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Article ; Online: Decreasing the Effects of Aldosterone in Resistant Hypertension - A Success Story.

Azizi, Michel

2023 Volume 388, Issue 5, Page(s) 461–463

MeSH term(s)	Humans ; Aldosterone ; Blood Pressure/drug effects ; Hyperaldosteronism/complications ; Hyperaldosteronism/drug therapy ; Hypertension/complications ; Hypertension/drug therapy
Chemical Substances	Aldosterone (4964P6T9RB)
Language	English
Publishing date	2023-02-17
Publishing country	United States
Document type	Editorial ; Comment
ZDB-ID	207154-x
ISSN	1533-4406 ; 0028-4793
ISSN (online)	1533-4406
ISSN	0028-4793
DOI	10.1056/NEJMe2216143
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Article ; Online: Aldosterone receptor antagonists.

Azizi, Michel

Annales d'endocrinologie

2020 Volume 82, Issue 3-4, Page(s) 179–181

Abstract: Blocking the mineralocorticoid receptor (MR) is one of the most effective ways of reducing blood pressure in patients with resistant hypertension and improving cardiovascular prognosis in patients with heart failure with reduced ejection fraction and ... ...

Abstract	Blocking the mineralocorticoid receptor (MR) is one of the most effective ways of reducing blood pressure in patients with resistant hypertension and improving cardiovascular prognosis in patients with heart failure with reduced ejection fraction and left ventricular dysfunction after myocardial infarction. Blockade of the biological effects of aldosterone has mostly been achieved with spironolactone and eplerenone, the two steroidal MR antagonists currently on the market. Development of new non-steroidal dihydropyridine-based third- and fourth-generation MR antagonists is ongoing. These antagonists are highly selective for the MR, but have no effect on the glucocorticoid, androgen, progesterone and estrogen receptors, in contrast with spironolactone.
MeSH term(s)	Aldosterone/metabolism ; Blood Pressure/drug effects ; Blood Pressure/physiology ; Heart Failure/drug therapy ; Heart Failure/physiopathology ; Humans ; Hypertension/drug therapy ; Hypertension/physiopathology ; Mineralocorticoid Receptor Antagonists/pharmacology ; Mineralocorticoid Receptor Antagonists/therapeutic use ; Myocardial Infarction/drug therapy ; Myocardial Infarction/physiopathology ; Receptors, Mineralocorticoid/metabolism ; Receptors, Mineralocorticoid/physiology
Chemical Substances	Mineralocorticoid Receptor Antagonists ; NR3C2 protein, human ; Receptors, Mineralocorticoid ; Aldosterone (4964P6T9RB)
Language	English
Publishing date	2020-05-27
Publishing country	France
Document type	Journal Article ; Review
ZDB-ID	299-9
ISSN	2213-3941 ; 0003-4266
ISSN (online)	2213-3941
ISSN	0003-4266
DOI	10.1016/j.ando.2020.03.009
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Article ; Online: Catheter-based renal denervation for treatment of hypertension.

Azizi, Michel

Lancet (London, England)

2017 Volume 390, Issue 10108, Page(s) 2124–2126

MeSH term(s)	Antihypertensive Agents/therapeutic use ; Autonomic Denervation/methods ; Blood Pressure Determination/methods ; Catheter Ablation/methods ; Female ; Follow-Up Studies ; Humans ; Hypertension/diagnosis ; Hypertension/drug therapy ; Hypertension/surgery ; Kidney/innervation ; Male ; Middle Aged ; Randomized Controlled Trials as Topic ; Risk Assessment ; Severity of Illness Index ; Treatment Outcome
Chemical Substances	Antihypertensive Agents
Language	English
Publishing date	2017-08-28
Publishing country	England
Document type	Comparative Study ; Journal Article ; Review
ZDB-ID	3306-6
ISSN	1474-547X ; 0023-7507 ; 0140-6736
ISSN (online)	1474-547X
ISSN	0023-7507 ; 0140-6736
DOI	10.1016/S0140-6736(17)32293-6
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Article ; Online: What We Know and Don't Know About Renal Denervation to Lower Blood Pressure.

Chau, Katherine H / Azizi, Michel / Kirtane, Ajay J

JAMA cardiology

2022 Volume 7, Issue 5, Page(s) 471–472

MeSH term(s)	Blood Pressure ; Denervation ; Humans
Language	English
Publishing date	2022-03-30
Publishing country	United States
Document type	Journal Article
ISSN	2380-6591
ISSN (online)	2380-6591
DOI	10.1001/jamacardio.2022.0169
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Article ; Online: Nouveaux traitements invasifs de l'hypertension artérielle résistante.

Azizi, Michel

Biologie aujourd'hui

2014 Volume 208, Issue 3, Page(s) 211–216

Abstract: The failure of pharmacological approaches to treat resistant hypertension has stimulated interest in invasive device-based treatments. New catheter systems using radiofrequency or ultrasound energy have been developed, allowing a percutaneous ... ...

