Relationship between blood pressure and outcome in intracerebral hemorrhage.
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Blood Pressure↗
Biomedical subjects
A Carré
Publications and source records attributed to A Carré.
[Effects of bisoprolol and ramipril on short-term variability of systolic blood pressure during mental stress test: spectrum analysis].
UNLABELLED: The mid frequency component (MFC = 66-128 mHz) of blood pressure is an index of sympathetic vascular control. To investigate the effect of bisoprolol (B) and ramipril (R) treatment (TT) on the short-term variability of systolic blood pressure (SBP) diastolic blood pressure (DPB) and heart rate (HR) reactivity during mental stress, we studied 54 mild essential untreated hypertensive patients (24 men, 45 +/- 9.6 years, BP > 160/90 mmHg after a 15-days placebo run-in period) who were randomly assigned to double blind treatment (B: 10 mg/day: n = 28 and R: 5 mg/day: n = 26). A Stroop Word Color Conflict Test (SWCCT) was performed before and after 2 months of treatment. Hemodynamic parameters (BP and HR) were measured by a non invasive device (Finapres 2300E, Ohmeda-Maurepas) and underwent spectral analysis (SBP: mmHg.Hz-1/2, HR: beats/min.Hz-1/2, Anapres 1.2, Notocord-Orgametrie Systems, Igny-Lille) at rest and during SWCCT. The sympathetic vascular activity was assessed by calculating the area of the mid-frequency component (MFC = 66-128 Hz). RESULTS: [table: see text] CONCLUSION: The absolute variations in sympathetic activity during SWCCT as demonstrated by analysis of MFC of SBP and HR is not affected by chronic ramipril treatment, whereas bisoprolol attenuates sympathetic reactivity during SWCCT.
Adult↗
[Evaluation of spiral computed tomography of the renal arteries alone or combined with Doppler ultrasonography in the detection of renal artery stenosis. Prospective study of 114 renal arteries].
A renovascular etiology occurs in 0.2 to 2% of hypertensive patients. Recently, spiral computed tomography (CT) has evolved as a new minimally invasive tool for the diagnosis of vascular pathologic conditions. The purpose of this study was to compare both spiral CT and color Doppler ultrasonography (US) with intraarterial digital subtraction angiography (DA) in the detection of renal artery stenosis (RAS) in hypertensive patients. Between December 1993 and April 1994, 44 hypertensives (men 22, mean age 52 years) suspected secondary hypertension were prospectively studied with spiral CT (Somatom Plus S, Siemens) US (Acuson, 3.5 MHz probe) and DA (double-blind evaluation). DA visualized 11 significant (> 50%) stenoses (11/114 renal arteries, including 27 accessory). On spiral CT, 9/11 were detected and 2 additional stenoses considered false positive. On US 5 stenoses were detected whereas 11 were demonstrated by DA; 2 patients had false positive US results. [table: see text] We conclude that combined spiral CT and color Doppler ultrasonography is an effective and relatively non invasive alternative to intraarterial digital angiography for the detection of renal artery stenosis in a hypertensive population screened for renovascular hypertension.
Adolescent↗
[Blood pressure variability and stimulation tests: value of the Stroop word color conflict test].
OBJECTIVES: To study the modifications of the BP and its short-term variability in hypertensives patients submitted at to a psychological stress test. DESIGN AND METHODS: Fourty nine hypertensive subjects (27 women and 22 men, aged 46 +/- 9, SBP 164 +/- 10, DBP 97 +/- 6 mmHg after a 15 days placebo run-in period) were studied. We used the original version of Stroop Word Color Conflict Test (SWCCT) to induce mental stress. Haemodynamic parameters (SBP, DBP, MPB and HR) were measured continuously by a non invasive method (Finapres) with data acquisition every 0.5 second allowing spectral analysis of SBP variability at rest, during and after SWCCT (FFT algorithm on 256 point time series Anapres 1.2). RESULTS: All haemodynamic parameters increased during stress test (p = 0.001). The mean value and the variability (V) of SBP standard deviation (SD) increased during SWCCT (p = 0.001 and p = 0.003 respectively). Two minutes after the test, SPB returned to the rest level, while the overall variability of SPB remained elevated (p = 0.007). Spectral analysis: the total area under the curve and the mid frequency component (MFC) (66-128 mHz) increased during and after SWCCT (p = 0.001). [table: see text] CONCLUSION: Short-term variability of SBP is increased in hypertensives when submitted to a SWCCT appears to induce sustained orthosympathetic stimulation as suggested by the increase of mid frequency component (Mayer waves).
