed before or after antihypertensive treatment was started, and the second was the last recording available before any cardiovascular event. We included 591 patients (mean age, 54 years) with a 7-year average interval between the first and last ABPM, a 10-year average follow-up, and a total of 111 cardiovascular events. The patients were divided into four groups: G0, first and last 24 h systolic blood pressure (SBP) < 130; G1, first 24 h SBP ≥ 130, last 24 h SBP < 130; G2, first 24 h SBP < 130, last 24 h SBP ≥ 130; and G3, first 24 h SBP ≥ 130, last 24 h SBP ≥ 130 mmHg. Baseline ABPM better predicted future events than the last ABPM. G0 and G2 had similar survival. G1 and G3 had a worse prognosis than G0 and G2, while G1 had an intermediate risk between G0 and G3, indicating some benefit of treatment. In conclusion, our study showed the prognostic value of the first ABPM recorded in hypertensive patients and the persistence of risk when 24 h BP is controlled by antihypertensive treatment.
Collapse
Affiliation(s)
- Philippe Gosse
- Hypertension excellence center, Hôpital Saint-André, University Hospital, Bordeaux, France.
| | - Julien Doublet
- Hypertension excellence center, Hôpital Saint-André, University Hospital, Bordeaux, France
| | - Julie Gaudissard
- Hypertension excellence center, Hôpital Saint-André, University Hospital, Bordeaux, France
| | - Romain Boulestreau
- Hypertension excellence center, Hôpital Saint-André, University Hospital, Bordeaux, France
| | - Antoine Cremer
- Hypertension excellence center, Hôpital Saint-André, University Hospital, Bordeaux, France
| |
Collapse
|
21
|
Bouhanick B, Delchier MC, Lagarde S, Boulestreau R, Conil C, Gosse P, Rousseau H, Lepage B, Olivier P, Papadopoulos P, Trillaud H, Cremer A. Radiofrequency ablation for adenoma in patients with primary aldosteronism and hypertension: ADERADHTA, a pilot study. J Hypertens 2021; 39:759-765. [PMID: 33196558 PMCID: PMC7969174 DOI: 10.1097/hjh.0000000000002708] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/16/2020] [Accepted: 10/17/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To evaluate the efficacy and the feasibility of radiofrequency ablation to treat aldosterone-producing adenomas. METHODS In an open prospective bicentric pilot study, patients with hypertension on ambulatory blood pressure measurement, a primary aldosteronism, an adenoma measuring less than 4 cm, and confirmation of lateralization by adrenal venous sampling were recruited. The primary endpoint, based on ABPM performed at 6 months after the radiofrequency ablation, was a daytime SBP/DBP less than 135/85 mmHg without any antihypertensive drugs or a reduction of at least 20 mmHg for SBP or 10 mmHg for DBP. RESULTS Thirty patients have been included (mean age = 51 ± 11 years; 50% women). Mean baseline daytime SBP and DBP were 144 ± 19 / 95 ± 15 mmHg and 80% received at least two antihypertensive drugs. At 6 months: 47% (95% CI 28-66) of patients reached the primary endpoint, mean daytime SBP and DBP were 131 ± 14 (101-154)/87 ± 10 (71-107) mmHg; 43% of them did not take any antihypertensive drug and 70% of them did not take potassium supplements. Few complications were recorded: four cases of back pain at day 1 postablation; three limited pneumothoraxes, which resolved spontaneously; one lesion of a polar renal artery. CONCLUSION Radiofrequency ablation for hypertensive patients with aldosterone-producing adenomas seems to be an emerging promising alternative to surgery. Its efficacy and its feasibility have to be confirmed in a larger sample of patients.
Collapse
Affiliation(s)
| | | | | | | | | | - Philippe Gosse
- Service de Cardiologie/HTA, Hôpital Saint André, CHU Bordeaux
| | | | | | - Pascale Olivier
- Service de Pharmacologie Médicale et Clinique, Pharmacovigilance, CHU Toulouse
| | | | - Hervé Trillaud
- Service d’imagerie diagnostique et interventionnelle, CHU Bordeaux, France
| | - Antoine Cremer
- Service de Cardiologie/HTA, Hôpital Saint André, CHU Bordeaux
| |
Collapse
|
22
|
Cremer A, Doublet J, Boulestreau R, Gaudissard J, Tzourio C, Gosse P. Short-term blood pressure variability, arterial stiffness, and cardiovascular events: results from the Bordeaux cohort. J Hypertens 2021; 39:947-951. [PMID: 33427788 DOI: 10.1097/hjh.0000000000002735] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Short-term blood pressure variability derived from 24-h ambulatory monitoring is associated with poor cardiovascular prognosis. However, previous analyses of this have clearly been influenced by clinical cofounders, particularly blood pressure (BP) level. Arterial stiffness is a powerful marker of cardiovascular risk, which may influence BP variability. In this study, we assessed the prognostic value of BP variability based on 24-h ambulatory measurements and adjusted for arterial stiffness. METHODS Population: Bordeaux cohort of hypertensive patients. Inclusion criteria were 24-h ambulatory BP monitoring at baseline with measurements every 15' day and night, determination of wake-up time and bedtime, and assessment of arterial stiffness with monitoring of Korotkoff sound arrival time. A total of 969 patients (age 54 ± 14 years) with an average follow up of 120 ± 78 months and 178 cardiovascular recorded events were included. RESULTS In univariate survival analyses, the standard deviations of day, night, and 24-h SBP were associated with the occurrence of cardiovascular events. The standard deviation of night-time SBP showed the strongest association with the outcome variable and was entered into multivariate analyses. In multivariate analyses, night-time SBP variability remained significantly associated with the occurrence of cardiovascular events after adjusting for major cardiovascular risk factors, 24-h SBP, and arterial stiffness. BP variability and arterial stiffness showed no significant association. CONCLUSION Our results suggest that variability of night-time SBP is an important marker of the risk of cardiovascular events in hypertensive patients, independently of average 24-h BP and arterial stiffness.
Collapse
Affiliation(s)
- Antoine Cremer
- Department of Cardiology and Hypertension, Bordeaux University hospital.,University Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219.,CHU de Bordeaux, Pole de sante publique, Service d'information medicale, Bordeaux
| | - Julien Doublet
- Department of Cardiology and Hypertension, Bordeaux University hospital
| | | | - Julie Gaudissard
- Department of Cardiology and Hypertension, Bordeaux University hospital
| | - Christophe Tzourio
- University Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219.,CHU de Bordeaux, Pole de sante publique, Service d'information medicale, Bordeaux
| | - Philippe Gosse
- Department of Cardiology and Hypertension, Bordeaux University hospital
| |
Collapse
|
23
|
Boulestreau R, Lorthioir A, Persu A, Rubin S, Gosse P, Cremer A, Debeugny S, Halimi J, Tharaux P. First prospective multicentric registry on malignant hypertension: Rational, design and early results from 100 patients of the french HAMA cohort. Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2020.10.144] [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: 11/29/2022]
|
24
|
Boulestreau R, Rubin S, Brockers C, Puel C, Doublet J, Cremer A, Gosse P. Evidence on malignant hypertension therapeutic management: The forgotten past. Insight from a historical literature review. Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2020.10.154] [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: 10/22/2022]
|
25
|
Boulestreau R, Brockers C, Rubin S, Doublet J, Halimi J, Cremer A, Gosse P. Therapeutic management of malignant hypertension: Proof of concept of an entirely oral therapeutic approach. Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2020.10.141] [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: 10/22/2022]
|
26
|
Gosse P, Cremer A, Kirtane AJ, Lobo MD, Saxena M, Daemen J, Wang Y, Stegbauer J, Weber MA, Abraham J, Kario K, Bangalore S, Claude L, Liu Y, Azizi M. Ambulatory Blood Pressure Monitoring to Predict Response to Renal Denervation: A Post Hoc Analysis of the RADIANCE-HTN SOLO Study. Hypertension 2020; 77:529-536. [PMID: 33356403 DOI: 10.1161/hypertensionaha.120.16292] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Renal denervation (RDN) is effective in lowering blood pressure (BP) in patients with hypertension. The issue remains how to best identify potential responders. Ambulatory BP monitoring may be useful. Baseline nighttime systolic BP (SBP) ≥136 mm Hg and its variability (SD) ≥12 mm Hg in DENER-HTN trial or 24-hour heart rate ≥73.5 bpm in SPYRAL HTN-OFF MED Trial were shown to predict the BP response to RDN. We applied these criteria to the patients with hypertension in the sham-controlled RADIANCE-HTN SOLO trial to predict the BP response to ultrasound RDN at 2 months while patients were maintained off medications. BP responders were defined as: clinical with 24-hour SBP <130 mm Hg (RDN: 22/64 versus sham: 7/58); meaningful with 24-hour SBP reduction ≥10 mm Hg (RDN: 24/64, sham: 7/58); and extreme with 24-hour SBP reduction above mean+2 SD of the SBP decrease in the sham group, that is, ≥16.5 mm Hg (RDN: 10/64 versus sham: 2/58). The predictive criteria reported above were tested for sensitivity, specificity, and positive and negative predictive values. The predictive value varied according to the definition of response, with the clinical definition being strongly influenced by regression to the mean. Baseline nighttime SBP and its variability, especially when combined, offered good specificity (>90% irrespective of definition) but low sensitivity (from 9.1% to 30% depending on the definition) to predict responders; the heart rate criterion had insufficient predictive value. This analysis suggests the potential role of nighttime SBP and its variability to predict BP response to RDN in patients with hypertension. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02649426.
Collapse
Affiliation(s)
- Philippe Gosse
- From the Hôpital Saint-André-CHU, Bordeaux, France (P.G., A.C.)
| | - Antoine Cremer
- From the Hôpital Saint-André-CHU, Bordeaux, France (P.G., A.C.)
| | - Ajay J Kirtane
- Columbia University Medical Center/New York-Presbyterian Hospital and the Cardiovascular Research Foundation (A.J.K.)
| | - Melvin D Lobo
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, United Kingdom (M.D.L., M.S.)
| | - Manish Saxena
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, United Kingdom (M.D.L., M.S.)
| | - Joost Daemen
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, NL, the Netherlands (J.D.)
| | - Yale Wang
- Minneapolis Heart Institute, Abbott Northwestern Hospital, MN (Y.W.)
| | - Johannes Stegbauer
- Department of Nephrology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany (J.S.)
| | - Michael A Weber
- Division of Cardiovascular Medicine, State University of New York, Downstate Medical Center (M.A.W.)
| | - Josephine Abraham
- Division of Nephrology and Hypertension, University of Utah, Salt lake city (J.A.)
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K.K.)
| | | | | | - Yuyin Liu
- Baim Institute for Clinical Research, Boston, MA (Y.L.)
| | - Michel Azizi
- Université de Paris, F-75006 Paris, France (M.A.).,AP-HP, Hôpital Européen Georges-Pompidou, Hypertension Department and DMU CARTE, F-75015 Paris, France (M.A.).,INSERM, CIC1418, F-75015 Paris, France (M.A.)
| |
Collapse
|
27
|
Rubin S, Boulestreau R, Gosse P, Combe C. A plea for renin–angiotensin system blockers as first-line treatment in cases of severe acute hypertension. Nephrol Dial Transplant 2020; 36:752-753. [DOI: 10.1093/ndt/gfaa313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Indexed: 11/12/2022] Open
Affiliation(s)
- Sébastien Rubin
- Néphrologie, Transplantation, Dialyse et Aphérèse, Hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France
- Unité INSERM U1034, Univ. Bordeaux, Bordeaux, France
| | | | - Philippe Gosse
- Cardiologie et Hypertension artérielle, European Hypertension Excellence Centre, Hôpital Saint André, CHU de Bordeaux, Bordeaux, France
| | - Christian Combe
- Néphrologie, Transplantation, Dialyse et Aphérèse, Hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France
- Unité INSERM Biotis U1026, Univ. Bordeaux, Bordeaux, France
| |
Collapse
|
28
|
Boulestreau R, Jambon F, Cremer A, Doublet J, Nunes ML, Ferrière A, Tabarin A, Haissaguerre M, Gosse P. [Chronic pheochromocytoma-induced myocardial injuries: What should we expect from modern and classical echocardiographic tools?]. Ann Cardiol Angeiol (Paris) 2020; 69:241-246. [PMID: 32980085 DOI: 10.1016/j.ancard.2020.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 09/01/2020] [Accepted: 09/03/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Pheochromocytoma is a rare disease, which may manifest as severe cardiac complications. Apart from these situations, the "chronic" cardiac impact is not clearly defined. A cardiac MRI study suggests that these patients are carrying areas of fibrosis and foci of left ventricular myocarditis. Since these abnormalities are usually associated with altered left ventricular longitudinal systolic strain, we hypothesize that this strain is altered in patients with a "chronic" pheochromocytoma. METHOD This retrospective case-control study was performed using patients from the Bordeaux University Hospital database, included between 2008 and 2016. We compared the left ventricular global longitudinal strain (GLS), radial and circumferential systolic strain and classic echocardiographic parameters between patients with pheochromocytoma and controls matched for age, sex, body mass index and systolic blood pressure. RESULTS The analysis included 47 patients and 47 correctly matched controls. There were no statistically significant differences between the 2 groups in terms of GLS (-20.7±2.4% vs. -20.2±2.7%, P=0.40), radial strain, left ventricular mass or diastolic function. Left ventricular ejection fraction and circumferential strain were significantly higher in patients than in controls, with a significantly lower telediastolic diameter. CONCLUSION No significant changes in GLS were observed in our pheochromocytoma patients, compared with controls. Several hypotheses may explain these results. The presence of fibrosis foci and areas of left ventricular myocarditis being associated with a poor cardiological prognosis, a systematic cardiac MRI could be discussed in these patients, until further studies are performed.
