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Biomedical subjects

D Herpin

Publications and source records attributed to D Herpin.

At least 19 recordsLinked to original sources
PubMed2006

Management in general practice of hypertensive patients poorly controlled with a fixed-dose renin-angiotensin system inhibitor and diuretic combination: results from a French national survey.

High rates of uncontrolled hypertensives have been reported in France as well as in other countries, partly owing to an inadequate management of hypertension by clinicians. The objectives of the study were (1) to describe the therapeutic decisions faced by general practitioners (GP) in hypertensives not controlled by fixed-dose combination antihypertensive therapy with a renin-angiotensin system (RAS) inhibitor and a diuretic (D) and (2) to evaluate the frequency with which ambulatory blood pressure monitoring (ABPM) is used in these patients. Each GP had to include five uncontrolled hypertensives on fixed-dose RAS inhibitor and D combination. A total of 2118 GPs included 9551 patients; 8643 patients were receiving at least one of the two drugs at a low dose (group 1) and the remaining 908 patients were receiving high doses of both drugs (group 2). The most common therapeutic choice was that of a new combination, either a fixed-dose in one pill or with separate preparations: 65% (n=5621) in group 1 and 56% (n=505) in group 2. An increase in dose was chosen in 28% of patients in group 1 (n=2467) and continuation of treatment without modification in 27% of patients in group 2 (n=242). A third active principle was only added in 2.5% of patients in group 1 (n=219) and 11% in group 2 (n=103). Ambulatory blood pressure monitoring was employed in 25% of patients (n=2413). An improvement in hypertension management should be expected from the implementation of the 2005 French guidelines. Journal of Human Hypertension (2006) 20, 407-418. doi:10.1038/sj.jhh.1002000; published online 30 March 2006.

Adult↗
PubMed2006

[The best of clinical cardiovascular pharmacology in 2005].

Although the year 2005 has reinforced the therapeutic advances of 2004, with confirmation of certain concepts, the 'coxib affair' has continued to provoke arguments between pharmaceutical companies, licensing agencies as well as patients, some of whom have amalgamated into consumer groups to reject en masse placing any responsibility on the prescribers in favour of an attack on the drug licensing process itself. Among the cardiovascular drugs that will soon be licensed, only ivabradine in stable angina, and remodulin in primary pulmonary arterial hypertension are new. The therapeutic advances in 2005 regarding platelet aggregation and blood coagulation have been significant, in the human, scientific and commercial context, while hypertension has not been ignored. Another new development is the ever more precise notion of the metabolic syndrome, a target of choice for the pharmaceutical industry. The potential range of applications has been widened to include obesity, hypertension, diabetes, HDL cholesterol... The licensing authorities find themselves facing a hurdle to overcome, with novel combinations of drugs (ACE inhibitors, calcium blockers/statins, statins/aspirin, ARA2/calcium blockers...).

Cardiovascular Agents↗
PubMed2006

Heart failure with preserved systolic function: a diagnostic algorithm for a pragmatic definition.

Heart failure is a major health problem which often concerns the elderly. Prevalence of heart failure with preserved systolic function is increasing and varies from 40 to 50%. In the literature, and in the large epidemiological studies, it is commonly designed with the term of "diastolic heart failure", even if a precise analysis of diastolic function is not performed. A diagnostic algorithm is proposed in order to better define the concept of heart failure with preserved systolic function. It consists of seven steps from symptoms and clinical signs to the echocardiographic analysis of diastolic function, in order to confirm the definition of heart failure with preserved systolic function.

Algorithms↗
PubMed2005

Determination of HbA1c concentrations in patients with acute myocardial infarction: comparison of the DCA 2000 device with the HPLC method.

