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Biomedical subjects

X Girerd

Publications and source records attributed to X Girerd.

At least 37 records · Page 2Linked to original sources
PubMed2000

Association between the apolipoprotein E polymorphism and arterial wall thickness in asymptomatic adults.

OBJECTIVES: The polymorphism of the apolipoprotein E gene (epsilon2, epsilon3, epsilon4) affects plasma cholesterol but the relationship with artery wall thickness has indicated contradictory results. This study investigated the relationship between apolipoprotein E polymorphism and vascular phenotypes of the carotid and radial arteries, two arterial sites differently affected by atherosclerosis. METHODS: We studied a cohort of 320 Caucasian subjects (age 49 +/- 12 years) without evidence of cardiovascular disease. Structural (internal diameter and wall thickness) and functional phenotypes (compliance, distensibility) were evaluated for the common carotid and the radial arteries using high resolution echo-tracking devices. Genotypes of apolipoprotein E were determined by allele-specific oligonucleotides hybridization. Because of the relative low frequency of some apolipoprotein E genotypes, they were designated as E2 (epsilon2/epsilon2, epsilon2/epsilon3), E3 (epsilon3/epsilon3), and E4 (epsilon4/epsilon4, epsilon3/epsilon4). RESULTS: Apolipoprotein E allele frequencies were epsilon2 = 0.08, epsilon3 = 0.79, epsilon4 = 0.13. Subjects with epsilon4 allele had the highest levels of total serum cholesterol and low density lipoprotein cholesterol; subjects with epsilon2 allele had the lowest levels (P < 0.001). Considering carotid hypertrophy as intima-media thickness > 660 microm, and radial hypertrophy as intima-media thickness > 260 microm, a logistic regression model testing determinants of arterial hypertrophy (age, gender, weight, systolic blood pressure, smoking habits, and total serum cholesterol) observed a significant and positive association between carotid hypertrophy and epsilon2 allele carriers (P= 0.03). In contrast, no association was found between hypertrophy and apolipoprotein E genotypes for the radial artery. No association was observed between the apolipoprotein E genotypes and functional artery parameters. CONCLUSIONS: In subjects without any evidence of cardiovascular disease, the presence of the epsilon2 allele is related to wall hypertrophy in carotid artery despite favourable effect on the lipid profile.

Adult↗
PubMed2000

[The estimation of cardiovascular risk in hypertensive patients is not modified by management of the hypertension].

OBJECTIVES: To compare antihypertensive therapeutic strategies and efficacy whether the physicians were aware or not of the calculated cardiovascular risk at 10 years obtained from the Framingham equation. It was also possible to evaluate the concordance of the general physicians estimation of the cardiovascular risk with the calculated percentage. METHODS: The participation of 953 general physicians to the study allowed to achieve an estimation of the absolute cardiovascular risk for 1,243 hypertensives. Patients were randomised in 2 groups according to the knowledge or not by the physicians of the calculated risk. The therapeutic strategy included a monotherapy (Fosinopril 20 mg/days) for a follow up of 8 weeks, with the possibility to increase the treatment after 4 weeks (Fosinopril + hydrochlorotiazide). To be included, patients had to be more than 18 and less than 75 years, and a blood pressure above 140/90 mmHg. Estimated and calculated cardiovascular risk at 10 years, were classified according to the 1999 WHO-ISH guidelines: low risk < 15%, medium risk 15-20%, high risk 20-30%, very high risk > 30%. RESULTS: In this population, aged 60 +/- 10 years, with 54% of men, the concordance between estimated risk and calculated risk was of 35%. This concordance was better for the "low risk" and "very high risk", but remains inferior to 50%. The determinants of concordance were: gender (male), smoking and a low HDL cholesterol. After 8 weeks of treatment, no difference was observed between the 2 groups concerning final blood pressure level, percentage of normalised patients and number of patients with bi-therapy. CONCLUSIONS: General physicians estimation of cardiovascular risk at 10 years of hypertensive subjects has a bad concordance with the calculated risk according to Framingham equation. The results of this study indicate that the estimation of cardiovascular risk of hypertensive subjects does not modify the management of hypertension.

Adult↗
PubMed2000

[Are the 1999 World Health Organization-International Society of Hypertension recommendations applicable to clinical practice?].