Collapse
Affiliation(s)
- R Boulestreau
- Centre d'excellence en hypertension artérielle, CHU de Bordeaux, hôpital Saint-André, 1, rue Jean-Burguet, 33000 Bordeaux, France.
| | - F Jambon
- Service de néphrologie et transplantation rénale, CHU de Bordeaux, hôpital Pellegrin, rue de la Pelouse-de-Douet, 33000 Bordeaux, France
| | - A Cremer
- Centre d'excellence en hypertension artérielle, CHU de Bordeaux, hôpital Saint-André, 1, rue Jean-Burguet, 33000 Bordeaux, France
| | - J Doublet
- Centre d'excellence en hypertension artérielle, CHU de Bordeaux, hôpital Saint-André, 1, rue Jean-Burguet, 33000 Bordeaux, France
| | - M L Nunes
- Service d'endocrinologie, CHU de Bordeaux, hôpital Haut-Leveque, avenue du Haut-Leveque, 33600 Pessac, France
| | - A Ferrière
- Service d'endocrinologie, CHU de Bordeaux, hôpital Haut-Leveque, avenue du Haut-Leveque, 33600 Pessac, France
| | - A Tabarin
- Service d'endocrinologie, CHU de Bordeaux, hôpital Haut-Leveque, avenue du Haut-Leveque, 33600 Pessac, France
| | - M Haissaguerre
- Service d'endocrinologie, CHU de Bordeaux, hôpital Haut-Leveque, avenue du Haut-Leveque, 33600 Pessac, France
| | - P Gosse
- Centre d'excellence en hypertension artérielle, CHU de Bordeaux, hôpital Saint-André, 1, rue Jean-Burguet, 33000 Bordeaux, France
| |
Collapse
|
29
|
Puel V, Godard I, Papaioannou G, Gosse P, Pepin JL, Thoin F, Deharo JC, Roche F, Zarqane N, Gagnadoux F, Suehs CM, Molinari N. Management of sleep apnoea syndrome (SAS) in patients with vasovagal syncope (VVS): a protocol for the VVS-SAS cohort study. BMJ Open 2020; 10:e038791. [PMID: 32998925 PMCID: PMC7528365 DOI: 10.1136/bmjopen-2020-038791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Recurrent vasovagal syncope (VVS) is associated with decreased quality-of-life and frequent use of emergency services. The evidence base for causality, diagnostic procedures and potential VVS treatments is poor. Scattered observations in the literature suggest a link between respiratory disturbances during sleep and VVS. Empirical observations lead us to further hypothesise that the appropriate management of sleep apnoea syndrome (SAS) may help resolve comorbid recurrent VVS in certain patients. We therefore designed this pilot study to provide a framework for the observation of changes in outcomes accompanying the deployment of SAS treatments in patients with VVS. METHODS AND ANALYSIS This is a multicentre, registry-based study whose primary objective is to evaluate the effect of SAS management on the number of syncope/presyncope episodes in a population suffering from both VVS and SAS. To this effect, syncope rates prior to the treatment of SAS will be compared with those occurring after the initiation of the latter. In addition, yearly assessments will collect data for echocardiography, polysomnography, Holter monitoring, table tilt tests, multiple sleep latency tests, SAS management parameters and questionnaires describing fatigue, depression and quality-of-life. Sixty patients will be included with a minimum follow-up period of 12 months. The primary analysis will use comparisons of centrality for paired data to describe the changes in syncope rates before versus after the initiation of SAS management. Longitudinal data will be analysed using mixed models with patients set as a random effect. Subgroup analyses will be performed for SAS-treatment adherence and efficacy. ETHICS AND DISSEMINATION The VVS-SAS registry was approved by an ethics committee (Comité pour la Protection des Personnes Ile-de-France VI, Reference number CPP/2-18) in accordance with French law. The princeps publication will present before-after SAS management results and longitudinal analyses. TRIAL REGISTRATION NUMBER NCT04294524. Pre-results.
Collapse
Affiliation(s)
- Vincent Puel
- Pôle d'Exploration des Apnées du Sommeil (PEAS), Nouvelle Clinique Bel-Air, Bordeaux, France
| | - Isabelle Godard
- Pôle d'Exploration des Apnées du Sommeil (PEAS), Nouvelle Clinique Bel-Air, Bordeaux, France
| | - Georgios Papaioannou
- Department of Cardiology and Hypertension, Hôpital Saint-André, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Philippe Gosse
- Department of Cardiology and Hypertension, Hôpital Saint-André, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Jean Louis Pepin
- Department of Physiology, Sleep and Exercise, Univ Grenoble Alpes, CHU Grenoble, Grenoble, France
| | | | - Jean Claude Deharo
- Department of Cardiology, Hôpital de la Timone, C2VN, APHM, Marseille, France
| | - Frederic Roche
- Department of Clinical Physiology and Excercise, Hôpital Nord, Centre Hospitalier Universitaire St Etienne, St Etienne, France
| | - Naïma Zarqane
- Department of Cardiology, Princess Grace Hospital Centre, Monaco
| | - Frédéric Gagnadoux
- Department of Respiratory and Sleep Medicine, Centre Hospitalier Universitaire Angers, Angers, France
| | - Carey Meredith Suehs
- Departments of Respiratory Diseases and Medical Information, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Nicolas Molinari
- Department of Medical Information, IMAG, CNRS, Univ Montpellier, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| |
Collapse
|
30
|
Tauzin-Fin P, Barrucand K, Sesay M, Roullet S, Gosse P, Bernhard JC, Robert G, Sztark F. Peri-operative management of pheochromocytoma with intravenous urapidil to prevent hemodynamic instability: A 17-year experience. J Anaesthesiol Clin Pharmacol 2020; 36:49-54. [PMID: 32174657 PMCID: PMC7047675 DOI: 10.4103/joacp.joacp_71_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 12/25/2018] [Accepted: 04/09/2019] [Indexed: 11/04/2022] Open
Abstract
Background and Aims Surgery for pheochromocytoma (PCC) can cause excessive catecholamine release with severe hypertension. Alpha blockade is the mainstay of preoperative management. The aim of this study was to evaluate the efficacy and tolerance of intra-venous (IV) urapidil, a competitive short acting α1 receptor antagonist, in the prevention of peri-operative hemodynamic instability of patients with PCC. Material and Methods This retrospective observational study included 75 patients (79 PCC) for PCC removal surgery from 2001 to 2017 at the Bordeaux University Hospital. They received, 3 days before surgery, continuous intravenous infusion of urapidil with stepwise increase to the maximum tolerated dose. Urapidil was maintained during the procedure and stopped after clamping the adrenal vein. Plasma catecholamine concentrations were measured during surgery. Hypertensive peaks (SAP >160 mmHg) and tachycardia >100 beats/min were treated with boluses of nicardipine 2 mg and esmolol 0.5 mg/kg. Results We recorded 20/79 (25%) cases with systolic arterial pressure (SAP) >180 mmHg. Only 11/79 (14%) had hypotension with SAP <80 mmHg. Peaks of catecholamine secretions were observed preferentially during peritoneal insufflation and tumor dissection (P < 0.05). A correlation was found between tumor size (mm) and the highest norepinephrine levels [r = 0.288, P = 0.015], and between hypertensive peaks (mmHg) and the highest norepinephrine levels [r = 0.45, P = 0.017]. No mortality was reported. The median [range] postoperative hospital stay was 4 [2-9] days. Conclusion IV urapidil limits hypertensive and hypotensive peaks during PCC surgery, and corresponds to surgical imperatives allowing a short hospital stay, due to its "on-off" effect.
Collapse
Affiliation(s)
- Patrick Tauzin-Fin
- Department of Anesthesia and Critical Care, CHU Bordeaux, Hôpital Pellegrin, Place Amélie Raba-Léon, Cedex, France
| | - Kévin Barrucand
- Department of Anesthesia and Critical Care, CHU Bordeaux, Hôpital Pellegrin, Place Amélie Raba-Léon, Cedex, France
| | - Musa Sesay
- Department of Anesthesia and Critical Care, CHU Bordeaux, Hôpital Pellegrin, Place Amélie Raba-Léon, Cedex, France
| | - Stéphanie Roullet
- Department of Anesthesia and Critical Care, CHU Bordeaux, Hôpital Pellegrin, Place Amélie Raba-Léon, Cedex, France
| | - Philippe Gosse
- Department of Cardiology, CHU Bordeaux, Hôpital Pellegrin, Place Amélie Raba-Léon, Cedex, France
| | | | - Gregoire Robert
- Department of Urology, CHU Bordeaux, Hôpital Pellegrin, Place Amélie Raba-Léon, Cedex, France
| | - François Sztark
- Department of Anesthesia and Critical Care, CHU Bordeaux, Hôpital Pellegrin, Place Amélie Raba-Léon, Cedex, France
| |
Collapse
|
31
|
Laurent S, Chatellier G, Azizi M, Calvet D, Choukroun G, Danchin N, Delsart P, Gosse P, London G, Mourad JJ, Pannier B, Pereira H, Stephan D, Boutouyrie P, On Behalf of SPARTE Investigators. Protocol of the SPARTE Study: A Strategy for Preventing Cardiovascular and Renal Events based on ARTErial Stiffness. Artery Res 2020. [DOI: 10.2991/artres.k.200711.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|
32
|
Hamdidouche I, Gosse P, Cremer A, Lorthioir A, Delsart P, Courand PY, Denolle T, Halimi JM, Girerd X, Ormezzano O, Rossignol P, Pereira H, Azizi M, Amar L, Bobrie G, Monge M, Pagny JY, Sapoval M, Claisse G, Midulla M, Mounier-Vehier C, Dauphin R, Fauvel JP, Lantelme P, Rouvière O, Grenier N, Lebras Y, Trillaud H, Dourmap C, Heautot JF, Larralde A, Paillard F, Cluzel P, Rosenbaum D, Alison D, Popovic B, Zannad F, Baguet JP, Thony F, Bartoli JM, Vaïsse B, Drouineau J, Herpin D, Sosner P, Tasu JP, Velasco S, Ribstein J, Kovacsik H, Bouhanick B, Chamontin B, Rousseau H, Le Jeune S, Lopez-Sublet M, Mourad JJ, Bellmann L, Esnault V, Ferrari E, Chatellier G. Clinic Versus Ambulatory Blood Pressure in Resistant Hypertension: Impact of Antihypertensive Medication Nonadherence. Hypertension 2019; 74:1096-1103. [DOI: 10.1161/hypertensionaha.119.13520] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Clinic-ambulatory blood pressure (BP) difference is influenced by patients- and device-related factors and inadequate clinic-BP measurement. We investigated whether nonadherence to antihypertensive medications may also influence this difference in a post hoc analysis of the DENERHTN trial (Renal Denervation for Hypertension). We pooled the data of 77 out of 106 evaluable patients with apparent resistant hypertension who received a standardized antihypertensive treatment and had both ambulatory BP and drug-screening results available at baseline after 1 month of standardized triple therapy and at 6 months on a median of 5 antihypertensive drugs. After drug assay samplings on study visits, patients took their antihypertensive treatment under supervision immediately after the start of the ambulatory BP recording, and supine clinic BP was measured 24 hours post-dosing; both allowed to calculate the clinic minus daytime ambulatory systolic BP (SBP) difference (clinic-SBP–day-SBP). A total of 29 (37.7%) were found nonadherent to medications at baseline and 38 (49.4%) at 6 months. At baseline, the mean clinic-SBP–day-SBP difference in the nonadherent group was 12.7 mm Hg (95% CI, 7.8–17.7 mm Hg,
P
<0.001). In contrast, clinic SBP was almost identical to day-SBP in the adherent group (clinic-SBP–day-SBP difference, 0.1 mm Hg; 95% CI, −3.3 to 3.5 mm Hg;
P
=0.947). Similar observations were made at 6 months. Using receiver operating characteristics curves, we found that a 6 mm Hg cutoff of clinic-SBP–day-SBP difference had 67% sensitivity and 69% specificity to predict nonadherence to the triple therapy at baseline. In conclusion, a large clinic-SBP–day-SBP difference may help discriminating between adherence and nonadherence to treatment in patients with resistant hypertension.
Clinical Trial Registration—
URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT01570777.
Collapse
Affiliation(s)
- Idir Hamdidouche
- From the INSERM, Centre d’Investigations Cliniques- Plurithématique 1418, Paris, France (I.H., H.P., M.A.)
| | - Philippe Gosse
- ESH Hypertension excellence center, Hopital Saint André, University hospital of Bordeaux, France (P.G., A.C.)
| | | | - Aurelien Lorthioir
- AP-HP, Hypertension unit and DMU CARTE, Hôpital Européen Georges-Pompidou, Paris, France (A.L., H.P., M.A.)
| | - Pascal Delsart
- CHU Lille, Institut Cœur Poumon, Bd Pr Leclercq, France (P.D.)
| | - Pierre-Yves Courand
- Cardiology department, European Society of Hypertension Excellence Center, Hôpital de la Croix-Rousse et Hôpital Lyon Sud, Hospices Civils de Lyon, France (P.-Y.C.)
- Université de Lyon, CREATIS; CNRS UMR5220; INSERM U1044; INSA-Lyon; Université Claude Bernard Lyon 1, France (P.-Y.C.)
| | - Thierry Denolle
- Hĉpital Arthur Gardiner, Centre d’Excellence en HTA Rennes- Dinard, France (T.D.)
| | - Jean-Michel Halimi
- Service de nephrologie-immunologie clinique, Hopital universitaire de Tours, et EA4245 Université Francois Rabelais, France (J.-M.H.)
| | - Xavier Girerd
- Unité de Prévention Cardio Vasculaire, Groupe Hospitalier Universitaire Pitié-Salpêtrière–Institut IE3M, Paris, France (X.G)
| | - Olivier Ormezzano
- Department of Cardiology, University Hospital and INSERM U1039, Bioclinic Radiopharmaceutics Laboratory, Grenoble, France (O.O.)
| | - Patrick Rossignol
- Université de Lorraine, Inserm, Centre d’Investigations Cliniques- Plurithématique 14-33, and Inserm U1116, CHRU, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France (P.R.)
| | - Helena Pereira
- From the INSERM, Centre d’Investigations Cliniques- Plurithématique 1418, Paris, France (I.H., H.P., M.A.)
- AP-HP, Hypertension unit and DMU CARTE, Hôpital Européen Georges-Pompidou, Paris, France (A.L., H.P., M.A.)
- AP-HP Clinical and Epidemiological Unit, Hopital Europeen Georges Pompidou, Paris, France (H.P.)
| | - Michel Azizi
- From the INSERM, Centre d’Investigations Cliniques- Plurithématique 1418, Paris, France (I.H., H.P., M.A.)
- AP-HP, Hypertension unit and DMU CARTE, Hôpital Européen Georges-Pompidou, Paris, France (A.L., H.P., M.A.)
- Université de Paris, Paris, France (M.A.)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Boulestreau R, Cremer A, Lorthioir A, Rubin S, Tharaux PL, Persu A, Halimi JM, Gosse P. [Malignant hypertension: A bright future]. Presse Med 2019; 48:1439-1444. [PMID: 31471092 DOI: 10.1016/j.lpm.2019.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Received: 04/27/2019] [Accepted: 07/01/2019] [Indexed: 01/01/2023] Open
Abstract
Malignant hypertension has not disappeared, it has been forgotten. Its incidence is increasing again. It considerably worsens the prognosis of young patients (35 to 55 years old on average). There might be susceptibility factors, several hypotheses are under study. New diagnostic criteria and therapeutic options have been proposed and will have to be validated. Faced with these important challenges for patients, the first prospective multicentric register on this pathology will be set up in France in September 2019.
