36 research outputs found

    Blood Pressure and Renal Responses to Orthostatic Stress Before and After Radiofrequency Renal Denervation in Patients with Resistant Hypertension.

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    In patients with resistant hypertension, renal denervation (RDN) studies have mainly focused their outcomes on blood pressure (BP). The aim of this study was to evaluate the long-term effect of RDN on neurohormonal profiles, renal hemodynamics and sodium excretion in a resting state and during stress induced by lower body negative pressure (LBNP). This was a single center prospective observational study. Norepinephrine, plasma renin activity (PRA), glomerular filtration rate (GFR), renal plasma flow (RPF) and sodium excretion were measured in unstimulated conditions (rest) and after one hour of LBNP at three different time points: before (M0), one (M1) and twelve months (M12) after RDN. Thirteen patients with resistant hypertension were included. In the resting state, no differences were observed in norepinephrine, PRA, sodium excretion and mean BP levels after RDN. GFR (78 ± 32 ml/min at M0 vs 66 ± 26 ml/min at M12 ( <i>p</i> = 0.012) and filtration fraction (22.6 ±5.4% at M0 vs 15.1 ±5.3% at M12 ( <i>p</i> = 0.002)) both decreased after RDN. During LBNP, the magnitude of the mean BP increase was reduced from +6.8 ± 6.6 mm Hg at M0 to +2.3 ± 1.3 mm Hg at M12 ( <i>p</i> = 0.005). The LBNP-induced increase in norepinephrine and decrease in GFR and sodium excretion observed before RDN were blunted after the procedure. A decrease in GFR and filtration fraction was observed one year after RDN. In addition, our results suggest that RDN blunts not only the norepinephrine but also the mean BP, the GFR and the sodium excretion responses to an orthostatic stress one year after the intervention. NCT01734096

    Effets du traitement par CPAP sur la vigilance, la qualité de vie, l'inflammation et la pression artérielle chez les patients apnéiques

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    Contexte¦Le syndrome d'apnées/hypopnées obstructives du sommeil (SAHOS) est une maladie qui¦touche 4% des hommes et 2% des femmes entre 30 à 60 ans. Les patients touchés par le¦SAHOS ont deux problèmes principaux: premièrement, ils ont davantage de risque de¦développer une maladie cardiovasculaire. Deuxièmement, ils ont une diminution de la qualité¦de vie se présentant principalement sous forme de somnolence diurne et une perte de¦vigilance. Le meilleur traitement à l'heure actuelle est le CPAP (continuous positive airway¦pressure) qui permet de normaliser la respiration nocturne et d'améliorer la qualité du¦sommeil. Les effets favorables du CPAP sur la qualité de vie, la vigilance et l'inflammation¦ont été suggérés par plusieurs études mais restent controversés.¦Objectifs¦Évaluer l'effet de 6 semaines de traitement par CPAP sur la qualité de vie, la vigilance, la¦pression artérielle et l'inflammation (HsCRP).¦Méthodes¦Vingt-neuf patients connus pour un SAHOS ont été inclus dans cette étude. Les critères¦d'exclusions comprenaient une grossesse chez la femme, la présence de facteurs de risque¦cardiovasculaires ou d'une autre pathologie sévère.¦Les patients inclus dans l'étude ont tous été investigués, avant de débuter le traitement par¦CPAP, par un PVT (psychomotor vigilance test), un questionnaire de qualité de vie (SF-36),¦une polysomnographie, un dosage de l'hsCRP et par 2 prises de pression artérielle (avant et¦après la polysomnographie). Après ces examens, le traitement par CPAP a été introduit pour¦six semaines à l'issue desquelles les mêmes examens ont été répétés.¦Résultats¦L'étude montre tout d'abord une amélioration significative des paramètres concernant la¦vigilance : 1/temps de réaction (P = 0.01) et les oublis (P = 0.04). Ensuite, tous les paramètres¦de la santé mentale évalués par le questionnaire SF-36 s'améliorent significativement ainsi¦que le score global de santé physique. L'hsCRP évaluant l'inflammation montre une tendance¦à la diminution (P = 0.07). Quant à la pression artérielle, la pression systolique du soir¦diminue de manière significative et la pression systolique du matin et les deux tensions¦artérielles moyennes calculées montrent une tendance à la diminution.¦Conclusion¦Cette étude montre un effet bénéfique du CPAP chez les patients atteints de SAHOS au niveau¦de la vigilance et de la qualité de vie. Les effets sur la pression artérielle et l'inflammation ne¦sont toutefois pas complètement établis et restent encore sujet à débat

    Insulines rapides et ultrarapides : quelles indications et utilités ? [Rapid and ultrarapid insulins: when and how?]

