Publications by authors named "Marilucy Lopez-Sublet"

24 Publications

  • Page 1 of 1

Prevalence and Disease Spectrum of Extracoronary Arterial Abnormalities in Spontaneous Coronary Artery Dissection.

JAMA Cardiol 2021 Nov 24. Epub 2021 Nov 24.

Department of Cardiovascular Sciences, University of Leicester, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom.

Importance: Spontaneous coronary artery dissection (SCAD) has been associated with fibromuscular dysplasia (FMD) and other extracoronary arterial abnormalities. However, the prevalence, severity, and clinical relevance of these abnormalities remain unclear.

Objective: To assess the prevalence and spectrum of FMD and other extracoronary arterial abnormalities in patients with SCAD vs controls.

Design, Setting, And Participants: This case series included 173 patients with angiographically confirmed SCAD enrolled between January 1, 2015, and December 31, 2019. Imaging of extracoronary arterial beds was performed by magnetic resonance angiography (MRA). Forty-one healthy individuals were recruited to serve as controls for blinded interpretation of MRA findings. Patients were recruited from the UK national SCAD registry, which enrolls throughout the UK by referral from the primary care physician or patient self-referral through an online portal. Participants attended the national SCAD referral center for assessment and MRA.

Exposures: Both patients with SCAD and healthy controls underwent head-to-pelvis MRA (median time between SCAD event and MRA, 1 [IQR, 1-3] year).

Main Outcome And Measures: The diagnosis of FMD, arterial dissections, and aneurysms was established according to the International FMD Consensus. Arterial tortuosity was assessed both qualitatively (presence or absence of an S curve) and quantitatively (number of curves ≥45%; tortuosity index).

Results: Of the 173 patients with SCAD, 167 were women (96.5%); mean (SD) age at diagnosis was 44.5 (7.9) years. The prevalence of FMD was 31.8% (55 patients); 16 patients (29.1% of patients with FMD) had involvement of multiple vascular beds. Thirteen patients (7.5%) had extracoronary aneurysms and 3 patients (1.7%) had dissections. The prevalence and degree of arterial tortuosity were similar in patients and controls. In 43 patients imaged with both computed tomographic angiography and MRA, the identification of clinically significant remote arteriopathies was similar. Over a median 5-year follow-up, there were 2 noncardiovascular-associated deaths and 35 recurrent myocardial infarctions, but there were no primary extracoronary vascular events.

Conclusions And Relevance: In this case series with blinded analysis of patients with SCAD, severe multivessel FMD, aneurysms, and dissections were infrequent. The findings of this study suggest that, although brain-to-pelvis imaging allows detection of remote arteriopathies that may require follow-up, extracoronary vascular events appear to be rare.
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http://dx.doi.org/10.1001/jamacardio.2021.4690DOI Listing
November 2021

Prevention of sudden cardiac death in persons living with HIV infection.

Curr HIV Res 2021 Sep 22. Epub 2021 Sep 22.

Center of Hypertension, Hôpital Avicenne, Hôpitaux Universitaires de Paris Seine Saint-Denis. France.

Persons living with HIV infection (PLWH) have been recognized to have an increased risk of sudden cardiac death (SCD). Prevention of this risk should theoretically be included in their long-term management. However, only a few approaches have been proposed to optimize such interventions. Targeting detection of the commonly associated conditions such as coronary artery disease, left ventricular dysfunction, heart failure, QT interval prolongation and ventricular arrhythmias is the first step of this prevention. However, although detection of the risk of SCD is a suitable challenge in PLWH, it remains uncertain whether optimized treatment of the identified risks would unequivocally translate into a decrease in SCD rates.
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http://dx.doi.org/10.2174/1570162X19666210922154011DOI Listing
September 2021

Isolated diastolic hypertension and target organ damage: Findings from the STANISLAS cohort.

Clin Cardiol 2021 Nov 15;44(11):1516-1525. Epub 2021 Sep 15.

Université de Lorraine, Inserm, Centre d'Investigations Cliniques, - Plurithématique 14-33, and Inserm U1116, CHRU Nancy, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France.

Background: Isolated diastolic hypertension (IDH) is defined as diastolic blood pressure (DBP) ≥80 mmHg and systolic blood pressure (SBP) <130 mmHg according to 2017 ACC/AHA guidelines. The effective cardiovascular risk linked to IDH is debated.

Hypothesis: IDH might contribute marginally to hypertension-related target organ damage (TOD) development.

