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Biomedical subjects

J Amar

Publications and source records attributed to J Amar.

At least 37 records · Page 2Linked to original sources
PubMed1998

[Influence of global cardiovascular risk assessment on the management of hypertension in southwestern France].

1,160 subjects aged 35-64 years were recruited by the Haute-Garonne MONICA center, and selected by stratified randomization on age and size of home area. The hypertensive group included: 176 subjects newly diagnosed as hypertensives (blood pressure > or = 140/90 mmHg), 86 known but untreated hypertensives and 178 hypertensives under treatment. For each subject a score of coronary heart disease risk based on the Framingham point score probability algorithm was calculated. The prevalence of hypertension was 37.9%. Among the 440 subjects considered as hypertensives, 60% were aware of having hypertension. Only 30% of the 178 patients treated achieved blood pressure control. The population as a whole was at low coronary heart disease risk (< 5% at 10 years); the groups at higher risk were newly diagnosed hypertensives and treated hypertensives. Among known hypertensives, the risk level was higher in treated compared with untreated. In this survey 1) the prevalence of hypertension was high; 2) only 30% of treated hypertensives were below 140/90 mmHg; 3) usual care failed to recognize 40% of hypertensives at same risk level as treated ones; 4) treated hypertensives had higher coronary heart disease risk than untreated known hypertensives. The hypertension therapeutic strategy could be based on the reduction of blood pressure below the threshold 140/90 mmHg rather than on the absolute cardiovascular risk.

Adult↗
PubMed1997

Influence of nycthemeral blood pressure pattern in treated hypertensive patients on hemodialysis.

Arterial hypertension in end-stage renal disease (ESRD) patients is characterized by an altered nycthemeral blood pressure (BP) rhythm and an increased pulse pressure, and it could be suggested that this association of risk factors plays a major role in the cardiovascular prognosis of this population. The aim of this study was to determine the influence of nycthemeral BP pattern on arterial distensibility and pulsatile components of BP in treated hypertensive patients on regular hemodialysis. Forty-two hypertensive patients were included, and all underwent ambulatory BP and pulse wave velocity (PWV) measurements between the femoral and carotid arteries. The patients were divided into two groups according to the magnitude of the nocturnal fall in BP: dippers and non-dippers. The groups were similar in gender, age, duration of hemodialysis, body mass index, body size, history of cardiovascular complications, class and number of antihypertensive drugs used per patient. PWV was significantly higher in non-dippers. For the whole population, a stepwise regression analysis showed that PWV and erythropoietin therapy were independently related to the impaired nycthemeral BP pattern. In addition to its pressor effect, erythropoietin could have a deleterious influence on the ambulatory BP profile of treated hypertensive patients in ESRD. Arterial distensibility and nycthemeral BP impairment are linked, and these cardiovascular risk factors should be taken into account together for the management of hypertensive hemodialysis patients.

Adult↗
PubMed1997

[Intima media thickness of the carotid artery in white coat and ambulatory hypertension].

Recent epidemiological studies have reported an association between carotid intima media thickness (IMT), ambulatory blood pressure (ABP) and absolute cardiovascular risk. To study the relation between white coat effect and vascular changes in hypertensives (HT), 57 essential HT (office blood pressure (OBP) 152.2 +/- 19.5/93.7 +/- 12.4 mmHg) were recruited (46.4 +/- 11.8 years old, 49 men). After antihypertensive drugs withdrawal, an ABP was performed (Spacelabs 90207). The right common carotid artery IMT 3 cm proximal to the bifurcation was examined by ultrasonography. IMT (0.59 +/- 0.09 mm; Software lotec system) were measured by a reader blinded to the ABP data. White coat hypertension (WCH) was defined by a mean day-time ambulatory BP (d-ABP) lower than the 90th percentile of the distribution of daytime ABP of a normotensive population reported by Verdecchia et al. (131/86 mmHg in women and 136/87 mmHg in men). [table: see text] White coat hypertension was found in 8 from 57 (14%) subjects. IMT was significantly increased in ambulatory HT when compared with white coat HT while age, sex ratio, OBP, smoking status were not different. In stepwise regression age and systolic d-ABP were the only determinants of IMT (p < 0.05). In our hypertensive population. ABP appears more closely related to IMT than OBP and IMT in sustained is greater than in white coat hypertensive.

Adult↗
PubMed1996

Dippers and non-dippers among overweight hypertensive men.