UNLABELLED: The aim of the 1999 WHO-ISH guidelines is to help the physicians in the management of hypertensive patients. The institution of antihypertensive treatment represents an important stage of this management sometimes at the detriment of lifestyle measures (non pharmacological treatments). OBJECTIVES: To evaluate if the 1999 WHO-ISH guidelines concerning the initiation of antihypertensive treatment are applied in a hypertension clinic. METHODS: Seventy hypertensive subjects never treated by antihypertensive drugs, aged 51 +/- 13 years, managed in daily hospitalization, were included in the study. According to their level of cardiovascular risk, we evaluated the concordance between the 1999 WHO-ISH guidelines and the clinical practice in term of institution of treatment. RESULTS: A concordance of 70% between the 1999 WHO-ISH guidelines and the clinical practice was observed (50/70 subjects) and a discordance in 30% of cases (20/70). Among the discordant subjects, the treatment was instituted in 65% of cases although it was not recommended. In contrast, in the remaining 35% of cases, lifestyle measures have been proposed although an antihypertensive treatment was recommended. The principal determinants of the discordance were the grade 2 of hypertension, the presence of 1 or 2 risk factors and an enhanced cardiovascular risk (> or = 3 risk factors). Neither age, nor gender were an explicative parameter of the observed discordance. CONCLUSIONS: The 1999 WHO-ISH guidelines concerning the initiation of antihypertensive treatment are more often applied in clinical practice. However, in some cases of grade 2 hypertension drug treatment is more often prescribed than recommended by guidelines, and not enough in the presence of numerous cardiovascular risk factors.

Age Factors↗
PubMed2000

[Validation of electronic automatic-measurement arterial blood pressure devices].

Validation of automatic devices for self blood pressure measurement is a necessity, as the mercury columns are no longer available. The European consensus meeting organized by the Group for blood pressure measurement and evaluation (GEM), from French Society of Hypertension held last June 1999 has defined a new international protocol for clinical validation of these devices. The main parts of this protocol are the following: the blood pressure is measured at the same arm with two observers simultaneously and then with the automatic device sequentially seven times among 38 patients. The evaluation is interrupted after the 15th patient if the pre-analysis fails defined criteria. Technical supports are available: A CD-rom from French society of HTA for the training and certification of observers, a special kit for the evaluation (2 mercury column's and a double stethoscope) and a specific software for data analysis created by the GEM.

Automation↗
PubMed2000

[What tests should be conducted for secondary arterial hypertension in hypertensive patients resistant to treatment?].

UNLABELLED: The aim of this study was to determine the prevalence of secondary hypertension in a population of refractory hypertension without initial clinical or biological findings suggesting identifiable causes of hypertension. METHODS: A survey included 200 consecutive hypertensive patients referred to hypertension specialists for refractory hypertension (BP > 140/90 mmHg on at least two antihypertensive drugs). Prior inclusion, the permanent elevation of blood pressure was confirmed by ambulatory monitoring. In each subject an extensive work-up was performed to detect a secondary cause for hypertension. RESULTS: An essential hypertension was confirmed in 61% of this cohort. A secondary hypertension was detected in 20% of the patients; 8.5% with a primary hyperaldosteronism, 8% with a reno-vascular hypertension and 3% with a nephropathy. Moreover, 18.5% had a low renin hypertension. Thus, 27% of these patients had an abnormality of the renin-aldosterone axis. CONCLUSION: Patients with refractory hypertension should be explored to detect secondary hypertension even without findings suggesting such causes. This additional diagnostic procedure must include at least renovascular investigations and plasma renin/aldosterone level determinations in appropriate conditions.

Aged↗
PubMed2000

[Validity of the clinical prediction rule for the diagnosis of renal arterial stenosis in hypertensive patients resistant to treatment].

PURPOSE: To perform an external validation of the clinical prediction rule established by Krijnen et al. (Ann Intern Med 1998; 129: 705-11) designed to identify renal artery stenoses (RAS) in hypertensive patients. METHODS: We included 102 patients with a refractory hypertension treated with at least two antihypertensive drugs. All subjects had the research of RAS by renal angiography, or angio-computed tomography, or doppler ultrasound. Probability to detect RAS was calculated with Krijnen's algorithm (Pre-test probability) from the following parameters: age, smoking status, diffuse atherosclerosis, recent hypertension (< 2 y), obesity (BMI > 25), abdominal bruit, hypercholesterolemia (> 6.5 mmol/L), creatinine. ROC curves were plotted for each pre-test probability value. A "post-test probability" was obtained from the likelihood ratio calculated at each pre-test probability level. RESULTS: RAS prevalence in this population was 49%. Area under the ROC curve was 0.79 and Youden index was maximal for a pre-test probability of 15%. Maximal likelihood ratio was obtained for a pre-test probability of 46%. Table shows post-test probability as a function of pre-test probability obtained with Krijnen's algorithm. [table: see text] CONCLUSION: Krijnen's algorithm is valid in a population of resistant hypertensives treated with a bi-therapy. This external validation obtained on a population with a high prevalence of RAS should also be tested on a population with a lower prevalence of SAR.

