[Acute hypertensive crisis. Emergency treatment].
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Acute Disease↗
Biomedical subjects
X Girerd
Publications and source records attributed to X Girerd.
[Effects of aging on arterial function in man].
The structure of arteries changes with age. Gradual disappearance of elastic fibres facilitates dilatation of the arterial lumen and increase in length of the vessels. Simultaneously, the arterial wall becomes thicker, but it is often difficult to distinguish the changes due to ageing from those caused by atherosclerosis. These structural alterations result in a greater rigidity of the arteries, which can now be evaluated by non-invasive segmental methods. This shows that ageing does not have the same functional effects on wide-caliber elastic arteries and on middle-sized muscular arteries. The increase of systolic arterial pressure observed in the elderly is a consequence of structural and functional changes in the arterial system.
Aged↗
Acute changes in forearm haemodynamics produced by cigarette smoking in healthy normotensive non-smokers are not influenced by propranolol or pindolol.
The aim of the present study was to examine the effect of cigarette smoking in healthy non-smokers on blood pressure and forearm haemodynamics after acute oral administration of non-selective beta-adrenoceptor blockers with and without intrinsic sympathomimetic activity, viz. pindolol 15 mg and propranolol 80 mg. A preliminary study was done to compare cigarette smoking and sham smoking to evaluate the time-course of the haemodynamic effects of cigarette smoking. The second experiment was then carried out in the same six volunteers, according to a double-blind randomized placebo-controlled crossover design, to evaluate the possible effect of pre-treatment with beta-adrenoceptor blockers on blood pressure, heart rate and forearm haemodynamics (forearm blood flow, brachial artery diameter and brachio-radial pulse-wave velocity) measured at baseline, during smoking and every five minutes up to 1 h afterwards. No major difference from placebo in blood pressure or forearm haemodynamics was found and pre-treatment with beta-blockers did not prevent the acute vascular effects of cigarette smoking.
Adult↗
[Absence of labetalol interference on urine metanephrine determination in hypertensive patients].
The dosage of urinary catecholamines and their metabolites is a main element of diagnosis in the research of a pheochromocytoma in patients with high blood pressure. The literature reports high values of these compounds in patients treated with labetalol (an alpha/beta-blocker). An analytical interference has been evoked to explain these misleading results, which have not been observed with other beta-blockers. The goal of this work was to look for this eventual analytical interference in the dosage of urinary metanephrine by reversed phase liquid chromatography coupled with electrochemical detection, in patients with high blood pressure. Eighteen hypertensive patients, 52 +/- 14 years old, were included in the study. In 8 patients, a dosage of metanephrine, normetanephrine and creatinine on a 24 hours urine sample was performed before (D1) and 24 hours after (D3) the prescription of labetalol (200 mg twice a day). In the other group, labetalol was not prescribed but dosage was made in the same conditions. Urinary excretion of these compounds (metanephrine+normetanephrine) divided by urinary creatinine was not modified in the treated group (0.16 +/- 0.08 vs 0.14 +/- 0.04), nor in the reference group (0.17 +/- 0.08 vs 0.17 +/- 0.08). This study shows that administration of labetalol in patients with essential hypertension does not interfere with urinary metanephrine and normetanephrine determination after 48 hours of treatment. This implies that research for a pheochromocytoma is possible in patients with hypertension and receiving labetalol, by using reversed phase liquid chromatography coupled with an electrochemical detector for the dosage of urinary metanephrine and normetanephrine.
Adrenal Gland Neoplasms↗
[SYST-EUR: a multicenter trial of treatment of systolic hypertension in aged subjects. An initial report].
Syst-Eur is a multicentre placebo-controlled outcome trial, designed by the European Working Party on High Blood Pressure in the Elderly (EWPHE), to investigate the effect of antihypertensive treatment on the incidence of stroke in elderly patients with isolated systolic hypertension (ISH). Eligible patients must be at least 60 years old and have a systolic blood pressure averaging 160-219 mmHg with a diastolic blood pressure less than 95 mmHg. The present paper in an interim report on the first 316 patients randomized into this trial. The placebo (N = 170) and active treatment (N = 146) groups were similar at randomization with respect to age (73 +/- 8 years; mean +/- standard deviation), sitting blood pressure (178 +/- 12/85 +/- 7 mmHg), percentage men (34%) and percentage of patients with cardiovascular complications (29%). After randomization blood pressure fell more (p < 0.001) on active treatment than in the placebo group (19 +/- 20/6 +/- 10 mmHg versus 7 +/- 19/1 +/- 10 mmHg for the sitting blood pressure). This first interim report on the Syst-Eur trial demonstrates that a multinational trial in elderly patients with ISH is feasible and that a significant blood pressure difference between the 2 treatment groups can be achieved and maintained. New centres are being recruited in order to randomize a total of 3,000 patients.