Collapse
Affiliation(s)
| | - Antoine Cremer
- CHU de Bordeaux, hôpital Saint-André, 1, rue Jean-Burguet, 33000 Bordeaux, France.
| | - Aurélien Lorthioir
- Hôpital européen Georges-Pompidou, unité d'hypertension artérielle, 75015 Paris, France.
| | - Sebastien Rubin
- CHU de Bordeaux, hôpital Pellegrin, service de néphrologie, place Amélie-Raba-Léon, 33076 Bordeaux, France.
| | - Pierre Louis Tharaux
- Hôpital européen Georges-Pompidou, service de néphrologie, équipe Inserm, 75015 Paris, France.
| | | | | | - Philippe Gosse
- CHU de Bordeaux, hôpital Saint-André, 1, rue Jean-Burguet, 33000 Bordeaux, France.
| |
Collapse
|
34
|
Puel V, Théophile H, Godard I, Raymond N, Miremont-Salamé G, Gosse P, Pépin JL, Pariente A. Ticagrelor and central sleep apnoea: Impact of withdrawal and reintroduction. Br J Clin Pharmacol 2019; 85:1855-1858. [PMID: 31206207 DOI: 10.1111/bcp.13967] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 03/08/2019] [Accepted: 04/06/2019] [Indexed: 11/27/2022] Open
Affiliation(s)
- Vincent Puel
- PEAS, Nouvelle Clinique Bel-Air, Bordeaux, France
| | - Hélène Théophile
- Département de Pharmacologie Médicale, Centre Régional de Pharmacovigilance, CHU Bordeaux, Bordeaux, France
| | | | | | - Ghada Miremont-Salamé
- Département de Pharmacologie Médicale, Centre Régional de Pharmacovigilance, CHU Bordeaux, Bordeaux, France.,INSERM, Bordeaux Population Health Research Center, team Pharmacoepidemiology, UMR 1219, Université de Bordeaux, Bordeaux, France
| | - Philippe Gosse
- Cardiology/Hypertension Department, University Hospital of Bordeaux, Bordeaux, France
| | - Jean-Louis Pépin
- Institut National de la Santé et de la Recherche Médicale (INSERM), U 1042, HP2 Laboratory (Hypoxia: Pathophysiology), University Grenoble Alpes, Grenoble, France
| | - Antoine Pariente
- Département de Pharmacologie Médicale, Centre Régional de Pharmacovigilance, CHU Bordeaux, Bordeaux, France.,INSERM, Bordeaux Population Health Research Center, team Pharmacoepidemiology, UMR 1219, Université de Bordeaux, Bordeaux, France
| |
Collapse
|
35
|
Azizi M, Schmieder RE, Mahfoud F, Weber MA, Daemen J, Lobo MD, Sharp AS, Bloch MJ, Basile J, Wang Y, Saxena M, Lurz P, Rader F, Sayer J, Fisher ND, Fouassier D, Barman NC, Reeve-Stoffer H, McClure C, Kirtane AJ, Jay D, Skeik N, Schwartz R, Dohad S, Victor R, Sanghvi K, Costello J, Walsh C, Abraham J, Owan T, Abraham A, Mauri L, Sobieszczky P, Williams J, Roongsritong C, Todoran T, Powers E, Hodskins E, Fong P, Laffer C, Gainer J, Robbins M, Reilly J, Cash M, Goldman J, Aggarwal S, Ledley G, His D, Martin S, Portnay E, Calhoun D, McElderry T, Maddox W, Oparil S, Huang PH, Jose P, Khuddus M, Zentko S, O’Meara J, Barb I, Garasic J, Drachman D, Zusman R, Rosenfield K, Devireddy C, Lea J, Wells B, Stouffer R, Hinderliter A, Pauley E, Potluri S, Biedermann S, Bangalore S, Williams S, Zidar D, Shishehbor M, Effron B, Costa M, Radhakrishnan J, Mathur A, Jain A, Iyer SG, Robinson N, Edroos SA, Levy T, Patel A, Beckett D, Bent C, Davies J, Chapman N, Shin MS, Howard J, Joseph A, D’Souza R, Gerber R, Faris M, Marshall AJ, Elorz C, Höllriegel R, Fengler K, Rommel KP, Böhm M, Ewen S, Lucic J, Ott C, Schmid A, Uder M, Rump C, Stegbauer J, Kröpil P, Sapoval M, Cornu E, Lorthioir A, Gosse P, Cremer A, Trillaud H, Papadopoulos P, Pathak A, Honton B, Lantelme P, Berge C, Courand PY, Feyz L, Blankestijn P, Voskuil M, Rittersma Z, Kroon A, van Zwam W, Persu A, Renkin J. Six-Month Results of Treatment-Blinded Medication Titration for Hypertension Control After Randomization to Endovascular Ultrasound Renal Denervation or a Sham Procedure in the RADIANCE-HTN SOLO Trial. Circulation 2019; 139:2542-2553. [PMID: 30880441 DOI: 10.1161/circulationaha.119.040451] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The multicenter, international, randomized, blinded, sham-controlled RADIANCE-HTN SOLO trial (A Study of the ReCor Medical Paradise System in Clinical Hypertension) demonstrated a 6.3 mm Hg greater reduction in daytime ambulatory systolic blood pressure (BP) at 2 months by endovascular ultrasound renal denervation (RDN) compared with a sham procedure among patients not treated with antihypertensive medications. We report 6-month results after the addition of a recommended standardized stepped-care antihypertensive treatment to the randomized endovascular procedure under continued blinding to initial treatment. METHODS Patients with a daytime ambulatory BP ≥135/85 mm Hg and <170/105 mm Hg after a 4-week discontinuation of up to 2 antihypertensive medications, and a suitable renal artery anatomy, were randomized to RDN (n=74) or sham (n=72). Patients were to remain off antihypertensive medications throughout the first 2 months of follow-up unless safety BP criteria were exceeded. Between 2 and 5 months, if monthly measured home BP was ≥135/85 mm Hg, a standardized stepped-care antihypertensive treatment was recommended consisting of the sequential addition of amlodipine (5 mg/d), a standard dose of an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, and hydrochlorothiazide (12.5 mg/d), followed by the sequential uptitration of hydrochlorothiazide (25 mg/d) and amlodipine (10 mg/d). Outcomes included the 6-month (1) change in daytime ambulatory systolic BP adjusted for medications and baseline systolic BP, (2) medication burden, and (3) safety. RESULTS A total of 69/74 RDN patients and 71/72 sham patients completed the 6-month ambulatory BP measurement. At 6 months, 65.2% of patients in the RDN group were treated with the standardized stepped-care antihypertensive treatment versus 84.5% in the sham group (P=0.008), and the average number of antihypertensive medications and defined daily dose were less in the RDN group than in the sham group (0.9±0.9 versus 1.3±0.9, P=0.010 and 1.4±1.5 versus 2.0±1.8, P=0.018; respectively). Despite less intensive standardized stepped-care antihypertensive treatment, RDN reduced daytime ambulatory systolic BP to a greater extent than sham (-18.1±12.2 versus -15.6±13.2 mm Hg, respectively; difference adjusted for baseline BP and number of medications: -4.3 mm Hg, 95% confidence interval, -7.9 to -0.6, P=0.024). There were no major adverse events in either group through 6 months. CONCLUSIONS The BP-lowering effect of endovascular ultrasound RDN was maintained at 6 months with less prescribed antihypertensive medications compared with a sham control. CLINICAL TRIAL REGISTRATION URL: https://www. CLINICALTRIALS gov. Unique identifier: NCT02649426.
Collapse
Affiliation(s)
- Michel Azizi
- Université Paris-Descartes, France (M.A., D.F.)
- AP-HP, Department of Hypertension, Hôpital Européen Georges-Pompidou, Paris, France (M.A., D.F.)
- INSERM, CIC1418, Paris, France (M.A., D.F.)
| | - Roland E. Schmieder
- Nephrology and Hypertension, University Hospital Erlangen, Friedrich Alexander University, Germany (R.E.S.)
| | - Felix Mahfoud
- Klinik für Innere Medizin III, Saarland University Hospital, Homburg/Saar, Germany (F.M.)
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge (F.M.)
| | - Michael A. Weber
- Division of Cardiovascular Medicine, State University of New York, Downstate Medical Center, New York (M.A.W.)
| | - Joost Daemen
- Erasmus MC, University Medical Center Rotterdam, Department of Cardiology, Rotterdam, The Netherlands (J.D.)
| | - Melvin D. Lobo
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, United Kingdom (M.D.L., M.S.)
| | - Andrew S.P. Sharp
- Royal Devon and Exeter NHS Foundation Trust, United Kingdom (A.S.P.S.)
| | - Michael J. Bloch
- Department of Medicine, University of Nevada School of Medicine, Vascular Care, Renown Institute of Heart and Vascular Health, Reno, NV (M.J.B.)
| | - Jan Basile
- Seinsheimer Cardiovascular Health Program, Medical University of South Carolina, Ralph H Johnson VA Medical Center, Charleston (J.B.)
| | - Yale Wang
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis (Y.W.)
| | - Manish Saxena
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, United Kingdom (M.D.L., M.S.)
| | - Philipp Lurz
- Heart Center Leipzig, University of Leipzig, Germany (P.L.)
| | - Florian Rader
- Cedars-Sinai Heart Institute, Los Angeles, CA (F.R.)
| | - Jeremy Sayer
- The Essex Cardiothoracic Centre, United Kingdom (J.S.)
| | | | - David Fouassier
- Université Paris-Descartes, France (M.A., D.F.)
- AP-HP, Department of Hypertension, Hôpital Européen Georges-Pompidou, Paris, France (M.A., D.F.)
- INSERM, CIC1418, Paris, France (M.A., D.F.)
| | | | | | | | - Ajay J. Kirtane
- Columbia University Medical Center/New York-Presbyterian Hospital and the Cardiovascular Research Foundation, NY (A.J.K.)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Boulestreau R, Cremer A, Delarche N, Gosse P. [Alteration of left ventricular longitudinal systolic function in 2D-strain in primary aldosteronism: A new target organ damage marker]. Ann Cardiol Angeiol (Paris) 2018; 67:315-320. [PMID: 30327134 DOI: 10.1016/j.ancard.2018.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 08/23/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Primary hyperaldosteronism is the leading cause of secondary hypertension, and leads to frequent cardiovascular complications. Many studies have studied left ventricular geometry and function in this population, but longitudinal systolic function is still poorly described. METHODS We studied 35 hypertensive patients with primary aldosteronism, and 35 with essential hypertension matched for age, sex, body mass index, and 24h blood pressure. Patients benefited from an echocardiography to measure the mass and the geometry of the left ventricle, left ventricle ejection fraction, systolic longitudinal, circumferential, and radial strain, and diastolic function. RESULTS Compared to essential hypertensive patients, patients with primary aldosteronism presented a significantly higher left ventricular mass index and relative wall thickness (60.3±16.1g/m2 vs 47.3±18.6, P=0.003, and 0.44±0.08 vs 0.36±0.06, P=0.00005, respectively), as well as a significantly reduced longitudinal systolic strain (-17.8±3,4 vs -20.3±3,6%, P=0.004). There were no significant differences in the other parameters. CONCLUSIONS Primary aldosteronism is associated with a deterioration of longitudinal systolic function of the left ventricle compared with essential hypertensive patients. This marker of cardiac damage, reproducible and easily available in routine could help for the screening of these patients.
Collapse
Affiliation(s)
- R Boulestreau
- Service de cardiologie, centre hospitalier de Pau, 4, boulevard Hauterive, 64000 Pau, France.
| | - A Cremer
- Centre d'excellence en hypertension artérielle, hôpital St-André, CHU de Bordeaux, 1, rue Jean-Burguet, 33000 Bordeaux, France
| | - N Delarche
- Service de cardiologie, centre hospitalier de Pau, 4, boulevard Hauterive, 64000 Pau, France
| | - P Gosse
- Centre d'excellence en hypertension artérielle, hôpital St-André, CHU de Bordeaux, 1, rue Jean-Burguet, 33000 Bordeaux, France
| |
Collapse
|
37
|
Kuntz S, Boulestreau R, Rubin S, Cremer A, Gosse P. [Arterial hypertension with multiple organ damage: A new entity?]. Presse Med 2018; 47:811-816. [PMID: 30293851 DOI: 10.1016/j.lpm.2018.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 06/08/2018] [Revised: 09/07/2018] [Accepted: 09/07/2018] [Indexed: 11/26/2022] Open
Abstract
Hypertensive emergency. Stable incidence for several decades or even increasing (under diagnosed). Early and specific management improves prognosis. Absence of eye damage or lack of access to fundus should not delay or prevent the diagnosis. Multi Organ Damage Hypertension: new definition for an old entity: unusual, sudden and persistent blood pressure rise without threshold and ocular involvement or involvement of at least 3 target organs among brain, heart, kidney or endothelial disease.
Collapse
Affiliation(s)
- Sophie Kuntz
- CHU de Bordeaux, hôpital Saint-André, 1, rue Jean-Burguet, 33000 Bordeaux, France.
| | | | - Sébastien Rubin
- CHU de Bordeaux, hôpital Pellegrin, service de néphrologie, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - Antoine Cremer
- CHU de Bordeaux, hôpital Saint-André, 1, rue Jean-Burguet, 33000 Bordeaux, France
| | - Philippe Gosse
- CHU de Bordeaux, hôpital Saint-André, 1, rue Jean-Burguet, 33000 Bordeaux, France
| |
Collapse
|
38
|
Bouhanick B, Amar J, Amar L, Gosse P, Girerd X, Reznik Y, Mounier-Vehier C, Baguet JP, Boutouyrie P, Lepage B, Lantelme P, Chamontin B. Arterial stiffness evaluated by pulse wave velocity is not predictive of the improvement in hypertension after adrenal surgery for primary aldosteronism: A multicentre study from the French European Society of Hypertension Excellence Centres. Arch Cardiovasc Dis 2018; 111:564-572. [DOI: 10.1016/j.acvd.2018.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 01/15/2018] [Accepted: 01/17/2018] [Indexed: 10/17/2022]
|
39
|
van den Born BJH, Lip GYH, Brguljan-Hitij J, Cremer A, Segura J, Morales E, Mahfoud F, Amraoui F, Persu A, Kahan T, Agabiti Rosei E, de Simone G, Gosse P, Williams B. ESC Council on hypertension position document on the management of hypertensive emergencies. European Heart Journal - Cardiovascular Pharmacotherapy 2018; 5:37-46. [DOI: 10.1093/ehjcvp/pvy032] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 08/16/2018] [Indexed: 12/31/2022]
Abstract
Abstract
Hypertensive emergencies are those situations where very high blood pressure (BP) values are associated with acute organ damage, and therefore, require immediate, but careful, BP reduction. The type of acute organ damage is the principal determinant of: (i) the drug of choice, (ii) the target BP, and (iii) the timeframe in which BP should be lowered. Key target organs are the heart, retina, brain, kidneys, and large arteries. Patients who lack acute hypertension-mediated end organ damage do not have a hypertensive emergency and can usually be treated with oral BP-lowering agents and usually discharged after a brief period of observation.