Methods: In this cross-sectional analysis 1605 subjects from the STANISLAS cohort, a large familiar longitudinal study from Eastern France, were included. Participants were categorized according to average values at 24-h ABP recording as having normal BP (SBP < 130/DBP < 80 mmHg); combined hypertension (SBP ≥130/DBP ≥80 mmHg or on antihypertensive treatment); IDH (SBP <130/DBP >80 mmHg); isolated systolic hypertension (ISH: SBP ≥130/DBP <80 mmHg). The association between hypertension status and TOD was assessed by multivariable-adjusted logistic models.

Results: Using normotension as reference, IDH was not significantly associated with NTproBNP levels (adjusted odds ratio [OR] 1.04 [95%CI 0.82;1.32], p = .750), microalbuminuria (OR 0.99 [0.69; 1.42], p = .960), diastolic dysfunction (OR 1.53 [0.88; 2.68], p = .130), left ventricular (LV) mass index (OR per 10 g/m increase 1.07 [0.95; 1.21], p = .250), LV longitudinal strain (global: OR 1.07 [0.99; 1.14], p = .054; subendocardial: OR 1.06 [0.99; 1.13], p = .087), carotid intima media thickness (OR 1.27 [0.79; 2.06], p = .320), reduced ankle-brachial index (<0.9; OR 1.59 [0.19; 13.55], p = .670) and pulse wave velocity (PWV; OR 1.07 [0.93; 1.23], p = .360). In contrast, combined hypertension and ISH were independently associated with LV mass index and PWV increase (all p ≤ .01).

Conclusions: IDH was not significantly associated with TOD. Further studies are needed to clarify the clinical role of IDH. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01391442.
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http://dx.doi.org/10.1002/clc.23713DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8571544PMC
November 2021

Impact of Diabetes on Cardiac Function in Patients with High Blood Pressure.

Int J Environ Res Public Health 2021 06 18;18(12). Epub 2021 Jun 18.

Department of Cardiology, Mustapha University Hospital Center Algiers, Algiers 16000, Algeria.

: Although the combination of high blood pressure (HBP) and type 2 diabetes (T2DM) increases the risk of left ventricular (LV) dysfunction, the impact of T2DM on LV geometry and subclinical dysfunction in hypertensive patients and normal ejection fraction (EF) has been infrequently evaluated. : Hypertensive patients with or without T2DM underwent cardiac echocardiography coupled with LV global longitudinal strain (GLS) assessment. : Among 200 patients with HBP (mean age 61.7 ± 9.7 years) and EF > 55%, 93 had associated T2DM. Patients with T2DM had a higher body mass index (29.9 ± 5.1 kg/m vs. 29.3 ± 4.7 kg/m, = 0.025), higher BP levels (158 ± 23/95 ± 13 vs. 142 ± 33/87 ± 12 mmHg, = 0.003), a higher LV mass index (115.8 ± 32.4 vs. 112.0 ± 24.7 g/m, = 0.004), and higher relative wall thickness (0.51 ± 0.16 vs. 0.46 ± 0.12, = 0.0001). They had more frequently concentric remodeling (20.4% vs. 16.8%, < 0.001), concentric hypertrophy (53.7% vs. 48.6%, < 0.001), elevated filling pressures (25.8 vs. 12.1%, = 0.0001), indexed left atrial volumes greater than 28 mL/m (17.2 vs. 11.2%, = 0.001), and a reduced GLS less than -18% (74.2 vs. 47.7%, < 0.0001). After adjustment for BP and BMI, T2DM remains an independent determinant factor for GLS decline (OR = 2.26, 95% CI 1.11-4.61, = 0.023). Left ventricular geometry and subclinical LV function as assessed with GLS are more impaired in hypertensive patients with than without T2DM. Preventive approaches to control BMI and risk of T2DM in hypertensive patients should be emphasized.
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http://dx.doi.org/10.3390/ijerph18126553DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8296398PMC
June 2021

Evidence of a Blood Pressure Reduction During the COVID-19 Pandemic and Associated Lockdown Period: Insights from e-Health Data.

Telemed J E Health 2021 Jun 8. Epub 2021 Jun 8.

Department of Internal Medicine and ESH Excellence Centre, Saint-Joseph Hospital, Paris, France.

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http://dx.doi.org/10.1089/tmj.2021.0006DOI Listing
June 2021

Children hypertension in Northern Africa.

Am J Cardiovasc Dis 2021 15;11(2):222-230. Epub 2021 Apr 15.

COCRG, Cardiology Oncology Research Collaborative Group (CORCG), Faculty of Medicine BENYOUCEF BENKHEDDA University Algiers.

Objectives: To assess factors associated with prehypertension and hypertension among children in North Africa.