Aged↗
Arterial distensibility and left ventricular hypertrophy in patients with sustained essential hypertension.
Reduced aortic distensibility and compliance may participate in the genesis of cardiac hypertrophy in patients with hypertension. In these patients the increase in end-systolic stress, a determinant factor contributing to the development of cardiac hypertrophy, is influenced not only by the geometric properties of the ventricle but also by the level of systolic pressure. In patients with sustained essential hypertension, the degree of cardiac hypertrophy correlates significantly with the increase in aortic rigidity, which is assessed by the calculation of the characteristic impedance, by the measurement of carotid-femoral pulse-wave velocity, or by the calculation of the Peterson elastic modulus at the level of the aortic arch. Dihydralazine-like substances are unable to modify arterial stiffness, whereas calcium-entry blockers and converting-enzyme inhibitors improve arterial stiffness when achieving the same degree of blood pressure reduction. Modifications in the stiffness of the aorta and other large arteries must be considered to understand reversion of cardiac hypertrophy as a result of antihypertensive treatment.
Antihypertensive Agents↗
[Study of flow-dependent vasodilation of the femoral artery in hypertensive and normal subjects].
Flow dependent vasodilation of brachial artery is not significantly different in hypertensives as compared to normotensives. Since, in vitro, changes in vasomotor tone of large arteries in response to endothelial stimulation may differ depending on the territory, we re-examined phenomenon of flow-dependent vasodilation at the level of the femoral artery in 10 normotensives (NT) and 12 age matched (45 +/- 9 vs 43 +/- 4 yrs) hypertensives (HT). Systolo-diastolic variations of femoral artery diameter (D) were recorded using an original echo-tracking system based on doppler shift while blood flow velocity was measured at the same level using a bidimensional pulsed doppler system (V). A 10 min period of leg ischemia did not induce any significant change in D and V in each group but decreased foot skin blood flow (laser doppler). This decrease occurred to the same extent in NT and HT. During reactive hyperemia following release of the pneumatic cuff, V increased (from 2.1 +/- 0.3 to 12.5 +/- 2.4 cm/s in NT) and returned to control level at the 3rd min. Diastolic diameter (Dd) increased (max: 2nd min) in NT (9.3 +/- 0.8 vs 8.8 +/- 0.9 mm; p less than 0.001) and in HT (9.5 +/- 1.2 vs 8.4 +/- 1.2 mm; p less than 0.01). Dd increased to a greater extent in HT than in NT while reactive hyperemia (laser doppler) did not differ. Thus, a non-invasive method is able to demonstrate a flow-dependent vasodilation at the level of the femoral artery.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
[Reproducibility of Doppler measurements in renal circulation].
Duplex ultrasonography is now used to detect renal artery (RA) stenosis, but measurement reproducibility was not assessed systematically in renal circulation. Our aim was to definite intra and inter-observer variabilities of initial acceleration time (AT), peak systolic velocity (SV), and end-diastolic velocity (DV) in RA. We examined 12 hypertensive patients with angiographically normal RA and 2 normotensives. During these 14 explorations, all measurement were made by the operator A twice, and 13/14 times by the operator B twice. A duplex ultrasound CGR Radius CF* device was used with a 3.75 MHz probe. Once the RA spotted by color imaging, AT, SV, DV were measured by pulsed doppler aligning on arterial axis without angle correction with translumbar approach at different levels (distal trunk, hilus, sinus). SV intra-observer variabilities were for operator A on mean 30% at distal trunk, 3% at hilus, 4% at sinus; for B, there were respectively 16, 0, 2%. About DV, there were for A 3, 0, 1% and for B 2, 7, 0%. Reproducibility was worse about AT. SV inter-observer variabilities were 14, 2, 3%, for DV 13, 3, 2%, for AT 2, 6, 5%. Therefore indexes based on SV, DV, and AT with a less reproducibility may be used for screening or follow-up, but their diagnostic value is still to assess.
