Publications by authors named "Daniel Herpin"

30 Publications

  • Page 1 of 1

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 Oct 10;6(10). Epub 2017 Oct 10.

INSERM CIC1418 Assistance Publique-Hôpitaux de Paris Hôpital Européen Georges Pompidou, Paris, France

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 (=0.0462) in the lowest tertile and -2.5 mm Hg (=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 m) but decreased in the control group (-8.0 mL/min per 1.73 m, =0.0148). In the 2 highest tertiles of AAC volume, estimated glomerular filtration rate decreased similarly in the RDN and control groups (=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.
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http://dx.doi.org/10.1161/JAHA.117.007062DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5721886PMC
October 2017

Twenty-Four-Hour Blood Pressure Monitoring to Predict and Assess Impact of Renal Denervation: The DENERHTN Study (Renal Denervation for Hypertension).

Hypertension 2017 03 23;69(3):494-500. Epub 2017 Jan 23.

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.).

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 (=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%; =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.
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http://dx.doi.org/10.1161/HYPERTENSIONAHA.116.08448DOI Listing
March 2017

Net Blood Pressure Reduction Following 9 Months of Lifestyle and High-Intensity Interval Training Intervention in Individuals With Abdominal Obesity.

J Clin Hypertens (Greenwich) 2016 11 29;18(11):1128-1134. Epub 2016 Apr 29.

Cardiovascular Prevention and Rehabilitation Center (ÉPIC), Montreal Heart Institute, Montreal, Canada.

The authors aimed to study the impact of a combined 9-month lifestyle program (Mediterranean diet nutritional counselling, and high-intensity interval training twice a week) on blood pressure (BP) in individuals with abdominal obesity, taking into account the regression-to-the-mean phenomena. A total of 115 participants (53±9 years; 84 women; waist circumference [WC]: 111±13 cm; systolic/diastolic BP [SBP/DBP]: 133±13/82±8 mm Hg; 13% diabetics; 12% smokers; and 30% taking antihypertensive therapy) were retrospectively analyzed before and after the program. After 9 months, we observed an improvement in weight (-5.2±5.6 kg) and WC (-6.3±6.0 cm), and an average SBP/DBP net decrease of -5.1±13.7/-2.8±8.7 mm Hg. These changes were not uniform: 67 participants (58%) decreased their SBP by 2 mm Hg or more. The characteristics of responders included a higher baseline BP than nonresponders (SBP/DBP: 137.2±13.7/83.1±7.3 mm Hg vs 127.0±10.3/80.0±7.3 mm Hg, P<.05) and a higher proportion of participants with a baseline BP ≥130/85 mm Hg (81% vs 52%, P=.001) or with the metabolic syndrome (75% vs 54%, P=.02).
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http://dx.doi.org/10.1111/jch.12829DOI Listing
November 2016

Adherence to Antihypertensive Treatment and the Blood Pressure-Lowering Effects of Renal Denervation in the Renal Denervation for Hypertension (DENERHTN) Trial.

Circulation 2016 Sep 30;134(12):847-57. Epub 2016 Aug 30.

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 Hospitalier Universitaire de Bordeaux, Hôpital Saint André, Cardiology/Hypertension Department, France (P.G.); Institut Mutualiste Montsouris, Paris, France (M.M.); Centre Hospitalier Régional Universitaire de Lille, Hôpital Cardiologique, Médecine Vasculaire et HTA, France (P.D., C.M.-V.); Hôpital Croix-Rousse, Cardiology Department, European Society of Hypertension Excellence Centre, Hospices Civils de Lyon, and Université de Lyon, CREATIS UMR5220; INSERM U1044; INSA-Lyon; Université Claude Bernard Lyon 1; Hospices Civils de Lyon, France (P.-Y.C., P.L.); Hôpital Arthur Gardiner, Centre d'excellence en HTA Rennes-Dinard, France (T.D.); Centre Hospitalier Universitaire de Rennes, Service de Cardiologie et Maladies Vasculaires, France (C.D.-C.); Assistance Publique-Hôpitaux de Paris, Hôpital de la Pitié Salpétrière, France (X.G.); Hôpital Bretonneau, Tours, France (J.M.H.); CHU Nancy-Brabois, Nancy, France (F.Z.); CHU de Grenoble, France (O.O.); CHU de la Timone, Marseille, France (B.V.); CHU de Poitiers, Cardiologie, France (D.H.); CHRU Montpellier, France (J.R.); CHU Rangueil, Toulouse, France (B.C.); Hôpital Avicenne, Bobigny, France (J.-J.M.); Hôpital Pasteur, Nice, France (E.F.); INSERM, UMR 1129, Paris, France (V.J.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Vascular and Oncological Interventional Radiology Department, France (M.S.).

Background: The DENERHTN trial (Renal Denervation for Hypertension) confirmed the blood pressure-lowering efficacy of renal denervation added to a standardized stepped-care antihypertensive treatment for resistant hypertension at 6 months. We report the influence of adherence to antihypertensive treatment on blood pressure control.

Methods: One hundred six patients with hypertension resistant to 4 weeks of treatment with indapamide 1.5 mg/d, ramipril 10 mg/d (or irbesartan 300 mg/d), and amlodipine 10 mg/d were randomly assigned to renal denervation plus standardized stepped-care antihypertensive treatment, or the same antihypertensive treatment alone. For standardized stepped-care antihypertensive treatment, spironolactone 25 mg/d, bisoprolol 10 mg/d, prazosin 5 mg/d, and rilmenidine 1 mg/d were sequentially added at monthly visits if home blood pressure was ≥135/85 mm Hg after randomization. We assessed adherence to antihypertensive treatment at 6 months by drug screening in urine/plasma samples from 85 patients.

