[Apropos of a voluminous hiatal hernia].
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Aged↗
Biomedical subjects
N Petetin
Publications and source records attributed to N Petetin.
[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↗
[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↗
[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↗
[Essential arterial hypertension and quality of life. Comparative crossed double-blind study of labetalol and captopril].
The purpose of this multicenter randomised, double-blind and cross-over study was to compare the antihypertensive effects of labetalol (L) and captopril (C) in 42 moderate hypertensive patients (mean age: 52 years). The drugs were given during two 4-weeks periods at the end of which the systolic (SBP) and diastolic blood pressures (DBP) were measured at rest in supine and standing positions. The assessment of the quality of life was realized with 4 scales completed by the practitioner [anxiety, depression, well-being, visual analog scale (VAS)] and 4 scales of auto-assessment completed by the patient [2 VAS, well-being, sub-scale of pleasure]. At the end of the first treatment's period (D28), both drugs had decreased significantly supine SBP and DBP (p less than 0.001), standing DBP (L = p less than 0.01; C = p less than 0.05), while only L lowered supine SBP (p less than 0.01). The cross-over analysis was unable to conclude, due to the number of patients and a significant interaction which reduced its power. Thus the effect of the first treatment's period seemed to influence the efficacy of the second one. The percentages of patients with a controlled BP were respectively: after 4 weeks of treatment, L = 61 p. 100 vs C = 42 p. 100 and at the end of study (D56), L = 67 p. 100 vs C = 64 p. 100.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
[Calcium intestinal absorption in normotensive and essential hypertensive subjects before and after nicardipine].
The part played by calcium in genesis of essential hypertension may be suspected. Yet, the whole of epidemiological research as well in the animal as in man is still not very convincing. The objective of such a research has been to appreciate the calcium intestinal absorption before and after nicardipine treatment in 11 subjects (5 M/6 F) aged between 32 and 82. The group is made up of 7 hypertensive patients (2 M/5 F) and 4 normotensive ones (3 M/1 F). Subjects showing bone disease, kidney insufficiency and stone in kidneys or under such a treatment as to interfere with calcium metabolism had been excluded. Dosage of calcium and phosphate, Na, K, aldosterone, in blood and urine and PTH and PRA in blood had been effectuated. Estimation of true calcium absorption has been made by double isotope deconvolution method. Blood pressure has been measured by semi-ambulatory monitoring method. Similar evaluation has been made after four weeks treatment (60 mg of nicardipine a day). Without any treatment, normotensive subjects have a lower intestinal absorption coefficient than the hypertensive ones, which is normal (non significative statistical results: NS). Under nicardipine, hypertensive patients seem to get lower intestinal absorption (NS); other clinical, biological parameters show no change, except a rise of apoprotein A after nicardipine treatment (P less than or equal to 0.05). So, the intestinal absorption of calcium would become higher in hypertensive subjects and diminished by calcium antagonist treatment.
Aged↗
[Familial venous and arterial thromboembolic disease due to protein C deficiency].
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Adult↗
[Blood pressure control and quality of life: a comparative multicenter double-blind and cross-over trial of labetalol and captopril].
The purpose of this multicenter randomised, double-blind and cross-over study was to compare the antihypertensive effects of labetalol (L) and captopril (C) in 42 moderate hypertensive patients (mean age: 52 years). The drugs were given during two 4-weeks periods at the end of which the systolic (SBP) and diastolic blood pressures (DBP) were measured at rest in supine and standing positions. The assessment of the quality of life was realized with 4 scales completed by the practitioner [anxiety, depression, well-being, visual analog scale (VAS)] and 4 scales of auto-assessment completed by the patient [2 VAS, well-being, sub-scale of pleasure]. At the end of the first treatment's period (D28), both drugs had decreased significantly supine SBP and DBP (p less than 0.001), standing DBP (L = p less than 0.01; C = p less than 0.05), while only L lowered supine SBP (p less than 0.01). The cross-over analysis was unable to conclude, due to the number of patients and a significant interaction which reduced its power. Thus the effect of the first treatment's period seemed to influence the efficacy of the second one. The percentages of patients with a controlled BP were respectively: after 4 weeks of treatment, L = 61 p. 100 vs C = 42 p. 100 and at the end of study (D56), L = 67 p. 100 vs C = 64 p. 100. The cross-over analysis didn't show any difference between the effects of L and C on the quality of life.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