Adult↗
[Visco-elastic properties of common carotid artery in treated hypertension].
It is now possible to measure clinically by a non-invasive method systolo-diastolic variations of the internal diameter of large arteries over 4 to 10 cardiac cycles with an original vascular echo-tracking device using Doppler shift. By the means of a transversal study of healthy subjects and patients followed up in the hypertension clinique, the authors set out to determine whether long-term non-specific antihypertensive treatment could, by correcting the blood pressure, also normalise the vascular changes encountered in hypertension. This study compared 46 normotensive subjects (Group I), 25 essential hypertensive patients with normal blood pressure recordings after at least 3 months' treatment (Group II) and 56 untreated essential hypertensive patients of the same average age (range 24 to 78 years). The common carotid artery was chosen for study of its geometry (internal diastolic diameter: Dd) and function (relative systolic expansion Ds-Dd/Dd; Perterson's elastic modulus; cross sectional compliance). The arterial diameter increased significantly with age in all three patients groups. In patients under 60 years of age, the diameter, corrected for age and sex, was significantly greater in Group II than in Group I, and similar in Groups II and III. This suggests that in spite of correcting blood pressure by long-term therapy (4.1 +/- 4.1 years), the internal diameter of a large artery such as the common carotid artery remains increased, which is in favour of the persistence of structural arterial changes rather than a prolonged vasodilator effect of the antihypertensive agents used.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Physical properties of the aorta and cardiac hypertrophy in essential hypertension.
The load of the heart in hypertension is related not only to increased peripheral vascular resistance but also to decreased aortic compliance. From non-invasive clinical studies involving determinations of pulse wave velocity and systolic-diastolic variations of aortic arch diameter, it can be shown that decreased aortic compliance is strongly related to increased cardiac mass. The correlation is observed even after adjustment for the level of blood pressure. It is suggested that decreased aortic compliance in hypertension causes a disproportionate increase in systolic pressure and end-systolic stress, thus contributing to promote cardiac hypertrophy with possible consequences for epidemiology, clinical investigation and treatment.
Aorta, Thoracic↗
[Cardiovascular mortality as a function of left electric ventricular hypertrophy. In a male population].
The prevalence of electrocardiographic left ventricular hypertrophy was studied in a population of 19,622 men born and living in France, aged from 40 to 69 years, who volunteered to have a medical check-up at the health centre of preclinical investigations, Paris, between 1972 and 1977. Enquiries were made among local authorities and physicians to determine the number of deaths and their causes. During the follow-up (median 9.5 years), 1,285 deaths were recorded. The overall cardiovascular mortality was 384 deaths: 178 patients died of ischaemic heart disease, 66 of sudden death, 93 of cerebral vascular accident and 47 of various cardiovascular diseases. The presence of an electrocardiographic left ventricular hypertrophy increased the incidence of overall mortality and all causes of cardiovascular mortality in all age-groups. An analysis of survival after adjustment for age, systolic blood pressure, cholesterol level and smoking habits indicated that left ventricular hypertrophy is indeed a predictor of total cardiovascular mortality and of mortality due to ischaemic heart disease.
Adult↗
Early arterial modifications in young patients with borderline hypertension.
Pulse wave velocity, used as an indicator of arterial distensibility, was recorded in 123 young male subjects, 63 untreated patients with borderline hypertension and 60 control subjects. The measurement was made with a continuous Doppler unit coupled to an ECG. In both groups mean age was similar, but mean arterial pressure was increased in borderline hypertensive compared with control patients. In comparison with controls, borderline hypertensives showed an increased pulse wave velocity. A significant correlation was observed between mean arterial pressure and pulse wave velocity in both populations, but the two regression lines were significantly different (covariance analysis). This result suggests that pulse wave velocity modifications in borderline hypertensives are not solely due to the elevated pressure, but also reflect structural or functional changes in the arterial tree.
Adolescent↗
Increased vasodilator response during stimulation of cardiopulmonary baroreceptors in borderline hypertensives.