Collapse
Affiliation(s)
- Bert-Jan H van den Born
- Department of Internal Medicine, Division of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Gregory Y H Lip
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
| | - Jana Brguljan-Hitij
- Hypertension Division, University Medical Centre Ljubljana, Department of Internal Medicine, Dr. Peter Držaj Hospital, Ljubljana, Slovenia
| | - Antoine Cremer
- Hypertension Unit, Department of Cardiology, Hopital Saint André and University Hospital of Bordeaux, Bordeaux, France
| | - Julian Segura
- Hypertension Unit, Department of Nephrology, Hospital 12 de Octubre, Madrid, Spain
| | - Enrique Morales
- Hypertension Unit, Department of Nephrology, Hospital 12 de Octubre, Madrid, Spain
| | - Felix Mahfoud
- Department for Internal Medicine III, Cardiology, Angiology, and Intensive Care Medicine, Saarland University, Homburg/Saar, Germany
| | - Fouad Amraoui
- Department of Internal Medicine, Division of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Alexandre Persu
- Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, and Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Thomas Kahan
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Cardiovascular Medicine, Stockholm, Sweden
| | - Enrico Agabiti Rosei
- Clinica Medica Generale, Department of Clinical and Experimental Sciences, University of Brescia, and Department of Medicine, Azienda Spedali Civili di Brescia, Brescia, Italy
| | - Giovanni de Simone
- Hypertension Research Center, Department of Translational Medical Sciences, Federico II University Hospital, Naples, Italy
| | - Philippe Gosse
- Hypertension Unit, Department of Cardiology, Hopital Saint André and University Hospital of Bordeaux, Bordeaux, France
| | - Bryan Williams
- University College London (UCL) and UCL Hospitals, London, UK
| |
Collapse
|
40
|
Cremer A, Boulestreau R, Gaillard P, Lainé M, Papaioannou G, Gosse P. Twenty-Four-Hour Central Pulse Pressure for Cardiovascular Events Prediction in a Low-Cardiovascular-Risk Population: Results From the Bordeaux Cohort. J Am Heart Assoc 2018; 7:JAHA.117.008225. [PMID: 29475873 PMCID: PMC5866337 DOI: 10.1161/jaha.117.008225] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Central blood pressure (BP) is a promising marker to identify subjects with higher cardiovascular risk than expected by traditional risk factors. Significant results have been obtained in populations with high cardiovascular risk, but little is known about low‐cardiovascular‐risk patients, although the differences between central and peripheral BP (amplification) are usually greater in this population. The study aim was to evaluate central BP over 24 hours for cardiovascular event prediction in hypertensive subjects with low cardiovascular risk. Methods and Results Peripheral and central BPs were recorded during clinical visits and over 24 hours in hypertensive patients with low cardiovascular risk (Systematic Coronary Risk Evaluation ≤5%). Our primary end point is the occurrence of a cardiovascular event during follow‐up. To assess the potential interest in central pulse pressure over 24 hours, we performed Cox proportional hazard models analysis and comparison of area under the curves using the contrast test for peripheral and central BP. A cohort of 703 hypertensive subjects from Bordeaux were included. After the first 24 hours of BP measurement, the subjects were then followed up for an average of 112.5±70 months. We recorded 65 cardiovascular events during follow‐up. Amplification was found to be significantly associated with cardiovascular events when added to peripheral 24‐hour pulse pressure (P=0.0259). The area under the curve of 24‐hour central pulse pressure is significantly more important than area under the curve of office BP (P=0.0296), and there is a trend of superiority with the area under the curve of peripheral 24‐hour pulse pressure. Conclusions Central pulse pressure over 24 hours improves the prediction of cardiovascular events for hypertensive patients with low cardiovascular risk compared to peripheral pulse pressure.
Collapse
Affiliation(s)
- Antoine Cremer
- Department of Cardiology and Hypertension, Bordeaux University Hospital, Bordeaux, France
- University of Bordeaux, INSERM, Bordeaux Population Health Research Center, Bordeaux, France
- CHU de Bordeaux, Pole de Sante Publique, Service d'Information Medicale, Bordeaux, France
| | - Romain Boulestreau
- Department of Cardiology and Hypertension, Bordeaux University Hospital, Bordeaux, France
| | - Prune Gaillard
- Department of Cardiology and Hypertension, Bordeaux University Hospital, Bordeaux, France
| | - Marion Lainé
- Department of Cardiology and Hypertension, Bordeaux University Hospital, Bordeaux, France
| | - Georgios Papaioannou
- Department of Cardiology and Hypertension, Bordeaux University Hospital, Bordeaux, France
| | - Philippe Gosse
- Department of Cardiology and Hypertension, Bordeaux University Hospital, Bordeaux, France
| |
Collapse
|
41
|
Courand PY, Pereira H, Del Giudice C, Gosse P, Monge M, Bobrie G, Delsart P, Mounier-Vehier C, Lantelme P, Denolle T, Dourmap C, Halimi JM, Girerd X, Rossignol P, Zannad F, Ormezzano O, Vaisse B, Herpin D, Ribstein J, Bouhanick B, Mourad JJ, Ferrari E, Chatellier G, Sapoval M, Azarine A, Azizi M. Abdominal Aortic Calcifications Influences the Systemic and Renal Hemodynamic Response to Renal Denervation in the DENERHTN (Renal Denervation for Hypertension) Trial. J Am Heart Assoc 2017; 6:JAHA.117.007062. [PMID: 29018027 PMCID: PMC5721886 DOI: 10.1161/jaha.117.007062] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background The DENERHTN (Renal Denervation for Hypertension) trial confirmed the efficacy of renal denervation (RDN) in lowering daytime ambulatory systolic blood pressure when added to standardized stepped‐care antihypertensive treatment (SSAHT) for resistant hypertension at 6 months. Methods and Results This post hoc exploratory analysis assessed the impact of abdominal aortic calcifications (AAC) on the hemodynamic and renal response to RDN at 6 months. In total, 106 patients with resistant hypertension were randomly assigned to RDN plus SSAHT or to the same SSAHT alone (control group). Total AAC volume was measured, with semiautomatic software and blind to randomization, from the aortic hiatus to the iliac bifurcation using the prerandomization noncontrast abdominal computed tomography scans of 90 patients. Measurements were expressed as tertiles. The baseline‐adjusted difference in the change in daytime ambulatory systolic blood pressure from baseline to 6 months between the RDN and control groups was −10.1 mm Hg (P=0.0462) in the lowest tertile and −2.5 mm Hg (P=0.4987) in the 2 highest tertiles of AAC volume. Estimated glomerular filtration rate remained stable at 6 months for the patients in the lowest tertile of AAC volume who underwent RDN (+2.5 mL/min per 1.73 m2) but decreased in the control group (−8.0 mL/min per 1.73 m2, P=0.0148). In the 2 highest tertiles of AAC volume, estimated glomerular filtration rate decreased similarly in the RDN and control groups (P=0.2640). Conclusions RDN plus SSAHT resulted in a larger decrease in daytime ambulatory systolic blood pressure than SSAHT alone in patients with a lower AAC burden than in those with a higher AAC burden. This larger decrease in daytime ambulatory systolic blood pressure was not associated with a decrease in estimated glomerular filtration rate. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT01570777.
Collapse
Affiliation(s)
- Pierre-Yves Courand
- Hôpital Croix-Rousse, Cardiology Department, European Society of Hypertension Excellence Centre, Hospices Civils de Lyon, France.,CREATIS UMR5220 INSERM U1044 INSA-Lyon Université de Lyon Université Claude Bernard Lyon 1, Lyon, France
| | - Helena Pereira
- Clinical Research Unit, Assistance Publique-Hôpitaux de Paris Hôpital Européen Georges Pompidou, Paris, France.,INSERM CIC1418 Assistance Publique-Hôpitaux de Paris Hôpital Européen Georges Pompidou, Paris, France
| | - Costantino Del Giudice
- 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
| | | | - Guillaume Bobrie
- Hypertension Unit, Assistance Publique-Hôpitaux de Paris Hôpital Européen Georges Pompidou, Paris, France
| | - Pascal Delsart
- Hôpital Cardiologique, Médecine Vasculaire et HTA, Centre Hospitalier Régional Universitaire de Lille, France
| | - Claire Mounier-Vehier
- Hôpital Cardiologique, Médecine Vasculaire et HTA, Centre Hospitalier Régional Universitaire de Lille, France
| | - Pierre Lantelme
- Hôpital Croix-Rousse, Cardiology Department, European Society of Hypertension Excellence Centre, Hospices Civils de Lyon, France.,CREATIS UMR5220 INSERM U1044 INSA-Lyon Université de Lyon Université Claude Bernard Lyon 1, Lyon, France
| | - Thierry Denolle
- Hôpital Arthur Gardiner, Centre d'excellence en HTA Rennes-Dinard, Dinard, France.,Service de Cardiologie et Maladies Vasculaires, Centre Hospitalier Universitaire de Rennes, France
| | - Caroline Dourmap
- Hôpital Arthur Gardiner, Centre d'excellence en HTA Rennes-Dinard, Dinard, France.,Service de Cardiologie et Maladies Vasculaires, Centre Hospitalier Universitaire de Rennes, France
| | | | | | - Patrick Rossignol
- Inserm Centre d'Investigations Cliniques-1433 Inserm U1116 CHRU Nancy F-CRIN INI-CRCT Université de Lorraine, Nancy, France
| | - Faiez Zannad
- Inserm Centre d'Investigations Cliniques-1433 Inserm U1116 CHRU Nancy F-CRIN INI-CRCT Université de Lorraine, Nancy, France
| | | | | | - Daniel Herpin
- Cardiology Department, CHU de Poitiers, Poitiers, France
| | - Jean Ribstein
- Hôpital Lapeyronie, Montpellier, France.,Hôpital Arnaud de Villeneuve, Montpellier, France
| | | | | | | | - Gilles Chatellier
- Clinical Research Unit, Assistance Publique-Hôpitaux de Paris Hôpital Européen Georges Pompidou, Paris, France.,INSERM CIC1418 Assistance Publique-Hôpitaux de Paris Hôpital Européen Georges Pompidou, Paris, France
| | - Marc Sapoval
- Vascular and Oncological Interventional Radiology Department, Assistance Publique-Hôpitaux de Paris Hôpital Européen Georges Pompidou, Paris, France.,Paris-Descartes University, Paris, France
| | - Arshid Azarine
- Vascular and Oncological Interventional Radiology Department, Assistance Publique-Hôpitaux de Paris Hôpital Européen Georges Pompidou, Paris, France
| | - Michel Azizi
- INSERM CIC1418 Assistance Publique-Hôpitaux de Paris Hôpital Européen Georges Pompidou, Paris, France .,Hypertension Unit, Assistance Publique-Hôpitaux de Paris Hôpital Européen Georges Pompidou, Paris, France.,Paris-Descartes University, Paris, France
| | | |
Collapse
|
42
|
Plouin PF, Baguet JP, Thony F, Ormezzano O, Azarine A, Silhol F, Oppenheim C, Bouhanick B, Boyer L, Persu A, Hammer F, Gosse P, Mounier-Vehier C, Le Hello C, Jeunemaitre X, Azizi M, Amar L, Chatellier G, Mousseaux E, Touzé; E. High Prevalence of Multiple Arterial Bed Lesions in Patients With Fibromuscular Dysplasia. Hypertension 2017; 70:652-658. [DOI: 10.1161/hypertensionaha.117.09539] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 04/23/2017] [Accepted: 05/12/2017] [Indexed: 12/16/2022]
Affiliation(s)
- Pierre-François Plouin
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit (P.-F.P., M.A., L.A.); Department of Radiology (A.A., E.M.), Department of Genetics (X.J.), and Department of Clinical Epidemiology (G.C.); INSERM CIC1418, Paris (M.A., G.C.); Department of Neurology (C.O.) and INSERM U894, Hôpital Sainte-Anne (C.O.), Paris; Faculté de Médecine, Université Paris-Descartes (P.-F.P., M.A., L.A., A.A., E.M., X.J., G.C., C.O.); Department of Cardiology, CHU de Grenoble (J.-P.B.,
| | - Jean-Philippe Baguet
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit (P.-F.P., M.A., L.A.); Department of Radiology (A.A., E.M.), Department of Genetics (X.J.), and Department of Clinical Epidemiology (G.C.); INSERM CIC1418, Paris (M.A., G.C.); Department of Neurology (C.O.) and INSERM U894, Hôpital Sainte-Anne (C.O.), Paris; Faculté de Médecine, Université Paris-Descartes (P.-F.P., M.A., L.A., A.A., E.M., X.J., G.C., C.O.); Department of Cardiology, CHU de Grenoble (J.-P.B.,
| | - Frédéric Thony
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit (P.-F.P., M.A., L.A.); Department of Radiology (A.A., E.M.), Department of Genetics (X.J.), and Department of Clinical Epidemiology (G.C.); INSERM CIC1418, Paris (M.A., G.C.); Department of Neurology (C.O.) and INSERM U894, Hôpital Sainte-Anne (C.O.), Paris; Faculté de Médecine, Université Paris-Descartes (P.-F.P., M.A., L.A., A.A., E.M., X.J., G.C., C.O.); Department of Cardiology, CHU de Grenoble (J.-P.B.,
| | - Olivier Ormezzano
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit (P.-F.P., M.A., L.A.); Department of Radiology (A.A., E.M.), Department of Genetics (X.J.), and Department of Clinical Epidemiology (G.C.); INSERM CIC1418, Paris (M.A., G.C.); Department of Neurology (C.O.) and INSERM U894, Hôpital Sainte-Anne (C.O.), Paris; Faculté de Médecine, Université Paris-Descartes (P.-F.P., M.A., L.A., A.A., E.M., X.J., G.C., C.O.); Department of Cardiology, CHU de Grenoble (J.-P.B.,
| | - Arshid Azarine
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit (P.-F.P., M.A., L.A.); Department of Radiology (A.A., E.M.), Department of Genetics (X.J.), and Department of Clinical Epidemiology (G.C.); INSERM CIC1418, Paris (M.A., G.C.); Department of Neurology (C.O.) and INSERM U894, Hôpital Sainte-Anne (C.O.), Paris; Faculté de Médecine, Université Paris-Descartes (P.-F.P., M.A., L.A., A.A., E.M., X.J., G.C., C.O.); Department of Cardiology, CHU de Grenoble (J.-P.B.,
| | - François Silhol
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit (P.-F.P., M.A., L.A.); Department of Radiology (A.A., E.M.), Department of Genetics (X.J.), and Department of Clinical Epidemiology (G.C.); INSERM CIC1418, Paris (M.A., G.C.); Department of Neurology (C.O.) and INSERM U894, Hôpital Sainte-Anne (C.O.), Paris; Faculté de Médecine, Université Paris-Descartes (P.-F.P., M.A., L.A., A.A., E.M., X.J., G.C., C.O.); Department of Cardiology, CHU de Grenoble (J.-P.B.,
| | - Catherine Oppenheim
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit (P.-F.P., M.A., L.A.); Department of Radiology (A.A., E.M.), Department of Genetics (X.J.), and Department of Clinical Epidemiology (G.C.); INSERM CIC1418, Paris (M.A., G.C.); Department of Neurology (C.O.) and INSERM U894, Hôpital Sainte-Anne (C.O.), Paris; Faculté de Médecine, Université Paris-Descartes (P.-F.P., M.A., L.A., A.A., E.M., X.J., G.C., C.O.); Department of Cardiology, CHU de Grenoble (J.-P.B.,