Age Factors↗
PubMed2000

[Treatment of arterial hypertension in the elderly].

The benefits of treating hypertension in the elderly have been demonstrated in therapeutic trials of patients over 60 years of age. In 1985, the EWPHE study, showing that thiazide diuretics decreased the risk of the main cardiovascular complications in elderly hypertensive patients, opened the field to the demonstration of the preventive efficacy of other classes of antihypertensive drugs. The high level of cardiovascular risk in the elderly explains why the prescription of antihypertensive agents provides a greater benefit in elderly rather than in young hypertensive patients. In the over 80 s', the benefits of lowering the blood pressure have been demonstrated in the prevention of non-fatal complications.

Aged↗
PubMed2000

[Efficacy of and tolerance to prolonged release prazosin in patients with hypertension and non-insulin dependent diabetes].

UNLABELLED: The treatment of hypertension represents one of the major elements of the cardiovascular prognosis in type II diabetes. Among antihypertensive drugs, alpha blockers may be interesting because of the absence of unfavourable effects on plasma glucose and lipid levels. OBJECTIVE: The aim of this study was to evaluate the effectiveness and the safety of prazosin osmotic tablet treatment in non-insulin-dependent diabetic patients with mild to moderate arterial hypertension. METHODS: After an initial 4-week-single-blind placebo period, 81 hypertensive subjects (162 +/- 11/96 +/- 5 mmHg) with type II diabetes were included in the study to receive prazosin osmotic tablet (o.t) open-label therapy at the dose of 2.5 mg/day for 12 weeks. After 4 weeks of treatment the dosage of prazosin o.t was increased to 5 mg/day if the diastolic blood pressure remained > or = 90 mmHg. RESULTS: Both supine and standing systolic and diastolic blood pressures were significantly decreased (P < 0.001) with prazosin therapy from 162 +/- 10/96 +/- 5 mmHg in supine and 160 +/- 12/95 +/- 6 mmHg in the upright position, to 149 +/- 15/86 +/- 9 mmHg and 148 +/- 16/86 +/- 9 mmHg respectively at the end of the 12-week-treatment period. There were no significant changes in the glycemic parameters (glycemia, haemoglobin A1c) during the prazosin therapy compared with baseline values. A significant decrease of triglycerides (P = 0.005), total cholesterol (P < 0.001) and LDL cholesterol (P = 0.03) levels was observed during prazosin therapy compared with the baseline measurements, whereas HDL cholesterol remained stable. Only 6% of the patients reported adverse events in relation with the study drug during the active treatment period. CONCLUSION: This study showed a significant decrease of the blood pressure in hypertensive subjects with type II diabetes after prazosin o.t treatment, without any change of glycemic parameters. Moreover, there was a favourable evolution of the lipidic parameters during the study characterised by a significant decrease of triglycerides and total and LDL cholesterol.

Aged↗
PubMed1999

Association between local pulse pressure, mean blood pressure, and large-artery remodeling.

BACKGROUND: The aim of the present study was to determine the respective influences of local pulse pressure and mean blood pressure on arterial remodeling in humans at 2 arterial sites: a central, predominantly elastic artery (the common carotid artery) and a peripheral muscular artery (the radial artery). METHODS AND RESULTS: Forty-three healthy subjects and 124 never-treated hypertensive patients were included in the study. Intima-media thickness and internal diameter of the carotid and radial arteries were noninvasively determined with high-definition echo-tracking devices. Pulse pressure was measured locally with applanation tonometry. Multivariate regression models including mean blood pressure and local pulse pressure were established in the whole population. Carotid internal diameter and intima-media thickness were strongly influenced (P<0.0001) by carotid pulse pressure but not by mean blood pressure or brachial pulse pressure, independently of age and sex. Radial artery internal diameter was correlated with age but not with mean blood pressure or radial pulse pressure. Radial artery intima-media thickness was correlated with mean blood pressure (P<0.001) but not with radial pulse pressure. CONCLUSIONS: Carotid pulse pressure was a strong independent determinant of carotid artery enlargement and wall thickening, whereas mean blood pressure and brachial pulse pressure were not, indicating the prominent influence of local pulsatile mechanical load on arterial remodeling. These relationships were observed at the site of an elastic artery but not at the site of a muscular artery, suggesting the contribution of cyclic stretching to the pulse pressure-induced arterial remodeling.

Adult↗
PubMed1999

[Management of patients with hypertension resistant to treatment].