OBJECTIVE: To determine the links between circadian blood pressure rhythm and metabolic profile in overweight essential hypertensive men with an elevated waist: hip ratio (> 0.95). METHODS: Ambulatory blood pressure monitoring (ABPM) was performed in 53 patients (using a SpaceLabs 90207 device) after withdrawal of antihypertensive medication. All of the patients underwent an oral glucose-tolerance test. Blood lipids and lipoproteins were measured with standard techniques. The left ventricular mass index was determined by echocardiography according to American Society of Echocardiography (ASE) recommendations. According to the magnitude of the decrease in nocturnal blood pressure measured by ABPM two groups were defined: dippers (n = 27) and non-dippers (n = 26). RESULTS: The non-dipper group showed a higher diurnal and noctural pulse pressure, a greater left ventricular mass index and a higher level of 2 h glycaemia, in spite of their body mass index being almost identical to that of the dipper group. There were no differences in lipid parameters. In stepwise regression analysis, age and 2 h glycaemia appeared to be the only independent determinants of an altered circadian blood pressure pattern. In order to specify the potential influence of the metabolic profile independently of age on the circadian blood pressure pattern, two age-matched subgroups were constituted. Of the 53 hypertensive patients, 28 from the dipper and non-dipper groups were considered; for each non-dipper patient an age-matched (within 2 years) dipper patient was selected from the population. Despite their having the same age, body mass index and fasting glycaemia, a higher 2 h glycaemia (P < 0.01) and, to a lesser extent, a higher 3 h glycaemia (P = 0.06) were observed in the non-dipper group compared with the dipper group. CONCLUSION: It is suggested that, in overweight hypertensive men, a reduced nocturnal blood pressure decrease could be related both to age and to metabolic profile and that ABPM could be an effective tool for a global approach to cardiovascular risk in this population.

Journal Article↗
PubMed1996

Relationships between blood pressure components, lipids and lipoproteins in normotensive men.

The aim of this study is to assess the relationships between pulse pressure (PP) mean arterial pressure (MAP), clinical and lipid parameters in normotensive men. One hundred and twenty-seven normotensive men aged 35-64 years from the French department of Haute-Garonne were analysed. Blood pressure (BP) was measured using a random zero device. Correlation analysis was performed using Pearson's coefficient. Variables significantly related to PP and MAP were then introduced in a stepwise multiple regression analysis. On univariate analysis, PP was significantly and positively related to total cholesterol, triglycerides, VLDL and LDL-cholesterol and apo B. MAP was positively related to age, body mass index (BMI), triglycerides and VLDL-cholesterol. Stepwise multiple regression analysis showed only apo B to be independently related to PP after adjustment for MAP. Also, after adjustment for PP, only BMI and VLDL-cholesterol were related to MAP. Hence, MAP is related to BMI and VLDL-cholesterol, which are a common feature of hyperinsulinism. PP is linked to apo B, an important proatherogenic factor. These biological parameters appear specific of steady and pulsatile components of BP. The relationship between PP and apo B suggests a possible link between lipids and arterial stiffness, and may partly explain the prognostic value of PP in myocardial infarction.

Adult↗
PubMed1996

[Aldosterone precursors and hypertension with hypokalemia and adrenal module non caused by primary hyperaldosteronism].

The purpose of the study was to evaluate the interest of aldosterone precursors assays in arterial hypertension with hypokaliemia and adrenal nodules non due to aldosterone. Seven hypertensive patients, 3 men and 4 women, aged 59.5 +/- 10.1 years were included in the study. After drug withdrawal, kaliemia was 3.1 +/- 0.3 mmol/l (2.7-3.6), active renin 2.9 +/- 1.4 ng/l, plasma aldosterone (aldo) 108 +/- 49.4 pg/ml, cortisol 13 +/- 3.1 micrograms/100 ml, and [S] 0.47 +/- 0.5 micrograms/100 ml. Adrenal CT scan showed an adenoma in 3 patients (30.5 +/- 5 mm) and an unilateral nodular hyperplasia in 4 patients. In all patients, the plasma levels (RIA, chomatographic step) of the following steroids in the mineralocorticoid (MC) pathway were determined: DOC, 18 OH-DOC, B, 18 OH-B and aldosterone. Two from 7 (28%) exerted aldosterone precursors excess, 1 with DOC-producing adenoma (DOC-PA) (table), and 1 with a partial 11 beta hydroxylase deficiency (DOC: 211 pg/ml; S: 1 mu/100 ml). Aldosterone/DOC + 18 OH-DOC ratio proposed as a malignancy index was decreased in the patient with DOC-PA (8.1). No dysfunction in the MC pathway was identified in the 5 other patients. [table: see text] The study suggests the relevance of aldosterone precursors assays in low renin hypertension non due to aldosterone and in incidentally discovered adrenal masses.

