Causes of secondary hypertension in the young population: A monocentric study.

OBJECTIVE: To study the prevalence of different causes of hypertension in young adults referred to a hypertension center in the south west of France. METHODS: We conducted a retrospective overview of patients younger than 40years old hospitalized consecutively in the Hypertension department of Toulouse University Hospital between 2012 and 2014. Clinical data about gender, age, anthropomorphic parameters and blood pressure measurement by 24h Ambulatory Blood Pressure Monitoring (ABPM) were recorded. Biological data concerned dosages of kalemia, renin and aldosterone in the supine or after 15min of seating. Recorded radiological examinations were renal artery ultrasound and abdominal CT scan. RESULTS: One hundred and forty-eight detailed medical records were analyzed, 69 women and 79 men. Among the 69 women, the causes of secondary hypertension were primary aldosteronism (n=7), fibromuscular dysplasia (n=5) and renal disease (n=4). Oral contraceptives were involved in 13 women. In addition, essential hypertension concerned 40 women (58%). Among the 79 men, the causes of secondary hypertension were primary aldosteronism (n=10), fibromuscular dysplasia (n=3), left main renal artery entrapment by a diaphragmatic crura (n=2), renal disease (n=1), pheochromocytoma (n=3) and coarctation of the aorta (n=2). In addition, essential hypertension concerned 58 men (73%). CONCLUSIONS: In our population, the prevalence of secondary hypertension is close to 33% (42% of females and 27% of males), with the following main causes: primary aldosteronism for 11.5%; fibromuscular dysplasia for 5.4%. Oral contraceptives were involved in the hypertension of 19% of the females.

Surgical site infection after valvular or coronary artery bypass surgery: 2008-2011 French SSI national ISO-RAISIN surveillance.

BACKGROUND: Multisite information regarding surgical site infection (SSI) rates for cardiac surgery programmes is not widely available. Ward characteristics that may affect outcomes have not been analysed previously. AIM: To determine individual- and ward-level factors associated with SSI occurrence after coronary artery bypass grafting (CABG) and valvular surgery. METHODS: A dataset from the French national SSI database ISO-RAISIN 2008-2011 was used. Only adult patients were included. A standardized questionnaire was completed for each patient who underwent surgery, and patients with and without SSI were characterized. Patients and ward risk factors for SSI were analysed using a multilevel logistic regression model with SSI as binary outcome (two levels: patient and ward). RESULTS: Out of 8569 patients from 39 wards, the SSI rate was 2.2%. Micro-organisms were isolated in 144 patients (74%): 35% coagulase-negative staphylococci (N = 51), 23% Staphylococcus aureus (N = 33), 6% Escherichia coli (N = 8). Higher probability of SSI was associated with the duration of preoperative hospitalization, the duration of follow-up, the duration of surgery >75th percentile and the SSI rate in the surgery ward. The residual heterogeneity between wards (median odds ratio: 1.53) was as relevant as duration of preoperative hospitalization (odds ratio: 1.57). CONCLUSION: Although patient risk factors were more strongly associated with SSI occurrence, this study provided evidence for the existence of a ward-level effect. This should be taken into account when considering possible corrective interventions.

[Ambulatory blood pressure, intima media thickness, global cardiovascular risk and therapeutic decisions]. / Mesure ambulatoire de la pression artérielle, épaisseur intima média carotidienne, risque cardiovasculaire global et décision thérapeutique.

OBJECTIVE: To determine the influence of ambulatory blood pressure monitoring (ABPM), carotid intima media thickness (IMT) and global cardiovascular risk on the therapeutic strategies issued from our hypertension unit. METHODS: All essential uncomplicated and never treated hypertensive patients referred to our hypertension unit between 1996 and 1997 for etiologic or target organ damage evaluation were considered eligible. We excluded diabetics and patients with renal disease who need a specific therapeutical approach. 54 patients (44.7 +/- 10.1 years) were included (40 men). All patients underwent an ABPM measurement. The right common carotid IMT measurement had been performed (0.06 +/- 09 mm). The global cardiovascular risks were assessed with the Framingham prediction chart taking into account age, sex, total cholesterol, smoking status and systolic office blood pressure. According to the therapeutic decision three groups were made up: group 1 lifestyle counselling (n = 13), group 2 single drug therapy (n = 31), and group 3 combination therapy (n = 10). RESULTS: No significant difference was found in age, sex ratio, prevalence of severe hypertension, office systolic blood pressure, body mass index, global cardiovascular risk between the three groups. In contrast ABP (24 h ABP mmHg: group 1: 128.23 +/- 6.91/79.7 +/- 6.4; group 2: 140.48 +/- 9.7/97.48 +/- 8.17; group 3: 152.4 +/- 15.35/99.4 +/- 12.14 p < .0001) and IMT (group 1: 10.55 +/- .09, group 2: .59 +/- .07, group 3: .66 +/- .11 p = .02), were significantly higher in group 3 than in group 2 and in group 1. The percentage of white coat hypertensives was higher in group 1 than in group 3 (group 1: 61.5%, group 2: 3.2%, group 3: 0%). In the whole population, the higher was the global cardiovascular risk, the higher was the common carotid intima media thickness. In this study the global cardiovascular risks are not related to therapeutic decisions. Therapeutic strategies are influenced by ABP level and by the vascular remodeling which depends partly on the global cardiovascular risk.

