[Cardiac output studied by a non invasive method in hypertensive patients]. / Etude du débit cardiaque par une méthode non invasive chez des hypertendus.

We measured by thoracic bioimpedance (BoMed, NCCOM3-R7) non invasive cardiac index (CI), stroke index (SI) and systemic vascular resistance index (SVRI) in 48 hypertensive patients (OMS) compared to 30 normotensive. The mean arterial pressure (MAP) and the SVRI were significantly higher in the hypertensive group while the CI are significantly lower, as that was shown in previous invasive studies. We found an inverse correlation between age and CI (r = -.30, p < or = .05) in relation with a negative correlation between SI and age (r = -.35, p < or = .05) and no correlation between heart rate and age. Furthermore we divided normotensive and hypertensive patients in three groups of CI (low CI < 2.8 l/min/m2, 2.8 < or = normal CI < or = 4.2 l/min/m2, high CI > 4.2 l/min/m2) and in three groups of SVRI (low SVRI < 1660 Flohms/m2, 1660 < or = normal SVRI < or = 2580 Flohms/m2, high SVRI > 2580 Flohms/m2). Despite CI diminution in hypertension, high CI percentage's was the same in normotensive and hypertensive patients. In conclusion, these results confirm previous studies by using a simple, easy, non invasive and reproducible method.

[Adjustment of double-chamber pacemakers in VDD mode by measurement of thoracic electric bio-impedance]. / Réglage des stimulateurs double chambre en mode VDD par mesure de la bio-impédance electrique thoracique.

An optimal atrioventricular interval (AVI) was sought in 6 patients with a double chamber pacemaker by an non-invasive technique: measurement of stroke volume by thoracic bioimpedance. This method proved to be easy and reliable in practice when there was only one pacing spike (VDD mode). It confirmed the existence of a variable optimal AVI according to individual patients: 250 ms (3 patients), 200-250 ms (1 patient), 150 ms (1 patient), 75-100 ms (1 patient). The value of optimal AVI is unpredictable since it depends upon individual electrophysiological and hemodynamic parameters. In a patient with severe mitral incompetence, Echo-Doppler provided evidence of end-diastolic ventriculo-atrial regurgitation at middle and long AVI, while a short AVI enabled elimination of end-diastolic regurgitation and a 15.45 per cent improvement in stroke volume. In two patients with a long optimal AVI (250 ms), a programmed short AVI (75 ms) paradoxically appeared to be more favourable than a middle AVI (150 ms).

[Cardiac mass, ventricular relaxation parameters and their correlation with blood pressure during rest and ambulatory monitoring]. / Paramètres de masse cardiaque, de relaxation ventriculaire et leurs corrélations avec la pression artérielle enregistrée au repos et en ambulatoire.

UNLABELLED: A resting blood pressure (Dynamap, 8AM-8PM, one recording every 15 minutes) has been recorded among 60 patients; mean age: 51 +/- 14 years (24 females, 36 males; 3 normotensive and 57 hypertensive WHO) and a echocardiogram TM and two-dimensional with doppler in order to measure the interventricular septum thickness, Left Ventricular Posterior Wall Thickness and the left Ventricular Internal diameter with which we can calculate the myocardial mass (MM, Devereux formula) and the myocardial mass index using the body surface. Furthermore ventricular relaxation has been studied (A/E, PHT) by using doppler echocardiogram. During the same week an ambulatory blood pressure (Nippon Colin 8AM-8PM one reading every 15 minutes) has been recorded. The blood variables are the mean of the recording, systolic, diastolic, mean. We have confirmed the conclusion between blood pressure and left ventricular mass by using resting and ambulatory blood pressure recordings. But it does not exist any significant difference within we compare the correlations coefficients (Hotteling's Test with Williams modification) obtained with two devices. In revenge this difference exists with ventricular relaxation index A/E to MBP: mMBPr = 0.51, mMBPa = 0.34 (p less than 0.05), and PHT to MBP: mMBPr = 0.49, mMBPa = 0.31, (p less than 0.05) and to the SBP: mSBPr = 0.54, mSBPa = 0.35, (p less than 0.05). CONCLUSION: the relationship between blood pressure and myocardial mass and by, the heart effect from hypertension can be studied by using in any case resting and ambulatory blood pressure recordings. This will confirm the hypothesis in which the blood pressure recordings multiplication is more important than the way of recording it.(ABSTRACT TRUNCATED AT 250 WORDS)

[Blood pressure variability and morbidity]. / Variabilité tensionnelle et morbidité.