Title translation	New invasive therapies for management of resistant hypertension.
Abstract	The failure of pharmacological approaches to treat resistant hypertension has stimulated interest in invasive device-based treatments. New catheter systems using radiofrequency or ultrasound energy have been developed, allowing a percutaneous endovascular approach to renal denervation for patients with resistant hypertension. To date, this technique has been evaluated only in a few open-label trials including small numbers and the available evidence suggests a favorable blood pressure-lowering effect in the short-term and a low incidence of immediate complications. All studies published to date have several limitations due to their open-label design. Carotid baroreceptor stimulation requires surgical implantation of electrodes connected to a stimulator. Preliminary results show a positive effect on blood pressure with a complication rate similar to the implantation of a pacemaker. In this context, there are arguments against an uncontrolled use of these procedures in routine practice: an unknown benefit/risk ratio, a variable blood pressure response, absence of cost-effectiveness evaluation. The indications of these procedures should follow the 2013 European Society of Hypertension guidelines. A strict follow-up of patients remains necessary at best by including them in clinical trials or international registries.
MeSH term(s)	Electric Stimulation ; Electric Stimulation Therapy/methods ; Endovascular Procedures/adverse effects ; Endovascular Procedures/methods ; Humans ; Hypertension/therapy ; Kidney/innervation ; Kidney/surgery ; Pressoreceptors/physiology ; Sympathectomy/adverse effects ; Sympathectomy/methods ; Treatment Failure
Language	French
Publishing date	2014
Publishing country	France
Document type	English Abstract ; Journal Article ; Research Support, Non-U.S. Gov't
ISSN	2105-0686
ISSN (online)	2105-0686
DOI	10.1051/jbio/2014012
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Article: Blocage combiné du système rénine angiotensine.

Azizi, Michel

Bulletin de l'Academie nationale de medecine

2014 Volume 198, Issue 2, Page(s) 351–62; discussion 362

Abstract: Blockade of the renin-angiotensin system (RAS) with angiotensin-converting-enzyme (ACEI) inhibitors or angiotensin II receptor blockers (ARB) has become a major therapeutic tool. Due to internal counter-regulation, however, this system cannot be fully ... ...

Title translation	Combined blockade of the renin-angiotensin system.
Abstract	Blockade of the renin-angiotensin system (RAS) with angiotensin-converting-enzyme (ACEI) inhibitors or angiotensin II receptor blockers (ARB) has become a major therapeutic tool. Due to internal counter-regulation, however, this system cannot be fully blocked by targeting only one of its components. Instead of increasing the doses of an ACEI, an ARB or a renin inhibitor, blocking RAS at two successive levels neutralizes the consequences of internal counter-regulation and thus provides a more complete blockade with more pronounced biological effects. Additive effects on blood pressure lowering and on renin secretion during combined administration of RAS blockers were first demonstrated in normotensive subjects and in various experimental models of hypertension, heart failure and renal failure. Although combined RAS blockade provided an additional hemodynamic response and more complete neutralization of the cellular effects of angiotensin II, no benefit was observed in terms of cardiovascular or renal protection in heart disease (heart failure, post-myocardial infarction, high vascular risk) or kidney disease (diabetic nephropathy). Moreover, more complete RAS blockade is risky in conditions where blood pressure and renal perfusion are renin-dependent (renal failure and hypotension) and also in hypoaldosteronism (hyperkalemia). The European, French and US. health agencies have contraindicated combined RAS blockade because of its unfavorable risk-benefit balance, especially in patients with diabetes or renal failure.
MeSH term(s)	Angiotensin Receptor Antagonists/administration & dosage ; Angiotensin Receptor Antagonists/pharmacology ; Angiotensin-Converting Enzyme Inhibitors/administration & dosage ; Angiotensin-Converting Enzyme Inhibitors/pharmacology ; Animals ; Antihypertensive Agents/pharmacology ; Antihypertensive Agents/therapeutic use ; Cardiovascular Diseases/drug therapy ; Contraindications ; Drug Therapy, Combination/adverse effects ; Female ; Humans ; Hypertension/drug therapy ; Kidney Diseases/drug therapy ; Renin-Angiotensin System/drug effects
Chemical Substances	Angiotensin Receptor Antagonists ; Angiotensin-Converting Enzyme Inhibitors ; Antihypertensive Agents
Language	French
Publishing date	2014-02
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	213227-8
ISSN	0001-4079
ISSN	0001-4079
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Ua VI Zs.16: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 2021: Bestellungen von Artikeln über das Online-Bestellformular ab Jg. 2022: Lesesaal (EG)

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Article ; Online: Endovascular ultrasound renal denervation to lower blood pressure in young hypertensive women planning pregnancy: study protocol for a multicentre randomised, blinded and sham controlled proof of concept study.

