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Biomedical subjects

G Chatellier

Publications and source records attributed to G Chatellier.

232 records · Page 13Linked to original sources
PubMed1983

Factors predictive of attendance at clinic and blood pressure control in hypertensive patients.

Poor compliance with appointments and drug treatment is one of the recognised factors preventing effective management of hypertension. Factors predictive of poor attendance and inadequate blood pressure control in patients attending a hypertension clinic were therefore determined using univariate analyses and a multivariate logistic model. Out of 1346 patients with blood pressure exceeding 160/95 mm Hg followed up for three years, 209 (15.5%) dropped out during the first year. Variables that were significantly related to increased drop out rates were male sex, young age, obesity at entry, cigarette smoking, direct referral to the clinic as a result of screening instead of referral by a general practitioner, absence of pre-existing antihypertensive treatment at the first visit, moderate hypertension, and low socioeconomic category. Variables at entry that were significantly related to poor blood pressure control at one year were old age, evidence of coronary heart disease, severe hypertension, and raised blood glucose concentrations. Early detection of patients at high risk of drop out or poor blood pressure control might improve treatment of hypertension and allow management to be more individually adapted to each patient.

Adult↗
PubMed1982

[Critical evaluation of the functional signs of arterial hypertension].

Influence of blood pressure levels on the prevalence of symptoms was studied in a group of 1771 untreated hypertensive patients referred to the Saint-Joseph Hypertension Clinic in Paris. Information on symptoms was obtained from a standardized physician-conducted interview during the patient's first visit at the Outpatient Clinic. The most frequent symptoms were headaches (40.5 p. 100), palpitations (28.5 p. 100), nocturia (20.4 p. 100) and dizziness (20.8 p. 100). Except for nocturia, symptom prevalence was higher in females than males. In males as well as in females, no correlation was found between blood pressure level and the presence of headaches, dizziness and palpitations when results were adjusted for age. In contrast, the relationship between two behavioural characteristics, anxiety and lack of regular physical activity, and symptom prevalence was more pronounced than the relationship with the blood pressure level itself. Moreover symptom prevalence differed significantly between the five permanent physicians of the Clinic; comparison of results obtained by physician conducted interview and self administered questionnaire indicated that difference between physicians were not due to difference in patient's characteristics but to differences in physician behaviour.

Adolescent↗
PubMedDate not supplied

[Renovascular hypertension: diagnostic and therapeutic strategy].

Investigations for renal artery stenosis have been greatly facilitated by advances in imaging techniques. Intravenous digital subtraction angiography is now performed in all patients with progressive, drug-resistant hypertension associated with aorto-iliac lesions or with renal impairment induced by angiotensin-converting enzyme inhibitors. Yet the finding of hypertension with renal artery stenosis is not enough to make the diagnosis of renovascular hypertension, this term being reserved to hypertension reversible by revascularization. The selection of patients who may benefit from revascularization rests on urography to explore the excretory and endocrine functions of the ischaemic kidney, as well as on scintigraphy and measurement of renin levels in renal veins before and after administration of captopril. The functional data are completed by vascular exploration which helps in evaluating the usefulness and safety of revascularization: repercussions of hypertension on target organs and extension of the vascular disease to other territories. Revascularization as first-line treatment consists of percutaneous transluminal dilatation; surgery must be reserved to difficult cases, such as arterial obliteration or failed dilatation.

Angiography, Digital Subtraction↗
PubMedDate not supplied

How much can blood pressure be lowered?

Whatever the therapeutic goal proposed for diastolic blood pressure in hypertensive patients, the actual results of treatment in various health care delivery systems throughout the world are not as good as generally assumed. In the two recent controlled therapeutic trials, 24.5% (Australian trial) and 29.9% (Hypertension Detection and Follow-up Program) of actively treated patients had diastolic blood pressure levels above 90 mm Hg. In three British hospital clinics, diastolic blood pressure was greater than 90 mm Hg in 69% of the treated patients after 6 months to 1 year of treatment. In our own clinic, the blood pressure of 947 hypertensive patients registered in the Artemis system (Paris) between 1976 to 1980 decreased after 2 years on medical treatment from 177/108 to 142/87 mm Hg. However 21.1% of the patients studied still had a diastolic blood pressure above 95 mm Hg. In the general population, the percentage of treated patients not attaining goal levels varies from 42.9% to 71%. Not only is it important to agree upon goals, but it is urgent to standardize methods for collecting and analyzing the results of antihypertensive treatments in various health care delivery systems, since high rates of therapeutic failures might be related to the physician's strategy, the patient's characteristics, the disease's particularities, and the limited efficacy and side-effects of presently available drugs.

