Why and how should the patient perform a correct home blood pressure measurement?

Home blood pressure (BP) measurement is a medical prescription. The interpretation of the results must be left to the physician. This method is complementary to the classical office BP measurement and the 24 hour ambulatory blood pressure measurement. It must be proposed to some selected patients on the basis of their capacity of learning and understanding the place of the technique for the diagnosis and the treatment compliance. It allows a more active contribution of the patient to the management of her chronic disease and, this, may improve the prevention of cardiovascular complication. A normal blood pressure during self BP measurement is equal or lower to 135/85 mmHg or even lower in high cardiovascular risk patients. This new technique, already largely used by patients, needs adequate education and good advice for buying a validated device.L’automesure de la pression artérielle est un acte médical. Sa prescription et l’interprétation de ses données sont à réaliser par le médecin. Ce pré-requis étant dit, cette technique, complémentaire de la mesure au cabinet de consultation et de celle ambulatoire de la pression artérielle, apporte, chez les sujets sélectionnés, des informations pour la confirmation d’un diagnostic d’hypertension artérielle et pour l’appréciation de la qualité de son traitement. Elle permet de responsabiliser le patient dans sa prise en charge d’un problème souvent asymptomatique jusqu’à sa révélation lors d’une complication. La pression artérielle normale est, en automesure, inférieure à 135/85 mmHg, voire plus basse chez le patient à haut risque cardiovasculaire. Cette technique, fréquemment utilisée de nos jours par le patient, mérite qu’une éducation correcte de ce dernier soit faite après lui avoir conseillé d’acheter un appareil validé.Peer reviewe

Hyperkalemia: The New Killer?

peer reviewedHyperkalemia is now commonly observed due to several associated factors such as old age, diabetes, congestive heart failure, renal insufficiency and drugs such as spironolactone used to improve cardiac function. Moreover, the easily prescribed new antiinflammatory drugs COX2 selective inhibitors in these patients lead to a very acute risk for vital hyperkalemia development. This review insists on the prevention of such potentially reversible disorder.L'hyperkaliémie devient un trouble ionique assez habituel suite à la conjonction du vieillissement de la population avec un fond d'insuffisance rénale, de l'épidémie de diabète, d'insuffisance cardiaque et des nouvelles stratégies thérapeutiques prônant notamment l'usage de spironolactone. Le recours aussi fréquent aux anti-inflammatoires expose ces patients à un risque aigu d'élévation de la kaliémie pouvant conduire au décès (surtout les nouveaux COX2 inhibiteurs sélectifs). Cette revue insiste sur la prévention de ce risque vital

Polyomavirus Bk Infection in Renal Transplant Recipients

peer reviewedBeside acute rejection or immunosuppressive therapy toxicity, infection by Polyomavirus BK, usually not aggressive in immunoactive patients, has emerged as an important factor affecting graft function in renal transplant recipients. Indeed, one of the most important complications of BK infection is nephropathy. Viral replication in the urinary tract as assessed by the presence of "decoy cells", or by a positive PCR for BK virus has been detected in up to half of the recipients but only 5% will present nephropathy which is usually the only sign. The most common risk factors for this emerging new cause are new immunosuppressive drugs and rejection episodes. The gold standard to diagnose BK nephropathy is immunohistochemical staining for large T antigen in graft biopsy specimens. Urine cytology examination and DNA BK PCR are used as a screening test. The prognosis in BK nephropathy has been considered to be poor. The early reduction of immunosuppression can improve the prognosis and perhaps also cidofovir or leflunomide use

Practical issues in medication compliance in hypertensive patients

Unsatisfactory compliance in the treatment of high blood presure is frequently due to sequential barriers, such as insufficient patient education about the illness and low motivation to receive any treatment, existence of a large gap between physicians'perceptions of the problem and clinical reality, complexity of the treatment potentially generating adverse effects, and a health care environment with few public education compaigns and incentives for better coordinated supportive care. In order to improve drug compliance, establishment of personalized plans adapted to each patient is required. First, a good doctor-patient relationship is mandatory, with regular education of the patient about hypertension and its risks, discussion about adverse drug effects, and the complexity and cost of treatment. Second, to have any chance of success, the provider should offer convenient appointments and tailor the treatment regimen to the patient's lifestyle and needs, with written instructions. Third, there is a need to promote active patient collaboration with treatment. An innovative combination of home self-measurement of blood pressure, use of new technology options, eg, texting or telemedicine, and creation of a multi-disciplinary working team can offer new, effective opportunities. This approach could reduce cardiovascular complications by improving the control of high blood pressure, and thereby the overall costs of hypertension to the health care system.Peer reviewe

L'anticoagulation de l'hémofiltration continue: Citrate versus Héparine

peer reviewedL'insuffisance rénale aiguë aux Soins Intensifs affecte un patient sur cinq et souvent nécessite le recours à une épuration extra-rénale. L'hémofiltration continue est choisie pour certains patients (instabilité hémodynamique, neurologique, mais nécessite, comme d'ailleurs l'hémodialyse, une anticoagulation. Le citrate, utilisé dans le travail publié, est sorti vainqueur de sa comparaison avec l'héparine non fractionnée. Son utilisation nécessite cependant une surveillance attentive

