Search PubMed⌕ Search

Biomedical subjects

A Carré

Publications and source records attributed to A Carré.

At least 19 recordsLinked to original sources
PubMed2002

[Renovaascular hypertension and Von Recklinghausen neurofibromatosis].

This clinical case illustrates the diagnosis of a secondary cause of hypertension in a patient with Von Recklinghausen's disease. The hypertension resulted from a complex malformation of the right renal artery and dysplasic stenosis of the left inferior polar artery treated successfully by simple angioplasty. This case illustrates the high proportion of vascular (renal artery dysplasia, coarctation of the aorta) and endocrine (pheochromocytoma) causes of hypertension in patients with neurofibromatosis.

Adult↗
PubMed2001

[Are demographic characteristics of hypertensive patients different with renal artery stenosis?].

UNLABELLED: Atheromatous renal disease is more and more involved in end stage renal failure in polyatheromatous patients. The goal of this work was to study the demographic differences between hypertensive patients with renal artery stenosis (RAS) or without RAS. METHOD: Between November 1995 and July 1997, 49 hypertensive patients were included consecutively for a suspicion of RAS. Age, sex, hypertension history, tabagism, cardiovascular heredity, body mass index, diabetes history, hypercholesterolemia, kalmia, serum creatinine, creatinine clearance, systolic blood pressure (SBP), diastolic blood pressure (DBP) and pulse pressure (PP) were studied. A renal echo-doppler and a renal TDM were performed in all patients. A renal arteriography was performed in 23 patients with a RAS suspicion after the two morphologic exams. The demographic characteristics of both clinical groups control (group 1) and patients with unilateral RAS (group 2), were compared. STATISTICS: Descriptive analysis, Wilcoxon test, Khi 2 test, spearman correlation (p < 0.05). RESULTS: Group 2 patients were significantly older than group 1 patients (p = 0.008) with a mean age difference of 8 years. Creatinine clearance was lower in patients suffering from RAS with a mean difference of 23 mL/min between groups 1 and 2 (p = 0.0007) but we also had to take into account the negative correlation existing between creatinine clearance and age (r = 0.63; p = 0.0001) when interpreting these results. The DBP was lower (p = 0.03) and the PP higher (p = 0.01) in group 2. The SBP was higher in group 2 but this result was not significant. Mean differences in SBP and PP between group 1 and group 2 were 6 mmHg and 15 mm Hg respectively. Smoking was more common in group 2 (p = 0.04). The history of hypertension, cardiovascular heredity, sex ratio (M/F), body mass index and prevalence of diabetic were comparable between the two clinical groups. CONCLUSION: Although there were demographic differences between the two clinical groups, no clinical or biological variable could be used alone to identify which patients suffered from renal stenosis, because the distribution of these variables did not differ significantly between the two groups and the effective was small. Then, we thought that Krijnen's predictive rule is interesting in the screening of hypertensive patients with RAS suspicion.

Adult↗
PubMed2001

[Method of studying renal morphology in hypertensive patients with and without renal artery stenosis].

UNLABELLED: Although the size of the kidney is still the most commonly used as morphological parameter, it is not enough sensitive for early detection of ischemic nephropathy. PURPOSE: To study a novel method of renal morphology analysis using spiral computed tomography angiography (CTA) in hypertensive patients with or without unilateral atheromatous renal artery stenosis (RAS). METHODS: Forty-nine hypertensive patients suspected RAS underwent spiral CTA. Arteriography showed significant RAS in 26 patients. Renal length, 3 upper and 3 lower cortical thicknesses were measured in 46 control kidneys (C) i.e. 23 patients without RAS (group 1), in 26 stenosed (S) and in 26 opposite kidneys (OPP) i.e. 26 patients with unilateral RAS (group 2). Mean cortical thickness (MCT), cortical area (CA), medullary length (ML) were calculated in the same groups. The reproducibility and agreement of measurements were investigated in two groups. The demographic parameters (age, sex, bodymass index, and history of hypertension) were correlated with morphological parameters in group 1. RESULTS: The reproducibility and agreement of measurements were confirmed (R2 = 0.53 to 0.93) except for anterosuperior thickness. The C kidneys were of comparable morphology: MCT (mm) = 9.1 +/- 0.6; 9.2 +/- 1.0, CA (mm2) = 950 +/- 119; 934 +/- 157, ML (mm) = 85 +/- 11. In group of Opp kidneys, MCT = 7.9 +/- 1.4 mm, CA = 806 +/- 210 mm2, ML = 84 +/- 13 mm. In group of S kidneys, MCT = 6.6 +/- 1.6 mm, CA = 612 +/- 193 mm2, ML = 77 +/- 14 mm. Demographic parameters were not correlated to renal morphology. CONCLUSION: Spiral CTA is a suitable method to study renal morphology. Cortical thickness and medullary length could be used to obtain a reliable diagnosis of early ischemic nephropathy.

