Presse Med
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Review Comparative Study
[New treatment strategies for hypertension. Which guidelines and how to apply them].
The diagnosis of hypertension by blood pressure measurements taken in the physician's office has been called into question by several studies. The onset of cardiovascular events appears to correlate better with ambulatory blood pressure measurements than with those taken during consultation (either "white coat" or masked hypertension). While the US, WHO, French and European guidelines diverge as to the specific antihypertensive drug among the seven classes available should be chosen for first-line treatment, there is a consensus for specific choices as a function of the type of hypertension. ⋯ Diastolic blood pressure remains the most important figure for those younger than 50 years, but afterwards, systolic pressure is more relevant. Aortic pressure may be more closely associated with cardiovascular risk than the blood pressure measured at the brachial artery. The concept of comprehensive management is radically modifying our behavior : the hypertensive patient is now above all a patient at high cardiovascular risk and the treatments to consider must not be limited to antihypertensive drugs but must also include treatment of other cardiovascular risk factors (aspirin, statins, smoking cessation, etc.).
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Review Comparative Study
[Cardiovascular protection and prevention in patients with cardiac conditions and diabetes].
Good glycemic control can have a positive effect on the course and prognosis of coronary disease during and after myocardial infarction. It also reduces the risk of its onset. ⋯ Optimal treatment of coronary patients should include reduction of risk factors and 4 drugs: a beta-blocker at an effectively beta-blocking dose, aspirin at a daily dose between 75 and 100 mg, a statin that leads to an LDL-cholesterol level less than 1 g/L, and an angiotensin-converting enzyme inhibitor, with a demonstrated dose-effect relation. Efficacy is best when compliance is considered an essential objective.
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Earlier guidelines for type 2 diabetes (Afssaps 1999 and Anaes 2000) were based on the UK Prospective Diabetes Study, published in 1998. These guidelines recommended treatment according to HbA1c value (< 6.5%, between 6.5 and 8% and > 8%): an oral antidiabetic agent for levels > 6.5% despite diet and exercise; combined metformin + sulfonylurea) if HbA1c >8%; and insulin if the latter failed. Blood pressure goals were < 130/80 mmHg, with the antihypertensives necessary to achieve it. ⋯ All health professionals must participate in the more effective diffusion and application of these guidelines. Patient education is fundamental. The establishment of care networks for these patients seems to us to be the best tool for meeting the objectives of these guidelines.
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Review Comparative Study
[Primary cardiorenal prevention in patients with type-2 diabetes. The Roadmap study].
The incidence of type-2 diabetes is increasing throughout the world. By 2010, 350 million people will have this disease. Microalbuminuria is present in more than one third, for some at diabetes diagnosis. ⋯ The Roadmap study (Randomized Olmesartan And Diabetes Microalbuminuria Prevention Study) of primary prevention has as its objective measurement of the impact of ARBs (olmesartan 40 mg/d) treatment on renal outcome in 4400 patients with type 2 diabetes without microalbuminuria. Follow-up of this placebo-controlled study will last for 5 years. Conducted in 200 European centers, its results are expected for 2012.
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Mucosal surfaces of the respiratory tract represent a major portal of entry for most human viruses and a critical component of the mammalian immunologic repertoire. The major antibody isotype in external secretions is secretory immunoglobin A (S-IgA). The major effector cells in mucosal surfaces, however, are not IgA B cells, but T lymphocytes, which may account for up to 80% of the mucosal lymphoid cell population. ⋯ By this route they induce only a moderate local mucosal response. Neither the development of mucosal immunity nor the administration of vaccines via the mucosal route is essential for control or prevention of most respiratory viral infections and diseases acquired through the respiratory tract. Nonetheless, the example of the live attenuated intranasal influenza vaccine, which induces both systemic and local immune response, is promising for the future of mucosal immunization against respiratory viral infections.