Results: The numbers of fully adherent (20/40 versus 21/45), partially nonadherent (13/40 versus 20/45), or completely nonadherent patients (7/40 versus 4/45) to antihypertensive treatment were not different in the renal denervation and the control groups, respectively (P=0.3605). The difference in the change in daytime ambulatory systolic blood pressure from baseline to 6 months between the 2 groups was -6.7 mm Hg (P=0.0461) in fully adherent and -7.8 mm Hg (P=0.0996) in nonadherent (partially nonadherent plus completely nonadherent) patients. The between-patient variability of daytime ambulatory systolic blood pressure was greater for nonadherent than for fully adherent patients.

Conclusions: In the DENERHTN trial, the prevalence of nonadherence to antihypertensive drugs at 6 months was high (≈50%) but not different in the renal denervation and control groups. Regardless of adherence to treatment, renal denervation plus standardized stepped-care antihypertensive treatment resulted in a greater decrease in blood pressure than standardized stepped-care antihypertensive treatment alone.

Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01570777.
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http://dx.doi.org/10.1161/CIRCULATIONAHA.116.022922DOI Listing
September 2016

SFE/SFHTA/AFCE consensus on primary aldosteronism, part 7: Medical treatment of primary aldosteronism.

Ann Endocrinol (Paris) 2016 Jul 14;77(3):226-34. Epub 2016 Jun 14.

Service d'endocrinologie, diabète et maladies métaboliques, centre hospitalier universitaire, 76031 Rouen, France. Electronic address:

Spironolactone, which is a potent mineralocorticoid receptor antagonist, represents the first line medical treatment of primary aldosteronism (PA). As spironolactone is also an antagonist of the androgen and progesterone receptor, it may present side effects, especially in male patients. In case of intolerance to spironolactone, amiloride may be used to control hypokaliemia and we suggest that eplerenone, which is a more selective but less powerful antagonist of the mineralocorticoid receptor, be used in case of intolerance to spironolactone and insufficient control of hypertension by amiloride. Specific calcic inhibitors and thiazide diuretics may be used as second or third line therapy. Medical treatment of bilateral forms of PA seem to be as efficient as surgical treatment of lateralized PA for the control of hypertension and the prevention of cardiovascular and renal morbidities. This allows to propose medical treatment of PA to patients with lateralized forms of PA who refuse surgery or to patients with PA who do not want to be explored by adrenal venous sampling to determine whether they have a bilateral or lateralized form.
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http://dx.doi.org/10.1016/j.ando.2016.01.010DOI Listing
July 2016

SFE/SFHTA/AFCE primary aldosteronism consensus: Introduction and handbook.

Ann Endocrinol (Paris) 2016 Jul 15;77(3):179-86. Epub 2016 Jun 15.

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. Electronic address:

The French Endocrinology Society (SFE) French Hypertension Society (SFHTA) and Francophone Endocrine Surgery Association (AFCE) have drawn up recommendations for the management of primary aldosteronism (PA), based on an analysis of the literature by 27 experts in 7 work-groups. PA is suspected in case of hypertension associated with one of the following characteristics: severity, resistance, associated hypokalemia, disproportionate target organ lesions, or adrenal incidentaloma with hypertension or hypokalemia. Diagnosis is founded on aldosterone/renin ratio (ARR) measured under standardized conditions. Diagnostic thresholds are expressed according to the measurement units employed. Diagnosis is established for suprathreshold ARR associated with aldosterone concentrations >550pmol/L (200pg/mL) on 2 measurements, and rejected for aldosterone concentration<240pmol/L (90pg/mL) and/or subthreshold ARR. The diagnostic threshold applied is different if certain medication cannot be interrupted. In intermediate situations, dynamic testing is performed. Genetic forms of PA are screened for in young subjects and/or in case of familial history. The patient should be informed of the results expected from medical and surgical treatment of PA before exploration for lateralization is proposed. Lateralization is explored by adrenal vein sampling (AVS), except in patients under 35 years of age with unilateral adenoma on imaging. If PA proves to be lateralized, unilateral adrenalectomy may be performed, with adaptation of medical treatment pre- and postoperatively. If PA is non-lateralized or the patient refuses surgery, spironolactone is administered as first-line treatment, replaced by amiloride, eplerenone or calcium-channel blockers if insufficiently effective or poorly tolerated.
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http://dx.doi.org/10.1016/j.ando.2016.05.001DOI Listing
July 2016

Prevalence and management of hypertensive patients in clinical practice: Cross-sectional registry in five countries outside the European Union.

Blood Press 2016 ;25(2):104-16

d UFR Médecine et Pharmacie, Université de Poitiers , Poitiers , France ;

Inadequate blood pressure (BP) control may be linked with poor adherence to guidelines by the treating physician. This study aimed at assessing the rates of controlled hypertension as per the 2009 Reappraisal of the 2007 European Society of Cardiology/European Society of Hypertension (ESC/ESH) guidelines in 2185 hypertensive adults across five countries (Algeria, Pakistan, Ukraine, Egypt and Venezuela). The rates of controlled hypertension according to physician perception, type of therapy and risk factors were evaluated. Overall, 40% of patients had controlled hypertension according to the guidelines. A marked divergence in the rates of controlled hypertension as assessed by physicians and guidelines was observed (72% vs 40%). The presence of high/very high risks was linked to poor BP control. High salt intake [29%; odds ratio (OR) 9.94, 95% confidence interval (CI) 6.72;14.69], treatment non-adherence (27%; OR 7.32, 95% CI 4.82;11.13), lack of understanding of the treatment's importance (25%; OR 4.95, 95% CI 3.16;7.75), comorbidity (13%) and depression (9%; OR 10.50, 95% CI 5.37;20.54) were major reasons for not achieving hypertension control. Addition of another drug was the most frequent medication change prescribed. Poor rates of BP control warrant repeated promotion of guidelines while identifying potential contributing factors and implementing strategies that re-establish BP control.
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http://dx.doi.org/10.3109/08037051.2015.1110922DOI Listing
November 2016

Spontaneous baroreflex sensitivity measured early after acute myocardial infarction is an independent predictor of cardiovascular mortality: results from a 12-year follow-up study.

