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Biomedical subjects

X Girerd

Publications and source records attributed to X Girerd.

At least 19 recordsLinked to original sources
PubMed2005

[Biochemical evaluation of the results of lipid regulating treatment in France].

The objective of the SPOT study (Study of Practice versus Objectives of Treatment) was the biochemical evaluation of the results of long term lipid regulating treatment in France, compared to the objectives defined by AFSSAPS (French regulatory agency for the safety of medical products) in 2000. A random sample of doctors was recruited in 21 French regions by the Regional Health Observation service. To be included in the SPOT study, the patients had to be on lipid regulating medication for at least six months and consent to biochemical evaluation following a consultation. A sample of 641 doctors examined 2,479 patients treated for 7 years on average. These middle aged patients (aged 63 +/- 11 years) were mostly taking statins (72%). They had an average total cholesterol level of 5.41 +/- 1.01 mmol/L (2.10 +/- 0.39 g/L). and LDL of 3.25 +/- 0.93 mmol/L (1.26 +/- 0.36 g/L), reflecting previous results and confirming the stability of their treatment. In primary prevention and in low risk subjects (with less than 2 associated risk factors), the AFSSAPS objectives were achieved in 95% of cases. In secondary prevention or in very high risk subjects (at least 3 associated risk factors 0), 35% of patients had LDL cholesterol greater than 3.4 mmol/L (1.30 g/L). The SPOT study, performed on subjects who had in theory been stabilised with lipid regulating medication, gave two conclusions: cardiovascular prevention with lipid regulating medication is improving in France, and the subjects at greatest risk attain the recommended objectives less often despite the expected benefit of treatment being higher.

Aged↗
PubMed2004

Association between pulse pressure, carotid intima-media thickness and carotid and/or iliofemoral plaque in hypertensive patients.

Increased common carotid artery intima-media thickness (CCA-IMT) and carotid and/or iliofemoral (C/IF) plaque are frequent in subjects treated for hypertension, but their association with pulse pressure (PP) has rarely been studied. Using ultrasound techniques, CCA-IMT and C/IF plaques were studied in 323 hypertensive subjects, who were classified into four groups according to the adequacy of blood pressure (BP) control (systolic BP (SBP) <140 mmHg and diastolic BP (DBP) <90 mmHg) and PP (high or low). After adjustment for confounding variables, an increase in CCA-IMT was the only factor significantly and independently associated with high PP, irrespective of the effectiveness of blood pressure control and of antihypertensive drug treatment. CCA-IMT correlated with age, PP, waist-to-hip ratio, tobacco consumption, and heart rate. C/IF plaques correlated with age, tobacco consumption, diabetes mellitus, and dyslipidaemia. To conclude, even with SBP<140 mmHg and DBP<90 mmHg on treatment, hypertensive subjects may have increased CCA-IMT values and C/IF plaque. Four cardiovascular risk factors seem to be involved in these alterations, namely tobacco consumption, dyslipidaemia, diabetes and increased PP. Only the latter factor does not have a standardized effective treatment.

Aged↗
PubMed2004

Diuretics for cardiovascular prevention in the elderly.

High blood pressure (BP) is a major risk factor for cardiovascular and cerebrovascular diseases in elderly subjects. Antihypertensive drugs have shown clinical benefit both in primary and secondary prevention of cardiovascular events. If BP lowering represents the major determinant of the effects conferred by the antihypertensive treatment for prevention, recent studies have suggested some differences between classes of antihypertensive drugs according to age. Based on the available clinical data, the recent medical guidelines have recommended thiazide-type diuretics as the preferred drug for the treatment of elderly hypertensive patients, followed by long-acting calcium antagonists. Indeed, diuretics constitute one of the most valuable classes of antihypertensive drugs, and in the elderly, diuretic-based treatment studies have been clearly shown to prevent major cardiovascular events, including stroke, heart failure and coronary heart disease.

Aged↗
PubMed2003

[Erectile dysfunction in cardiovascular diseases].

After the acute phase, a patient who is diagnosed with cardiac or vascular disease becomes "chronically ill". This patient will then still spend many years without symptoms or impairments. One day, a percentage of such patients will be confronted with the problem of erectile dysfunction. Various studies have demonstrated that this problem occurs with a higher frequency in patients with cardiovascular diseases, in particular when they have to be treated for hypertension, diabetes mellitus or dyslipidemia. Very rarely are stenoses or occlusions found in the arteries responsible for penile circulation. More recent data indicates that a diffuse anomaly of the vascular endothelium is present, for which erectile dysfunction is a marker. Nowadays, medical care has achieved a better degree of standardization, not only thanks to knowledge about the effects of cardiovascular medication, but also because the physician can now prescribe drugs that treat erectile dysfunction.