Methods: An epidemiological observational, school- and college-based study among 3562 healthy children and adolescents to assess factors associated with blood pressure categories (normal, prehypertensive, hypertensive), including perinatal (gestational age, birth weight, breastfeeding) and current lifestyle characteristics (body mass index, time spent watching a screen and time spent exercising).

Results: Prevalence of hypertension increased with age from 8.7% between 6-10 years to 14.7% between 11-15 years, and 15.6% above 15 years. Prevalence of prehypertension and hypertension increased with body mass index from 9.9% and 11.5% among children not overweight to 15.6% (RR 1.58, 95% CI 1.24-2.02, P<0.001) and 17.2% (RR 1.50, 95% CI 1.22-1.85, P<0.001) among those overweight and to 26.8% (RR 2.72, 95% CI 2.04-3.64, P<0.01) and 32.3% (RR 2.82, 95% CI 2.27-3.50, P<0.01) among obese children. There was a trend of association of prehypertension with the time spent watching Television, internet and electronic games. Children whose mother or father had a history of hypertension had a trend to be prehypertensive or hypertensive. A parental hypertension was found in 33.6% of normotensive, 38.2% of prehypertensive, and 42.6% of hypertensive children (P=0.05). Children with prehypertension or hypertension were more likely to have a diabetic father or mother (22.8% and 22.6% vs 15.8%, respectively, P=0.01). Also, prehypertension and hypertension were associated with shorter gestational age, early birth, reduced birth weight, and shorter breastfeeding.

Conclusion: Prehypertension and hypertension have a high prevalence among children in North Africa. They are associated with overweight, obesity, diabetes, a shorter gestational age, a lower birth weight and a shorter breastfeeding.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8166588PMC
April 2021

A short course of corticosteroids reduces the risk of mechanical ventilation and death in patients with moderate to severe COVID 19 pneumonia: results of a retrospective monocentric cohort.

Infect Dis (Lond) 2021 Oct 22;53(10):779-788. Epub 2021 May 22.

Department of Internal Medicine, Sorbonne Paris Nord University, Avicenne Hospital, Bobigny, France.

Background: Reduced mortality at 28 days in patients treated with corticosteroids was demonstrated, but this result was not confirmed by certain large epidemiological studies. Our aim was to determine whether corticosteroids improve the outcomes of our patients hospitalized with COVID-19 pneumonia.

Methods: Our retrospective, single centre cohort study included consecutive patients hospitalized for moderate to severe COVID-19 pneumonia between March 15 and April 15 2020. An early short course of corticosteroids was given during the second phase of the study. The primary composite endpoint was the need for mechanical ventilation or mortality within 28 days of admission. A multivariate logistic regression model was used to estimate the propensity score, i.e. the probability of each patient receiving corticosteroid therapy based on the initial variables.

Results: About 120 consecutive patients were included, 39 in the "corticosteroids group", 81 in the "no corticosteroids group"; their mean ages (±SD) were 66.4 ± 14.1 and 66.1 ± 15.2 years, respectively. Mechanical ventilation-free survival at 28 days was higher in the "corticosteroids group" than in the "no corticosteroids group" (71% and 29% of cases, respectively,  < .0001). The effect of corticosteroids was confirmed with HR .28 (95%CI .10-.79),  = .02. In older and comorbid patients who were not eligible for intensive care, the effect of corticosteroid therapy was also beneficial (HR .36 (95%CI .16-.80),  = .01).

Conclusion: A short course of corticosteroids reduced the risks of death or mechanical ventilation in patients with moderate to severe COVID-19 pneumonia in all patients and also in older and comorbid patients not eligible for intensive care.
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http://dx.doi.org/10.1080/23744235.2021.1928745DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8146301PMC
October 2021

Starting Antihypertensive Drug Treatment With Combination Therapy: Controversies in Hypertension - Pro Side of the Argument.

Hypertension 2021 03 10;77(3):800-805. Epub 2021 Feb 10.

Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institut für Klinische Pharmakologie und Toxikologie, Germany. DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany (E.A.E.-H.A., R.K.).

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http://dx.doi.org/10.1161/HYPERTENSIONAHA.120.12857DOI Listing
March 2021

ADL-dependency, D-Dimers, LDH and absence of anticoagulation are independently associated with one-month mortality in older inpatients with Covid-19.

Aging (Albany NY) 2020 06 23;12(12):11306-11313. Epub 2020 Jun 23.

Université Sorbonne Paris Nord, INSERM, U942, Cardiovascular Markers in Stressed Conditions, MASCOT, Bobigny 93000, France.

Background: To assess factors associated with one-month mortality among older inpatients with Covid-19.

