Traitement spŽcifique : les essais thŽrapeutiques

2>BG;C! MG>HMG>C! =AA4>C]! GA! 8>9:=;A! A5ET9>! 3R>CC=;C! :J49=B>G:;MG>C! 8;TH>A:! CB48;P;MG>E>A:! HR'0<O)B[! )A! 9=;C5A! 3>! 8>9:=;AC! E48=A;CE>C! BJ7C;5B=:J5H5I;MG>C! >:! C7EB:5E>C! 85EEGAC! Q! HR'0< O)B!>:!HR'0<O)9]!8>C!4:G3>C!5A:!:>C:4!3=AC!HR'0<O)B!3>C!E5H48GH>C!=7=A:!34SQ!P=;:!H>G9!B9>G@>!3=AC! HR'0<O>9! >A! ;A:>9=I;CC=A:! =@>8! H>! C7C:FE>! 94A;A><=AI;5:>AC;A><=H35C:495A>]! H>! C7C:FE>! A>9@>G6! C7EB=:J;MG>! 5G! H\J5E45C:=C;>! 8=H8;MG>[! nG5;MGR;H! >A! C5;:]! H>! 9>I;C:9>! >G95B4>A! 3>! H\;ACGPP;C=A8>! 8=93;=MG>! E5A:9>! =GS5G93RJG;! MG>! 8>C! E43;8=E>A:C! C5A:! A>::>E>A:! E5;AC! B9>C89;:C! MG>! 3=AC! H\'0< O)9[!

1- Inhibition du syst•me rŽnine-angiotensine -aldostŽrone

/>!C7C:FE>!94A;A><=AI;5:>AC;A><=H35C:495A>!>C:!;EBH;MG4!3=AC!GA!8>9:=;A!A5ET9>!3>!B958>CCGC! =CC58;4C! Q! H\;ACGPP;C=A8>! 8=93;=MG>! 85EE>! H\J7B>9:>AC;5A! =9:49;>HH>]! H\J7B>9:95BJ;>! @>A:9;8GH=;9>! I=G8J>]! H=! P;T95C>! E758=93;MG>! >:! H=! 37CP5A8:;5A! =9:49;>HH>[! />! TH58=I>! 3>! 8>! C7C:FE>! Q! C>C! 3;PP49>A:C! A;@>=G6! =! B95G@4! C5A! >PP;8=8;:4! 8J>U! H>C! B=:;>A:C! =@>8! '0<O)9! ^0$V#)V#l#! "jXdc! #$/L2!'A@>C:;I=:59C!"jj"c!?;::]!ƒ=AA=3!>:!=H[!"jjjc!?;::]!p;HH;=EC!>:!=H[!*YY"c!.9=AI>9]!%8%G99=7! >:! =H[! *YY+c! m5GAI]! 2GAH=B! >:! =H[! *YY,_! >:! H>C! ;AJ;T;:>G9C! 3>! HR>AU7E>! 3>! 85A@>9C;5A! 3>! HR=AI;5:>AC;A>!^')0_!5A:!GA!>PP>:!T4A4P;MG>!CG9!H=!94I9>CC;5A!3>!H\J7B>9:95BJ;>!@>A:9;8GH=;9>!8J>U!H>C! B=:;>A:C! J7B>9:>A3GC! ^?;::]! p;HH;=EC! >:! =H[! *YY"_]! 3;=T4:;MG>C! 5G! =7=A:! GA>! 8595A=95B=:J;>[! 0>B>A3=A:]!GA!>PP>:!B5C;:;P!>C:!3;PP;8;H>!Q!34E5A:9>9!=G!85G9C!3>!HR'0<O)B[!

