Search PubMed⌕ Search

Biomedical subjects

L Poggi

Publications and source records attributed to L Poggi.

At least 37 records · Page 2Linked to original sources
PubMed1998

[Cardiovascular risk and the measurement of arterial pressure].

Clinical measurement of the blood pressure associated with assessment of the other cardiovascular risk factors: cholesterol, smoking, age, sex, diabetes and cardiovascular heredity, allow appreciation of the cardiovascular risk of hypertensive patients after the results of the Framingham study. There is no consensus about the optimal clinical blood pressure with treatment and about the control of treated hypertensives which remains low in population studies (28% in France, 27% in the United States). New methods of blood pressure measurements such as ambulatory blood pressure monitoring and self-measurement of the blood pressure are better correlated to cardiovascular events and morbi-mortality than measurement of the blood pressure during consultation in hypertensive patients. Ambulatory blood pressure recording also seems to be more predictive of regression of left ventricular hypertrophy. Therefore, the latest recommendations, especially the American consensus, advise using these techniques when the physician is in doubt about the value of the clinical blood pressure measurement of hypertensive patients, especially in the case of apparent antihypertensive drug resistance. Finally, what does good blood pressure control imply in 1988: normal clinical blood pressure measurements compared with ambulatory blood pressure monitoring or self-measurement of the blood pressure? Does it mean control of the patient's absolute cardiovascular risk? The answers to these questions can only be obtained by future prospective studies.

Age Factors↗
PubMed1997

Assessment of antihypertensive effect by blood pressure monitoring: applications to bisoprolol and lisinopril in a double-blind study.

The aim of this study was to evaluate the antihypertensive effect of drugs according to the initial ambulatory blood pressure (BP) level. After a 15-day placebo run-in period, 105 patients with moderate essential hypertension (mean age, 52 years) underwent 24-h BP monitoring (spacelabs: 1 measure/15 min). Patients were subdivided into two groups: the "High" group, with 24-h mean values of systolic BP (SBP) > 137 or diastolic BP (DBP) > 87 mm Hg, and the "Low" group, with SBP < or = 137 and DBP < or = 87 mm Hg. All patients received, in a random and double-blind design, either bisoprolol (10 mg q.d.) or lisinopril (20 mg q.d.) for 8 weeks. At the end of this active treatment period, office and ambulatory BP measurements were performed. Casual measurements revealed similar BP decreases in all subgroups receiving bisoprolol and lisinopril; BP monitoring showed that the antihypertensive effect depended on the baseline mean 24-h value; -15/-12 mm Hg for bisoprolol and -18/-13 mm Hg for lisinopril in the High group; -7/-6 mm Hg for bisoprolol and -6/-6 mm Hg for lisinopril in the Low group. This study shows that the antihypertensive effect depended on initial ambulatory BP values, with a lower BP decrease in the Low group. Assessment of the antihypertensive effect on ambulatory BP is useful in clinical trials.

Adrenergic beta-Antagonists↗
PubMed1996

[Prevalence, treatment and control of hypertension in family practice patients in France during 1994].

