[Exercise test in hypertensive subjects. Recommendations of the French Society on Hypertension].
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Clinical Protocols↗
Biomedical subjects
P Gosse
Publications and source records attributed to P Gosse.
[Complementary transthoracic and transesophageal echo-doppler in the diagnosis of rupture of the sinus of Valsalva in right heart. Apropos of 4 cases].
Aneurysms of the sinus of Valsalva are rare and usually present with rupture communicating with the right heart cavities. Echocardiography is a powerful diagnostic tool in ruptured sinus of Valsalva aneurysms, especially the Color Doppler mode which shows abnormal, continuous flow as a mosaic of colour extending from the aortic root to the right heart cavities. The four case reports describe rupture of the right sinus of Valsalva aneurysm into the right atrium (2 cases) and the right ventricle (2 cases). Transesophageal echocardiography was performed in two cases and provided valuable information by confirming the site of rupture and the length of the diverticulum. The results illustrate the accuracy of Doppler echocardiographic techniques by the transthoracic and transoesophageal approaches in the diagnosis of ruptured sinus of Valsalva aneurysms.
Adolescent↗
[Thrombosis of mechanical heart valve prosthesis. Value of transesophageal echocardiography in the study of mitral valve prosthesis].
Forty-three consecutive patients with mechanical valve prostheses underwent transthoracic and transoesophageal echocardiography for suspected thrombolic prosthetic valve dysfunction. The results of these investigations were compared with those of cineradiography and the clinical outcome. The diagnosis of thrombosis was retained in 11 of the 43 patients (10 mitral and 1 aortic valve prostheses). The transthoracic Doppler echo was clearly abnormal in 6 of the 11 cases. Transoesophageal echo was of essential value in all cases but one, showing abnormal movement of the mobile element and/or a paraprosthetic thrombus. The cineradiography gave false negative results in 6 cases. In conclusion, these cases underline the undeniable value of transoesophageal echocardiography in occlusive or non-occlusive thrombosis of a mitral valve prosthesis. This investigation should be undertaken whenever there is the least suspicion of thrombosis of the prosthesis.
Adult↗
Is echocardiography an adequate method to evaluate left ventricular hypertrophy regression?
M mode echocardiography is certainly an adequate method to evaluate left ventricular hypertrophy (LVH) regression in hypertensive patients, provided that some important conditions are fulfilled. Left ventricular mass assessment can be made only with non-distorted ventricles, as usually encountered in non-complicated hypertensive patients. The main problem is to limit all sources of variability for serial measurements and all sources of subjectivity in their interpretation. So, we propose some guidelines that should be useful when designing and completing such studies. Two-dimensional echocardiography offers the potential advantage of allowing assessment of left ventricular mass even when the left ventricle is far from its usual shape. However, a standardization of methods and studies of its reproducibility are still required before this method could be recommended in studies of LVH regression.
Antihypertensive Agents↗
Beta-blockers vs. angiotensin-converting enzyme inhibitors in hypertension: effects on left ventricular hypertrophy.
Both beta-blockers and angiotensin-converting enzyme (ACE) inhibitors have been shown to cause left ventricular hypertrophy regression in hypertensive patients. So far, no study allowed a true comparison of these drugs in this regard. Therefore, 56 hypertensive patients (38 newly recognized and 18 without any antihypertensive drugs for more than 2 months, mean of 9.5+/-14 months) were randomized to enalapril (En, n = 30) or a beta-blocker, bisoprolol (Bi, n = 26), once daily and underwent before and after 2 and 6 months on treatment (a) office and 24-h ambulatory monitoring of BP, (b) M-mode echo assessment of left ventricular mass (LVM) index and fractional shortening (FS), and (c) Doppler evaluation of left ventricular filling. All recordings were read blindly by two observers. The intraobserver coefficient of variation of LVM was 9%. After 6 months, office BP (146+/-18/90+/-10 vs. 170+/-14/104+/-8 mm Hg) and 24-h BP(120+/-17/77+/-9 vs. 138+/-15/90+/-9 mm Hg) were similarly reduced with both drugs. The LVM index was significantly reduced (p < 0.001) (Bi, 11%; En, 7%) and FS was unchanged. The early to late diastolic left ventricular flow ratio (E/A) was increased with bisoprolol (1.06+/-0.29 vs. 0.85+/-0.17, p < 0.0001) but not with enalapril (0.95+/-0.24 vs. 0.88+/-0.34), but this was mainly due to heart rate reduction with bisoprolol. We found no correlation between the reductions in 24-h BP and in LVM index. Bisoprolol and enalapril were similarly effective in lowering blood pressure (BP) in the office and during 24-h monitoring and in reducing the left ventricular mass index in hypertensive patients.
