To investigate the hemodynamic effects of a moderately low-salt diet in a 9-week, randomized, dou... more To investigate the hemodynamic effects of a moderately low-salt diet in a 9-week, randomized, double-blind, crossover study in 20 hypertensive, ambulatory patients. All subjects followed a 9-week, low-salt diet. During this period, they received capsules containing either lactose or salt in 4-week treatment periods, separated by a 1-week washout period. Hemodynamic and biological parameters were evaluated on the day of randomization and at the end of weeks 4 and 9. We defined a low-sodium diet (LSD) as a salt-restriction period with lactose capsules, and a normal-sodium diet (NSD) as a salt-restriction period with capsular salt supplementation. Blood pressure was significantly lower during LSD compared with NSD. This fall in blood pressure was associated with a decrease in peripheral resistance in carotid and forearm circulation. Brachial artery diameter was larger during LSD whereas carotid artery diameter remained unchanged. The changes in brachial artery were: (1) not related to blood pressure changes; (2) positively related to age, and (3) negatively correlated with baseline intracellular sodium content. These results suggest that moderate low-salt restriction is capable of decreasing blood pressure and peripheral resistance in carotid and forearm circulation. The increase in brachial, but not carotid, artery diameter following salt restriction suggests a difference in salt dependence among different arteries.
International journal of epidemiology, Jan 18, 2015
A longer leukocyte telomere length (LTL) in women than men has been attributed to a slow rate of ... more A longer leukocyte telomere length (LTL) in women than men has been attributed to a slow rate of LTL attrition in women, perhaps due to high estrogen exposure during the premenopausal period. To test this premise we performed a longitudinal study (an average follow-up of 12 years) in a subset of the population-based Danish National Twin Registry. Participants consisted of 405 women, aged 37.5 (range 18.0-64.3) years, and 329 men, aged 38.8 (range 18.0-58.5) years, at baseline examination. Women showed a longer LTL [kb ± standard error(SE)] than men (baseline: 7.01 ± 0.03 vs 6.87 ± 0.04; follow-up: 6.79 ± 0.03 vs 6.65 ± 0.03; both P = 0.005). Women displayed deceleration of LTL attrition (bp/years ± SE), as they transitioned from the premenopausal period (20.6 ± 1.0) through the perimenopausal period (16.5 ± 1.3) to the postmenopausal period (15.1 ± 1.7). Age was not associated with LTL attrition in women after statistical control for menopausal status. Men, in contrast, displayed a ...
ABSTRACT The aim of the REASON (REgression of Arterial Stiffness with perindOpril/iNdapamide fixe... more ABSTRACT The aim of the REASON (REgression of Arterial Stiffness with perindOpril/iNdapamide fixed low-dose combination) project was to compare the antihypertensive effects of a fixed low-dose combination of perindopril 2 mg/indapamide 0.625 mg (Per/Ind),versus atenolol 50 mg (ATE) in patients with essential mild-to-moderate and uncomplicated hypertension, as well as effects on arterial stiffness through tonometry and pulse wave velocity evaluation and carotid ultrasonography. The projects included also 24-h ABPM, echocardiography, 24-h ECG holter, and genotypes identification.The REASON project was a 12-month international (13 countries) multicentre, randomized, parallel groups double-blind study. Treatment was given OD over one year and dosage doubled if uncontrolled casual BP. At intermediary visits (M0, M1, M3, M6, M9, M12) BP was measured at rest in a supine position using sphygmomanometer 24-h after the last drug intake. Enrolled patients were aged between 18 and 85 years with uncomplicated essential hypertension defined as 95≤ DBP< 110 mm Hg and 160 mm Hg≤ SBP< 210 mm Hg. Evaluation criteria were change (Δ) in SBP, DBP, PP, MBP and percentage of responders. Enrolled patients: 562; randomized : 471 ; treatment duration:11.7 ± 2.0 months, age: 54.2 ± 12.3 years, men: 66.7%. Preliminary results from 469 patients (ITT) are shown: (See Table)The 95% confidential interval shows a statistical superiority of the fixed low-dose combination of Per 2 mg/ Ind 0.625 mg treatment group on SBP, PP and MBP versus atenolol. This observation is of importance when considering the prognosis value of SBP and PP. Heart rate was significantly decrease with Atenolol but not with Per/Ind. These results confirm the efficacy of the fixed low-dose combination Per 2 mg/Ind 0.625 mg as first line therapy in Hypertension.