Adenoma↗
PubMed1995

Influence of glucose metabolism on nycthemeral blood pressure variability in hypertensives with an elevated waist-hip ratio. A link with arterial distensibility.

We studied the influence of glucose metabolism on the nycthemeral blood pressure (BP) pattern and arterial distensibility in 33 nontreated hypertensive patients, 45.6 +/- 8.5 years old, with elevated waist/hip ratio. All patients underwent an ambulatory BP monitoring, a pulse wave velocity (PWV) measurement, and an oral glucose tolerance test. The ratio of mean nocturnal:diurnal systolic BP (N/D ratio) was used to assess nycthemeral BP variability. N/D ratio correlated positively with PWV (r = 0.62; P < .01). When considered according to their glycemic status, N/D ratio and PWV were significantly higher (P < .05; P < .01) in diabetics and in glucose intolerants compared to patients with normal glucose levels. Our data indicate that the nycthemeral BP pattern was different according to the metabolic status. The loss of nocturnal decline in BP is associated with carbohydrate disturbances and reduced arterial stiffness.

Adult↗
PubMed1995

Plasma levels of aldosterone versus aldosterone precursors: a way to estimate the malignancy of asymptomatic and nonsecretory adrenal tumors: a French Retrospective Multicentric Study.

The aim of this study was to find out whether the dysfunction of aldosterone pathway, previously proposed as a marker of secretory adrenal carcinoma, is also found in nonsecretory adrenal carcinomas, which pose even more difficult diagnostic problems even for patients with hypertension accompanied or not by hypokalemia. The exploration consisted of using the same method (RIA preceded by a chromatographic step) to determine the plasma levels of the following steroids in the mineral corticosteroid pathway: deoxycorticosterone (DOC), 18-hydroxydeoxycorticosterone (18-OHDOC), corticosterone (B), 18 hydroxycorticosterone (18 OH B), and aldosterone. The subjects included 16 adults, each presenting with an endocrinologically asymptomatic adrenal mass associated for some patients with hypokalemia and hypertension (8 with adrenal carcinoma, 2 with adrenal metastasis from other forms of cancer, and 6 adenomas). These results show that even in nonsecretory adrenal carcinoma, there is a dysfunction of the aldosterone pathway, which can be evaluated from the ratio between aldosterone and the substrate of 11 beta hydroxylase (DOC) and its derivative (18-OH DOC). This study suggests that exploration of mineralocorticosteroid pathway can be used as a hormonal marker of adrenal carcinoma for both secretory and non-secretory malignant masses.

Adrenal Gland Neoplasms↗
PubMed1995

[Conceptual basis and diagnosis of primary hyperaldosteronism].

Primary aldosteronism comprises two different conditions, the tumoral form usually caused by an adenoma and the idiopathic form due to nodular hyperplasia of the two adenals. More rarely, an adenoma of the adrenal cortex, glucocorticosteroid-sensitive hyperplasia, and angiotensin-sensitive adenoma or an autonomous nodule transformed to primary tumoral hyperplasia, may be observed. Primary alderosteronism may be conceived as a spectrum of genetic abnormalities which express themselves either by hyperplasia or by a tumour. A defect in steroid genesis and prolonged stimulation of the cortex would lead to the formation of nodules which may become autonomous and generate a tumour. Hypertension may be isolated. Detection requires three sampling of serum potassium in all hypertensive patients, a study of the aldosterone-renin axis when the value is less than 3.6 mEq, or whenever the hypertension is severe or resistant to treatment. The diagnosis is made by the association of an increased plasma aldosterone level before getting up in the morning and a plasma renin unaffected by orthostatism. The choice of medical or surgical treatment depends on the uni- or bilateral anatomic substrate. Computerised tomography, very sensitive but not specific, like hormonal studies, often provides incomplete answers. Adrenalectomy is indicated in the presence of a mass of centimetric proportions with concordant results of the dynamic test. In other situations, investigations are continued with the search for an aldosterone gradient by selective venous sampling. This is very valuable to determine the lateralisation but fails in 25% of cases, and its results have to be compared with those of imaging techniques: CT scan, venography and, when necessary, scintigraphy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenoma↗
PubMed1995

[Combination therapy in the therapeutic strategy of arterial hypertension].