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    Treatment combining long-acting and short-acting insulins is essential for people with type 1 diabetes, but may become also compulsory in other forms of diabetes in case of insulinopenia. The purpose of short-acting insulins is to mimic physiological insulin secretion in response to carbohydrate intake at meals. There is a delay between the injection and its action, sometimes limiting their use and effectiveness. Ultra-rapid insulins have been developed to more closely approximate the expected insulin response to a meal, through faster absorption. They do not improve diabetes control but allow more flexibility with mealtime injections. These new analogues are also an attractive alternative for use in insulin pumps

    Dialyse et écologie: est-il possible de faire mieux à l'avenir [Dialysis and ecology: can we do better in the future?].

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    Development of dialysis has saved the lives of many patients. However, haemodialysis and peritoneal dialysis are very demanding in resources such as water and electricity, and generate a large amount of waste. In this article, we will review the environmental aspects of dialysis. Different solutions will be discussed, such as recycling of water discharged during reverse osmosis, the integration of solar energy, recycling of waste plastics, and the use of other techniques such as sorbent dialysis. In a world where natural resources are precious and where global warming is a major problem, it is important that not only dialysis, but all branches of medicine become more attentive to ecology

    Impact métabolique des fibres en cas de diabète gestationnel [The metabolic impact of fiber in gestational diabetes]

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    An adequate fiber intake is recommended for pregnant women, with or without gestational diabetes, similarly to the general population. Due to the lack of precise data on the composition of fiber in foods, dietary advices are not specific. Their objective is to increase the overall fiber consumption, ideally up to a daily consumption of 28g. Fiber intake has diverse effects and it is predominantly the intake of the viscous soluble fibers that improves the glycemic profile. In the case of gestational diabetes, supplementation with fiber products can be of interest in addition to the dietary recommendations to improve the postprandial glycemic profiles. More precise information on the impact of foods according to their fiber composition is needed to optimize the dietary advice

    Insulinothérapie basale chez les patients diabétiques de type 2 [Basal insulin therapy in patients with type 2 diabetes]

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    Insulin therapy, often initiated after hygiene and dietary measures and non-insulin antidiabetics, is part of the treatment of patients with type 2 diabetes. Fear of injections or hypoglycemia often delays its implementation. However, its introduction is recommended in cases of poorly balanced diabetes despite a well-controlled therapeutic escalation but also in cases of acute imbalance. Introduction of insulin therapy requires patient education and close monitoring by the healthcare team. Type of insulin and its titration reduce the incidence of hypoglycemia in patients at risk. The determination of the fasting glycemic target - relative to HbA1c - for the titration of insulin is important to define for an optimal benefit (prevention of secondary complications)/risk (hypoglycemia, weight gain) balance

    Hypertension et adhérence thérapeutique: un challenge de tous les jours [Hypertension and medication compliance: a challenge every day]

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    Hypertension is a cardiovascular risk factor frequently encountered in everyday practice. A drug therapy is often necessary to normalize blood pressure. However, despite adequate intensive drug treatment, adequate blood pressure target are not reached. Lack of adherence to treatment is often the cause. This article reviews various techniques for assessing patients' adherence and offers several ways to improve it

    State-of-the-art treatment of hypertension: established and new drugs.

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    The treatment of essential hypertension is based essentially on the prescription of four major classes of antihypertensive drugs, i.e. blockers of the renin-angiotensin system, calcium channel blockers, diuretics and beta-blockers. In recent years, very few new drug therapies of hypertension have become available. Therefore, it is crucial for physicians to optimize their antihypertensive therapies with the drugs available on the market. In each of the classes of antihypertensive drugs, questions have recently been raised: are angiotensin-converting enzyme (ACE) inhibitors superior to angiotensin II receptor blockers (ARB)? Is it possible to reduce the incidence of peripheral oedema with calcium antagonists? Is hydrochlorothiazide really the good diuretic to use in combination therapies? The purpose of this review is to discuss these various questions in the light of the most recent clinical studies and meta-analyses. These latter suggest that ACE inhibitors and ARB are equivalent except for a better tolerability profile of ARB. Third generation calcium channel blockers enable to reduce the incidence of peripheral oedema and chlorthalidone is certainly more effective than hydrochlorothiazide in preventing cardiovascular events in hypertension. At last, studies suggest that drug adherence and long-term persistence under therapy is one of the major issues in the actual management of essential hypertension
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