[Short-term impact of an ambulatory cardiac rehabilitation program on arterial rigidity]. / Impact à court terme d'un programme de réadaptation cardiaque ambulatoire sur la rigidité artérielle.

BACKGROUND: If the positive impact of cardiac rehabilitation on metabolic profile and exercise tolerance is well documented in the literature, very few studies evaluated the impact of these rehabilitation programs on arterial rigidity. PURPOSE: The main objective of this study was to determine if a short and intense 4-week cardiac rehabilitation program could yield a positive impact on arterial rigidity. METHOD: A cohort study was performed on Leopold Bellan Foundation. All patients referred for cardiac rehabilitation program after an acute event (surgery, technical gesture or acute decompensate heart failure) were included in this study. Our CR program consists of four sessions per week for five weeks (total of 20 sessions) and includes both exercise and health and nutrition education sessions. In addition to clinical and therapeutic data collection, biochemical analysis for carbohydrate and lipid metabolism and exercise capacity measurements, carotid femoral pulse wave velocity (PWV) were measured in a quiet room in the morning of their first and last day prior to any exercise. RESULTS: One hundred and ninety-eight cardiac patients have participated in this study, of which 79% were male, mean age 60 ± 10, 50 (25%) were diabetic, 103 (52%) were hypertensive, 60 (30%) were current smokers, 98 (50%) had dyslipidemia, and 140 (71%) were referred for cardiac rehabilitation after acute coronary syndrome. Arterial stiffness is defined by a VPWV value greater or equal to 10. At the beginning, 59% of our patients have rigid arteries. After 20 sessions of cardiac rehabilitation, this number is significantly reduced to 51% (P=0.12). Patients with arterial stiffness have accumulated more major cardiovascular risk factors, and have had less exercise capacity than others. However they benefit similarly from the cardiovascular rehabilitation program. CONCLUSION: In the present study, we observed that arterial stiffness, as reflected by the PWV, tends to decrease after short-term ambulatory cardiac rehabilitation program.

Prophylactic effect of aqueous extract of Sesamum indicum seeds on ethanol-induced toxicity in male rats.

The liver is vulnerable to alcohol-related injury because it is the primary site of alcohol metabolism. Additionally, a number of potentially dangerous by-products are generated as alcohol is broken down in the liver. However, dietary supplements may prevent or relieve some of alcohol's deleterious effects. Therefore, this study was conducted to evaluate the prophylactic effect of aqueous extract of Sesamum indicum (SI) on ethanol induced toxicity in rats. Male Wistar albino rats were divided into control, ethanol, pre-treatment, simultaneous and post-treatment groups. In the prophylactic experiment, Sesamum indicum, (200 mg/kg body weight) was administered by oral gavage for 28 days; two hours before, simultaneously with or two hours after ethanol exposure. Toxicity was induced by administering 45% ethanol (4.8 g/kg bw) by oral gavage. Lipid peroxidation (TBARS) and reduced glutathione (GSH) levels and catalase (CAT), glutathione peroxidase (GPx), superoxide dismutase (SOD) and gluthathione-S-transferase (GST) activities were then determined in the liver, serum triglyceride (TG) levels, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) activities were monitored and histological examination was carried out. The results revealed that ethanol administration led to significant elevation of TBARS level while depleting in the level of GSH as well as CAT, GPx, SOD and GST activities. Similarly, TG level and ALT and AST activities were elevated. The SI pre-treated group significantly inhibited TBARS, restored GSH level, enhanced CAT, GPx, SOD and GST activities and significantly decreased the elevated level of serum TG, ALT and AST activities. SI treatment (simultaneously with ethanol) exhibited similar effects to those of the SI pre-treated groups, while the SI post-treated group did not show the same protection as the Pre-treated group. S. indicum possesses antioxidant and hepatoprotective properties, that eliminate the deleterious effects of toxic metabolites of ethanol.

The effect of applying a pipe-joint lubricant to connect ductile iron pipe on off-flavors in drinking water distribution systems.