Which blood pressure targets in patients with type 2 diabetes?

peer reviewedL'hypertension artérielle est fréquemment observée chez le patient diabétique de type 2 et aggrave le pronostic cardio-vasculaire et rénal. Abaisser la pression artérielle représente donc un objectif essentiel dans cette population. Cependant, les valeurs de pression systolique et diastolique à atteindre restent controversées et la cible doit sans doute être ajustée en fonction des caractéristiques individuelles du patient ("médecine personnalisée"). Cette vignette clinique résume les principaux arguments à propos du choix des cibles tensionnelles, en termes de rapport bénéfices/risques, selon que le patient diabétique présente un syndrome métabolique sans complications, une néphropathie ou une insuffisance coronaire

How to measure office blood pressure?

peer reviewedaudience: professional, studentLa mesure de la pression artérielle de façon classique repose toujours sur l’auscultation des bruits de Korotkoff. Devenue un geste banal, elle est souvent mal pratiquée et, donc, source d’erreurs dans l’estimation du niveau réel de pression d’un patient. Elle exige rigueur et précision pour être utile en pratique médicale quotidienne. Cette vignette à destination des étudiants veut rappeler les grands principes de la mesure de la pression artérielle au cabinet de consultation, mais aussi au domicile du patient.Routinely measuring blood pressure is still performed according to the auscultatory method using recognition of Korotkoff sounds. This usual technique is, however, often mishandled and is thus a source of error in the estimation of the true blood pressure level. Accuracy of such measure is, however, of paramount importance to be useful in daily medical practice. This methodology paper more specifically written for medical students recalls the essential principles of blood pressure measurement at the medical office, but also at home

Exforge® (amlodipine/valsartan combination) in hypertension: the evidence of its therapeutic impact

peer reviewedAbstract Introduction: Hypertension is an important risk factor for cardiovascular disease and its management requires improvement. New treatment strategies are needed. Aims: This review analyses one of these strategies, which is the development of effective and safe combination therapy. Indeed, at least two antihypertensive agents are often needed to achieve blood pressure control. Exforge® (Novartis) is a new drug combination of the calcium channel blocker, amlodipine, and the angiotensin II receptor blocker, valsartan. Evidence review: The amlodipine/valsartan combination is an association of two well-known antihypertensive products with specific targets in cardiovascular protection, namely calcium channel blockade and antagonism of the renin-angiotensin-aldosterone system. This kind of association, with neutral metabolic properties and significant antihypertensive efficacy, could be a useful new antihypertensive product. Currently available data have shown that this new combination is well-tolerated and effective even in severe hypertension. Clinical value: Clinical trials are ongoing for further assessment of the efficacy, compliance, and safety of this combination and its congeners. No data exist to prove that the amlodipine/valsartan combination is better than other antihypertensive strategies for cardiovascular or renal protection, but some trials with other combination therapies show such potential advantage

Optimal Blood Pressure Level and Best Measurement Procedure in Hemodialysis Patients

Hypertension occurs frequently among hemodialysis (HD) patients and can be due to many factors, such as salt intake, elevated sympathetic tone, and uremic toxins. It is responsible for the high cardiovascular risk associated with renal disease. Generally, in HD patients, while there is an elevation of systolic blood pressure (BP), diastolic BP seems to decrease, and the resultant effect is high pulse pressure, which can have a deleterious effect on the cardiovascular system. Although controversial, in the HD population the relationship between BP and risk of death seems to be U shaped, probably because of pre-existing cardiac disease in patients with the lowest BP. In chronic kidney disease, BP lower than 130/80 mmHg is recommended, but an appropriate target for BP in the HD population remains to be established. Moreover, there is no consensus regarding which routine peridialysis BP (pre- or post-dialysis BP, or both) can ensure the diagnosis of hypertension in this population. Ambulatory BP monitoring remains the gold standard to quantify the integrated BP load applied to the cardiovascular system. As well, home BP assessment could contribute to improve the definition of an optimal BP in the HD population. An ideal goal for post-dialysis systolic BP seems to be a value higher than 110 mmHg and lower than 150 mmHg. However, HD patients are generally old and often have cardiac complications, so a reasonable pre-dialysis target systolic BP could be 150 mmHg. It is prudent to suggest that an improvement in BP control is necessary in the HD population, first by slow and smooth removal of extracellular volume (dry weight) and thereafter by the use of appropriate antihypertensive medication

Reference values of central blood pressure and pulse wave velocity in relations with 24 hours ambulatory blood pressure monitoring in Belgian normotensive young subjects

The present study aimed to define reference values of central blood pressure (cBP) and Pulse Wave Velocity (PWV) together with 24H APPM in healththy normotensive young adults before starting a follow-up of their CV profile modifications over time