[Pancreatic panniculitis with polyarthritis and pathological fracture].
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Arthritis↗
Biomedical subjects
J Ribstein
Publications and source records attributed to J Ribstein.
[Renal impact of primary hyperaldosteronism].
The impact of hyperaldosteronism on target organs, and particularly kidney function, is greater than that of essential hypertension. Hyperaldosteronism provokes a glomerular hyperfiltration and hypertension that may cause renal alterations. Those may explain why elevated blood pressure may persist, even after radical treatment of the cause of hyperaldosteronism.
Humans↗
[Hypertension: the main causes revisited].
Does "essential" mean "ignorance"? The historical demonstration made by Jerome Conn who was the first to describe primary hyperaldosteronism, back in 1954, shows how an outstanding diagnostic route has enlightened our knowledge. Using the examples of hyperaldosteronism and reno-vascular hypertension, a reflex ion is made to arouse our curiosity. In the end, the term "essential" is only the cover-up of what we yet have to learn.
History, 20th Century↗
[Efficacy and acceptability of lercanidipine are not age dependent in patients with essential hypertension: the AGATE study].
UNLABELLED: Calcium channel blockers (CCB) are known to be more efficacious and better tolerated in elderly patients. Lercanidipine is a highly lipophilic CCB with a specific safety profile linked to its pharmacokinetics. OBJECTIVES: To evaluate and compare the efficacy and safety of lercanidipine according to age. METHODS: Two groups of hypertensive patients (G1: aged < 65, G2: aged > or = 65) entered an open study conducted over 56 days. All received lercanidipine 10 mg/d (monotherapy or add-on), titrated to 20 mg/d if blood pressure (BP) was not controlled at D28. BP was measured using a semi-automatic device at doctor's office (three measurements at 1-min intervals) and at home by the patient himself (three measurements in the morning and in the evening at 1-min intervals over the 7 days before D0 and D56). RESULTS: Seven hundred and fifty-six patients entered the study. Thirty-eight patients dropped out prematurely and 30 were excluded because they were normotensive; 691 patients (G1 n = 375, G2 n = 316) were kept for analysis. At the end of the study, 507 patients were treated with lercanidipine alone (10 mg/d n = 221, 20 mg/d n = 286) and 184 with a combination including lercanidipine (10 mg/d n = 91, 20 mg/d n = 93). Efficacy was not different between the groups excepted home pulse pressure which decreased more in G2. In the office, SBP decreased by 17 and 21 mmHg, respectively, for G1 and G2, and DBP by 9 and 10 mmHg. The prevalence of leg edema was not different between G1 and G2 and was particularly low in both groups (3%). CONCLUSION: Lercanidipine was as efficacious and well tolerated in younger patients as in elderly patients.
Age Factors↗
[Thyreotoxic periodic paralysis. A cause of pseudo-paralysing hypokalemia that should not be ignored in Caucasians].
INTRODUCTION: Despite its rare occurrence in Caucasians, thyreotoxic periodic paralysis should be evoked in young male Caucasians presenting with episodes of pseudo-paralytic hypokalemia. OBSERVATION: A 37 year-old Caucasian was admitted in intensive care for an acute episode of hypotonic tetraplegia and hypokalemia during which laboratory tests revealed hyperthyroidism due to Basedow's disease. The clinical course was rapidly favourable after a small dose of intravenous potassium. Antithyroid treatment avoided any new occurrence of similar episodes. DISCUSSION: In Caucasians, sporadic acute paralysis with hypokalemia requires testing for hyperthyroidism. Though it is well know that hypokalemia results from potassium intracellular shift, the underlying mechanism remains poorly elucidated. Treatment includes potassium administration with caution and/or beta blockers but the specific treatment is that of hyperthyroidism.
Adult↗
[Baroreflex failure syndrome: an uncommon case of an extreme blood pressure variability].
INTRODUCTION: The arterial baroreflex operates in physiological conditions. It induces sympathetic and vagal activity modulation resulting in arterial tone and heart rate changes. These appropriate responses limit blood pressure fluctuations and blood pressure is therefore regulated since the baroreflex constantly buffers the changes. EXEGESIS: Bilateral carotid body tumor excision resulted in excessive fluctuations of blood pressure. Indices of spontaneous baroreflex activity were markedly altered in the patient described herein. CONCLUSION: The excessive fluctuations of blood pressure due to the sinoaortic denervation demonstrate how powerful is this negative feedback control mechanism in control conditions.
Antihypertensive Agents↗
Haemodynamic and renal effects of intravenous enalaprilat during coronary artery bypass graft surgery in patients with ischaemic heart dysfunction.