Adult↗
PubMed2000

Electronic pill-boxes in the evaluation of antihypertensive treatment compliance: comparison of once daily versus twice daily regimen.

The objective was to compare the compliance of hypertensive patients treated with captopril twice daily or trandolapril once daily. After a 2-week placebo period, hypertensive patients (diastolic BP 95-115 mm Hg) were randomly allocated to trandolapril 2 mg once daily or to captopril 25 mg twice daily for 6 months. Trandolapril and captopril were packed in electronic pill-boxes equipped with a microprocessor that recorded date and time of each opening (MEMS). Patients' compliance was assessed both by standard pill-count and by electronic monitoring. Blood pressure was measured using a validated semi-automatic device at the end of the placebo period and of the treatment period. One hundred sixty-two patients entered the study. Compliance data were evaluable for 133 patients (62 in the captopril group and 71 in the trandolapril group). Treatment groups were comparable at baseline except for age (P = .046). Using electronic pill-box, overall compliance was 98.9% in the trandolapril group and 97.5% in the captopril group (P = .002). The percentage of missed doses was 2.6% in the trandolapril group and 3.3% in the captopril group (P = .06). The percentage of delayed doses was 1.8% in the trandolapril group and 11.7% in the captopril group (P = .0001). The percentage of correct dosing periods, ie, a period with only one correct recorded opening, was 94.0% in the trandolapril group and 78.1% in the captopril group (P = .0001). Results were unchanged when adjusted for age. At the end of the study, 41% of patients in the trandolapril group and 27% in the captopril group (NS) had their blood pressure normalized (systolic BP <140 and diastolic BP <90 mm Hg). In this 6-month study, the electronic pill-box allowed refined analysis of compliance of hypertensive patients. Patients' compliance with once daily trandolapril was higher than with twice daily captopril. The between-group difference is mainly explained by an increase in delayed doses in the twice daily group.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed2000

[Better understanding of atheromatous ischemic renal vascular disease].

Atheromatous ischaemic renal vascular disease (AIRVD) comprises ischaemic renal disease, atheromatous disease of the large arteries and intra-renal atheromatosis. Cholesterol emboli and lesions of nephroangiosclerosis are often associated, affecting the two kidneys. It is an increasingly common cause of chronic renal failure in an aging population, affecting 12 to 14% of new patients requiring dialysis in the United States. Atheromatous stenoses are very progressive with a risk of renal atrophy; they are a marker of polyvascular disease, often detected during other angiographic investigation. Hypertension secondary to the stenosis, still incorrectly called renovascular hypertension, is, however rare, affecting less than 0.5% of hypertensives. For economic reasons, it is important to select patients who need complementary investigation. In view of the absence of specific signs of the pathology, the "presumptive" diagnosis is based on a range of clinical and biological results, especially in a high risk context. The method of investigation varies from team to team, depending on the availability of equipment, the experience of the operators and the patient himself. Duplex Doppler, spiral angioscan and magnetic resonance angiography are the most pertinent investigations for the management of AIRVD. When the diagnosis of renal artery stenosis has been made, the problem of revascularisation, the objective of which is to preserve or restore the functional nephronic mass, has to be treated to prevent progression to end stage renal failure. Although epidemiological and physiopathological evidence is in favour of revascularisation, only renal salvage procedures are imperative. Apart from these indications, the clinical benefits of revascularisation have not yet been demonstrated. In all cases, the control of associated risk factors is essential to maintain the success of revascularisation and slow down the progression of atheromatous disease.