Antihypertensive Agents↗
PubMedDate not supplied

Pharmacological demonstration of the additive effects of angiotensin-converting enzyme inhibition and angiotensin II antagonism in sodium depleted healthy subjects.

A blockade of the hemodynamic and tissue effects of angiotensin II (Ang II) more complete than that presently achieved with usual daily doses of angiotensin coverting enzyme (ACE) inhibitors or type 1 Ang II receptor antagonists has potential advantages and risks. Therefore, it is worthwhile to investigate the biological and the hemodynamic effects of the simultaneous blockade of the renin-angiotensin system (RAS) at the two sites where it can be currently achieved, ACE and type 1 Ang II receptors. To investigate this issue, 2 double-blind randomized crossover studies were performed in a model of mild sodium depletion in normotensive volunteers. They ingested single oral doses of captopril 50 mg, losartan 50 mg, their combination or matched placebos, and in a second study, single oral doses of enalapril 10 mg, enalapril 20 mg and the combination of losartan 50 mg with enalapril 10 mg. The combination of captopril 50 mg and losartan 50 mg had additive effects on blood pressure fall and renin release in sodium-depleted normotensive subjects. When compared to enalapril 10 mg and the doubling of its dose, the combination of losartan 50 mg and enalapril 10 mg significantly increased both the area under the time curve of mean blood pressure fall and plasma active renin levels. It did not further decrease plasma aldosterone levels. The conclusion is that a more complete blockade of the RAS can be achieved by concomitant administration of a type 1 Ang II receptor antagonist and an ACE inhibitor.

Aldosterone↗
PubMedDate not supplied

[The problem of therapeutic efficacy indices. 1. Elements of the problem].

Efficacy indices measure the efficacy of therapies. They derive, by definition, from two quantities, the basal or control risk of event, Rc, observed in the control group, and the on-treatment risk, Rt, observed in the treated group. In clinical trials and meta-analyses, each is an unbiased measure of efficacy. Although they are a combination of frequencies, these indices are used in clinical practice to predict the benefit in treated patients. Their relevance to express efficacy depends on the type of clinical condition, and is better for acute diseases than for chronic diseases. In order to be useful for prescribers, they should meet certain specifications. In addition, they should be considered in the more general framework of effect models.

Clinical Trials as Topic↗
PubMedDate not supplied

[The problem of therapeutic efficacy indices. 2. Description of the indices].

The four indices for a binary outcome or therapeutic objective are: the odds ratio, the relative risk, the absolute benefit and the number of patients to treat. For a continuous outcome, the effect size is the best choice. The odds ratio approximates the relative risk. The difference may be large in some instances. The number of patients to treat is the reciprocal of the absolute benefit. Although they are built on the same two quantities, they are not interchangeable and should not be considered in the same way. Moreover, their meaning is not straightforward and they can be misused.

Clinical Protocols↗
PubMedDate not supplied

[Outline of the problem of indices of therapeutic efficacy. 4. Expression of efficacy when the underlying illness is incurable. Study Group for the Indices of Efficacy].

In chronic illness, when death or a non-fatal event can occur at any time, the current efficacy indices are no longer appropriate to express the effect of the treatment on the potential therapeutic objectives. The inappropriateness is not dependent on the effect model. Clues for solutions are proposed.

Chronic Disease↗
PubMedDate not supplied

[The problem of therapeutic efficacy indices. 3. Comparison of the indices and their use].