BACKGROUND: Recent studies suggest that HbA1c is an important predictor of the glycometabolic state of patients admitted for acute myocardial infarction (AMI). OBJECTIVE: We aimed at comparing the results of HbA1c concentrations obtained by 2 different methods in patients with AMI. RESEARCH DESIGN AND METHODS: In a first study, HbA1c was measured in all patients consecutively hospitalized for AMI, during a 6 month period using the HPLC method and the DCA 2000 device in the biochemistry laboratory. In a second study, HbA1c measured by the DCA 2000 device in the intensive care unit was compared with HbA1c determined by HPLC in the biochemistry laboratory in a similar sample of patients. In patients without personal history of diabetes, those patients with HbA1c > 6.5% (HPLC method), were classified as possible diabetes. RESULTS: A total of 146 patients were included (119 males, 27 females; mean age: 63 +/- 15 years). Twenty-seven of the patients had a personal history of diabetes. HbA1c determined by 2 techniques were highly correlated (r = 0.939, P < 0.0001). The mean of the differences (Bland and Altman analysis) was 0.4 +/- 0.3%. Compared with the HPLC method, the sensitivity of DCA 2000 device for the detection of possible diabetes was 81.8 +/- 11.6 and the specificity was 99.1 +/- 0.9%. The diagnostic accuracy of DCA method was 97.5 +/- 1.4%. In the second study, the HbA1c concentrations of 21 additional subjects, determined in an intensive care unit, were not different from the first 21 patients of the first study. CONCLUSIONS: HbA1c can be effectively determined using the DCA 2000 device. This method is reliable and easy to be implemented in an intensive care unit.

Autoanalysis↗
PubMed2005

Appraisal of the knowledge of hypertensive patients and assessment of the role of the pharmacists in the management of hypertension: results of a regional survey.

The objectives of the study were to appraise the knowledge which the patients have about their hypertension, and to assess the knowledge and involvement of pharmacists in the management of the hypertensive patient. All the pharmacies in the Poitou-Charentes area were invited both to participate in a training session about arterial hypertension and asked to fill in a pharmacist's questionnaire. Furthermore, each participant was required to submit a patient's questionnaire to 20 consecutive hypertensives. A total of 104 pharmacies and 1015 hypertensive patients participated in the survey. In all, 88% of the patients (n = 893) were aware of their blood pressure (BP) figures, but 68% (349/515) considered themselves wrongly, to be normalized; 39% (n = 350) only had BP figures <140/90 mmHg. They said they had been poorly informed about recommended lifestyle changes. In all, 18% (n = 185) were equipped with an automatic device. A total of 77% (n = 779) were able to give the names of their drugs without the help of the pharmacist. Treatment-related unwanted effects were reported by 8% of the patients (n = 79). Only 18% (n = 29) of the pharmacists were able to provide a correct definition of hypertension. Most of them thought hypertension was well controlled in the general population and considered that both tolerance of and compliance with antihypertensive treatment were satisfactory. They could most often (80%, n = 135) supply a SBPM device, but 58 (36%) only were able to provide relevant advice regarding the recommended procedures. In conclusion, The BP goals and the lifestyle modifications are poorly known by the hypertensives. Pharmacists' knowledge is frequently wrong and should be improved by appropriate training programmes.

Aged↗
PubMed2005

[The best of clinical pharmacology in 2004].

The year 2004 was not marked by major pharmacological advances, but by confirmation of previous "evidence". Several innovative drugs for stable angina (ranolazine, ivabradine), some interesting results in acute coronary syndrome (PROVE IT study), some classic concepts (cannabinoid receptors and their antagonists such as rimonabant) applied to novel indications (treatment of obesity), hopes for the "sartans" revived in the light of new evidence (VALUE study), advances in the management of diabetes and hypertension (ASCOT and CARDS studies), nebivolol which is not just a betablocker but also produces the NO radical (is this why it decreased the mortality of heart failure in the elderly in the SENIOR study?). In contrast, although Chronadalate did not live up to expectations for coronary insufficiency, the year was marked above all by the much heralded withdrawal of Vioxx for increasing cardiovascular risk. The old adage: primum non nocere springs to mind.

Angina Pectoris↗
PubMed2005

[Atrial remodeling, systemic hypertension, stroke].

Atrial remodeling has been demonstrated to be associated with rapid atrial pacing or with hemodynamic overload. It may refer to changes in electrophysiological properties and/or in structure and function. Hemodynamic overload of the atria has been found to be an important pathogenic factor of atrial fibrosis, providing a morphological substrate for atrial fibrillation. This finding could partly account for the high risk of stroke in hypertensive patients. In this respect, a strong involvement of the renin angiotensin system has been suggested by experimental, clinical and epidemiological data. Thus, prevention or even partial regression of atrial remodeling could be reasonably expected from ACE-inhibitors and angiotensin 2-blockers.

