In Switzerland, as in other Occidental countries, the prevalence of arterial hypertension (AHT) i... more In Switzerland, as in other Occidental countries, the prevalence of arterial hypertension (AHT) in the adult population is around 30-40%. Among the causes of secondary AHT, drug induced hypertension is sometimes omitted. Many molecules can induce AHT or worsen it due to an interaction with anti hypertensive drugs. Among these, NSAIDs and anti depressants, widely prescribed, should be used with caution, particularly in patients at risk, namely: those with preexisting AHT, the elderly, or patients suffering from kidney disease, diabetes, and/or heart failure. Increases in blood pressure have also been described with anti-vascular endothelial growth factor (VEGF) drugs, used in the treatment of (metastatic) cancer. A thorough anamnesis of drugs, including over the counter ones, should be performed in every hypertensive patient, and can avoid cumbersome and unnecessary investigations and therapy
The crucial role of the sympathetic nervous system activity in the initiation and maintenance of ... more The crucial role of the sympathetic nervous system activity in the initiation and maintenance of hypertension was already in mind in the 1920s when surgical options were proposed to severely hypertensive patients. Despite constant evolution of pharmacological treatments, one estimates that 15-30% of hypertensive patients are still not well controlled and present resistant hypertension. The development of a new endovascular catheter used for selective sympathetic renal denervation by radiofrequency offers new perspectives of treatment. Encouraged by the recent results of the first clinical trials in a targeted population, this procedure could be used in some more indications in the future. However, long term morbidity and mortality of this technique are still not known
Objective: Caffeine has been associated with many chronic disease such as high blood pressure. Ca... more Objective: Caffeine has been associated with many chronic disease such as high blood pressure. Caffeine intake is generaly estimated by the use of self-reported consumption of caffeine, but it is not clear how well self-reported consumption of caffeine correlates with validated method to measure caffeine intake (e.g., urinary excretion). We investigated the associations of self-reported consumption of caffeinated drinks with urinary excretion of caffeine and its major metabolite (paraxanthine). Design and method: We used data from 267 men and 280 women to the population-based Swiss Kidney Project on Genes in Hypertension (SKIPOGH) study. Caffeinated drink consumption was assessed by food frequency questionnaire, where intake frequency was self-reported through 5 categories: “Never”, “1–4 beverages/month”, “1–4 beverages/week”, “> = 5 beverages/week”, “1>= beverage/day”. Physiological data was collected through medical visit and 24-h urine collection (caffeine and paraxanthine ...
Glaucoma is the second cause of blindness in industrialized countries. One of the principal risk ... more Glaucoma is the second cause of blindness in industrialized countries. One of the principal risk factors for open angle glaucoma, the most prevalent form of the disease, is an increase in intraocular pressure (IOP). An excessive drop in nocturnal blood pressure (so called dipping) can be harmful by increasing ischemic damage to the optic nerve. In case of progression of glaucoma despite well controlled IOP, 24h BP monitoring is recommended. The relationship between IOP and systemic blood pressure has been the subject of several studies that are reviewed in this article. The influence of antihypertensive drugs on IOP is also discussed.
Objective: Arterial calcifications are associated with cardiovascular and all-cause mortality in ... more Objective: Arterial calcifications are associated with cardiovascular and all-cause mortality in patients with kidney disease and/or hypertension. A novel in vitro blood test has recently been developed to measure the calcification propensity of serum. It has been shown that a shorter maturation time of calciprotein particles (T50) is associated with greater vascular stiffness and lower all-cause survival in chronic kidney disease (CKD), but its associations with markers of renal vascular resistance and oxygenation have not been described. Design and method: In the LauBOLD (Lausanne Blood oxygenation level-dependent MRI) study, patients with CKD or arterial hypertension (AHT) underwent BOLD-MRI and renal Doppler ultrasound and were compared with healthy controls. The mean R2* values in the medulla and cortex were calculated, a high R2* value corresponds to a low oxygenation. Serum calcification propensity (T50) was determined in blood taken from the study participants. Aortic pulse ...