lA>! B>:;:>! 4:G3>! E>A4>! 8J>U! *"! B=:;>A:C! =@>8! GA>! '0<O)B! >:! GA! =A:4843>A:! 3\;AP=98:GC! 3G! E758=93>!^&95A5f!=A3!i95AU5A!"jj+_!=@=;:!;A;:;=H>E>A:!34E5A:94!H\>PP;8=8;:4!3>!H\4A=H=B9;H!3=AC! H\=E4H;59=:;5A! 3>! H=! 8H=CC>! P5A8:;5AA>HH>! >:! H=! :5H49=A8>! Q! HR>6>98;8>! :5G:! >A! 943G;C=A:! H=! E=CC>! @>A:9;8GH=;9>! I=G8J>[! 2\=G:9>C! B>:;:C! >CC=;C! 8H;A;MG>C! :>C:=A:! H>! H;C;A5B9;H! CG9! "*! B=:;>A:C! ^/=AI]! %8&HB;A>!>:!=H[!"jj-_!>:!H>!MG;A=B9;H!CG9!d,!B=:;>A:C!^ƒ;]!0=9E;8J=>H!>:!=H[!*YY+_!A\5A:!B=C!=BB59:4! 3>! 85AP;9E=:;5A[! 2>! ErE>]! GA>! B>:;:>! 4:G3>! E>A4>! 8J>U! *Y! B=:;>A:C! J7B>9:>A3GC! B94C>A:=A:! GA>! 37CBA4>! 3\>PP59:! =! E5A:94! HR>PP;8=8;:4! 3G! H5C=9:=A! 3=AC! H\=GIE>A:=:;5A! 3>! H=! 8=B=8;:4! 3\>6>98;8>! ^p=9A>9]! %>:UI>9! >:! =H[! "jjj_! E=;C! 8>::>! 3;PP49>A8>! AR=! B=C! 4:4! 9>:95G@4>! =@>8! H>! @=HC=9:=A! ^?=9:J=C=9=:J7]!?;>Cw>!>:!=H[!*YYj_[!

&! 8k:4! 3>C! 8>C! B>:;:>C! 4:G3>C]! 3>! I9=A3C! >CC=;C! :J49=B>G:;MG>C! 5A:! 4:4! E>A4C[! /\4:G3>! ?)?< 0NO! ^0H>H=A3]! K>A3>9=! >:! =H[! *YYg_]! EGH:;8>A:9;MG>! >A! 35GTH>! =@>GIH>]! >A! I95GB>C! B=9=HHFH>C]! 9=A35E;C4>!^B49;A35B9;H!@>9CGC!BH=8>T5_]!=!;A8HGC!X-Y!B=:;>A:C!3>!BHGC!3>!dY!=AC!>:!B94C>A:=A:!GA>! '0<O)B!^34P;A;>!B=9!GA>!O)€,Ye_[!/>!89;:F9>!B9;E=;9>!3>!SGI>E>A:!4:=;:!85EB5C;:>!>:!85EB9>A=;:!H=! E59:=H;:4!:5G:>C!8=GC>C!85AP5A3G>C!>:!H>C!J5CB;:=H;C=:;5AC!B5G9!;ACGPP;C=A8>!8=93;=MG>!=@>8!GA!CG;@;!

!d"! B95I9=EE4! 3\=G! E5;AC! GA! =A[! &G8GA>! 3;PP49>A8>! C;IA;P;8=:;@>! >A:9>! H>C! 3>G6! I95GB>C! AR=! 4:4! 34:>8:4>!CG9!8>!89;:F9>!3>!SGI>E>A:]!ErE>!C;!H\5A!85AC;3F9>!MG>!H=!BG;CC=A8>!3>!H\4:G3>!=!4:4!H;E;:4>! B=9!GA>!P94MG>A8>!3\4@FA>E>A:C!;AP49;>G9>!Q!8>HH>!B94@G>[!2>!ErE>!3=AC!H\4:G3>!&//N&K!^2=@;C]! i5C:;C! >:! =H[! *YYX_]! H>! H;C;A5B9;H! 4:=;:! ;AP>9;>G9! Q! H=! 8JH59:=H;35A>! 3=AC! H=! B94@>A:;5A! 3>! A5G@>=G6! 4B;C53>C!3R'0<O)B[!

