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Biomedical subjects

J Ménard

Publications and source records attributed to J Ménard.

At least 73 records · Page 4Linked to original sources
PubMed1995

Angiotensin-converting enzyme gene polymorphism has no influence on the circulating renin-angiotensin-aldosterone system or blood pressure in normotensive subjects.

BACKGROUND: Angiotensin-converting enzyme (ACE) is involved in the metabolism of two major vasoactive peptides, converting angiotensin (Ang) I into Ang II and inactivating bradykinin. An insertion/deletion (I/D) polymorphism is present in the 16th intron of the ACE gene and is strongly associated with plasma and cellular ACE levels. Contrasting with the lack of relation between ACE gene polymorphism and blood pressure level, a large case-control study has shown that the deletion marker allele of the ACE gene was associated with an increased risk of myocardial infarction. The pathophysiological link between ACE gene polymorphism and cardiovascular events remains hypothetical. One hypothesis is that this polymorphism influences Ang II and bradykinin concentrations in the peripheral and/or local circulations through its effects on ACE levels in plasma and endothelial cells. The aim of this study was to investigate the effect of the ACE gene I/D polymorphism on blood pressure, plasma active renin, and aldosterone regulation in normal subjects. METHODS AND RESULTS: Twenty-four normotensive male volunteers homozygous for the ACE I/D polymorphism (12 DD and 12 II) received a renin inhibitor infusion (remikiren 0.1 mg.kg-1.h-1 for 130 minutes) to suppress endogenous Ang I and Ang II production. Forty minutes after initiating the remikiren infusion, an exogenous Ang I infusion was begun and increased gradually every 15 minutes from 1 to 10 ng.kg-1.min-1. Median (range) plasma ACE levels (mU/mL) were 39 (32 to 57) and 24 (12 to 30) in the DD and II groups, respectively. Remikiren suppressed plasma Ang I and Ang II, increased plasma active renin (from 23 +/- 12 to 154 +/- 161 pg/mL), decreased plasma aldosterone (from 106 +/- 42 to 82 +/- 33 pg/mL), and slightly decreased diastolic blood pressure (from -2.4 +/- 2.7 mm Hg). The blood pressure and hormonal responses to Ang I infusion after renin inhibition and the slope of the rise in plasma Ang II with increasing Ang I dose were identical in both groups, as was the plasma Ang I/Ang II ratio before (DD, 2.09 +/- 1.04; II, 2.59 +/- 0.76) and after (DD, 0.15 +/- 0.13; II, 0.09 +/- 0.03) combined renin inhibitor and Ang I infusion. CONCLUSIONS: Despite its association with a major difference in plasma ACE levels, the ACE I/D polymorphism did not influence the Ang II and plasma aldosterone production, plasma active renin decrease, or diastolic blood pressure increase induced by exogenous Ang I infusion, suggesting that ACE has no limiting influence on systemic Ang II generation and effects under these experimental conditions.

Adolescent↗
PubMed1995

Dose-dependent effects of the renin inhibitor zankiren HCl after a single oral dose in mildly sodium-depleted normotensive subjects.

BACKGROUND: Zankiren HCl (A-72517) is a potent renin inhibitor shown to have substantial bioavailability in several animal species and to produce dose-related reductions in blood pressure, plasma renin activity, and angiotensin II (Ang II) in salt-depleted dogs. The present study was designed to evaluate the hemodynamic effects of oral zankiren HCl administration in healthy volunteers and to characterize the response of the renin-angiotensin system (RAS) to specific blockade by this new renin inhibitor. METHODS AND RESULTS: Twenty-four male volunteers participated in a double-blind randomized, placebo-controlled in-hospital study to evaluate the effects of zankiren HCl (10 to 250 mg). All subjects were pretreated with 40 mg furosemide 12 hours before study drug administration. Blood pressure and heart rate were monitored by an automated oscillometric device, and blood samples were obtained for active renin, total renin, plasma renin activity, angiotensin I (Ang I), Ang II, aldosterone, and plasma zankiren concentration. Satisfactory absorption of zankiren HCl was demonstrated by the results of plasma drug concentration determinations, and renin inhibitory activity was confirmed by dose-related suppression of plasma renin activity, Ang I, Ang II, and aldosterone and increases in plasma active renin concentration. Furthermore, hypotensive activity was readily observed in these normotensive subjects, as evidenced by statistically significant dose-related blood pressure reductions (P < .01). CONCLUSIONS: Results from this study demonstrate for the first time that oral administration of a renin inhibitor can dose-dependently decrease blood pressure and circulating components of the RAS in normotensive volunteers as a result of documented absorption.

