How I treat ... by optimizing the blockade of renin-angiotensin-aldosterone system

peer reviewedThe blockade of the renin-angiotensin-aldosterone system (RAAS) has been shown to be useful, or even mandatory, in the management of arterial hypertension, congestive heart failure, post-myocardial infarction and nephropathy with albuminuria, due to diabetes or not. Such blockade can be obtained with an angiotensin converting enzyme inhibitor, a specific antagonist of angiotensin II AT1 receptors and/or recently a direct inhibitor of renin such as aliskiren. Various studies have demonstrated the advantage of optimising RAAS blockade in order to benefit of the best cardiorenal protection. The present article describes the various modalities to optimize the RAAS blockade, either by using a maximal dosage of a monotherapy, or by choosing a double inhibition of RAAS. New prospects for the RAAS blockade will be also briefly considered.Le blocage du système rénine-angiotensine-aldostérone (SRAA) s'est avéré très utile, voire incontournable, dans le traitement de l'hypertension artérielle, de la décompensation cardiaque, du post-infarctus et de la néphropathie albuminurique, diabétique ou non. Ce blocage peut être réalisé par un inhibiteur de l'enzyme de conversion de l'angiotensine, un antagoniste des récepteurs AT1 de l'angiotensine II et/ou, récemment, un inhibiteur direct de la rénine, comme l'aliskiren. Diverses études ont montré l'intérêt d'optimiser le blocage du SRAA pour bénéficier des meilleurs effets de protection cardio-rénale. Cet article décrit les modalités pour obtenir un blocage optimal du SRAA, soit en recourant à un dosage maximal d'une monothérapie, soit en faisant appel à une double inhibition pharmacologique du SRAA. De nouvelles perspectives concernant le blocage du SRAA seront également évoquées

New Therapeutic Guidelines in Cardiology

peer reviewedCardiovascular diseases are the leading cause of mortality in the so-called industrial countries. An appropriate management is mandatory and its modalities should be known and applied by physicians. European and American recommendations are regularly published and updated. They are available on the web sites of the European Society of Cardiology (www.escardio.org), the American Heart Association (www.aha.org) and the American College of Cardiology (www.acc.org This article describes the recent therapeutic options of some cardiovascular diseases, especially coronary artery disease, valvular diseases, atrial fibrillation and implantable defibrillator, but is far to be exhaustive

Basic initiatory glossary to clinical research

peer reviewedWe present a glossary of terms frequently used in medico-scientific studies

Cutaneous complications of insulin therapy. A drug-induced condition on the decline.

peer reviewedInsulin therapy is increasingly used. Hopefully, its complications are steadily decreasing in incidence since the introduction of new generations of insulin. The main cutaneous side effects were varied, including lipoatrophy, lipohypertrophy, allergic reactions, infectious abcesses and some idiosyncratic reactions

La L(+)-alanine-déshydrogénase

Doctorat en Sciencesinfo:eu-repo/semantics/nonPublishe

Aliskiren (Rasilez), direct renin inhibitor

peer reviewedAliskiren (Rasilez) is the first oral renin inhibitor. Its present indication is essential hypertension, as monotherapy or in combination with other antihypertensive agents (diuretic, calcium antagonist, ...). It may also be associated with an angiotensin converting enzyme inhibitor (or an AT1 angiotensin receptor antagonist) in order to benefit of a dual blockade of the renin-angiotensin-aldosterone system. The usual daily dose is 150 mg, to be increased up to 300 mg if necessary. New clinical trials are ongoing to validate this novel therapeutic approach in other indications such as congestive heart failure and diabetic nephropathy

The Brugada Syndrome

peer reviewedThe Brugada syndrome, a genetically transmitted disease according to an autosomal mode with a variable penetrance, is responsible for sudden death secondary to polymorphic ventricular tachycardia. The diagnosis is based on a typical electrocardiographical paturn that combines a right bundle branch block with ST elevation in the right precordial leads. In high risk patients, the automatic implantable defibrillator has the unique capability to protect against the occurrence of ventricular arrhythmias

The psoriasis--metabolic syndrome comorbidity, a complex multigenic disease

peer reviewedPsoriasis is a common chronic inflammatory dermatitis mediated by cytokines released by dendritic plasmacytoid cells in combination with Th1- and Th17-cells. This complex and multifactorial condition is commonly associated with some comorbidities. The complexity of a coordinated management of such intricated pathologies is obvious. It calls for the so-called medicine "centered around the patient" which tops off the evidence-based medicine. Vitamin D by its immunomodulatory effect on T helper cells exerts a therapeutic benefit on psoriasis and some of its comorbidities including the metabolic syndrome. A vitamin D oral treatment was proposed in order to reduce the cardiovascular risk, and the ensuing morbidity and mortality

syncope

peer reviewedSyncope remains a clinical challenge. Accurate history taking, physical examination and EKG are mainstays of the diagnosis work up. The most important parameter for prognosis and requiring aggressive management is a structural heart disease. Patient without cardiopathy presenting multiple episodes may be candidate for tilt testing and loop EKG recorder

Cardiovascular and renal protection of patients with type 2 diabetes : focus after EMPA-REG OUTCOME and LEADER

peer reviewedRésumé : Le diabète de type 2 (DT2), souvent associé à une hypertension artérielle, expose à un risque élevé de cardiopathie et d’insuffisance rénale. Deux essais cliniques ont démontré la supériorité versus un placebo de deux médicaments antidiabétiques chez des patients DT2 à haut risque cardiovasculaire : l’empagliflozine, un inhibiteur sélectif des cotransporteurs sodium-glucose de type 2 (SGLT2), dans l’étude EMPA-REG OUTCOME et le liraglutide, un agoniste des récepteurs du glucagon-like peptide-1 (GLP-1), dans l’étude LEADER. Ces deux médicaments ont entraîné une réduction significative des événements cardiovasculaires majeurs (respectivement, -14 et -13 %), de la mortalité cardiovasculaire (-38 et -22 %), de la mortalité globale (-32 et -15 %) et des événements rénaux (-39 et -22 %). Les mécanismes sous-jacents expliquant le meilleur pronostic restent discutés. Des études en cours devraient permettre de savoir s’il s’agit d’un effet propre à la molécule ou d’un effet attribuable à la classe pharmacologique.Summary : Type 2 diabetes (T2D), often associated with arterial hypertension, represents a high risk of cardiovascular disease and nephropathy. Two clinical trials demonstrate the superiority versus a placebo of two antidiabetic drugs in patients with T2D and high cardiovascular risk : empagliflozin, an inhibitor of sodium-glucose type 2 (SGLT2) cotransporters, in EMPA-REG OUTCOME and liraglutide, an agonist of glucagon-like peptide-1 (GLP-1) receptors, in LEADER. Both medications showed a significant reduction in major cardiovascular events (-14 and -13 %, respectively), cardiovascular mortality (-38 and -22%), all-cause mortality (-32 and -15 %) and renal events (-39 et -22 %). The underlying protective mechanisms remain controverted. Ongoing studies should allow to decide whether the benefits are specific to each molecule or may be attributed to a class effect