Adult↗
[Stress, blood pressure reactivity and arterial hypertension: not an unambiguous relation].
UNLABELLED: In order to determine the different ways the hypertensives' blood pressure would react during mental stress, 49 patients, 27 women and 22 men, were submitted at the Stroop Word Colour Conflict Test. Their haemodynamic parameters were recorded by finger photoplethysmography (Finapres device), with equidistant sampling (2 Hz). Temporal and spectral analysis showed evidence of: a quick and short elevation of BP and HR and a greater variability of SBP, as shown by the increase of the MF (66-128 mHZ) module. Patients can be divided into 3 clusters according to the reactivity of SBP. Group I (N, mean +/- sigma) 13, + 32.7 +/- 8 mmHg; group II 24, + 10.3 +/- 6; group III 12, -10.2 +/- 7. They were comparable on anxiety level and on any demographic and clinical feature. In group III, the higher NA at rest, the bigger the fall of SBP when stressed. The cognitive efficiency of these patients is increased by stress. Spectral analysis: Mid frequency (66-128 mHz) components are markedly higher in group III, before, during and after SWCCT showing a higher sympathetic tonus. CONCLUSION: The reactivity of BP is not homogeneous. One fourth of our patients showed a decrease of SBP during the cognitive treatment stage of the test without showing a decrease of sympathetic tone. Anxiety level is not predictive of BP's response.
Adult↗
[New approach to arterial hypertension: study of short-term blood pressure variability. Values and prognostic implications: preliminary data].
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Blood Pressure↗
[Evaluation and surveillance of blood pressure during pregnancy].
Despite a large body of literature or hypertension in pregnancy, there still is no recognized prognosis factor for this frequent and severe disease. Management still relies on clinical features (occasional blood pressure measurements, weight curve) and appropriate tests including fetal and maternal echodoppler, urinary uric acid, 24 h proteinuria and fetal heart rate monitoring. Recent developments including self measurement and ambulatory monitoring of blood pressure have helped improve follow-up and therapeutic management in high risk pregnancies. By repeating the measurements, these techniques require more intensive medical follow-up and an adapted therapy near the term of pregnancy. They do not however provide a means of predicting outcome or recurrence of preeclampsia. These techniques have effectively been shown to reduce the number and duration of hospitalizations.
Blood Pressure Determination↗
Childhood leukemia incidence in the vicinity of La Hague nuclear-waste reprocessing facility (France).
The incidence of leukemia is examined in young people (aged under 25 years) living within a 35 km radius of the French nuclear-waste reprocessing plant operating in La Hague, Normandy. During the period 1978-90, a total of 23 cases was diagnosed, giving an incidence rate of 2.99 per 100,000 which is close to the expected rate. In the 'canton' in which the nuclear plant is located, three cases of leukemia were observed compared with 1.2 expected, giving a standardized incidence ratio of 2.5. This nonsignificant finding is compatible with no increased risk and also with a sevenfold excess risk. Therefore, it reinforces the necessity of conducting a case-control survey, which is now planned, to assess the part played by occupational radiation exposure in leukemia incidence for this French area.
Acute Disease↗
[Is scheduled hospitalization over a specific period still justified in hypertension?].
To general practitioners' request, a 36-hour scheduled hospitalization over a determined period (SHDP) was set up to assess the effects and the etiology of the arterial hypertensions they had detected and to propose an appropriate treatment. From November 1988 to December 1990, 277 patients (156 male/121 female) with mean age of 44.7 +/- 14.5 were thus hospitalized over a determined period. All of them underwent 24-hour semi-ambulatory blood pressure monitoring (Bard Sentron) by using the oscillometric method, which permits to measure mean blood pressure (MBP) instead of calculating it. This 24-hour MBP was on average of 108.5 +/- 16.2 mmHg and not significantly different from daytime MBP (111 +/- 16.3 mmHg). Figures of MBP superior to 105 mmHg confirmed permanent HBP (High Blood Pressure). On the 277 patients, 46 (16%) had a normal MBP, 67 (24%) had a "borderline" MBP (between 96 and 105 mmHg). A severe HBP (MBP > 125 mmHg) found in 66 cases (23%) was confirmed by visceral impairment. Left ventricular hypertrophy (LVH) was detected in 12 cases (4.3%) on the chest radiograph, in 24 cases (8.6%) on the ECG and in 75 cases (27%) on the echocardiogram. The etiological assessment revealed 10 cases (3.61%) of secondary hypertension with 3 reno-vascular HBP and 2 Conn's adenomas. Eventually, therapeutic abstention was recommended in 57 patients (20.5%) though 20 of them had previously received antihypertensive therapy. All in all, SHDP permits a more accurate determination of the consequences and severity of HBP. The small number of secondary HBP reflects the proportion found in practice.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
The French multicentre study of ramipril in ambulatory patients with mild-to-moderate hypertension.