The aim of this study was to measure the percentage of patients with hypertension, treated hypertension and controlled hypertension, using data collected over one week by 235 general practitioners well representative of the French medical population and selected by SOFRES Médical. Practitioners had to carry out their own survey over a period of one week on all patients above 18 years of age who visited their office. They were initially instructed to use the same type of mercury sphygmomanometer, equiped with the same pneumatic cuffs of different sizes. Three consecutive blood pressure measurements were effected, the last two were recorded. Patients were considered as hypertensive if the mean of the two recorded BP measurements was > or = 140-90 mmHg, or < 140-90 mmHg under pharmacological treatment. Hypertensive patients were considered as controlled when their blood pressure levels were overall < 140-90 mmHg under treatment. According to age, two other control levels were analysed: blood pressure < 160-95 mmHg before 65 years and blood pressure < 160-90 mmHg at 65 years or more. Among 12,351 patients, 5,020 are hypertensive (4%), 2,985 under pharmacological treatment (59%) and 2,035 without treatment (4%). Among untreated patients, 9% had an hypertension above the borderline values. Before 65 years, 28% had an under treatment blood pressure < 140-90 mmHg and 71% < 160-95 mmHg. Among 65 years or more hypertensive patients, 21% had an under treatment blood pressure < 140-90 mmHg and 60% < 160-90 mmHg. Before 65 years, 25% among patients with a monotherapy remained with a blood pressure > 160-95 mmHg and 34% with a blood pressure > 160-90 mmHg among those of 65 years or more; 230 patients (5%) remained in high risk with a blood pressure > 180-105 mmHg. 176 untreated and 54 despite their treatment. This study carried out in French medical practice yield two main conclusions regarding the management of hypertension: as the prevalence of hypertensive patients is 41%: one patient out of two, high blood pressure has to be a main aim for the medical teaching. Even if a reasonable control of the blood pressure is achieved in most cases, blood pressure got a normal level for 24% only of treated hypertensive patients and too many patients were keeping high risk because they have been not or not enough treated. This study, as a real audit, gives some useful informations to general practitioners in order to improve their scores.

Adolescent↗
PubMed1994

Treatment of essential hypertension in general practice: an open-label study of 47,351 French hypertensive patients treated for one year with perindopril.

The efficacy and acceptability of perindopril were assessed over one year by 4800 French general practitioners in an open label study of 47,351 freely consenting adults with mild to moderate hypertension. Perindopril was administered as a single daily dose each morning. The starting dose of 4 mg (or 2 mg in patients over 70 years) was doubled after one month, to a maximum of 8 mg if diastolic blood pressure (DBP) was greater than 95 mmHg. Thereafter a non-potassium sparing diuretic was added to the 8 mg dose if necessary. At 12 months, effective blood pressure control, defined as recumbent DBP below 90 mmHg, was achieved in between 68 and 77% of patients. The majority of patients (80% [n = 37,348]) received perindopril alone throughout the 12-month study period. The final prescription (at six months) revealed that 65% of patients were treated with the once daily 4 mg dose. Throughout the 12 months of the study, 7.6% of patients (n = 3564) discontinued treatment, 5.1% (n = 2401) due to adverse events and 0.4% (n = 187) due to fatal events (principally cardiovascular reasons). Cough was the most frequent adverse symptom, leading to withdrawal of 3.28% of patients; this symptom was spontaneously reported in an additional 6.4% of patients throughout the one-year period but did not lead to discontinuation. All other adverse events leading to withdrawal were present in less than 0.4% of cases. The majority of fatal outcomes was due to cardiovascular events (n = 78), 37 were due to cancer, 19 due to road accidents and 53 due to miscellaneous causes.(ABSTRACT TRUNCATED AT 250 WORDS)

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1994

[Asymptomatic hyperparathyroidism. Influence of PTH values on the therapeutic decision].

The majority of patients affected by primary hyperparathyroidism present now in surgical series are little or totally asymptomatic. This is due to widespread use of multiphasic screening for hypercalcemia as far as to more liberal indications for parathyroid exploration. The debate about the need for parathyroidectomy is open in these patients, having few or no signs at all of primary hyperparathyroidism, because conservative treatment has yielded confused results. The authors analyzed preoperative biochemical values and surgical outcome from 26 patients affected by primary hyperparathyroidism. Thirteen cases had overt primary hyperparathyroidism (group A) and 13 had asymptomatic disease (group B). Patients in group A had higher preoperative PTH values than patients in group (p < 0.05). After surgery, the patients in group A showed parathyroid glands which weighted significatively more than ones in group B (p +/- 0.01). Further, a significant correlation between preoperative PTH value and glandular weight was demonstrated in all cases. The authors conclude surgery for patients having mild primary hyperparathyroidism may give some problems related to the very small size of abnormal glands found during operation. We advise a close follow-up for these patients initially without treatment: surgery should be recommended for those showing PTH values higher than 150 pg/ml.