Background Disturbances in renal microcirculation play an important role in the pathophysiology o... more Background Disturbances in renal microcirculation play an important role in the pathophysiology of chronic kidney disease (CKD), but the lack of easy accessible techniques hampers our understanding of the regulation of the renal microcirculation in humans. We assessed whether contrast-enhanced ultrasound (CEUS) can identify differences in cortical perfusion and alterations induced by different dietary salt intakes in CKD patients and controls. Methods Participants underwent CEUS twice: once after 5 days of high-salt (HS) intake, and again after 5 days of low salt (LS) diet. Sonovue® (0.015 mL/kg/min) was perfused as contrast agent and four consecutive destruction–reperfusion sequences were analysed per visit. The primary outcome measure was the (change in) mean perfusion index (PI) of the renal cortex. Results Forty healthy volunteers (mean age ± standard deviation 50 ± 8 years) and 18 CKD Stages 2–4 patients [aged 55 ± 11 years, estimated glomerular filtration rate (eGFR) 54 ± 28 m...
La prevalence de l'hypertension arterielle est importante en transplantation. Depuis l'in... more La prevalence de l'hypertension arterielle est importante en transplantation. Depuis l'introduction des inhibiteurs de la calcineurine comme immunosuppresseurs, la survie du patient et du greffon, par diminution du rejet aigu, s'est considerablement amelioree. Ainsi les complications cardiovasculaires sont devenues une des causes importantes de morbi-mortalite et de perte de greffon. La prise en charge des facteurs de risque cardiovasculaire comme le diabete, les dyslipidemies et l'hypertension arterielle semble evidente; cependant aucune recommandation fondee n'existe ni en termes de valeurs cibles de tension a atteindre, ni de la meilleure maniere d'y parvenir. Le propos de cet article est d'aborder l'epidemiologie de l'hypertension en transplantation, de discuter des mecanismes y aboutissant et les strategies therapeutiques permettant sa prise en charge.
The crucial role of the sympathetic nervous system activity in the initiation and maintenance of ... more The crucial role of the sympathetic nervous system activity in the initiation and maintenance of hypertension was already in mind in the 1920s when surgical options were proposed to severely hypertensive patients. Despite constant evolution of pharmacological treatments, one estimates that 15-30% of hypertensive patients are still not well controlled and present resistant hypertension. The development of a new endovascular catheter used for selective sympathetic renal denervation by radiofrequency offers new perspectives of treatment. Encouraged by the recent results of the first clinical trials in a targeted population, this procedure could be used in some more indications in the future. However, long term morbidity and mortality of this technique are still not known.
Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 2018
Functional renal magnetic resonance imaging (MRI) has seen a number of recent advances, and techn... more Functional renal magnetic resonance imaging (MRI) has seen a number of recent advances, and techniques are now available that can generate quantitative imaging biomarkers with the potential to improve the management of kidney disease. Such biomarkers are sensitive to changes in renal blood flow, tissue perfusion, oxygenation and microstructure (including inflammation and fibrosis), processes that are important in a range of renal diseases including chronic kidney disease. However, several challenges remain to move these techniques towards clinical adoption, from technical validation through biological and clinical validation, to demonstration of cost-effectiveness and regulatory qualification. To address these challenges, the European Cooperation in Science and Technology Action PARENCHIMA was initiated in early 2017. PARENCHIMA is a multidisciplinary pan-European network with an overarching aim of eliminating the main barriers to the broader evaluation, commercial exploitation and ...
Hypertension is highly prevalent in transplantation and affects all type of organs. With the intr... more Hypertension is highly prevalent in transplantation and affects all type of organs. With the introduction of calcineurin inhibitors as immunosuppressive drugs, acute allograft rejection episodes have been significantly reduced and hence patient and allograft survival rates have dramatically improved. However, cardiovascular complications have become an important cause of morbidity and mortality. Treating cardiovascular risk factors such as diabetes, dyslipidemia and hypertension seems obvious, however in this population, there is little evidence for specific blood pressure targets, or for the best strategy to achieve blood pressure control. The aim of this article is to review the epidemiology and physiopathology of hypertension in transplant recipients as well as its clinical management.