Efficacy indices do not contain the same information although they are all combinations of the same two quantities. Therefore, one should choose the proper index. Actually, none is entirely appropriate. Each more or less meets the specifications, depending on the underlying effect model for the therapy considered. However, one can say that the absolute benefit is more appropriate from the patient's point of view, the relative from the scientific point of view and the number of patients to treat from the policy maker's point of view. Nevertheless, this classification needs to be considered with caution. Finally, it emerges from the review that none is fully relevant to express the efficacy of a therapy, even in the most suitable condition, the acute illness.

Drug Evaluation↗
PubMedDate not supplied

[Blood pressure control after a one year follow-up in high risk subject screened in occupational medicine].

OBJECTIVE: To identify factors predicting the success or the failure of intervention on blood pressure in a population estimated at high risks. METHODS: The program "Coeur 2001" has analysed the absolute cardiovascular risk (ACVR Framingham) in 107 371 voluntary French railways employees. In the company, were considered at high risk (HR), subjects for whom risk was > or = to the 95th percentile of the distribution of the observed ACVR by age range: ACVR > or = 4.5% before 35 years, 12% between 35 and 45 years and 19% beyond 45 years, i.e. a total of 4 190 subjects. These subjects were warned about their risk and advised to choose and consult a physician. A two-year follow up was planned. Identical data (risk factors, ACVR, type of management and therapies) were collected during the first consultation with the occupational physician (T0), one year later (T1) and two years later (T2). RESULTS: Our work concerned 2376 employees at HR, consulting at T1. At T1, 54% of subjects were in the hight risk group (SHR) [48% when BP at T1 was < 140/90 mmHg and 62% when the BP was > or = 140/90 mmHg]. The mean decrease of the systolic BP (SBP) was 4 mmHg in the whole sample, 7.7 mmHg in subjects with normalised ACVR, and it remained stable in the group still at HR (-0.7 mmHg). At T0, blood pressure (BP) was > or = 140/90 mmHg in 55.8% of the patients and 38.4 at T1. This high BP was associated with higher frequency of diabetes (14 vs 7%) and overweight (BMI > or =30 kg/m2; 32.8 vs 19.7%). The percentage of treated hypertensive subjects had increased from 35 to 62% but one third of uncontrolled hypertensive subjects was treated by mono therapies at T1. CONCLUSION: To keep BP under control is a difficult task in routine medicine. At T1, despite a more aggressive treatment, 38% of subjects at high risk were still hypertensive subjects.

Adult↗
PubMedDate not supplied

[Prevalence and mechanism of masked hypertension: the ol'mesures survey].

RATIONALE: Masked hypertension (MH) and uncontrolled hypertension (UCH) have both bad prognosis. The influence of measurement circumstances on MH prevalence and reproducibility are little known. OBJECTIVE: To evaluate the prevalence and reproducibility of MH after excluding confusing factors [method and time of blood pressure (BP) measurement, antihypertensive treatment] by a standardization procedure. METHODS: 2189 hypertensive patients (61+/- 12 years, men 57%) having been treated in monotherapy by an angiotensin II receptor inhibitor for at least 8 weeks Were evaluated in a French multicenter prospective observational survey. Three BP successive office measurements were performed by the GPs during 2 visits (V) at similar times 13 +/- 9 days apart (BP: V1 149 +/- 19 / 85 +/- 11 mmHg, V2 145 +/- 19/83 +/- 11 mmHg) and home BP self-measurements (HBPM) were performed morning and evening for 3 consecutive days (HBPM morning + evening : n=18 +/- 1; 142 +/- 16/81 +/- 9 mmHg) and at the time of the visit (daytime HBPM: n=9 +/- 1; 140 +/- 16/80 +/- 10 mmHg) by the patients (Omron-705CP). RESULTS: [table: see text]. CONCLUSION: the observed MH prevalence is similar to previous published studies and is independent of: treatment, BP measurement methods, measurements frequency and HBPM time but it depends on office BP values. Consequently, its reproducibility is directly dependent of the quality of office BP measurements.

Angiotensin II Type 1 Receptor Blockers↗
PubMedDate not supplied

[Effect of glipizide on glycemic control and peripheral insulin sensitivity in type 1 diabetics].