/\4:G3>! 0N&(%! =@=;:! B5G9! 5TS>8:;P! 3\4@=HG>9! H\>PP;8=8;:4! 3G! 8=A34C=9:=A! CG9! GA! I95GB>! 3>! B=:;>A:C! =::>;A:C! 3\;ACGPP;C=A8>! 8=93;=MG>! 8J95A;MG>! >:! 9>8>@=A:! 34SQ! GA! :9=;:>E>A:! 85A@>A:;5AA>H! ^mGCGP!*YY+_[!?=9E;!H>C!:95;C!I95GB>C!3>!B=:;>A:C!:9=;:4C!B=9!8>:!=A:=I5A;C:>!3>C!948>B:>G9C!&K"!3>! H\=AI;5:>AC;A>!'']!H>!T9=C!3>!HR4:G3>!3>A5EE4!`0N&(%<B9>C>9@>3`!85EB9>A=;:!+Y*+!B=:;>A:C!=3E;C! B5G9!'0<O)B!^P9=8:;5A!3R4S>8:;5A!E57>AA>!3>!-,e_]!:9=;:4C!B=9!H>!8=A34C=9:=A!^35C>!8;TH>!1!+*EI_!5G! H>!BH=8>T5[!&G!:>9E>!3\GA!CG;@;!3>!+]-!=AC]!GA>!T=;CC>!3>!""e!3>C!348FC!3\59;I;A>!8=93;5@=C8GH=;9>! 5G!3>C!J5CB;:=H;C=:;5AC!B5G9!;ACGPP;C=A8>!8=93;=MG>!=!4:4!85AC:=:4>]!E=;C!>HH>!A\=!B=C!=::>;A:!H>!C>G;H! 3>!C;IA;P;8=:;@;:4!C:=:;C:;MG>[!/>!A5ET9>!3\J5CB;:=H;C=:;5AC!B5G9!;ACGPP;C=A8>!8=93;=MG>!E5A:9=;:!GA>! :>A3=A8>! A5A! C;IA;P;8=:;@>! Q! H=! T=;CC>]! E=;C! 8>8;! 4:=;:! GA! 89;:F9>! C>85A3=;9>! 3>! SGI>E>A:[! 0>C! 94CGH:=:C! 5A:! 4:4! 85AP;9E4C! B=9! H\4:G3>! '<?()#)(L)! ^%=CC;>]! 0=9C5A! >:! =H[! *YYX_! 85AqG>! B5G9! 34E5A:9>9! H=! CGB49;59;:4! 3>! H\;9T>C=9:=A! ^35C>! 8;TH>! +YY! EIDS5G9_! CG9! H>! BH=8>T5! >A! :>9E>C! 3\=E4H;59=:;5A!3>!H=!CG9@;>!>:!3>!H=!943G8:;5A!3>!H=!E59T;3;:4!8=93;5@=C8GH=;9>!>A!B94C>A8>!3\GA>!'0< O)B!8J>U!,"*X!;ACGPP;C=A:C!8=93;=MG>C!vI4C!3>!BHGC!3>!gY!=AC]!C7EB:5E=:;MG>C]!=@>8!GA>!P9=8:;5A! 3R4S>8:;5A! CGB49;>G9>! Q! ,-e! >:! 948>EE>A:! J5CB;:=H;C4C! B5G9! 3>C! C7EB:kE>C! 3R;ACGPP;C=A8>! 8=93;=MG>[! &B9FC! -! =AA4>C! 3>! CG;@;]! =G8GA>! 3;PP49>A8>! C;IA;P;8=:;@>! AR=! 4:4! 34:>8:4>! >A:9>! H>C! 3>G6! I95GB>C[!)AP;A]!$?K'%'ƒ)<NO!^O5A=95f]!#:5GIJ!>:!=H[!*YYd_!;A8HG=A:!+XYg!B=:;>A:C!=@>8!GA>!'0< O)B!=!85AP;9E4!HR=TC>A8>!3R>PP>:!T4A4P;MG>!3RGA!=A:=I5A;C:>!3>C!948>B:>G9C!&K"!3>!HR=AI;5:>AC;A>!''[!

