Showing papers by "Robert Fagard published in 2014"

European Society of Hypertension practice guidelines for ambulatory blood pressure monitoring.

Abstract: Given the increasing use of ambulatory blood pressure monitoring (ABPM) in both clinical practice and hypertension research, a group of scientists, participating in the European Society of Hypertension Working Group on blood pressure monitoring and cardiovascular variability, in year 2013 published a comprehensive position paper dealing with all aspects of the technique, based on the available scientific evidence for ABPM. The present work represents an updated schematic summary of the most important aspects related to the use of ABPM in daily practice, and is aimed at providing recommendations for proper use of this technique in a clinical setting by both specialists and practicing physicians. The present article details the requirements and the methodological issues to be addressed for using ABPM in clinical practice, The clinical indications for ABPM suggested by the available studies, among which white-coat phenomena, masked hypertension, and nocturnal hypertension, are outlined in detail, and the place of home measurement of blood pressure in relation to ABPM is discussed. The role of ABPM in pharmacological, epidemiological, and clinical research is also briefly mentioned. Finally, the implementation of ABPM in practice is considered in relation to the situation of different countries with regard to the reimbursement and the availability of ABPM in primary care practices, hospital clinics, and pharmacies.

2013 ESH/ESC Practice guidelines for the management of arterial hypertension

Abstract: ABPMambulatory blood pressure monitoringACEangiotensin converting enzymeARBangiotensin receptor blockerA-Vatrio-ventricularBBbeta-blockerBPblood pressureCHDcoronary heart diseaseCKDchronic kidney d...

Prognostic impact from clinic, daytime, and night-time systolic blood pressure in nine cohorts of 13,844 patients with hypertension.

Abstract: Background and method To determine which SBP measure best predicts cardiovascular events (CVEs) independently, a systematic review was conducted for cohorts with all patients diagnosed with hypertension, 1+ years follow-up, and coronary artery disease and stroke outcomes. Lead investigators provided ad hoc analyses for each cohort. Meta-analyses gave hazard ratios from clinic SBP (CSBP), daytime SBP (DSBP), and night-time SBP (NSBP). Coefficients of variation of SBP measured dispersion. Nine cohorts (n = 13,844) were from Europe, Brazil, and Japan. For sleep-wake SBP classification, seven cohorts used patient-specific information. Results Overall, NSBP's dispersion exceeded DSBP's dispersion by 22.6% with nonoverlapping confidence limits. Within all nine cohorts, dispersion for NSBP exceeded that for CSBP and DSBP. For each comparison, P = 0.004 that this occurred by chance. Considered individually, increases in NSBP, DSBP, and CSBP each predicted CVEs: hazard ratios (95% confidence intervals) = 1.25 (1.22-1.29), 1.20 (1.15-1.26), and 1.11 (1.06-1.16), respectively. However, after simultaneous adjustment for all three SBPs, hazard ratios were 1.26 (1.20-1.31), 1.01 (0.94-1.08), and 1.00 (0.95-1.05), respectively. Cohorts with baseline antihypertensive treatment and cohorts with patient-specific information for night-day BP classification gave similar results. Within most cohorts, simultaneously adjusted hazard ratios were greater for NSBP than for DSBP and CSBP: P = 0.023 and 0.012, respectively, that this occurred by chance. Conclusion In hypertensive patients, NSBP had greater dispersion than DSBP and CSBP in all cohorts. On simultaneous adjustment, compared with DSBP and CSBP, increased NSBP independently predicted higher CVEs in most cohorts, and, overall, NSBP independently predicted CVEs, whereas CSBP and DSBP lost their predictive ability entirely.

