128 research outputs found

    Effects of a multifaceted intervention on cardiovascular risk factors in high-risk hypertensive patients: the ESCAPE trial, a pragmatic cluster randomized trial in general practice

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    BACKGROUND: Several observational studies on hypertensive patients have shown a gap between therapeutic targets recommended in guidelines and those achieved in daily practice. The ESCAPE trial aimed to determine whether a multifaceted intervention focused on general practitioners (GPs), could increase significantly the proportion of hypertensive patients at high risk in primary prevention who achieved all their recommended therapeutic targets. METHODS: A pragmatic, cluster randomized trial involving 257 GPs randomized by region. The GPs in the intervention group had a one-day training session and were given an electronic blood pressure measurement device and a short recommendation leaflet. Along with usual follow-up, they focused one consultation on hypertension and other cardiovascular risk factors every six months for two years. They also received feedback at baseline and at one year on their patients’ clinical and biological parameters. Main outcome measures were change in the proportion of patients achieving all their therapeutic targets and each individual therapeutic target at two years, and quality of life. RESULTS: 1,832 high-risk hypertensive patients were included. After two years, the proportion of patients achieving all their therapeutic targets increased significantly in both groups, but significantly more in the intervention group: OR (odds-ratio) 1.89, (95% confidence interval (CI) 1.09 to 3.27, P = 0.02). Significantly more patients achieved their blood pressure targets in the intervention group than in the usual care group: OR 2.03 (95% CI 1.44 to 2.88, P < 0.0001). Systolic and diastolic blood pressures decreased significantly more in the intervention group than in the usual care group, by 4.8 mmHg and 1.9 mmHg, respectively (P < 0.0001 for both). There were no significant difference changes in physical and mental quality of life between groups. CONCLUSION: An easy-to-perform, multifaceted intervention targeting only GPs increased significantly the proportion of high-risk hypertensive patients in primary prevention achieving their recommended therapeutic targets. TRIAL REGISTRATION: This trial was registered with ClinicalTrials.gov, number NCT0034885

    Sex differences in mineralocorticoid receptor antagonist trials: a pooled analysis of three large clinical trials

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    Aims: Women with heart failure (HF) are under-represented in individual randomized clinical trials (RCTs). Little is known about sex-specific treatment effects in HF medications. We evaluated sex differences in the response to mineralocorticoid receptor antagonists (MRAs) in major HF MRA trials, including a broad spectrum of left ventricular ejection fraction (LVEF). Methods and results: Individual patient data fixed-effect meta-analysis was performed using 6167 patients (31.4% were women) recruited in three placebo-controlled RCTs: Randomized Aldactone Evaluation Study (RALES), Eplerenone in Mild Patients Hospitalization and Survival Study in Heart Failure (EMPHASIS-HF) and Spironolactone for Heart Failure with Preserved Ejection Fraction (TOPCAT)-Americas. Compared to men, women were older, had higher body mass index and lower glomerular filtration rate. They also had higher LVEF and poorer New York Heart Association functional class and were less likely to be taking angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers. Placebo-arm event rates were lower for women compared with men (15.4 vs. 22.1 per 100 person-year; P = 0.002). MRAs reduced consistently, in men and women, the relative risk for cardiovascular death or HF hospitalization (P for interaction = 0.83), cardiovascular death (P for interaction = 0.44) and all-cause death (P for interaction = 0.19). These findings remained consistent after adjustment for potential confounders, regardless of LVEF. There was no sex-specific impact of MRA on the rate of hyperkalaemia and worsening renal function during the median 22 months of follow-up. Conclusion: In three large MRA RCTs, women were substantially different from men with regard to their clinical features and event rates. Nonetheless, this meta-analysis supports a consistent and beneficial MRA effect regardless of sex

    Intérêt pour la pratique clinique de l' évaluation de la pression artérielle centrale et de la rigidité artérielle chez les patients consultant pour hypertension arterielle