Adrenergic beta-Antagonists↗
[Complementarity of transthoracic and transesophageal Doppler echocardiography in the diagnosis of thrombosis of a mitral prosthesis. Apropos of 3 cases].
The diagnosis of partial thrombosis of mitral disc valve prostheses is particularly difficult because the clinical presentation is often atypical and the motion of the two hemi-discs is hard to analyse by transthoracic echocardiography. The authors report three cases of partial thrombosis of mitral double-disc valve prostheses. It was not possible to analyse the motion of the two hemi-disc correctly in any of the three patients. The mitral transprosthetic flow recorded by continuous wave Doppler was abnormal with respect to the reference postoperative recording. In addition, in one case, an abnormal echo was observed floating in the left ventricular inflow tract and was suggestive of a thrombus. Transesophageal echo showed abnormal motion of one of the hemi-discs. In two patients this consisted in immobility of the hemi-disc in the semi-closed position; in the other patient, limited excursion of the hemi-disc was recorded. Abnormal retrograde flow in the left atrium was observed in 2 cases and abnormal echoes on the atrial surface of the valve were recorded in one case. After fibrinolysis the transthoracic and transesophageal Doppler echocardiographic parameters returned to normal. These three cases underline the complementarity of transthoracic and transesophageal echocardiography in the diagnosis of dysfunction of mitral disc valve prostheses.
Adult↗
[Value and limitations of transthoracic Doppler echocardiography in the diagnosis of thromboses of mechanical valve prosthesis. Report of 19 cases].
The diagnosis of thrombosis of a valvular prosthesis is difficult especially in cases of partial thrombosis. The authors report 19 cases of partial thrombosis of mainly (16 cases) mechanical valve prostheses confirmed by radioscopy and treated either by reoperation or fibrinolysis. Mitral Valve Prostheses: 14 cases (6 Björk, 7 SJM, 1 Carbomedics). All but one case showed significant prolongation of the pressure half time compared with the postoperative reference value. In one case, however, the functional parameters of the prosthesis were normal; the diagnosis was made from the finding of a mobile thrombus on the ventricular surface of the prosthesis. Aortic Valve Prostheses: 5 cases (3 Björk, 1 SJM, 1 Duromedics). Continuous wave Doppler showed significant increases in the velocity of transprosthetic blood flow with respect to the postoperative reference values. Accurate analysis of the mobile elements of the prostheses was usually impossible. These results show that transthoracic Doppler echocardiography remains an excellent method of study and surveillance of mechanical valve prostheses but the limitations of the technique should be familiar to all operators.
Aged↗
[Two-dimensional echocardiography in the diagnosis of intracardiac metastases].
The authors describe the echocardiographic features of 19 cases of intracardiac metastatic tumours diagnosed over a 5-year period. The cardiac appearances were very varied: pericardial effusion alone or associated with an intrapericardial tumour (9 cases), myocardial infiltration (9 cases), immobile or mobile intracavitary tumour sometimes simulating a myxoma (15 cases). In 18 out of the 19 cases, the tumour mass was hyperechogenic which made it easy to diagnose. However, in one case of right atrial tumour, the mass was hypoechogenic and the diagnosis could only be made by contrast echocardiography. This study illustrates the important role that two-dimensional echocardiography plays in the non-invasive diagnosis of intracardiac metastatic tumours but physicians should be aware of the potential pitfalls and limitations of the technique.