This study was used to help define the contribution to taste and odor problems caused by the application of a pipe-joint lubricant to connect ductile iron pipe in drinking water distribution systems. Tyton Joint Lubricant (TJL) was studied. The lubricant produced odors that are continually oxidized by chlorine or oxygen. The mechanism of oxidative rancidity, one of the major causes of food spoilage is the apparent mechanism of oxidation. The odors produced by the lubricant were characterized by a Flavor Profile Analysis (FPA) panel as well as GC/MS and Sensory GC analysis. The most common odors perceived in the TJL water samples for the first six days were waxy/oily and soapy odors with a rancid oil, odor note. The waxy/oily and soapy odors decreased with time in the chlorine medium as the rancid oily odor note increased. Numerous aldehydes, ketones, alcohols and borneol compounds, produced from the lubricants, were tentatively identified and linked to the odors perceived by the FPA panel.

[Is assessment of kidney involvement in patients with essential hypertension satisfactory? General medical observation results in a national study (PHENOMEN)]. / L'évaluation de l'atteinte rénale est-elle satisfaisante chez l'hypertendu essentiel? Observatoire en médecine générale résultats d'une enquête nationale (PHENOMEN).

UNLABELLED: According to ANAES guidelines (2000) adapted from the international guidelines, kidney function should be regularly monitored in hypertensive patients in order to detect vascular nephropathy at an early stage and prevent kidney failure which is a major cardiovascular factor. The PHENOMEN survey was conducted between January and July 2001 on a representative sample of 16,358 patients suffering from hypertension being followed by a General Practitioner (GP). The population included patients from all 22 administrative regions in France. AIMS: To determine the prevalence of renal involvement in patients with hypertension (both treated and untreated); to compare the GP's subjective evaluation of the extent of renal involvement with a more objective assessment made according to ANAES guidelines. METHODS: Kidney function was evaluated by measuring plasma creatinine levels to derive a value for the creatinine clearance rate (CCR) using the Cockeroft-Gault formula. RESULTS: Out of the 16,358 patients included, plasma creatinine levels could be measured in 11,586 (76%) [53% men; 47% women, mean age = 63 +/- 12 years]: mean plasma creatinine = 90 +/- 49 mumol/l, i.e. a mean CCR of 83 +/- 32 ml/min. For 8,650 of the patients (75%), kidney function had been monitored in the preceding twelve months. The physicians defined their patient's kidney function as normal in 10,080 (87%) of cases whereas in reality, 4,411 of 8,650 (51%) were suffering from some degree of renal insufficiency (RI): in 2,422 (28%), RI was mild (> or = 60 CCR < 80 ml/min): in 1,903 (22%) RI was moderate (> or = 30 CCR < 60 ml/min). A minority of patients (44 i.e. 1%) showed severe RI (CCR < 30 ml/min). CONCLUSION: Most GPs apply ANAES guidelines and order plasma creatinine assays. However, there is a discrepancy between how the physician "perceives" the seriousness of the renal insufficiency and a more objective measure based on the CCR figure. It would seem that the CCR derivative is insufficiently exploited despite the widespread availability of converters. Thus, the PHENOMEN survey has revealed that the extent of renal involvement in patients with hypertension still tends to be underestimated by GPs despite the major implications of this complication in terms of therapeutic strategy and global cardiovascular risk.

Doppler sonograpy with dynamic testing in a case of aortic dissection extending to the innominate and right common carotid arteries.

A 50-year-old woman with Marfan's syndrome was admitted for an aortic dissection with an intimal flap extending from the sinus of Valsalva to the descending aorta and aortic valve incompetence. Ultrasonography revealed a double lumen in the innominate and right common carotid (RCCA) arteries. The false lumen extended from the aortic arch to the distal RCCA and compressed and nearly occluded the true lumen in the innominate artery. At the end of the RCCA was a large tear allowing communication between the false and true lumens. Colour-coded Doppler sonography showed blood passing from the false lumen into the true lumen and antegrade flow in the false lumen but reverse flow in the true channel. A dynamic test, as used in accessing for subclavian steal syndrome, producing reactive hyperaemia, showed the retrograde flow in the true channel to be markedly increased, supplying the subclavian artery. We emphasie the importance of functional description of an abnormal haemodynamic situation, which in this case helped to avoid unnecessary surgery to the supra-aortic arteries.