Angiotensin II Type 1 Receptor Blockers↗
PubMed2005

[Value of systematic biological markers of inflammation for the prognosis at 12 months of patients undergoing programmed coronary angioplasty].

Value of systematic dosage of biological markers of inflammation for the prognosis at 12 months of patients undergoing programmed coronary angioplasty Systematic dosage of proteins of inflammation has been suggested for assessing the prognosis of athero-thrombotic diseases. The authors undertook a study of plasma C-reactive protein (CRP) and interleukin 6 (IL-6) for evaluating the prognosis of patients undergoing programmed coronary angioplasty. A prospective monocentric study of 117 patients (65 +/- 8 years) was divided into a control group of 28 patients undergoing coronary angiography (Group 1) and 89 patients undergoing programmed coronary angioplasty (Group 2). Serum IL-6 and CRP levels were measured before arterial puncture and at H12 and H24 after coronary catheterisation. The follow-up period was 12 months. The angioplasty did not significantly increase CRP and IL-6 concentrations compared with coronary angiography. Twenty patients (Group 2) (22%) suffered a cardiovascular event in the 12 months' follow-up. These patients had significantly higher CRP levels at H0, H12 and H24 after coronary angioplasty than those who had uncomplicated outcomes. This was not observed for IL-6 concentrations because of the wide dispersion of the results obtained. Increased CRP concentrations between H0 and H24 was also a good predictive factor independently of high basal CRP levels potentially due to other causes than atheroma. Coronary angioplasty is associated with increased CRP at H0, H12 and H24. These values are correlated with the risk of future events at 6 and 12 months. This information is easily obtained and should help management of these patients.

Aged↗
PubMed2005

[Do beta-blockers prevent coronary events in hypertensive patients?].

Beta-blockers have been considered for decades as effective agents in preventing coronary events in hypertensive patients. Actually, the scrutiny of the available data arises some doubts over the real value of this pharmacological class. In primary prevention, the clinical benefits of beta-blockers are poorly documented: the studies conducted against placebo (MRC, IPPPSH...) did not show any significant differences regarding the rate of coronary events (except within non smokers); moreover, the beneficial effect of propranolol in preventing sudden deaths and silent myocardial infarctions has been reported byjust one retrospective analysis. Likewise in HAPPHY study, the comparison with diuretics did not emphasize a clear superiority of one of both classes; the better effect of metoprolol regarding overall mortality and fatal coronary events was shown in the pecular subset MAPHY, only. Furthermore, in elderly people, HEP, MRC OA and STOP studies did not find any significant effect of beta-blockers in preventing coronary events, as compared with placebo. However, SHEP study, which involved patients older than 60 years with isolated systolic hypertension receiving first a diuretic, then a beta-blocker(atenolol) in 1/4 of the cases, demonstrated a significant reduction versus placebo both in strokes and in coronary events. Finally, in UKPDS, CAPP, LIFE and CONVINCE studies, atenolol turned out to have a similar efficacy as captopril, losartan and verapamil, in preventing ischemic heart disease. Among the numerous published meta-analyses, that of Psaty pointed out the absence of a primary cardioprotective effect by beta-blockers; more recently, that of Carlberg, emphasized atenolol given alone as the first-line drug to fail in significantly reducing coronary events and strokes. In secondary prevention, some more convincing data may be found in the literature, regarding post myocardial infarction patients (meta-analyses of Staessen, 1982, Yusuf, 1985 and Soriano, 1997), as well as those with stable angina (BIP study in diabetics) or silent ischemia (ASIST study: significant reduction in number and duration of ischemic events by atenolol). Moreover, INVEST study recently showed atenolol and verapamil to have an equivalent efficacy in the hypertensive patients with stable coronary artery disease. Last, hypertension should be reminded as resulting in many cases of heart failure, a pathology where beta-blockers have clearly demonstrated their beneficial effects.

Adrenergic beta-Antagonists↗
PubMed2004

Prognostic value of admission plasma glucose and HbA in acute myocardial infarction.