| | - Béatrice Bouhanick
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit (P.-F.P., M.A., L.A.); Department of Radiology (A.A., E.M.), Department of Genetics (X.J.), and Department of Clinical Epidemiology (G.C.); INSERM CIC1418, Paris (M.A., G.C.); Department of Neurology (C.O.) and INSERM U894, Hôpital Sainte-Anne (C.O.), Paris; Faculté de Médecine, Université Paris-Descartes (P.-F.P., M.A., L.A., A.A., E.M., X.J., G.C., C.O.); Department of Cardiology, CHU de Grenoble (J.-P.B.,
| | - Louis Boyer
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit (P.-F.P., M.A., L.A.); Department of Radiology (A.A., E.M.), Department of Genetics (X.J.), and Department of Clinical Epidemiology (G.C.); INSERM CIC1418, Paris (M.A., G.C.); Department of Neurology (C.O.) and INSERM U894, Hôpital Sainte-Anne (C.O.), Paris; Faculté de Médecine, Université Paris-Descartes (P.-F.P., M.A., L.A., A.A., E.M., X.J., G.C., C.O.); Department of Cardiology, CHU de Grenoble (J.-P.B.,
| | - Alexandre Persu
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit (P.-F.P., M.A., L.A.); Department of Radiology (A.A., E.M.), Department of Genetics (X.J.), and Department of Clinical Epidemiology (G.C.); INSERM CIC1418, Paris (M.A., G.C.); Department of Neurology (C.O.) and INSERM U894, Hôpital Sainte-Anne (C.O.), Paris; Faculté de Médecine, Université Paris-Descartes (P.-F.P., M.A., L.A., A.A., E.M., X.J., G.C., C.O.); Department of Cardiology, CHU de Grenoble (J.-P.B.,
| | - Frank Hammer
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit (P.-F.P., M.A., L.A.); Department of Radiology (A.A., E.M.), Department of Genetics (X.J.), and Department of Clinical Epidemiology (G.C.); INSERM CIC1418, Paris (M.A., G.C.); Department of Neurology (C.O.) and INSERM U894, Hôpital Sainte-Anne (C.O.), Paris; Faculté de Médecine, Université Paris-Descartes (P.-F.P., M.A., L.A., A.A., E.M., X.J., G.C., C.O.); Department of Cardiology, CHU de Grenoble (J.-P.B.,
| | - Philippe Gosse
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit (P.-F.P., M.A., L.A.); Department of Radiology (A.A., E.M.), Department of Genetics (X.J.), and Department of Clinical Epidemiology (G.C.); INSERM CIC1418, Paris (M.A., G.C.); Department of Neurology (C.O.) and INSERM U894, Hôpital Sainte-Anne (C.O.), Paris; Faculté de Médecine, Université Paris-Descartes (P.-F.P., M.A., L.A., A.A., E.M., X.J., G.C., C.O.); Department of Cardiology, CHU de Grenoble (J.-P.B.,
| | - Claire Mounier-Vehier
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit (P.-F.P., M.A., L.A.); Department of Radiology (A.A., E.M.), Department of Genetics (X.J.), and Department of Clinical Epidemiology (G.C.); INSERM CIC1418, Paris (M.A., G.C.); Department of Neurology (C.O.) and INSERM U894, Hôpital Sainte-Anne (C.O.), Paris; Faculté de Médecine, Université Paris-Descartes (P.-F.P., M.A., L.A., A.A., E.M., X.J., G.C., C.O.); Department of Cardiology, CHU de Grenoble (J.-P.B.,
| | - Claire Le Hello
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit (P.-F.P., M.A., L.A.); Department of Radiology (A.A., E.M.), Department of Genetics (X.J.), and Department of Clinical Epidemiology (G.C.); INSERM CIC1418, Paris (M.A., G.C.); Department of Neurology (C.O.) and INSERM U894, Hôpital Sainte-Anne (C.O.), Paris; Faculté de Médecine, Université Paris-Descartes (P.-F.P., M.A., L.A., A.A., E.M., X.J., G.C., C.O.); Department of Cardiology, CHU de Grenoble (J.-P.B.,
| | - Xavier Jeunemaitre
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit (P.-F.P., M.A., L.A.); Department of Radiology (A.A., E.M.), Department of Genetics (X.J.), and Department of Clinical Epidemiology (G.C.); INSERM CIC1418, Paris (M.A., G.C.); Department of Neurology (C.O.) and INSERM U894, Hôpital Sainte-Anne (C.O.), Paris; Faculté de Médecine, Université Paris-Descartes (P.-F.P., M.A., L.A., A.A., E.M., X.J., G.C., C.O.); Department of Cardiology, CHU de Grenoble (J.-P.B.,
| | - Michel Azizi
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit (P.-F.P., M.A., L.A.); Department of Radiology (A.A., E.M.), Department of Genetics (X.J.), and Department of Clinical Epidemiology (G.C.); INSERM CIC1418, Paris (M.A., G.C.); Department of Neurology (C.O.) and INSERM U894, Hôpital Sainte-Anne (C.O.), Paris; Faculté de Médecine, Université Paris-Descartes (P.-F.P., M.A., L.A., A.A., E.M., X.J., G.C., C.O.); Department of Cardiology, CHU de Grenoble (J.-P.B.,
| | - Laurence Amar
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit (P.-F.P., M.A., L.A.); Department of Radiology (A.A., E.M.), Department of Genetics (X.J.), and Department of Clinical Epidemiology (G.C.); INSERM CIC1418, Paris (M.A., G.C.); Department of Neurology (C.O.) and INSERM U894, Hôpital Sainte-Anne (C.O.), Paris; Faculté de Médecine, Université Paris-Descartes (P.-F.P., M.A., L.A., A.A., E.M., X.J., G.C., C.O.); Department of Cardiology, CHU de Grenoble (J.-P.B.,
| | - Gilles Chatellier
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit (P.-F.P., M.A., L.A.); Department of Radiology (A.A., E.M.), Department of Genetics (X.J.), and Department of Clinical Epidemiology (G.C.); INSERM CIC1418, Paris (M.A., G.C.); Department of Neurology (C.O.) and INSERM U894, Hôpital Sainte-Anne (C.O.), Paris; Faculté de Médecine, Université Paris-Descartes (P.-F.P., M.A., L.A., A.A., E.M., X.J., G.C., C.O.); Department of Cardiology, CHU de Grenoble (J.-P.B.,
| | - Elie Mousseaux
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit (P.-F.P., M.A., L.A.); Department of Radiology (A.A., E.M.), Department of Genetics (X.J.), and Department of Clinical Epidemiology (G.C.); INSERM CIC1418, Paris (M.A., G.C.); Department of Neurology (C.O.) and INSERM U894, Hôpital Sainte-Anne (C.O.), Paris; Faculté de Médecine, Université Paris-Descartes (P.-F.P., M.A., L.A., A.A., E.M., X.J., G.C., C.O.); Department of Cardiology, CHU de Grenoble (J.-P.B.,
| | - Emmanuel Touzé;
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit (P.-F.P., M.A., L.A.); Department of Radiology (A.A., E.M.), Department of Genetics (X.J.), and Department of Clinical Epidemiology (G.C.); INSERM CIC1418, Paris (M.A., G.C.); Department of Neurology (C.O.) and INSERM U894, Hôpital Sainte-Anne (C.O.), Paris; Faculté de Médecine, Université Paris-Descartes (P.-F.P., M.A., L.A., A.A., E.M., X.J., G.C., C.O.); Department of Cardiology, CHU de Grenoble (J.-P.B.,
| | | |
Collapse
|
43
|
Cremer A, Soumaré A, Berr C, Dartigues JF, Gabelle A, Gosse P, Tzourio C. Orthostatic Hypotension and Risk of Incident Dementia: Results From a 12-Year Follow-Up of the Three-City Study Cohort. Hypertension 2017; 70:44-49. [PMID: 28559394 DOI: 10.1161/hypertensionaha.117.09048] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 01/23/2017] [Accepted: 04/28/2017] [Indexed: 01/12/2023]
Abstract
Several studies indicate a potential link between orthostatic hypotension (OH) and incident dementia but without substantial evidence to date. Our objective is to study the association between OH and dementia in a cohort of elderly individuals. To do so, baseline lying and standing blood pressure measurements were taken from 7425 subjects in the Three-City study. These subjects were then followed-up for 12 years. Cox proportional hazard models, adjusted for potential confounders, were used to estimate the risk of incident dementia according to OH status. Sensitivity analysis was performed using the so-called illness-death model, a specific statistical method which takes into account competitive risk with death. OH frequency was found to be around 13%, and 760 cases of dementia were diagnosed during follow-up. We observed significant associations between the presence of OH at baseline and the occurrence of dementia during the follow-up, with an increased risk of at least 25% observed regardless of the OH threshold and the statistical method used. In conclusion, there is an association between OH and dementia. Considering that OH is a common condition and is easy to measure, OH measurements could help to identify subjects with higher risk of dementia. Moreover, reducing OH could be a step to prevent conversion to dementia.
Collapse
Affiliation(s)
- Antoine Cremer
- From the Department of Cardiology and Hypertension, Bordeaux University Hospital, France (A.C., P.G.); University of Bordeaux, Inserm, Bordeaux Population Health Research Center, France (A.C., A.S., J.-F.D., C.T.); CHU de Bordeaux, Pole de sante publique, Service d'information medicale, F-33000 Bordeaux, France (A.C., A.S., J.-F.D., C.T.); INSERM Unité 1061, Neuropsychiatrie: Recherche Epidémiologique et Clinique, Montpellier, France (C.B.); and Department of Neurology, Montpellier University Hospital, France (A.G.)
| | - Aicha Soumaré
- From the Department of Cardiology and Hypertension, Bordeaux University Hospital, France (A.C., P.G.); University of Bordeaux, Inserm, Bordeaux Population Health Research Center, France (A.C., A.S., J.-F.D., C.T.); CHU de Bordeaux, Pole de sante publique, Service d'information medicale, F-33000 Bordeaux, France (A.C., A.S., J.-F.D., C.T.); INSERM Unité 1061, Neuropsychiatrie: Recherche Epidémiologique et Clinique, Montpellier, France (C.B.); and Department of Neurology, Montpellier University Hospital, France (A.G.)
| | - Claudine Berr
- From the Department of Cardiology and Hypertension, Bordeaux University Hospital, France (A.C., P.G.); University of Bordeaux, Inserm, Bordeaux Population Health Research Center, France (A.C., A.S., J.-F.D., C.T.); CHU de Bordeaux, Pole de sante publique, Service d'information medicale, F-33000 Bordeaux, France (A.C., A.S., J.-F.D., C.T.); INSERM Unité 1061, Neuropsychiatrie: Recherche Epidémiologique et Clinique, Montpellier, France (C.B.); and Department of Neurology, Montpellier University Hospital, France (A.G.)
| | - Jean-François Dartigues
- From the Department of Cardiology and Hypertension, Bordeaux University Hospital, France (A.C., P.G.); University of Bordeaux, Inserm, Bordeaux Population Health Research Center, France (A.C., A.S., J.-F.D., C.T.); CHU de Bordeaux, Pole de sante publique, Service d'information medicale, F-33000 Bordeaux, France (A.C., A.S., J.-F.D., C.T.); INSERM Unité 1061, Neuropsychiatrie: Recherche Epidémiologique et Clinique, Montpellier, France (C.B.); and Department of Neurology, Montpellier University Hospital, France (A.G.)
| | - Audrey Gabelle
- From the Department of Cardiology and Hypertension, Bordeaux University Hospital, France (A.C., P.G.); University of Bordeaux, Inserm, Bordeaux Population Health Research Center, France (A.C., A.S., J.-F.D., C.T.); CHU de Bordeaux, Pole de sante publique, Service d'information medicale, F-33000 Bordeaux, France (A.C., A.S., J.-F.D., C.T.); INSERM Unité 1061, Neuropsychiatrie: Recherche Epidémiologique et Clinique, Montpellier, France (C.B.); and Department of Neurology, Montpellier University Hospital, France (A.G.)
| | - Philippe Gosse
- From the Department of Cardiology and Hypertension, Bordeaux University Hospital, France (A.C., P.G.); University of Bordeaux, Inserm, Bordeaux Population Health Research Center, France (A.C., A.S., J.-F.D., C.T.); CHU de Bordeaux, Pole de sante publique, Service d'information medicale, F-33000 Bordeaux, France (A.C., A.S., J.-F.D., C.T.); INSERM Unité 1061, Neuropsychiatrie: Recherche Epidémiologique et Clinique, Montpellier, France (C.B.); and Department of Neurology, Montpellier University Hospital, France (A.G.)
| | - Christophe Tzourio
- From the Department of Cardiology and Hypertension, Bordeaux University Hospital, France (A.C., P.G.); University of Bordeaux, Inserm, Bordeaux Population Health Research Center, France (A.C., A.S., J.-F.D., C.T.); CHU de Bordeaux, Pole de sante publique, Service d'information medicale, F-33000 Bordeaux, France (A.C., A.S., J.-F.D., C.T.); INSERM Unité 1061, Neuropsychiatrie: Recherche Epidémiologique et Clinique, Montpellier, France (C.B.); and Department of Neurology, Montpellier University Hospital, France (A.G.)
| |
Collapse
|
44
|
Gosse P, Cremer A, Pereira H, Bobrie G, Chatellier G, Chamontin B, Courand PY, Delsart P, Denolle T, Dourmap C, Ferrari E, Girerd X, Michel Halimi J, Herpin D, Lantelme P, Monge M, Mounier-Vehier C, Mourad JJ, Ormezzano O, Ribstein J, Rossignol P, Sapoval M, Vaïsse B, Zannad F, Azizi M. Twenty-Four-Hour Blood Pressure Monitoring to Predict and Assess Impact of Renal Denervation: The DENERHTN Study (Renal Denervation for Hypertension). Hypertension 2017; 69:494-500. [PMID: 28115517 DOI: 10.1161/hypertensionaha.116.08448] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 11/09/2016] [Accepted: 12/07/2016] [Indexed: 11/16/2022]
Abstract
The DENERHTN trial (Renal Denervation for Hypertension) confirmed the blood pressure (BP) lowering efficacy of renal denervation added to a standardized stepped-care antihypertensive treatment for resistant hypertension at 6 months. We report here the effect of denervation on 24-hour BP and its variability and look for parameters that predicted the BP response. Patients with resistant hypertension were randomly assigned to denervation plus stepped-care treatment or treatment alone (control). Average and standard deviation of 24-hour, daytime, and nighttime BP and the smoothness index were calculated on recordings performed at randomization and 6 months. Responders were defined as a 6-month 24-hour systolic BP reduction ≥20 mm Hg. Analyses were performed on the per-protocol population. The significantly greater BP reduction in the denervation group was associated with a higher smoothness index (P=0.02). Variability of 24-hour, daytime, and nighttime BP did not change significantly from baseline to 6 months in both groups. The number of responders was greater in the denervation (20/44, 44.5%) than in the control group (11/53, 20.8%; P=0.01). In the discriminant analysis, baseline average nighttime systolic BP and standard deviation were significant predictors of the systolic BP response in the denervation group only, allowing adequate responder classification of 70% of the patients. Our results show that denervation lowers ambulatory BP homogeneously over 24 hours in patients with resistant hypertension and suggest that nighttime systolic BP and variability are predictors of the BP response to denervation. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT01570777.