Int J Cardiol 2014 Nov 28;177(1):120-2. Epub 2014 Sep 28.

Université de Poitiers, CIC1402, 86021 Poitiers, France; CHU de Poitiers, Centre d'investigation clinique, 86021 Poitiers, France; Inserm, CIC1402, 86021 Poitiers, France; Université de Poitiers, Faculté de Médecine et de Pharmacie, 86000 Poitiers, France. Electronic address:

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http://dx.doi.org/10.1016/j.ijcard.2014.09.100DOI Listing
November 2014

Cardiovascular prognosis in patients with type 2 diabetes: contribution of heart and kidney subclinical damage.

Am Heart J 2015 Jan 28;169(1):108-14.e7. Epub 2014 Sep 28.

Université de Poitiers, Faculté de Médecine et de Pharmacie, Poitiers, France; Université de Poitiers, CIC1402, Poitiers, France; CHU de Poitiers, Centre d'Investigation Clinique, Poitiers, France; Inserm, CIC1402, Poitiers, France; CHU de Poitiers, Endocrinologie, Poitiers, France.

Background: Left ventricular hypertrophy (LVH) and kidney damage (abnormal urinary albumin-to-creatinine ratio [uACR] or estimated glomerular filtration rate [eGFR]) are predictive of major cardiovascular events (MACE) in patients with type 2 diabetes (T2D) but are rarely used in cardiovascular score calculators. Our study aimed to assess their respective prognostic values for MACE and the additive information they provide to score calculators.

Methods: A total of 1298 T2D (43% women) aged 65 (SD 11) years were followed up for a median of 65 months, with MACE as a primary composite end point: cardiovascular death, nonfatal myocardial infarction, or stroke. Electrocardiogram (ECG)-derived LVH was defined using Sokolow, Gubner, and Cornell product indexes; uACR was considered as abnormal if >2.5 mg/mmol in men or >3.5 mg/mmol in women and eGFR if <60 mL/min per 1.73 m(2).

Results: Urinary albumin-to-creatinine ratio was higher in subjects with electrocardiographic LVH (ECG-LVH) than in subjects without (median [interquartile range] 7.61 [43.48] and 2.56 [10.53], respectively; P < .0001). After adjustment for age, history of myocardial infarction, and peripheral artery disease, ECG-LVH and kidney damage were strong predictors for MACE (adjusted hazard ratio [1.64; 95% CI 1.23-2.20], [1.90; 95% CI 1.43-2.53], and [1.85; 95% CI 1.42-2.41] for ECG-LVH, uACR, and eGFR, respectively). Net reclassification improvement was higher with the model including both ECG-LVH and uACR than models with ECG-LVH alone (P < .0001) or uACR alone (P < .0001). In addition, using cardiovascular risk calculators (Framingham score and others), we observed an additional prognostic value of ECG-LVH for each one of them.

Conclusions: Electrocardiographic LVH is complementary to kidney damage for MACE prediction in T2D.
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http://dx.doi.org/10.1016/j.ahj.2014.09.012DOI Listing
January 2015

[Management of resistant hypertension. Expert consensus statement from the French Society of Hypertension, an affiliate of the French Society of Cardiology].

Presse Med 2014 Dec 20;43(12 Pt 1):1325-31. Epub 2014 Nov 20.

Société française d'hypertension artérielle, 75012 Paris, France.

To improve the management of resistant hypertension, the French Society of Hypertension, an affiliate of the French Society of Cardiology, has published a set of eleven recommendations. The primary objective is to provide the most up-to-date information, based on the strongest scientific rationale and which is easily applicable to daily clinical practice for health professionals working within the French health system. Resistant hypertension is defined as uncontrolled blood pressure (BP) both on office measurements and confirmed by out-of-office measurements despite a therapeutic strategy comprising appropriate lifestyle and dietary measures and the concurrent use of three antihypertensive agents including a thiazide diuretic, a renin-angiotensin system blocker (ARB or ACEI) and a calcium channel blocker, for at least four weeks, at optimal doses. Treatment compliance must be closely monitored, as most factors that are likely to affect treatment resistance (excessive dietary salt intake, alcohol, depression and drug interactions, or vasopressors). If the diagnosis of resistant hypertension is confirmed, the patient should be referred to a hypertension specialist to screen for potential target organ damage and secondary causes of hypertension. The recommended treatment regimen is a combination therapy comprising four treatment classes, including spironolactone (12.5 to 25mg/day). In the event of a contraindication or a non-response to spironolactone, or if adverse effects occur, a β-blocker, an α-blocker, or a centrally acting antihypertensive drug should be prescribed. Because renal denervation is still undergoing assessment for the treatment of hypertension, this technique should only be prescribed by a specialist hypertension clinic.
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http://dx.doi.org/10.1016/j.lpm.2014.07.016DOI Listing
December 2014

Heart failure care in low- and middle-income countries: a systematic review and meta-analysis.

PLoS Med 2014 Aug 12;11(8):e1001699. Epub 2014 Aug 12.

The George Institute for Global Health, University of Oxford, Oxford, United Kingdom.

Background: Heart failure places a significant burden on patients and health systems in high-income countries. However, information about its burden in low- and middle-income countries (LMICs) is scant. We thus set out to review both published and unpublished information on the presentation, causes, management, and outcomes of heart failure in LMICs.