/>C! >CC=;C! 85A3G;:C! SGCMGR=H59C! B5G9! 4@=HG>9! H\>PP;8=8;:4! 3>! H=! CB;95A5H=8:5A>! 5A:! 35AA4! 3>C! ;A3;8=:;5AC!@=9;=TH>C!1!;H!=!4:4!;A;:;=H>E>A:!5TC>9@4!GA>!=E4H;59=:;5A!3>!H=!:5H49=A8>!Q!H\>PP59:!>:!3>!H=! P5A8:;5A!3;=C:5H;MG>!3=AC!GA!I95GB>!3>!P>EE>C!=@>8!'0<O)B!^2=A;>H]!p>HHC!>:!=H[!*YYj_!:5G:!85EE>! 3=AC!GA!I95GB>!3>!B=:;>A:C!=@>8!GA!C7A395E>!E4:=T5H;MG>!>:!GA>!'0<O)B!8J>U!MG;!H>C!E=9MG>G9C!3>! P;T95C>! >A! 94CGH:=;>A:! 943G;:C! ^i5CE=H=]! ?9U>fH58w=<i5CE=H=! >:! =H[! *Y""_[! &G! 85A:9=;9>]! 3=AC! H\4:G3>!&H35<2NO!^)3>HE=AA]!p=8J:>9!>:!=H[!*Y"+_!MG;!=!;A8HGC!,**!B=:;>A:C!>A!C:=3>!VmN&!''<''']! H=!CB;95A5H=8:5A>!^*-!EIDS_!=!B>9E;C!GA>!=E4H;59=:;5A!3>C!B=9=EF:9>C!3>!P5A8:;5A!3;=C:5H;MG>!C=AC! >PP>:!CG9!H>C!C7EB:kE>C[!&@=A:!3>!9>:>A;9!8>::>!5B:;5A!:J49=B>G:;MG>]!;H!P=G:!=::>A39>!H>C!94CGH:=:C!3>! H\;EB59:=A:>! 4:G3>! K$?0&K! ^#J=J]! N>;:A>9! >:! =H[! *Y"+_[! )HH>! >C:! B95EG>]! >A:9>! =G:9>C]! B=9! H>!

!d*! H>!+"!S=A@;>9!*Y"*[!)HH>!=!;A8HGC!+,,-!B=:;>A:C!B94C>A:=A:!GA>!'0<O)B!>:!:9=;:4C!B=9!H=!CB;95A5H=8:5A>! 5G!GA!BH=8>T5[!!

?=9!=;HH>G9C]!GA!;AJ;T;:>G9!3;9>8:!3>!H=!94A;A>!^H\=H;Cw;9FA>_!^.9=3E=A]!#8JE;>3>9!>:!=H[!*YY-_! >:!3>!H=!A4B9;C;H;A>!^/0ƒgjg_!5A:!4:4!>6BH594C!!B5G9!H>G9!G:;H;C=:;5A!8J>U!H\J5EE>[!/\>CC=;!&//&m! ^#5H5E5A]! &BB>HT=GE! >:! =H[! *YYj_! =! ;A8HGC! ,g-! B=:;>A:C! =@>8! J7B>9:>AC;5A! >:! =! E5A:94! H=! A5A! ;AP49;59;:4! 3>! H\=H;Cw;9FA>! vs.! H>! H5C=9:=A! 3=AC! H=! 943G8:;5A! 3>! H=! E=CC>! 3G! L.[! /\=H;Cw;9FA>! 9>C:>! 85A:9><;A3;MG4! >A! 85<=3E;A;C:9=:;5A! =@>8! H>C! ')0! >:! H>C! &(&<''! 8J>U! H>C! B=:;>A:C! 3;=T4:;MG>C! >A! 9=;C5A!3\GA!9;CMG>!=GIE>A:4!3\J7B>9w=H;4E;>]!3\J7B5:>AC;5A!>:!3\=II9=@=:;5A!3>!H=!P5A8:;5A!94A=H>]! 85EE>!9>:95G@4!B=9!H\>CC=;!&/K'Kl2)!^?=9@;AI]!W9>AA>9!>:!=H[!*YYj_[!/>!/0ƒgjg!8GEGH>!GA!>PP>:! 3>!TH58=I>!3G!948>B:>G9!:7B>!"!3>!H\&K''!=@>8!H\;AJ;T;:;5A!3>!H=!A4B9;C;H;A>!B>9E>::=A:!3>!943G;9>!H>! 8=:=T5H;CE>! 3>C! B>B:;3>C! A=:9;G9>:;MG>C_]! E5A:9=A:! GA! >PP>:! =A:;J7B>9:>AC>G9! BHGC! ;EB59:=A:! MG>! H>! @=HC=9:=A!^(G;H5B>]!2Gw=:!>:!=H[!*Y"Y_!c!H\>CC=;!8H;A;MG>!3>!BJ=C>!''!?&(&%$lVK!^#J=J]!N>;:A>9! >:!=H[!*Y"+_!8J>U!3>C!B=:;>A:C!=@>8!'0<O)B!=!5TC>9@4!GA>!943G8:;5A!BHGC!;EB59:=A:>!3>C!A;@>=G6!3>! VK<B95WV?!85EB=94!=G!@=HC=9:=A[!

