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See detailAssociation entre les taux circulants de matrix-gla protein et rigidité artérielle en transplantation rénale.
Dinic, M; Maillard, N; DELANAYE, Pierre ULiege et al

in Néphrologie & Thérapeutique (2017), 13(5), 309

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See detailFACILITER L'ADHÉRENCE AU TRAITEMENT IMMUNOSUPPRESSEUR CHEZ LES TRANSPLANTÉS DU REIN- TEST D'UN SYSTEME DE COACHING PAR SMARTPHONE
Saint-Remy, Annie ULiege; Spiroux, Marie; WEEKERS, Laurent ULiege et al

Poster (2016, December 08)

Facilitate adherence to immunosuppressive treatment in kidney transplant recipients – test of a coaching system with smartphone application A.Saint-Remy, M. Spiroux, L. Weekers, C. Bonvoisin, JM ... [more ▼]

Facilitate adherence to immunosuppressive treatment in kidney transplant recipients – test of a coaching system with smartphone application A.Saint-Remy, M. Spiroux, L. Weekers, C. Bonvoisin, JM. Krzesinski Introduction: Nonadherence to immunosuppressants is a determining cause of graft loss. The present study tested during 1 month, the usefulness and the effectiveness of a coaching system using smartphone application (the Transplant Smartcoach®) on adherence in kidney transplant recipients. Methodology: The sample included 51 patients (28m/23w) transplanted for 1 year at least, mean age 52±12 years, mean graft survival 3.7±1 years. Each patient had a smartphone configured with its detailed treatment. Using the smartphone application, patient had to notify daily the intake of each tablet into a 2-hour window. If no notification was performed 1 hour later than the scheduled time of intake, the patient was contacted by a nurse to remind him to take medications. Results: 90 % of patients were treated with Tacrolimus and 10 % with cyclosporine, associated with mycophenolic acid (41 %) or mycophenolate mofetil (49 %), 41 % had corticosteroids. Whatever was the immunosuppressant, a perfect adherence (medications taken at the scheduled time) was observed on average in 53 % of the morning monthly intakes. There was no difference in adherence rates between the morning intakes of Advagraf ® (once/day) and Prograft® (2 times/day), a decrease of perfect adherence was identified with the evening intake of Prograft® (53 % vs 44%; P=0.07) and the one of Myfortic® (P=0.03) with consequently an increased frequency of nurse’s recalls. Adherence was lower in younger patients and in those still working. The complexity of treatment (many drugs intake/day) and the respect for time intervals between drug intakes were the major barriers to adherence. When compared to the one measured before using the Smartcoach, the variability (coefficient of variation, %) of the Tacrolimus trough level decreased by 32.6 % (P=0.027) in the 3 to 6 months following the test. Conclusion: patients appreciated the ease and usefulness of the coaching system with smartphone application to help medication adherence. Coupled with therapeutic education of the patients, that tool deserves to be used notably in newly transplanted patients and when a worrying decrease in adherence is observed to help them in the management of a rigorous adherence which should contribute to graft survival. [less ▲]

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See detailComment mesurer correctement la PA chez les patients hémodialysés?
VANDERWECKENE, Pauline ULiege; SAINT-REMY, Annie ULiege; KRZESINSKI, Jean-Marie ULiege

Poster (2016, December)

Objectifs : Le contrôle de la pression artérielle (PA) chez le patient hémodialysé (HD) est un enjeu majeur en raison des résultats controversés sur les risques cardiovasculaires qui y sont associés ... [more ▼]