Methods And Findings: Medline, Embase, Global Health Database, and World Health Organization regional databases were searched for studies from LMICs published between 1 January 1995 and 30 March 2014. Additional unpublished data were requested from investigators and international heart failure experts. We identified 42 studies that provided relevant information on acute hospital care (25 LMICs; 232,550 patients) and 11 studies on the management of chronic heart failure in primary care or outpatient settings (14 LMICs; 5,358 patients). The mean age of patients studied ranged from 42 y in Cameroon and Ghana to 75 y in Argentina, and mean age in studies largely correlated with the human development index of the country in which they were conducted (r = 0.71, p<0.001). Overall, ischaemic heart disease was the main reported cause of heart failure in all regions except Africa and the Americas, where hypertension was predominant. Taking both those managed acutely in hospital and those in non-acute outpatient or community settings together, 57% (95% confidence interval [CI]: 49%-64%) of patients were treated with angiotensin-converting enzyme inhibitors, 34% (95% CI: 28%-41%) with beta-blockers, and 32% (95% CI: 25%-39%) with mineralocorticoid receptor antagonists. Mean inpatient stay was 10 d, ranging from 3 d in India to 23 d in China. Acute heart failure accounted for 2.2% (range: 0.3%-7.7%) of total hospital admissions, and mean in-hospital mortality was 8% (95% CI: 6%-10%). There was substantial variation between studies (p<0.001 across all variables), and most data were from urban tertiary referral centres. Only one population-based study assessing incidence and/or prevalence of heart failure was identified.

Conclusions: The presentation, underlying causes, management, and outcomes of heart failure vary substantially across LMICs. On average, the use of evidence-based medications tends to be suboptimal. Better strategies for heart failure surveillance and management in LMICs are needed. Please see later in the article for the Editors' Summary.
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http://dx.doi.org/10.1371/journal.pmed.1001699DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4130667PMC
August 2014

Effect of Cornell product and other ECG left ventricular hypertrophy criteria on various cardiovascular endpoints in type 2 diabetic patients.

Int J Cardiol 2014 Jul 29;175(1):193-5. Epub 2014 Apr 29.

Université de Poitiers, Faculté de Médecine et de Pharmacie, Poitiers, France; Université de Poitiers, CIC1402, Poitiers, France; CHU de Poitiers, Centre d'Investigation Clinique, Poitiers, France; Inserm, CIC1402, Poitiers, France; CHU de Poitiers, Endocrinologie, Poitiers, France.

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http://dx.doi.org/10.1016/j.ijcard.2014.04.242DOI Listing
July 2014

Prevalence and management of uncontrolled hypertension in French patients aged over 80 years.

Arch Cardiovasc Dis 2014 Apr 22;107(4):236-44. Epub 2014 Apr 22.

Université de Poitiers, UFR médecine et pharmacie, 86000 Poitiers, France; CHU de Poitiers, cardiologie, 86000 Poitiers, France.

Background: The rate of uncontrolled hypertensives aged >80 years is not well known. The available literature on this topic has used the threshold <140/90 mmHg, whereas there is now a consensus for a different target: systolic blood pressure (SBP)<150 mmHg.

Aims: This prospective observational population-based study sought to assess the frequency and management of uncontrolled hypertension in French patients aged ≥80 years.

Methods: Nine hundred and seventy-one treated hypertensive outpatients were evaluable (204 recruited by cardiologists, 767 by general practitioners [GPs]; mean age 84.8 ± 3.8 years; 57.8% women).

Results: The frequency of SBP ≥ 150 mmHg was 36.6% (44.6% in cardiologists' patients and 34.4% in GPs' patients). The frequency of satisfaction with SBP ≥ 150 mmHg was 22.0% for cardiologists (32.6% if diastolic blood pressure [DBP] <90 mmHg and 9.5% if ≥90 mmHg; P=0.008) and 30.4% for GPs (51.7% if DBP <90 mmHg and 13.2% if ≥90 mmHg; P<0.0001). Non-diabetic status (for cardiologists) and DBP <90 mmHg (for cardiologists and GPs) were independent determinants of SBP being considered acceptable. Accordingly, in patients with an SBP level ≥ 150 mmHg that was considered too high, treatment was reinforced more often if DBP was ≥90 mmHg (82.3%) than <90 mmHg (68.5%).

Conclusion: In France, hypertension is uncontrolled in more than one in three elderly hypertensives. Physicians are aware that SBP should be lowered to <150 mmHg in patients aged>80 years, but when the target is not reached they are less likely to increase treatment if DBP is <90 mmHg.
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http://dx.doi.org/10.1016/j.acvd.2014.03.002DOI Listing
April 2014

How are physicians prescribing the direct renin inhibitor aliskiren in the management of essential hypertension? A French observational study.

J Hypertens 2013 Jul;31(7):1491-6; discussion 1496

CHU de Poitiers, Cardiology Department, Poitiers, France.

Objectives: The aim of this French observational study was to evaluate how the direct renin inhibitor aliskiren is being prescribed to treat hypertension by primary care providers (PCPs) and office-based cardiologists.

Methods: Each participating physician included the first three consecutive hypertensive patients who had been prescribed aliskiren at least 4 weeks beforehand and noted whether aliskiren was prescribed: alone or as part of a combination; as first-line therapy, to replace another drug or as an add-on therapy.

Results: Five thousand, four hundred and eleven patients were analyzed [mean age, 63; 58% men; 24% diabetic; mean blood pressure (BP) 148/85 mmHg]. A total of 23.6% of patients had a controlled BP. Aliskiren was prescribed alone in 49.4% patients and as part of a combination in 50.6% (bitherapy 28.3%, tritherapy 14.7%, and quadri+therapy 7.6%), at the higher recommended dosage (300 mg daily) to two-thirds of cases. Aliskiren replaced another drug in 71.9% [mainly an angiotensin receptor blocker (ARB) or an angiotensin-converting enzyme inhibitor (ACEi)] and was added to an existing regimen in 22.5%. For bitherapy, aliskiren was combined with a diuretic (D; 39%) or a calcium channel blocker (CCB; 32%). For tritherapy, it was prescribed with CCB and D in 28% and β-blocker and D in 26%. In 8.9% of patients, aliskiren was prescribed with an ACEi or an ARB.