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    La prise en charge de l HTA repose sur la pression humérale. Des études récentes ont montré que la pression centrale et la vitesse de l onde de pouls sont de meilleurs facteurs prédictifs de mortalité. L objectif est d évaluer l impact de ces paramètres pris comme cibles thérapeutique. 48 hypertendus ont bénéficié de mesures de pression humérale (4 en 10 minutes), de pression centrale et de vitesse de l onde de pouls (VOP) par tonométrie. La première (PAmax), la dernière (PAmin) mesure brachiale, l indice d augmentation (AI), la pression systolique centrale (PASc) et la pression pulsée centrale (PPc) ont été étudiés. Les patients définis non contrôlés avaient une PAmax >=140/90mmHg, une PAmin>=135/85mmHg. Les cibles d AI, de PASc, de PPc, et de VOP ont été calculés individuellement ( tables de référence). Le seuil de VOP de 10m/s a aussi été étudié. Pour l analyse de concordance, réalisée avec un test kappa, un seuil de 0,5 a été considéré significatif. Pour les comparaisons de groupes, les tests T student, fisher-snedecor et Chi 2 ont été utilisés. L HTA était non contrôlée chez 45% des patients pour la PAmax et 35% pour la PAmin. Une élévation a été retrouvée (% patients) pour l AI (12), pour la PPc (35), pour la PASc (27), pour la VOP (23), pour la VOP avec le seuil à 10m/s (58). Il n y avait pas de concordance entre la pression humérale, centrale et la VOP. Une élévation de la VOP (40), de l AI (7), de la PASc (7), de la PPc(7) a été retrouvée parmi (% patients) traités efficacement. Il existe une discordance entre le contrôle tensionnel huméral et central. La VOP reste élevée chez 40% des patients efficacement traités. Utiliser ces paramètres comme cibles thérapeutiques, bouleverserait la prise en charge de l HTA.PARIS6-Bibl.Pitié-Salpêtrie (751132101) / SudocSudocFranceF

    Utilisation d'un nouvel outil informatique, le personal digital assistant (PDA) PALM PILOT, dans les Ă©tudes en clinique

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    PARIS-BIUM (751062103) / SudocCentre Technique Livre Ens. Sup. (774682301) / SudocSudocFranceF

    Evaluation de la stratégie des "paniers thérapeutiques" dans le traitement de l'hypertension artérielle

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    PARIS5-BU MĂ©d.Cochin (751142101) / SudocPARIS-BIUM (751062103) / SudocCentre Technique Livre Ens. Sup. (774682301) / SudocSudocFranceF

    Recherche des facteurs prédictifs d'un hyperaldostéronisme primaire dans l'hypertension artérielle résistante

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    PARIS6-Bibl.Pitié-Salpêtrie (751132101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

    L'hypertension artérielle en France en 2012 (évolution sur 10 années de la prescription d'antihypertenseurs)

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    L'hypertension artérielle en France est décrite de 2002 à 2012 par les enquêtes FLASHS (French League Against Hypertension Survey, enquêtes du Comité Français de Lutte contre l'hypertension Artérielle) qui interrogent des échantillons représentatifs de la population française métropolitaine. Elles montrent que l'hypertension artérielle est une pathologie fréquente et en constante augmentation. De nombreux traitements antihypertenseurs sont progressivement apparus depuis les années 60, et leur utilisation n'a cessé d'évoluer. Ces évolutions sont la conséquence de facteurs externes modifiant la prescription des antihypertenseurs tels que les recommandations éditées par les Autorités de santé ou par les sociétés savantes, les preuves apportées par l'évidence clinique ou la promotion de traitements par les laboratoires. Si ces facteurs n'ont individuellement qu'un effet limité sur le choix des antihypertenseurs, ils se révèlent conjointement avoir une influence certaine sur la prescription.The FLASHS surveys (French League Against Hyepertension Survey) describe the Hypertension in the French between 2002 and 2012. Those surveys show that the Hypertension is a frequent and continuously increasing pathology. Many antihypertensive treatments have progressively appeared since the 60's, and their use evolves over time. These evolutions are due to external factors which influence the antihypertensive treatment prescriptions, such as the guidelines from Health Authorities or from Scientific Societies, the evidence based medicine, the promotion of new treatments by the pharmaceutical industries. These factors individually have a limited effect on the antihypertensive trends but joined they ensure a major influence on those.RENNES1-BU Santé (352382103) / SudocLYON1-BU Santé (693882101) / SudocSudocFranceF

    ETUDE DE LA FAISABILITE DE LA MESURE DE LA PRESSION ARTERIELLE PAR DES MONITEURS ELECTRONIQUES EN MEDECINE GENERALE

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    ST QUENTIN EN YVELINES-BU (782972101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

    Recherche des déterminants génétiques de phénotypes artériels chez l'homme (application au vieillissement vasculaire)

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    PARIS-BIUSJ-Thèses (751052125) / SudocPARIS-BIUSJ-Physique recherche (751052113) / SudocSudocFranceF
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