Adult↗
PubMed1995

Renal and endocrine effects of flosulide, after single and repeated administration to healthy volunteers.

UNLABELLED: Two double-blind, placebo-controlled, balanced cross-over studies were carried out successively in 8 male normotensive volunteers to investigate the acute and chronic effects of two doses of a novel non-steroidal anti-inflammatory drug flosulide (5 mg b.d. and 25 mg b.d.), on the renin-angiotensin-aldosterone system, linking this to changes in the urinary excretion of prostaglandins. Plasma renin and aldosterone were determined on Days 2 and 9, with the subject supine, after 1 h of rest in the sitting position following 1 h of walking, and 3 h after oral intake of 40 mg furosemide, also in the sitting position. Twenty-four hour urine samples were collected on Days 1 and 8 for the measurement of the electrolytes, aldosterone pH1 and the urinary prostaglandins PGE2, PGF2 alpha, 6-keto-PGF1 alpha and TxB2. RESULTS: After the first day of treatment with 25 mg b.d. flosulide, the increase in body weight was close to significance (0.86 vs -0.08 kg with placebo). A dose- and time-dependent decrease in both active and inactive plasma renin were observed, whereas the fall in plasma and urinary aldosterone was statistically significant only after the higher dose of flosulide. These changes in the renin-angiotensin-aldosterone system were observed in the absence of oedema. Two out of eight volunteers experienced a strong and immediate reduction in the excretion of prostaglandins but overall the two doses tested did not produce a statistically significant inhibition in renal prostaglandins, especially following repeated dosing. The inhibitory effect of flosulide on renal prostaglandin synthesis was found to be less pronounced after repeated treatment, as documented on Day 9 by the lower inhibition of 6-keto-PGF1 alpha and TxB2. CONCLUSION: These two studies in normal volunteers, in spite of some methodological limitations, were helpful in order to select doses of flosulide which should be effective and safe in patients during Phase II trials, by examining the inhibitory effect of the drug on renin synthesis and renal prostaglandin synthesis.

Adult↗
PubMed1995

Developmental studies demonstrate age-dependent elevation of renin activity in TGR(mRen2)27 rats.

The objective of the present study was to determine the relationship between plasma renin levels, and the development of hypertension and cardiac hypertrophy in TGR (mREN2)27 hypertensive rats. Systolic blood pressure and left ventricular mass index (LVMI) were measured in transgenic heterozygote and normotensive Sprague Dawley control rats at 25, 35, 45, 55, 65, and 75 days of age together with determinations of plasma active renin and prorenin, and renal and adrenal tissue renin, which were assayed at pH 6.5, 7.4, and 8.5. The systolic blood pressure and the LVMI of the transgenic rats were significantly increased compared to control rats by 55 and 65 days of age, respectively. Plasma active renin of the transgenic rats, measured at physiological pH, was significantly higher from 55 days of age, increasing in parallel with blood pressure and remaining significantly higher than controls at all age groups tested. Assays of both plasma and adrenal renin at various pHs showed a profile of angiotensin I generation that matched mouse renin more closely than that of rat renin. The ratio of angiotensin I (Ang I) generation at pH 8.5 and pH 6.5 was 0.5 for normal rat plasma but was between 3 and 5 for mouse plasma. Plasma prorenin and adrenal tissue renin from transgenic rats exhibited a pH profile consistent with the major portion being mouse renin. However, the low level of kidney renin observed in the transgenic rats exhibited a pH ratio (8.5/6.5) identical to that of normal rat renin (0.5), suggesting that residual renin within the kidney was predominantly of rat origin. These data indicate that plasma renin levels closely parallel the development of high blood pressure and LVMI and show that interpretation of the renin status of this strain is critically dependent on the assay conditions used. Under the conditions used in this study it was found that the TGR(mRen2)27 rat is a high mouse plasma renin model of hypertension.

Adrenal Glands↗
PubMed1995

Comparison of the angiotensin II antagonist UP269-6 with the angiotensin converting enzyme inhibitor enalapril in normotensive volunteers challenged with angiotensin I.