Conclusion: French physicians are generally following the current prescribing recommendations for aliskiren, but the place of this new class of antihypertensive in the management of essential hypertension will become clearer with longer experience, especially concerning effective doses and combinations.
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http://dx.doi.org/10.1097/HJH.0b013e328360f716DOI Listing
July 2013

Prevalence of heart failure with preserved ejection fraction in Latin American, Middle Eastern, and North African Regions in the I PREFER study (Identification of Patients With Heart Failure and PREserved Systolic Function: an epidemiological regional study).

Am J Cardiol 2011 Nov;108(9):1289-96

Centro Médico Nacional Siglo XXI, Mexico City, Mexico.

The aims of the present study were to estimate the prevalence of heart failure (HF) with preserved ejection fraction (HF-PEF) in patients with HF and to compare their clinical characteristics with those with reduced ejection fraction in non-Western countries. The left ventricular ejection fraction ≥ 45% if measured < 1 year before the visit was used to qualify the patients as having HF-PEF. Of the 2,536 consecutive outpatients with HF, 1990 (79%) had the EF values recorded. Of these patients, 1291 had HF-PEF, leading to an overall prevalence of 65% (95% confidence interval 63% to 67%). Compared to the patients with HF and a reduced ejection fraction, those with HF-PEF were more likely to be older (65 vs 62 years, p < 0.001), female (50% vs 28%, p < 0.001), and obese (39% vs 27%, p < 0.001). They more frequently had a history of hypertension (78% vs 53%, p < 0.001) and atrial fibrillation (29% vs 24%, p = 0.03) and less frequently had a history of myocardial infarction (21% vs 44%, p < 0.001). Only 29% of patients with HF-PEF and hypertension had optimal blood pressure control. Left ventricular hypertrophy was less frequent in those with HF-PEF (58% vs 69%, p < 0.001). The prevalence of HF-PEF was lower in the Middle East (41%), where coronary artery disease was more often found than in Latin America (69%) and North Africa (75%), where the rate of hypertension was greater. In conclusion, in the present diverse non-Western study, HF-PEF represented almost 2/3 of all HF cases in outpatients. HF-PEF mostly affects older patients, women, and the obese. Hypertension was the most frequently associated risk factor, highlighting the need for optimal blood pressure control.
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http://dx.doi.org/10.1016/j.amjcard.2011.06.044DOI Listing
November 2011

[Hypertensive emergencies in adults: a practical review].

Presse Med 2010 Oct 23;39(10):1026-31. Epub 2010 May 23.

Université de Poitiers, CHU de Poitiers, centre de prévention des maladies cardiaques et vasculaires, Poitiers, faculté de médecine et de pharmacie, 86021 Poitiers, France.

Hypertensive emergencies must be distinguished from severe blood pressure elevations without acute target organ damage. Clinical examination (chest pain, dyspnoea, neurological disorders, ECG, retinal examination) and laboratory tests (blood and urine tests, cerebral imaging in case of neurological disorders) have to be immediately performed. Immediate referral to an intensive care unit is indicated, and an intravenous antihypertensive therapy has to be implemented. Blood pressure objectives depend on the associated acute pathology (myocardial infarction, pulmonary oedema, aortic dissection, severe pre-eclampsia and eclampsia of pregnancy, hypertensive encephalopathy, retinopathy, subarachnoid hemorrhage, cerebral hemorrhage, ischemic stroke treated or not with thrombolysis).
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http://dx.doi.org/10.1016/j.lpm.2010.03.015DOI Listing
October 2010

Real three-dimensional assessment of left atrial and left atrial appendage volumes by 64-slice spiral computed tomography in individuals with or without cardiovascular disease.

Int J Cardiol 2010 Apr 23;140(2):189-96. Epub 2008 Dec 23.

Department of Cardiology, Poitiers University Hospital, France.

Context: Left atrial (LA) volume is a prognosis factor of cardiovascular morbidity in patients with cardiovascular disease (CD). Recent developments of multislice computed tomography (MSCT) have made non invasive coronary angiography reliable for selected patients and new software facilitates truly volume measurements without geometrical assumptions.

Objective: To define, by using MSCT, LA and left atrial appendage (LAA) volumes in patients with or without CD.

Methods And Results: In the population of patients referred to our laboratory for a conventional MSCT coronary angiography, 40 individuals without CD (Normal group) and 80 patients with CD (CD group) were prospectively selected. The CD group was constituted from 4 subgroups of patients with either coronary artery disease (n=20), idiopathic dilated cardiomyopathy (n=20), left ventricular hypertrophy (n=20) or severe mitral regurgitation (MR group, n=20). LAA and LA volumes were measured on a commercially available workstation. LA maximal and minimal volumes were lower in Normal group than in CD group, as LA ejection fraction (54+/-10 versus 67+/-20 ml/m(2), p<0.0001; 31+/-8 versus 46+/-20 ml/m(2), p<0.0001; 43+/-8% versus 33+/- 14%, p<0.001). LAA volume was larger in MR group than in Normal group (15+/-7 ml versus 9+/-3 ml, p<0.0001).

Conclusion: This MSCT study provides normal values of LA and LAA volumes for patients who underwent MSCT coronary angiography and suggests that MSCT is helpful to assess the changes of LA volumes related to various CD.
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http://dx.doi.org/10.1016/j.ijcard.2008.11.055DOI Listing
April 2010

Heart transplantation in systemic (AL) amyloidosis: a retrospective study of eight French patients.

Arch Cardiovasc Dis 2008 Sep 17;101(9):523-32. Epub 2008 Nov 17.

