[Intermittent claudications].
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Atherosclerosis↗
Biomedical subjects
C Mounier-Véhier
Publications and source records attributed to C Mounier-Véhier.
[Assessment of acute blood pressure variability during a stress test].
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Adrenergic beta-Antagonists↗
[Post-embolic chronic pulmonary heart disease: a case report].
Echocardiography and pulmonary scintigraphy demonstrated post-embolic chronic cor pulmonale in a six-year-old woman presenting with dyspnoea. The patient's symptoms deteriorated during subsequent thromboembolic episodes, despite treatment consisting of oral anticoagulants and diuretics. After discussing the pathophysiology and diagnostic methods, the authors emphasize the limits of medical treatment of post-embolic chronic cor pulmonale and the value of two surgical treatments: thromboendarterectomy and lung transplantation. They also recall the precise selection criteria for lung transplantation.
Aged↗
[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↗
[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↗
[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↗
[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↗
[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↗
Talking effect and white coat phenomenon in hypertensive patients.
Both white coat effect (the tendency of blood pressure to rise during a medical visit) and talking effect were analyzed in 42 patients with essential hypertension. Blood pressure was measured during the clinic visit and over the subsequent 24-hour ambulatory period, with the physician performing 49 +/- 4 measurements for each patient. Three silent periods and two talking periods (stress and relaxation) were randomly allocated in a crossover design and studied, using analysis of variance. During the initial 11-minute silent period, systolic/diastolic blood pressures increased by 6 mm Hg/5 mm Hg. During the subsequent talking periods, these variations were significantly greater: +22 mm Hg/+17 mm Hg. Measures of systolic/diastolic blood pressure were higher during stressful talking than during relaxed talking. The talking and its emotional contents seemed to explain 70% of the white coat phenomenon. To minimize the white coat phenomenon in the clinic, physicians, nurses, and clinicians are advised to measure blood pressure during an initial period of silence.
Communication↗
[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↗
[Stress, blood pressure reactivity and arterial hypertension: not an unambiguous relation].
UNLABELLED: In order to determine the different ways the hypertensives' blood pressure would react during mental stress, 49 patients, 27 women and 22 men, were submitted at the Stroop Word Colour Conflict Test. Their haemodynamic parameters were recorded by finger photoplethysmography (Finapres device), with equidistant sampling (2 Hz). Temporal and spectral analysis showed evidence of: a quick and short elevation of BP and HR and a greater variability of SBP, as shown by the increase of the MF (66-128 mHZ) module. Patients can be divided into 3 clusters according to the reactivity of SBP. Group I (N, mean +/- sigma) 13, + 32.7 +/- 8 mmHg; group II 24, + 10.3 +/- 6; group III 12, -10.2 +/- 7. They were comparable on anxiety level and on any demographic and clinical feature. In group III, the higher NA at rest, the bigger the fall of SBP when stressed. The cognitive efficiency of these patients is increased by stress. Spectral analysis: Mid frequency (66-128 mHz) components are markedly higher in group III, before, during and after SWCCT showing a higher sympathetic tonus. CONCLUSION: The reactivity of BP is not homogeneous. One fourth of our patients showed a decrease of SBP during the cognitive treatment stage of the test without showing a decrease of sympathetic tone. Anxiety level is not predictive of BP's response.
Adult↗
[Is scheduled hospitalization over a specific period still justified in hypertension?].
To general practitioners' request, a 36-hour scheduled hospitalization over a determined period (SHDP) was set up to assess the effects and the etiology of the arterial hypertensions they had detected and to propose an appropriate treatment. From November 1988 to December 1990, 277 patients (156 male/121 female) with mean age of 44.7 +/- 14.5 were thus hospitalized over a determined period. All of them underwent 24-hour semi-ambulatory blood pressure monitoring (Bard Sentron) by using the oscillometric method, which permits to measure mean blood pressure (MBP) instead of calculating it. This 24-hour MBP was on average of 108.5 +/- 16.2 mmHg and not significantly different from daytime MBP (111 +/- 16.3 mmHg). Figures of MBP superior to 105 mmHg confirmed permanent HBP (High Blood Pressure). On the 277 patients, 46 (16%) had a normal MBP, 67 (24%) had a "borderline" MBP (between 96 and 105 mmHg). A severe HBP (MBP > 125 mmHg) found in 66 cases (23%) was confirmed by visceral impairment. Left ventricular hypertrophy (LVH) was detected in 12 cases (4.3%) on the chest radiograph, in 24 cases (8.6%) on the ECG and in 75 cases (27%) on the echocardiogram. The etiological assessment revealed 10 cases (3.61%) of secondary hypertension with 3 reno-vascular HBP and 2 Conn's adenomas. Eventually, therapeutic abstention was recommended in 57 patients (20.5%) though 20 of them had previously received antihypertensive therapy. All in all, SHDP permits a more accurate determination of the consequences and severity of HBP. The small number of secondary HBP reflects the proportion found in practice.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
[Predictive criteria of left ventricular hypertrophy given by ambulatory monitoring of blood pressure in hypertension of the elderly].
Eighty-nine patients over 65 years of age, with mild to moderate hypertension, underwent ambulatory blood pressure monitoring during 1988 and 45 of them also underwent echocardiography. Concentric left ventricular hypertrophy was diagnosed in 9 patients (20%) and criteria predictive of this complication were looked for in the results of the ambulatory pressure monitoring. The most predictive factors seemed to be: nocturnal systolic blood pressure (the average of the systolic values recorded between 22 h and 6 h); the percentage of excessive nocturnal values (values over 120/80 during the same nocturnal period); the loss of diurnal rythm with absence of the clearcut difference between the daytime and nocturnal blood pressure value; increased differential pressure, a sign of reduced arterial compliance. These notions, based on ambulatory blood pressure recordings, have diagnostic and prognostic implications (need for echocardiography) and important therapeutic consequences (drugs reducing LHV and improving arterial compliance).
Age Factors↗