We assessed the inhibitory effect of UP269-6, a new orally active angiotensin II (ANG II) receptor antagonist, on the pressor action of exogenous ANG I in healthy male volunteers maintained on an unrestricted sodium intake and compared it with that of enalapril. Seven different single doses of UP269-6 ranging from 5 to 180 mg, 20 mg enalapril, or placebo were administered to 16 subjects in a double-blind fashion. The order of placebo and enalapril was randomized, and UP269-6 was given in an ascending dose order. The peak systolic blood pressure (SBP) response to a test dose of ANG I was determined serially before and after oral drug administration by monitoring finger BP by a photoplethysmographic method. No drug-related side effect was observed. There was a dose-dependent inhibition of the SBP response to the ANG I challenge. Doses as low as 40 to 80 mg had blocking effects quite similar to that of enalapril 20 mg. Ten hours after the 20- and 40-mg doses of UP269-6, the SBP response was still attenuated when drug levels no longer were measurable in plasma. UP269-6 also produced a dose-related increase in active renin and ANG II levels at 24 h after drug intake. In these volunteers on unrestricted salt intake, no statistically significant effect on 24-h urinary aldosterone excretion was observed. Based on these preliminary data, the pharmacokinetic drug half-life (t 1/2) was estimated at 4.7 h and the EC50 was estimated at 41 ng/ml. UP269-6 appears to be a well-tolerated, potent, orally active, antagonist of ANG II receptors in men. Doses of 40-80 mg might block the ANG I pressor response as does enalapril 20 mg.

Administration, Oral↗
PubMed1995

Plasma angiotensin in binephrectomised mice.

Plasma renin-angiotensin parameters were measured before and 24h after binephrectomy (BNx) in male Swiss (Ren-1, Ren-2) and BALB/c (Ren-1) female mice (representing the extremes of differences in tissue renin expression), together with in vivo inhibition of residual renin. Plasma Ang II increased from 18.9 +/- 7.3 to 48.1 +/- 16.9 pg/ml after BNx in conscious Swiss mice (+/- sd, p < 0.001, n = 11&12), renin activity (PRA) increased 2.76 times, angiotensinogen (aogen) increased 4.57 times and renin concentration (PRC) fell by 65%. In BALB/c, Ang II+Ang III decreased slightly (56.6 +/- 11 to 37.7 +/- 14.7, p < 0.05, n = 5&6), PRA was unchanged, aogen increased 12 times and PRC fell by 93%. Plasma ACE decreased by 26% and 28% respectively. Aogen did not increase further when post BNx plasma renin was inhibited with antirenin in vivo during 20h. Thus plasma angiotensin is maintained or considerably increased following BNx in mice and the change is consistent with first-order kinetics with respect to renin and aogen in the circulation. Whether the strain carries one or two renin genes, high renal and extrarenal renin production combined with a low plasma aogen phenotype yields resting angiotensin levels similar to other mammals. A kinetic regulation of aogen levels is proposed in mice wherein Ang II production is limited by low substrate concentration thereby ensuring normotension in the face of abundant extrarenal renin secretion.

Angiotensin II↗
PubMed1995

Limiting factors in the control of BP: why is there a gap between theory and practice?

The benefits of BP reduction are undisputed, and management guidelines are well established. Nevertheless, epidemiological studies and randomised clinical trials have consistently shown that, although treated, BP frequently remains inadequately controlled. This failure to control BP adequately is not fully recognised by physicians or their patients. Furthermore, even when BP control is not achieved, there is evidence that many physicians do little to modify therapy. This gap between theory and practice in the control of hypertension is a multifactorial phenomenon. Patients may not take medication or adhere to their physician's advice; physicians appear satisfied with sub-optimal therapy; the underlying pathophysiology of hypertension is heterogeneous and thus it can be difficult to predict which patients will respond to a specific treatment; there is poor communication between physicians and their patients; and treatment guidelines may be too complex, theoretical and unclear to be followed in general practice. Despite these difficulties, it is clear that BP control can be improved by combining several antihypertensive drugs. This requires careful consideration with regard both to the mechanisms of action of the agents selected and their tolerability.

Antihypertensive Agents↗
PubMed1995

Structural changes and cyclic GMP content of the aorta after calcium antagonism or angiotensin converting enzyme inhibition in renovascular hypertensive rats.