Department of Cardiology, CHU of Poitiers, University of Poitiers, Poitiers, France.

Background: Immunoglobulinic (AL) amyloidosis is a complication of plasma cell dyscrasia, characterized by widespread deposition of amyloid fibrils derived from monoclonal light chains. Cardiac amyloid is the main prognostic factor, with a median survival of six months. Cardiac transplantation in AL amyloidosis is associated with high mortality, due to disease recurrence in the allograft and systemic progression. Suppression of light chain (LC) production with chemotherapy by melphalan plus dexamethasone (MD) or high dose melphalan followed by autologous stem cell transplantation (HDM/ASCT) improves survival. However, both the indications and results of chemotherapy in patients transplanted for cardiac AL amyloidosis remain unclear.

Aims: To assess the outcome of cardiac transplantation and haematological therapy in patients with cardiac AL amyloidosis.

Methods: Eight French patients, who underwent heart transplantation for cardiac AL amyloidosis between 2001 and 2006 were studied retrospectively.

Results: Before transplantation, six patients received MD (n=5) or HDM/ASCT (n=1). Haematological remission was obtained in three patients treated with MD. In the three remaining patients, postoperative HDM/ASCT (n=2) or allogeneic bone marrow transplantation (n=1) resulted in haematological remission in one patient. In 2 patients not treated before transplantation, post-operative treatment with MD resulted in complete hematological remission in one. After a median follow-up of 26 months from cardiac transplantation, six patients were alive and four had sustained haematological remission, as indicated by normal serum free LC levels.

Conclusion: Appropriate haematological therapy, including MD, may result in a survival benefit in AL amyloidosis patients with advanced heart failure requiring transplantation.
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http://dx.doi.org/10.1016/j.acvd.2008.06.018DOI Listing
September 2008

Successful heart transplantation following melphalan plus dexamethasone therapy in systemic AL amyloidosis.

Haematologica 2008 Mar;93(3):e32-5

Department of Clinical Hematology, CHU Limoges, 1 avenue Martin Luther King, 87000 Limoges, France.

Recurrence in the allograft and progression in other organs increase mortality after cardiac transplantation in AL amyloidosis. Survival may be improved after suppression of monoclonal light chain (LC) production following high dose melphalan and autologous stem cell transplantation (HDM/ASCT). However, because of high treatment related mortality, this tandem approach is restricted to few patients without significant extra-cardiac involvement. A diagnosis of systemic AL amyloidosis was established in a 45-year old patient with congestive heart failure related to restrictive cardiomyopathy, nephrotic syndrome, peripheral neuropathy, postural hypotension, macroglossia, and lambda LC monoclonal gammopathy. After melphalan and dexamethasone (M-Dex) therapy, which resulted in 80% reduction of serum free lambda LC, he underwent orthotopic cardiac transplantation. Two years later, he remains in a sustained hematologic remission, with no evidence of allograft or extra-cardiac amyloid accumulation. M-Dex should be considered as an alternative therapy in AL amyloid heart transplant recipients ineligible for HDM/ASCT.
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http://dx.doi.org/10.3324/haematol.12108DOI Listing
March 2008

A new method for measurement of left atrial volumes using 64-slice spiral computed tomography: comparison with two-dimensional echocardiographic techniques.

Int J Cardiol 2009 Jan 4;131(2):217-24. Epub 2008 Jan 4.

Département de Cardiologie, Centre Hospitalo-Universitaire de Poitiers, France.

Background: Left atrial (LA) volume, is related to cardiovascular morbidity. LA enlargement is usually assessed using trans-thoracic echocardiography (TTE). The association of modern multislice computed tomography (MSCT) imaging and new 3D reconstruction software, allows direct cardiac chamber volume measurement without geometrical assumptions. This study was designed to evaluate the maximal (LAmax) and minimal (LAmin) LA volumes during the cardiac cycle using MSCT and TTE approaches.

Methods: We screened 26 consecutive patients referred for coronary imaging using a 64-MSCT scanner and a TTE within 12 h. Contiguous multiphase images were generated from axial MSCT data and semi-automated 3D segmentation technique was applied to generate LA volumes. Using TTE, LA volumes and LA ejection fraction (LAEF) were obtained using five assumptions methods: cubing equation, diameter-length formula, area-length formula, ellipsoidal formula and biplane Simpson rule.

Results: Five patients were excluded for inadequate TTE visualization and one for ectopic beats during MSCT. The sample consisted in 20 patients (11 men, age: 56+/-14 years). Using MSCT, LA volumes indexed to body surface area were: LAmax=74+/-27 ml/m(2), LAmin=49+/-26 ml/m(2), with close correlations with TTE measurements and a significant underestimation by all TTE approaches. A close correlation was observed between LAEF using MSCT and TTE Simpson's method: 36+/-14% vs. 37+/-14%, r=0.99, p<0.0001.

Conclusion: Theses results suggest that the assessment of LA volumes and ejection fraction was reliable using 64-MSCT in patients referred for coronary computed tomography imaging.
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http://dx.doi.org/10.1016/j.ijcard.2007.10.020DOI Listing
January 2009

[Management of hypertension in patients with diabetes].

Presse Med 2006 Jun;35(6 Pt 2):1041-6

Département de Cardiologie, CHU Poitiers.

Cardiovascular risk is generally high in patients with both hypertension and diabetes and should be specifically assessed for each individual. The blood pressure target is<130/80 mm Hg. Two or even three different drugs are often necessary to reach this rather difficult goal. Angiotensin-converting enzyme (ACE) inhibitors are preferred for patients with renal damage. Proteinuria should be reduced to less than 0.5 g/day. Associated risk factors should be treated with equal effectiveness. In particular, LDL cholesterol should be lowered to less than 1 g/L when additional risk factors are present. Aspirin (0.75 mg a day) should be given routinely as soon as blood pressure is controlled.
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http://dx.doi.org/10.1016/s0755-4982(06)74745-5DOI Listing
June 2006

Blunt renal trauma-induced hypertension: prevalence, presentation, and outcome.