Renal dysfunction occurring after open heart surgery is multifactorial in origin but activation of the renin-angiotensin system may have a prominent role. Fourteen patients with ischaemic heart dysfunction scheduled for elective coronary artery bypass graft (CABG) surgery were allocated to a treatment group [enalaprilat for 2 days; ACEI (angiotensin-converting enzyme inhibitor) group, n=7] or a control group (n=7). The cardiac index was significantly higher in ACEI-treated patients than in the controls before and after cardiopulmonary bypass (CPB) (P<0.05) and on postoperative day 2 (P<0.05). The systemic vascular resistance was significantly lower in the ACEI-treated patients than in the controls before and after CPB (P<0.05). Renal plasma flow, measured as [131I]orthoiodohippuran clearance (ClH), was higher in the ACEI group than in the control group before CPB, as was endogenous creatinine clearance after CPB (P<0.05). On post-operative day 7, ClH was significantly higher in the ACEI group than in the control group (P<0.05). Plasma renin activity and vasopressin concentration increased in both groups during CPB (P<0.05). The study demonstrates that administration of an i.v. ACEI, enalaprilat, improves cardiac output during CABG surgery in patients with ischaemic heart dysfunction. Moreover, renal perfusion was better maintained during surgery, and this effect was sustained up to post-operative day 7.
Aged↗
Glucose tolerance and age-associated decline in renal function of hypertensive patients.
BACKGROUND: Renal function is thought to decrease with age in the general population, but the determinants of this age-associated evolution are poorly understood. Hypertension and diabetes mellitus, two leading causes of chronic renal failure in the elderly, may accelerate this decline. PATIENTS AND METHODS: Urinary clearances of [99mTc]diethylene triaminopentaacetic acid (DTPA) (glomerular filtration rate) and [131I]hippuran (effective renal plasma flow) were assessed in 227 never-treated essential hypertensives aged 20-69 years. Based on the oral glucose tolerance test, the study population consisted of 4% patients with previously unknown diabetes mellitus, 24% with impaired glucose tolerance and 72% with normal glucose tolerance. RESULTS: When the population of 218 non-diabetic subjects was considered, glomerular filtration rate was inversely correlated with age and arterial blood pressure, and positively correlated with effective renal plasma flow, filtration fraction and fasting plasma glucose. In multivariate analysis, age and blood pressure were independent determinants of renal plasma flow, whereas renal plasma flow, age and fasting plasma glucose were independent determinants of glomerular filtration rate. The slope of the regression line relating glomerular filtration rate to age was steeper in patients with impaired glucose tolerance than in those with normal glucose tolerance (-1.52 +/- 0.28 versus -0.65 +/- 0.12, P < 0.01). CONCLUSIONS: These results suggest that impaired glucose tolerance, which is seldom searched for in patients with essential hypertension, may be an important determinant of the age-associated decline in renal function.
Adult↗
Inhibition of the acute effects of angiotensin II by the receptor antagonist irbesartan in normotensive men.
Irbesartan (SR 47436, BMS 186295) is an imidazole derivative that specifically binds to the angiotensin type 1 receptor. The purpose of this study was to assess the inhibitory effect of irbesartan on the pressor action of exogenous angiotensin II in healthy subjects, to evaluate the dose dependency and duration of this inhibition, and to determine the effect of irbesartan on plasma components of the renin-angiotensin system. Forty-two healthy male volunteers maintained on ad libitum sodium intake were enrolled in a randomized, double-blind, placebo-controlled, parallel-design, dose-ranging study. On 2 study days 1 week apart, volunteers were given either a placebo or the active drug at one of the chosen doses (5, 25, 50, 75, 100, 150, or 300 mg). The pressor effects of an individually titrated test dose of exogenous angiotensin II as well as plasma levels of angiotensin II, active renin, aldosterone, and treatment drug were determined before and throughout the 24 h after drug administration. The inhibitory effect of irbesartan on the pressor response to angiotensin II was observed within 1 h after dosing, peaked between 2 and 4 h, and lasted more than 24 h for doses of 25 mg and more. The effect was clearly dose related. Two and 24 h after administration of irbesartan, 300 mg, the response of arterial blood pressure (systolic and diastolic) to a given dose of angiotensin II was reduced by approximately 100% and 60%, respectively. Plasma concentrations of angiotensin II and active renin increased markedly after irbesartan administration, whereas plasma concentrations of aldosterone decreased. No evidence was found that the high levels of circulating angiotensin II observed after irbesartan administration could override the inhibitory effect of irbesartan on any of the measured parameters up to 24 h after dose. In conclusion, irbesartan appears to be a well-tolerated, orally active, potent antagonist of the renin-angiotensin system in men.
Adult↗
Nephrotic-range proteinuria in patients with renovascular disease.