The aim of this 16-week trial was to determine the safety and efficacy of a step-care regimen of ramipril, an angiotensin converting enzyme inhibitor, from the minimal active dose (2.5 mg) in patients treated for mild to moderate hypertension. The trial was conducted by 102 general practitioners in 770 patients with mild to moderate hypertension. After a response rate to a 4-week placebo therapy of 9.1%, 57.0% of patients given active treatment with ramipril responded to daily doses of 2.5 mg. Ramipril 5 mg daily was effective in 55.6% of the remaining patients. There was no apparent statistically significant difference between the treatments with ramipril 10 mg or a combination of ramipril 5 mg + Lasix 20 mg daily (44.7% and 47.4% response respectively) in a 6-week double-blind arm of the study. In total, more than 90% of patients responded to treatment with ramipril by the end of the study. The incidence of adverse events was generally low, such as headache, cough, dizziness, asthenia, cramps and nausea. The incidence of cough appeared to be related both to the dosage of ramipril given and to outbreaks of influenza syndrome. Thirty-eight patients discontinued active treatment as a result of minor events such as cough, dizziness or diarrhoea, and one case each of myalgia and papular rash. There were no significant variations in laboratory parameters during the study, especially fasting blood glucose and apolipoprotein A1 and B. The results of this study provide evidence of the safety and efficacy.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
[Measurement of blood pressure in obese patients: reliability and value of finger measurement (Finapres)].
Indirect measurement of the blood pressure in obese persons is still inaccurate, especially if the arm circumference deeply differs from one measure point to the other, so that the use of a wide bladder is inappropriate. Some alternative solutions have been described: oscillometric device on the arm or on the forearm, different shapes of the cuff-bladder, auscultation on the radial artery with the cuff on the forearm. We tested the capability of the Finapres device which measures the finger arterial blood pressure, beat to beat, using the volume clamp method of Penâz. In six obese patients (BMI > 30, arm circumference > 35 cm) treated for hypertension were undergoing functional respiratory tests. The finger pressure was measured simultaneously with intrabrachial on homolateral arm. Blood pressure was measured at rest and after a cold pressor test. [table: see text] The use of the Finapres seems to be possible. The correlation with the systolic is excellent, where as the correlation with the diastolic is weaker; which however is usual in any diastolic correlation between non invasive and invasive device. The CPT does not modify the correlations. Moreover the Finapres allows dynamic exploration which is of particular interest in obese persons because their blood pressure is particularly variable.
Blood Pressure↗
A double-blind comparison of perindopril and hydrochlorothiazide-amiloride in mild to moderate essential hypertension.
The aim of this 3-month double-blind multicenter trial was to compare the antihypertensive efficacy and tolerability of the ACE inhibitor perindopril with those of a diuretic combination. After 1 month of receiving placebo, 165 patients with essential hypertension were randomised to perindopril 4 mg (n = 82) or to 50 mg hydrochlorothiazide + 5 mg amiloride (n = 83). The patients were treated for 3 months with monthly assessments, "uncontrolled" patients (DBP greater than 90 mm Hg) had their dosage doubled and then, if necessary, atenolol 50 mg was added. At the end of the 3-month study, mean decreases in supine and standing systolic and diastolic blood pressures were similar in both groups. In the perindopril group, BP control was obtained in 56% of the patients with the 4 mg dosage and required an increase to 8 mg alone in 16% and with atenolol in 5%. The corresponding percentages in the diuretic group were 48, 23 and 13%. The overall percentage of "controlled" patients was similar in the 2 groups, respectively 78 and 84%. The nature and incidence of complaints were comparable in the 2 groups. Adverse laboratory changes were more frequent in the diuretic group: decrease in blood sodium (140.5 vs 139.1 mmol/l; P less than 0.01), potassium (4.2 vs 3.9 mmol/l; P less than 0.01) with 10 patients having significant hypokalemia, increase in blood urea, triglycerides and uric acid. By contrast, a transient increase in blood potassium with a decrease in triglycerides was observed in the perindopril group.
Adolescent↗
Tolerability of ramipril in a multicenter study of mild-to-moderate hypertension in general practice.