2- !-bloquants

/>C!#<TH5MG=A:C!5A:!P=;:!H=!B9>G@>!3>!H>G9!>PP;8=8;:4!3=AC!H=!943G8:;5A!3>!H=!E59:=H;:4!=G!85G9C! 3>! HR'0<O)9! B=9! 3>C! EGH:;BH>C! E48=A;CE>C! ^K9;B5Cw;=3;C]! i=9=7=AA;C! >:! =H[! *YYj_[! ?>G! 3\4:G3>C! C>! C5A:!B=9!85A:9>!;A:49>CC4>C!=G6!B=:;>A:C!=@>8!GA>!'0<O)B[!lA>!B9>E;F9>!4:G3>!^&95A5f]!&JA!>:!=H[! "jjd_! ! ;A8HG=A:! "-X! B=:;>A:C! 3>! BHGC! 3>! g*! =AC! E5A:9=;:! GA! >PP>:! T4A4P;MG>! 3G! B95B9=A5H5H! ^35C>! 8;TH>! jY! EIDS5G9_! =@>8! GA>! 943G8:;5A! 3>! H=! E59:=H;:4! :5G:>C! 8=GC>C! 85AP5A3G>C[! 0>B>A3=A:]! H>! B5G98>A:=I>!3>!348FC!H;4C!=G6!8=GC>C!8=93;=MG>C!AR4:=;:!B=C!C;IA;P;8=:;@>E>A:!3;PP49>A:!3>!8>HG;!3G! I95GB>! A>! 9>8>@=A:! B=C! H>! #<TH5MG=A:[! lA! =G:9>! =A:=I5A;C:>]! H>! 8=9@43;H5H! =! =E4H;594! H>C! ;A3;8>C! 48J58=93;5I9=BJ;MG>C! 4@=HG=A:! H=! P5A8:;5A! 3;=C:5H;MG>! ^4:G3>! #p)2'0]! ^W>9IC:95E]! &A3>9CC5A! >:! =H[! *YY,__[! 0>C! >PP>:C! T4A4P;MG>C! 3G! 8=9@43;H5H! 5A:! 4:4! 9>:95G@4C! 3=AC! GA>! =G:9>! 4:G3>! E>A4>! =G! S=B5A! CG9! GA! P=;TH>! >PP>8:;P! 3>! ,Y! B=:;>A:C! ^K=w>3=]! OGwG:5E;! >:! =H[! *YY,_[! 2>! ErE>! H>! 9>I;C:9>! 0$N)()! =! >6=E;A4! H\>PP;8=8;:4! 3G! 8=9@43;H5H! 3=AC! H=! B9;C>! >A! 8J=9I>! 3>! H\;ACGPP;C=A8>! 8=93;=MG>! ^%=CC;>]! V>HC5A! >:! =H[! *YYd_[! />C! B=:;>A:C! B94C>A:=A:! GA>! P9=8:;5A! 3\4S>8:;5A! CGB49;>G9>! Q! ,Ye! =@=;>A:! GA>! =E4H;59=:;5A! 3>! H>G9! 4:=:! P5A8:;5AA>H! >:! 3>C! :=G6! 3\J5CB;:=H;C=:;5A! 943G;:C! H59CMG\;HC! 4:=;>A:!:9=;:4C!B=9!H>!8=9@43;H5H[!0>B>A3=A:]!H\=E4H;59=:;5A!4:=;:!;AP>9;>G9>!Q!8>HH>!5TC>9@4>!8J>U!H>C! B=:;>A:C!=@>8!'0<O)9[!/\>CC=;!y<2NO!^m=E=E5:5]!$9;I=C=!>:!=H[!*Y"*_!@;>A:!3>!E5A:9>9!3>C!94CGH:=:C! A4I=:;PC!3=AC!GA>!B5BGH=:;5A!S=B5A=;C>!:9=;:4>!B=9!GA>!35C>!P=;TH>!^>A@;95A!d[-!EIDwI_!3>!8=9@43;H5H! E=;C! H=;CC>! >A:9><=B>98>@5;9! MG\Q! GA>! BHGC! P59:>! 35C>! ^*Y! EIDwI_! H>C! >PP>:C! B5G99=;>A:! r:9>! T4A4P;MG>C[!