Objectifs : Le contrôle de la pression artérielle (PA) chez le patient hémodialysé (HD) est un enjeu majeur en raison des résultats controversés sur les risques cardiovasculaires qui y sont associés. Cependant, la mesure de la PA dans cette population est difficile à appréhender au vu de sa grande variabilité. L’exactitude des mesures péridialytiques (enregistrées dans l’unité d’HD pendant la séance) est souvent remise en question. L’objectif de notre étude est d’établir la contribution et la concordance entre deux techniques de mesure ambulatoire pour détecter la PA non contrôlée chez ces patients HD. Il s’agit du monitoring ambulatoire interdialytique de 44h (MAPA) et de l’automesure au domicile (HBPM) pendant une durée variable de 3, 5 et 7 jours. Méthodologie : 43 patients hémodialysés chroniques (H=28, F = 15), avec une moyenne de 68,3±13 ans ont réalisé une MAPA de 44h (Spacelabs 90207), de la fin d’une séance d’HD au début de la suivante, immédiatement suivie par une automesure de 7 jours (Omron M6). Les mesures péridialytiques étaient la moyenne des PA pré-dialyse ou post-dialyse enregistrées sur 2 semaines (6 séances d’HD). L’hypertension était définie par une PA égale ou supérieure à 140/90 mmHg pour la PA pré-HD, 130/80 mmHg pour la PA post-HD, 130/80 mmHg pour la MAPA de 44 h et 135/85 mmHg pour l’HBPM. Résultats : Nous avons constaté de bonnes corrélations entre la MAPA et l’HBPM pour le diagnostic de l’hypertension chez le patient HD. Comparées aux PA péridialytiques, les 2 techniques ambulatoires ont permis d’identifier la même proportion d’hypertension masquée et d’hypertension de la blouse blanche (25%). La plus grande précision de diagnostic sur le status tensionnel est retrouvée pour les plus longues périodes d’enregistrement (44h pour la MAPA et 7 jours pour l’HBPM). Les plus courtes périodes étaient mieux tolérées par les patients mais moins précises pour détecter l’hypertension. L’automesure était plus appréciée que la MAPA de 44h. Conclusion : La MAPA et l’automesure ont permis d’identifier un quart de patients avec un phénotype particulier d’hypertension, qui n’aurait pas été classé correctement en se fiant uniquement aux mesures péridialytiques. L’automesure devrait être recommandée en première ligne chez le patient HD (au moins une semaine/mois). Cependant, la MAPA fournit des informations uniques comme la PA nocturne et pourrait être proposée, idéalement une fois par an, chez tous les patients. [less ▲]

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See detailAssociation entre taux circulants de matrix-gla protéine et rigidité artérielle en transplantation rénale.
Dinic, Miriana; Maillard, Nicolas; DELANAYE, Pierre ULiege et al

Conference (2016, December)

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See detailHow to measure accurately blood pressure in hemodialysis patients?
VANDERWECKENE, Pauline ULiege; SAINT-REMY, Annie ULiege; KRZESINSKI, Jean-Marie ULiege

Conference (2016, October 29)

Objective : Blood pressure (BP) control in chronic hemodialysis (HD) patients is a major challenge and could explain the controversial results about its cardiovascular risk. Our study aimed to assess the ... [more ▼]

Objective : Blood pressure (BP) control in chronic hemodialysis (HD) patients is a major challenge and could explain the controversial results about its cardiovascular risk. Our study aimed to assess the contribution of two ambulatory techniques of measurements compared with office BP (OBP): ambulatory monitoring during a maximum of 44h interdialytic period (ABPM) and home blood pressure (HBPM) during a variable period of days in prevalent HD patients. Methodology : 43 prevalent chronically HD patients (M=28; F=15), mean age 68.3±13 years were submitted to a 44h monitoring of BP (Spacelabs 90207) from the end of an HD session to 10 minutes before the next session, immediately followed by a 7days HBPM (Omron M6). Office BP was the mean of pre-dialysis BP or post-dialysis-BP recorded over 2 weeks (6 HD sessions). Hypertension was defined as BP equal or higher than 140/90 mmHg for pre-HD, 130/80 mmHg for post-HD, 130/80 mmHg for 44 h ABPM and 135/85 mmHg for HBPM. Results : Good correlations were noted between ABPM and HBPM for the diagnosis of hypertension in HD patients. Both ambulatory techniques give the same proportion of masked hypertension and white coat hypertension compared with OBP (25%). The best diagnostic precision was noted for the longest periods of recordings (44h for ABPM and 7days for HBPM). Shorter periods were more practical for the patients but less precise for high BP identification. HBPM was more appreciated than ABPM by the patients Conclusion : ABPM and HBPM identified a quarter of patients with a particular phenotype of hypertension not correctly classified by OBP. HBPM should be first recommended in HD (at least 1 week/month). As ABPM provides unique information for nocturnal BP, it could be proposed 1 time/year in all patients. [less ▲]