A better understanding of the interrelationships between the structure and function of the large ... more A better understanding of the interrelationships between the structure and function of the large arteries would lead to optimize cardiovascular disease prevention strategies. In this study, we investigated the relationships of aortic arterial stiffness assessed by carotid-femoral pulse-wave velocity (PWV), with carotid plaque echogenicity assessed by B-mode ultrasound. We analyzed 561 subjects (without coronary heart disease or stroke) who were
Hypertension treatment is beneficial for most hypertensive patients. The benefits for patients wh... more Hypertension treatment is beneficial for most hypertensive patients. The benefits for patients who are very old and frail, especially those taking numerous medications, are less certain. To provide recommendations for the evaluation and treatment of hypertension among patients aged 80 years and older. MEDLINE, PubMed Central, and the Cochrane Database of Systematic Reviews were searched from inception through April 2015, with an emphasis on 2010-2015. Manual cross-referencing of review articles and meta-analyses was also performed to identify randomized controlled trials (RCTs) examining antihypertensive use in octogenarians. The search strategy included the following Medical Subject Headings: hypertension or high blood pressure and trials and oldest old or very old or very elderly. Six post hoc analyses of the previously published Hypertension in the Very Elderly Trial (HYVET) met the inclusion criteria. In the only placebo-controlled RCT on hypertension management in patients olde...
The aim of the present study was to assess the effects of high heart rate on mortality in differe... more The aim of the present study was to assess the effects of high heart rate on mortality in different subgroups in a French population according to age, gender, and blood pressure levels. We studied 19 386 subjects (12 123 men, 7263 women), aged 40 to 69 years, who had a routine health examination at the Centre d'Investigations Preventives et Cliniques
ABSTRACT Recent longitudinal studies have highlighted associations between Alzheimer's di... more ABSTRACT Recent longitudinal studies have highlighted associations between Alzheimer's disease (AD) and several factors, especially some cardiovascular risk factors, including hypertension, diabetes, diet, obesity, and elevated levels of homocysteine and lipids in the blood. The strongest associations are with hypertension and diabetes. Moderate alcohol consumption also appears to be associated with a decreased risk of incident AD. Studies of the effect of interventions to control these risk factors on the onset and course of dementia report encouraging results about antihypertensive agents and statins. Benefits from other drug therapies such as nonsteroidal antiinflammatory drugs and antioxidants remain uncertain, and initial hopes for hormonal replacement therapy for postmenopausal women have not been confirmed. Physical, cognitive and leisure activities seem to provide protection against incident AD. Cautious interpretation is necessary in view of the possible biases in these studies (confounding factors as well as survival, regression dilution, and indication biases). These epidemiologic data raise questions about the diagnostic boundaries between AD and vascular dementia. Additional studies are needed to validate these concepts and to confirm the possible benefits of preventive measures.
Diagnosis of epileptic seizure may be difficult in older patients because seizure manifestations ... more Diagnosis of epileptic seizure may be difficult in older patients because seizure manifestations are often unusual: confusion, paresis... and because there are multiple differential diagnoses (syncope, transient ischemic attack, transient global amnesia...). To promote and facilitate the diagnosis of seizures in the elderly, neurologists and gerontologists must work together and focus their strategy on two points: firstly, the knowledge of the specific presentation of seizures in elderly patients, and secondly, the adoption of a reasoning based on seizures and not epileptic syndromes. A multidisciplinary group worked on epilepsy of the elderly to elaborate an electro-clinical score which aims to help establish the diagnosis of epilepsy in elderly patients in different clinical settings. This electro-clinical score is based on a systematic review of scientific literature and the recommendations are explicitly linked to supporting evidence. Further, clinical validation of the electro-...
In subjects with hypertension, converting enzyme inhibitors and calcium entry blockers may decrea... more In subjects with hypertension, converting enzyme inhibitors and calcium entry blockers may decrease arterial stiffness independently of blood pressure changes, but the heterogeneity of response of the arterial tree has never been taken into account. In 31 subjects with hypertension, we determined through the use of Doppler echographic techniques the compliance and distensibility of the common carotid and femoral arteries and of the abdominal aorta, the radial artery wall thickness, and cardiac mass. In a double-blind randomized study, the converting enzyme inhibitor ramipril and the calcium entry blocker nitrendipine were studied and compared during 12 weeks treatment, then 4 weeks after treatment was stopped. The two drugs caused significantly different plasma levels of active renin, angiotensin I, and norepinephrine but the same effects on blood pressure, cardiac mass, radial artery wall thickness, and stiffness indices. In contrast, the effect of treatment differed substantially ...