Constriction, Pathologic↗
PubMed1999

[Hypertensive syndromes in pregnancy. Physiopathology, definition and fetomaternal complications].

A MAJOR CONCERN: Hypertensive syndromes occur in approximately 10 to 15% of all pregnancies and are the cause of 30% of maternal deaths and 20% of fetal and neonatal deaths. Syndromes include gestational hypertension also called pregnancy-induced hypertension, chronic hypertension and preeclampsia. DEFINITION: In pregnant women, hypertension is defined as blood pressure levels above 140/90 mmHg at two successive measurements at a 4-hour interval. The primum movens is the development, at about 16 weeks gestation, of secondary placental ischemia due to a defect in the second trophoblastic invasion of the spiral arteries of the myometrium. This induces endothelial dysfunction leading to pro-coagulation activation and inhibited physiological vasodilatation. RISK FACTORS: The risk of vasculoplacental disease increases with age, body mass index, primiparity, stressful working conditions, and personal history of vascular events during pregnancy. MATERNAL RISKS: Maternal complications include preeclampsia-eclampsia, retroplacental hematoma, acute renal failure, and HELLP syndrome (hemolysis, elevated liver enzymes, low platelet count). FETAL RISKS: Hypotrophy, in utero death and prematurity may occur. The development of hypertension during pregnancy may also reveal a hypertensive background which could progress to persistent high blood pressure. Preeclampsia is an independent risk factor of cardiovascular disease requiring regular surveillance after delivery.

Female↗
PubMed1999

[Hypertensive syndromes in pregnancy. Diagnosis and therapy].

UNLABELLED: ACHIEVE PRECISE DIAGNOSIS: Hypertensive syndromes during pregnancy secondary to placental ischemia still cause threatening matemofetal complications. A precise differential diagnosis between gestational hypertension, chronic hypertension and preeclampsia must be achieved as the management protocols are quite different. PATIENT MONITORING: Blood tests for urea, creatinine, platelet counts, coagulation, and liver enzymes are required. Fetal monitoring, urine protein and ambulatory blood pressure measurements are also helpful. Ultrasound-Duplex explorations allow an evaluation of the maternal vascular status and fetal development. THERAPEUTIC MANAGEMENT: These patients should be managed in specialized centers, limiting the minimum the number of hospitalizations. Unlike good rules of hygiene and dietetics, antihypertensive therapy has little effect on the progression of the pregnancy. An antihypertensive therapy is only warranted to avoid cardiovascular complications in the mother. In case of chronic hypertension, treatment should be tailored to the measured pressures. Prudent antihypertensive therapy may be useful for severe gestational hypertension and preeclampsia. Because of their safety profile and pharmacologic properties, antihypertension drugs with central action and alph-beta-blockers should be preferred over other drug classes. PREVENTIVE TREATMENT: Antiaggregates (aspirin 50-100 mg/d) starting at 16 weeks gestation should be reserved for high-risk pregnancies. Regular follow-up, both pre- and post-natally, is essential, especially in light of the large number of women who can be expected to progress to established hypertensive states.

Female↗
PubMed1999

[Anatomic results of the endoluminal revascularization of renal arterial stenoses. A retrospective study of 113 patients].

The aim of the study was to evaluate the anatomic results of percutaneous transluminal renal angioplasty in a population of 113 hypertensive patients (66 men, mean age 63 years) who had a significant renal artery stenosis (atheromatous in 105 patients and fibrodysplastic in the eight others). Conventional angioplasty was performed in 89 arteries, and stent implantation in 46 cases. Stenting was associated with a better immediate result than simple angioplasty for atheromatous stenoses (rate of residual stenosis < 30% = 93.5% and 71.2% respectively, p < 0.003). Technical success for angioplasty of atheromatous stenoses was achieved in 73.8% of procedures involving non ostial lesions and 51.6% for ostial stenoses (p = 0.05). Restenosis was detected 6.3 +/- 0.3 months later (by echodoppler and/or helical computed tomography angiography) in 9.1% of cases after stent implantation and in 47% after simple angioplasty (p = 0.00017). The presence of a residual stenosis < 30% immediately after revascularization was associated with a significantly (26.4% versus 50%, p = 0.044) lower rate of restenosis. In conclusion, this study confirms the utility of percutaneous transluminal renal angioplasty for treatment of renovascular hypertension, particularly with the utilisation of stents for atheromatous and ostial stenoses.

