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The preparation for phaeochromocytoma surgery is a matter of debate. Pre-operative blockade of α-1 receptors is increasingly employed in an attempt to reduce the risk of hypertensive episodes, especially during manipulation of the tumour. In this study, we compared the interest of an almost complete blockade of these receptors by high doses of urapidil in comparison with that of moderate doses of this drug. The study was conducted in two consecutive series of 18 patients, the first treated by a moderate dose, and the second by the highest dose tolerated by the patient. The two groups were comparable in other respects. All patients were operated under laparoscopy by the same surgeon and managed by the same anaesthetist using the same protocol. The number of hypertensive peaks was significantly reduced using the high dose of urapidil, with no more hypotensive episodes after tumour removal in this group. The area under the curve of norepinephrine levels as a function of time was significantly larger with the high doses of urapidil, arguing in favour of a more complete blockade of α-1 receptors. Our findings indicate the value of aggressive blockade of α-1 receptors in preparation for surgery of phaeochromocytoma.Journal of Human Hypertension (2009) 23, 605–609; doi:10.1038/jhh.2008.172; published online 19 February 2009 [ABSTRACT FROM AUTHOR]

The author analyzes the future of Eplerenone, an antihypertension drug, in Europe. Presently, the medical profession is looking forward to this new inhibitor of aldosterone receptor owing to its significantlyless adverse effects. Though, the drug is available in Europe, the cost factor of the drug and the lack of any proven efficacy in comparison to that of spironolactone will determine the future of the drug.

Patients with systemic sclerosis commonly exhibit increased arterial stiffness, which may be predictive of the overall severity of the disease. The aim of the present study was to check the stability of parameters of arterial stiffness after 1 year in this population. ERAMS is a French multicentric prospective study designed to identify a link between arterial distensibility and outcome in 100 patients with systemic sclerosis. Arterial distensibility was evaluated by 24-h ambulatory monitoring of QKD interval along with blood pressure (BP) and heart rate (HR) (four measurements/hour). The index QKD[sub 100-60], which is linked to aortic distensibility, was calculated automatically. QKD[sub 100-60] is the value of QKD (which depends on pulse wave velocity) for 100 mm Hg sBP and 60bpm HR. The reproducibility of QKD[sub 100-60] was assessed on the first patients to be followed up for a complete year. So far the 100 patients have been recruited from 14 participating centres and 48 were re-evaluated after 1 year. QKD[sub 100-60] was highly reproducible: 201 ± 6 vs 202 ± 18 msec, standard deviation of difference = 13 msec. In conclusion: determination of QKD[sub 100-60] to assess arterial stiffness gives stable results over 1 year in patients with systemic sclerosis. [ABSTRACT FROM AUTHOR]

Previous works using ambulatory blood pressure (BP) monitoring demonstrated that independently of the mean level of BP, the variability in BP, or the day-night range, could have prognostic significance. We have also found that the value of BP on rising in the morning is strongly correlated with left ventricular mass of hypertensive individuals independently of the 24-h value. In the present study, we sought its predictive value for cardiovascular complications in a cohort of hypertensive patients. The population studied belongs to a cohort of initially untreated hypertensive patients recruited since 1983 and followed for more than 5 years. Patients were then treated and followed by their family doctor. At entry, all patients were equipped with a device to measure ambulatory BP. They were requested to trigger a measurement manually on rising in the morning (arising BP). The data on their outcome were collected by a physician unaware of the initial state of the patients. A total of 256 patients have been followed up for 5 years or more, 19 were lost to follow-up. The mean follow-up period was 84 ± 29 months. Cardiovascular complications were recorded in 23 individuals. The arising systolic BP (SBP) was significantly higher in the group who presented a complication. In a stepwise discriminant analysis including age, office, fitting, arising and 24-h average SBPs only age and arising SBP entered the equation. In conclusion, the single BP value measured by an ambulatory device on rising in the morning seems more discriminant of future cardiovascular events than the value of BP measured on fitting the device or the average of three measurements taken under standardised conditions in the hospital or office. [ABSTRACT FROM AUTHOR]