Cardiovascular Agents↗
PubMed2003

[Causes of uncontrolled hypertension. DUO-HTA survey].

OBJECTIVES: To identify the socio-demographic, clinical, psycho-behavioural and therapeutic factors explaining uncontrolled blood pressure in a population of hypertensives in ambulatory practice. METHODS: The DUO-HTA survey is a national, cross-sectional, mirrored, observational study, from a representative sample of 347 general practitioners (MG) and 210 cardiologists, and a population of 2022 hypertensive patients followed by these doctors. The data were collected by means of questionnaires completed by the hypertensives and their doctors. RESULTS: The factors significantly discriminating patients for whom BP was controlled (C) from those patients whose BP was not controlled (NC) were an age less than 65 years, smoking, obesity, alcohol consumption, sedentary lifestyle and multiple anti-hypertensive treatment. On the psycho-behavioural front, the NC patients were more often anxious and irritable, claiming to lead a stressful life and for whom hypertension was often perceived as a "foreign entity" and a source of frustration and multiple deprivations. The factors discriminating the NC doctors from the C doctors were essentially psycho-behavioural, with the NC doctors considering the management of hypertension as being less gratifying, and hypertension as a condition with fluctuating progression, poorly understood and dramatized by patients. CONCLUSION: The DUO-HTA survey underlines the weight of reciprocal representation systems in hypertension for patients and their doctors, as well as the quality of the doctor-patient relationship in blood pressure control. It prompts the development of sensitisation actions for practitioners centered on improving the doctor-patient relationship.

Adult↗
PubMed2002

[Structure and function of the arteries of very elderly people. The PROTEGER Study (Cardiovascular Prognosis and Therapeutic Optimization in Geriatrics)].

The purpose of PROTEGER, a multicenter prospective observational study, was to determine the contribution of hemodynamic, arterial, echocardiographic and biological parameters to the evaluation of individual cardiovascular risk in the elderly. The study included patients aged over 70 years hospitalized in geriatric units with overt cardiovascular disease. Cross sectional analysis of the first 194 subjects included in the study demonstrated a high rate of arterial alterations involving both structure and function. The principal alterations observed were: high pulse pressure despite normal mean systolic and diastolic pressures, frequent and diffuse arterial calcifications, reduced compliance and distensibility, increased thickness, diameter and incremental elastic modulus of the carotid and increased pulse wave velocity. Analysis of monitoring results in the PROTEGER study will demonstrate the role of hemodynamic measurements and arterial alterations in the prediction of cardiovascular risk in hospitalized elderly.

Aged↗
PubMed2001

Aging, carotid artery distensibility, and the Ser422Gly elastin gene polymorphism in humans.

Elastin is a protein of the extracellular matrix that forms the major component of elastic fibers from the arterial wall thickness and plays an important role in elastic properties of large blood vessels. To study the relationships between the Ser422Gly polymorphism in exon 16 of the gene-encoding elastin and the distensibility of 2 different arteries, the radial artery (a muscular artery) and the common carotid artery (an elastic artery), we studied a cohort of 320 subjects (49+/-12 years of age) without evidence of cardiovascular disease and who had never been treated with cardiovascular drugs. Distensibility and elastic modulus were evaluated for the common carotid and the radial arteries with high-resolution echo-tracking devices (NIUS-02 and Wall Track System). The A-to-G nucleotide change corresponding to the Ser422Gly amino acid change was studied by digestion of polymerase chain reaction products with BstNI. Results indicate that genotype frequencies (AA=10%, AG=51%, GG=39%) were in agreement with the Hardy-Weinberg equilibrium. For the carotid artery, a significant decrease in distensibility was observed in subjects carrying the A allele (with AA+AG genotypes) compared with subjects with the GG genotype (13.8+/-6.4 kPa(-1). 10(-3) versus 15.9+/-6.2 kPa(-1). 10(-3), P<0.01), assuming a dominant effect of the A allele. Moreover, the presence of the A allele was associated with a significant increase in elastic modulus (0.98+/-0.40 kPa. 10(3) in subjects with AA+AG genotypes versus 0.83+/-0.41 kPa. 10(3) in subjects with GG genotypes, P<0.01). Multivariate analysis indicated that these results were observed after adjustment for age, gender, and mean arterial blood pressure (P<0.01). In contrast, no association was found between arterial parameters and genotypes for the radial artery. The 2-way analysis of covariance adjusted for mean arterial blood pressure indicated that the association between the A allele and distensibility of the carotid artery was observed only in subjects >50 years of age, assuming for carotid distensibility a significant age effect (P<0.01), genotype effect (P=0.01), and age-genotype interaction (P=0.04). The present results indicate a relationship between the Ser422Gly polymorphism and the distensibility of elastic arteries but not of muscular arteries and suggest that there is an age-genotype interaction for carotid artery distensibility.

