[The drug of the month: a new antihypertensive association: Preterax, low doses of ACE inhibitor and thiazide in the same pill].

Preterax is the first fixed very- low - dose combination of an angiotensin--converting enzyme inhibitor and a diuretic for first line treatment of hypertension. Its antihypertensive efficacy is remarkable due to the presence of 2 drugs with additional effects. The tolerance is also excellent, with adverse effects similar to placebo.

[Guidelines for the management of arterial hypertension in general practice].

Guidelines for the management of arterial hypertension are regularly updated. This article summarizes the last international guidelines in this field published last year. The decision to initiate an antihypertensive treatment will not only depend on blood pressure levels, but also on global cardiovascular risk assessment.

Effect of haemodialysis on acoustic shear wave propagation in the skin.

Background: Diverse skin alterations may develop in patients under chronic haemodialysis. Among them, signs of premature photo-ageing have been described.

Aim: To assess alterations in the physical properties of skin consistent with ageing effects and with cutaneous fluid exchanges during haemodialysis sessions.

Sustained antihypertensive activity of telmisartan compared with valsartan.

Background: Early morning blood pressure (BP) surge and 24 h mean BP are linked to target-organ damage and cardiovascular events. Antihypertensive agents should sustain BP control, particularly in the last 6 h of the dosing interval or if dosing is missed. The efficacies of the long half-life telmisartan compared with shorter half-life valsartan in the last 6 h of the dosing interval following active treatment and during 24 h after a missed dose were compared.

Impact of erythropoietic activity on red cell parameters in chronic renal failure patients.

We measured red cell parameters during recombinant human erythropoietin (rHuEPO) therapy associated with appropriate iron supplementation in chronic hemodialysis patients. Increased erythropoietic activity led to a bias in red cell parameter determination. The percentage of hypochromic red blood cells, usually used as the most effective predictor of response to iron supplementation, increased following the appearance of a younger red cell population since the same Hb content in these younger, larger cells gives a lower Hb concentration.

[Cystatin C in the evaluation of renal function].

Glomerular filtration rate (GFR) is the best indicator of renal function. GFR is usually estimated by serum creatinine or the creatinine clearance calculated on urine collected over 24 hours or with the Cockcroft formula. These methods are however limited.

[New American and European 2003 guidelines for the management of arterial hypertension].

New American and European guidelines have been released in 2003, the purpose of which is to improve the management of arterial hypertension. The decision to treat high blood pressure now mainly relies on the individual cardiovascular risk rather than on the sole blood pressure level. Thus, antihypertensive drugs could be proposed even to normotensive individuals, provided they have a high cardiovascular risk (> 20% at 10 years).

[Clinical case of the month. Rapid atrial fibrillation causing ventricular tachycardia and syncope].

We report a rare case of rapid atrial fibrillation triggering an episode of ventricular tachycardia. We review the literature and discuss the potential mechanisms of the ventricular arrhythmia.

[Management of serum magnesium abnormalities].

Because symptoms associated with hypomagnesia are highly aspecific, this ionic abnormality is rarely searched for although it could be present in as much as 20% of the population. The mode of correction (oral or intravenous) depends on the etiology, severity and clinical consequences of hypomagnesemia. Significant hypermagnesemia only occurs in the presence of renal insufficiency and/or acute excess administration, mainly by the intravenous route.

[Prevention of chronic renal failure in the adult].

Chronic renal failure is an unrecognised disease, with an insidious and rather silent development, for which the general practitioners are too often passive. This review would like to insist on the detection of people at risk or with early abnormalities, on the optimal guidelines to slowdown the evolution to more severe and irreversible stages, on the prevention of uremic and cardiovascular complications and on the preparation to end stage renal treatments.

[Can arterial hypertension be prevented?].

Prevalence of arterial hypertension is growing, in particular due to population ageing. Hypertension is a major risk factor for cardiovascular morbidity and mortality. Prevention is conceivable on a theoretical basis by reduction or, if possible, prevention of excess weight, diet modifications, increased physical activity among other means.

[Abnormalities in serum magnesium concentration].

Magnesium (Mg) therapy is often proposed against stress and to correct asthenia. Thus our aim has been to review the role of Mg, the mechanisms of its homeostasis before detailing the clinical presentations and etiologies of hypo- and hypermagnesemia and their exploration. Hypomagnesemia frequently occurs but is clinically rarely recognized without biological serum ionic determinations because causing atypical signs miming those of other ion deficiencies.

[Evaluation of glomerular filtration rate in clinical practice].