Angioplasty, Balloon↗
PubMed1999

[Clinical results of angioplasty of the renal arteries in renovascular arterial hypertension. A retrospective study in 113 patients].

The aim of the study was to evaluate the clinical results of percutaneous transluminal renal angioplasty in a population of 113 consecutive hypertensive patients who underwent endoluminal revascularization for angiographically significant renal artery stenosis. Retrospective analysis of the case records of 104 patients showed that systolic blood pressure (SBP) and diastolic blood pressure (DBP) decreased significantly 6 months after angioplasty (-20.9 mmHg and -8.4 mmHg respectively; p = 0.0001). This decrease was maintained until 19.8 months after the procedure. In cases with suboptimal revascularization (persistence of a residual stenosis more than 30%), only the SBP decreased significantly at 6 months (from 177 mmHg to 156.1 mmHg; p = 0.0061); when DBP decreased from 91.4 mmHg to 86.1 mmHg (NS) at 6 months, and fell to 80.9 mmHg (p = 0.026) at 19.8 months (after the performance of a second transluminal angioplasty for 41% patients of this group due to restenosis). Twenty-nine patients presented a restenosis of the renal artery 6 months after the initial procedure. In this group, only SBP decreased significantly at 6.1 months and at 18.7 months (from 171.9 mmHg to 156.1 mmHg and 146.5 mmHg respectively; p = 0.0064 and p = 0.0001). DBP decreased significantly only at 18.7 months (-12.6 mmHg; p = 0.0001), after a second renal angioplasty in 23 patients (79%). In the 60 patients without restenosis at 6 months, SBP and DBP decreased significantly at 6.1 and 18.7 months. No significant variation of creatinine levels was observed. These results confirm the utility of percutaneous transluminal renal angioplasty for the treatment of renovascular hypertension.

Angioplasty, Balloon↗
PubMed1999

[Importance of the echo-doppler and helical angioscanner of the renal arteries in the management of renovascular diseases. Results of a retrospective study in 113 patients].

The aim of this study was to determine the sensitivity and specificity of two non invasive methods for the diagnosis of renal artery stenosis, compared with renal angiography. Retrospective analysis of 113 hypertensive patients who underwent renal angiography permitted us to evaluate the results of echo-Doppler (n = 53) and helical computed tomography angiography (n = 50). Regarding echo-Doppler, sensitivity and specificity were 0.75 and 0.86 respectively (40 true positives/53 stenoses, and negative result in 38/44 normal arteries). Regarding helical CT angiography, these values were 0.94 and 0.95 respectively (positive result in 45/48 stenoses, and 41 true negatives/43 normal arteries). These results suggest that echo-Doppler and helical CT angiography are two reliable methods for the diagnosis of renal artery stenosis. Thus, renal angiography could be reserved for patients who may require percutaneous transluminal renal angioplasty.

Female↗
PubMed1998

Compliance and antihypertensive efficacy of amlodipine compared with nifedipine slow-release.

