Biomedical subjects

L Vaur

Publications and source records attributed to L Vaur.

60 records · Page 4Linked to original sources

PubMedDate not supplied

[Hypertension management in patients with stable coronary disease].

AIMS: To assess hypertension control in patients with stable coronary disease in France. DESIGN: A cross sectional study was conducted in a representative sample of 794 cardiologists. PARTICIPANTS: The first 6 patients with coronary disease received at practitioner's office were included. MAIN OUTCOME MEASURES: Cardiovascular risk factors, antihypertensive drugs, cardiovascular history were reported. BP was measured. Patients considered as hypertensive by his cardiologist and receiving antihypertensive drugs were considered as hypertensive. Controlled hypertension was defined as a blood pressure < 140/90 mmHg. Uncontrolled hypertension was defined as blood pressure > or = 140/90 mmHg. Among the uncontrolled hypertensives we distinguished patients with isolated systolic hypertension: diastolic blood pressure < 90 mmHg and systolic blood pressure > or = 140 mmHg. RESULTS: All variables were available in 6,349 patients who form the basis of this report. 3,161 patients were hypertensive. Of them, 1,846 (58.4%) were uncontrolled hypertensives, whom 1,280 (69.3%) were uncontrolled on the basis of systolic blood pressure alone. CONCLUSION: This study conducted in a representative sample of French cardiologists indicates that there is a considerable potential to further reduce cardiovascular morbidity in patients in secondary prevention.

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PubMedDate not supplied

[Arterial hypertension management in patients with type 2 diabetes].

AIMS: To assess hypertension management and blood pressure control in patients with type 2 diabetes in France. DESIGN: A cross sectional study was conducted in a representative sample of 410 diabetologists. The first 8 patients with type 2 diabetes, treated with oral antidiabetic agents and/or insulin, received at practitioner's office were included. Cardiovascular risk factors, antihypertensive drugs, cardiovascular history were reported. BP was measured. Patients considered as hypertensive by his practitioner and receiving antihypertensive drugs were considered as hypertensives. Controlled hypertension was defined as a blood pressure < 140/80 mmHg. Uncontrolled hypertension was defined as blood pressure > or = 140/80 mmHg. RESULTS: 4,930 diabetics were included in the study. Of them 3,085 (63%) patients were hypertensives. They were markedly older, overweight and reported most frequently complications. Only 723 (23%) patients presented with controlled hypertension. 40% of hypertensives were under monotherapy, 36% received 2 antihypertensive treatments and 24% received 3 treatments or more. ACE-inhibitors (49%), diuretics (41%), beta-blockers (35%), calcium channel blockers (33%), angiotensin II antagonists (19%) were the most commonly prescribed agents. Apart from hypertension, the main risk factors associated with each kind of prescription was micro or macroalbuminuria for ACE-I (OR = 1.5), coronary artery disease for beta-blockers and calcium channel blockers (OR = 3.8 and 2.5 respectively), and age for diuretics and angiotensin II antagonists (OR = 1.05 and 1.03). CONCLUSION: This study conducted in a representative sample of french diabetologists indicated that despite the large use of antihypertensive treatments only 23% of hypertensive diabetics were well controlled. Due to the high CV risk of these patients, hypertension management is of major importance.

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PubMedDate not supplied

[Comparative lipophilia of trandolapril and other converting enzyme inhibitors].

The lipophilicity of angiotensin converting enzyme inhibitors (ACE-I) available in France has been compared using two complementary methods. Studies have been performed both on active ACE-I and prodrugs. The first study used reverse phase high performance liquid chromatography (HPLC) in order to measure the n-octanol water partition coefficients. They were measured at 3 pH values (2.5, 4.7 and 7.4). The second study was performed on the basis of computer drawn chemical formula. The lipophilic area to hydrophilic area ratio was calculated from the three dimensional structure of each ACE-I. A calculated n-octanol water partition coefficient was then determined. Whatever the method, a broad range of values was seen. The HPLC n-octanol water partition coefficient ranged from -1.86 (captopril) to 1.02 (trandolaprilate). The lipophilic to hydrophilic ratio ranged from 1.33 (captopril) to 2.74 (trandolaprilate) and the computer determined n-octanol water partition coefficient ranged from -0.36 (perindoprilate) to 0.69 (quinaprilate). A strong correlation (r = 0.97 p = 0.0001) was found between the lipophilic/hydrophilic area ratio and the HPLC partition coefficient. The classification of the ACE-I was very close whatever the mode of determination. The less lipophilic ACE-I are lisinopril and captopril and the most lipophilic are quinalapril and trandolapril. Clinical consequences of such differences remain unknown.

Angiotensin-Converting Enzyme Inhibitors↗

PubMedDate not supplied

[Duration of action of trandolapril in mild to moderate hypertensive patients evaluated by ambulatory measurement of blood pressure].