PURPOSE: Proteinuria is usually considered a manifestation of glomerular disease. We sought to describe the characteristics of patients with nephrotic-range proteinuria resulting from renovascular disease and to compare them with those of patients who had glomerulonephritis. SUBJECTS AND METHODS: We identified 14 patients with nephrotic-range proteinuria and renovascular disease and compared them with 14 patients who had nephrotic-range proteinuria and biopsy-proven glomerulonephritis, matched for sex, age, and glomerular filtration rate. RESULTS: Patients with renovascular disease were more likely to have known atherosclerotic vascular disease [13 of 14 (93%) vs 3 of 14 (21%), P < 0.0001) and were usually smokers [12 of 14 (85%) vs 3 of 14 (21%), P < 0.0001]. They also had a greater mean (+/- SD) difference between the lengths of their kidneys (29 +/- 10 vs 5 +/- 5 mm, P < 0.001); greater systolic blood pressure (203 +/- 22 vs 174 +/- 25 mm Hg, P < 0.005), plasma renin activity (17 +/- 19 vs 2 +/- 2 ng/mL/h, P = 0.005), and plasma aldosterone concentration (40 +/- 23 vs 11 +/- 10 ng/dL, P = 0.0001); and lower serum potassium levels (3.3 +/- 0.5 vs 3.8 +/- 0.5, P <0.05). Effective renal plasma flow was lower (139 +/- 68 vs 307 +/- 185 mL/min/1.73 m3) and filtration fraction was markedly greater (0.28 +/- 0.04 vs 0.15 +/- 0.07, P = 0.0001) in the patients with renovascular disease. After the oral administration of captopril, blood pressure, effective renal plasma flow, and glomerular filtration rate decreased only among patients with renovascular disease. Of the 14 patients with renovascular disease, 13 had evidence of renal artery thrombosis seen at angiography; 2 patients required dialysis, and 3 others died during follow-up. CONCLUSION: Our findings suggest that the patients with nephrotic-range proteinuria resulting from renovascular disease have distinct characteristics and a poor prognosis.
Aged↗
Antioxidant supplementation and chronic renal transplant dysfunction.
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Antioxidants↗
Left ventricular adaptation to hypertension and plasma renin activity.
Chronic pressure and volume overload result in morphologically and functionally distinct forms of myocardial hypertrophy. In essential hypertension, the respective effect of these factors on the morphology of the left ventricle remains unknown. In the present study, we hypothesised that activity of the renin angiotensin system (assessed by plasma renin activity) may be associated to the variability of the left ventricular adaptation to essential hypertension. To assess this relation, we categorised by echocardiography 333 never-treated hypertensive patients, according to values of left ventricular mass and relative wall thickness. Higher systolic and pulse arterial pressure was strongly associated with concentric left ventricular hypertrophy (27% of hypertensives). When compared to the normal left ventricle group, patients with eccentric left ventricular hypertrophy (15% of hypertensives) had a high cardiac index (5 +/- 1 vs 4 +/- 0.8 L/min/m2; P = 0.0001), a lower basal plasma renin activity (0.81 +/- 0.63 vs 1.45 +/- 1.3 ng/ml/h; P = 0.02) and similar mean values of left ventricular performance and glomerular filtration rate. A tendency for depressed myocardial contractility assessed by the midwall shortening/end-systolic stress was associated with concentric left ventricular remodelling and hypertrophy when compared to hypertensive with a normal left ventricle. In conclusion, at the early phase of essential hypertension, in patients without renal dysfunction, each anatomic pattern of cardiac adaptation to hypertension was associated with a distinct profile of haemodynamics, myocardial function and activity of the renin-angiotensin system. Journal of Human Hypertension (2000) 14, 181-188.
Adaptation, Physiological↗
[Lumbago with increase of the cardiac silhouette in a context of chronic fever...].
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Adult↗
[Primary dysautonomia in the elderly: the diagnostic value of the inversion of the circadian rhythm of arterial blood pressure].
PURPOSE: Ambulatory blood pressure monitoring allows characterization of the circadian variations in blood pressure. METHODS: In order to investigate the diagnostic value of circadian variations in blood pressure in the elderly, 11 patients with autonomic failure and 11 control subjects paired on age, blood pressure level and daily life activity range were studied. RESULTS: Periodic postural disorders, positive response to passive tilt-test and alpha denervation supersensitivity to noradrenaline were found in all patients with autonomic failure. In control subjects, blood pressure levels assessed by ambulatory monitoring were lower at night. Conversely, circadian variations in blood pressure were higher at night and lower in the morning in patients with autonomic failure. The nadir of blood pressure measurement was related with the reported time of peak incidence of orthostatic symptoms. CONCLUSION: Ambulatory 24-hour blood pressure monitoring may therefore be of value in the diagnosis and management of patients with autonomic failure.