Results: The mean age was 78 ± 7.8 years, 55.5% were men, CT scan lung damage was observed in 76% of the patients (mild 23%, moderate 38%, extensive 22%, and severe 7%). The mortality rate was 26%. Dependency/Activities of Daily Living (ADL) score ≤ 5/6, D-Dimers, LDH, and no anticoagulation by reference for curative were independently associated with one-month mortality. A score derived from the multivariate model showed good calibration and very good discrimination (Harrell's C index [95%CI] = 0.83 [0.79-0.87]).

Conclusion: ADL-dependency, high serum levels of D-Dimers and LDH and the absence of anticoagulation were independently associated with one-month mortality among older inpatients with Covid-19.

Methods: 108 consecutive older inpatients aged 65 and over with Covid-19 confirmed by RT-PCR and/or typical CT chest scan were prospectively included in a French single-centre cohort study from March to April 2020. A systematic geriatric assessment was performed. Covariates were lymphocyte count, serum levels of albumin, C-Reactive Protein, D-Dimers and Lactate Dehydrogenase (LDH), anticoagulation level, and exposure to the hydroxychloroquine and azithromycin combined therapy. Cox uni- and multivariate proportional-hazard regressions were performed to identify predictors of one-month mortality.
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http://dx.doi.org/10.18632/aging.103583DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7343508PMC
June 2020

Reply.

J Hypertens 2019 12;37(12):2499-2500

Hypertension and Cardiovascular Prevention Unit, Diagnosis and Therapeutic Center, Hôtel-Dieu Hospital, AP-HP, Paris-Descartes University.

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http://dx.doi.org/10.1097/HJH.0000000000002215DOI Listing
December 2019

Prevalence and characteristics of renal artery fibromuscular dysplasia in hypertensive women below 50 years old.

Eur J Clin Invest 2019 Oct 19;49(10):e13166. Epub 2019 Sep 19.

Division of Cardiology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium.

Background: Renal fibromuscular dysplasia (FMD) is typically diagnosed in young hypertensive women. The 2014 European FMD Consensus recommended screening in all hypertensive women <30 yo. However, the prevalence of renal FMD in young/middle-aged hypertensive women remains unclear. The aim of this work was to assess the prevalence and characteristics of renal FMD in hypertensive women ≤50 yo.

Methods: We retrospectively included all consecutive women aged ≤50 years referred to our Hypertension Unit from 2014 to 2017 and collected standardized information on patient characteristics and screening modalities.

Results: Of 1083 incident hypertensive patients, 157 patients fitted with inclusion criteria. The prevalence of renal FMD varied between 3.2% in the whole sample and 7.5% in patients explored by CTA and/or MRA (n = 67). In the subgroup of patients ≤30 yo (n = 32), the corresponding figures were 3.1% and 5.6%. The yearly prevalence of FMD tended to increase over time, in parallel with increased use of CTA/MRA as a first-line imaging modality. Out of 5 patients with renal FMD, 2 were revascularized and 1 had extra-renal FMD.

Conclusions: The prevalence of renal FMD in young/middle-aged hypertensive women is probably one order of magnitude higher than previously assumed, in the range of 3%-8%, depending on imaging modalities. While the diagnosis of FMD does not influence short-term management in all patients, it may allow close monitoring and prevention of complications of the disease over time. This analysis provides the rationale for a prospective, multicentre study aiming at determining the cost-effectiveness of systematic screening for renal FMD.
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http://dx.doi.org/10.1111/eci.13166DOI Listing
October 2019

Association between different lipid parameters and aortic stiffness: clinical and therapeutic implication perspectives.

J Hypertens 2019 11;37(11):2240-2246

Hypertension and Cardiovascular Prevention Unit, Diagnosis and Therapeutic Center, Hôtel-Dieu Hospital, Paris-Descartes University, AP-HP, Paris.

Introduction: Recommendations about lipid parameters varied from different guidelines. Aortic stiffness is a marker of vascular aging and may reflect occurrence of cardiovascular diseases. Aortic pulse wave velocity (PWV), a marker of aortic stiffness, can be measured by applanation tonometry. The purpose of our study was to test the associations between lipid parameters and aortic stiffness.

Methods: A cross-sectional study was conducted from 2012 to 2017, 603 participants were included: 517 patients and 86 'healthy' individuals used to calculate the theoretical PWV. Lipid parameters, including total cholesterol, triglycerides, low-density lipoprotein (LDL), high-density lipoprotein (HDL), non-HDL, total cholesterol/HDL ratio, triglycerides/HDL ratio and LDL/HDL ratio were measured. Theoretical PWV can be calculated according to age, sex, mean blood pressure and heart rate, allowing to form an individual PWV index [(measured PWV - theoretical PWV)/theoretical PWV]. PWV index [(measured PWV -  theoretical PWV)/theoretical PWV] greater than 0 defined aortic stiffness.