A patient with a blood pressure greater than 140/90 mmHg under triple drug therapy, including a diuretic, has a resistant hypertension. Management mandates the following steps: to identify antihypertensive treatments previously prescribed (doses, efficacy, side effects); to evaluate blood pressure levels outside the medical office; to inquire about poor compliance; to search for secondary hypertension. In most cases, tailoring of treatments improves the care of such patients.

Antihypertensive Agents↗
PubMed1999

Validation of two devices for self-measurement of blood pressure by elderly patients according to the revised British Hypertension Society protocol: the Omron HEM-722C and HEM-735C.

BACKGROUND: The validation of self-measurement devices for clinical use by elderly patients has been recommended. The Omron HEM-722C device has recently been validated according to the British Hypertension Society (BHS) protocol for use for general populations and the Omron HEM-735C is a new fully automatic device with a high capacity for storage of measurements that is integrated with a personal computer. OBJECTIVE: To perform a clinical validation for use by elderly people of the Omron HEM-722C and HEM-735C devices according to the revised protocol of the BHS and the criteria of the Association for the Advancement of Medical Instrumentation (AAMI). METHODS: We carried out a main validation test according to the revised BHS protocol for validation procedures for special groups on two groups of 30 subjects aged more than 65 years (29 men and 31 women), 11 of 30 with systolic blood pressures (SBP) <110mmHg, 10 of 30 with SBP >200 mmHg, 15 of 30 with diastolic blood pressures (DBP( <70 mmHg and 10 of 30 with DBP >110 mmHg. The results were graded according to the BHS system from A to D. RESULTS: The Omron HEM 722C achieved an overall A/A grading and satisfied the AAMI criteria for accuracy whereas the Omron HEM-735C achieved an overall B/A grading and satisfied the AAMI criteria for accuracy. The sphygmomanometer measurements were 147 +/- 31/79 +/- 15 and 144 +/- 30/78 +/- 15 mmHg (means+/-SD) respectively, for the models 722C and 735C. The average differences between mercury sphygmomanometer and HEM-722C readings for SBP and DBP were, respectively, 0.76+/-5 and 0.41+/-8 mmHg; those for HEM-735C were, respectively, 0.24+/-8 and 0.9+/-8 mmHg. Readings of the HEM-722C device differed by less than 5 mmHg for 76% of systolic readings and 96% of the readings differed by less than 10 mmHg. Diastolic measurements differed by less than 5 mmHg for 71% and less than 10 mmHg for 71 and 87% of all readings. Readings of the HEM-735C device differed by less than 5 mmHg for 68% of systolic readings and 74% of the readings differed by less than 10 mmHg. Diastolic measurements differed by less than 5 mmHg in 74% and less than 10 mmHg in 88 and 87% of all readings. CONCLUSIONS: On the basis of these results, for elderly subjects both self-measurement devices (Omron HEM-722C and HEM-735C) satisfied the validation criteria of the BHS and therefore can be recommended for the clinical measurement of blood pressure in elderly patients.

Automation↗
PubMed1999

The aging process modifies the distensibility of elastic but not muscular arteries.

Aging decreases the distensibility of large elastic arteries; however, the effects of age on the functional parameters of muscular, medium-sized arteries are not well determined. This study evaluated the consequences of aging on the functional parameters of the carotid and radial arteries in normotensive men. A total of 62 elderly subjects (aged 74+/-2 years) were compared with 87 young subjects (aged 35+/-3 years). Internal diameter and intima-media thickness (IMT) were measured by a high-resolution echo-tracking system to calculate distensibility and incremental elastic modulus (Einc). Although in the normal range, systolic and diastolic blood pressure levels were statistically different in the 2 groups at 128+/-19 and 74+/-13 mm Hg versus 121+/-27 and 71+/-18 mm Hg in the young and elderly subjects, respectively (P<0.05). At the carotid artery level, elderly subjects exhibited a greater IMT (742+/-144 versus 469+/-132 microm; P<0.01) and internal diameter (7067+/-828 versus 6062+/-1026 microm; P<0.01) than young subjects; elderly subjects also had lower distensibility (12+/-2 versus 21+/-2 kPa(-1) x 10(-3); P<0.01) and higher Einc (0.9+/-0.2 versus 0.7+/-0.3 kPa x 10(3); P<0.01). At the radial artery level, both IMT (240+/-42 versus 218+/-51 microm; P<0.01) and internal diameter (2685+/-432 versus 2491+/-444 microm; P<0.01) were greater in elderly subjects, but no differences in distensibility and Einc were observed between the 2 groups. All differences remained significant, even after adjusting for mean blood pressure. These results indicate that the increase of the internal diameter and IMT observed during the aging process can have opposite effects on the functional parameters of large elastic or medium-sized muscular arteries.

