Biomedical subjects

M Burnier

Publications and source records attributed to M Burnier.

186 records · Page 11Linked to original sources

PubMedDate not supplied

Compliance in hypertension.

Despite improvements in the management of hypertension in the past several years, nearly 70% of patients with hypertension are not adequately controlled. Today's physician treating hypertension is armed with numerous efficacious antihypertensive agents. Thus, one of the major contributors to the large number of uncontrolled hypertensive patients appears to be non-compliance with prescribed regimens. Non-compliance is a universal characteristic and can affect all patients. However, the major problem of non-compliance is that it remains largely unrecognised in clinical practice. Several types of non-compliance exist with the 'drug holiday' being the most common. Good communication with the patient and the entire health care team is critical in increasing patient compliance. Long-acting medications that provide good blood pressure control beyond the 24-hour dosing period should be considered drugs of choice in non-compliant hypertensive patients. This article will discuss different types of compliance, methods to measure compliance, and clinical consequences of non-compliance in hypertension.

Humans↗

PubMedDate not supplied

Sodium balance and hypertension: rare genetic disorders expose pathogenic mechanisms.

The importance of sodium in the pathophysiology of hypertension has been revealed by several sources, including large epidemiological analyses, interventional trials, and a large body of experimental and clinical evidence. According to Guyton's hypothesis, a shift of the pressure-natriuresis curve has been described in all forms of hypertension, suggesting that the ability of the kidney to excrete sodium must be altered in hypertension. Yet, the intrarenal mechanism responsible for the abnormal salt excretion remains unknown. In recent years, the discovery of the molecular mechanisms involved in the pathogenesis of some rare forms of hypertension, i.e. , Liddle's syndrome, glucocorticoid-remediable hypertension, and apparent mineralocorticoid excess, has revived the interest in salt-induced hypertension, since the reported genetic defects decrease the ability of the kidneys to excrete sodium. This review presents the pathogenic mechanisms revealed by these rare disorders and discusses the possible implication of these discoveries for the understanding of the pathophysiology of essential hypertension.

Animals↗

PubMedDate not supplied

Compliance to live oral Ty21a typhoid vaccine, and its effect on viability.

BACKGROUND: Concerns have been expressed that in travelers the efficacy of the live oral Ty21a typhoid vaccine Vivotif could be lower than reported, maybe due to a lack of compliance. The purpose of this study was to examine the level of compliance with the recommendations regarding dosing, timing of dosing with respect to food intake, and storage. METHODS: Travelers were randomized into two groups: one received oral information only, and the second, a combination of oral and written information. Four criteria of compliance were applied to travelers: 3 capsules needed to be swallowed (criterion 1) on day 1, 3 and 5 (criterion 2), at least 1 hour before or 2 hours after a meal (criterion 3) and the vaccine had to be kept refrigerated (2-8 degrees C) (criterion 4). Compliance was evaluated using three different methods: a questionnaire, pill counting, and electronic monitoring using the Medication Event Monitoring System (MEMS). Storage conditions were checked by temperature tags, and viability of the vaccine was assessed by culturing the content of remaining capsules. RESULTS: The data of 115 travelers were analyzed. All the travelers took the 3 capsules. Compliance to all four criteria was complete in 68% of travelers according to the questionnaire, and 53% according to the MEMS (p =.05). Sixty-seven percent of all the doses intervals were of 48 hours +/- 6 hours, 12% being shorter than 36 hours and 7% longer than 60 hours. Eighty-seven travelers (76%) took their capsules on each alternate day. The method of information had no significant impact on compliance. Forty-two percent of tags showed exposure to temperature over 10 degrees C for more than 24 hours. Yet, no difference could be found in the viability of the vaccine compared with controls. CONCLUSIONS: Most travelers take their 3 capsules on alternate days, but many did not follow the other recommendations. Electronic monitoring of compliance provides more accurate results than questionnaires. Emphasis must be put on motivating the travelers to take the vaccine as recommended.