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See detailHome blood pressure in kidney transplant recipients (Ktr) - Validity of different schedules of self-monitoring
SAINT-REMY, Annie ULiege; WEEKERS, Laurent ULiege; BONVOISIN, Catherine ULiege et al

in Journal of Hypertension (2016, September), 34(e supplement 2), 119

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See detailHOME BLOOD PRESSURE IN KIDNEY TRANSPLANT RECIPIENTS (Ktr)-VALIDITY OF DIFFERENT SCHEDULES OF SELF-MONITORING
Saint-Remy, Annie ULiege; WEEKERS, Laurent ULiege; BONVOISIN, Catherine ULiege et al

Poster (2016, June 11)

Office blood pressure (OBP) coupled with 24-h ambulatory monitoring (24-h ABPM) or home self-monitoring (HBPM) allow a more accurate assessment of BP control in treated hypertensive patients and ... [more ▼]

Office blood pressure (OBP) coupled with 24-h ambulatory monitoring (24-h ABPM) or home self-monitoring (HBPM) allow a more accurate assessment of BP control in treated hypertensive patients and identification of different phenotypes of BP. ESH/ESC guidelines (2013) recommended 7 days of home measurements (3 days at least) but that duration is questioned. The present study examined if we can reduce, and to what extent, the 7-days schedule for home measurements in treated hypertensive kidney transplant recipients (ktr) while keeping a reliable assessment of their BP status? [less ▲]

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See detailHome Blood Pressure in Kidney Transplant Recipients (ktr)- Validity of different schedules of self-monitoring
Saint-Remy, Annie ULiege; WEEKERS, Laurent ULiege; BONVOISIN, Catherine ULiege et al

Conference (2015, October 24)

HOME BLOOD PRESSURE IN KIDNEY TRANSPLANT RECIPIENTS (KTR)-Validity of different schedules of self-monitoring A. Saint-Remy, L. Weekers, C. Bonvoisin, P. Xhignesse, B.Dubois, JM. Krzesinski NEPHROLOGY ... [more ▼]

HOME BLOOD PRESSURE IN KIDNEY TRANSPLANT RECIPIENTS (KTR)-Validity of different schedules of self-monitoring A. Saint-Remy, L. Weekers, C. Bonvoisin, P. Xhignesse, B.Dubois, JM. Krzesinski NEPHROLOGY - CHU LIEGE AIM: Office blood pressure (OBP), 24-h ambulatory monitoring (ABPM) and home self- monitoring (HBP) allow assessing BP control in treated HT patients. For HBP, ESH guidelines recommend 7 days of measurements but that duration is questioned. The present study analyzed the agreement between daytime ABP and different schedules for HBP in 70 treated hypertensive KTR. METHOD: BP control defined by OBP <140/90 and daytime ABP or HBP <135/85 mmHg was tested in 70 KTR (mean age 56 ± 11 y; mean graft survival 7 ± 6.6 y). OBP and HBP were measured with an Omron M6 and 24-h ABPM with a Spacelabs 90207. HBP was measured on consecutive days (2 times in morning and 2 times at evening/day), the first day was discarded for the mean calculation. Agreement between daytime and HBP was studied when HBP was measured during 7, 5 or 3 days. RESULTS: BP was uncontrolled in 50% of the KTR based on OBP, in 61 % according to daytime ABP and even in 64 % with HBP. Sensitivity (Se) testing agreement between daytime ABP and HBP decreased progressively when number of days was shortened: the highest Se was observed for a 7 days duration with 1st day discarded (86 %). Specificity (Sp) fluctuated around 70 % and was the highest for a 5 (73 %) and 3 days schedule. However the 5 days schedule had higher Se (83 %) than the 3 days. Proportions of KTR correctly classified according to daytime ABP were 79 %, 79 % and 78 % with the 7, 5 or 3 days schedule, respectively. CONCLUSIONS: HBP, easier and less restricting method than 24h ABPM, is a good alternative to daytime ABPM as nearly 80 % of treated KTR were similarly classified. HBP recording period can be shortened to 5 days according to Se and Sp. A 3 days schedule seems more risky reducing the chance to identify masked HT due to a decreased drug adherence. [less ▲]