OBJECTIVE: To evaluate the respective roles of elevated blood pressure and stimulation of the renin-angiotensin system in the development of structural changes in the aortae of rats with renovascular hypertension. MATERIALS AND METHODS: Renovascular hypertensive rats (two-kidney, one clip) were randomly allocated to three different groups and were treated with equihypotensive doses of an angiotensin converting enzyme (ACE) inhibitor (enalapril, 3 mg/kg per day) or of a new long-acting calcium antagonist (mibefradil, 30 mg/kg per day). A renovascular hypertensive group was left untreated. A sham-operated group of rats was used as a normotensive control group. At the end of the 5-week treatment period the rats were killed and their aortae were removed. Medial hypertrophy, elastin and collagen content and density of nuclei were evaluated using quantitative morphometry. The aortic cyclic GMP (cGMP) content was quantified by radioimmunoassay. RESULTS: Hypertension was associated with medial hypertrophy, a decreased elastin: collagen ratio, hypertrophy of the smooth muscle cells and increased cGMP content of the aorta. Mibefradil and enalapril equally prevented the morphological consequences of hypertension (i.e. medial hypertrophy and the decreased elastin:collagen ratio). The aortic cGMP content was increased by enalapril but not by mibefradil. CONCLUSION: The present results show that, even in a high-renin model (two-kidney, one clip), it is possible to prevent or suppress the vascular consequences of hypertension without interfering with the renin-angiotensin system. This suggests that the changes observed in the aorta are directly related to blood pressure or to other mechanisms independent of the renin-angiotensin system, which could be blocked by a calcium antagonist such as mibefradil.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1995

[Effect of 2 types of diet changes on dietary habits, body weight and cholesterol levels in high risk cardiovascular patients].

Several non-pharmacological interventions such as weight reduction in obese subjects or diet alteration in subjects having hypercholesterolemia have been shown to be effective in therapeutic trials. Our aim was to test the value of two different ways of teaching patients about their diet. From March 1, 1993, to May 30, 1994, 300 consecutive patients seen in a one-day care hospital were randomised into two groups. The 2 inclusion criteria were: 1) body mass index > 27 kg/m2 in men and > to 25 kg/m2 in women and/or 2) presence of a hypercholesterolemia defined by a total cholesterol > 6.5 mmol/l. Patients in the first group (C) were educated in a 20 to 50 minutes consultation tailored to their needs. Patients in the second group (CC) were given in addition a one-hour course about diet. The goal of the diet was to loss at least 3 kg of body weight and/or to have a cholesterol value below 6.5 mmol/l without treatment. All Patients were followed-up by the same 3 dietician nurses. An out-patient visit was planned at 3 months, and a recall letter was sent to the patients who missed their appointments. Among the 300 patients, 169 (55%) were seen at the 3-month outpatient visit. This proportion did not differ between the 2 groups. Knowledge on diet was assessed by the same 33-item self-administered questionnaire. At baseline scores were comparable between groups (16 vs 17). Scores improved more in the CC than in the C group both at the end of the teaching question (27 vs 23 in the CC and C group respectively, p < 0.001), and at 3 months (25 vs 23 in the CC and C group respectively; p < 0.001). Total cholesterol decreased below 6.5 mmol/l in 28% of the patients with dyslipidemia and a weight loss > 3 kg was observed in 32% of the obese subjects, but improvement did not differ between the 2 groups. We conclude that a specific one-hour course on diet is able to improve knowledge of patients more than a consultation alone, but that better knowledge did not result in improved alteration of risk factors at 3 months.

Adult↗
PubMed1994

Oil and water? Economic advantage and biomedical progress do not mix well in a government guidelines committee.

This article examines the results of the Joint National Committee's Fifth Report on the treatment of hypertension (JNC-V), especially regarding the economic arguments put forth therein. Economics are a poor basis for treatment decisions, as the cheapest therapies may not be the best for any given patient. Broad treatment guidelines based on economic motives will result in poorer patient care and less valuable medical research.

Antihypertensive Agents↗
PubMed1994

Calcium blockade versus ACE inhibition in clipped and unclipped kidneys of 2K-1C rats.

ACE inhibitors have been shown to worsen the kidney damage occurring distal to a renal artery stenosis. To determine if this effect was due to the decrease of arterial pressure or to an inhibition of the formation of angiotensin, we compared the effects of equihypotensive doses of an angiotensin converting enzyme inhibitor (enalapril) and a long-acting calcium antagonist (Ro 40-5967) in 2K-1C rats. The rats were treated for five weeks with either enalapril, Ro 40-5967, or were left untreated. A group of sham operated rats was used as control. At the end of the five-week treatment period, proteinuria, plasma urea and creatinine were measured and quantitative morphometry of the clipped and unclipped kidneys was performed. Ro 40-5967, despite an absence of inhibition of the renin-angiotensin system, worsened the lesions of the clipped kidney to the same extent as enalapril. In contrast, the effects of both drugs on the unclipped kidney were different. Ro 40-5967, and not enalapril, increased the weight and the glomerular surface area of the unclipped kidney. Ro 40-5967 did not change the glomerulosclerosis index, which was improved by enalapril. In contrast with enalapril, Ro 40-5967 decreased plasma urea and creatinine concentrations. Only enalapril decreased proteinuria which originated from the unclipped kidney as shown by nephrectomy experiments. We conclude that during ACE inhibition the fall in renal perfusion pressure seems to be the main determinant of the renal damage distal to a renal artery stenosis, independently of a blockade of the renin-angiotensin system.(ABSTRACT TRUNCATED AT 250 WORDS)

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1994

Influence of sodium diet on L-NAME effects on renin release and renal vasoconstriction.