Results: In multiple linear regression analyses, total cholesterol (P = 0.03), LDL (P = 0.04), non-HDL (P = 0.03), total cholesterol/HDL (P = 0.01) and LDL/HDL (P = 0.03) were significantly correlated with PWV. In multiple logistic regression analyses, non-HDL [OR = 1.12 (1.04-1.20), P = 0.01, R value: 0.224], total cholesterol/HDL [OR = 1.12 (1.02-1.22), P = 0.03, R value: 0.219] and total cholesterol [OR = 1.11 (1.01-1.23), P = 0.03, R value: 0.209] were significantly associated with aortic stiffness.

Conclusion: Non-HDL, total cholesterol and total cholesterol/HDL were significantly associated with aortic stiffness than others and especially individually lipid parameters. This result should be considered in future clinical lipid-lowering trials.
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http://dx.doi.org/10.1097/HJH.0000000000002161DOI Listing
November 2019

[Epidemiology of hypertension: Differences between women and men].

Presse Med 2019 Nov 28;48(11 Pt 1):1240-1243. Epub 2019 May 28.

AP-HP, CHU Avicenne, université Paris 13, centre d'excellence européen en hypertension Artérielle, service de médecine interne, 93000 Bobigny, France.

PREVALENCE OF HYPERTENSION LESS FREQUENT IN WOMEN BEFORE MENOPAUSE: In adults, up to the age of 50-60, hypertension is an uncommon disease, less frequent in women than in men. The literature review does not determine whether this difference is related to a protective effect of endogenous estrogens on the risk of high blood pressure, to genetic or immuno-enzymatic differences related to sex but of non-hormonal origin or to a large number of confounding variables (salt consumption, alcohol consumption, fruit and vegetable consumption, body mass index, psycho-socio-economic factors, sedentary lifestyle). PREVALENCE OF HYPERTENSION INCREASES AT MENOPAUSE: After menopause, the risk of hypertension in women increases and quickly reaches that of men, even exceeding it from the seventh decade onwards. The factors that make hypertension more frequent after the seventh decade in women are related to differences in cardiovascular risk and life expectancy between men and women, as well as a likely surviving effect in older men. The mechanisms by which estrogen-progestin deficiency increases the risk of hypertension have been extensively studied. These mechanisms are obviously numerous. However, it has not been clearly demonstrated that hormone replacement therapy during menopause reduces blood pressure levels. It should be noted that the route of administration, the choice of molecules, the respect of the intervention window and the dosage seem to modulate the potential vascular effects.
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http://dx.doi.org/10.1016/j.lpm.2019.04.010DOI Listing
November 2019

Arterial Tortuosity.

Hypertension 2019 05;73(5):951-960

Division of Cardiology, Cliniques Universitaires Saint-Luc and Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique (A.P.), Université Catholique de Louvain, Brussels, Belgium.

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http://dx.doi.org/10.1161/HYPERTENSIONAHA.118.11647DOI Listing
May 2019

Nondipping Pattern and Cardiovascular and Renal Damage in a Population-Based Study (The STANISLAS Cohort Study).

Am J Hypertens 2019 06;32(7):620-628

French Clinical Research Infrastructure Network Investigation Network Initiative-Cardiovascular and Renal Clinical Trialists (FCRIN INI-CRCT), Nancy, France.

Objective: The attenuation of physiological nocturnal decline of blood pressure (BP)-called nondipper pattern-has previously been reported to be associated with target organ damage in hypertensive subjects. However, this association remains debated and poorly studied in normotensive patients. This study aimed to investigate the association between nondipper pattern and subclinical cardiovascular and renal damage in an initially healthy population-based cohort study.

Methods: The STANISLAS Cohort is a single-center, familial longitudinal cohort composed of 1,006 families (4,295 subjects) recruited in 1993-1995 for a 5-year periodic health examination. A total of 1,334 subjects from the 4th visit (2011-2016) of the STANISLAS cohort were included. This 4th examination included estimated glomerular filtration rate, albumin/creatinine ratio, pulse wave velocity, central systolic BP, carotid intima-media thickness and distensibility, left ventricular mass index, left ventricular hypertrophy, diastolic dysfunction, and ambulatory blood pressure monitoring (ABPM). Nondipping status was defined as a mean reduction in systolic BP (SBP) or diastolic BP (DBP) lower than 10% during nighttime.