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See detailPrise en charge de l'hypertension artérielle du patient âgé
XHIGNESSE, Patricia ULiege; Saint-Remy, Annie ULiege; Krzesinski, Jean-Marie ULiege

in Revue Médicale de Liège (2014), 69(5-6), 294-300

High blood pressure is very frequent in the elderly; it represents a real threat for the patient’s health and a source of huge costs for the economic system. Systolic hypertension is the most frequent ... [more ▼]

High blood pressure is very frequent in the elderly; it represents a real threat for the patient’s health and a source of huge costs for the economic system. Systolic hypertension is the most frequent form observed in the old, due to large arteries stiffness. Antihypertensive therapy has proven effective to decrease significantly the cardiovascular morbi-mortality and total mortality in this population. A non pharmacological approach is also very useful, but should not be too restrictive. Blood pressure target in patients older than 65 (and, particularly, in octogenarians) is 150/80 mmHg. Blood pressure should be checked in the upright position before changing the drug dosage. The first line therapy in the old should generally be a calcium channel antagonist or a low dose diuretic. [less ▲]

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See detailBlood pressure dipping and arterial stiffness in kidney transplant recipients
XHIGNESSE, Patricia ULiege; Saint-Remy, Annie ULiege; BONVOISIN, Catherine ULiege et al

Conference (2013, October 05)

In 70 kidney transplant recipients, nocturnal blood pressure(BP) nondipping (nondipping or reversed rhythm) was highly frequent (48% were nondippers and 29% had a reversed rhythm). When compared dippers ... [more ▼]

In 70 kidney transplant recipients, nocturnal blood pressure(BP) nondipping (nondipping or reversed rhythm) was highly frequent (48% were nondippers and 29% had a reversed rhythm). When compared dippers, nondippers and reversed, neither BMI, time on hemodialysis, graft survival, eGFR or antihypertensive drugs allowed to distinct the three groups. Pulse Wave Velocity (PWV) did not differ between groups but calcification score and ambulatory arterial stiffness index (AASI) were significantly the highest in récipients with reversed rhythm. That was also the case in nondippers recipients. [less ▲]

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See detailMasked hypertension is associated with a high cardiovascular risk in hypertensive kidney transplant recipients
XHIGNESSE, Patricia ULiege; Saint-Remy, Annie ULiege; BONVOISIN, Catherine ULiege et al

Poster (2013, June 16)

Objective: High blood pressure (BP) is a major risk factor for graft function in kidney transplant recipients (KTs) Our aim was to evaluate BP control in the office, but also in the ambulatory and home ... [more ▼]

Objective: High blood pressure (BP) is a major risk factor for graft function in kidney transplant recipients (KTs) Our aim was to evaluate BP control in the office, but also in the ambulatory and home settings, in stable KTs, ali treated for hypertension, and to characterize patients with masked hypertension (MHT). Design and Method: Three BP measurement techniques were used in 70 late KT patients, (mean age 56.5 years; 43 males): ambulatory BP monitoring (ABPM-Spacelab 90207) office (OBP) and home BP monitoring (HBPM)- (OMRON M6). Carotid­ femoral pulse wave velocity was measured (Sphygmocor) as weil as a calcification score (arteries) and the systolic ankle brachial index (ABI) as recommended. The period since transplantation was 6.9±6.6 years, the mean GFR was 65.6±24±ml/min, Body Mass Index was 25.8±4.7 kg/m2 and the number of antihypertensive drug was 2.1±1 pills/d. Results: Uncontrolled hypertension (HTN) remained frequent in our treated population, 46 % were still hypertensive in the office, 39% using ABPM and 43% with HBPM. The proportion of MHT was 22% whatever the out-of-clinic method used, with more males, more overweight (BMI between, 25-30). lnterestingly when compared with controlled KTs (i.e both OBP and Daytime ABP controlled or both OBP and HBP controlled), using either ABPM or Home BP, patients with MHT had significantly higher PWV, a higher aortic augmentation pressure (AP), a higher calcification score and a higher ABI. However we did not find any significant impact of graft survival, immunosuppressive drugs, smoking habits, diabetes, or alcohol use. Conclusion: A high percentage of uncontrolled HTN was noted by OBP, but also by ABPM and HBPM despite antihypertensive treatment. MHT was frequently observed in KTs. This particular HT subtype, either defined by OBP vs ABPM or by OBP vs HBP, was significantly associated with major markers of arterial stiffness. So, MHT is associated with a high cardiovascular (cv) risk and therefore has to be manage to reduce incidence of cv events and graft loss. [less ▲]