To investigate the hemodynamic effects of a moderately low-salt diet in a 9-week, randomized, dou... more To investigate the hemodynamic effects of a moderately low-salt diet in a 9-week, randomized, double-blind, crossover study in 20 hypertensive, ambulatory patients. All subjects followed a 9-week, low-salt diet. During this period, they received capsules containing either lactose or salt in 4-week treatment periods, separated by a 1-week washout period. Hemodynamic and biological parameters were evaluated on the day of randomization and at the end of weeks 4 and 9. We defined a low-sodium diet (LSD) as a salt-restriction period with lactose capsules, and a normal-sodium diet (NSD) as a salt-restriction period with capsular salt supplementation. Blood pressure was significantly lower during LSD compared with NSD. This fall in blood pressure was associated with a decrease in peripheral resistance in carotid and forearm circulation. Brachial artery diameter was larger during LSD whereas carotid artery diameter remained unchanged. The changes in brachial artery were: (1) not related to blood pressure changes; (2) positively related to age, and (3) negatively correlated with baseline intracellular sodium content. These results suggest that moderate low-salt restriction is capable of decreasing blood pressure and peripheral resistance in carotid and forearm circulation. The increase in brachial, but not carotid, artery diameter following salt restriction suggests a difference in salt dependence among different arteries.
International journal of epidemiology, Jan 18, 2015
A longer leukocyte telomere length (LTL) in women than men has been attributed to a slow rate of ... more A longer leukocyte telomere length (LTL) in women than men has been attributed to a slow rate of LTL attrition in women, perhaps due to high estrogen exposure during the premenopausal period. To test this premise we performed a longitudinal study (an average follow-up of 12 years) in a subset of the population-based Danish National Twin Registry. Participants consisted of 405 women, aged 37.5 (range 18.0-64.3) years, and 329 men, aged 38.8 (range 18.0-58.5) years, at baseline examination. Women showed a longer LTL [kb ± standard error(SE)] than men (baseline: 7.01 ± 0.03 vs 6.87 ± 0.04; follow-up: 6.79 ± 0.03 vs 6.65 ± 0.03; both P = 0.005). Women displayed deceleration of LTL attrition (bp/years ± SE), as they transitioned from the premenopausal period (20.6 ± 1.0) through the perimenopausal period (16.5 ± 1.3) to the postmenopausal period (15.1 ± 1.7). Age was not associated with LTL attrition in women after statistical control for menopausal status. Men, in contrast, displayed a ...
ABSTRACT The aim of the REASON (REgression of Arterial Stiffness with perindOpril/iNdapamide fixe... more ABSTRACT The aim of the REASON (REgression of Arterial Stiffness with perindOpril/iNdapamide fixed low-dose combination) project was to compare the antihypertensive effects of a fixed low-dose combination of perindopril 2 mg/indapamide 0.625 mg (Per/Ind),versus atenolol 50 mg (ATE) in patients with essential mild-to-moderate and uncomplicated hypertension, as well as effects on arterial stiffness through tonometry and pulse wave velocity evaluation and carotid ultrasonography. The projects included also 24-h ABPM, echocardiography, 24-h ECG holter, and genotypes identification.The REASON project was a 12-month international (13 countries) multicentre, randomized, parallel groups double-blind study. Treatment was given OD over one year and dosage doubled if uncontrolled casual BP. At intermediary visits (M0, M1, M3, M6, M9, M12) BP was measured at rest in a supine position using sphygmomanometer 24-h after the last drug intake. Enrolled patients were aged between 18 and 85 years with uncomplicated essential hypertension defined as 95≤ DBP< 110 mm Hg and 160 mm Hg≤ SBP< 210 mm Hg. Evaluation criteria were change (Δ) in SBP, DBP, PP, MBP and percentage of responders. Enrolled patients: 562; randomized : 471 ; treatment duration:11.7 ± 2.0 months, age: 54.2 ± 12.3 years, men: 66.7%. Preliminary results from 469 patients (ITT) are shown: (See Table)The 95% confidential interval shows a statistical superiority of the fixed low-dose combination of Per 2 mg/ Ind 0.625 mg treatment group on SBP, PP and MBP versus atenolol. This observation is of importance when considering the prognosis value of SBP and PP. Heart rate was significantly decrease with Atenolol but not with Per/Ind. These results confirm the efficacy of the fixed low-dose combination Per 2 mg/Ind 0.625 mg as first line therapy in Hypertension.