Results: Data were obtained from 798 normotensive subjects (45 ± 14 years, 395 [49%] nondippers, SBP/DBP mmHg 24 hours: 116/71 ± 7/5) and 536 hypertensive patients (56 ± 11 years, 257 [48%] nondippers, SBP/DBP mmHg 24 hours: 127/78 ± 10/7). Mean 24-hour and daytime ABPM measurements were within the normal range, even in hypertensive participants (19% treated). The nondipping pattern was not associated with cardiovascular or renal alterations in this population.

Conclusion: In this middle-aged population with an overall 24-hour optimal BP control, the nondipper pattern was not associated with increased cardiovascular or renal damage.
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http://dx.doi.org/10.1093/ajh/hpz020DOI Listing
June 2019

Impact of psychological profile on drug adherence and drug resistance in patients with apparently treatment-resistant hypertension.

Blood Press 2018 12 28;27(6):358-367. Epub 2018 Jun 28.

b Department of Cardiology , Cliniques Universitaires Saint-Luc, Université Catholique de Louvain , Brussels , Belgium.

Purpose: Patients with apparent treatment-resistant hypertension (a-TRH) are often poorly adherent to drug treatment and have an unusual personal history and psychological profile. The aim of this study was to identify predictors of drug adherence and drug resistance in a cohort of patients with aTRH, with emphasis on psychological characteristics.

Methods: All patients with confirmed aTRH on standardized antihypertensive treatment were eligible. Drug adherence was assessed by drug dosages in urine using Liquid Chromatography coupled with tandem Mass Spectrometry (LC-MS/MS). Drug resistance was assessed by 24-hour ambulatory blood pressure adjusted for the number of antihypertensive drugs and for drug adherence. Psychological profile was assessed using a broad array of validated questionnaires.

Results: The analysis included 35 consecutive patients. The proportion of adherent, partly adherent and totally non-adherent patients was 29, 40 and 31%, respectively. In regression analysis, independent predictors of poor drug adherence were recent hospital admission for hypertension, a lower ability to put things into perspective when facing negative events and a higher tendency to somatize, accounting for 51% of variability in drug adherence. Independent predictors of treatment resistance were a higher recourse to the strategies of blaming others and oneself, accounting for 37% of variability in drug treatment resistance.

Conclusion: In patients with aTRH, poor adherence is frequent but does not entirely account for treatment resistance. Psychological characteristics appear as strong predictors of both drug adherence and drug resistance. Our results suggest that therapeutic drug monitoring and psychological evaluation should be an integral part of assessment of patients with aTRH.
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http://dx.doi.org/10.1080/08037051.2018.1476058DOI Listing
December 2018

Focus on increased serum angiotensin-converting enzyme level: From granulomatous diseases to genetic mutations.

Clin Biochem 2018 Sep 18;59:1-8. Epub 2018 Jun 18.

Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium; Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium.

Angiotensin I-converting enzyme (ACE) is a well-known zinc-metallopeptidase that converts angiotensin I to the potent vasoconstrictor angiotensin II and degrades bradykinin, a powerful vasodilator, and as such plays a key role in the regulation of vascular tone and cardiac function. Increased circulating ACE (cACE) activity has been reported in multiple diseases, including but not limited to granulomatous disorders. Since 2001, genetic mutations leading to cACE elevation have also been described. This review takes advantage of the identification of a novel ACE mutation (25-IVS25 + 1G > A) in two Belgian pedigrees to summarize current knowledge about the differential diagnosis of cACE elevation, based on literature review and the experience of our centre. Furthermore, we propose a practical approach for the evaluation and management of patients with elevated cACE and discuss in which cases search for genetic mutations should be considered.
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http://dx.doi.org/10.1016/j.clinbiochem.2018.06.010DOI Listing
September 2018

Impact of miscuffing during home blood pressure measurement on the prevalence of masked hypertension.

Am J Hypertens 2013 Oct 1;26(10):1205-9. Epub 2013 Jun 1.

Excellence Center for Hypertension, CHU Avicenne, AP-HP, Bobigny, France.

Background: Masked hypertension has been associated with obesity. However, because most studies do not mention the specific cuff size used for home measurements, masked hypertension prevalence may have been overestimated in obese patients because of undersized cuffs. In this prospective, observational study, the effect of miscuffing on hypertension status was evaluated in patients with large arms.

Methods: Fifty-three patients with an upper-arm circumference >33cm, undergoing treatment for mild-to-moderate hypertension, took 2 sets of home blood pressure (BP) measurements (standard vs. large cuff) using the validated Microlife BP A100 Plus automated device.

