Stent treatment for pseudocoarctation and refractory hypertension in an elderly patient with Takayasu's arteritis.
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Angiography↗
Biomedical subjects
A La Batide-Alanore
Publications and source records attributed to A La Batide-Alanore.
Comparison of nurse- and physician-determined clinic blood pressure levels in patients referred to a hypertension clinic: implications for subsequent management.
BACKGROUND: When measuring BP, the physician induces a transient pressor response triggered by an alarm reaction. This 'white-coat effect' can influence therapeutic decisions. Whether it depends on the characteristics of the physician has not been evaluated. OBJECTIVE: To assess the 'white-coat effect' induced by several physicians in a large sample of patients, using the blood pressure measured by trained nurses as a reference. SETTING: Referral hypertension clinic. METHODS: Patients were selected for the study if they had been referred for the first time to the clinic and if they had had their supine systolic/diastolic blood pressure measured by a trained nurse (mean of the last two of three measurements taken every 1 min by an oscillometric device) and a physician (auscultatory method using a standard mercury sphygmomanometer). Physicians were included in the study provided they had seen at least 25 patients during the study period. The between-physician difference was assessed using linear regression analysis. Physician blood pressure was the dependent and nurse blood pressure was the independent variable. RESULTS: From 1 January 1997 to 15 September 1997, 1062 patients (50% male, aged 52 +/- 14 years), seen by 10 physicians (26-187 patients per physician) and one nurse were included for analysis. The mean systolic/diastolic blood pressure for physicians was 162 +/- 27/ 97 +/- 15 mmHg and that for the nurse was 155 +/- 24/ 88 +/- 14 mmHg. The nurse-physician differences were -6 mmHg (range -67 to +66) for systolic and -8 mmHg (-44 to +31) for diastolic blood pressures. Major differences were observed between individual physicians. Intercepts of the physician blood pressure versus nurse blood pressure relationship ranged from 0.1 -60.7 mmHg for systolic and from 13.3-55.3 mmHg for diastolic pressures. The slopes of this relationship differed less between physicians for systolic (0.72-1) than for diastolic pressures (0.56-0.97). There was no difference between the patients seen by physicians in patients' age, sex, tobacco consumption, anti-hypertensive treatment or target-organ damage. CONCLUSION: Large between-physician differences exist in the magnitude of the white-coat effect that cannot be explained by patient characteristics. Physicians should therefore not make any decisions based on blood pressure measured manually during a first encounter.
Adolescent↗
[Refractory hypertension].
Refractory or resistant hypertension is an entity without a universally recognised definition. The ANAES (Agence Nationale d'Accréditation et d'Evaluation en Santé) working group in 1997 considered hypertension to be drug-resistant when, at two successive consultations (2 measurements at each consultation) the readings were > or = 160 mmHg for the systolic and or > or = 100 mmHg for the diastolic blood pressure despite triple therapy including a diuretic. These criteria were lowered to 140/90 mmHg in the latest ANAES recommendations published in 2000. The frequency of refractory hypertension varies according to the population studied and the recommendations. Resistance to therapy is usually multifactorial. If one of the main causes is volume overload due to inadequate diuretic therapy, risk factors to drug-resistance must be looked for and evaluated when antihypertensive therapy is started. If ambulatory blood pressure recordings or self-measured readings confirm that the hypertension is not controlled, it is recommended that the patient be referred to a specialised team to exclude unrecognised secondary hypertension or to adapt antihypertensive therapy.
Antihypertensive Agents↗