In a previous study (resting blood pressure profile, Dinamap) we have confirmed the correlations between blood pressure and left ventricular mass (myocardial hypertrophy being one of the morbidity criteria in Hypertension) and we have demonstrated the absence of significant difference (Fisher's z Test) with the results of ambulatory recordings found in literature. Furthermore, we have showed a weaker correlation between absolute variability (AV) and left ventricular mass (LVM). If indeed there exists a cause-effect relationship between the AV increase and the LVM increase, a relative independence between VA and blood pressures mean (mBP) should still be demonstrated. In order to do that we have used the factorial analysis (main components analysis) with which a small number of independent factors can be isolated from a large number of correlated variables. A resting blood pressure (Dinamap, 8AM-8PM, one reading every 15 minutes) has been recorded among 551 patients (259 females, 292 males; 109 normotensive WHO, 442 hypertensive WHO) and an echocardiogram TM and two-dimensional in order to measure the interventricular septum thickness (IVST), the posterior wall thickness (PWT) and the left ventricular internal diameter (LVID) with which we can calculate the myocardial mass (MM, Devereux formula) and the myocardial mass index (MMI) using the body surface (BS). The blood pressure variables are the means of the recordings (mBP): systolic (mSBP), diastolic (mDBP), mean (mMBP) and their standard deviations (SSD, DSD, MSD) corresponding to the AV. We have studied the heart rate (HR) with its standard deviation (HRSD) and age.(ABSTRACT TRUNCATED AT 250 WORDS)

[Relationship between heart mass and semi-ambulatory pressure profiles]. / Relation masse cardiaque et profils tensionnels semi-ambulatoires.

This work was undertaken with 420 patients (90 normotensives: casual blood pressure less than or equal to 140/90 mmHg and 330 hypertensives) in which was recorded a semi ambulatory blood pressure profile (Dinamap 8AM-8PM, a reading every fifteen minutes). On the same day an echocardiogram was performed. We have correlated the left ventricular mass, the left ventricular mass index, the interventricular septum, the left ventricular cavity volume and the left ventricular posterior wall with casual blood pressure, average daily blood pressure standard deviation and variation coefficient for mean blood pressure, systolic blood pressure and diastolic blood pressure. Analysis by sex, left ventricular mass index and blood pressure level (normotensive, hypertensive): we observe a left ventricular hypertrophy in normotensive males (18 p. 100) and hypertensive ones (39.8 p. 100), in normotensive females (15 p. 100) and hypertensive ones (33.3 p. 100). Overall in 420 patients: excellent correlation (p less than 0.001) between average daily blood pressure, casual blood pressure and the four echocardiographic parameters except for left ventricular cavity volume. But correlation is better (z test of Fisher) with average daily blood pressure than with casual blood pressure. No difference exists between results obtained in women (194) and men (226). Concerning variability, four observations: there exists a correlation between standard deviation, left ventricular mass index, interventricular septum, left ventricular posterior wall (only for standard deviation of MBP). No correlation with coefficient correlation except for the MBP with septum in women. The correlation for the standard deviation are weaker than with average daily blood pressure. They are better with the septum than with other echocardiographic parameters.(ABSTRACT TRUNCATED AT 250 WORDS)

[Arterial pressure--self measurement. Recommendations. French Society for Arterial Hypertension--the Measurement Group]. / Pression artérielle--automesure. Recommandations. Société française d'hypertension artérielle--Groupe de la mesure.

Self-measurement of blood pressure has become widespread in recent years. It may be defined as the measurement of arterial pressure by a conscious and free-willed subject. Self-measurement must remain a medical procedure, which means that doctors should be able to advise their patients (a) on the type of apparatus they should purchase and get validated at regular intervals; (b) on the method of using the apparatus in practice, and (c) on the circumstances, conditions and numbers of measurements to be performed. Doctors must remain responsible for the interpretation of the results obtained and for the diagnostic, pronostic an therapeutic applications of the method. Self-measurement of blood pressure naturally has advantages and disadvantages, but it must be noted that it may offer an alternative to hospitalization or to ambulatory arterial pressure measurement, avoid excessive or defective therapies and improve the patient's compliance with his treatment.

[Blood pressure variation]. / Etude de la variabilité tensionnelle.