The standard treatment of mild-to-moderate hypertension is monotherapy chosen from one of the five main classes of antihypertensives following the World Health Organisation and Joint National Committee guidelines. If first-line monotherapy fails, the physician must decide whether to increase the dose, choose a drug from a different class or add a second antihypertensive. However, greater efficacy must not be obtained at the cost of an unacceptable increase in side-effects. Sequential monotherapy is partly based on the impossibility of predicting the blood pressure response to a given antihypertensive. The validity of this strategy is supported by the findings of the Materson study, which suggest combination therapy only after the failure of at least two monotherapies. The aim of combination therapy is to optimize treatment by using two different classes of antihypertensives with synergistic effects. The anticipated advantages are ease of use, the enhancement or addition of the antihypertensive effects, and the possibility of administration to a wide population. This has led to the development of fixed combinations which are low-dosed to reduce the incidence of side-effects. Validated combinations (dosed differently according to the medicinal product) include: beta-blocker + diuretic, beta-blocker + dihydropyridine (DHP) calcium antagonist, angiotensin converting enzyme (ACE)-inhibitor + diuretic and in the future, ACE-inhibitor + calcium antagonist. The pharmacokinetic interaction of beta-blocker + DHP at the hepatic level must be considered to assess the efficacy of this combination.(ABSTRACT TRUNCATED AT 250 WORDS)

Antihypertensive Agents↗
PubMed1995

[What can we think about diastolic hypertension?].

Isolated diastolic hypertension is not officially recognized as a form of hypertension. It is currently defined as a diastolic pressure greater than 90 mm Hg with systolic pressure < 140 mmHg. It implies an elevation of vascular resistance in the arteriolar sector and small arteries, and persistence of distensibility of the aorta and large vessels. It therefore predominantly affects young patients with relatively recent HT, without any accentuation of aging of the vessel wall by smoking, diabetes, or atheroma. It is responsible for a reduction of pulse pressure, and does not appear to be associated with deterioration of the prognosis. The demonstration of diastolic HT indicates the presence of excess adrenergic tone with predominance of alpha tone, or raised plasma renin, in the absence of any alteration of myocardial function capable of reducing systolic pressure. Monotherapy with angiotensin converting enzyme inhibitors, which reduce stimulation of growth of smooth muscle fibres, and calcium channel blockers, whose effects increase with increasing vasoconstrictor tone, would be preferable to diuretics and non-selective beta-blockers.

Adrenergic alpha-Antagonists↗
PubMed1994

A relationship between aortic stiffness and serum HDL3 cholesterol concentrations in hypercholesterolaemic, symptom-free men. The PCVMETRA Group (Groupe de Prévention Cardiovasculaire en Médecine du Travail).

OBJECTIVE: We set out to evaluate the relationship between aortic stiffness and serum lipids and lipoprotein fractions, including high-density-lipoprotein (HDL) cholesterol subfractions. METHODS: One hundred and five asymptomatic, normotensive, untreated, hypercholesterolaemic men underwent measurement of aortic pulse-wave velocity (PWV) by mecanography and assay of total cholesterol, triglycerides, HDL cholesterol and its subfractions (HDL2 cholesterol and HDL3 cholesterol), determined by electrophoresis. RESULTS: PWV was related to HDL cholesterol (r = 0.21, p = 0.05) and more specifically to HDL3 cholesterol subfraction (r = 0.29, p < 0.01). The latter association remained significant after adjustment for systolic blood pressure and age. Multivariate analysis demonstrated an independent association of PWV (r2 = 0.27, P < 0.001) with age, systolic blood pressure and HDL3 cholesterol. CONCLUSION: Although hypercholesterolaemia was not accompanied by increased aortic rigidity, there was a positive relationship between PWV and HDL cholesterol and between PWV and HDL3 cholesterol independently of the influence of age and systolic blood pressure on PWV. These results suggest that, in hypercholesterolaemic men, HDL3 could, in addition to its anti-atherogenic property, have a prosclerotic stiffening effect. This duality could explain why, in clinical studies, although the level of the HDL2 subfraction is frequently associated with a lower incidence of coronary artery disease, results for the HDL3 subfraction are less convincing and remain equivocal.

Adult↗
PubMed1994

[Arterial blood pressure changes, circadian rhythm and arterial elasticity in hemodialysed patients].