[Management of essential arterial hypertension and cardiovascular risk levels. Observation in general medicine: national PHENOMEN study. Evaluation and stratification of cardiovascular risk based on the 2000 ANAES recommendations in a population of hypertensive patients]. / Prise en charge de l'HTA essentielle et du niveau de risque cardiovasculaire. Observatoire en médecine générale: enquête nationale PHENOMEN. Evaluation et stratification du risque cardiovasculaire selon les recommandations de l'ANAES 2000 dans une population d'hypertendus.

OBJECTIVE: To define the prevalence of cardiovascular risk (CVR) levels in a population of hypertensive patients (whether treated or not) monitored by General Practitioners, using the stratification system proposed by the ANAES in 2000. METHODS: Between January and July 2001, a nation-wide survey was carried out based on a representative sample of 8,177 General Practitioners spread evenly throughout all of the 22 administrative regions in France. The evaluation of CVR levels took into account blood pressure readings as well as CVR factors and indicators. RESULTS: This survey covered 16,358 patients (53.2% men, 46% women; mean age = 62.5 +/- 11.9 years; BMI = 27.3 +/- 4.5 kg/m2) with a mean history of hypertension of 7 +/- 7 years. The most common CVR factors were dyslipidemia (59.5%), smoking (19%) and diabetes (16%). Concomitant target organ damage was recorded in 17% and heart disease in 21.8%. One patient in four had more than three CVR factors; respectively 56.5%, 30.9% and 12.5% of the patients had mild, moderate or severe hypertension. More than 50% of the patients were classified as being at "high" or "very high" CV risk. The distribution of risk levels was similar throughout the country with a North-South gradient of the high/very high levels. Only 17% of the patients being treated had completely normal blood pressure (< 140/190 mmHg), although 19% more count as normal if the limit values are included. CONCLUSION: The main objective of this large-scale, nation-wide epidemiological survey was to evaluate how well CVR is being managed in a representative sample of patients with high blood pressure. In general, none of the risk factors is adequately controlled, especially in populations considered as being at high CVR. Moreover, the notion of CVR has only been partially assimilated by General Practitioners.

[Quality of blood pressure measurement in the management of arterial hypertension. Pilot study]. / Qualité de la mesure de la PA dans la prise en charge de l'hypertension artérielle. Etude pilote.

UNLABELLED: In clinical practice, diagnosis and follow-up of hypertension is based on blood pressure (BP) as measured by auscultatory method. BP is usually measured using a stethoscope to auscultate the Korotkoff sounds and mercury or an aneroid sphygmomanometer. However due to the lack of regulatory rules, the devices are rarely checked making the quality of the measures doubtful. OBJECTIVE: To compare BP measured following the WHO recommendations, using 2 different devices: the mercury or aneroid sphygmomanometer used by the physician and a SECURUS manometer that has been calibrated just before the implementation of the study. METHOD: The study was performed with 1694 French general practitioners. Every physician included 2 ambulatory patients: a newly diagnosed non-treated hypertensive patient and a treated hypertensive patient. The physician was asked to include the first patient of each category attending his office. BP was measured sequentially with the 2 devices in a random order. Collected data were socio-demographic parameters, cardiovascular risk factors, hypertension related diseases, drug treatment for hypertension and BP levels. RESULTS: Mean BPs differ by less than 1 mmHg between the 2 devices. However 10% of the treated hypertensive patients are not classified as having normalised BP values (BP < 140/90 mmHg) or high BP values, in the same way by the 2 devices. Mean absolute difference between the 2 devices is > 5 mmHg in 22% and 13% of the physicians for SBP and DBP respectively. CONCLUSION: This pilot study emphasises the need of BP measurements of good quality in clinical practice, because of the possible impact on the care of the patients and the related costs. Regulatory rules on the control of the devices might improve the quality of BP measurements.

[Are the 1999 World Health Organization-International Society of Hypertension recommendations applicable to clinical practice?]. / Les recommandations de l'OMS-ISH 1999 sont-elles appliquées en pratique clinique?

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.