Gosse, Philippe / Sentilhes, Loïc / Boulestreau, Romain / Doublet, Julien / Gaudissard, Julie / Azizi, Michel / Cremer, Antoine

BMJ open

2023 Volume 13, Issue 9, Page(s) e071164

Abstract: Introduction: A major issue confronting clinicians treating hypertension in pregnancy is the limited number of pharmacological options. Endovascular catheter-based renal denervation (RDN) is a new method to lower blood pressure (BP) in patients with ... ...

Abstract	Introduction: A major issue confronting clinicians treating hypertension in pregnancy is the limited number of pharmacological options. Endovascular catheter-based renal denervation (RDN) is a new method to lower blood pressure (BP) in patients with hypertension by reducing the activity of the renal sympathetic nervous system. Drugs that affect this system are safe in pregnant women. So there is reasonable evidence that RDN performed before pregnancy should not have deleterious effects for the fetus. Because the efficacy of RDN may be greater in younger patients and in women, we may expect a larger proportion of BP normalisation in young hypertensive women, but this remains to be proven. Our primary objective is to quantify the proportion of BP normalisation with RDN in this population. Methods and analysis: WHY-RDN is a multicentre randomised sham-controlled trial conducted in six French hypertension centres that will include 80 women with essential hypertension treated or untreated, who are planning a pregnancy in the next 2 years and will be randomly assigned to RDN or classic renal arteriography and sham RDN in a ratio of 1:1. The primary outcome is the normalisation of 24-hour BP (<130/80 mm Hg) at 2-month post procedure off treatment. Sample size is calculated with the following assumptions: 5% one-sided significance level (α), 80% power (1-β), expected responder rates of 24% and 3% in the treatment and control group, respectively. Secondary outcomes include the absence of adverse outcomes for a future pregnancy, the variations of BP in ambulatory and home BP measurements and the evaluation of treatment prescribed. Ethics and dissemination: WHY-RDN has been approved by the French Ethics Committee (Tours, Region Centre, Ouest 1- number 2021T1-28 HPS). This project is being carried out in accordance with national and international guidelines. The findings of this study will be disseminated by publication. Trial registration number: ClinicalTrials.gov, NCT05563337.
MeSH term(s)	Pregnancy ; Humans ; Female ; Blood Pressure ; Proof of Concept Study ; Hypertension/drug therapy ; Kidney ; Denervation/methods ; Treatment Outcome ; Antihypertensive Agents/therapeutic use ; Randomized Controlled Trials as Topic ; Multicenter Studies as Topic
Chemical Substances	Antihypertensive Agents
Language	English
Publishing date	2023-09-29
Publishing country	England
Document type	Clinical Trial Protocol ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2022-071164
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Article ; Online: Endocrine causes of hypertension: literature review and practical approach.

de Freminville, Jean-Baptiste / Amar, Laurence / Azizi, Michel / Mallart-Riancho, Julien

Hypertension research : official journal of the Japanese Society of Hypertension

2023 Volume 46, Issue 12, Page(s) 2679–2692

Abstract: Hypertension (HTN) affects more than 30% of adults worldwide. It is the most frequent modifiable cardiovascular (CV) risk factor, and is responsible for more than 10 million death every year. Among patients with HTN, we usually distinguish secondary HTN, ...

Abstract	Hypertension (HTN) affects more than 30% of adults worldwide. It is the most frequent modifiable cardiovascular (CV) risk factor, and is responsible for more than 10 million death every year. Among patients with HTN, we usually distinguish secondary HTN, that is HTN due to an identified cause, and primary HTN, in which no underlying cause has been found. It is estimated that secondary hypertension represents between 5 and 15% of hypertensive patients [1]. Therefore, routine screening of patients for secondary HTN would be too costly and is not recommended. In addition to the presence of signs suggesting a specific secondary cause, screening is based on specific criteria. Identifying secondary HTN can be beneficial for patients in certain situations, because it may lead to specific treatments, and allow better control of blood pressure and sometimes even a cure. Besides, it is now known that secondary HTN are more associated with morbidity and mortality than primary HTN. The main causes of secondary HTN are endocrine and renovascular (mainly due to renal arteries abnormalities). The most frequent endocrine cause is primary aldosteronism, which diagnosis can lead to specific therapies. Pheochromocytoma and Cushing syndrome also are important causes, and can have serious complications. Other causes are less frequent and can be suspected on specific situations. In this article, we will describe the endocrine causes of HTN and discuss their treatments.
MeSH term(s)	Adult ; Humans ; Hypertension/therapy ; Cushing Syndrome/complications ; Cushing Syndrome/therapy ; Cushing Syndrome/diagnosis ; Adrenal Gland Neoplasms/diagnosis ; Blood Pressure ; Pheochromocytoma/diagnosis
Language	English
Publishing date	2023-10-11
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	1175297-x
ISSN	1348-4214 ; 0916-9636
ISSN (online)	1348-4214
ISSN	0916-9636
DOI	10.1038/s41440-023-01461-1
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Article ; Online: HTA secondaires chez la femme.