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See detailPeritoneal equilibration test with conventional ‘low pH/high glucose degradation product’ or with biocompatible ‘normal pH/low glucose degradation product’ dialysates: does it matter?
VAN OVERMEIRE, Lionel ULiege; Goffin, Eric; Krzesinski, Jean-Marie ULiege et al

in Nephrology Dialysis Transplantation (2013)

Abstract Background. The evaluation of the peritoneal transport characteristics is mandatory in peritoneal dialysis (PD) patients. This is usually performed in routine clinical practice with a peritoneal ... [more ▼]

Abstract Background. The evaluation of the peritoneal transport characteristics is mandatory in peritoneal dialysis (PD) patients. This is usually performed in routine clinical practice with a peritoneal equilibration test (PET) using conventional dialysates, with low pH and high glucose degradation product (GDP) concentrations. An increasing proportion of patients are now treated with biocompatible dialysates, i.e. with physiological pH and lower GDP concentrations. This questions the appropriateness to perform a PET with conventional solutions in those patients. The aim of our study is to compare the results of the PET using biocompatible and conventional dialysates, respectively. Methods. Nineteen stable PD patients (13 males, 6 females; mean age: 67.95 ± 2.36 years, mean body surface area: 1.83 ± 0.04 m2, dialysis vintage: 2.95 ± 0.19 years) were included, among which 10 were usually treated with biocompatible and 9 with conventional solutions. Two PETs were performed, within a 2-week interval, in each patient. PET sequence (conventional solution first or biocompatible solution first) was randomized in order to avoid ‘time bias’. Small (urea, creatinine and glucose), middle (beta-2-microglobulin) and large molecules’ (albumin and alpha-2-macroglobulin) dialysate/plasma (D/P) concentration ratios and clearances were measured during each PET. Ultrafiltration (UF) and sodium filtration were also recorded. Results of both tests were compared by the Wilcoxon paired test. Results. No statistical difference was found between both dialysates for small molecule transport rates or for sodium filtration and UF. However, a few patients were not similarly classified for small-solute transport characteristics within the PET categories. Beta-2-microglobulin and albumin D/P ratios at different time points of the PET were significantly higher with the biocompatible, when compared with the conventional, solutions: 0.10 ± 0.03 versus 0.08 ± 0.02 (P < 0.01) and 0.008 ± 0.003 versus 0.007 ± 0.003 (P = 0.01), respectively. A similar difference was also observed for beta-2-microglobulin that was higher with biocompatible dialysates (1.04 ± 0.32 versus 0.93 ± 0.32 mL/min, respectively). Conclusion. Peritoneal transport of water and small solutes is independent of the type of dialysate which is used. This is not the case for the transport of beta-2-microglobulin and albumin that is higher under biocompatible dialysates. Vascular tonus modification could potentially explain such differences. The PET should therefore always be carried out with the same dialysate to make longitudinal comparisons possible. [less ▲]

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See detailUrinary and dietary sodium and potassium associated with blood pressure control in treated hypertensive kidney transplant recipients: an observational study
Saint-Remy, Annie ULiege; SOMJA, Mélanie ULiege; Gellner, Karen et al

in BMC Nephrology (2012), 13

Background In kidney transplant (Kt) recipients, hypertension is a major risk for cardiovascular complications but also for graft failure. Blood pressure (BP) control is therefore mandatory. Office BP ... [more ▼]