The intervention of the L-arginine-NO pathway in renal vasodilation and renin secretion was studied in an isolated perfused rat kidney model. NG-nitro-L-arginine methyl ester (L-NAME, 1-25 microM), an inhibitor of nitric oxide (NO) synthesis, caused a dose-dependent increase in perfusion pressure (PP) and a dose-dependent decrease in renal perfusate flow. Renin was inhibited independently of the rise in PP, since the effect of L-NAME on renin release was the same when PP was maintained constant. Exposure of rats to low [salt depleted (SD)] or high [salt repleted (SR)] salt intake for 1 mo influenced the renal vascular response to L-NAME (3 microM). Isolated SR rat kidney vasculature vasoconstricted to a greater extent after inhibition of NO synthase than did that of SD kidneys. A similar fall in renin release was observed after L-NAME in both groups, despite a higher renin secretion rate in SD than in SR rats. These results suggest that NO-dependent vasodilation counteracts the renal vasoconstrictor effect of sodium loading.

Analysis of Variance↗
PubMed1994

Self-measurement of blood pressure at home to evaluate drug effects by the trough: peak ratio.

AIM: Studies were carried out to assess (1) the statistical and clinical meaning of the trough:peak ratio and (2) the value of self-measurement of blood pressure at home in monitoring the duration of action of antihypertensive drugs in individual patients and in groups of patients. PATIENTS AND METHODS: Data from previous single-blind trials in 44 individual patients were reanalysed. The trough:peak ratio was calculated from mean blood pressure values. RESULTS: There are two major limitations in using this method. (1) Estimates of the trough:peak ratio are biased by the inclusion of non-responders. These patients have the usual random variations in blood pressure, and small differences can result in a spuriously high trough:peak ratio which may lead to an overestimate of the actual ratio. (2) The standard deviation of the trough:peak ratio is large; for a given mean trough:peak ratio some patients have the required 24-h drug cover, whereas others do not. The large standard deviation is partly a result of statistical problems, since four different blood pressure values are used to calculate the ratio. It is therefore essential to increase the precision of the measurement to decrease the standard deviation. CONCLUSIONS: Self-measurement of blood pressure at home might be a useful and inexpensive way of estimating the trough:peak ratio. As repeated measurements of blood pressure can be carried out at home under standardized conditions, this method increases the precision of each measurement. It is possible, therefore, to calculate individual trough:peak ratios and the drug regimen (once or twice a day) can be individualized.

Antihypertensive Agents↗
PubMed1994

[Evaluation of a computer assisted training program for hypertensive patients].

ISIS tutorial program (French abbreviation for Animated and Computerized Initiation into Health) was carried out for Macintosh type computers to place a modern and interactive learning device at cardiovascular risk patients' disposal. Such a program combines strict scientific explanations and aesthetic attractiveness of multimedia communication. To test the effect of this device on health knowledge gain, 158 hypertensives admitted in one-day or in half-week clinics for an initial check-up or for a therapeutic adjustment were randomised into two groups: a control group (n = 79), receiving usual education (contacts with physicians, nurses, dieticians, health oriented booklets), and an experimental or "ISIS" group (n = 79) undergoing an interactive session with the computer during 30 to 60 minutes, in addition to usual education. Health knowledge of both groups was assessed through a 28-item questionnaire, before any education procedure, two months after the discharge, through a standardized interview by phone, thanks to the same investigator. On the whole, 69 + 69 = 138 complete case records could be analysed. Initial health knowledge mean score, at admission to the hospital, was 14.3 +/- 4.2 (range: 4 to 25). This score significantly improved among the whole population (difference between the two evaluations: 3.7 +/- 3.5 points; p = 0.0001). Improvement was greater in ISIS group than in controls (p = 0.02). Among hypertensives with initial scores < or = 16, improvement was respectively 4.5 +/- 3.6 and 2.9 +/- 3.0 for ISIS and control groups (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