Amar, Laurence / Azizi, Michel

Presse medicale (Paris, France : 1983)

2019 Volume 48, Issue 11 Pt 1, Page(s) 1265–1268

Abstract: The two main non-iatrogenic causes of secondary hypertension in women of childbearing age are primary aldosteronism and renal fibromuscular dysplasia. It is recommended to look for a secondary hypertension in women who remain hypertensive three months ... ...

Title translation	Secondary hypertension in women.
Abstract	The two main non-iatrogenic causes of secondary hypertension in women of childbearing age are primary aldosteronism and renal fibromuscular dysplasia. It is recommended to look for a secondary hypertension in women who remain hypertensive three months after pregnancy, in patients under 40 years of age or in patients with a grade 3 HTN (BP≥180/110mm Hg) (Professional agreement). It is suggested that the initial assessment of a secondary HTN in women is performed by a HTN specialist; it will include an assessment of renin and aldosterone concentrations and an angio-CT of the renal arteries (or angio-MRI if contraindicated) (Grade C - Class 2).
MeSH term(s)	Adult ; Age Factors ; Aldosterone/blood ; Computed Tomography Angiography ; Female ; Fibromuscular Dysplasia/complications ; Fibromuscular Dysplasia/diagnosis ; Humans ; Hyperaldosteronism/complications ; Hyperaldosteronism/diagnosis ; Hypertension/blood ; Hypertension/diagnosis ; Hypertension/etiology ; Postpartum Period ; Renal Artery/diagnostic imaging ; Renin/blood ; Sex Factors
Chemical Substances	Aldosterone (4964P6T9RB) ; Renin (EC 3.4.23.15)
Language	French
Publishing date	2019-11-13
Publishing country	France
Document type	Journal Article ; Review
ZDB-ID	120943-7
ISSN	2213-0276 ; 0032-7867 ; 0755-4982 ; 0301-1518
ISSN (online)	2213-0276
ISSN	0032-7867 ; 0755-4982 ; 0301-1518
DOI	10.1016/j.lpm.2019.07.029
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Article ; Online: Qu’est-ce que l’hypertension artérielle résistante et comment l’objectiver ?

Lorthioir, Aurélien / Belmihoub, Inès / Amar, Laurence / Azizi, Michel

La Revue du praticien

2020 Volume 69, Issue 10, Page(s) 1099–1103

Abstract: WHAT IS RESISTANT HYPERTENSION AND HOW TO DIAGNOSE IT?. High blood pressure is one of the leading factors influencing the cardiovascular risk. Despite current knowledge on the management of hypertension and the numerous antihypertensive drugs available, ... ...

Title translation	What is resistant hypertension and how to diagnose it?
Abstract	WHAT IS RESISTANT HYPERTENSION AND HOW TO DIAGNOSE IT?. High blood pressure is one of the leading factors influencing the cardiovascular risk. Despite current knowledge on the management of hypertension and the numerous antihypertensive drugs available, hypertension remains insufficiently controlled and part of these « uncontrolled » patients meet the definition of resistant hypertension. Resistant hypertension is defined by the failure to achieve blood pressure target (office blood pressure smaller than 140/90 mm Hg) despite appropriate treatment with optimal doses of three antihypertensive drugs, ideally a combination of a renin angiotensin system blocker, a calcium channel blocker and a diuretic. Pseudoresistance should be excluded by using 24 h ambulatory blood pressure or home blood pressure measurements. The management of resistant hypertension includes the identification of lifestyle factors such as obesity, excessive alcohol and dietary sodium intake, volume overload, drug-induced hypertension and the screening of secondary forms of hypertension. The treatment associates lifestyle changes, reinforcement of adherence to treatment, discontinuation of interfering substances, association of antihypertensive drugs on top of the initial triple therapy, especially aldosterone antagonists (spironolactone) as fourth line treatment. Follow-up should be based on home blood pressure.
MeSH term(s)	Antihypertensive Agents ; Blood Pressure ; Blood Pressure Monitoring, Ambulatory ; Drug Resistance ; Drug Therapy, Combination ; Humans ; Hypertension/diagnosis ; Hypertension/drug therapy
Chemical Substances	Antihypertensive Agents
Language	French
Publishing date	2020-04-01
Publishing country	France
Document type	Journal Article
ZDB-ID	205365-2
ISSN	2101-017X ; 0035-2640
ISSN (online)	2101-017X
ISSN	0035-2640
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