!d+! lA! =G:9>! #<TH5MG=A:! =! 4I=H>E>A:! P=;:! H\5TS>:! 3\;A@>C:;I=:;5AC]! H>! A4T;@5H5H! MG;! B94C>A:>! H=! B=9:;8GH=9;:4!3>!P=@59;C>9!H=!H;T49=:;5A!3>!V$!^05A9==3C]!%>:9=!>:!=H[!*Y"*_[!/\4:G3>!#)V'$(#!=!4:4! 94=H;C4>!>A!)G95B>!>:!=!;A8HGC!*"+-!B=:;>A:C!vI4C!3>!BHGC!3>!dY!=AC]!J5CB;:=H;C4C!B5G9!;ACGPP;C=A8>! 8=93;=MG>! ;A34B>A3=EE>A:! 3>! H>G9! P9=8:;5A! 3\4S>8:;5A! ^OH=:J>9]! #J;T=:=! >:! =H[! *YY-_[! />C! B=:;>A:C! 5A:! 4:4! 9=A35E;C4C! B5G9! 9>8>@5;9! >A! 35GTH>! =@>GIH>! H>! A4T;@5H5H! ^35C>! 8;TH>! "Y! EIDS5G9_! 5G! GA! BH=8>T5[! &G! :>9E>! 3>! :95;C! =AC! 3>! CG;@;]! H>! 89;:F9>! B9;E=;9>! ^E59:=H;:4! :5G:>! 8=GC>! 85AP5A3G>! >:! =3E;CC;5A!B5G9!4@FA>E>A:C!8=93;5<@=C8GH=;9>C_!=!4:4!943G;:!3>!",e!=@>8!GA!T4A4P;8>!3FC!H>!C;6;FE>! E5;C[! K5G:>P5;C]! H>! T4A4P;8>! 3G! A4T;@5H5H! A\=! B=C! 4:4! 9>:95G@4! 8J>U! H>C! B=:;>A:C! MG;! =@=;>A:! GA>! P9=8:;5A! 3\4S>8:;5A! C7C:5H;MG>! CGB49;>G9>! Q! ,Ye[! 2=AC! H\4:G3>! )/&V22! 948>EE>A:! BGTH;4>! ^05A9==3C]! %>:9=! >:! =H[! *Y"*_]! H>! A4T;@5H5H! A\=! B=C! =E4H;594! H=! 8=B=8;:4! 3\>6>98;8>! 5G! H>C! C7EB:kE>C]!85EB=94!=G!BH=8>T5[!

2>! E=A;F9>! BHGC! I4A49=H>]! H>! 9>I;C:9>! $?K'%'ƒ)<NO! =! >A9kH4! ,"-+! B=:;>A:C! =@>8! NOB)O! S=E=;C! :9=;:4C! B=9! #<TH5MG=A:C! H59C! 3>! H>G9! B9>E;F9>! J5CB;:=H;C=:;5A! B5G9! 37CP5A8:;5A! 8=93;=MG>! ^N>9A=A3>U]! N=EE;HH! >:! =H[! *YYj_[! &! H=! C59:;>]! +je! 3>! 8>C! B=:;>A:C! 9>8>@=;>A:! GA! :9=;:>E>A:! #< TH5MG=A:!1!8>!:9=;:>E>A:!A\=!B=C!E53;P;4!3>!P=q5A!C;IA;P;8=:;@>!H=!E59:=H;:4]!H=!94<J5CB;:=H;C=:;5A!5G! 3\=G:9>C! B=9=EF:9>C! 85ET;A4C! 3>! SGI>E>A:[! lA! =G:9>! >CC=;! 8H;A;MG>! 3>! I9=A3>! =EBH>G9! ^"*YY! B=:;>A:C_!>C:!>A!85G9C!^H\>CC=;!#<?()#)(L)!^ƒJ5G]!#J;!>:!=H[!*Y"Y__[!