A better understanding of the interrelationships between the structure and function of the large ... more A better understanding of the interrelationships between the structure and function of the large arteries would lead to optimize cardiovascular disease prevention strategies. In this study, we investigated the relationships of aortic arterial stiffness assessed by carotid-femoral pulse-wave velocity (PWV), with carotid plaque echogenicity assessed by B-mode ultrasound. We analyzed 561 subjects (without coronary heart disease or stroke) who were
Hypertension treatment is beneficial for most hypertensive patients. The benefits for patients wh... more Hypertension treatment is beneficial for most hypertensive patients. The benefits for patients who are very old and frail, especially those taking numerous medications, are less certain. To provide recommendations for the evaluation and treatment of hypertension among patients aged 80 years and older. MEDLINE, PubMed Central, and the Cochrane Database of Systematic Reviews were searched from inception through April 2015, with an emphasis on 2010-2015. Manual cross-referencing of review articles and meta-analyses was also performed to identify randomized controlled trials (RCTs) examining antihypertensive use in octogenarians. The search strategy included the following Medical Subject Headings: hypertension or high blood pressure and trials and oldest old or very old or very elderly. Six post hoc analyses of the previously published Hypertension in the Very Elderly Trial (HYVET) met the inclusion criteria. In the only placebo-controlled RCT on hypertension management in patients olde...
The aim of the present study was to assess the effects of high heart rate on mortality in differe... more The aim of the present study was to assess the effects of high heart rate on mortality in different subgroups in a French population according to age, gender, and blood pressure levels. We studied 19 386 subjects (12 123 men, 7263 women), aged 40 to 69 years, who had a routine health examination at the Centre d'Investigations Preventives et Cliniques
ABSTRACT Recent longitudinal studies have highlighted associations between Alzheimer's di... more ABSTRACT Recent longitudinal studies have highlighted associations between Alzheimer's disease (AD) and several factors, especially some cardiovascular risk factors, including hypertension, diabetes, diet, obesity, and elevated levels of homocysteine and lipids in the blood. The strongest associations are with hypertension and diabetes. Moderate alcohol consumption also appears to be associated with a decreased risk of incident AD. Studies of the effect of interventions to control these risk factors on the onset and course of dementia report encouraging results about antihypertensive agents and statins. Benefits from other drug therapies such as nonsteroidal antiinflammatory drugs and antioxidants remain uncertain, and initial hopes for hormonal replacement therapy for postmenopausal women have not been confirmed. Physical, cognitive and leisure activities seem to provide protection against incident AD. Cautious interpretation is necessary in view of the possible biases in these studies (confounding factors as well as survival, regression dilution, and indication biases). These epidemiologic data raise questions about the diagnostic boundaries between AD and vascular dementia. Additional studies are needed to validate these concepts and to confirm the possible benefits of preventive measures.
Diagnosis of epileptic seizure may be difficult in older patients because seizure manifestations ... more Diagnosis of epileptic seizure may be difficult in older patients because seizure manifestations are often unusual: confusion, paresis... and because there are multiple differential diagnoses (syncope, transient ischemic attack, transient global amnesia...). To promote and facilitate the diagnosis of seizures in the elderly, neurologists and gerontologists must work together and focus their strategy on two points: firstly, the knowledge of the specific presentation of seizures in elderly patients, and secondly, the adoption of a reasoning based on seizures and not epileptic syndromes. A multidisciplinary group worked on epilepsy of the elderly to elaborate an electro-clinical score which aims to help establish the diagnosis of epilepsy in elderly patients in different clinical settings. This electro-clinical score is based on a systematic review of scientific literature and the recommendations are explicitly linked to supporting evidence. Further, clinical validation of the electro-...
In subjects with hypertension, converting enzyme inhibitors and calcium entry blockers may decrea... more In subjects with hypertension, converting enzyme inhibitors and calcium entry blockers may decrease arterial stiffness independently of blood pressure changes, but the heterogeneity of response of the arterial tree has never been taken into account. In 31 subjects with hypertension, we determined through the use of Doppler echographic techniques the compliance and distensibility of the common carotid and femoral arteries and of the abdominal aorta, the radial artery wall thickness, and cardiac mass. In a double-blind randomized study, the converting enzyme inhibitor ramipril and the calcium entry blocker nitrendipine were studied and compared during 12 weeks treatment, then 4 weeks after treatment was stopped. The two drugs caused significantly different plasma levels of active renin, angiotensin I, and norepinephrine but the same effects on blood pressure, cardiac mass, radial artery wall thickness, and stiffness indices. In contrast, the effect of treatment differed substantially ...
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