Aging↗
PubMed2001

[Evaluation of patient compliance among hypertensive patients treated by specialists].

OBJECTIVES: To evaluate compliance with antihypertensive therapy by a self-report in patients referred to hypertension specialists. METHODS: We studied 484 treated hypertensive subjects referred to several hypertension clinics and who were treated since at least one year. Patients were asked to fill in the Compliance Evaluation Test (CET), a questionnaire with 6 questions previously validated to assess factors that could affect medication compliance. We defined patients as "good compliant" when "No" was answered to the 6 items, as "minor noncompliant" when 1 or 2 "Yes" were answered, and as "noncompliant" when 3 or more "Yes" were answered. A good agreement was demonstrated between CET score and compliance evaluated by the number of pills missed during the previous month according to patient interview. RESULTS: We observed 8% of "noncompliant", 53% of "minor noncompliant" and 39% of "good compliant". [table: see text] Logistic regression analysis including age, sex, education level, blood pressure level and the number of antihypertensive tablets confirm the statistical differences observed. CONCLUSIONS: In clinical practice, a method of assessing medication compliance is to ask the patient for a self-report interview. We demonstrated that the compliance evaluation test is able to detect factors usually associated with poor compliance (young age, elevated blood pressure, number of tablets per day). The use of the compliance evaluation test may help physicians to face the problem of nonadherence among their hypertensive patients.

Aged↗
PubMed2001

[Blood pressure self-monitoring contributes to improved patient education among hypertensive subjects].

UNLABELLED: Education of hypertensive subject must sensitize the patient to its pathway and to the prescribed treatment. Self-measurement of blood pressure, which directly implicates the patient, should ameliorate the education of hypertensive subject. OBJECTIVES: To evaluate if the possession of a self-measurement blood pressure device improves patients' knowledge of hypertension. METHODS: In 484 treated hypertensive subjects referred to hypertension specialists, a questionnaire evaluating patients knowledge of hypertension and its treatment was given before the consultation. During this consultation, the practitioner evaluated the concordance between antihypertensive treatments declared by the patient and those effectively prescribed. RESULTS: In this population, aged 61 +/- 12 years, with 55% of men, a self-measurement blood pressure device was possessed by 165 subjects (34%). These devices have been bought without medical advice by 83 patients. For a minority of subjects (n = 41), self-measurements of blood pressure were made at the wrist. Blood pressure level was similar in subjects with (141 +/- 19/80 +/- 10 mmHg) or without (140 +/- 19/80 +/- 10 mmHg) self-measurement devices. Subjects possessing a self measurement device had a better knowledge of their usual blood pressure level and of the normal blood pressure values (< 140/90 mmHg), than subjects without self measurement device (93% vs 77%, p < 0.01, and 56% vs 33%, p < 0.01, respectively). Moreover, subjects in possession of self-measurement devices had a better knowledge of their antihypertensive treatment than those without device (83% vs 70%, p < 0.05). Logistic regression analysis including age, sex, smoking, education level, blood pressure level and the number of antihypertensive tablets confirm the statistical differences observed. CONCLUSION: Hypertensive subjects who possess a self-measurement blood pressure device have a better knowledge of their hypertension. These results indicate that the possession of a self-measurement device contributes to the education of hypertensive patients.

Aged↗
PubMed2001

[Influence of protocol on the quality of blood pressure self-monitoring].