Objectives: It has been suggested that hypertensives at high risk of cardiovascular complications can be identified on the basis of their left ventricular mass as determined echographically. However, there is as yet a lack of consensus on the mode of indexation (body surface area, height, height[SUP2.7]) of left ventricular mass (LVM), and on the cut-off values for definition of left ventricular hypertrophy (LVH). The main objective of this study is to test the influence of the different modes of indexation for LVM on the prevalence of LVH in a population of never treated hypertensive patients on the basis of cut-offs for LVM based upon its relationship with ambulatory blood pressure (BP) measurement. Methods: A population of 363 untreated hypertensives was investigated using a standardised procedure. The men and women were analysed separately. We studied the relationship between mean daytime ambulatory systolic BP and LVM and calculated the LVM cut-off for a BP of 135 mm Hg using three different methods of indexation. On the basis of these criteria, the population was divided into those with and those without LVH. Results: The prevalence of LVH was found to be higher when LVM was indexed to height[SUP2.7] (50.4%) or height (50.1%). Prevalence was lowest when LVM was indexed to body surface area (48.2%), which tended to minimise the hypertrophy in obese individuals. Only indexation by height[SUP2.7] fully compensates for relationships between height and ventricular mass in this population. Conclusions: Indexing LVM to height[SUP2.7] thus appeared to give a more sensitive estimate of LVH by eliminating the influence of growth. Cut-offs of 47 g/m[SUP2.7] in women and 53 g/m[SUP2.7] in men corresponded to a cardiovascular risk indicated by a daytime systolic BP ⩾135 mm Hg. [ABSTRACT FROM AUTHOR]

The PICXEL study is designed to evaluate the effects of long-term administration of very low-dose combination perindopril 2 mg/indapamide 0.625 mg (Per/Ind) vs enalapril in reducing left ventricular hypertrophy (LVH) in hypertensive patients. This multicentre, controlled, randomised, double-blind, parallel group study is carriedout to assess the variation of left ventricular mass index (LVMI) after treatment, using a centralised control of Mmode echocardiography determinations, and a dedicated software for semi-automatic measurement. Following a 4-week placebo run-in period, hypertensive outpatients aged ≥18 years, with LVH (LVMI >120 and 100 g/m² for men and women, respectively), are randomised to receive once daily, over 52 weeks, either Per/Ind or enalapril. According to blood pressure levels, the dose may be adjusted. In addition to clinical examinations, ECG, blood pressure, heart rate and laboratory assessments echocardiographic determinations are performed for selection, at baseline, after 24 weeks and at the end of the study. The main outcome criteria is the change from baseline in LVMi which is considered the primary efficacy criterion; changes in blood pressure and echo-Doppler parameters constitute secondary criteria. Two-sided Student's t-test for independent samples will be used to differentiate the effects of the treatment between groups with α = 5%, and the intergroup difference of LVMI variation will be analysed with a power of 90%. A sample size of 500 patients is required making it necessary to randomise at least 550 patients, based on a 10% proportion of potentially nonassessable patients. The results of this study, obtained after applying strict methodological procedures and requirements, are expected to provide valuable and reliable information on the effects of long-term administration of Per/Ind on LVH, and on its potential superiority over enalapri. [ABSTRACT FROM AUTHOR]

We report the case of a 20-year-old female patient with Beckwith-Wiedemann syndrome presenting with high blood pressure and bilateral adrenal pheochromocytoma successfully removed with laparoscopy in the same time. To our knowledge, the present case is the first observation of a bilateral pheochromocytoma occurring in the Beckwith-Wiedemann syndrome. It provides further support for a genetic anomaly in this condition. Our case also indicates the interest of laparoscopy for the surgical treatment of adrenal pheochromocytoma, even in bilateral tumors. [ABSTRACT FROM AUTHOR]