Am J Hypertens 2006 May;19(5):500-4

Hypertension unit, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, and Université René Descartes, Paris, France.

Background: Blunt renal trauma (RT) may cause hypertension. We assessed the frequency and mechanisms of RT, and blood pressure (BP) outcome after treatment.

Methods: We searched the records of all patients referred to our hypertension unit and included those of previously normotensive patients who developed hypertension within 6 months of RT.

Results: Ten of the 17,410 referred patients, with a median age of 26 years, developed hypertension 0 to 3 months after a well-documented RT. Median BP at referral was 170/107 mm Hg. Median glomerular filtration rate was 89 mL/min. Five patients had hematuria. Median kidney length was 107 mm on the damaged side and 114 mm on the opposite side. Renal artery lesions were present in six cases. A pattern of unilateral renin hypersecretion and contralateral suppression was present in five of eight cases with unilateral RT. Six patients underwent surgery. Seven months after referral, median BP was 128/79 mm Hg. The BP was <140/90 mm Hg without medication in one patient who did not undergo surgery and in three patients who did.

Conclusions: Renal trauma is a rare cause of hypertension, mostly in young men. Hypertension is usually renin dependent and associated with parenchymal injury. The RT-induced hypertension may resolve spontaneously and is amenable to surgery.
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http://dx.doi.org/10.1016/j.amjhyper.2005.08.015DOI Listing
May 2006

Home blood pressure during normal pregnancy.

Am J Hypertens 2005 Sep;18(9 Pt 1):1178-80

Dinard Hospital and Biotrial, 35800 Rennes, France.

To determine values for home blood pressure (HBP) during pregnancy, nurses taught 45 healthy pregnant women to use a HBP method for 1 week before 15 weeks of gestation, between weeks 15 and 27, and after 28 weeks for the last 3 months of gestation. HBP values were significantly lower during the second trimester and higher during the last trimester (102 +/- 8/59 +/- 7*, 101 +/- 8/57 +/- 8*, 105 +/- 8*/62 +/- 9* mm Hg;*P< 0.05) than during other trimesters. Heart rate increased significantly during the pregnancy. The present study suggests upper limits for HBP: 118/73, 117/73, and 121/80 mm Hg, respectively during the 3-month gestational periods. These findings may be helpful in providing clinicians with comparative values so as begin to establish reference values for HBP during pregnancy.
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http://dx.doi.org/10.1016/j.amjhyper.2005.03.736DOI Listing
September 2005

The left atrial appendage, a small, blind-ended structure: a review of its echocardiographic evaluation and its clinical role.

Chest 2005 Sep;128(3):1853-62

University Hospital of Rennes, France.

The increasing prevalence of stroke and atrial fibrillation is a stimulus for new therapeutic strategies and also warrants a review of imaging modalities of the most important source of cardiac systemic embolic events: the left atrial appendage (LAA). This blind-ended, complex structure is embryologically distinct from the body of the left atrium and is sometimes regarded as just a minor extension of the atrium. However, it should routinely be analyzed as part of a transesophageal echocardiographic (TEE) examination. A pulsed Doppler TEE analysis of LAA emptying flow should supplement a two-dimensional (2-D) analysis; these examinations have proven to be highly reproducible and to help assess thromboembolic risk. In 2-D imaging, potential thrombus and spontaneous echo contrast should be sought. In addition, LAA plays a hemodynamic role that participates in atrial function and is influenced by various hemodynamic conditions. In view of the embolic risks from a dysfunctional appendage, the LAA is often ligated during cardiac valve surgery. New devices are under evaluation for percutaneous closure of the LAA, and further studies should improve the definition, understanding, and treatment of LAA dysfunction.
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http://dx.doi.org/10.1378/chest.128.3.1853DOI Listing
September 2005

Tissue Doppler echocardiographic quantification. Comparison to coronary angiography results in Acute Coronary Syndrome patients.

Cardiovasc Ultrasound 2005 Apr 8;3:10. Epub 2005 Apr 8.

Department of Cardiology, University Hospital La Miletrie, 86021 POITIERS - France.

Background: Multiples indices have been described using tissue Doppler imaging (DTI) capabilities. The aim of this study was to assess the capability of one or several regional DTI parameters in separating control from ischemic myocardium.

Methods: Twenty-eight patients with acute myocardial infarction were imaged within 24-hour following an emergent coronary angioplasty. Seventeen controls without any coronary artery or myocardial disease were also explored. Global and regional left ventricular functions were assessed. High frame rate color DTI cineloop recordings were made in apical 4 and 2-chamber for subsequent analysis. Peak velocity during isovolumic contraction time (IVC), ejection time, isovolumic relaxation (IVR) and filling time were measured at the mitral annulus and the basal, mid and apical segments of each of the walls studied as well as peak systolic displacement and peak of strain.

Results: DTI-analysis enabled us to discriminate between the 3 populations (controls, inferior and anterior AMI). Even in non-ischemic segments, velocities and displacements were reduced in the 2 AMI populations. Peak systolic displacement was the best parameter to discriminate controls from AMI groups (wall by wall, p was systematically < 0.01). The combination IVC + and IVR< 1 discriminated ischemic from non-ischemic segments with 82% sensitivity and 85% specificity.

Conclusion: DTI-analysis appears to be valuable in ischemic heart disease assessment. Its clinical impact remains to be established. However this simple index might really help in intensive care unit routine practice.
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http://dx.doi.org/10.1186/1476-7120-3-10DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1084356PMC
April 2005

Quantitative regional analysis of left atrial function by Doppler tissue imaging-derived parameters discriminates patients with posterior and anterior myocardial infarction.