Adult↗
PubMed1994

[Ambulatory measurement of blood pressure and efficacy of diltiazem. Influence of the timing of drug ingestion and initial blood pressure level].

Clinical and 24-hour ambulatory measurements were made in 46 patients with mild to moderate essential hypertension in order to confirm that the efficacy and safety of sustained-release diltiazem LP 300 mg were the same regardless of the time of day at which it was taken. After two weeks of placebo, patients were randomly assigned double-blind to take diltiazem LP 300 mg either morning or evening for four weeks. Diltiazem LP 300 mg significantly lowered diastolic and systolic blood pressure in both groups by clinical or 24-hour ambulatory measurement, and without any difference according to whether diltiazem LP 300 mg was administered morning or evening. A lesser fall in blood pressure during the night in both groups led to study of the effect of diltiazem LP 300 mg according to initial ambulatory diastolic blood pressure level. Diltiazem brought about a greater fall in blood pressure when patients had an ambulatory diastolic pressure of 90 mmHg or more. Clinical, laboratory and electrocardiographic parameters were all satisfactory, regardless of the time at which the drug was taken.

Adult↗
PubMed1993

[Evaluation of hypertrophic cardiomyopathy in treated essential hypertensive patients].

Assessment of left ventricular hypertrophy (LVH) in 231 essential hypertensive patients (61 year'old) treated in a department of internal medicine. Incidence of LVH defined by echocardiography: 34%. Better relationship between LVH and ambulatory blood pressure (BP) monitoring than with casual BP. Influence of age and obesity in the occurrence of LVH.

Aged↗
PubMed1993

[Influence of the position of the arm on the level of clinical arterial pressure].

The position of the arm in relation to the heart is one of the factors responsible for variations in arterial blood pressure. The purpose of this study was to confirm these variations and their diagnostic and therapeutic consequences. The blood pressure of 59 subjects was measured in supine position with or without support, this support being a device, recently developed by Swedish physicians, that brings the radial notch of the ulna at heart level. The results obtained confirmed the existence of variations in blood pressure values according to the position of the arm in relation to the heart. When measured with the support, blood pressure fell by 5 mmHg for systolic pressure and 4.6 mmHg for diastolic pressure. These results prove the need for standardization of blood pressure measurement in supine position. It is permissible to believe that at this moment a non-negligible proportion of patients (12 percent in our series) is either wrongly regarded as hypertensive or overtreated. In addition, the blood pressure variations induced by the brachial support should be taken into account in the analysis of future epidemiological studies. We conclude that using the brachial support can be recommended for a better evaluation of supine blood pressure measurements.

Arm↗
PubMed1993

[Evaluation of the antihypertensive efficacy of lisinopril and captopril associated with hydrochlorothiazide by ambulatory measurement of arterial pressure].

The objective of this study was to evaluate the efficacy, particularly in terms of the 24-hour cover, and the safety of lisinopril 20 mg + hydrochlorothiazide 12.5 mg 5L/HCTZ) and captopril 50 mg + hydrochlorothiazide 25 mg (C/HCTZ) in patients with essential HT requiring two-agent therapy. Twenty patients with a diastolic blood pressure (DBP) between 95 and 120 mmHg after 2 weeks of placebo were randomised to receive, under double-blind conditions, either L/HCTZ or C/HCTZ as a single daily dose for 4 weeks. Clinical examination, laboratory tests and 24-hour ambulatory blood pressure monitoring (ABPM) were performed at the end of the placebo and active treatment periods. L/HCTZ and C/HCTZ significantly lowered SBP and DBP on occasional recordings and on ABPM. The mean fall in blood pressure on ABPM (SBP, DBP, mean of 24-hour recording, diurnal and nocturnal) at 4 weeks was greater with L/HCTZ than with C/HCTZ. Both treatments were effective for 24 hours and did not alter the circadian cycle. The clinical and laboratory safety was good. The blood pressure figures obtained by ABPM were lower than on occasional recordings, emphasising the value of this technique in the evaluation of a patient's poor response to antihypertensive treatment.