3- Les antagonistes calciques

#>GH>C! 3>C! 4:G3>C! E>A4>C! Q! GA>! B>:;:>! 48J>HH>! 5A:! :>C:4! H>C! >PP>:C! 3\=A:=I5A;C:>C! 8=H8;MG>C! 85EE>!H>!@49=B=E;H[!2=AC!GA!>CC=;!;A8HG=A:!*Y!B=:;>A:C!B5G9!GA>!3G94>!3>!-!C>E=;A>C!^#>:=95]!ƒ=9>:! >:!=H[!"jjY_]!H>!@49=B=E;H!=!=GIE>A:4!H=!8=B=8;:4!Q!H\>6>98;8>!3>!++e!>:!H>!9>EBH;CC=I>!3;=C:5H;MG>! 3>! +Ye[! 2=AC! GA! =G:9>! >CC=;! E>A4! CG9! "-! B=:;>A:C! vI4C! >A! 8H=CC>! ''<'''! 3>! H=! New Y ork Heart

A ssociation!>:!B94C>A:=A:!GA>!P9=8:;5A!3\4S>8:;5A!A59E=H>]!^NGAI]!0J>9AI!>:!=H[!*YY*_]!=B9FC!+!E5;C!

3>! :9=;:>E>A:]! H>! @49=B=E;H! =! C;IA;P;8=:;@>E>A:! =E4H;594! H>! C859>! 3>! H\;ACGPP;C=A8>! 8=93;=MG>]! H=! 3G94>!3\>6>98;8>!>:!H>C!B=9=EF:9>C!3>!H=!P5A8:;5A!3;=C:5H;MG>[!/=!A;P43;B;A>]!GA!TH5MG>G9!3>C!8=A=G6! 8=H8;MG>C!3>!:7B>!/!>C:!=8:G>HH>E>A:!>A!85G9C!3\>CC=;!^V0KY""-d,X"_[!

4- Les digitaliques

/>C!3;I;:=H;MG>C!B5G99=;>A:!:J459;MG>E>A:!B94C>A:>9!GA!T4A4P;8>!>A!9=;C5A!3>!H=!943G8:;5A!3>! H=! P94MG>A8>! 8=93;=MG>! >:! 3\GA>! =8:;@=:;5A! 3>C! P5A8:;5AC! 3>C! T=958>B:>G9C[! /\>CC=;! 8H;A;MG>! 2'.! ^&JE>3]! (;8J! >:! =H[! *YYg_! =! 9=A35E;C4! jXX! B=:;>A:C! =@>8! '0<O)B! 9>8>@=A:! 3>! H=! 3;I56;A>! 5G! GA! BH=8>T5[! &G8GA! T4A4P;8>! A\=! 4:4! 85AC:=:4! >A! :>9E>C! 3\J5CB;:=H;C=:;5A! 5G! 3>! E59:=H;:4! H;4>C! Q! H\;ACGPP;C=A8>!8=93;=MG>!>HH><ErE>[!

!d,!