Poor compliance is a principal cause of treatment failure in hypertensive patients. Once-daily dosing improves compliance, but 24-h antihypertensive activity should be provided. The compliance, efficacy, and safety of amlodipine and nifedipine slow-release (SR) were compared in patients with mild-to-moderate essential hypertension recruited among 24 centers in France. After a 2-week washout period, 103 patients were randomized to 12 weeks of 5 to 10 amlodipine mg once daily (n = 55) or 20 mg nifedipine SR twice daily (n = 48). Compliance was calculated by electronic drug monitoring. Efficacy was measured by ambulatory and casual BP recordings. Patients receiving amlodipine demonstrated better compliance than patients receiving nifedipine SR with respect to compliance index (the total number of doses taken divided by the total number of doses prescribed, expressed as a percentage; 98.3% v 87%; P < .0001), days on which the correct number of doses were taken (92.5% v 74.8%; P < .0001), and prescribed doses taken on schedule (88.7% v 71.6%; P < .0001). Absolute and relative therapeutic coverage were higher in patients receiving amlodipine than nifedipine SR (P < .0001). Mean SBP and DBP decreased equally in both groups, although amlodipine offered better BP control compared with nifedipine SR at specific times of day. Fewer patients had high nocturnal SBP with amlodipine (39.3%) than nifedipine SR (71.4%; P = .042). Adverse events and treatment withdrawals occurred less frequently in amlodipine-treated patients than in nifedipine SR-treated patients. Amlodipine (5 to 10 mg) once daily provides improved compliance, better 24-h BP control, and fewer adverse events than 20 mg nifedipine SR twice daily in patients with mild-to-moderate hypertension.

Adolescent↗
PubMed1998

Essential hypertension: first reason for persistent hypertension after unilateral adrenalectomy for primary aldosteronism?

BACKGROUND: Despite cure of primary aldosteronism by surgical resection, hypertension persists postoperatively in 30% to 50% of patients. The aim of this study was to determine factors influencing long-term outcome of blood pressure after unilateral adrenalectomy for primary aldosteronism. METHODS: Records of 100 patients who underwent unilateral adrenalectomy for primary aldosteronism from 1970 through 1997 were reviewed. Patients were distributed in 2 groups according to whether blood pressure was normal (criteria of World Health Organization). Clinical, biochemical, and pathologic data were compared. RESULTS: All patients were biochemically cured. Blood pressure was normal in 56 patients and improved in 44 (mean follow-up, 69 and 59 months). Persistent hypertension correlated with age, known duration and seriousness of preoperative hypertension, family history of hypertension, no preoperative response to spironolactone, and contralateral adrenal hypertrophy. Gender, surgical approach, and pathologic findings were not predictive factors of blood pressure outcome. The prevalence of hypertension was almost the same in these postoperative patients as the prevalence of essential hypertension in a random population of the same age. CONCLUSIONS: Early unilateral adrenalectomy allows cure or improvement of hypertension in all patients with primary aldosteronism induced by unilateral excessive source of aldosterone secretion regardless of the pathologic findings. Persistent hypertension suggests that coexisting essential hypertension is present.

Adolescent↗
PubMed1998

[Pharmacologic importance of the combination atenolol/nifedipine in hypertensive patients].

When used as first-line treatment, any monotherapy selected from one of the main classes of agents for the management of slight to moderate arterial hypertension cannot be expected to have a success rate exceeding 60%. However, this level of efficacy approaches 80% if two classes of antihypertensive drugs with complementary modes of action are combined--a notable example being the combination of a beta-blocker, atenolol 50 mg, and a calcium antagonist, sustained-release nifedipine 20 mg. This fixed combination provides efficacy and tolerability in the treatment of arterial hypertension. Atenolol has beta-adrenolytic properties similar to those of propranolol, the most commonly named comparator drug. Atenolol is a selective beta 1-adrenergic antagonist with negative chronotropic, bathmotropic, dromotropic and inotropic actions. Because of its selectivity, it induces only moderate vasoconstriction. Its cardioselective nature diminishes the risk of bronchospasm, an event commonly induced by this type of drug. Atenolol reduces renin secretion from the renin-angiotensin system and consequently decreases the production of angiotensin II and plasma aldosterone. The renal effects of atenolol are an increase in both diuresis and natriuresis, with a reduction in the renal plasma flow. beta-Adrenergic antagonists in general modify carbohydrate metabolism and may mask the precursor signs of hypoglycaemia. They have a negligible effect upon lipid metabolism and practically no effect on total or high density lipoprotein cholesterol levels. Nifedipine belongs to the class of dihydropyridines. It acts by blocking the influx of calcium ions through the slow channels. Although a potent vasodilating agent, nifedipine does not induce tachycardia or water-sodium retention. The negative inotropic effect observed in vitro has not been reported in humans; the coronary dilatation produced by nifedipine is indisputable, both in unstable angina and exertional or exercise-induced angina. However, its cardioprotective effect remains questionable outside the context of recent-onset atheromatous plaques. Nifedipine increases renal blood flow and is practically devoid of diabetes-inducing factors. The fixed combination of atenolol 50 mg and sustained release nifedipine 20 mg offers a particularly interesting complementary action, the beta-blocker reducing the dihydropyridine-induced activation of the sympathetic nervous system and the latter reducing the vasoconstriction induced by the beta-blocker. Compared with each agent used alone, the pharmacokinetic profiles of atenolol and nifedipine remain unmodified by their administration in the fixed combination.

