[Try to achieve quickly the blood pressure target in newly diagnosed hypertensive patients is safe and effective]. / Tenter d'atteindre rapidement la cible tensionnelle chez les hypertendus nouvellement diagnostiqués est efficace et sans danger.

OBJECTIVES: To compare a so-called an "accelerated" antihypertensive strategy to a "standard" strategy, in terms of blood pressure control rates and adverse events. METHODS: Prospective open-label randomized controlled trial, which included consecutive hypertensive patients, newly diagnosed, 40 to 70 years old, with no prior antihypertensive treatment. Hypertension was diagnosed if office blood pressure was≥140/90mmHg, confirmed by an increase of Home or a daytime ambulatory blood pressure. The patients were randomly assigned according to 1:1 ratio to an "accelerated" strategy or to a "standard" strategy. The primary end-point was the rate of blood pressure control at 12weeks. The secondary end-point was the rate of adverse events (a safety end-point). RESULTS: We recruited 268 patients (132 in the "accelerated" strategy group), with a mean age of 55 years and 62% of men. The mean office blood pressure at baseline was 168/95mmHg. The clinical characteristics were on average similar between the 2 treatment groups. At 12 weeks, the rates of blood pressure control were 63.6% in the "accelerated" strategy and 38.2% in the "standard" strategy (P<0.001). There was no significantly difference between the rates of adverse events in the 2 strategies (6.06% versus 5.14%; P=0.8). CONCLUSION: The "accelerated" antihypertensive strategy was more effective than a standard one, in terms of blood pressure control, without an increase in adverse events rate. This could translate into a future cardiovascular events reduction.

[Prevalence of true resistant hypertension among uncontrolled hypertensive patients referred to a tertiary health care center]. / Prévalence de l'hypertension artérielle résistante chez des hypertendus non contrôlés adressés dans un centre de soins tertiaires.

OBJECTIVES: Estimate the prevalence of resistant hypertension (rHTN) in uncontrolled hypertensive treated patients referred to a tertiary care center specialized for hypertension management. METHODS: The study was prospective observational. Between January 2013 and April 2015, we recruited hypertensive treated patients, 18years age or older, under antihypertensive drugs since at least 12months, and referred to the hypertension unit of Tizi-ouzou university hospital for uncontrolled hypertension. rHTn was defined as an office blood pressure≥140mmHg despite a triple therapy including renin angiotensin system blockers, calcium antagonists and diuretics at optimal doses, since at least 4weeks. RESULTS: We screened 2367 patients with a mean age of 61.1±11.2years and 64.2% of men. Eight hundred forty-three (35.6%) patients had suboptimal treatment, 364 (15.4%) a poor adherence to treatment and 202 (8.5%) a white-coat effect. An excessive salt intake and a drug-related hypertension were identified in 281 (11.9%) and 36 (1.5%) patients, respectively. A secondary cause of hypertension was diagnosed in 468 (19.8%) subjects. Finally, only 173 patients showed a true rHTN requiring four drugs or more and its prevalence was 7.3% (CI 95%: 6.3-8.3). CONCLUSION: Less than one patient from ten referred in our center for uncontrolled hypertension had a true rHTN, and more than fifty percent of patients had pseudo-resistance. Most of patients with seemingly rHTN can reach blood pressure target provided they undergo thorough work up and care by a specialized team.

[Epidemiology of pre-eclampsia in Tizi-ouzou city (Algeria)]. / Épidémiologie de la prééclampsie dans la région de Tizi-ouzou (Algérie).