Background In kidney transplant (Kt) recipients, hypertension is a major risk for cardiovascular complications but also for graft failure. Blood pressure (BP) control is therefore mandatory. Office BP (OBP) remains frequently used for clinical decisions, however home BP (HBP) have brought a significant improvement in the BP control. Sodium is a modifiable risk factor, many studies accounted for a decrease of BP with a sodium restricted diet. Increased potassium intake has been also recommended in hypertension management. Using an agreement between office and home BP, the present study investigated the relations between the BP control in Kt recipients and their urinary excretion and dietary consumption of sodium and potassium. Methods The BP control defined by OBP <140/90 mmHg and HBP <135/85 mmHg was tested in 70 Kt recipients (mean age 56 +/- 11.5 years; mean graft survival 7 +/- 6.6 years) treated with antihypertensive medications. OBP and HBP were measured with a validated oscillometric device (Omron M6(R)). The 24-hour urinary sodium (Na+) and potassium (K+) excretions as well as dietary intakes were compared between controlled and uncontrolled (in office and at home) recipients. Non parametric Wilcoxon Mann--Whitney Test was used for between groups comparisons and Fisher's exact test for frequencies comparisons. Pearson correlation coefficients and paired t-test were used when sample size was >30. Results Using an agreement between OBP and HBP, we identified controlled (21%) and uncontrolled recipients (49%). Major confounding effects susceptible to interfere with the BP regulation did not differ between groups, the amounts of sodium excretion were similar (154 +/- 93 vs 162 +/- 88 mmol/24 h) but uncontrolled patients excreted less potassium (68 +/- 14 vs 54 +/- 20 mmol/24 h; P = 0.029) and had significantly lower potassium intakes (3279 +/- 753 vs 2208 +/- 720 mg/24 h; P = 0.009), associated with a higher urinary Na+/K + ratio. Systolic HBP was inversely and significantly correlated to urinary potassium (r = -0.48; P = 0.002), a positive but non significant relation was observed with urinary sodium (r = 0,30;P = 0.074). Conclusions Half of the treated hypertensive Kt recipients remained uncontrolled in office and at home. Restoring a well-balanced sodium/potassium ratio intakes could be a non pharmacological opportunity to improve blood pressure control. [less ▲]

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See detailComment je mesure la pression artérielle au cabinet
Krzesinski, Jean-Marie ULiege; Saint-Remy, Annie ULiege

in Revue Médicale de Liège (2012), 67(9), 492-498

Routinely measuring blood pressure is still performed according to the auscultatory method using recognition of Korotkoff sounds. This usual technique is, however, often mishandled and is thus a source of ... [more ▼]

Routinely measuring blood pressure is still performed according to the auscultatory method using recognition of Korotkoff sounds. This usual technique is, however, often mishandled and is thus a source of error in the estimation of the true blood pressure level. Accuracy of such measure is, however, of paramount importance to be useful in daily medical practice. This methodology paper more specifically written for medical students recalls the essential principles of blood pressure measurement at the medical office, but also at home. [less ▲]

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See detailDietary and urinary excretion of sodium and potassium associated with blood pressure control in treated hypertensive kidney transplant patients
Saint-Remy, Annie ULiege; SOMJA, Mélanie ULiege; BONVOISIN, Catherine ULiege et al

Conference (2012, April 26)

Abstract Background. In kidney transplant (kt) recipients , hypertension is a major risk for cardiovascular complications but also for graft failure. Blood pressure (BP) control is therefore mandatory ... [more ▼]