Glomerular filtration rate (GFR) is the most frequently used parameter to evaluate the renal function. GFR may be estimated with serum creatinine, creatinine clearance based on 24 hours urine collection or Cockcroft formula. All these methods have bias.

[Clinical study of the month. Which initial antihypertensive? Results from the ALLHAT trial].

Antihypertensive therapy is well established to reduce hypertension-related morbidity and mortality, but the optimal first-step therapy is still controversial. The "Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial" (ALLHAT) should give such an answer. It is a randomised, double-blind, trial designed to determine whether treatment with either a calcium channel blocker or an angiotensin-converting enzyme inhibitor lowers the incidence of coronary heart disease (CHD) or other cardiovascular disease (CVD) events vs treatment with a diuretic.

Belgian peer review experience on the Achille's Heel in haemodialysis care: vascular access.

Aims: In order to improve the supervision and to evaluate the quality of care in dialysis units, a national project was promoted as a Peer Review. It consisted of systematic, continuous and critical evaluation of the care and the application of international guidelines and compared the reality of care with standards.

Method: The first chart consisted of the evaluation of infectious episodes of vascular access.

[Cardiac decompensation, renal function and non-steroidal anti-inflammatory agents].

Thanks to a case report of heart failure in an old people with a cardiovascular history treated by the new coxib-inhibitors, we would like to remember and insist to the risk of renal and cardiac complications which appear to be the same as those with the non specific antiinflammatory drugs. Old age, diuretic or converting enzyme inhibitor treatment, heart failure, liver insufficiency, nephrotic syndrome are risk factors for acute renal failure and cardiac failure during such treatment.

[Arterial hypertension and tachycardia: monitoring the patient's personal drug therapy].

The case report of a young patient with an increase in blood pressure and heart rate offers the opportunity to discuss the clinical guidelines to explore and treat high blood pressure. The value of the 24 h blood pressure monitoring and the need for precise information on all drugs taken are stressed.

[How I investigate...a refractory hypertension].

Hypertension is a cardiovascular risk factor which needs a good evaluation before treatment. When this latter is decided, the target is to normalize high blood pressure. This requires a complete information of the patient; the latter will also receive individualized non pharmacological advices and, also, possibly different antihypertensive drugs.

[Hypertension and arteriopathy].

High blood pressure as other factors of atherosclerosis is a well-known risk factor for development of peripheral arterial disease. A patient characterized by an isolated systolic hypertension and a low ankle/arm systolic blood pressure ratio very often presents coronary heart disease. Practising exercise (such as walking), stoping smoking and following an adapted diet are recommended.

[Renal artery stenosis: acute congestive heart failure as a possible cause].

Among the different causes of pulmonary edema, there are all the clinical situations with hydrosaline overload. A significant (> 70%) bilateral renal artery stenosis or a unilateral stenosis in the presence of a solitary kidney is one possibility. Recurrent acute pulmonary edema not fully explained on a cardiac basis is rather typical for such a disease in a cardiac patient with moderate renal failure aggravated when angiotensin converting enzyme inhibitors are used.

Diagnostic criteria for renovascular hypertension.

Renovascular hypertension is a clinical situation characterized by high blood pressure in the presence of renal ischemia mainly related to atherosclerotic or fibromuscular dysplasic narrowing of the renal artery (ies). This diagnosis is often "a posteriori" validated, because the discovery of a significant renal artery stenosis is not obligatory responsible of the blood pressure elevation. This article proposes a diagnostic strategy for exploring patient with this suspected secondary cause of hypertension before proposing an invasive approach (intra-arterial angiography) possibly followed by a revascularization.

[Quality of hypertension management. Can we, must we do better?].

Hypertension is well controlled in only less than 30% of the patients treated by drugs. It is thus important to improve this situation first by checking the treatment compliance but also by trying to better educate the hypertensive population about the risk of uncontrolled hypertension and how to decrease this risk.

[Epidemiology of arterial hypertension].

The prevalence of high blood pressure increases in our industrialized society. The main risk factors are hypertensive heredity, small birth weight for the gestational age, large increase of weight in teenagers, low physical activity, excess in salt and/or alcohol consumption. The normotensive people with high normal blood pressure are the future hypertensive population.

[Do calcium antagonists have a first-line role in the treatment of arterial hypertension?].

During the nineties, a controversy was noted in the literature about the potential risk of using calcium antagonists in the treatment of hypertension. Several recent studies, such as the INSIGHT's one have not confirmed this provided that one uses long-acting molecule. But the real beneficial effect due to the different antihypertensive classes is mainly linked to the magnitude of the blood pressure lowering effect.