Results: Mean BP was 143/85mm Hg at the office using a large cuff, 141/84mm Hg at home using a standard cuff, and 134/80mm Hg at home using a large cuff. Standard vs. large cuff home BP mean differences were 6.9mm Hg (95% confidence interval (CI) = 4.7-9.2; P < 0.0001) for systolic BP and 4.0mm Hg (95% CI = 2.4-5.5; P < 0.0001) for diastolic BP. Hypertension status differed significantly between standard vs. large cuffs: sustained hypertension (56.6% vs. 41.5%, respectively; P = 0.002), controlled hypertension (20.8% vs. 28.3%, respectively; P = 0.04), white coat hypertension (7.5% vs. 22.6%, respectively; P = 0.002), masked hypertension (15.1% vs. 7.5%, respectively; P = 0.04).

Conclusions: In patients with large arms, use of an appropriately sized large cuff for home BP measurements led to a 2-fold reduction in masked hypertension. Regarding clinical and epidemiological implications, future studies investigating masked hypertension should specify cuff size for home BP measurements. The low market availability and increased cost of large cuffs should also be addressed.
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http://dx.doi.org/10.1093/ajh/hpt084DOI Listing
October 2013

Combinations of inhibitors of the renin-angiotensin system with calcium channel blockers for the treatment of hypertension: focus on perindopril/amlodipine.

Curr Med Res Opin 2010 Sep;26(9):2263-76

Dept of Internal Medicine & Arterial Hypertension, Avicenne Hospital, Bobigny Cedex, France.

Background: Combination antihypertensive therapy with an inhibitor of the renin-angiotensin system (RAS) and a calcium channel blocker (CCB) is a rational approach to achieve blood pressure (BP) goals in patients with hypertension, and may provide additional cardiovascular protection compared to other strategies in special populations. This article reviews the rationale for, and evidence supporting, the use of newer fixed-dose combinations of RAS inhibitors and CCBs, with particular emphasis on perindopril/amlodipine.

Methods: A literature search was performed in Medline and EMBASE databases to identify articles published up to May 2010 describing the impact of combination treatment with angiotensin receptor blocker (ARB)/CCB or angiotensin-converting enzyme (ACE) inhibitor/CCB based antihypertensive strategies on BP or clinical outcomes.

Findings: A substantial body of evidence supports the BP-lowering efficacy of RAS inhibitor/CCB combination therapy in patients with hypertension. RAS inhibitors and CCBs represent two different and complementary mechanisms of actions; their use in combination is associated with effective BP lowering with favourable tolerability and fewer adverse metabolic effects than some other combination therapies. Currently, intervention studies demonstrating the impact of ARB/CCB combinations on cardiovascular mortality and morbidity are lacking. However, evidence from large outcome trials supports the use of ACE inhibitor/CCB combinations for reducing the risk of cardiovascular and renal events, particularly in high-risk patients. There is also evidence that the benefits of ACE inhibitor/CCB combinations may extend beyond those solely associated with brachial BP lowering, by an additional impact on central BP haemodynamics.

Conclusions: RAS inhibitor/CCB combination therapy is an effective antihypertensive therapy. Strong evidence supports the antihypertensive efficacy of ACE inhibitor/CCB combinations with cardioprotective and renoprotective properties. In particular, evidence suggests that fixed-dose perindopril/amlodipine effectively decreases BP and currently is the only RAS inhibitor/CCB combination proven to decrease all-cause and cardiovascular mortality as well as major cardiovascular events, and thus is a valuable option for the management of hypertension, especially in high-risk patients.
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http://dx.doi.org/10.1185/03007995.2010.510925DOI Listing
September 2010

Urinary aldosterone-to-active-renin ratio: a useful tool for predicting resolution of hypertension after adrenalectomy in patients with aldosterone-producing adenomas.

Am J Hypertens 2008 Jul 24;21(7):742-7. Epub 2008 Apr 24.

Hypertension Unit, Avicenne Hospital, AP-HP, Paris XIII University (EA 3412), Paris, France.

Background: The purpose of this study was to determine the preoperative clinical and biological factors that predict the clinical outcomes after surgery, in subjects with aldosterone-producing adenomas (APAs).

Methods: Fifty-eight patients (mean age 52 +/- 11 years) with APA were followed up for 43 +/- 13 months after they had undergone unilateral adrenalectomy. The subjects were classified as "cured" (n = 23) if the blood pressure (BP) was <140/90 mm Hg without postoperative medication, "normalized" (n = 20) if BP was <140/90 mm Hg with antihypertensive therapy, and "uncontrolled" (n = 15) if a BP of < or =140/90 mm Hg was not achieved despite intensive therapy.