1. The effects of passive leg elevation on the forearm circulation were compared in 14 borderline hypertensive and 16 normotensive men. 2. In the supine position, mean arterial pressure (MAP), heart rate (HR) and forearm blood flow (FBF) were significantly greater in borderline hypertensives. 3. With leg raising, MAP and HR did not change significantly from basal values. FBF increased by +0.6 +/- 0.2 (s.e.m.) mL/min/100 mL (P less than 0.02) in normotensives and by + 1.3 +/- 0.2 mL/min/100 mL (P less than 0.001) in hypertensives (P for difference between groups less than 0.05).
Adolescent↗
Pulsatile versus steady component of blood pressure: a cross-sectional analysis and a prospective analysis on cardiovascular mortality.
Studies on the prognostic significance of blood pressure on cardiovascular disease have essentially investigated the levels of diastolic or systolic blood pressure. However, blood pressure may also be divided into two other components: steady (mean arterial pressure) and pulsatile (pulse arterial pressure). The relations of these two components with cardiovascular risk factors and cardiovascular mortality were investigated in 18,336 men and 9,351 women aged 40-69 years, who were followed up for a mean period of 9.5 years. However, the interpretation of the relations is complicated by the strong correlation existing between these two components. A principal component analysis was performed to obtain two independent parameters: a steady and a pulsatile component index, strongly correlated with mean and pulse arterial pressure, respectively. In the cross-sectional analysis, relations were stronger with the steady component index than with the pulsatile component index; an association was found between left ventricular hypertrophy and the pulsatile component index in both sexes. The survival analysis was not performed in women under 55 as only 11 cardiovascular deaths occurred in this group. The steady component index was a strong prognostic factor of all types of cardiovascular death in both sexes. In women, the pulsatile component index was positively correlated to death from coronary artery disease and inversely correlated to stroke. In conclusion, the steady component of blood pressure is a strong risk factor for cardiovascular death in both sexes; the pulsatile component could be a risk factor independent of the steady component in women older than 55 years.
Adult↗
[Increased vasodilation response to the stimulation of low pressure mechanoreceptors in borderline hypertension].
Passive lifting of the lower limbs (antitilt) is a simple manoeuvre which stimulates low-pressure mechanoreceptors. Patients with borderline hypertension have an alteration of the arterial baroreflex modulated by an increased inhibitory effect of cardiopulmonary mechanoreceptors on vasomotor centres. The repercussions of antitilt on mean arterial pressure (MAP), heart rate (HR) and blood flow rate in the forearm (FRFA) were studied in 30 male subjects aged 18 to 25 years: 14 with untreated borderline hypertension ("patients") and 16 controls. FRFA was measured with a plethysmograph by means of a mercury constraint gauge. MAP was recorded during exploration with a DINAMAP instrument. The parameters were measured in recumbent position, then within minutes of the antitilt manoeuvre. In recumbent position the differences between patients and controls were: MAP 94.7 +/- 6 vs 84.7 +/- 7 mmHg (p less than 0.001); HR 76 +/- 13 vs 63 +/- 9 beats/min (p less than 0.01); FRFA 4.6 +/- 1.5 vs 3.5 +/- 1.4 ml/min/100 ml (p less than 0.05). Following antitilt, MAP and HR remained unchanged in the two groups, but there was a significant increase of FRFA in both controls (+ 0.6 +/- 0.2 ml/min/100 ml; p less than 0.02) and patients (+ 1.3 +/- 0.2 ml/min/100 ml; p less than 0.001). This increase was significantly greater in patients than in controls (p less than 0.05). This study shows that antitilt produces an increase of blood flow rate in the forearm that is more pronounced in patients with borderline hypertension than in controls. The stability of MAP and HR is in favour of non-actuation of the high-pressure arterial baroreflex.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
[Electric left ventricular hypertrophy and pulsatile component of arterial pressure in a population study].