An increased blood pressure variability (BVP) and a loss of nocturnal decline in BP could enhance cardiovascular disease. Peripheral resistances and arterial compliance determine systolic BP. BVP could depend on arterial stiffness. We tested this hypothesis in patients with end-stage renal disease (ERSD) who have arterial elasticity impairment. Twenty one ESRD patients (49.9 +/- 16.7 years) 12 mean and 9 women, undergoing maintenance hemodialysis were studied; 19 had treated hypertension. Ambulatory (ABP) monitoring was performed in all patients: BP was measured every 15 minutes in day-time and every 30 minutes at night. Systolic diurnal variation coefficient was calculated as the ratio between standard deviation and the mean of systolic diurnal BP. Nycthemeral BP pattern was evaluated as the ratio between mean diurnal and nocturnal systolic BP (N/D). Pulse wave velocity (PVW), an index of arterial stiffness, was determined between carotid and femoral sites (11.6 +/- 4.22 m/s). These investigations were performed after the midweek dialysis session. We found a positive correlation between PVW and systolic diurnal BPV (stepwise regression F = 12.9, p < 0.01). This correlation was independent of hypertension, antihypertensive treatment, duration of hemodialysis, and erythropoientin. We also found a positive correlation between N/D and PWV (stepwise regression: F = 8.9 p < 0.05). Our study shows that arterial distensibility links BPV and N/D. It is suggested that an arterial distensibility impairment could enhance BPV and modify nycthemeral BP pattern.

Adult↗
PubMed1994

[Ambulatory measurement of blood pressure and plasma catecholamines in the study of orthostatic hypotension].

The purpose of the study was to investigate the interest of ambulatory blood pressure (BP) monitoring (ABPM) and plasma catecholamines in the management of orthostatic hypotension (OH). Fifteen patients, 4 men, 11 females, 53.3 +/- 21.1 years old, with OH were included in the study: 7 with dysautonomia (G1) = multiple systemic atrophy, pure autonomic failure, OH in elderly people; 8 with OH from other origin (G2) = hypovolemia, neurodystonia, vaso-vagal syncope. ABPM and plasma catecholamines assays (HPLC) in lying then in standing position were carried out in all patients. BP was 131.2 +/- 31.9/78.1 +/- 12.0 mmHg in lying and 112.1 +/- 25.3/75.4 +/- 15.8 in standing position (n = 15). The systolic (S) standing-induced (delta) decrease in BP after 1 min and 10 min (delta SBP) correlated with standard-deviation and variation coefficient of mean SBP (r = 0.78, p < 0.01; r = 0.82, p < 0.01 for delta sBP 1 min and r = 0.80, p < 0.01; r = 0.81, p < 0.01 for delta sBP 10 min), but not with norepinephrine (NorE) or epinephrine levels. There was a significant correlation between diastolic nycthemeral BP variability expressed by mean night-time DBP/mean day-time DBP ratio/diastolic N/D) and standing-induced decrease in DBP after 1 min (r = 0.59, p < 0.05). delta SBP 1 min and 10 min, delta DBP 1 min (p = 0.02, p = 0.05, p = 0.01) and systolic and diastolic N/D (p = 0.02; p < 0.01) were significantly different in G1 and G2.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Blood pressure measurements and left ventricular mass in young adults with arterial hypertension screened at high school check-up.

The aim of this study was to determine which BP measurement is the best related to target organ damage. There were 49 young adults with a history of childhood hypertension (school check-up) and to increase the prevalence of hypertension in the study group, 25 males 24 females, aged 20.1 +/- 2.2 years old were included in the study. All patients had a diurnal ambulatory BP monitoring and office BP measurements taken with a sphygmomanometer and with an oscillometric device during a 15 minute period monitoring (Dinamap BP). Echocardiography and blood samples (cholesterol and triglycerides) were performed in all patients. In contrast with office BP, a mean ambulatory SBP and mean Dinamap SBP significantly correlated to left ventricular mass index (LVMI) (P < 0.01). There was also a correlation between triglycerides and mean Dinamap SBP (P < 0.01) which could suggest an early insulin resistance. In this selected population, a short period BP monitoring, as well as ambulatory BP, is more closely related to LVMI than office BP.

Adolescent↗
PubMed1993

[Rheumatologic aspects of toxocariasis (visceral Larva migrans). Apropos of 2 cases].

Visceral Larva migrans is a human infection by the larvae of dog ascarids or, more rarely, ascarids of other animal species. It is endemic in France. Two cases which respectively manifested as acute oligoarthritis and inflammatory myalgia with increased muscle enzyme levels are reported. Manifestations of the minor forms of this infestation are reviewed.

Adult↗