A blood pressure profile at rest was recorded in 2,000 patients (1,069 females, 931 males) by DINAMAP 845 (from 8 AM to 8 PM. a record every fifteen minute). The limit between normotensive and hypertensive patients in this settled by WHO (BP = 160/95 mmHg). The analysis of percentage of pathological values (BP greater than 160/95 mmHg) allowed us to identify eight type of recordings. Normal (295), Border line hypertension less than or equal 20 p. 100 of pathological values (573), Paroxysmal hypertension (58), hypertension with predominance (963) of whom 484 with systolic predominance and 479 with diastolic predominance, Isolated systolic hypertension (15), Isolated diastolic hypertension (47), hypertension without predominance (15) and Permanent hypertension (82). The variability of blood pressure was studied by using the coefficient of variation = p. 100 of standard deviation/mean.(ABSTRACT TRUNCATED AT 250 WORDS)

[Analysis of 1,400 blood pressure profiles]. / Analyse de 1,400 profils tensionnels.

Hypertension may be defined by 3 criteria obtained by indirect, non invasive, automatic measurement of blood pressure using the DINAMAP device analyses the profile obtained over a 12 hour period (one recording every fifteen minutes): percentage of abnormal values (BP greater than 160/95 mm Hg), average values of systolic, diastolic and mean BP, variability (standard deviation of means), The analysis was based on 1,400 profiles recorded from 174 normotensive and 1,226 hypertensive patients. The following observations were made: the largest group was that of patients with predominantly diastolic hypertension under 60 years of age (81.3 p. 100 vs. 18.9 p. 100 systolic hypertension) and predominantly systolic hypertension over 60 years of age (68.9 p. 100 vs. 31.1 p. 100 diastolic hypertension), borderline hypertension (between 1 and 20 p. 100 of pathological values) is observed in 34.5 p. 100 of hypertensive patients under 60 years of age, and 21.8 p. 100 of patients over 60 years of age. This form of hypertension may be managed without drug therapy but requires a control blood pressure profile at least once a year, the other groups of patients were much smaller: pure diastolic hypertension (4.8 p. 100 in the under 60's, 0.6 p. 100 in the over 60's); pure systolic hypertension (1/1,226 cases of hypertension), permanent hypertension (5.7 p. 100 in the under 60's and 4.4 p. 100 in the over 60's), paroxysmal hypertension (2.1 p. 100 in the under 60's and 5.6 p. 100 in the over 60's).(ABSTRACT TRUNCATED AT 250 WORDS)

[Study of the placebo effect by the pressure profile method]. / Etude de l'effet placebo par la méthode des profils tensionnels.

The effect of one tablet of placebo daily for 8 days on blood pressure was studied in 90 hypertensive patients, using the blood pressure profile method, with a 12-hour recording period (from 8 a.m. to 8 p.m) and readings every 15 minutes (Dinamam 845). Statistical analysis of the results showed no significant difference in diastolic, systolic and mean blood pressure in 50% of the cases. A significant decrease of about 10% in blood pressure without change in variability was observed in more than 20% (complete placebo effect) and in about 30% (total placebo effect) of the cases. A significant increase of about 8% on blood pressure was recorded in less than 20% of the cases. Almost 25% of the patients had a significant decrease in heart rate. There was no correlation between heart rate and blood pressure under placebo. These criteria, which are both qualitative and quantitative, can be taken as reference when the blood pressure profile method is used to evaluate the effectiveness of antihypertensive drugs.

[Delayed filling of the anterior interventricular artery. Apropos of 9 cases]. / Retard de remplissage de l'artère interventriculaire antérieure. A propos de 9 cas.

Selective coronary angiography has shown that typical angina pectoris may occur in the absence of atheromatous coronary stenosis. Other causes of these attacks of pain have been found: coronary spasm, small vessel disease, abnormal dissociation of haemoglobin or metabolic disturbances of the myocardial cell. Of all the patients undergoing coronary angiography in 1984 at the Centre Cantini, 9 had no classical coronary lesions but delayed filling of the left anterior descending artery. This syndrome was described for the first time in 1972 by Tambe as the "slow flow velocity syndrome". The aim of this study was to analyse the clinical, ECG and haemodynamic profiles of those patients. Five of them also underwent stress Thallium myocardial scintigraphy. An ergometrine provocation test was performed afterwards under ECG control. Delayed filling was appreciated by comparison with the other vessels and also by measuring the filling time which was two or three times longer than in a control series of 9 patients with angina and normal coronary arteries. The difference was statistically significant. These findings were only observed in strictly normal coronary vessels; they were reproducible and unaffected by the administration of nitrate derivatives. In our series all 9 patients were men with an average age of 51.4 years. One patient was asymptomatic and had a history suggestive of myocardial infarction, and 4 others had typical angina of effort: all had abnormal exercise stress tests. The other 3 patients had spontaneous atypical chest pain, normal resting ECG and a negative exercise stress test (impossible in one case). The five stress Thallium scintigraphies showed myocardial perfusion defects.(ABSTRACT TRUNCATED AT 250 WORDS)

[Large right intracardiac thrombus cause of recurrent pulmonary embolism. Apropos of a case of favourable course]. / Thrombus intracardiaque droit volumineux cause d'embolies pulmonaires répétitives. A propos d'un cas d'évolution favorable.