Adult↗
PubMed1993

[Prognostic value of thallium-201 myocardial scintigraphy in patients with hypertension, suspected of coronary disease].

This study was undertaken to determine the prognostic value of exercise myocardial scintigraphy in hypertension patients suspected of coronary disease. One hundred and thirty six hypertension patients (mean age: 59) suspected of coronary disease were monitored for 46 months after thallium 201 exercise myocardial scintigraphy (tomographic mode). Prognostic factors analysed were clinical (typical nature of pain, exercise blood pressure), electrocardiographic (presence of repolarisation abnormalities in resting ECG), ergometric (electrically positive test) and scintigraphic (existence or not of transitory hypofixation). Events sought were: death of coronary origin, non-fatal myocardial infarction, aorto-coronary bypass and coronary angioplasty. One-way analysis showed that the existence of transitory hypofixation by scintigraphy, positive exercise electrocardiogram and typical angina pain enabled the prediction of coronary events. Thus 14 of 36 patients (39%) with transitory or combined hypofixation had a coronary event as against 7 of the 100 patients without transitory hypofixation. Only the existence of transitory hypofixation retained a prognostic value for coronary events by multivariate analysis (relative risk = 5.4, p = 0.001). It was also found that the prognosis was good when scintigraphy did not reveal transitory hypofixation while exercise testing was positive (2 coronary events/27 patients). It is concluded that, despite the possibility of "false positives", linked in particular to myocardial hypertrophy, myocardial scintigraphy offers better prediction of coronary events in hypertension patients that other clinical or electrocardiographic parameters.

Adult↗
PubMed1993

[Non-invasive ambulatory measurement of arterial pressure. Recommendations of the measurement group of the French Society of Arterial Hypertension].

Ambulatory blood pressure monitoring is being widely used now that relatively simple, reliable and well-tolerated, non-invasive blood pressure measuring devices have become available. The following recommendations are only to help physicians to use this technique in their daily practice: only use homologated devices; ambulatory monitoring should be performed during normal, everyday activities; at least one measurement of blood pressure should be taken every 1/4 hour during the day time (7 h-22 h) and every 1/2 hour during the night (22 h-7 h); the arm must be absolutely still and relaxed during the measurement; the function of the measuring device should be checked when the patient is fitted up and when the device is removed; data processing should provide at least: all values of blood pressure and heart rate, and their times of measurement, the mean values of systolic end diastolic blood pressure and heart rate during the day and during the night, the maximal and minimal systolic and diastolic blood pressure values, a chronogramme of the values. Reasonable indications of ambulatory blood pressure monitoring include: elimination of the "white coat" effect: to confirm the diagnosis of borderline hypertension; to demonstrate inversion of diurnal rhythm in severe hypertension; to demonstrate episodic hyper or hypotension; to confirm certain cases of toxaemia of pregnancy. It is also justified in the evaluation of antihypertension therapy, especially in cases of suspected drug resistance.

Ambulatory Care↗
PubMed1993

[Comparative effects of angiotensin converting enzyme inhibitors and calcium antagonists on pulse pressure and blood pressure variability, based on ambulatory measurements in 236 mild to moderate hypertensive patients].