To assess the effect of Glipizide on glycaemic control and peripheral insulin sensitivity, 9 type 1 (insulin dependent) diabetic patients with normal BMI, mean age 42.1 +/- 11.0 years, diabetes duration 16.3 +/- 9.2 years were studied. They were treated by continuous subcutaneous insulin infusion for a mean duration of 32.2 +/- 11.0 months, they were in good glycaemic control (mean HbA1 7.9 +/- 1.2%, upper limit of normal value 7.5%). In a double blind randomized control study they were successively allocated for a three month period to 15 mg of Glipizide daily or a Placebo. At the end of each period the following parameters were recorded: HbA1, mean plasma glucose levels, daily insulin dosage: basal rate and pre prandial bolus, peripheral insulin sensitivity assessed by euglycaemic hyperinsulinic clamp technique, the addition of Glipizide did not induce any statistically significant modification of HbA1, glycaemic values, and daily insulin dosage: basal rate 18.2 +/- 8.7 vs. 17.9 +/- 7.3 IU/24 hours and pre prandial bolus 18.6 +/- 7.0 vs 17.6 +/- 6.3 IU/24 hours. During the glucose clamp, glucose uptake was similar under Glipizide or Placebo with the 3 levels of insulin infused. These results suggest that in type 1 diabetic patients the addition of Glipizide to insulin therapy does not alter glycaemic control and peripheral insulin sensitivity.

Adult↗
PubMedDate not supplied

Use of a standardized personal medical record by patients with hypertension: a randomized controlled prospective trial.

It is widely believed that patients' compliance can be increased by persuading them to participate in their own care. We tested whether patients with hypertension could manage their own clinical records and whether their doing so would affect the quality of their care. Two hundred patients were randomly assigned to an intervention or a control group. Those in the intervention group were asked to complete a 10-page booklet containing a personal standardized medical record. All patients were scheduled for a follow-up appointment at the end of one year and were referred to their general practitioners for interim care. At the end of the follow-up period, the proportion of patients seen was comparable in the two groups. More of the patients in the intervention group than in the control group filled out a questionnaire as requested, and more added comments. Within the intervention group, the proportion of patients seen and the fall in systolic blood pressure were significantly higher among the 44 patients who had completed the personal record as requested than among the 57 who had not. Patients who completed the personal record also had fewer compliance problems.

Adult↗
PubMedDate not supplied

[Demonstration of differences in the effect of 2 antihypertensive agents by self blood pressure measurement: comparison of trandolapril and perindopril].

In this double blind randomized study, blood pressure lowering effects and duration of action of two angiotensin converting enzyme (ACE) inhibitors were compared using home self blood pressure measurement (SBPM). After a two-week placebo run-in period, 128 hypertensive patients received during four weeks a daily morning dose of either perindopril (P) 4 mg or trandoplapril (T) 2 mg. One week of SBPM was planned at the end of both the run-in and the treatment period. Three consecutive measurements, with printed results, were requested in the morning before drug intake and in the evening. Run-in period home systolic (SBP) and diastolic (DBP) blood pressures were comparable in both groups: 149.9 +/- 14.5/97.3 +/- 8.1 mmHg in the P group (n = 63), 148.9 +/- 14.3/96.7 +/- 6.9 mmHg in the T group (n = 65). During the treatment period, evening BP was similar in the 2 groups: 139.1 +/- 14.3/89.9 +/- 9.1 mmHg in P group, 137.5 +/- 15.3/89.4 +/- 9.1 mmHg in T group (NS). On the other hand, morning BP was higher in the P group: 143.1 +/- 16.3/93.8 +/- 9.6 mmHg vs 137.4 +/- 16.7/90.3 +/- 9.7 mmHg (p < 0.05 for SBP and DBP-Student's t test). These results were confirmed by co-variance analysis after adjustment on initial BP. Due to standardized conditions of measurement, home SBPM was able to show a difference in BP lowering effects at the end of the inter-dose interval between two ACE inhibitors.

Adult↗