Echocardiography may be used in patients presenting with pulmonary embolism to visualise the right heart. The authors report the case of a patient who had recurrent pulmonary embolism. Echocardiography demonstrated a large, mobile thrombus moving freely through the tricuspid valve. There were many cardiac and general contraindications to surgery and fibrinolytic therapy in this particular case. Nevertheless, the mass had totally disappeared on control echocardiography after anticoagulant therapy with heparin. There were no further embolic symptoms. The only change was observed on pulmonary scintigraphy. The patient was discharged a few weeks later on oral anticoagulant therapy. In comparison with previously published results, the outcome of this case was surprisingly good; surgery, which was impossible in our case, would seem to be the treatment of choice.

Effect of a new calcium antagonist, tiapamil, in hypertension of the elderly.

The antihypertensive effect of a single oral dose of tiapamil (450 mg) and placebo were compared in a single blind randomized cross-over study in 10 71-86 year old hypertensive patients. Blood pressure (BP) and heart rate (HR) were recorded every 15 min for 12 h by an automatic device. Tiapamil led to a decrease in mean daytime systolic (SBP) and diastolic (DBP) BP from 171 +/- 12/98 +/- 10 mm Hg to 159 +/- 11/90 +/- 9 mm Hg (P less than 0.001) without significant variation in HR. Thereafter patients received tiapamil 450 twice daily; by the seventh day of treatment mean daytime SBP and DBP were 155 +/- 13/85 +/- 14 mm Hg (P less than 0.001 vs placebo). The hourly mean values of SBP recorded for 8/12 h (first tiapamil day) and 10/12 h (seventh tiapamil day) were significantly lower than the corresponding values after placebo. We conclude that tiapamil in the elderly exerts a sustained antihypertensive effect lasting 12 h or more, with only minor variations in HR. This effect predominates on systolic pressure and is significant from the first dose.

[Arterial hypertension induced by a nasal decongestant. Value of the use of an automatic and programmable recording technic]. / Hypertension artérielle créée par un décongestionnant nasal. Intérêt de l'utilisation d'un mode d'enregistrement automatique et programmable.

The case of a twenty-three-year-old woman with spasmodic coryza in whom the overuse of a nasal decongestant resulted in arterial hypertension is reported. The relationship between the treatment and the occurrence of hypertension is firmly established. The original feature of this case is the use of the technique for monitoring the blood pressure and heart rate, before and after the treatment had been discontinued, which ascertained the hypertension, making it appear as an experimental model.

[Abnormalities of insulin secretion in coronary patients. Apropos of 67 cases]. / Anomalies de la sécrétion d'insuline chez les coronariens. A propos de 67 observations.

The curve of blood insulin levels recorded during the oral provoked hypoglycaemia test (OPHG) was studied in 67 proven coronary patients. None of the curves obtained was normal. The abnormalities found in this way are of two types: either a hypoinsulinaemic response, with a high non-retarded peak (type 1) or a high retarded peak (type 2), or else a hypoinsulinaemic response, with a flat curve (type 3) or a very small late peak (type 4). The possible role of these abnormalities of insulin secretion in the pathogenesis of atheroma is discussed. The correlations between age, sex, obesity, hypertriglyceridaemia, and the OPHG curve are investigated. The preliminary results of a test in which insulin levels are monitored after intravenous provoked hypoglycaemia, followed by tolbutamide, are reported.

Effect of atenolol, a new cardioselective beta-blocker, on plasma renin activity in treatment of hypertension.

Atenolol, a cardioselective beta-blocking drug, was prescribed in doses of 100 mg b.i.d. in 23 patients with essential hypertension. At the end of the first month of treatment with Atenolol we found a significant fall in blood pressure, heart rate and plasma renin activity (P.R.A.). Besides, there existed a relationship between changes in diastolic blood pressure, in mean arterial pressure and initial plasma renin activity, and a relationship between changes in blood pressure and changes in P.R.A. It results from this finding that pretreatment P.R.A. is of predictive value of short-term efficacy of the beta-blocker. This correlation was borderline in 21 patients after a mean of 7 month treatment and could no be found for 12 cases after a mean of 10 month-treatment while the fall in P.R.A. was still significant. It therefore appears that--with reserve of the representativeness of the sample--quantitative relations between the antihypertensive effect of Atenonol and P.R.A. are no longer significant on long-term treatment.