High systolic or diastolic blood pressure is a risk factor of left ventricular hypertrophy. However, haemodynamically speaking blood pressure is made of two components: continuous and pulsatile. Few authors have analysed the relationship between these two components and left ventricular hypertrophy. A horizontal study was conducted in 27, 687 subjects who volunteered for a medical check-up in Paris. A principal component analysis led to the estimation of two distinct parameters: a continuous pressure index (CPI) and a pulsed pressure index (PPI). The correlation between CPI and age was linear, whereas PPI was independent of age before 55 years and thereafter increased in a linear manner. This study also confirmed the importance of the relationship between the continuous component of blood pressure and electrocardiographic left ventricular hypertrophy. It is suggested that the pulsatile component might also be a risk factor of left ventricular hypertrophy independently of the continuous component level. Only a prospective study would confirm that an increase in the pulsatile component of blood pressure has a prognostic value as regards ventricular hypertrophy.
Adult↗
[Therapeutic response to canrenone of patients with essential hypertension as a function of sodium transport anomalies and ouabain sensitivity of erythrocytes].
The presence of Na+ transport abnormalities (decreased affinity of the Na+/K+ pump or the Na+, K+ cotransport for internal Na+, increased Na+:Li+ countertransport, increased Na+ leak), Na+ content, Na+/K+ pump activity and sensitivity to ouabain were investigated in erythrocytes from 13 patients with essential hypertension. According to the presence or absence of Na+ transport abnormalities, the patients were divided into two groups: TrNa(+) (n = 9) and TrNa(-) (n = 4) respectively. Compared with TrNa(-) patients, TrNa(+) patients were characterized by: (i) a higher arterial pressure (131.4 +/- 11.8 vs 110.0 +/- 13.2 mmHg, p less than 0.05), (ii) an increased erythrocyte Na+ content (8.9 +/- 1.0 vs 6.3 +/- 0.8 mmol/l.cells, p less than 0.01) associated with (iii) a decreased rate constant of Na+/K+ pump activity (235 +/- 26 vs 309 +/- 45 h-1, p less than 0.05) and (iv) a higher sensitivity to ouabain (0.76 +/- 0.23 vs 1.12 +/- 0.26 microM, p less than 0.05). Oral administration of canrenone 50 mg per day during 7 weeks decreased mean arterial pressure by 10-30 mmHg in 6 out of the 9 TrNa(+) patients. Conversely, it decreased mean arterial pressure in only one out of the 4 TrNa(-) patients. The hypotensive effect of canrenone in TrNa(+) patients was not associated with normalization of their Na+/K+ pump activity. Canrenone did not modify the sensitivity to ouabain of either the TrNa(+) or the TrNa(-) patients. Before treatment, acute injection of ouabain provoked an inhibition of the erythrocyte Na+/K+ pump, without any change in Na+ content.(ABSTRACT TRUNCATED AT 250 WORDS)
Biological Transport↗
[The influence of anthropometric factors, hemorheologic parameters and the level of arterial pressure on pulse wave velocity].
UNLABELLED: The measurement of the pulse wave velocity (PWV) is widely used in clinical practice to assess the elasticity of the arterial system. It can be influenced by a number of factors. The present study was undertaken to assess the possible role of anthropometric factors, hemorheological parameters and blood pressure on this element. STUDY DESIGN: Sixty-three male subjects, mean age: 21 +/- 1.6 years,; height: 177 +/- 7 cm; weight: 76 +/- 13 kg, were subjected to Doppler measurement of the carotid-femoral PWV with synchronous recording of blood pressure. In parallel, the following were carried out: nycthemeral blood pressure recording, measurement of plasma vicosity and erythrocyte deformability, determination of hematocrit, fibrinogen and total proteins. The Quetelet indices and body surface area (BSA) were calculated for each patient. These data were analyzed by multiple linear regression. RESULTS: Three parameters affect PWV: 24-hours diastolic blood pressure, hematocrit, and body surface area (the coefficient of multiple correlation: r = 0.597, the percent variability of the explained variable is equal to 35.7%, the regression equation can be written: PWV CF (cm/sec) + 0.283*Diast/24 hours + 0.742* hematocrit + 9.486* BSA = 0.629). The following parameters are not involved: plasma viscosity, erythrometry, total proteins, fibrinogen, Quetelet index, systolic and diastolic blood pressure during the investigation, mean systolic pressure and mean heart rate over 24 hours. COMMENTS: The PWV-diastolic pressure relationship is well-known. In contrast, the effect of the hematocrit and body surface area has never been reported.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