OBJECTIVES: The main objective was to estimate the prevalence of pre-eclampsia (PE) in pregnant women in Tizi-ouzou (Algeria). Secondary objectives were to estimate the frequency of PE risk factors, and the incidence of maternal and fetal complications. METHODS: Our study was observational, prospective and descriptive, including all pregnant women at the prenatal appointment in the 2 maternity units of Tizi-ouzou, between January 2012 and June 2013. PE was diagnosed if gestational hypertension was associated with proteinuria > 300 mg/24h, after 20 weeks of gestation. RESULTS: We had 252 cases of PE on 3225 pregnant women. The prevalence of PE was 7.8% (CI 95%: 6.9%-8.7%). The most frequent PE risk factors were nulliparity (56%), age >40 years (27%), obesity (26%) and PE in any previous pregnancy (21%). The incidence of maternal adverse events was 28.7% (CI 95%: 23.1%-34.3%), including 5 deaths. The rates of prematurity, small for gestational age infant and fetal death were 58.2%, 49.7% and 6.7%, respectively. CONCLUSION: The prevalence of PE in pregnant women in Tizi-ouzou is around 8%. The incidence of maternal and fetal adverse outcomes remains high. Only earlier diagnosis and closer monitoring could improve the prognosis of our patients, since the treatment of PE remains currently childbirth.

Effect of feeding yogurt versus milk in children with acute diarrhea and carbohydrate malabsorption.

BACKGROUND: The aim of this study was to compare the effect of infant formula and the same formula subjected to microbial fermentation (yogurt) on the duration of diarrhea in young children with acute watery diarrhea, with or without reducing substances in stools. METHODS: One hundred twelve well-nourished children, aged 3 to 24 months, who were admitted to the hospital with acute watery diarrhea were included in a randomized trial. After appropriate rehydration, they were fed either an infant formula (group M, n = 56) or the same formula fermented with Lactobacillus bulgaricus and Streptococcus thermophilus (group Y, n = 56). The two feedings were comparable in lactose concentration (40 to 42 g/L), pH 4.5, flavor, and texture. The groups were subdivided into those with or without reducing sugars in stools at presentation. The presence of reducing sugars in stool was used as a marker of carbohydrate malabsorption. RESULTS: Group M and group Y had comparable clinical characteristics at admission, including the number of patients with reducing sugars in stools (n = 31 in group M and 27 in group Y). The success rate (cessation of diarrhea and appropriate weight gain 7 days after enrollment into the study) was similar in both groups (82% in group M vs. 84% group Y). Clinical failure was 3.6% in both groups. The percentage of patients withdrawn from the study for medical reasons (5.4% in group M vs. 7.1% in group Y) or withdrawn at the parents' request (8.9% in group M vs. 5.4% in group Y) was similar. Duration of diarrhea and number of stools were significantly less in group Y compared with group M. Forty-eight hours after inclusion, diarrhea was still present in 62% of group M versus in 35% of group Y (P < 0.002). In children with reducing sugars in stools, the rate of success (82%) was similar in groups M and Y, but the duration of diarrhea and number of stools per day were significantly decreased in group Y. Forty-height hours after inclusion, diarrhea was still present in 75% of group M patients and in 20% of group Y patients who had reducing substances in the stool. CONCLUSION: Young children with acute watery diarrhea, without malnutrition or associated disease, can be equally well treated with feeding of either infant formula or yogurt. Yogurt feeding is associated with a clinically relevant decrease in stool frequency and duration of diarrhea in children who have reducing sugars in stools.

Prevalence of coeliac disease in diabetic children and their first- degree relatives in west Algeria: screening with serological markers.

Atypical and relatively silent forms of coeliac disease (CD) have been described in insulin-dependent diabetes mellitus (IDDM). Our aim was to evaluate the prevalence of CD-IDDM with serological markers and to investigate the presence of CD in the IDDM first-degree relatives. During 1993-94 we explored 116 IDDM patients reported as new cases and 381 first-degree relatives of IDDM patients. Determination of IgA and IgG antigliadin antibodies (AGA) and IgA antiendomysium antibodies (AEA) was made. Jejunal biopsy was performed in symptomatic patients or in those with positive serological markers, (i) Nineteen IDDM-CD were identified and 5 were suspected. Thus, the prevalence of CD in IDDM patients was between 16.4 and 20%. AGA and/or AEA were abnormal in 13 and normal in 5. Sensitivity was 80% for the three tests when used simultaneously and specificity was 100%. (ii) In the family study, 26 sera of asymptomatic first-degree relatives of IDDM patients were positive for at least one of the serological markers; 13 of them had villous atrophy. Systematic serological screening in IDDM allowed us to detect CD and evaluate the true incidence.