[Current aspects of arterial hypertension. Doppler echocardiography. Value and indications]. / Actualités sur l'hypertension artérielle. Echo-Doppler cardiaque. Intérêt et indications.

DETECTION OF LEFT VENTRICULAR HYPERTROPHY: High blood pressure can lead to left ventricular hypertrophy and is an independent risk factor of cardiovascular disease. Echocardiography can be used to measure left ventricular mass based on equations established from anatomoclinical studies. Echocardiography can also give a precise map of the left ventricle allowing a prognostic classification: poor prognosis, concentric remodeling, eccentric hypertrophy, concentric hypertrophy. INDICATIONS: Doppler-echocardiographic analysis of left ventricular filling provides information on systolic function and is clearly indicated in case of symptomatic hypertension, or associated cardiopathies or electrocardiographic abnormalities. Indications should be discussed in case of moderate hypertension in order to evaluate the cardiovascular risk. LIMITATIONS AND PERSPECTIVES: Because of the low reproducibility, Doppler-echocardiography is not useful for follow-up of established left ventricular hypertrophy in hypertensive patients, all the more so since it has not been established that regression is associated with improved cardiovascular prognosis.

[Essential arterial hypertension treated with rilmenidin : what dose for what patient?]. / Hypertension artérielle essentielle traitée par rilménidine: quelle posologie pour quel patient?

OBJECTIVE: To study the therapeutic interest of dose adaptation from 1 mg to 2 mg daily when treating essential hypertension with rilmenidine in monotherapy, in terms of normalisation of blood pressure, of clinical tolerance and of laboratory parameters. METHODS: In a non-comparative multicentre study conducted in France in patients with essential hypertension, rilmenidine was started at 1 mg daily. When the target blood pressure was not achieved (supine diastolic blood pressure (DBP) < or = 90 mm Hg) after 6 weeks, the dose was adapted to 2 mg daily. For persistent non-responders, a second antihypertensive was added from 3 months and a third from 6 months as necessary. Total follow up was for 12 months. RESULTS: Eighteen thousand two hundred and thirty five (18,235) patients of either sex, average age 61.2 years and 90 mm Hg < supine DBP < 115 mm Hg were included. Sixteen thousand four hundred and ninety six (16,496) patients were followed for 12 months with complete data being available for 15,963 of them., 13,565 (84.9%) were treated with rilmenidine in monotherapy, 9,626 (60.3%) at 1 mg daily, and 3,939 (24.6%) at 2 mg daily. For patients who were treated with rilmenidine 1 mg daily throughout the study, mean reduction of blood pressure between D0 and M12 was -27.5/-18.9 mm Hg. Mean reduction was -30.0/-20.3 mm Hg for those who completed the study on 2 mg per day. 82.8% of the analysed population were normalised with rilmenidine in monotherapy, 59.1% with 1 mg daily. Dose adaptation to 2 mg normalised an additional 23.7% of patients. Rilmenidine monotherapy was associated with good clinical and laboratory acceptability. CONCLUSION: The step-wise adaptation of rilmenidine dose in the treatment of essential hypertension is justified by the superior normalisation rate achieved by increasing the dose from 1 mg to 2 mg daily. This adaptation neither increases side effects nor changes laboratory parameters. These data support dose adaptation of rilmenidine monotherapy before association with another antihypertensive. However, neither ther blood pressure level nor associated risk factors predict the type of patients who will be normalised by 1 mg daily or those who require 2 mg. The practice of always starting rilmenidine at 1 mg daily in essential hypertension is therefore supported.

Increased arterial distensibility in postmenopausal hypertensive women with and without hormone replacement therapy after acute administration of the ACE inhibitor moexipril.