In Switzerland, as in other Occidental countries, the prevalence of arterial hypertension (AHT) i... more In Switzerland, as in other Occidental countries, the prevalence of arterial hypertension (AHT) in the adult population is around 30-40%. Among the causes of secondary AHT, drug induced hypertension is sometimes omitted. Many molecules can induce AHT or worsen it due to an interaction with anti hypertensive drugs. Among these, NSAIDs and anti depressants, widely prescribed, should be used with caution, particularly in patients at risk, namely: those with preexisting AHT, the elderly, or patients suffering from kidney disease, diabetes, and/or heart failure. Increases in blood pressure have also been described with anti-vascular endothelial growth factor (VEGF) drugs, used in the treatment of (metastatic) cancer. A thorough anamnesis of drugs, including over the counter ones, should be performed in every hypertensive patient, and can avoid cumbersome and unnecessary investigations and therapy
The crucial role of the sympathetic nervous system activity in the initiation and maintenance of ... more The crucial role of the sympathetic nervous system activity in the initiation and maintenance of hypertension was already in mind in the 1920s when surgical options were proposed to severely hypertensive patients. Despite constant evolution of pharmacological treatments, one estimates that 15-30% of hypertensive patients are still not well controlled and present resistant hypertension. The development of a new endovascular catheter used for selective sympathetic renal denervation by radiofrequency offers new perspectives of treatment. Encouraged by the recent results of the first clinical trials in a targeted population, this procedure could be used in some more indications in the future. However, long term morbidity and mortality of this technique are still not known
Objective: Caffeine has been associated with many chronic disease such as high blood pressure. Ca... more Objective: Caffeine has been associated with many chronic disease such as high blood pressure. Caffeine intake is generaly estimated by the use of self-reported consumption of caffeine, but it is not clear how well self-reported consumption of caffeine correlates with validated method to measure caffeine intake (e.g., urinary excretion). We investigated the associations of self-reported consumption of caffeinated drinks with urinary excretion of caffeine and its major metabolite (paraxanthine). Design and method: We used data from 267 men and 280 women to the population-based Swiss Kidney Project on Genes in Hypertension (SKIPOGH) study. Caffeinated drink consumption was assessed by food frequency questionnaire, where intake frequency was self-reported through 5 categories: “Never”, “1–4 beverages/month”, “1–4 beverages/week”, “> = 5 beverages/week”, “1>= beverage/day”. Physiological data was collected through medical visit and 24-h urine collection (caffeine and paraxanthine ...
Glaucoma is the second cause of blindness in industrialized countries. One of the principal risk ... more Glaucoma is the second cause of blindness in industrialized countries. One of the principal risk factors for open angle glaucoma, the most prevalent form of the disease, is an increase in intraocular pressure (IOP). An excessive drop in nocturnal blood pressure (so called dipping) can be harmful by increasing ischemic damage to the optic nerve. In case of progression of glaucoma despite well controlled IOP, 24h BP monitoring is recommended. The relationship between IOP and systemic blood pressure has been the subject of several studies that are reviewed in this article. The influence of antihypertensive drugs on IOP is also discussed.
Objective: Arterial calcifications are associated with cardiovascular and all-cause mortality in ... more Objective: Arterial calcifications are associated with cardiovascular and all-cause mortality in patients with kidney disease and/or hypertension. A novel in vitro blood test has recently been developed to measure the calcification propensity of serum. It has been shown that a shorter maturation time of calciprotein particles (T50) is associated with greater vascular stiffness and lower all-cause survival in chronic kidney disease (CKD), but its associations with markers of renal vascular resistance and oxygenation have not been described. Design and method: In the LauBOLD (Lausanne Blood oxygenation level-dependent MRI) study, patients with CKD or arterial hypertension (AHT) underwent BOLD-MRI and renal Doppler ultrasound and were compared with healthy controls. The mean R2* values in the medulla and cortex were calculated, a high R2* value corresponds to a low oxygenation. Serum calcification propensity (T50) was determined in blood taken from the study participants. Aortic pulse ...