Abstract Background. In kidney transplant (kt) recipients , hypertension is a major risk for cardiovascular complications but also for graft failure. Blood pressure (BP) control is therefore mandatory. Office BP (OBP) remains the most frequently used for clinical decisions, however home BP (HBP) have brought a significant improvement in the BP control. Sodium is a modifiable risk factor, many studies accounted for a decrease of BP with a sodium restricted diet. Increased potassium intake has been also recommended in hypertension management. Using an agreement between office and home BP, the present study investigated the relations between the BP control in kt recipients and their urinary excretion and dietary consumption of sodium and potassium. Methods. The BP control defined by OBP <140/90 mmHg and HBP <135/85 mmHg was measured in 70 kt recipients (mean age 56 ± 11.5 years; mean graft survival 7 ± 6.6 years) treated with antihypertensive medications. OBP and HBP were measured with a validated oscillometric device (Omron M6â). 24-hour urinary sodium (Na+) and potassium (K+) excretion as well as dietary intakes (food recall) were compared between controlled and uncontrolled (in office and at home) recipients. Non parametric Wilcoxon Mann-Whitney Test was used for between groups comparisons and Fisher’s exact test for frequencies comparisons. Results. Using an agreement between OBP and HBP, we identified controlled (21%) and uncontrolled recipients (49%). Major confounding effects susceptible to interfere with the BP regulation did not differ between groups, the amounts of sodium excretion were similar (154 ± 93 vs 162 ± 88 mmol/24h) but uncontrolled patients excreted less potassium (68 ± 14 vs 54 ± 20 mmol/24h; P=0.029) and had significantly lower intakes (3279 ± 753 vs 2208 ± 720 mg/24h; P=0.009), resulting in a higher Na+/K+ ratio. Systolic HBP was inversely and significantly correlated to urinary potassium when age, BMI and urinary sodium were controlled (r= -0.46; P=0.002). When age, BMI and urinary potassium were controlled, a positive relation was observed with urinary sodium (P=0.042). Conclusions. Half of the treated hypertensive kt recipients remained uncontrolled in office and at home. Restoring a well-balanced sodium/potassium ratio intakes could be a non pharmacological opportunity to improve blood pressure control. [less ▲]

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See detailMesure de la pression artérielle : un geste quotidien à ne pas banaliser
Saint-Remy, Annie ULiege

Conference (2012, February 11)

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See detailLes maladies complexes : l'hypertension artérielle
Krzesinski, Jean-Marie ULiege; Saint-Remy, Annie ULiege

in Revue Médicale de Liège (2012), 67(5-6), 279-285

Essential hypertension, defined as a blood pressure equal to or above 140/90 mmHg, is a common (25% of the population), but complex disease the phenotype of which results from interactions between ... [more ▼]

Essential hypertension, defined as a blood pressure equal to or above 140/90 mmHg, is a common (25% of the population), but complex disease the phenotype of which results from interactions between numerous genes and environmental factors. The role attributable to genetic factors amounts to some 25% among hypertensive families, but can reach 65% when monozygotic twins are compared. In the present state of our knowledge, there is no hope to obtain a genetic test of value for the diagnosis and prognosis of hypertension. An individualized environmental approach, applied early in life, is the only worhtwhile attitude. Nonetheless, in the presence of a subject with still normal blood pressure values, but with a family history of hypertension, the physician should firmly recommend an appropriate hygieno-dietetic lifestyle with a view to lower blood pressure, or retard the development of arterial hypertension [less ▲]

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See detailAssociation entre le contrôle de la pression artérielle et le rapport sodium/potassium urinaire chez les transplantés rénaux hypertendus
Saint-Remy, Annie ULiege; SOMJA, Mélanie ULiege; WEEKERS, Laurent ULiege et al

Poster (2011, December 15)

Design and method : Office blood pressure (OBP) and home BP (HBP) were measured in 70 kidney transplant patients (KT) (43 men/27 women;KT>1 year), all were treated with antihypertensive drugs (mean number ... [more ▼]