In this study, the tolerability and safety of ramipril, as monotherapy and in combination with a low dose of furosemide, were assessed in patients with mild-to-moderate hypertension in general practice. After a placebo run-in phase, patients received ramipril as monotherapy in a dose of 2.5 to 5 mg daily for 6 weeks. Nonresponders (diastolic blood pressure greater than 90 mm Hg) entered a double-blind treatment period, and received either 10 mg of ramipril daily, or 5 mg of ramipril in combination with 20 mg of furosemide daily. The tolerability of the study medication was assessed by reported adverse events, and by monitoring blood cell count, electrolytes, serum creatinine, fasting blood glucose, and apolipoproteins AI and B. Of a total of 770 patients who entered the placebo run-in phase, 661 patients were enrolled in the first active treatment period. The most commonly reported adverse events were headache, cough, dizziness, asthenia, cramps, diarrhea, and nausea, but not all of these events were related to ramipril treatment. A total of 38 patients discontinued active treatment due to nonserious adverse events, mainly cough, dizziness, or diarrhea. There appeared to be a relationship between the prevalence of cough and ramipril dosage; however, an increased incidence of cough was also observed during outbreaks of influenza in France. There were no significant changes in laboratory variables during the study.
Adult↗
[Predictive criteria of left ventricular hypertrophy given by ambulatory monitoring of blood pressure in hypertension of the elderly].
Eighty-nine patients over 65 years of age, with mild to moderate hypertension, underwent ambulatory blood pressure monitoring during 1988 and 45 of them also underwent echocardiography. Concentric left ventricular hypertrophy was diagnosed in 9 patients (20%) and criteria predictive of this complication were looked for in the results of the ambulatory pressure monitoring. The most predictive factors seemed to be: nocturnal systolic blood pressure (the average of the systolic values recorded between 22 h and 6 h); the percentage of excessive nocturnal values (values over 120/80 during the same nocturnal period); the loss of diurnal rythm with absence of the clearcut difference between the daytime and nocturnal blood pressure value; increased differential pressure, a sign of reduced arterial compliance. These notions, based on ambulatory blood pressure recordings, have diagnostic and prognostic implications (need for echocardiography) and important therapeutic consequences (drugs reducing LHV and improving arterial compliance).
Age Factors↗
[Ambulatory blood pressure: methods, equipment, technical problems, validations].
The measurement of ambulatory blood pressure provides a discontinuous recording which reflects the pressure load over a 24 hour period. The latest recorders allow the patient a relative autonomy due to discontinuous but programmable recording and the miniaturisation of the recorder and relative silence during inflation of the cuff. The main disadvantage of the technique is the necessity of interruption of the patient's physical activity at the moment of recording indicated by an audible "beep". The concept of "active pressure load" is therefore illusory. The traditional controversy between supporters of the auscultatory versus those for the oscillometric method is far from being settled and these discussions do not resolve the problem. The use of finger plethysmographic techniques (Finapress-Ohmeda) is an interesting approach but limited for the time being by the necessity of confinement to a laboratory and recordings of short durations requiring strict conditions of ambient temperature. Future developments using ultrasonic techniques may provide a solution to these problems.
Ambulatory Care↗
[Ambulatory multicenter study of Triatec (ramipril). Observations concerning the lessons of the trial for the realization of future trials and for the management of hypertensive patients].
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Adult↗
[Reliability of the measurement of arterial pressure in the forearm in the obese subject].
The measurement of the blood pressure of corpulent persons often leads to over-estimation. We have therefore compared, for 10 over-weight women (body mass index = 38.04 +/- 1.32 kg/m2) whose average age was 54 +/- 4 years, the blood pressure figures obtained by the invasive method (humeral artery) with values measured automatically by the Bard-Sentron apparatus (B.S.) on the one hand, and the mercury sphygmomanometer (S. Hg) on the other hand. The cuff (bladder = 25 X 12.5 cm) was placed on the same side of the forearm. (table; see text) We have compared the values obtained by invasive and Bard-Sentron methods (I), invasive and mercury sphygmomanometer methods (II), and Bard-Sentron and mercury sphygmomanometer (III) respectively. (Table: see text). The correlations are excellent for the systolic blood pressure, as the Bard-Sentron over-estimates by 5.5 p. 100. They are not so good for the diastolic blood pressure as the Bard-Sentron over-estimates by 33 p. 100. The mercury sphygmomanometer over-estimates the diastolic blood pressure by about 43 p. 100. For conclusion: The blood pressure measurement taken on the forearm of corpulent persons by auscultation or by automatic methods is reliable for the systolic blood pressure, but the diastolic blood pressure is largely over-estimated.
Adult↗