OBJECTIVES: To determine the minimum number of self-measurements of blood pressure to provide the maximum quality and reliability during home-blood pressure monitoring. METHODS: We studied 38 hypertensive subjects in which we compared self-reported with electronically stored home BP (OMRON HEM 720 CIC). Subjects were asked to measure BP in the sitting position, three times consecutively in the morning and three times in the evening during 7 consecutive days. BP values over the 7 days were averaged and the differences with BP recorded over the first day (6 values per day), the first 2 days, the first 3 days, the first 4 days, the first 5 days and the first 6 days were calculated. Confidence interval were calculated. RESULTS: We observed that 47% of patients completed the entire protocol (42 measurements over 7 days), but 89% completed 4 days with 6 measurements. Erroneous reporting was evident in 10% of patients. In patients which performed 100% of the 42 planned values, confidence interval for the mean value was < 4 mmHg for SBP and < 3 mmHg for DBP when the patient completed a 4 days protocol with a minimum of 4 measurements per day. CONCLUSIONS: These results indicate that determining average home blood pressure over 4 consecutive days with 2 measurements twice daily, is the minimum protocol that provides a reliable estimate of home blood pressure with a good quality of patient reporting.

Aged↗
PubMed2000

Pulse pressure not mean pressure determines cardiovascular risk in older hypertensive patients.

BACKGROUND: Current guidelines for the management of hypertension rest almost completely on the measurement of systolic and diastolic blood pressure. However, the arterial blood pressure wave is more correctly described as consisting of a pulsatile (pulse pressure) and a steady (mean pressure) component. OBJECTIVE: To explore the independent roles of pulse pressure and mean pressure as determinants of cardiovascular prognosis in older hypertensive patients. METHODS: This meta-analysis, based on individual patient data, pooled the results of the European Working Party on High Blood Pressure in the Elderly trial (n = 840), the Systolic Hypertension in Europe Trial (n = 4695), and the Systolic Hypertension in China Trial (n = 2394). The relative hazard rates associated with pulse pressure and mean pressure were calculated using Cox regression analysis, with stratification for the 3 trials and with adjustments for sex, age, previous cardiovascular complications, smoking, and treatment group. RESULTS: A 10-mm Hg wider pulse pressure increased the risk of major cardiovascular complications; after controlling for mean pressure and the other covariates, the increase in risk ranged from approximately 13% for all coronary end points (P = .02) to nearly 20% for cardiovascular mortality (P = .001). In a similar analysis, mean pressure predicted the incidence of cardiovascular complications but only after removal of pulse pressure as an explanatory variable from the model. Furthermore, the probability of a major cardiovascular end point increased with higher systolic blood pressure; at any given level of systolic blood pressure, it also increased with lower diastolic blood pressure, suggesting that the wider pulse pressure was driving the risk of major complications. CONCLUSIONS: In older hypertensive patients, pulse pressure not mean pressure is the major determinant of cardiovascular risk. The implications of these findings for the management of hypertensive patients should be further investigated in randomized controlled outcome trials in which the pulsatile component of blood pressure is differently affected by antihypertensive drug treatment.

Aged↗
PubMed2000

Dehydroepiandrosterone (DHEA), DHEA sulfate, and aging: contribution of the DHEAge Study to a sociobiomedical issue.

The secretion and the blood levels of the adrenal steroid dehydroepiandrosterone (DHEA) and its sulfate ester (DHEAS) decrease profoundly with age, and the question is posed whether administration of the steroid to compensate for the decline counteracts defects associated with aging. The commercial availability of DHEA outside the regular pharmaceutical-medical network in the United States creates a real public health problem that may be resolved only by appropriate long-term clinical trials in elderly men and women. Two hundred and eighty healthy individuals (women and men 60-79 years old) were given DHEA, 50 mg, or placebo, orally, daily for a year in a double-blind, placebo-controlled study. No potentially harmful accumulation of DHEAS and active steroids was recorded. Besides the reestablishment of a "young" concentration of DHEAS, a small increase of testosterone and estradiol was noted, particularly in women, and may be involved in the significantly demonstrated physiological-clinical manifestations here reported. Bone turnover improved selectively in women >70 years old, as assessed by the dual-energy x-ray absorptiometry (DEXA) technique and the decrease of osteoclastic activity. A significant increase in most libido parameters was also found in these older women. Improvement of the skin status was observed, particularly in women, in terms of hydration, epidermal thickness, sebum production, and pigmentation. A number of biological indices confirmed the lack of harmful consequences of this 50 mg/day DHEA administration over one year, also indicating that this kind of replacement therapy normalized some effects of aging, but does not create "supermen/women" (doping).

Absorptiometry, Photon↗