OBJECTIVE: Stress hyperglycaemia increases the risk of mortality after acute myocardial infarction in diabetic and in non-diabetic patients. We aimed to determine the contribution of admission plasma glucose and HbA(1c) on post-acute myocardial infarction prognosis. PATIENTS AND METHODS: Admission plasma glucose and HbA(1c) were simultaneously measured in all patients consecutively hospitalized for acute myocardial infarction. Patient survival was measured on 5 and 28 days after admission. Patients were defined as having 'previously diagnosed diabetes' (personal history of diabetes defined using ADA 1997 criteria), 'no diabetes', those without previously diagnosed diabetes and HbA(1c) below 6.5%, or 'possible diabetes', i.e. those without previously diagnosed diabetes and HbA(1c) above 6.5%. RESULTS: Of the 146 patients included, four had died by day 5 and 14 by day 28. Admission plasma glucose was higher in patients who had died by day 28 (11.7 +/- 5.8 vs. 8.0 +/- 3.3 mmol/l, P = 0.002), whereas HbA(1c) was not (6.4 +/- 1.9 vs. 6.1 +/- 0.8%, NS). Admission plasma glucose was significantly higher in those who had died by day 28 after adjustment on HbA(1c). A multivariate analysis, including sex, age and heart failure prior to acute myocardial infarction, showed that admission plasma glucose concentration was an independent predictor of survival after acute myocardial infarction. Twenty-seven of the patients had previously diagnosed diabetes and 119 had no history of diabetes. Eleven were found to have possible diabetes. Admission plasma glucose was significantly higher in previously diagnosed diabetes (11.1 +/- 5.6) than in the other groups: 7.7 +/- 2.9 in non-diabetes, 8.2 +/- 2.1 in possible diabetes (P < 0.0001). The relationship between HbA(1c)-adjusted admission plasma glucose and mortality after acute myocardial infarction was also found in the non-diabetes group. CONCLUSIONS: Admission plasma glucose, even after adjustment on HbA(1c), is a prognostic factor associated with mortality after acute myocardial infarction. Acute rather than the chronic pre-existing glycometabolic state accounts for the prognosis after acute myocardial infarction.

Acute Disease↗
PubMed2003

[Investigation of hyperaldosteronism in the hypertensive patient. Why? When? How?].

Primary aldosteronism (PA) has been regarded for a long time as being a rare cause of arterial hypertension, but its prevalence has recently been reassessed as about 10%. This etiology should obviously be sought in the following settings: hypertension associated with hypokaliemia < 3.6 mmol/L (or < 3.9 mmol/L on ACE inhibitors): refractory hypertension: severe hypertension occurring before 40 years of age, especially in women. It must be reminded that more than 20% of PA are normokaliemic. Most of the authors recommend to use the aldosterone/renin ratio (ARR) as a screening test within these selected patients. When ARR turns out to be equal to or higher than 23 (if aldosterone and renin are given in pg/mL or ng/L), a suppression testing should be performed, using salt loading and/or fludrocortisone. Computed tomography scanning yields a specificity of 58% and a positive predictive value of 72%, only. Adenoma and hyperplasia have to be distinguished, using either NP-59 scintigraphy or adrenal venous samplings. Such a strategy appears to be useful, for the following reasons: removal of an adenoma results in a significant blood pressure lowering and in a blood pressure normalization in 95% and in 32% of the patients, respectively; in patients with hyperplasia, spironolactone therapy is followed by a 20% mean reduction in blood pressure.

Adenoma↗
PubMed2003

[The best of hypertension in 2002].

This year, the writing of "Best of hypertension 2002" was completed by the coordinators of 4 working groups of the French Society of Hypertension, in various domains: (a) the working group on BAroreflex and VARiability (BAVAR): it appeared mandatory to evaluate the influence of calculation methods on the values of spontaneous baroreflex sensitivity, through an european study (The EuroBaVar collaboration study); (b) the working group on Blood Pressure Measurement, was first involved in the establishment of an international protocol for the validation of self blood pressure measurement, then validated, according to this procedure and in collaboration with the French Medicine Agency, several apparatus dedicated to the French market; (c) the working group on epidemiology: after the publication of the IHPAF study (Incidence de l'hypertension dans la population active française), which unmasked the influence of social and professional determinants on blood pressure control, this group settled down ancillary studies in French Indias, the INAPAG study (INcidence de l'hypertension artérielle dans la population Antilles-Guyane), and the PHAPPG study (Prévalence de l'hypertension artérielle dans la population précaire guadeloupéenne); finally (d) the working group for continuous medical education settled down a national diploma, entitled "Hypertension and renal and cardiovascular risk".