Design and method : Office blood pressure (OBP) and home BP (HBP) were measured in 70 kidney transplant patients (KT) (43 men/27 women;KT>1 year), all were treated with antihypertensive drugs (mean number: 2±1). Mean age: 56±11 years, mean graft survival: 7±6.6 years, mean GFR: 65.6±24 ml/min, diabetes:27% and current smoking:11.5%. HBP (Omron M6) was measured during 7 days following the OBP measurement, mean HBP was calculated from day 2 to day 7. Uncontrolled BP was defined by OBP>=140-90 (>=130-80 when diabetes) and HBP>=135-85 (>=130-80 when diabetes). The day of the OBP measurement and the last day of HBP, patients collected 24h- urine and recorded at the same time their food and beverage consumption. Sodium and potassium were measured in urines and their intakes were quantified through food records. Urinary and diet Na+, K+ did not differ between the two urine collections 7 days apart. Results: 16 patients(23%) had controlled BP (OBP and HBP) while 34 (49%) remained with sustained hypertension (SHT) despite treatment, 14 (20%) had masked uncontrolled hypertension (MHT, OBP<140-90 and HBP>=135-85,130-80 if diabetes for both).When comparing the controlled and SHT, no differences were found with age, graft survival, BMI, GFR, calcineurin inhibitors or number and type of antihypertensive drugs. The groups did not differ by their sodium excretion (154±93 vs 162±88 mmol/24h) but well by their K excretion significantly higher in controlled patients (68±17 vs 53±20 mmol/24h,p=0.018) giving a Na/K ratio higher in SHT (3.2±1.3 vs2.2±1.2,p=0.03). Diet analysis showed significantly higher intakes of K (fruits, vegetables) in controlled patients (3279±753 vs 2208±720 mg/24h,p=0.010) whereas both groups consumed on average 9 g/24h of salt. When controlled for age, BMI and Na excretion, Home systolic BP was inversely and significantly correlated with urinary potassium (- 0.46;P=0.002) while no correlation was found with urinary Na.Conclusions: KT patients remaining hypertensive and well controlled patients had both high salt consumption. However, well controlled patients differed by significant higher potassium intakes and excretion. Urinary Na/K ratio could be a useful tool contributing to an optimal BP control in KT patients. However, impact of increasing potassium intakes on uncontrolled BP in KT has to be validated by prospective randomized studies [less ▲]

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See detailAssociation entre le contrôle de la pression artérielle et le rapport sodium/potassium urinaire chez les transplantés rénaux hypertendus
Saint-Remy, Annie ULiege; SOMJA, Mélanie ULiege; WEEKERS, Laurent ULiege et al

in Archives des Maladies du Coeur et des Vaisseaux (2011, December), Hors série 3

Etude de la relation entre le contrôle de la pression artérielle (PA) mesurée en clinique et/ou à domicile chez des transplantés rénaux (Tr) hypertendus et l'excrétion urinaire du sodium (Na), potassium ... [more ▼]

Etude de la relation entre le contrôle de la pression artérielle (PA) mesurée en clinique et/ou à domicile chez des transplantés rénaux (Tr) hypertendus et l'excrétion urinaire du sodium (Na), potassium (K) et de leur rapport (Na/K urinaire et alimentaire) qui pourrait être un indice utile à prendre en compte dans la recherche d'un contrôle efficace de la PA chez les transplantés rénaux. [less ▲]

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See detailContrôle de la pression artérielle (PA) et mesure de la rigidité artérielle (RA) chez des transplantés rénaux (TR) (étude EPARA)
Gellner, Karen; Saint-Remy, Annie ULiege; BONVOISIN, Catherine ULiege et al

in Archives des Maladies du Coeur et des Vaisseaux (2011, December), Hors série 3

EPARA a étudié le contrôle de la PA au cabinet de consultation et en dehors, et l'état de rigidité artérielle chez des transplantés rénaux stables, greffés depuis plus d'un an. Le contrôle de la PA est ... [more ▼]

EPARA a étudié le contrôle de la PA au cabinet de consultation et en dehors, et l'état de rigidité artérielle chez des transplantés rénaux stables, greffés depuis plus d'un an. Le contrôle de la PA est loin d‘être satisfaisant dans cette population de TR hypertendus, traîtés pour la plupart, particulièrement à domicile. L‘HTA masquée est fréquente, associée à un risque cardio-vasculaire élevé et une rigidité accrue des grosses artères. La PAS centrale est d‘autant plus élevée que la fonction rénale est mauvaise. Proposer de recourir systématiquement à des mesures ambulatoires de PA est hautement conseillé chez ce type de patients! [less ▲]

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