Administration, Oral↗

PubMedDate not supplied

Compliance with antihypertensive therapy.

Poor compliance with antihypertensive therapy is a major cause of unsatisfactory blood pressure control. The doctor has a key role in all steps that lead the patient to adopt a treatment and to take it as prescribed lifelong. Compliance with therapy is a parameter which is difficult to assess. There is often an important mismatch between the subjective views of physicians and patients regarding long-term drug taking. Electronic monitoring of compliance represents a valuable method to evaluate the "real time" compliance of the patient. Discussing a compliance recording with a patient may help to identify and solve problems linked with everyday adherence to antihypertensive treatment. Improving compliance is an important task not only for the doctors, but also for all healthcare providers.

Adrenergic beta-Antagonists↗

PubMedDate not supplied

[Influence of moderate body weight excess on the nycthemeral pattern of blood pressure, renal function and sodium and water excretion in patients with essential hypertension].

Obesity is a risk factor for arterial hypertension. We studied the relationships between the body mass index (BMI) and the nycthemeral pattern of blood pressure (BP), renal function and sodium and water excretion (EX) in a group of 25 moderately hypertensive untreated men (41 +/- 2 y, 80 +/- 3 kg). Subjects were given a high sodium diet (6 g NaCl added to their usual diet, daily EX=200 mmol). On the 7th day, BP was monitored during 24 h and urine collected in 2 fractions (day=D, 8:00-22:00 and night=N, 22:00-8:00). Subjects were a posteriori divided into 2 groups according to the median BMI (26 kg/m2): Group 1, n=12, BMI 23.2 +/- 0.6 (mean +/- SEM) and Group 2, n=13, BMI 29.2 +/- 0.5 kg/m2. No difference was observed between the two groups for age, 24 h urine and sodium EX, or systolic and diastolic BP. However, heart rate was significantly higher during N in Group 2 (66 +/- 2 vs 57 +/- 2 b/min, p=0.012). Na and water EX were significantly higher during D than during N in Group 1, but lower during D than during N in Group 2. Creatinine clearance was higher in Group 2 than in Group 1 especially during N (D+29%, p=0.013; N+49%, p<0.001). In Group 2, subjects concentrated their urine more than in Group 1, as evaluated from the urine/plasma creatinine ratio (+49%, p=0.019). This ratio was positively correlated to BMI during D (r=0.561, p=0.004) but not during N. These results show that the glomerular hyperfiltration associated with overweight is more intense at night and that moderately overweight hypertensives have a reduced sodium and water EX during the day and a compensatory larger EX at night. The reduced diurnal EX goes along with an increased urine concentration. The nocturnal rise in EX is concomittant with a rise in heart rate. Given the growing health problems linked to obesity and hypertension, these results open a new field for the understanding of the difficulty to excrete sodium in this condition.

Adult↗

PubMedDate not supplied

[Angiotensin II AT1 receptor antagonists: clinical development and future perspectives].

Blockade of the renin-angiotensin system with angiotensin-converting enzyme (ACE) inhibitors is now recognized as an effective approach for the treatment of hypertension and congestive heart failure. In addition, ACE inhibitors are very effective for the prevention of chronic renal failure. Today, it is possible to antagonize the effects of angiotensin II more specifically using AT1 receptor antagonists. Several non-peptide, orally active angiotensin II receptor antagonists have recently been developed clinically. These new molecules are as effective as ACE inhibitors, calcium antagonists and beta-blockers at reducing blood pressure in hypertensive patients. Furthermore, they appear to have similar systemic and renal hemodynamic properties in patients with congestive heart failure and renal diseases. Now, several large clinical trials such as the LIFE, the RENAAL and the ELITE II studies are under way to investigate the long-term benefits of one of these compounds in hypertension, heart failure and type II diabetic nephropathy.

Angiotensin II↗