[Iatrogenic and drug-induced hypertension]. / Hypertensions artérielles médicamenteuses et toxiques.

Various toxic or drug agents can induce arterial hypertension, aggravate or limit the efficiency of anti-hypertensive drugs. Iatrogenic and drug-induced hypertension should be well known by the clinicians and the pharmacists, given the impact for driving the management of patients. In the food, an excessive alcohol consumption (more than 30 g per day) and more rarely glycerizine (active ingredient of the licorice) should be systematically looked for in front of a recent hypertension or do not respond to usual treatment. In the list of offending medicines, we must remember ethinyl estradiol contained in the contraception (oral, vaginal ring or transcutaneous patch), non steroidal anti-inflammatory drugs, immunosuppressants (cyclosporine, tacrolimus), vascular endothelial growth factor and its receptor R2 (avastin, inhibitors of receptor tyrosine kinases), recombinant human erythropoietin, sympathomimetics (nasal decongestants), anabolic steroids, bromocriptine (inhibitor of lactation), psychotropes (tricyclics antidepressants, monoamine oxydase inhibitors). The diagnosis of iatrogenic hypertensions should be systematically suspected in front of a suggestive clinical context with a meticulous food questioning because these hypertensions are partially or fully reversible after exposure stops.

Evaluation of blood pressure control in an obstructive sleep apnea population followed in cardiology.

OBJECTIVE: Obstructive sleep apnea (OSA) is the most common factor involved in uncontrolled blood pressure (BP). Management of OSA is part of cardiologist work. We have few data on BP control in a population of OSA followed by cardiologists. AIM: We evaluated the prevalence of effective BP control using ambulatory measurement in a population of patients followed in cardiology. METHODS: Data from 69 OSA patients treated for more than 6 months by continuous positive airway pressure (CPAP) were collected prospectively from March 2012 until December 2012. These patients were divided into 2 groups according to the results of 24-h ambulatory BP monitoring (ABPM). Controlled BP was defined as a 24 h BP <130/80 mmHg. RESULTS: All patients were hypertensive. 44 patients (63 %) had uncontrolled hypertension (HTN). The onset of OSA (p = 0.01) and persistent daytime sleepiness appeared as predictors of uncontrolled BP. Systolic BP (SBP) during consultation and all the ABPM variables were higher in uncontrolled BP patients. Uncontrolled BP was associated with greater left ventricular mass (p = 0.02) and greater diameter of the ascending aorta (p = 0.04). CONCLUSION: Control of HTN should be evaluated in all OSA patients, using ABPM. The onset of OSA and high SBP during consultation are both factors associated with uncontrolled BP in this population. Repeating ABPM should be of interest for the follow up of these patients.

Predictors of poor blood pressure control assessed by 24 hour monitoring in patients with type B acute aortic dissection.

UNLABELLED: The chronic management of post-acute aortic dissection (AD) of the descending aorta (Type B) is based on optimal control of blood pressure (BP), with a target BP < 135/80 mmHg. The aim of our study was to determine and verify effective blood pressure control with an objective measurement method and to identify predicting factors. METHODS: We collected data from 26 patients hospitalized in the acute phase of a Type B AD between 2006 and 2009. Two groups were defined according to 24 hour BP monitoring results at follow-up. Group 1 consisted of patients with a controlled BP (<130/80 mmHg), and Group 2 consisted of patients with an uncontrolled BP. RESULTS: Thirty four percent of patients showed an uncontrolled BP at checkup. Vascular history before AD (P = 0.06), high baseline BP trend (P = 0.01 for systolic and P = 0.08 for diastolic), and greater diameter of the descending aorta (P = 0.02) were associated with poor BP control. CONCLUSION: Prognosis after AD is associated with BP control. Therefore, 24 hour BP monitoring can be made.

[Acute aortic syndrome: medical care at acute phase and long-term follow-up]. / Syndromes aortiques aigus: organiser la prise en charge médicale à la phase aiguë et au long cours.

For the management of acute aortic syndromes, there is a major interest of a multidisciplinary decision: resuscitator, cardiologist, radiologist, vascular surgeons. Do not delay the thoracic computed tomography: the gold standard in such an urgent situation. Use intravenous beta-blocade therapy anytime it is possible. At the acute phase: systolic blood pressure target is < 120 mmHg, and the heart rhythm target is < 60 bpm. Type A acute aortic dissection is a surgical emergency. Type B acute aortic dissection is a medical emergency and need a management of peripheral ischemia and/or organ failures if necessary. Beta-blocade therapy has to be pursued indefinitely at discharge. The angiotensin II receptor blockers (ARB) could be a future treatment in patient swith a Marfan syndrome. All etiological investigations of hypertension are systematically performed. Cardiovascular risk stratification and management is mandatory. Educational support and use of ambulatory blood pressure monitoring. Clinical and MRI follow-up at six month and then once a year, and in any case of suspicious clinical manifestations are needed.