Collapse
Affiliation(s)
- Philippe Gosse
- From the Hopital Saint André, University Hospital of Bordeaux, France (P.G., A.C.); Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigations Cliniques 1418, Paris, France (H.P., G.C., M.A.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, Paris, France (G.B., M.M., M.A.); Paris-Descartes University, Paris, France (G.C., M.A.); Service de médecine Interne et Hypertension artérielle Pole Cardiovasculaire et métabolique, University Hospital Rangueil, Toulouse, France (B.C.); Cardiology Department, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France (P.-Y.C.); Hôpital Cardiologique, Service de médecine vasculaire et HTA, University Hospital Lille, France (P.D., P.L., C.M.-V.); Arthur Gardiner Hospital, Dinard, France (T.D.); University Hospital of Rennes, France (C.D.); Department of Cardiology, University Hospital Nice, France (E.F.); Unité de Prévention Cardio Vasculaire, University Hospital Pitié-Salpêtrière, Paris, France (X.G.); Service de Néphrologie-Immunologie clinique, University hospital Tours et EA4245 Université François-Rabelais, Tours, France (J.M.H.); Department of Cardiology, University Hospital Poitiers, France (D.H.); University Hospital Avicenne-APHP, Bobigny, France (J.-J.M.); Department of Cardiology, University Hospital and INSERM U1039, Bioclinic Radiopharmaceutics Laboratory, Grenoble, France (O.O.); Department of Medicine and Hypertension, University Hospital of Montpellier, France (J.R.); INSERM, Centre d'Investigations Cliniques, Plurithématique 14-33, and INSERM U1116, and University Hospital Nancy and Université de Lorraine and F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France (P.R., F.Z.); Vascular and Oncological Interventional Radiology Department, Hôpital Européen Georges Pompidou, Paris, France (M.S.); and University Hospital La Timone, Marseille, France (B.V.).
| | - Antoine Cremer
- From the Hopital Saint André, University Hospital of Bordeaux, France (P.G., A.C.); Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigations Cliniques 1418, Paris, France (H.P., G.C., M.A.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, Paris, France (G.B., M.M., M.A.); Paris-Descartes University, Paris, France (G.C., M.A.); Service de médecine Interne et Hypertension artérielle Pole Cardiovasculaire et métabolique, University Hospital Rangueil, Toulouse, France (B.C.); Cardiology Department, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France (P.-Y.C.); Hôpital Cardiologique, Service de médecine vasculaire et HTA, University Hospital Lille, France (P.D., P.L., C.M.-V.); Arthur Gardiner Hospital, Dinard, France (T.D.); University Hospital of Rennes, France (C.D.); Department of Cardiology, University Hospital Nice, France (E.F.); Unité de Prévention Cardio Vasculaire, University Hospital Pitié-Salpêtrière, Paris, France (X.G.); Service de Néphrologie-Immunologie clinique, University hospital Tours et EA4245 Université François-Rabelais, Tours, France (J.M.H.); Department of Cardiology, University Hospital Poitiers, France (D.H.); University Hospital Avicenne-APHP, Bobigny, France (J.-J.M.); Department of Cardiology, University Hospital and INSERM U1039, Bioclinic Radiopharmaceutics Laboratory, Grenoble, France (O.O.); Department of Medicine and Hypertension, University Hospital of Montpellier, France (J.R.); INSERM, Centre d'Investigations Cliniques, Plurithématique 14-33, and INSERM U1116, and University Hospital Nancy and Université de Lorraine and F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France (P.R., F.Z.); Vascular and Oncological Interventional Radiology Department, Hôpital Européen Georges Pompidou, Paris, France (M.S.); and University Hospital La Timone, Marseille, France (B.V.)
| | - Helena Pereira
- From the Hopital Saint André, University Hospital of Bordeaux, France (P.G., A.C.); Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigations Cliniques 1418, Paris, France (H.P., G.C., M.A.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, Paris, France (G.B., M.M., M.A.); Paris-Descartes University, Paris, France (G.C., M.A.); Service de médecine Interne et Hypertension artérielle Pole Cardiovasculaire et métabolique, University Hospital Rangueil, Toulouse, France (B.C.); Cardiology Department, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France (P.-Y.C.); Hôpital Cardiologique, Service de médecine vasculaire et HTA, University Hospital Lille, France (P.D., P.L., C.M.-V.); Arthur Gardiner Hospital, Dinard, France (T.D.); University Hospital of Rennes, France (C.D.); Department of Cardiology, University Hospital Nice, France (E.F.); Unité de Prévention Cardio Vasculaire, University Hospital Pitié-Salpêtrière, Paris, France (X.G.); Service de Néphrologie-Immunologie clinique, University hospital Tours et EA4245 Université François-Rabelais, Tours, France (J.M.H.); Department of Cardiology, University Hospital Poitiers, France (D.H.); University Hospital Avicenne-APHP, Bobigny, France (J.-J.M.); Department of Cardiology, University Hospital and INSERM U1039, Bioclinic Radiopharmaceutics Laboratory, Grenoble, France (O.O.); Department of Medicine and Hypertension, University Hospital of Montpellier, France (J.R.); INSERM, Centre d'Investigations Cliniques, Plurithématique 14-33, and INSERM U1116, and University Hospital Nancy and Université de Lorraine and F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France (P.R., F.Z.); Vascular and Oncological Interventional Radiology Department, Hôpital Européen Georges Pompidou, Paris, France (M.S.); and University Hospital La Timone, Marseille, France (B.V.)
| | - Guillaume Bobrie
- From the Hopital Saint André, University Hospital of Bordeaux, France (P.G., A.C.); Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigations Cliniques 1418, Paris, France (H.P., G.C., M.A.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, Paris, France (G.B., M.M., M.A.); Paris-Descartes University, Paris, France (G.C., M.A.); Service de médecine Interne et Hypertension artérielle Pole Cardiovasculaire et métabolique, University Hospital Rangueil, Toulouse, France (B.C.); Cardiology Department, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France (P.-Y.C.); Hôpital Cardiologique, Service de médecine vasculaire et HTA, University Hospital Lille, France (P.D., P.L., C.M.-V.); Arthur Gardiner Hospital, Dinard, France (T.D.); University Hospital of Rennes, France (C.D.); Department of Cardiology, University Hospital Nice, France (E.F.); Unité de Prévention Cardio Vasculaire, University Hospital Pitié-Salpêtrière, Paris, France (X.G.); Service de Néphrologie-Immunologie clinique, University hospital Tours et EA4245 Université François-Rabelais, Tours, France (J.M.H.); Department of Cardiology, University Hospital Poitiers, France (D.H.); University Hospital Avicenne-APHP, Bobigny, France (J.-J.M.); Department of Cardiology, University Hospital and INSERM U1039, Bioclinic Radiopharmaceutics Laboratory, Grenoble, France (O.O.); Department of Medicine and Hypertension, University Hospital of Montpellier, France (J.R.); INSERM, Centre d'Investigations Cliniques, Plurithématique 14-33, and INSERM U1116, and University Hospital Nancy and Université de Lorraine and F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France (P.R., F.Z.); Vascular and Oncological Interventional Radiology Department, Hôpital Européen Georges Pompidou, Paris, France (M.S.); and University Hospital La Timone, Marseille, France (B.V.)
| | - Gilles Chatellier
- From the Hopital Saint André, University Hospital of Bordeaux, France (P.G., A.C.); Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigations Cliniques 1418, Paris, France (H.P., G.C., M.A.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, Paris, France (G.B., M.M., M.A.); Paris-Descartes University, Paris, France (G.C., M.A.); Service de médecine Interne et Hypertension artérielle Pole Cardiovasculaire et métabolique, University Hospital Rangueil, Toulouse, France (B.C.); Cardiology Department, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France (P.-Y.C.); Hôpital Cardiologique, Service de médecine vasculaire et HTA, University Hospital Lille, France (P.D., P.L., C.M.-V.); Arthur Gardiner Hospital, Dinard, France (T.D.); University Hospital of Rennes, France (C.D.); Department of Cardiology, University Hospital Nice, France (E.F.); Unité de Prévention Cardio Vasculaire, University Hospital Pitié-Salpêtrière, Paris, France (X.G.); Service de Néphrologie-Immunologie clinique, University hospital Tours et EA4245 Université François-Rabelais, Tours, France (J.M.H.); Department of Cardiology, University Hospital Poitiers, France (D.H.); University Hospital Avicenne-APHP, Bobigny, France (J.-J.M.); Department of Cardiology, University Hospital and INSERM U1039, Bioclinic Radiopharmaceutics Laboratory, Grenoble, France (O.O.); Department of Medicine and Hypertension, University Hospital of Montpellier, France (J.R.); INSERM, Centre d'Investigations Cliniques, Plurithématique 14-33, and INSERM U1116, and University Hospital Nancy and Université de Lorraine and F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France (P.R., F.Z.); Vascular and Oncological Interventional Radiology Department, Hôpital Européen Georges Pompidou, Paris, France (M.S.); and University Hospital La Timone, Marseille, France (B.V.)
| | - Bernard Chamontin
- From the Hopital Saint André, University Hospital of Bordeaux, France (P.G., A.C.); Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigations Cliniques 1418, Paris, France (H.P., G.C., M.A.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, Paris, France (G.B., M.M., M.A.); Paris-Descartes University, Paris, France (G.C., M.A.); Service de médecine Interne et Hypertension artérielle Pole Cardiovasculaire et métabolique, University Hospital Rangueil, Toulouse, France (B.C.); Cardiology Department, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France (P.-Y.C.); Hôpital Cardiologique, Service de médecine vasculaire et HTA, University Hospital Lille, France (P.D., P.L., C.M.-V.); Arthur Gardiner Hospital, Dinard, France (T.D.); University Hospital of Rennes, France (C.D.); Department of Cardiology, University Hospital Nice, France (E.F.); Unité de Prévention Cardio Vasculaire, University Hospital Pitié-Salpêtrière, Paris, France (X.G.); Service de Néphrologie-Immunologie clinique, University hospital Tours et EA4245 Université François-Rabelais, Tours, France (J.M.H.); Department of Cardiology, University Hospital Poitiers, France (D.H.); University Hospital Avicenne-APHP, Bobigny, France (J.-J.M.); Department of Cardiology, University Hospital and INSERM U1039, Bioclinic Radiopharmaceutics Laboratory, Grenoble, France (O.O.); Department of Medicine and Hypertension, University Hospital of Montpellier, France (J.R.); INSERM, Centre d'Investigations Cliniques, Plurithématique 14-33, and INSERM U1116, and University Hospital Nancy and Université de Lorraine and F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France (P.R., F.Z.); Vascular and Oncological Interventional Radiology Department, Hôpital Européen Georges Pompidou, Paris, France (M.S.); and University Hospital La Timone, Marseille, France (B.V.)
| | - Pierre-Yves Courand
- From the Hopital Saint André, University Hospital of Bordeaux, France (P.G., A.C.); Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigations Cliniques 1418, Paris, France (H.P., G.C., M.A.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, Paris, France (G.B., M.M., M.A.); Paris-Descartes University, Paris, France (G.C., M.A.); Service de médecine Interne et Hypertension artérielle Pole Cardiovasculaire et métabolique, University Hospital Rangueil, Toulouse, France (B.C.); Cardiology Department, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France (P.-Y.C.); Hôpital Cardiologique, Service de médecine vasculaire et HTA, University Hospital Lille, France (P.D., P.L., C.M.-V.); Arthur Gardiner Hospital, Dinard, France (T.D.); University Hospital of Rennes, France (C.D.); Department of Cardiology, University Hospital Nice, France (E.F.); Unité de Prévention Cardio Vasculaire, University Hospital Pitié-Salpêtrière, Paris, France (X.G.); Service de Néphrologie-Immunologie clinique, University hospital Tours et EA4245 Université François-Rabelais, Tours, France (J.M.H.); Department of Cardiology, University Hospital Poitiers, France (D.H.); University Hospital Avicenne-APHP, Bobigny, France (J.-J.M.); Department of Cardiology, University Hospital and INSERM U1039, Bioclinic Radiopharmaceutics Laboratory, Grenoble, France (O.O.); Department of Medicine and Hypertension, University Hospital of Montpellier, France (J.R.); INSERM, Centre d'Investigations Cliniques, Plurithématique 14-33, and INSERM U1116, and University Hospital Nancy and Université de Lorraine and F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France (P.R., F.Z.); Vascular and Oncological Interventional Radiology Department, Hôpital Européen Georges Pompidou, Paris, France (M.S.); and University Hospital La Timone, Marseille, France (B.V.)
| | - Pascal Delsart
- From the Hopital Saint André, University Hospital of Bordeaux, France (P.G., A.C.); Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigations Cliniques 1418, Paris, France (H.P., G.C., M.A.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, Paris, France (G.B., M.M., M.A.); Paris-Descartes University, Paris, France (G.C., M.A.); Service de médecine Interne et Hypertension artérielle Pole Cardiovasculaire et métabolique, University Hospital Rangueil, Toulouse, France (B.C.); Cardiology Department, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France (P.-Y.C.); Hôpital Cardiologique, Service de médecine vasculaire et HTA, University Hospital Lille, France (P.D., P.L., C.M.-V.); Arthur Gardiner Hospital, Dinard, France (T.D.); University Hospital of Rennes, France (C.D.); Department of Cardiology, University Hospital Nice, France (E.F.); Unité de Prévention Cardio Vasculaire, University Hospital Pitié-Salpêtrière, Paris, France (X.G.); Service de Néphrologie-Immunologie clinique, University hospital Tours et EA4245 Université François-Rabelais, Tours, France (J.M.H.); Department of Cardiology, University Hospital Poitiers, France (D.H.); University Hospital Avicenne-APHP, Bobigny, France (J.-J.M.); Department of Cardiology, University Hospital and INSERM U1039, Bioclinic Radiopharmaceutics Laboratory, Grenoble, France (O.O.); Department of Medicine and Hypertension, University Hospital of Montpellier, France (J.R.); INSERM, Centre d'Investigations Cliniques, Plurithématique 14-33, and INSERM U1116, and University Hospital Nancy and Université de Lorraine and F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France (P.R., F.Z.); Vascular and Oncological Interventional Radiology Department, Hôpital Européen Georges Pompidou, Paris, France (M.S.); and University Hospital La Timone, Marseille, France (B.V.)
| | - Thierry Denolle
- From the Hopital Saint André, University Hospital of Bordeaux, France (P.G., A.C.); Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigations Cliniques 1418, Paris, France (H.P., G.C., M.A.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, Paris, France (G.B., M.M., M.A.); Paris-Descartes University, Paris, France (G.C., M.A.); Service de médecine Interne et Hypertension artérielle Pole Cardiovasculaire et métabolique, University Hospital Rangueil, Toulouse, France (B.C.); Cardiology Department, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France (P.-Y.C.); Hôpital Cardiologique, Service de médecine vasculaire et HTA, University Hospital Lille, France (P.D., P.L., C.M.-V.); Arthur Gardiner Hospital, Dinard, France (T.D.); University Hospital of Rennes, France (C.D.); Department of Cardiology, University Hospital Nice, France (E.F.); Unité de Prévention Cardio Vasculaire, University Hospital Pitié-Salpêtrière, Paris, France (X.G.); Service de Néphrologie-Immunologie clinique, University hospital Tours et EA4245 Université François-Rabelais, Tours, France (J.M.H.); Department of Cardiology, University Hospital Poitiers, France (D.H.); University Hospital Avicenne-APHP, Bobigny, France (J.-J.M.); Department of Cardiology, University Hospital and INSERM U1039, Bioclinic Radiopharmaceutics Laboratory, Grenoble, France (O.O.); Department of Medicine and Hypertension, University Hospital of Montpellier, France (J.R.); INSERM, Centre d'Investigations Cliniques, Plurithématique 14-33, and INSERM U1116, and University Hospital Nancy and Université de Lorraine and F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France (P.R., F.Z.); Vascular and Oncological Interventional Radiology Department, Hôpital Européen Georges Pompidou, Paris, France (M.S.); and University Hospital La Timone, Marseille, France (B.V.)