Menopause and essential hypertension are associated with a decreased compliance and distensibility of the arteries. ACE inhibitors have been shown to improve arterial distensibility. Hormone replacement therapy (HRT), especially estrogens, could have a positive influence through their atheroprotective, vasodilative, and blood pressure-lowering effect. The vascular interactions of HRT and ACE inhibitors, like moexipril hydrochloride, have not been investigated so far. This trial was intended to assess the effect of combined sequential HRT for 25 days on acute changes in arterial distensibility after a single oral dose of 15 mg moexipril hydrochloride in postmenopausal women with borderline to mild essential hypertension. This study had a monocentric, randomized, parallel-group design, and was open for moexipril, and double-blind, and placebo-controlled for HRT. Assessment of arterial distensibility was by automatic noninvasive measurement of the carotid-femoral pulse wave velocity (PWV). The PWV and the pulse pressure decreased significantly after a single oral dose of 15 mg moexiprill. An influence of HRT on the changes in the PWV and pulse pressure could not be seen. The plasma concentrations of renin increased and of aldosterone decreased after moexipril administration. Arterial function improves after acute administration of 15 mg moexipril in postmenopausal women with mild to moderate essential hypertension. The changes in PWV and pulse pressure are of similar magnitude in women with and without HRT.

[Arterial hypertension, non-drug treatment and cardiovascular risk]. / Hypertension artérielle, traitement non médicamenteux et risque cardiovasculaire.

Four non-drug measures have been shown to be effective on reduction of blood pressure: low-salt diet, weight loss, reduction of alcohol consumption and sports activity. Other measures, mainly dietary (increased potassium intake, DASH diet), may also be effective. The two limits to non-drug treatment of HT are the absence of demonstrated benefit in terms of cardiovascular morbidity-mortality, and the difficulty to ensure good patient compliance with this type of often constraining measure. However, these non-drug measures could probably decrease the overall level of cardiovascular risk. The main drawback, related to the required modification of the patient's lifestyle, is poor compliance with these measures. Compliance can be improved by various methods which share in common their time-consuming nature.

[Conn's syndrome. Study of systemic cardiovascular hemodynamics after medical treatment with spironolactone and after surgical treatment]. / Syndrome de Conn. Etude de l'hémodynamique cardio-vasculaire systémique après traitement médical par spironolactone et après traitement chirurgical.

OBJECTIVES: Assess hemodynamic effect of Conn's syndrome in order to better prepare patients for surgical resection of their adenoma. PATIENTS AND METHODS: Hemodynamic investigations were conducted before any treatment in 13 patients with Conn's syndrome. Results were compared with those in 13 control subjects with permanent primary hypertension. In the 13 patients with Conn's syndrome, the same hemodynamic parameters were studied in 13 after drug therapy using spironolactone and in 8 after surgery. RESULTS: Hypertension was associated with a significant increase in stroke volume and a non-significant increase in cardiac index. Blood pressure normalized after sprironolactone and after surgery in parallel with a significant decrease in blood volume. DISCUSSION: These hemodynamic disorders in Conn's disease patients suggest that the increase in stroke volume is a consequence of increased venous return and more likely, in myocardium contractility or a combination of both. CONCLUSION: These hemodynamic characteristics of Conn's disease should be useful in guiding monitoring schemes for these patients in the perioperative period.

Association between increased plasma levels of aldosterone and decreased systemic arterial compliance in subjects with essential hypertension.

We previously observed that, in subjects with essential hypertension, acute ouabain constricts the brachial artery diameter in the presence of spironolactone treatment, a finding that is not observed in the absence of aldosterone antagonist and therefore suggests a specific effect of aldosterone on the arterial wall. To evaluate whether aldosterone excess may contribute to modulate arterial function, we investigated 56 patients with sustained essential hypertension in comparison with 36 normotensive controls. Systemic arterial compliance was measured from intraarterial blood pressure and cardiac output measurements using a classical Windkessel model to determine the elasticity of the proximal arterial tree. Radial artery compliance was determined using a previously described echo tracking technique. In hypertensive, but not in normotensive, subjects, systemic arterial compliance was strongly and negatively correlated with plasma aldosterone. The correlation was observed even after adjustment for age and blood pressure. Plasma potassium and renin activity did not interfere in the correlation. Acute administration of diltiazem did not change systemic compliance but significantly decreased plasma aldosterone, suggesting that, in the presence of calcium blockade, the same compliance was achieved for a lower plasma aldosterone level. Taken together, these findings strongly suggest that significant interactions exist between aldosterone and central conduit arteries and that aldosterone might modulate arterial function in subjects with essential hypertension.