Biomedical subjects

P Gosse

Publications and source records attributed to P Gosse.

150 records · Page 9Linked to original sources

PubMedDate not supplied

[Prognostic value of QKD interval corrected by QRS duration in hypertensive patients].

OBJECTIVES: The QKD interval is measured between the onset of QRS on the ECG and detection of last Korotkoff sound by a microphone placed on the brachial artery while measuring BP. It is the sum of preejection time and pulse transmission time and thus is correlated to pulse wave velocity (PWV). This interval is automatically monitored with BP and HR every 15 minutes during 24 h with an ambulatory blood pressure monitoring device (Diasys integra, Novacor, France). The 96 measurements obtained allow to automatically calculate the QKD(100-60), QKD value for 100 mmHg SBP and 60 bpm HR. This indice of arterial stiffness has been shown to be linked to future cardiovascular (CV) events, independently of 24 h BP. However this interval may be abnormally prolonged in case of left bundle branch blocks (LBBB). METHODS: We tested the effects of simply removing QRS duration from QKD(100-60) value on the prediction of CV events in a population of 412 hypertensives (247 males: age = 53 +/- 14 years; office BP = 158 +/- 19/97 +/- 11 mmHg; 24 h BP = 133 +/- 17/86 +/- 11 mmHg) followed prospectively. RESULTS: Mean follow up was 65 months, 32 pts were lost, 49 CV events occurred including 11 deaths. Cox model showed that baseline QKD(100-60) (m = 202 +/- 19; 142-254 ms) was significantly (p < 0.05) associated to events independently of age, 24h SBP and other traditional risk factors. Removing QRS duration (m = 85 +/- 10: 61-158 ms) improves the relation to events (monovariate khi2 = 38 vs 30). CONCLUSION: Removing QRS duration from QKD(100-60) improves its predictive value of future CV events and allows using this method in patients with LBBB.

Adult↗

PubMedDate not supplied

[Rilmenidine, a new antihypertensive agent in the first line treatment of essential arterial hypertension. Multicenter double-blind study versus atenolol].

After 4 weeks on placebo, 90 hypertensive patients (37 men, 53 women, mean age 55 years) with systolic (SBP) and diastolic (DBP) blood pressures of 162/99 and 165/100 mmHg respectively received double-blind treatment with either rilmenidine 1 mg/day or atenolol 50 mg/day. This treatment was given alone for 8 weeks, with possible DBP greater than or equal to 90 mmHg, hydrochlorothiazide 25 mg/day was added between the 9th and 12th weeks of treatment. At week 13 all treatments were replaced by placebo. Both groups were similar at randomisation, and both treatments were similarly effective: after 8 weeks of monotherapy with rilmenidine or atenolol, the SBP/DBP had decreased by -18/-13 mmHg and by -21/-15 mmHg respectively, and the proportion of patients with normalised blood pressure (SBP/DBP less than or equal to 160/90 mmHg) was 66 percent and 65 percent. Effectiveness was maintained at 12 weeks, when less than 20 percent of the patients had taken hydrochlorothiazide. Both drugs were well tolerated clinically and electrocardiographically. There was a significantly greater decrease in heart rate on atenolol than on rilmenidine. Eleven patients (5 on rilmenidine, 6 on atenolol) dropped out of the trial, 2 and 3 patients in the respective groups on account of side-effects. Laboratory tests showed that the HDL-cholesterol level significantly decreased on atenolol and remained stable on rilmenidine (P less than 0.01), whereas the LDL-cholesterol level was stable on atenolol and decreased on rilmenidine (P less than 0.05). No rebound in blood pressure was observed on discontinuation of both treatments. This study shows that rilmenidine administered as first-line treatment is as effective as atenolol in lowering blood pressure, and it confirms that this drug is clinically and biochemically well tolerated.

Adult↗

PubMedDate not supplied

Ambulatory blood pressure monitoring. Values in normotensive patients and suggestions for interpretation.

We performed 24 hours ambulatory blood pressure monitoring with non invasive devices in 233 normotensive patients during a workday. Their age ranged from 21 to 74 years (mean +/- standard deviation = 39 +/- 11, 37% females). These patients were mainly recruited on their workplace. Blood pressure monitoring was proposed to all volunteers without any history of hypertension, independently of the casual blood pressure measured by a doctor after 10 minutes sitting, just before monitoring. Patients were asked to note precisely their bedtime and the moment of getting up and to start a blood pressure measurement as getting up. This measure was used as the starting point of the 24 hours blood pressure curve for each patient. Pooling all patients in that way shows an important rise of blood pressure as standing up but no significant variation before. So we calculated the average blood pressure during the true time of activity and of bedrest for each block of 10 years from 20 to 60 years, separately for men and women. These values may be used as a guide when interpreting 24 hours blood pressure recordings.

Adult↗

PubMedDate not supplied

[Calcium inhibitors and cardioprotection].

The main goal in treating hypertensive patients is to reduce the incidence of complications, especially on the heart. The lowering of blood pressure do not seem enough. Some properties, not shared by all antihypertensive drugs, are likely to allow some protection against heart and coronary diseases. These properties are: the absence of deleterious effects on glucids, lipids and kaliemia; the ability to induce left ventricular hypertrophy regression, antiarrhythmics effects, anti-ischemic effects and the ability to improve arterial compliance. Calcium inhibitors share all these properties and also have some more original and beneficial effects on arterial spasm and may be on progression of atherosclerosis. For all these reasons, a great interest arise for this new therapeutic class in hypertension. However we are still waiting for the demonstration of a true cardiac protection in hypertension with controlled long term trials.

Animals↗

PubMedDate not supplied

[The coronary hypertensive: therapeutic principles].

Since arterial hypertension is one the main risk factors of coronary atherosclerosis, the association hypertension-coronary disease is a frequent one. Moreover, arterial hypertension aggravates the coronary disease and this association is therefore of very poor prognosis. However, this prognosis seems to improve with early and adapted treatment based largely at this time on beta-blockers and calcium inhibitors.

Adrenergic beta-Antagonists↗

PubMedDate not supplied

Long term reproducibility of ambulatory blood pressure monitoring.

The long term reproducibility of ambulatory blood pressure measurements was evaluated over two 24 h recordings made under identical conditions 2 years apart in 20 normotensive and 13 essential hypertensive patients not receiving antihypertensive treatment. There was excellent agreement between the mean 24 h values of blood pressure as well as for the day time and night time means. The standard deviation of the differences was half that of casual determinations. On the other hand, the reproducibility of the mean hourly values was comparable to that of casual measurements. The reproducibility of the white coat effect was poor, as assessed by the difference between blood pressure on fitting the device and the mean day time value. These results indicate that the short term reproducibility of ambulatory blood pressure is maintained over the long term.

Blood Pressure Monitoring, Ambulatory↗