Adult↗
PubMed1999

[A new cause of resistant arterial hypertension: coprescription with anticonvulsant treatments].

UNLABELLED: This article provides two case reports about pharmacokinetic interactions with hypertensive drug therapy and anticonvulsive treatment. First, a 49-year-old patient presenting severe hypertension had a non-traumatic cerebral hemorrhage with convulsions. Extensive etiologic investigations did not find any cause of secondary hypertension. Under an association of four antihypertensive drugs regimen, associated with carbamazepine blood pressure was not controlled. Finally, blood pressure was well controlled after replacement of carbamazepine with vigabatrin. The second case reports a 64-year-old treatment-resistant essential hypertensive patient, carbamazepine was associated with antihypertensive treatment because of aggressivity attributed to Alzheimer's disease. After withdrawal of carbamazepine treatment, blood pressure reached normal values with the same antihypertensive regimen. Those case reports suggest drug-drug interactions between antihypertensive and anticonvulsive drug therapies. Following explanation can be hypothesis: several antihypertensive drugs are liver-metabolised by microsomal cytochrome P450 3A4 isoform that could explain a significantly decreased half-life in association with enzymatic inducers, such as rifampicine or antiepileptic drugs (phenobarbital, phenytoin or carbamazepine). CONCLUSION: When blood pressure is not controlled without cause of secondary hypertension, physicians must be careful with drug-drug interactions.

Anticonvulsants↗
PubMed1999

[Antihypertensive treatment can normalize the geometry and the arterial function in the aged patient].

The aging process and the elevation of arterial blood pressure (BP) have synergistic effects on the modifications of the arterial system. The effects of the treatment on these modifications are unknown. Our objective was to study the consequences of anti-hypertensive treatment on the geometry and function of the arteries in men over 70 years old. In 89 men aged 74 +/- 2 years, we measured internal diameter and intima-media thickness (IMT) of carotid and radial arteries using high resolution echography (WALL TRACK SYSTEM and NIUS-02), and carotid-femoral pulse wave velocity (PWV) by COMPLIOR. The BP was measured in supine position by Dinamap. In 28 subjects the BP was more than 140/90 mmHg (poor controlled hypertensives-HTpc); in the subjects where BP < 140/90 mmHg, 44 were normotensives (NT) without treatment and 17 were well controlled hypertensives (HTwc) on use of at least one antihypertensive. [table: see text] The PWV was increased in HTpc (20.1 m/s) in comparison with NT (14.6 m/s) and HTwc (16.1 m/s) (p < 0.05). The operational distensibility of radial artery was similar in the three groups. In conclusion, in elderly men aged more than 70 years, the anti-hypertensive treatment can normalize the functional properties and the geometry of muscular and elastic arteries. These results indicate that the arterial modifications observed in elderly hypertensives are consequence of the high blood pressure per se and not only consequent the modifications due to the aging.

Aged↗
PubMed1999

[Feasibility and importance of self-monitoring in patients over 75 years old].

The feasibility of self-measurement (SM) of the blood pressure (BP) is well demonstrated in hypertensive patients (pts) but, in elderly pts physical and intellectual limitations can restrict the use of SM. The aim was to evaluate the feasibility of SM as a function of autonomic psychomotricity in pts aged more than 75 years and to estimate the reproducibility of SM in comparison with office's measurements (OM). We initially proposed the use of SM devices of BP to 53 pts aged > 75 years. One-third of pts refused to participate in the study. In 32 pts we did a mini-mental-state score (MMS) and an evaluation of autonomic functions (IADL). Two patients with a MMS < 20 were excluded. The OM of BP was done in sitting position with a mercury sphygmomanometer (4 measures) and the SM by a Omron device during 5 consecutive days (3 measures morning and night). Eighteen (60%) pts did more or equal to 15 measures (good measurer) and 12 less than 15 (bad measurer). The pts of the group "good measurer" were significantly younger, were all hypertensive treated patients and had a higher MMS and a lower IADL than those of the group "bad measurer". Considering the differences (OM-SM), 55% of patients showed values superior to 10 mmHg for systolic blood pressure, and 64% of subjects had values superior to 5 mmHg for diastolic blood pressure. We conclude that the SM is acceptable by patients older than 75 years and that feasibility is optimal in those patients where the autonomic and cognitive functions are preserved and when the patient is hypertensive. Also, as the concordance between OM and SM of patients older than 75 years is below 50%, diagnostic and therapeutic decisions based on OM is hazardous in these patients.

Aged↗