[Intima media thickness of the carotid artery in white coat and ambulatory hypertension]. / Epaisseur intima-média carotidienne chez l'hypertendu de la blouse blanche et ambulatoire.

Recent epidemiological studies have reported an association between carotid intima media thickness (IMT), ambulatory blood pressure (ABP) and absolute cardiovascular risk. To study the relation between white coat effect and vascular changes in hypertensives (HT), 57 essential HT (office blood pressure (OBP) 152.2 +/- 19.5/93.7 +/- 12.4 mmHg) were recruited (46.4 +/- 11.8 years old, 49 men). After antihypertensive drugs withdrawal, an ABP was performed (Spacelabs 90207). The right common carotid artery IMT 3 cm proximal to the bifurcation was examined by ultrasonography. IMT (0.59 +/- 0.09 mm; Software lotec system) were measured by a reader blinded to the ABP data. White coat hypertension (WCH) was defined by a mean day-time ambulatory BP (d-ABP) lower than the 90th percentile of the distribution of daytime ABP of a normotensive population reported by Verdecchia et al. (131/86 mmHg in women and 136/87 mmHg in men). [table: see text] White coat hypertension was found in 8 from 57 (14%) subjects. IMT was significantly increased in ambulatory HT when compared with white coat HT while age, sex ratio, OBP, smoking status were not different. In stepwise regression age and systolic d-ABP were the only determinants of IMT (p < 0.05). In our hypertensive population. ABP appears more closely related to IMT than OBP and IMT in sustained is greater than in white coat hypertensive.

Proteolytic and peroxidatic reactions of commercial horseradish peroxidase with myelin basic protein.

Degradation of myelin basic protein during incubations with high concentrations of horseradish peroxidase has been demonstrated [Johnson & Cammer (1977) J. Histochem. Cytochem.25, 329-336]. Possible mechanisms for the interaction of the basic protein with peroxidase were investigated in the present study. Because the peroxidase samples previously observed to degrade basic protein were mixtures of isoenzymes, commercial preparations of the separated isoenzymes were tested, and all three degraded basic protein, but to various extents. Three other basic proteins, P(2) protein from peripheral nerve myelin, lysozyme and cytochrome c, were not degraded by horseradish peroxidase under the same conditions. Inhibitor studies suggested a minor peroxidatic component in the reaction. Therefore the peroxidatic reaction with basic protein was studied by using low concentrations of peroxidase along with H(2)O(2). Horseradish peroxidase plus H(2)O(2) caused the destruction of basic protein, a reaction inhibited by cyanide, azide, ferrocyanide, tyrosine, di-iodotyrosine and catalase. Lactoperoxidase plus H(2)O(2) and myoglobin plus H(2)O(2) were also effective in destroying the myelin basic protein. Low concentrations of horseradish peroxidase plus H(2)O(2) were not active against other basic proteins, but did destroy casein and fibrinogen. Although high concentrations of peroxidase alone degraded basic protein to low-molecular-weight products, suggesting the operation of a proteolytic enzyme contaminant in the absence of H(2)O(2), incubations with catalytic concentrations of peroxidase in the presence of H(2)O(2) converted basic protein into products with high molecular weights. Our data suggest a mechanism for the latter, peroxidatic, reaction where polymers would form by linking the tyrosine side chains in basic-protein molecules. These data show that the myelin basic protein is unusually susceptible to peroxidatic reactions.

Quantitation of myelin carbonic anhydrase-development and subfractionation of rat brain myelin and comparison with myelin from other species.

A number of related studies have been performed to characterize further the carbonic anhydrase activity of myelin. Recent assertions that carbonic anhydrase activity is intrinsic to the myelin sheath were subjected to the additional test of isolation of rat brain myelin in the presence of purified carbonic anhydrase. This procedure did not increase the carbonic anhydrase activity in myelin above the endogenous level, indicating that this enzyme does not stick to myelin membranes. A developmental study of rat brain carbonic anhydrase showed that the enzyme activity increased in whole brain homogenates and in myelin, with the greatest increments in enzyme activity occurring before the animals were 60 days old. When myelin from adult rat brains was fractionated on a density gradient, carbonic anhydrase activity was relatively enriched in the heavy subfraction but was present in all three layers. This finding suggested that the activity in myelin preparations was not due to contamination with a carbonic anhydrase-rich membrane fragment. Carbonic anhydrase in myelin was not confined to the rat. Beef brain homogenates and myelin had low activities of the enzyme, but myelin from rabbit, cat, monkey and mouse had carbonic anhydrase activities comparable to that of the rat, accounting for 6.3--13.6% of the respective homogenate activities.