5- Les diurŽtiques

/>C! 3;G94:;MG>C! C5A:! ;A3;CB>AC=TH>C! B5G9! H>! 85A:9kH>! 3>C! C7EB:kE>C! 85AI>C:;PC! 8J>U! H>C! B=:;>A:C! =@>8! '0<O)B! :5G:! 85EE>! B5G9! H\'0<O)9[! ?=9! H=! 943G8:;5A! 3>! H=! 85AI>C:;5A! 8>A:9=H>]! H>! @>A:9;8GH>!B>G:!5B49>9!3=AC!GA>!U5A>!BHGC!85EBH;=A:>!3>!H=!85G9T>!B9>CC;5A<@5HGE>[!/>C!3;G94:;MG>C! C5A:!E5;AC!G:;H>C!8J>U!H>C!B=:;>A:C!C=AC!4@;3>A8>!8H;A;MG>!3>!CG98J=9I>]!>:!>A!9=;C5A!3>!H=!B948J=9I>< 34B>A3=A8>!BHGC!;EB59:=A:>!=G!85G9C!3>!H\NOB)O]!H>G9!G:;H;C=:;5A!B5G99=;:!r:9>!3=AI>9>GC>!^W59H=GI! =A3!i=CC!*YYX_[!2=AC!H\4:G3>!&//N&K!^2=@;C]!i5C:;C!>:!=H[!*YYX_]!H=!8JH59:=H;35A>]!GA!3;G94:;MG>! :J;=U;3;MG>]! 943G;C=;:! H\;A8;3>A8>! 3>! H\'0<O)B]! 2>! ErE>]! GA>! =G:9>! 4:G3>! =! 85A8HG! Q! GA! T4A4P;8>! 3=AC! H\=E4H;59=:;5A! 3>C! C7EB:kE>C! B=9! H>C! 3;G94:;MG>C! =G! 85G9C! 3>! H\'0<O)B! ^m;B]! p=AI! >:! =H[! *YYX_[!

6- Les dŽrivŽs nitrŽs

L;=!GA!E48=A;CE>!.%?8<34B>A3=A:!>:!?i.<34B>A3=A:]!H>C!349;@4C!A;:94C!B>G@>A:!943G;9>!H=! B948J=9I>]! B>9E>::=A:! =;AC;! =G! @>A:9;8GH>! 3>! :9=@=;HH>9! Q! 3>C! A;@>=G6! 3>! 8J=9I>! BHGC! T=C! ^W59H=GI! =A3!i=CC!*YYg_[!%=HI94!H=!EGH:;:G3>!3\>PP>:C!B5:>A:;>HH>E>A:!T4A4P;MG>C!^KC=;!=A3!i=CC!*YYj_]!H>C! 35AA4>C! 8H;A;MG>C! C5A:! 9=9>C!1! H>G9! G:;H;C=:;5A! CG9! 3>C! 85G9:>C! 5G! H5AIG>C! 3G94>C! B5G99=;:! r:9>! G:;H>! 3=AC!H>!:9=;:>E>A:!3>!H=!37CBA4>!8J>U!H>C!B=:;>A:C!=@>8!'0<O)B]!CG9:5G:!8>G6!MG;!C5A:!>G@5H4E;MG>C! >:!8J>U!H>CMG>HC!H>C!3;G94:;MG>C!A>!C5A:!B=C!;A3;MG4C[!/=!85ET;A=;C5A!3>!3;A;:9=:>!3\;C5C59T;3>!>:!3>! H\J739=H=U;A>! B5G99=;:! =@5;9! GA! >PP>:! P=@59=TH>! =G! 85G9C! 3>! H\'0<O)B!c! >HH>! >C:! :>C:4>! 3=AC! GA! >CC=;! 8H;A;MG>!=8:G>HH>E>A:!>A!85G9C!^VK0Y"-"g+,g_[!

)AP;A]! =G! 85G9C! 3>! H\;ACGPP;C=A8>! 8=93;=MG>]! H>! C:9>CC! 5673=A:! P=@59;C>! H>! 3485GBH=I>! 3>! H=! V$#[!2>!8>!P=;:]!;H!B5G99=;:!>6=8>9T>9!H=!37CP5A8:;5A!3;=C:5H;MG>[!/=!:>:9=J7395T;5B:49;A>!^WN,_]!GA!

85P=8:>G9! >CC>A:;>H! 3>! H=! V$#! >A35:J4H;=H>]! >C:! 8=B=TH>! 3\=::4AG>9! H>! 9>E53>H=I>! >:! =E4H;59>9! H>! 85GBH=I>!3>!H=!V$#!3=AC!GA!E53FH>!=A;E=H!3>!CG98J=9I>!@5HGE;MG>!^%5>AC]!K=w;E5:5!>:!=H[!*YYX_[! 'H!A\7!=!B=C!3>!35AA4>C!8H;A;MG>C!3;CB5A;TH>C!Q!8>!S5G9[!