Background Disturbances in renal microcirculation play an important role in the pathophysiology o... more Background Disturbances in renal microcirculation play an important role in the pathophysiology of chronic kidney disease (CKD), but the lack of easy accessible techniques hampers our understanding of the regulation of the renal microcirculation in humans. We assessed whether contrast-enhanced ultrasound (CEUS) can identify differences in cortical perfusion and alterations induced by different dietary salt intakes in CKD patients and controls. Methods Participants underwent CEUS twice: once after 5 days of high-salt (HS) intake, and again after 5 days of low salt (LS) diet. Sonovue® (0.015 mL/kg/min) was perfused as contrast agent and four consecutive destruction–reperfusion sequences were analysed per visit. The primary outcome measure was the (change in) mean perfusion index (PI) of the renal cortex. Results Forty healthy volunteers (mean age ± standard deviation 50 ± 8 years) and 18 CKD Stages 2–4 patients [aged 55 ± 11 years, estimated glomerular filtration rate (eGFR) 54 ± 28 m...
La prevalence de l'hypertension arterielle est importante en transplantation. Depuis l'in... more La prevalence de l'hypertension arterielle est importante en transplantation. Depuis l'introduction des inhibiteurs de la calcineurine comme immunosuppresseurs, la survie du patient et du greffon, par diminution du rejet aigu, s'est considerablement amelioree. Ainsi les complications cardiovasculaires sont devenues une des causes importantes de morbi-mortalite et de perte de greffon. La prise en charge des facteurs de risque cardiovasculaire comme le diabete, les dyslipidemies et l'hypertension arterielle semble evidente; cependant aucune recommandation fondee n'existe ni en termes de valeurs cibles de tension a atteindre, ni de la meilleure maniere d'y parvenir. Le propos de cet article est d'aborder l'epidemiologie de l'hypertension en transplantation, de discuter des mecanismes y aboutissant et les strategies therapeutiques permettant sa prise en charge.
The crucial role of the sympathetic nervous system activity in the initiation and maintenance of ... more The crucial role of the sympathetic nervous system activity in the initiation and maintenance of hypertension was already in mind in the 1920s when surgical options were proposed to severely hypertensive patients. Despite constant evolution of pharmacological treatments, one estimates that 15-30% of hypertensive patients are still not well controlled and present resistant hypertension. The development of a new endovascular catheter used for selective sympathetic renal denervation by radiofrequency offers new perspectives of treatment. Encouraged by the recent results of the first clinical trials in a targeted population, this procedure could be used in some more indications in the future. However, long term morbidity and mortality of this technique are still not known.
Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 2018
Functional renal magnetic resonance imaging (MRI) has seen a number of recent advances, and techn... more Functional renal magnetic resonance imaging (MRI) has seen a number of recent advances, and techniques are now available that can generate quantitative imaging biomarkers with the potential to improve the management of kidney disease. Such biomarkers are sensitive to changes in renal blood flow, tissue perfusion, oxygenation and microstructure (including inflammation and fibrosis), processes that are important in a range of renal diseases including chronic kidney disease. However, several challenges remain to move these techniques towards clinical adoption, from technical validation through biological and clinical validation, to demonstration of cost-effectiveness and regulatory qualification. To address these challenges, the European Cooperation in Science and Technology Action PARENCHIMA was initiated in early 2017. PARENCHIMA is a multidisciplinary pan-European network with an overarching aim of eliminating the main barriers to the broader evaluation, commercial exploitation and ...
Hypertension is highly prevalent in transplantation and affects all type of organs. With the intr... more Hypertension is highly prevalent in transplantation and affects all type of organs. With the introduction of calcineurin inhibitors as immunosuppressive drugs, acute allograft rejection episodes have been significantly reduced and hence patient and allograft survival rates have dramatically improved. However, cardiovascular complications have become an important cause of morbidity and mortality. Treating cardiovascular risk factors such as diabetes, dyslipidemia and hypertension seems obvious, however in this population, there is little evidence for specific blood pressure targets, or for the best strategy to achieve blood pressure control. The aim of this article is to review the epidemiology and physiopathology of hypertension in transplant recipients as well as its clinical management.
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