Antihypertensive Agents↗
PubMed2002

Resistance to aspirin in vitro at rest and during exercise in patients with angiographically proven coronary artery disease.

BACKGROUND: Acetylsalicylic acid, or aspirin, is widely used in secondary prevention of coronary artery diseases, but the inhibition of platelet aggregation is not uniform in all individuals. OBJECTIVE: To investigate the prevalence of aspirin resistance at rest and during exercise in coronary artery disease patients. MATERIALS AND METHODS: Fifty patients with stable coronary artery disease were prospectively studied. All patients received aspirin (75-300 mg/day for >1 month) and no other antiplatelet therapy. Aspirin resistance was studied, at rest and immediately after a stress test, using the standardized platelet function analyzer (PFA-100(R), Dade-Behring). Aspirin resistance was defined as a normal collagen/epinephrine closure time (<186 s). RESULTS: Ten patients (20%) were aspirin-resistant at rest. Out of the 40 patients who were aspirin-sensitive at rest, 9 (22%) were aspirin-resistant immediately after the exercise stress test. There were no differences in aspirin sensitivity regarding gender, age, diabetes, hypertension, dyslipidemia, platelet count, medical treatment or number of the coronary arteries involved. CONCLUSIONS: Aspirin resistance is detected, at rest, in 20% of our patients with stable coronary artery disease. Aspirin treatment does not seem to protect against exercise-induced platelet activation in 22% of such patients, despite aspirin sensitivity at rest.

Aged↗
PubMed2002

[Assessment of the effects of antihypertensive drugs on stress-induced cardiovascular changes].

The authors reviewed some of the most relevant studies dedicated to the assessment of the effects of the antihypertensive drugs on the stress-induced cardiovascular changes. The rises in both blood pressure and heart rate turned out not to be significantly altered by calcium channel blockers, ACE inhibitors, moxonidine, nor beta-blockers, whereas they seemed to be slightly blunted by alpha-blocking drugs. However, since baseline blood pressure was significantly lower in treated hypertensives than in placebo-given patients, all antihypertensive drugs eventually resulted in a lower blood pressure level during stress, as compared with untreated patients. Regarding white coat effect, which has to be considered as a very particular stress, it appeared to be lowered to the same extent by placebo and antihypertensive drugs; moreover, its changes were not associated with any clinical beneficial effect.

Adrenergic alpha-Antagonists↗
PubMed2002

Comparison of trough effect of telmisartan vs perindopril using self blood pressure measurement: EVERESTE study.

This multicentre study was aimed at comparing the trough effect of telmisartan and perindopril on diastolic blood pressure (DBP), using self blood pressure measurement (SBPM). A second objective was to compare the data obtained from SBPM with those provided by automatic office BP measurement. A total of 441 mild-to-moderate hypertensive patients were randomised to receive either telmisartan 40 mg or perindopril 4 mg for a period of 12 weeks. Patients whose clinic DBP remained higher than or equal to 90 mmHg at the end of the 6th week (W6) were given a double-dose regimen. Office BP and SBPM were performed at baseline (W0), at W6 and at week 12 (W12), both with the same automatic device. A greater diminution of trough DBP was obtained with telmisartan (-6.6+/-6.7 mmHg) than with perindopril (-5.1+/-7.0 mmHg; P=0.018). Regarding clinic BP, the same results were observed. Doubling dose was significantly less frequent with telmisartan (41%; n=85) than with perindopril (55%; n=115, P=0.005). Mean values of SBPM were lower than office BP values, with a difference of a greater importance at W0 than at W12: 6.6 vs 4.7 mmHg for systolic blood pressure (P<0.005) and 3.2 vs 1.4 mmHg for DBP (P<0.0001). At W12, isolated office hypertension was found in 9% of the patients (n=37), while there were 14% of the patients (n=55) with isolated home hypertension. In conclusion, the trough effect on DBP was statistically higher with telmisartan than with perindopril. SBPM values were lower than office BP values, with greater differences before than after treatment. About a quarter of the patients were found to be controlled with a method but not with the other one.