Aged↗
[Value and limitations of the measurement of the jet diameter in aortic insufficiency using Doppler color. Report of 68 patients].
The aim of this study is to specify the feasibility and value of the diameter measurement of the jet of aortic insufficiency (AI) in colour Doppler. 68 consecutive patients had a supra-sigmoid angiography and a colour echo-Doppler. An aortic insufficiency was revealed 58 times by the angiography and Doppler. In all the cases except four, it has been possible to measure the jet diameter at the origin in para-sternal incidence in colour TM by confronting the images in great and small axis section. The Doppler results have been compared to the angiographic score in 4 grades according to Sellers classification. The jet diameter at the origin in colour TM is significantly different in groups I, II, III-IV. In the group III-IV, it is always higher or equal to 13 mm. The failures of quantification of the AI jet in colour Doppler are linked with the very eccentric nature of the jet or to the poor quality of the echo-Doppler imaging. On the whole, the jet diameter measurement proves to be a very useful element in the assessment of the gravity of an AI, particularly when it is a central and circular jet.
Adult↗
Left ventricular mass changes with nicardipine therapy in essential hypertension.
Eighteen hypertensive patients (13 males, 5 females; age 48 +/- 13; diastolic blood pressure greater than 95 mmHg), either previously untreated or who had been off treatment for more than 3 months, underwent M-mode echocardiography before (DO) and after (D90) 3 months of nicardipine therapy (60-90 mg/day). All echocardiograms were read blind, and left ventricular mass (LVM) was calculated (Devereaux's formula). Blood pressure was significantly reduced after 3 months from 167 +/- 15/102 +/- 8 mmHg on DO to 152 +/- 16/92 +/- mmHg on D90 (p less than 0.001). The reduction in LVM was not significant: 266 +/- 95 g on DO, 247 +/- 78 g on D90. There was a trend to a higher (although nonsignificant) LVM reduction in patients with left ventricular hypertrophy at entry (-11%, n = 11) than in patients without left ventricular hypertrophy (-2%), n = 7).
Adult↗
Left ventricular mass in normotensive subjects. Importance of blood pressure response to activity.
Recent works have shown the importance of blood pressure (BP) response to exercise or to daily activity as determinants of hypertensive cardiac hypertrophy. We have tested the relationship between BP and left ventricular (LV) mass in 23 normotensive young adults (mean age 25 +/- 5) with normotensive parents. Blood pressure was measured at rest, at the end of maximal exercise test, and during 24-hour ambulatory monitoring during daily routine. Left ventricular mass was assessed with M-mode echocardiography. We found a closer relationship between LV mass with BP when measuring during activity (average day time BP and end exercise BP) than with rest BP (rest BP and average nighttime BP). Multiple regression analysis indicates an independent association of LV mass with both average day time and end exercise systolic blood pressure. Thus, we conclude that these two ways of assessing "activity" BP may be more complementary than opposing. Ambulatory BP monitoring appreciates the reactions to daily stresses and the exercise test measures the response to physical activity.
Adult↗
Captopril test in the detection of renovascular hypertension in a population with low prevalence of the disease. A prospective study.