Adrenergic beta-Antagonists↗
PubMed1998

[Heart rate and lipids].

Heart rate (HR) appears to be an independent marker of cardiovascular risk, based on certain epidemiological data. Several studies have tried to establish a predictive cutt-off value. Many studies have observed the existence of a positive and independent correlation between HR and triglyycerides, VLDL, and a negative correlation between HR and HDL cholesterol. The recommended techniques for HR measurement, pathophysiological hypotheses, and clinical implications are discussed.

Cardiovascular Diseases↗
PubMed1998

[Modifications of heart rate and blood pressure during pregnancy].

The pathophysiology of pre-eclampsia, disease of the endothelium, placental ischaemia, and its consequences on blood pressure and heart rate variations are described. The methods of evaluation of heart rate and blood pressure during pregnancy, outpatient visit clinical measurement, self-measurement, ambulatory measurement, "Finapres", electrocardiogram and Holter ECG are reviewed; the practical implications of the nocturnal fall of vagal tone with tachycardia, demonstrated during pre-eclampsia, are discussed.

Blood Pressure↗
PubMed1996

[Panic attack: viewpoint of the internist].

The first part of this paper presents the history of a panic attack occurring during an acute hypertensive crisis, which led to the discovery of a left adrenal phaeochromocytoma. The second part of the paper presents a discussion of conditions that can simulate panic attacks. Accounts are given of: acute hypertensive crises, the post-ictal phase of epilepsy, overt tetany, certain forms of hypercalcaemia, hyperventilation syndromes, and lastly, paroxysmal dysrhythmias. The third part of the paper discusses panic reactions occurring in a variety of clinical conditions, in particular, once again, hypertensive attacks, profuse external haemorrhage, dyspnoeic attacks and hypoglycaemic attacks. These different manifestations demonstrate that failure to recognise a clinical sub-stratum responsible for, or co-existing with, a panic attack leads to the risk that treatment of a neuro-psychological nature may be inappropriate.

Adrenal Gland Neoplasms↗
PubMed1995

[Effects of bisoprolol and ramipril on short-term variability of systolic blood pressure during mental stress test: spectrum analysis].

UNLABELLED: The mid frequency component (MFC = 66-128 mHz) of blood pressure is an index of sympathetic vascular control. To investigate the effect of bisoprolol (B) and ramipril (R) treatment (TT) on the short-term variability of systolic blood pressure (SBP) diastolic blood pressure (DPB) and heart rate (HR) reactivity during mental stress, we studied 54 mild essential untreated hypertensive patients (24 men, 45 +/- 9.6 years, BP > 160/90 mmHg after a 15-days placebo run-in period) who were randomly assigned to double blind treatment (B: 10 mg/day: n = 28 and R: 5 mg/day: n = 26). A Stroop Word Color Conflict Test (SWCCT) was performed before and after 2 months of treatment. Hemodynamic parameters (BP and HR) were measured by a non invasive device (Finapres 2300E, Ohmeda-Maurepas) and underwent spectral analysis (SBP: mmHg.Hz-1/2, HR: beats/min.Hz-1/2, Anapres 1.2, Notocord-Orgametrie Systems, Igny-Lille) at rest and during SWCCT. The sympathetic vascular activity was assessed by calculating the area of the mid-frequency component (MFC = 66-128 Hz). RESULTS: [table: see text] CONCLUSION: The absolute variations in sympathetic activity during SWCCT as demonstrated by analysis of MFC of SBP and HR is not affected by chronic ramipril treatment, whereas bisoprolol attenuates sympathetic reactivity during SWCCT.

Adult↗