J Am Soc Echocardiogr 2005 Jan;18(1):32-8

Department of Cardiology, University Hospital La Miletrie, 86021 Poitiers, France.

Background: Doppler tissue imaging can now be used for the assessment of left atrial (LA) function. LA function was evaluated by this technique in a group of patients hospitalized for acute myocardial infarction and in a control population.

Methods: Patients were all prospectively imaged with a scanner. To study the LA, a region of interest was located in the proximal part of the lateral and septal LA walls. Doppler tissue imaging, tissue tracking, strain, and delays were recorded.

Results: In all, 12 patients with posterior (age 54 +/- 9 years) and 13 with anterior (age 64 +/- 16 years) acute myocardial infarction, along with 16 control patients (age 54 +/- 9 years), were analyzed. Early diastolic septal velocity was found to be the best parameter for discriminating among the 3 groups. Peak strain was also relevant and did not correlate with left ventricular function.

Conclusions: LA is accessible to Doppler tissue imaging analysis. Strain can quantify LA function relatively independently of left ventricular function, and may provide new insights on LA function.
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http://dx.doi.org/10.1016/j.echo.2004.08.004DOI Listing
January 2005

Automated office and home phone-transmitted blood pressure recordings in uncontrolled hypertension treated with valsartan and hydrochlorothiazide.

Blood Press Suppl 2004 Dec;2:18-24

Service d'Endocrinologie et Métabolisme, Hôpital de La Pitié, Paris, France.

The study objective was to evaluate, by means of automated office and phone-transmitted home blood pressure (OBP and HBP) recordings, the effects of a fixed combination of valsartan 160 mg and hydrochlorothiazide (HCTZ) 25 mg in hypertensive patients previously uncontrolled with the combination of an angiotensin receptor antagonist and HCTZ. From 241 selected patients, 171 (71%) had uncontrolled hypertension OBP and HBP [mean baseline OBP and HBP systolic and diastolic (SBP/DBP): 157/91 and 152/87 mmHg]. In this open-design study, patients were directly switched from other angiotensin receptor blocker combination products to valsartan/HCTZ for 6 weeks. The same validated automated device was used for OBP and HBP recordings. At baseline, mean HBP was 152 +/- 15/87 +/- 10 mmHg and mean OBP was 157 +/- 12/91 +/- 9 mmHg. After 6 weeks of treatment with valsartan 160 mg and HCTZ 25 mg, a significant decrease in BP was observed both at home (146 +/- 17/83 +/- 12 mmHg) and at the office (151 +/- 18/87 +/- 11 mmHg), with a difference from baseline of -4 mmHg, p < 0.001 for DBP and of -6 mmHg for SBP, p < 0.001. The percentage of patients with office and home control was 24% and 23% respectively, with a kappa index at 0.459. Elevated OBP only (office hypertension) was observed in 3.6% and elevated HBP only (masked hypertension) in 10% of patients. In conclusion, treatment with valsartan and HCTZ 25 mg in patients with confirmed uncontrolled hypertension induced a clinically relevant decrease in BP with approximately 23% of additional patients strictly controlled with a single tablet. The use of an automated oscillometric device at the office and at home allowed the detection of controlled subjects with good agreement.
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http://dx.doi.org/10.1080/08038020410004756DOI Listing
December 2004

Anatomic M-mode, a pertinent tool for the daily practice of transthoracic echocardiography.

J Am Soc Echocardiogr 2004 Sep;17(9):962-7

Department de Cardiologie, Centre Hospitaler Universitaire La Miletrie, Poitiers, France.

Objectives: We sought to compare anatomic M-mode (AMM), a new echocardiographic postprocessing option, and conventional M-mode (CMM) using fundamental imaging and tissue harmonic imaging.

Methods: Transthoracic echocardiography was performed in 15 selected patients to analyze the reproducibility of AMM and in 47 patients to assess its clinical value versus CMM. Acquisitions were performed successively: CMM fundamental imaging; CMM tissue harmonic imaging; tissue harmonic imaging cineloops for AMM; and fundamental imaging cineloops for AMM. Quantitative analysis was performed offline. The angle alpha between the CMM line and the septal endocardial interface was calculated and the expected percentage of error in measuring left ventricular diameter was derived.

Results: AMM analysis was reproducible. Optimal AMM full echocardiographic definition was obtainable in 77% of the population, whereas CMM was optimal for 49% because of scan line misalignment, causing a measurement overestimation exceeding 5%.

Conclusion: The ability with AMM to reduce the alpha angle to 0 degrees and, thus, avoid overestimation of left ventricular dimensions might improve follow-up in several pathologic conditions.
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http://dx.doi.org/10.1016/j.echo.2004.05.009DOI Listing
September 2004

[Initial management of arterial hypertension].

Authors:
Daniel Herpin

Rev Prat 2004 Mar;54(6):603-11

Service de cardiologie, CHU hôpital Jean Bernard-La Milétrie, 86021 Poitiers Cedex.

Systemic arterial hypertension is currently defined by a systolic BP or a diastolic BP higher than 140/90 mmHg. There are about 8 million hypertensives in France. The diagnosis of arterial hypertension can be made in some cases using ambulatory BP recording or home self BP measurement. The associated risk factors have to be identified, as well as target organs damage (heart, brain, kidney, great vessels). Arterial hypertension is most often mild or moderate. A specific etiology is found in less than 5% of the patients. The goal of therapy is usually a clinic BP lower than 140/90 mmHg (130/80 in patients with diabetes or renal failure). Monotherapy results in a well-controlled BP in 50% of the cases, only. Then, hypertensive patients should be often given 2 or 3 drugs.
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March 2004

[Acute and chronic dyspnea].

Rev Prat 2003 Sep;53(13):1489-96

Service de pneumologie, CHU hôpital de la Milétrie, 86021 Poitiers.

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September 2003
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