Reversible and irreversible differentiation of cardiac fibroblasts

Abstract: Aims Differentiation of cardiac fibroblasts (Fbs) into myofibroblasts (MyoFbs) is responsible for connective tissue build-up in myocardial remodelling. We examined MyoFb differentiation and reversibility. Methods and results Adult rat cardiac Fbs were cultured on a plastic substratum providing mechanical stress, with conditions to obtain different levels of Fb differentiation. Fb spontaneously differentiated to proliferating MyoFb (p-MyoFb) with stress fibre formation decorated with alpha-smooth muscle actin (α-SMA). Transforming growth factor-β1 (TGF-β1) promoted differentiation into α-SMA-positive MyoFb showing near the absence of proliferation, i.e. non-p-MyoFb. SD-208, a TGF-β-receptor-I (TGF-β-RI) kinase blocker, inhibited p-MyoFb differentiation as shown by stress fibre absence, low α-SMA expression, and high proliferation levels. Fb seeded in collagen matrices induced no contraction, whereas p-MyoFb and non-p-MyoFb induced 2.5- and four-fold contraction. Fb produced little collagen but high levels of interleukin-10. Non-p-MyoFb had high collagen production and high monocyte chemoattractant protein-1 and tissue inhibitor of metalloproteinases-1 levels. Transcriptome analysis indicated differential activation of gene networks related to differentiation of MyoFb (e.g. paxilin and PAK) and reduced proliferation of non-p-MyoFb (e.g. cyclins and cell cycle regulation). Dedifferentiation of p-MyoFb with stress fibre de-polymerization, but not of non-p-MyoFb, was induced by SD-208 despite maintained stress. Stress fibre de-polymerization could also be induced by mechanical strain release in p-MyoFb and non-p-MyoFb (2-day cultures in unrestrained 3-D collagen matrices). Only p-MyoFb showed true dedifferentiation after long-term 3-D cultures. Conclusions Fb, p-MyoFb, and non-p-MyoFb have a distinct gene expression, ultrastructural, and functional profile. Both reduction in mechanical strain and TGF-β-RI kinase inhibition can reverse p-MyoFb differentiation but not non-p-MyoFb.

Exercise-based cardiac rehabilitation improves endothelial function assessed by flow-mediated dilation but not by pulse amplitude tonometry*

Abstract: We aimed to investigate the effect of exercise on endothelium-dependent vasodilator function assessed simultaneously in the brachial artery and in the distal arterial bed by flow-mediated dilation and the pulse amplitude tonometry method, respectively, in coronary artery disease patients. The study included 146 patients with stable coronary artery disease (123 men, mean age 62 ± 9 years) who participated in the Cardiac Rehabilitation and Genetics of Exercise performance study. All patients completed a 12-week supervised cardiac rehabilitation programme (three sessions per week at an intensity of 80% of the heart rate reserve). At baseline and upon completion of the training, we measured brachial artery diameters by means of ultrasound scanning (linear array transducer of 12 MHz) and simultaneously assessed pulse amplitudes in the fingertip using a pulse amplitude tonometry device both at rest and after reactive hyperaemia induced by a 5-min forearm cuff occlusion. Peak oxygen uptake significantly increase...

Subgroup and per-protocol analyses from the Hypertension in the Very Elderly Trial

Abstract: BACKGROUND The results of the Hypertension in the Very Elderly Trial showed positive benefits from blood pressure-lowering treatment in those aged 80 and over. METHOD An analysis by the pre-specified subgroups [age, sex, history of cardiovascular disease (CVD) and initial SBP] was performed. The Hypertension in the Very Elderly Trial was a randomized, double-blind, placebo-controlled trial of 3845 participants aged 80 and over with SBPs of 160-199 mmHg and diastolic pressures below 110 mmHg recruited from Europe, China, Australasia and Tunisia. Active treatment was indapamide sustained-release 1.5 mg with the addition of perindopril 2-4 mg as required to reach a target blood pressure of less than 150/80 mmHg. RESULTS For total mortality, benefits were consistent: men [hazard ratio 0.82, 95% confidence interval (CI) 0.62-1.11], women (hazard ratio 0.77, 95% CI 0.66-0.99), those aged 80-84.9 (hazard ratio 0.76, 95% CI 0.60-0.96), those aged 85 and over (hazard ratio 0.87, 95% CI 0.64-1.20), those with a history of CVD (hazard ratio 0.76, 95% CI 0.48-1.20) and those without (hazard ratio 0.81, 95% CI 0.65-0.99), and similarly across a range of baseline SBPs. The point estimates for cardiovascular mortality, strokes, heart failure and cardiovascular events were all in favour of benefit. In the per-protocol analysis, strokes were reduced by 34% (P = 0.026), total mortality by 28% (P = 0.001), cardiovascular event by 37% (P < 0.001) and heart failure by 72% (P < 0.001). CONCLUSION In hypertensive patients aged 80 or more, treatment based on indapamide (sustained-release) 1.5 mg showed consistent benefits across pre-specified subgroups including those without established CVD (the majority), supporting the need for treatment even at this advanced age. There were too few aged 90 or over to determine benefit from treatment at extreme age.