The duration of the antihypertensive action of transdolapril, a new angiotensin converting enzyme inhibitor, was studied in 23 patients using ambulatory blood pressure monitoring (ABPM) over 48 hours. After a 20-day placebo period (D1 to D20), mild to moderate hypertensive patients received 2 mg trandolapril once daily for 30 days (D21 to D50). The first 24-hour ABPM recording was performed on day 14, during the placebo run-in period. Two additional recordings were done successively on days 50 and 51 corresponding to a normal dosing day and a following day with a simulated missed dose, respectively. The three blood pressure recordings (placebo, treatment, missed dose) were compared. The average 24-hour systolic (SBP) and diastolic (DBP) blood pressure were significantly decreased by trandolapril. The mean +/- s.d. decrease between day 14 and day 50 were - 8.0 +/- 7.2 mmHg for the DBP and -13.3 +/- 7.8 mmHg for the SBP. Blood pressure was also consistently decreased during the daytime period (-8.7 +/- 7.9 mmHg for the DBP and - 15.6 +/- 8.5 mmHg for the SBP), nighttime period (-5.6 +/- 9.1 mmHg for the DBP and - 8.5 +/- 11.3 mmHg for the SBP) and early morning (- 12.3 +/- 9.7 mmHg for the DBP and - 15.9 +/- 15.1 mmHg for the SBP). The normal circadian pattern of blood pressure was maintained under treatment. The antihypertensive effect of trandolapril was sustained beyond 24 hours after the last intake: there were no significant difference beetween days 50 and 51 in terms of 24-hour, daytime and nighttime average blood pressure.(ABSTRACT TRUNCATED AT 250 WORDS)

Ambulatory Care↗

PubMedDate not supplied

[Demonstration of differences in the effect of 2 antihypertensive agents by self blood pressure measurement: comparison of trandolapril and perindopril].

In this double blind randomized study, blood pressure lowering effects and duration of action of two angiotensin converting enzyme (ACE) inhibitors were compared using home self blood pressure measurement (SBPM). After a two-week placebo run-in period, 128 hypertensive patients received during four weeks a daily morning dose of either perindopril (P) 4 mg or trandoplapril (T) 2 mg. One week of SBPM was planned at the end of both the run-in and the treatment period. Three consecutive measurements, with printed results, were requested in the morning before drug intake and in the evening. Run-in period home systolic (SBP) and diastolic (DBP) blood pressures were comparable in both groups: 149.9 +/- 14.5/97.3 +/- 8.1 mmHg in the P group (n = 63), 148.9 +/- 14.3/96.7 +/- 6.9 mmHg in the T group (n = 65). During the treatment period, evening BP was similar in the 2 groups: 139.1 +/- 14.3/89.9 +/- 9.1 mmHg in P group, 137.5 +/- 15.3/89.4 +/- 9.1 mmHg in T group (NS). On the other hand, morning BP was higher in the P group: 143.1 +/- 16.3/93.8 +/- 9.6 mmHg vs 137.4 +/- 16.7/90.3 +/- 9.7 mmHg (p < 0.05 for SBP and DBP-Student's t test). These results were confirmed by co-variance analysis after adjustment on initial BP. Due to standardized conditions of measurement, home SBPM was able to show a difference in BP lowering effects at the end of the inter-dose interval between two ACE inhibitors.

Adult↗

PubMedDate not supplied

[Risk factors of adverse effects of angiotensin-converting enzyme inhibitors. Apropos of 30,072 patients treated by trandolapril].

SUMMARY: The aim of the present study was to investigate the incidence of adverse effects and the prognostic value of various risk factors in a large population of unselected hypertensive patients treated with the ACE inhibitor trandolapril. Among the 30 072 patients investigated in this post marketing retrospective study, 1813 patients (6.0 per cent) reported an adverse effect. The five most frequent side effects were coughing (3.1 per cent), dizziness (0.7 per cent), headache (0.6 per cent) asthenia (0.5 per cent) and nausea (0.3 per cent). Intolerance risk factors for trandolapril were researched using both univariate and multivariate analysis. In the univariate analysis, a prior intolerance of an ACE inhibitor and female gender were strongly correlated with either overall intolerance or coughing. The most relevant variables for the occurrence of adverse effects, listed according to their entry order in the multivariate analysis, were: prior intolerance of ACE inhibitors (OR: 4.19, 95 per cent CI: 3.66-4.78), female gender (OR: 1.46, 95 per cent CI: 1.31-1.63), prior intolerance of other antihpertensive agents (OR: 1.27, 95 per cent CI: 1.14-1.41), smoking (OR: 0.76, 95 per cent CI: 0.66-0.87) and combination with a beta blocker (OR: 1.31, 95 per cent CI: 1.08-1.58). A prior intolerance of an ACE inhibitor appears to be a very strong predictor of coughing (OR: 6.14, 95 per cent CI: 5.24-7.19). The following variables, namely female gender (OR: 1.61, 95 per cent CI: 1.40-1.85), age 60-80 (OR: 1.25, 95 per cent CI: 1.09-1.44) and prior intolerance of other antihypertensive agents (OR: 1.20, 95 per cent CI: 1.03-2.39) appear less significant.

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