Adult↗
PubMed2001

Relationship between short-term and long-term blood pressure variabilities in essential hypertensives.

This study was designed to analyse the relationship between the different blood pressure (BP) variabilities obtained in a non-invasive way and to determine the potential contribution of aging, severity of hypertension and increased ventricular mass to these different BP variabilities. Two hundred and six hypertensive patients underwent a 24-h ambulatory BP measurement (ABPM) as well as a photoplethysmographic BP recording and a standard echocardiography. Nocturnal BP fall and standard deviations of hourly mean BP levels as well as post-prandial fall in BP were calculated from the 24-h ABPM and were considered as indexes of long-term variability. Baroreflex sensitivity (BRS) and spectral powers of systolic BP, diastolic BP and heart rate (HR) over the low frequency band (LF: 0.05--0.14 Hz) were obtained from photoplethysmographic recording and were used as indexes of short-term variability. Short-term variability indexes were shown to be significantly related to those of long-term variability. A decrease in LF spectral powers was associated with a particular profile characterised by an attenuation of nocturnal BP fall, an increase of daytime BP standard deviations, an increase in post-prandial BP fall, a decrease in BRS and to a lesser extent, a diminution in night-time HR standard deviation. Moreover, a negative significant relationship was found between standard deviation of daytime systolic BP and both night systolic BP fall and BRS. Age and nocturnal BP level were associated with all BP variability disorders, whereas left ventricular hypertrophy was associated only with a decrease in LF spectral powers and in night BP fall, and an increase in standard deviation of daytime BP. Finally, LF spectral power of SBP was identified as independently predicted by age and night SBP fall. Journal of Human Hypertension (2001) 15, 41-48

Adult↗
PubMed2001

Prediction of major coronary events by coronary risk profile and silent myocardial ischaemia: prospective follow-up study of primary prevention in 72 diabetic patients.

UNLABELLED: The aim of this study was to examine the predictive value of coronary risk profile (CRP) for major coronary events in patients screened for silent myocardial ischemia (SMI). We studied 72 diabetic patients, aged 41 to 65 years, recruited consecutively at the Poitiers diabetes clinic. All patients had at least one cardiovascular risk factor associated with diabetes mellitus (type 1 diabetes duration > or =15 years, dyslipidaemia, smoking, hypertension, micro/macro-albuminuria). A structured questionnaire, physical examination and resting electrocardiogram provided no evidence of coronary heart disease. SMI was defined as positive exercise electrocardiogram and/or dipyridamole thallium myocardial scintigraphy. CRP was estimated using the Framingham equation adapted to the French population. We defined a high CRP value as annual CRP > or =1.5%. Major coronary events (MCE) were defined as myocardial infarction, ischaemic heart failure, unstable angina or sudden death. Twenty-one patients with type 1, and 51 with type 2 diabetes were followed up for 39+/-12 months: 30 women and 42 men, aged 55+/-7 years with diabetes duration of 16 +/- 11 years (mean +/- SD). SMI was detected in 8 patients. Major coronary events occurred in 8 patients, 2 of whom had SMI. High CRP was found in 18 patients, 3 of whom had MCE. CRP was significantly higher in those patients with a major coronary event (1.71 +/- 1.11 versus 1.03 +/- 0.56%; p=0.048), but not in those with SMI (1.19 +/- 0.72 vs 1.09 +/- 0.67%; p=0.654). In Kaplan-Meier survival analysis, a high CRP was associated with the risk of a major coronary event (log-rank=5.36; p=0.021), whereas SMI was not (log-rank=2.02; p=0.155). The cumulative incidence of MCE in those patients with high and low CRP was 8.08 (0.49-15.67) vs 2.15 (0.06-4.22) events per 100 patient year of follow-up, respectively. CONCLUSION: CRP had a good predictive value for major coronary events regardless the presence of SMI. Prevention should therefore be focused primarily on patients with high CRP, wether or not they have SMI.

Adult↗