Activities of Daily Living↗
Microalbuminuria in essential hypertension.
Urinary excretion of albumin exceeds normal values in 10 to 25% of patients with essential hypertension. The level of albuminuria is highly correlated with arterial pressure, and more closely with ambulatory arterial pressure. The interaction between albuminuria and arterial pressure is enhanced by overweight, smoking, protein intake, insulin resistance, lipid abnormalities, and possibly genotypes of the components of the renin-angiotensin system. The renal mechanisms of microalbuminuria are not well elucidated. Notably, an increase in filtration fraction suggestive of intraglomerular hypertension was observed in patients with hyperfiltration. Microalbuminuria may be a marker of diffuse vascular abnormalities predisposing to cardiovascular disease and/or hypertensive renal disease heralding future renal failure, but its predictive value needs to be tested in more long-term follow-up studies. Antihypertensive treatment has a varied influence on albuminuria; angiotensin-converting enzyme inhibitors may correct this abnormality (at least partially) better than other agents.
Albuminuria↗
Renal characteristics and effect of angiotensin suppression in oral contraceptive users.
-The determinants of the increase in arterial blood pressure associated with the use of estrogen-progestogen oral contraceptives (OC) remain poorly known. The purpose of this study was to assess the renal characteristics and the role of the renin-angiotensin system in women with OC-associated hypertension. Urinary clearances of technetium-labeled diethylene triaminopentaacetic acid (glomerular filtration rate) and 131I-ortho iodohippurate (effective renal plasma flow) were estimated before and after acute administration of captopril in 38 women who became hypertensive while taking OC, 38 non-OC users with essential hypertension matched for age, body mass index, and level of blood pressure, and 38 normotensive women (19 with and 19 without OC). Plasma renin activity was higher in OC hypertensives when compared with those with essential hypertension, but captopril-induced changes in blood pressure and renal hemodynamics and function were similar in both groups. In addition, 24-hours urinary albumin excretion was increased in OC users when compared with nonusers with similar arterial blood pressure. In 13 hypertensive women followed up for 6 months after OC withdrawal, a decrease in plasma renin activity, blood pressure, and glomerular filtration rate but no significant change in urinary albumin excretion and captopril-induced changes in blood pressure and renal hemodynamics were observed. These results indicate that the use of OC is associated with an increased albuminuria and no evidence of a prominent role for the renin-angiotensin system in the maintenance of high blood pressure and renal hemodynamics when compared with non-OC users with essential hypertension.
Adult↗
Angiotensin receptor blockers: pharmacology and clinical significance.
Several imidazole derivatives that bind specifically to the angiotensin II type 1 receptor (the angiotensin receptor blockers, or ARB), have been developed in recent years and made available to clinicians. Preclinical studies revealed some differences in pharmacokinetic parameters and in vitro effects. However, most of the reported physiologic effects associated with ARB administration are similar to those of angiotensin-converting enzyme inhibitors (ACEI). In short-term clinical studies, the efficacy of ARB in reducing BP (BP) was similar to that of the ACEI, whereas (with a few exceptions) the side-effect profile was comparable to that of placebo. Whether targeting antihypertensive treatment with such a high specificity within the renin cascade carries major clinical advantages over inhibiting angiotensin-converting enzyme remains to be demonstrated.
Angiotensin II↗
[Determinant of left ventricular hypertrophy in the hypertensive woman. Influence of hormone replacement therapy for menopause].
BACKGROUND: This study investigated the influence of hormone replacement therapy on the variability of the cardiac hypertrophic response to hypertension in postmenopausal women. METHODS: 25 menopausal essential hypertensive women (mean age 54 +/- 0.8 years, range 45 to 70) treated with estrogen (without progestin) for at least 1 year were studied and compared with 25 menopausal age-matched women (55 +/- 1 years old, range 46 to 70) not taking such therapy. No women had ever received antihypertensive therapy. Left ventricular mass corrected by height2.7 and relative wall thickness were assessed by M mode echocardiography. RESULTS: Age, blood pressure, body mass index, 24 h urinary sodium excretion and plasma renin activity were in the 2 groups with and without hormone replacement therapy. Left ventricular mass corrected by height2.7 was significantly higher in the group with without estrogen replacement therapy when compared to menopausal women with estrogen replacement (55 +/- 3 vs 45 +/- 4 g/m2.7 p < 0.02). In addition the slope of the regression line between LV mass and systolic BP was significantly higher (p < 0.01) in the group of women without hormonal therapy r = 0.50 p < 0.001. CONCLUSION: These results suggest that estrogen therapy of menopause attenuate the cardiac hypertrophic response to hypertension.
Aged↗