Results: The cured patients had a significantly lower mean preoperative age, cardiac mass, and serum creatinine (P < 0.001) than the other subjects. The main independent predictors of surgical curability were: age (P < 0.01), low serum potassium (P < 0.0001), and the urinary aldosterone-to-active-renin (UAAR) ratio (P < 0.008). Among the hormonal parameters, the UAAR ratio provided the best area under the receiver operating-characteristics curve (0.802 (confidence interval (CI) 95%: 0.676-0.944)). For a cutoff value of 15, the positive and negative predictive values of the UAAR ratio were 85 and 92%, respectively. In the study population as a whole, surgical treatment restored the age-systolic BP (SBP) relationship (P < 0.006), which was insignificant before surgery.

Conclusions: Although all the subjects showed lowering of BP after surgery, and the age-BP relationship was restored, the long-term cure rate of APA subjects was 40%. The UAAR ratio, by comparison with other classical hormonal features of primary aldosteronism, was the best independent predictor of the cure of hypertension after adrenalectomy.
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http://dx.doi.org/10.1038/ajh.2008.175DOI Listing
July 2008

Blood pressure normalization in a large population of hypertensive patients treated with perindopril/indapamide combination: results of the OPTIMAX trial.

Vasc Health Risk Manag 2007 ;3(1):173-80

Dept Internal Medicine and Hypertension Unit, Avicenne Hospital-APHP and Paris 13 University, Bobigny, France.

Objective: To determine if the fixed-dose perindopril/indapamide combination (Per/Ind) normalizes blood pressure (BP) in the same fraction of hypertensive patients when treated in everyday practice or in controlled trials.

Methods: In this prospective trial, 17 938 hypertensive patients were treated with Per 2 mg/Ind 0.625 mg for 3-6 months. In Group 1 Per/Ind was initiated in newly diagnosed patients (n = 7032); in Group 2 Per/Ind replaced previous therapy in patients already treated but having either their BP still uncontrolled or experiencing side-effects (n = 7423); in Group 3 Per/Ind was added to previous treatment in patients with persistently high BP (n = 3483). BP was considered normalized when < or = 140/90 mm Hg. A multivariate analysis for predictors of BP normalization was performed.

Results: Subjects were on average 62 years old and had a baseline BP of 162.3/93.6 mm Hg. After treatment with Per/Ind, BP normalization was reached in 69.6% of patients in the Initiation group, 67.5% in the Replacement Group, and 67.4% in the Add-on Group (where patients were more frequently at risk, diabetic, or with target organ damage). Mean decreases in systolic BP of 22.8 mm Hg and in diastolic BP of 12.4 mm Hg were recorded.

Conclusions: This trial was established to reflect everyday clinical practice, and a treatment strategy based on the Per/Ind combination, administered as initial, replacement, or add-on therapy, led to normalization rates that were superior to those observed in Europe in routine practice. These results support recent hypertension guidelines which encourage the use of combination therapy in the management of arterial hypertension.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1994035PMC
August 2007

Aortic pulse pressure is related to the presence and extent of coronary artery disease in men undergoing diagnostic coronary angiography: a multicenter study.

Am J Hypertens 2004 Feb;17(2):129-33

Department of Cardiology, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015 Paris, France.

Background: In the general population, pulse pressure (PP) is a correlate of cardiovascular outcomes. Few data are available regarding the links between PP and documented coronary artery disease (CAD).

Methods: From July 2000 to January 2002, a total of 1337 patients referred for a first diagnostic coronary angiogram at 75 participating centers were prospectively included. Of these individuals, 280 patients receiving no hypertensive therapy constituted the study population. Pulse pressure was recorded in the aortic root before angiography, and baseline characteristics, medical history, treatment used, and data from coronary angiography were recorded.

Results: In the whole population, aortic PP strongly correlated with the presence and extent of CAD in univariate analyses. However, the correlation disappeared in multivariate analysis, and a strong interaction with gender was found. In women (n = 82), aortic PP was not an independent predictor of CAD. However, in men (n = 198) an independent correlation between aortic PP and CAD was found, together with age and hypercholesterolemia. In addition, PP was strongly correlated with the extent of CAD (no disease, 51 +/- 16 mm Hg; one or two stenoses, 54 +/- 18 mm Hg; and more than two stenoses: 64 +/- 20 mm Hg).

Conclusions: In this multicenter study, aortic PP was significantly correlated with the presence and extent of CAD in patients without antihypertensive therapy. This correlation, however, was independent of other risk factors for CAD in men but not in women.
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http://dx.doi.org/10.1016/j.amjhyper.2003.09.010DOI Listing
February 2004
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