| | - Caroline Dourmap
- From the Hopital Saint André, University Hospital of Bordeaux, France (P.G., A.C.); Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigations Cliniques 1418, Paris, France (H.P., G.C., M.A.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, Paris, France (G.B., M.M., M.A.); Paris-Descartes University, Paris, France (G.C., M.A.); Service de médecine Interne et Hypertension artérielle Pole Cardiovasculaire et métabolique, University Hospital Rangueil, Toulouse, France (B.C.); Cardiology Department, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France (P.-Y.C.); Hôpital Cardiologique, Service de médecine vasculaire et HTA, University Hospital Lille, France (P.D., P.L., C.M.-V.); Arthur Gardiner Hospital, Dinard, France (T.D.); University Hospital of Rennes, France (C.D.); Department of Cardiology, University Hospital Nice, France (E.F.); Unité de Prévention Cardio Vasculaire, University Hospital Pitié-Salpêtrière, Paris, France (X.G.); Service de Néphrologie-Immunologie clinique, University hospital Tours et EA4245 Université François-Rabelais, Tours, France (J.M.H.); Department of Cardiology, University Hospital Poitiers, France (D.H.); University Hospital Avicenne-APHP, Bobigny, France (J.-J.M.); Department of Cardiology, University Hospital and INSERM U1039, Bioclinic Radiopharmaceutics Laboratory, Grenoble, France (O.O.); Department of Medicine and Hypertension, University Hospital of Montpellier, France (J.R.); INSERM, Centre d'Investigations Cliniques, Plurithématique 14-33, and INSERM U1116, and University Hospital Nancy and Université de Lorraine and F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France (P.R., F.Z.); Vascular and Oncological Interventional Radiology Department, Hôpital Européen Georges Pompidou, Paris, France (M.S.); and University Hospital La Timone, Marseille, France (B.V.)
| | - Emile Ferrari
- From the Hopital Saint André, University Hospital of Bordeaux, France (P.G., A.C.); Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigations Cliniques 1418, Paris, France (H.P., G.C., M.A.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, Paris, France (G.B., M.M., M.A.); Paris-Descartes University, Paris, France (G.C., M.A.); Service de médecine Interne et Hypertension artérielle Pole Cardiovasculaire et métabolique, University Hospital Rangueil, Toulouse, France (B.C.); Cardiology Department, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France (P.-Y.C.); Hôpital Cardiologique, Service de médecine vasculaire et HTA, University Hospital Lille, France (P.D., P.L., C.M.-V.); Arthur Gardiner Hospital, Dinard, France (T.D.); University Hospital of Rennes, France (C.D.); Department of Cardiology, University Hospital Nice, France (E.F.); Unité de Prévention Cardio Vasculaire, University Hospital Pitié-Salpêtrière, Paris, France (X.G.); Service de Néphrologie-Immunologie clinique, University hospital Tours et EA4245 Université François-Rabelais, Tours, France (J.M.H.); Department of Cardiology, University Hospital Poitiers, France (D.H.); University Hospital Avicenne-APHP, Bobigny, France (J.-J.M.); Department of Cardiology, University Hospital and INSERM U1039, Bioclinic Radiopharmaceutics Laboratory, Grenoble, France (O.O.); Department of Medicine and Hypertension, University Hospital of Montpellier, France (J.R.); INSERM, Centre d'Investigations Cliniques, Plurithématique 14-33, and INSERM U1116, and University Hospital Nancy and Université de Lorraine and F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France (P.R., F.Z.); Vascular and Oncological Interventional Radiology Department, Hôpital Européen Georges Pompidou, Paris, France (M.S.); and University Hospital La Timone, Marseille, France (B.V.)
| | - Xavier Girerd
- From the Hopital Saint André, University Hospital of Bordeaux, France (P.G., A.C.); Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigations Cliniques 1418, Paris, France (H.P., G.C., M.A.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, Paris, France (G.B., M.M., M.A.); Paris-Descartes University, Paris, France (G.C., M.A.); Service de médecine Interne et Hypertension artérielle Pole Cardiovasculaire et métabolique, University Hospital Rangueil, Toulouse, France (B.C.); Cardiology Department, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France (P.-Y.C.); Hôpital Cardiologique, Service de médecine vasculaire et HTA, University Hospital Lille, France (P.D., P.L., C.M.-V.); Arthur Gardiner Hospital, Dinard, France (T.D.); University Hospital of Rennes, France (C.D.); Department of Cardiology, University Hospital Nice, France (E.F.); Unité de Prévention Cardio Vasculaire, University Hospital Pitié-Salpêtrière, Paris, France (X.G.); Service de Néphrologie-Immunologie clinique, University hospital Tours et EA4245 Université François-Rabelais, Tours, France (J.M.H.); Department of Cardiology, University Hospital Poitiers, France (D.H.); University Hospital Avicenne-APHP, Bobigny, France (J.-J.M.); Department of Cardiology, University Hospital and INSERM U1039, Bioclinic Radiopharmaceutics Laboratory, Grenoble, France (O.O.); Department of Medicine and Hypertension, University Hospital of Montpellier, France (J.R.); INSERM, Centre d'Investigations Cliniques, Plurithématique 14-33, and INSERM U1116, and University Hospital Nancy and Université de Lorraine and F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France (P.R., F.Z.); Vascular and Oncological Interventional Radiology Department, Hôpital Européen Georges Pompidou, Paris, France (M.S.); and University Hospital La Timone, Marseille, France (B.V.)
| | - Jean Michel Halimi
- From the Hopital Saint André, University Hospital of Bordeaux, France (P.G., A.C.); Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigations Cliniques 1418, Paris, France (H.P., G.C., M.A.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, Paris, France (G.B., M.M., M.A.); Paris-Descartes University, Paris, France (G.C., M.A.); Service de médecine Interne et Hypertension artérielle Pole Cardiovasculaire et métabolique, University Hospital Rangueil, Toulouse, France (B.C.); Cardiology Department, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France (P.-Y.C.); Hôpital Cardiologique, Service de médecine vasculaire et HTA, University Hospital Lille, France (P.D., P.L., C.M.-V.); Arthur Gardiner Hospital, Dinard, France (T.D.); University Hospital of Rennes, France (C.D.); Department of Cardiology, University Hospital Nice, France (E.F.); Unité de Prévention Cardio Vasculaire, University Hospital Pitié-Salpêtrière, Paris, France (X.G.); Service de Néphrologie-Immunologie clinique, University hospital Tours et EA4245 Université François-Rabelais, Tours, France (J.M.H.); Department of Cardiology, University Hospital Poitiers, France (D.H.); University Hospital Avicenne-APHP, Bobigny, France (J.-J.M.); Department of Cardiology, University Hospital and INSERM U1039, Bioclinic Radiopharmaceutics Laboratory, Grenoble, France (O.O.); Department of Medicine and Hypertension, University Hospital of Montpellier, France (J.R.); INSERM, Centre d'Investigations Cliniques, Plurithématique 14-33, and INSERM U1116, and University Hospital Nancy and Université de Lorraine and F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France (P.R., F.Z.); Vascular and Oncological Interventional Radiology Department, Hôpital Européen Georges Pompidou, Paris, France (M.S.); and University Hospital La Timone, Marseille, France (B.V.)
| | - Daniel Herpin
- From the Hopital Saint André, University Hospital of Bordeaux, France (P.G., A.C.); Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigations Cliniques 1418, Paris, France (H.P., G.C., M.A.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, Paris, France (G.B., M.M., M.A.); Paris-Descartes University, Paris, France (G.C., M.A.); Service de médecine Interne et Hypertension artérielle Pole Cardiovasculaire et métabolique, University Hospital Rangueil, Toulouse, France (B.C.); Cardiology Department, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France (P.-Y.C.); Hôpital Cardiologique, Service de médecine vasculaire et HTA, University Hospital Lille, France (P.D., P.L., C.M.-V.); Arthur Gardiner Hospital, Dinard, France (T.D.); University Hospital of Rennes, France (C.D.); Department of Cardiology, University Hospital Nice, France (E.F.); Unité de Prévention Cardio Vasculaire, University Hospital Pitié-Salpêtrière, Paris, France (X.G.); Service de Néphrologie-Immunologie clinique, University hospital Tours et EA4245 Université François-Rabelais, Tours, France (J.M.H.); Department of Cardiology, University Hospital Poitiers, France (D.H.); University Hospital Avicenne-APHP, Bobigny, France (J.-J.M.); Department of Cardiology, University Hospital and INSERM U1039, Bioclinic Radiopharmaceutics Laboratory, Grenoble, France (O.O.); Department of Medicine and Hypertension, University Hospital of Montpellier, France (J.R.); INSERM, Centre d'Investigations Cliniques, Plurithématique 14-33, and INSERM U1116, and University Hospital Nancy and Université de Lorraine and F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France (P.R., F.Z.); Vascular and Oncological Interventional Radiology Department, Hôpital Européen Georges Pompidou, Paris, France (M.S.); and University Hospital La Timone, Marseille, France (B.V.)
| | - Pierre Lantelme
- From the Hopital Saint André, University Hospital of Bordeaux, France (P.G., A.C.); Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigations Cliniques 1418, Paris, France (H.P., G.C., M.A.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, Paris, France (G.B., M.M., M.A.); Paris-Descartes University, Paris, France (G.C., M.A.); Service de médecine Interne et Hypertension artérielle Pole Cardiovasculaire et métabolique, University Hospital Rangueil, Toulouse, France (B.C.); Cardiology Department, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France (P.-Y.C.); Hôpital Cardiologique, Service de médecine vasculaire et HTA, University Hospital Lille, France (P.D., P.L., C.M.-V.); Arthur Gardiner Hospital, Dinard, France (T.D.); University Hospital of Rennes, France (C.D.); Department of Cardiology, University Hospital Nice, France (E.F.); Unité de Prévention Cardio Vasculaire, University Hospital Pitié-Salpêtrière, Paris, France (X.G.); Service de Néphrologie-Immunologie clinique, University hospital Tours et EA4245 Université François-Rabelais, Tours, France (J.M.H.); Department of Cardiology, University Hospital Poitiers, France (D.H.); University Hospital Avicenne-APHP, Bobigny, France (J.-J.M.); Department of Cardiology, University Hospital and INSERM U1039, Bioclinic Radiopharmaceutics Laboratory, Grenoble, France (O.O.); Department of Medicine and Hypertension, University Hospital of Montpellier, France (J.R.); INSERM, Centre d'Investigations Cliniques, Plurithématique 14-33, and INSERM U1116, and University Hospital Nancy and Université de Lorraine and F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France (P.R., F.Z.); Vascular and Oncological Interventional Radiology Department, Hôpital Européen Georges Pompidou, Paris, France (M.S.); and University Hospital La Timone, Marseille, France (B.V.)
| | - Matthieu Monge
- From the Hopital Saint André, University Hospital of Bordeaux, France (P.G., A.C.); Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigations Cliniques 1418, Paris, France (H.P., G.C., M.A.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, Paris, France (G.B., M.M., M.A.); Paris-Descartes University, Paris, France (G.C., M.A.); Service de médecine Interne et Hypertension artérielle Pole Cardiovasculaire et métabolique, University Hospital Rangueil, Toulouse, France (B.C.); Cardiology Department, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France (P.-Y.C.); Hôpital Cardiologique, Service de médecine vasculaire et HTA, University Hospital Lille, France (P.D., P.L., C.M.-V.); Arthur Gardiner Hospital, Dinard, France (T.D.); University Hospital of Rennes, France (C.D.); Department of Cardiology, University Hospital Nice, France (E.F.); Unité de Prévention Cardio Vasculaire, University Hospital Pitié-Salpêtrière, Paris, France (X.G.); Service de Néphrologie-Immunologie clinique, University hospital Tours et EA4245 Université François-Rabelais, Tours, France (J.M.H.); Department of Cardiology, University Hospital Poitiers, France (D.H.); University Hospital Avicenne-APHP, Bobigny, France (J.-J.M.); Department of Cardiology, University Hospital and INSERM U1039, Bioclinic Radiopharmaceutics Laboratory, Grenoble, France (O.O.); Department of Medicine and Hypertension, University Hospital of Montpellier, France (J.R.); INSERM, Centre d'Investigations Cliniques, Plurithématique 14-33, and INSERM U1116, and University Hospital Nancy and Université de Lorraine and F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France (P.R., F.Z.); Vascular and Oncological Interventional Radiology Department, Hôpital Européen Georges Pompidou, Paris, France (M.S.); and University Hospital La Timone, Marseille, France (B.V.)
| | - Claire Mounier-Vehier
- From the Hopital Saint André, University Hospital of Bordeaux, France (P.G., A.C.); Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigations Cliniques 1418, Paris, France (H.P., G.C., M.A.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, Paris, France (G.B., M.M., M.A.); Paris-Descartes University, Paris, France (G.C., M.A.); Service de médecine Interne et Hypertension artérielle Pole Cardiovasculaire et métabolique, University Hospital Rangueil, Toulouse, France (B.C.); Cardiology Department, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France (P.-Y.C.); Hôpital Cardiologique, Service de médecine vasculaire et HTA, University Hospital Lille, France (P.D., P.L., C.M.-V.); Arthur Gardiner Hospital, Dinard, France (T.D.); University Hospital of Rennes, France (C.D.); Department of Cardiology, University Hospital Nice, France (E.F.); Unité de Prévention Cardio Vasculaire, University Hospital Pitié-Salpêtrière, Paris, France (X.G.); Service de Néphrologie-Immunologie clinique, University hospital Tours et EA4245 Université François-Rabelais, Tours, France (J.M.H.); Department of Cardiology, University Hospital Poitiers, France (D.H.); University Hospital Avicenne-APHP, Bobigny, France (J.-J.M.); Department of Cardiology, University Hospital and INSERM U1039, Bioclinic Radiopharmaceutics Laboratory, Grenoble, France (O.O.); Department of Medicine and Hypertension, University Hospital of Montpellier, France (J.R.); INSERM, Centre d'Investigations Cliniques, Plurithématique 14-33, and INSERM U1116, and University Hospital Nancy and Université de Lorraine and F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France (P.R., F.Z.); Vascular and Oncological Interventional Radiology Department, Hôpital Européen Georges Pompidou, Paris, France (M.S.); and University Hospital La Timone, Marseille, France (B.V.)
| | - Jean-Jacques Mourad
- From the Hopital Saint André, University Hospital of Bordeaux, France (P.G., A.C.); Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigations Cliniques 1418, Paris, France (H.P., G.C., M.A.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, Paris, France (G.B., M.M., M.A.); Paris-Descartes University, Paris, France (G.C., M.A.); Service de médecine Interne et Hypertension artérielle Pole Cardiovasculaire et métabolique, University Hospital Rangueil, Toulouse, France (B.C.); Cardiology Department, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France (P.-Y.C.); Hôpital Cardiologique, Service de médecine vasculaire et HTA, University Hospital Lille, France (P.D., P.L., C.M.-V.); Arthur Gardiner Hospital, Dinard, France (T.D.); University Hospital of Rennes, France (C.D.); Department of Cardiology, University Hospital Nice, France (E.F.); Unité de Prévention Cardio Vasculaire, University Hospital Pitié-Salpêtrière, Paris, France (X.G.); Service de Néphrologie-Immunologie clinique, University hospital Tours et EA4245 Université François-Rabelais, Tours, France (J.M.H.); Department of Cardiology, University Hospital Poitiers, France (D.H.); University Hospital Avicenne-APHP, Bobigny, France (J.-J.M.); Department of Cardiology, University Hospital and INSERM U1039, Bioclinic Radiopharmaceutics Laboratory, Grenoble, France (O.O.); Department of Medicine and Hypertension, University Hospital of Montpellier, France (J.R.); INSERM, Centre d'Investigations Cliniques, Plurithématique 14-33, and INSERM U1116, and University Hospital Nancy and Université de Lorraine and F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France (P.R., F.Z.); Vascular and Oncological Interventional Radiology Department, Hôpital Européen Georges Pompidou, Paris, France (M.S.); and University Hospital La Timone, Marseille, France (B.V.)