OBJECTIVE: this retrospective study was aimed: at comparing the effects of angiotensin converting enzyme inhibitors (ACEI) and those of calcium antagonists (CA) on the pulse pressure of mild to moderate hypertensive patients; at assessing whether these effects were associated with some modifications of blood pressure variability or not. METHODS: the ambulatory blood pressure (ABP) recordings of 236 patients who previously entered clinical trials with a mean run-in placebo period of 2 weeks and a mean active treatment phase of 6 weeks (ACEI, n = 115; CA, n = 121) were reviewed. Baseline ABP has been analysed both as a continuous variable and as a categorical one (high when > 139/87 mmHg, low otherwise). Pulse pressure was calculated by the difference systolic ABP-diastolic ABP, whereas BP variability was estimated by the standard deviation and the variation coefficient of each recording. The results are given as percentage (mean +/- standard deviation). In the patients with high baseline systolic ABP, ACEI and CA did not significantly differ regarding their effects on pulse pressure (-11.1 +/- 17.2 vs -6.3 +/- 14.0, NS). By contrast, in the other patients, pulse pressure was lowered to a significantly greater degree by ACEI than by CA (-5.5 +/- 18.7 vs +1.8 +/- 18.8, p = 0.04). These differences were not related to baseline diastolic ABP. No difference at all was found with regard to BP variability which was altered by none of the drugs. In conclusion, pulse pressure, a reliable indicator of arterial compliance, seemed to be more decreased by ACEI than by CA, the difference being significant only in patients with apparent hypertension.

Adult↗
PubMed1992

Comparison of angiotensin-converting enzyme inhibitors and calcium antagonists in the treatment of mild to moderate systemic hypertension, according to baseline ambulatory blood pressure level.

This study was aimed at determining whether baseline ambulatory blood pressure (BP) levels influence the efficacy of angiotensin-converting enzyme inhibitors and calcium antagonists in the same manner. Accordingly, the ambulatory BP recordings of 236 mild to moderate hypertensive patients who had previously entered a clinical trial and had received either a calcium antagonist (n = 121) or an angiotensin-converting enzyme inhibitor (n = 115) were reviewed. The inclusion criterion was a clinic diastolic BP between 95 and 115 mm Hg at the end of the placebo period. Patients were classified according to the difference between their observed and predicted ambulatory BP (the latter assessed by regressing the observed ambulatory BP on the clinic BP). Reduction in ambulatory systolic and diastolic BP seemed to be greater (p less than 0.0001, p = 0.01) in patients receiving an angiotensin-converting enzyme inhibitor than in those who were given a calcium antagonist. However, analysis of variance showed (1) there was a significant interaction (F = 6.37 p = 0.01) between the pharmacologic class and the baseline systolic ambulatory BP; and (2) the difference in diastolic ambulatory BP reduction between both classes was no longer significant when adjusted for baseline diastolic ambulatory BP. In patients with higher than predicted ambulatory BP levels, angiotensin-converting enzyme inhibitors and calcium antagonists had roughly a similar effect (reduction in systolic BP, 9 +/- 8% vs 7 +/- 6%, p = not significant; reduction in diastolic BP, 11 +/- 8% vs 8 +/- 6%, p = not significant).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

[Efficacy of antihypertensive treatment in the French population. A multicenter survey].

In order to assess the efficacy of antihypertensive treatment in the population, a study was undertaken in 5 French cities during the commercial fairs of Grenoble, Marseilles, Nice, Toulouse and Lille. The blood pressure was measured according to the WHO recommendations in volunteers. The study included a total of 7107 subjects of both sexes, with 4064 subjects in the 35-64 year age group. The therapeutic efficacy was evaluated in the 791 hypertensive patients who knew their antihypertensive therapy. Taking < 160/95 mmHg as the criterion of efficacy, 52 to 73% of the hypertensive patients were well controlled. However, if the therapeutic objective of normalisation of the blood pressure (BP < 140/90 mmHg) is taken as the criterion of efficacy, only 23 to 29% of the hypertensive patients were controlled whilst their BP remained significantly higher than that of normotensive controls of the same age. The difference in efficacy of antihypertensive therapy between the cities may be explained by the heterogenicity of the populations whereas the treatment did not differ significantly. After adjustment analysis with respect to sex showed that women were better controlled than men whatever the criterion chosen. The group controlled at BP < 160/95 mmHg only differed from the group < 140/90 with respect to the average BP value which was higher before treatment and decreased less with treatment; though this did not achieve statistical significance. In matters of public health, if the ideal blood pressure is taken as < 140/90 mmHg, this study shows that the objective is only attained in one out of four patients in the population studied.

Adult↗