The value of the captopril test as a screening test for identifying renovascular hypertension has been outlined by several studies performed in populations with a high prevalence of renovascular disease (20% to 50%). We prospectively assessed the value of the test in 103 hypertensive patients referred to our center for evaluation of their hypertension. They had taken no diuretics and no converting-enzyme inhibitors for more than four days. The interpretation of the results of the test was done according to the criteria defined by Muller et al. All patients underwent a digital venous angiography and when positive or doubtful, a conventional angiography. Eleven patients (10%) had unilateral or bilateral artery stenosis greater than 70%. The sensitivity of the test was 73% with a specificity of 84% and a positive predictive value of 35%. The three patients with a false negative test underwent a surgical treatment or a transluminal angioplasty of the stenosis but remained hypertensive. Thus, the captopril test is a useful screening test for identifying patients with renovascular disease, even in a population with a low prevalence of the disease.
Captopril↗
Relationship between left ventricular mass and noninvasive monitoring of blood pressure.
We studied the relationship between left ventricular mass index (LVMI) and blood pressure (BP) monitored during 24 hours in 35 normotensive and 58 hypertensive patients with no treatment for more than three months. We found a close correlation between LVMI and the average daytime systolic BP (r = 0.68). Other parameters derived from BP monitoring were also correlated with LVMI: daytime diastolic BP (0.54), nighttime systolic and diastolic BP (0.61 and 0.54), pulse pressure (0.58), the average of the five highest systolic and diastolic BP (0.57 both), and the percentage of systolic BP above 140 mm Hg (r = 0.64). However, in a stepwise multiple regression analysis only daytime systolic BP was independently correlated to LVMI. The standard deviation of systolic BP was not significantly correlated to LVMI. The same positive correlation between daytime systolic BP and LVMI was found in normotensive and hypertensive patients, males and females, and patients with and without left ventricular hypertrophy. So, at least regarding the prediction of the degree of left ventricular hypertrophy, the average systolic BP during daytime seems to be the only valuable parameter to look at in ambulatory BP monitorings of untreated hypertensive patients.
Adult↗
[Association of sacciform aneurysm of the renal artery and hypertension. Cause or coincidence? Apropos of a case].
Aneurysms of the renal artery are seldom encountered. They present as different aetiopathological types. We report the case of a female patient who had both severe arterial hypertension and an apparently dysplastic aneurysm of the right prepyelic artery. Resection of the aneurysm failed to have the effect we expected on arterial hypertension. The relationship between arterial hypertension and aneurysm of the renal artery is discussed.
Adult↗
[Reference values of ambulatory arterial pressure in activity and during the night. Multicenter study of 394 normotensive subjects at rest].
The blood pressure pattern and variability were assessed in a population of 394 normotensive subjects (OMS) stratified by age (20 to 75 years) and sex. Ambulatory blood pressure measurements were performed with an automatic device (Spacelabs 5200) every 15 min. from 6 a.m. to 12 p.m., and every 30 min. from 0 a.m. to 6 a.m. The analysis was effected during normal daily activities (from 9 a.m. to 7 p.m.) and during night (from 11 p.m. to 7 a.m.). Blood pressure levels were higher in males than females. During daytime and nighttime, diastolic blood pressure rose with age until 59 years while SBP was not affected, except for the females older than 60 years. After this age, diastolic blood pressure decreased. No epidemiological study has provided a measure of the cardiovascular risk related to ambulatory blood pressure, so that we were unable to define true normal values. However, reference population values provided from two statistical methods: limit of the 95th upper confidence interval for the mean of limit of the 90th percentile value for the total data. These blood pressure distributions according to age and sex may allow a better approach to borderline hypertensive patients.
Adult↗
[Prognostic value of arterial pressure during exertion in hypertensive subjects].