| | - Olivier Ormezzano
- From the Hopital Saint André, University Hospital of Bordeaux, France (P.G., A.C.); Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigations Cliniques 1418, Paris, France (H.P., G.C., M.A.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, Paris, France (G.B., M.M., M.A.); Paris-Descartes University, Paris, France (G.C., M.A.); Service de médecine Interne et Hypertension artérielle Pole Cardiovasculaire et métabolique, University Hospital Rangueil, Toulouse, France (B.C.); Cardiology Department, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France (P.-Y.C.); Hôpital Cardiologique, Service de médecine vasculaire et HTA, University Hospital Lille, France (P.D., P.L., C.M.-V.); Arthur Gardiner Hospital, Dinard, France (T.D.); University Hospital of Rennes, France (C.D.); Department of Cardiology, University Hospital Nice, France (E.F.); Unité de Prévention Cardio Vasculaire, University Hospital Pitié-Salpêtrière, Paris, France (X.G.); Service de Néphrologie-Immunologie clinique, University hospital Tours et EA4245 Université François-Rabelais, Tours, France (J.M.H.); Department of Cardiology, University Hospital Poitiers, France (D.H.); University Hospital Avicenne-APHP, Bobigny, France (J.-J.M.); Department of Cardiology, University Hospital and INSERM U1039, Bioclinic Radiopharmaceutics Laboratory, Grenoble, France (O.O.); Department of Medicine and Hypertension, University Hospital of Montpellier, France (J.R.); INSERM, Centre d'Investigations Cliniques, Plurithématique 14-33, and INSERM U1116, and University Hospital Nancy and Université de Lorraine and F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France (P.R., F.Z.); Vascular and Oncological Interventional Radiology Department, Hôpital Européen Georges Pompidou, Paris, France (M.S.); and University Hospital La Timone, Marseille, France (B.V.)
| | - Jean Ribstein
- From the Hopital Saint André, University Hospital of Bordeaux, France (P.G., A.C.); Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigations Cliniques 1418, Paris, France (H.P., G.C., M.A.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, Paris, France (G.B., M.M., M.A.); Paris-Descartes University, Paris, France (G.C., M.A.); Service de médecine Interne et Hypertension artérielle Pole Cardiovasculaire et métabolique, University Hospital Rangueil, Toulouse, France (B.C.); Cardiology Department, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France (P.-Y.C.); Hôpital Cardiologique, Service de médecine vasculaire et HTA, University Hospital Lille, France (P.D., P.L., C.M.-V.); Arthur Gardiner Hospital, Dinard, France (T.D.); University Hospital of Rennes, France (C.D.); Department of Cardiology, University Hospital Nice, France (E.F.); Unité de Prévention Cardio Vasculaire, University Hospital Pitié-Salpêtrière, Paris, France (X.G.); Service de Néphrologie-Immunologie clinique, University hospital Tours et EA4245 Université François-Rabelais, Tours, France (J.M.H.); Department of Cardiology, University Hospital Poitiers, France (D.H.); University Hospital Avicenne-APHP, Bobigny, France (J.-J.M.); Department of Cardiology, University Hospital and INSERM U1039, Bioclinic Radiopharmaceutics Laboratory, Grenoble, France (O.O.); Department of Medicine and Hypertension, University Hospital of Montpellier, France (J.R.); INSERM, Centre d'Investigations Cliniques, Plurithématique 14-33, and INSERM U1116, and University Hospital Nancy and Université de Lorraine and F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France (P.R., F.Z.); Vascular and Oncological Interventional Radiology Department, Hôpital Européen Georges Pompidou, Paris, France (M.S.); and University Hospital La Timone, Marseille, France (B.V.)
| | - Patrick Rossignol
- From the Hopital Saint André, University Hospital of Bordeaux, France (P.G., A.C.); Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigations Cliniques 1418, Paris, France (H.P., G.C., M.A.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, Paris, France (G.B., M.M., M.A.); Paris-Descartes University, Paris, France (G.C., M.A.); Service de médecine Interne et Hypertension artérielle Pole Cardiovasculaire et métabolique, University Hospital Rangueil, Toulouse, France (B.C.); Cardiology Department, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France (P.-Y.C.); Hôpital Cardiologique, Service de médecine vasculaire et HTA, University Hospital Lille, France (P.D., P.L., C.M.-V.); Arthur Gardiner Hospital, Dinard, France (T.D.); University Hospital of Rennes, France (C.D.); Department of Cardiology, University Hospital Nice, France (E.F.); Unité de Prévention Cardio Vasculaire, University Hospital Pitié-Salpêtrière, Paris, France (X.G.); Service de Néphrologie-Immunologie clinique, University hospital Tours et EA4245 Université François-Rabelais, Tours, France (J.M.H.); Department of Cardiology, University Hospital Poitiers, France (D.H.); University Hospital Avicenne-APHP, Bobigny, France (J.-J.M.); Department of Cardiology, University Hospital and INSERM U1039, Bioclinic Radiopharmaceutics Laboratory, Grenoble, France (O.O.); Department of Medicine and Hypertension, University Hospital of Montpellier, France (J.R.); INSERM, Centre d'Investigations Cliniques, Plurithématique 14-33, and INSERM U1116, and University Hospital Nancy and Université de Lorraine and F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France (P.R., F.Z.); Vascular and Oncological Interventional Radiology Department, Hôpital Européen Georges Pompidou, Paris, France (M.S.); and University Hospital La Timone, Marseille, France (B.V.)
| | - Marc Sapoval
- From the Hopital Saint André, University Hospital of Bordeaux, France (P.G., A.C.); Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigations Cliniques 1418, Paris, France (H.P., G.C., M.A.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, Paris, France (G.B., M.M., M.A.); Paris-Descartes University, Paris, France (G.C., M.A.); Service de médecine Interne et Hypertension artérielle Pole Cardiovasculaire et métabolique, University Hospital Rangueil, Toulouse, France (B.C.); Cardiology Department, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France (P.-Y.C.); Hôpital Cardiologique, Service de médecine vasculaire et HTA, University Hospital Lille, France (P.D., P.L., C.M.-V.); Arthur Gardiner Hospital, Dinard, France (T.D.); University Hospital of Rennes, France (C.D.); Department of Cardiology, University Hospital Nice, France (E.F.); Unité de Prévention Cardio Vasculaire, University Hospital Pitié-Salpêtrière, Paris, France (X.G.); Service de Néphrologie-Immunologie clinique, University hospital Tours et EA4245 Université François-Rabelais, Tours, France (J.M.H.); Department of Cardiology, University Hospital Poitiers, France (D.H.); University Hospital Avicenne-APHP, Bobigny, France (J.-J.M.); Department of Cardiology, University Hospital and INSERM U1039, Bioclinic Radiopharmaceutics Laboratory, Grenoble, France (O.O.); Department of Medicine and Hypertension, University Hospital of Montpellier, France (J.R.); INSERM, Centre d'Investigations Cliniques, Plurithématique 14-33, and INSERM U1116, and University Hospital Nancy and Université de Lorraine and F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France (P.R., F.Z.); Vascular and Oncological Interventional Radiology Department, Hôpital Européen Georges Pompidou, Paris, France (M.S.); and University Hospital La Timone, Marseille, France (B.V.)
| | - Bernard Vaïsse
- From the Hopital Saint André, University Hospital of Bordeaux, France (P.G., A.C.); Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigations Cliniques 1418, Paris, France (H.P., G.C., M.A.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, Paris, France (G.B., M.M., M.A.); Paris-Descartes University, Paris, France (G.C., M.A.); Service de médecine Interne et Hypertension artérielle Pole Cardiovasculaire et métabolique, University Hospital Rangueil, Toulouse, France (B.C.); Cardiology Department, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France (P.-Y.C.); Hôpital Cardiologique, Service de médecine vasculaire et HTA, University Hospital Lille, France (P.D., P.L., C.M.-V.); Arthur Gardiner Hospital, Dinard, France (T.D.); University Hospital of Rennes, France (C.D.); Department of Cardiology, University Hospital Nice, France (E.F.); Unité de Prévention Cardio Vasculaire, University Hospital Pitié-Salpêtrière, Paris, France (X.G.); Service de Néphrologie-Immunologie clinique, University hospital Tours et EA4245 Université François-Rabelais, Tours, France (J.M.H.); Department of Cardiology, University Hospital Poitiers, France (D.H.); University Hospital Avicenne-APHP, Bobigny, France (J.-J.M.); Department of Cardiology, University Hospital and INSERM U1039, Bioclinic Radiopharmaceutics Laboratory, Grenoble, France (O.O.); Department of Medicine and Hypertension, University Hospital of Montpellier, France (J.R.); INSERM, Centre d'Investigations Cliniques, Plurithématique 14-33, and INSERM U1116, and University Hospital Nancy and Université de Lorraine and F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France (P.R., F.Z.); Vascular and Oncological Interventional Radiology Department, Hôpital Européen Georges Pompidou, Paris, France (M.S.); and University Hospital La Timone, Marseille, France (B.V.)
| | - Faiez Zannad
- From the Hopital Saint André, University Hospital of Bordeaux, France (P.G., A.C.); Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigations Cliniques 1418, Paris, France (H.P., G.C., M.A.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, Paris, France (G.B., M.M., M.A.); Paris-Descartes University, Paris, France (G.C., M.A.); Service de médecine Interne et Hypertension artérielle Pole Cardiovasculaire et métabolique, University Hospital Rangueil, Toulouse, France (B.C.); Cardiology Department, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France (P.-Y.C.); Hôpital Cardiologique, Service de médecine vasculaire et HTA, University Hospital Lille, France (P.D., P.L., C.M.-V.); Arthur Gardiner Hospital, Dinard, France (T.D.); University Hospital of Rennes, France (C.D.); Department of Cardiology, University Hospital Nice, France (E.F.); Unité de Prévention Cardio Vasculaire, University Hospital Pitié-Salpêtrière, Paris, France (X.G.); Service de Néphrologie-Immunologie clinique, University hospital Tours et EA4245 Université François-Rabelais, Tours, France (J.M.H.); Department of Cardiology, University Hospital Poitiers, France (D.H.); University Hospital Avicenne-APHP, Bobigny, France (J.-J.M.); Department of Cardiology, University Hospital and INSERM U1039, Bioclinic Radiopharmaceutics Laboratory, Grenoble, France (O.O.); Department of Medicine and Hypertension, University Hospital of Montpellier, France (J.R.); INSERM, Centre d'Investigations Cliniques, Plurithématique 14-33, and INSERM U1116, and University Hospital Nancy and Université de Lorraine and F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France (P.R., F.Z.); Vascular and Oncological Interventional Radiology Department, Hôpital Européen Georges Pompidou, Paris, France (M.S.); and University Hospital La Timone, Marseille, France (B.V.)
| | - Michel Azizi
- From the Hopital Saint André, University Hospital of Bordeaux, France (P.G., A.C.); Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigations Cliniques 1418, Paris, France (H.P., G.C., M.A.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, Paris, France (G.B., M.M., M.A.); Paris-Descartes University, Paris, France (G.C., M.A.); Service de médecine Interne et Hypertension artérielle Pole Cardiovasculaire et métabolique, University Hospital Rangueil, Toulouse, France (B.C.); Cardiology Department, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France (P.-Y.C.); Hôpital Cardiologique, Service de médecine vasculaire et HTA, University Hospital Lille, France (P.D., P.L., C.M.-V.); Arthur Gardiner Hospital, Dinard, France (T.D.); University Hospital of Rennes, France (C.D.); Department of Cardiology, University Hospital Nice, France (E.F.); Unité de Prévention Cardio Vasculaire, University Hospital Pitié-Salpêtrière, Paris, France (X.G.); Service de Néphrologie-Immunologie clinique, University hospital Tours et EA4245 Université François-Rabelais, Tours, France (J.M.H.); Department of Cardiology, University Hospital Poitiers, France (D.H.); University Hospital Avicenne-APHP, Bobigny, France (J.-J.M.); Department of Cardiology, University Hospital and INSERM U1039, Bioclinic Radiopharmaceutics Laboratory, Grenoble, France (O.O.); Department of Medicine and Hypertension, University Hospital of Montpellier, France (J.R.); INSERM, Centre d'Investigations Cliniques, Plurithématique 14-33, and INSERM U1116, and University Hospital Nancy and Université de Lorraine and F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France (P.R., F.Z.); Vascular and Oncological Interventional Radiology Department, Hôpital Européen Georges Pompidou, Paris, France (M.S.); and University Hospital La Timone, Marseille, France (B.V.)
| |
Collapse
|
45
|
Boulestreau R, Cremer A, Laine M, Gaillard P, Papaioannou G, Gosse P. Primary aldosteronism and left ventricle in 2D echocardiography: new insights. Archives of Cardiovascular Diseases Supplements 2017. [DOI: 10.1016/s1878-6480(17)30276-8] [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: 10/19/2022]
|
46
|
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.
Collapse
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)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Abstract
Left ventricular hypertrophy (LVH), which describes pathological changes in cardiac structure, is a powerful and reversible predictor of cardiovascular risk. There is a continuous relationship between left ventricular mass (LVM) and the likelihood of cardiovascular events, with no cut-off between the absence of such events and heightened risk. A correlation between LVH and blood pressure is well established. There is a paradox, however, that the structural changes to the heart as a result of increased workload due to high blood pressure appear to promote cardiovascular disease. This may be partially explained by the fact that ambulatory blood pressure measurements correlate more closely with LVH than resting blood pressure. Blood pressure variation throughout the day is also emerging as an important correlate of LVH, and a strong association has been identified between an early morning rise in blood pressure and increased LVM. Use of anti-hypertensive agents not only lowers blood pressure, but can also bring about LVH regression. The pathological role of angiotensin II in LVH and target-organ damage within the cardiovascular continuum suggest that agents targeting the renin – angiotensin - aldosterone system (RAAS), such as the angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers, may prove particularly effective and may confer beneficial effects in addition to the lowering of blood pressure. The angiotensin II receptor blockers may be very appropriate treatment options because of their placebo-like tolerability and the possibility of more complete blockade of the RAAS. Within this class of anti-hypertensive agents, pharmacological differences may mean that some agents afford greater cardioprotection than others.
Collapse
Affiliation(s)
- P Gosse
- Cardiology Service-Arterial Hypertension, Hospital Saint-André, Bordeaux, France.
| |
Collapse
|
48
|
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.
Collapse
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.
| |
Collapse
|
49
|
Cremer A, Lainé M, Papaioannou G, Yeim S, Gosse P. Increased arterial stiffness is an independent predictor of atrial fibrillation in hypertensive patients. J Hypertens 2015; 33:2150-5. [DOI: 10.1097/hjh.0000000000000652] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
50
|
Affiliation(s)
- Michel Azizi
- Paris-Descartes University, 75006 Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, Paris, France; INSERM, CIC1418, Paris, France.
| | | | - Guillaume Bobrie
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, Paris, France
| | - Philippe Gosse
- Centre Hospitalier Universitaire de Bordeaux Hôpital Saint André, Cardiology/Hypertension Department, Bordeaux, France
| | - Gilles Chatellier
- Paris-Descartes University, 75006 Paris, France; INSERM, CIC1418, Paris, France
| |
Collapse
|