UNLABELLED: We reviewed the course of 240 patients with uncomplicated essential hypertension whose condition has been initially evaluated between january 1976 and february 1979 with both exercise (bicycle) and casual BP. Their outcome was evaluated in the first months of 1988. Thirty-eight patients were lost to follow up. The remaining 202 patients (67 p. 100 males, mean age at entry 43 +/- 13 years, mean casual BP at entry 161 +/- 25/98 +/- 15) had a mean follow-up of 9.5 +/- 2 years. Events retained for the analysis were myocardial infarction (n = 12), angina pectoris with positive coronarography (n = 8), stroke (n = 8), cardiac failure (n = 2) and sudden death (n = 3). We performed a stepwise discriminant analysis first with only casual and end exercise systolic and diastolic BP, then after introducing age, overweight (Lorentz's formula), duration of hypertension, Sokoloff index and cholesterolemia. RESULTS: the analysis with only BP shown that end exercise BP was the best predictor of outcome with 64 p. 100 of the subjects correctly classified (CC). After introducing the other risk factors, the significantly discriminant variables were 1) overweight (65 p. 100 CC) 2) age, 3) end exercise systolic BP, 4) cholesterolemia. These 4 variables adequately classified 70 p. 100 of the subjects. Another analysis was performed in patients with maximal exercise test and gave the following results: 1) overweight, 2) cholesterolemia, 3) end exercise systolic BP with 77 p. 100 patients CC. In women, the pronostic value of exercise BP seems less important than in men.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
ACE inhibitors in mild to moderate hypertension: comparison of lisinopril and captopril administered once daily. French Cooperative Study Group.
A double-blind, parallel-group, multicentre study was carried out to compare the effects of once-daily treatment with lisinopril 20 mg and captopril 50 mg in 304 patients with mild to moderate hypertension. Following a 2-week placebo run-in period, patients with a lying DBP between 95 and 115 mmHg were randomised to either active treatment for 10 weeks. BP measurements were made approximately 24 h after the previous dose of either drug. After 6 weeks, hydrochlorothiazide 25 mg once daily was added for patients with a lying DBP greater than or equal to 95 mmHg and a final assessment was made in all patients after a further 4 weeks of treatment. After 6 weeks of monotherapy, lisinopril had reduced lying and standing BP by an average of 18/14 mmHg and 19/12 mmHg, respectively, compared with 15/12 mmHg and 14/11 mmHg respectively for captopril. The larger fall in SBP with lisinopril was statistically significant (lying SBP, P = 0.01; standing SBP, P = 0.0001). In addition, a significantly larger proportion of patients achieved BP control (DBP less than 95 mmHg) with lisinopril than with captopril (79% versus 67%; P = 0.02). Neither drug significantly altered heart rate. The addition of hydrochlorothiazide in some patients produced a further, small reduction in mean BP in both groups although, 10 weeks after randomisation, the proportion of patients in whom BP control had been achieved with lisinopril was still significantly greater than that achieved with captopril (90% versus 79%; P = 0.02). Both drugs were well tolerated and no serious adverse events occurred during the study.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
[Beta blocking drugs in chronic obstructive bronchopneumopathies].
UNLABELLED: The respiratory tolerance can limit the use of beta-blocker medication (beta-) currently indicated in numerous clinical situations, both cardiovascular and also neurological and ophthalmological. Blockade of beta adrenergic receptors is without risk in subjects free of bronchial pathology, but may destabilize underlying airflow obstruction; either presenting as or sustaining bronchospasm in an asthmatic, and increasing bronchial obstruction, in patients suffering from chronic airflow obstruction (BPCO). Now BPCO, and in particular asthma, are easily associated with diseases for which beta- are indicated. In addition the notion of cardioselectivity is relative and dose dependent. IN PRACTICE: beta- are contraindicated in chronic airflow obstruction with bronchial hyper-reactivity; in other cases, beta- should be used carefully choosing the most cardioselective products at the lowest effective dose. Whatever the route of administration (in particular eye drops), the beta- are reliable to produce the same harmful effects. There should be strict follow up of treatment and a watch kept for signs of a worsening or a provocation of respiratory problems; conversely the occurrence of such symptomatology in a patient with bronchial pathology should call into question the place of beta-. Finally beta- should be avoided in allergic subjects and (a fortiori) in specific immunotherapy where there is a possibility of anaphylactic shock.
Adrenergic beta-Antagonists↗