Prognostic impact of clinic, daytime, and nighttime systolic blood pressure in 9 cohorts of 13,843 patients with hypertension: systematic review and meta-analysis

Abstract: SBP and a 10 mmHg increase in SBP. Meta-regression and subgroup analyses were used to quantify the relative prognostic value of women versus men. Patients were from Europe, Brazil, and Japan (10 cohorts, N1⁄417,312, CVEs1⁄41,892). One cohort lacked gender-specific HRs from 24 hour and clinic SBP but otherwise had gender-specific information. There was a tendency for women to have a greater 1 SD of SBP and a greater coefficient of variation as compared to men. For women relative to men, a 1 SD increase in nighttime, daytime, 24 hour, and clinic SBP, gave RRs (95% confidence intervals) of 1.18 (1.05-1.31), 1.23 (1.09-1.40), 1.21 (1.07-1.37), and 0.94 (0.83-1.06), respectively. (See Figures.) For a 10 mmHg increase in SBP, the corresponding RRs were 1.06 (0.99-1.14), 1.13 (1.03-1.23), 1.10 (1.01-1.21), and 0.96 (0.89-1.03), respectively. In conclusion, in patients with hypertension, ambulatory SBPs better predict CVEs in women than in men.

Target blood pressure in elderly hypertensive patients and in patients with diabetes mellitus.

Abstract: Journal of Hypertension 2014, 32:1551–1552 Università Milano-Bicocca; IRCSS Istituto Auxologico Italiano, Milan, Italy, Hypertension and Cardiovascular Rehabilitation Unit, KU Leuven University, Leuven, Belgium, Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland, University of Valencia and INCLIVA Research Institute and CIBERobn, Madrid, Spain and University of Milan, Istituto Auxologico Italiano, Milan, Italy

Prehypertension, Hypertension and Associated Cardiovascular Risk Factors among Adult Congolese Urban Dwellers: Results of the Vitaraa Study

Abstract: Objective: To assess the prevalence of prehypertension and hypertension, their determinants and associated cardiovascular risk factors in Congolese urban dwellers. Methods: From July 2007 to March 2008, we collected information on lifestyle habits, medical history and anthropometric data in 1292 household members of Adoula Quarter, Kinshasa, aged 20 years or more, 731 women (56.6%). We obtained measurements of BP, blood glucose, serum lipids and qualitative proteinuria. We defined blood pressure categories according to JNC7 classification and used logistic regression analyses to assess their independent determinants. We obtained age adjustment of continuous and categorical variables using GLM and Genmod procedures, respectively. Results: Prehypertension was observed in 30.3% of subjects, 34.9% of men and 26.7% of women (P = 0.0045). The prevalence of hypertension amounted to 30.9% with no difference between genders. Participants with prehypertension had average age, BMI and waist circumference intermediate between those with normal BP and hypertensive subjects. Their glucose and lipids levels were similar to those of normotensives. The prevalence of prehypertension amounted to 33% at age 20 - 29 years and decreased to 16.7% at ≥60 years whereas the prevalence of hypertension increased from 11.2% to 71.4%. The rates of diabetes mellitus were similar accross blood pressure catogo- ries whilst prevalences of overweight/obesity, abdominal adiposity, dyslipidemia and metabolic syndrome significatively increased (P = 0.05 or less). Among participants with prehypertension, 73% had two or more additional cardiovascular risk factors. In the logistic model the probability of prehypertension was higher in men (OR: 1.429; 95% CI: 1.099 - 1.857) and participants with overweight/obesity (OR: 1.666; 1.146 - 2.422), lower in participants aged ≥ 55 years (0.427; 0.267 - 0.683) and those with high fruit intake (0.691; 0.488 - 0.977). The probability of hypertension was higher in participants aged ≥ 55 years (OR: 6.988; 4.561 - 10.706), overweight/obesity (2.263; 1.704 - 3.004), those with high vegetables consumption (1.152; 1.003 - 1.324) and faster pulse rate (1.013; 1.002 - 1.025). Conclusion: Our results suggest that fruit consumption and control of over-weight are important issues for prevention of cardiovascular disease in sub-Saharan Africa where high blood pressure is the main driver of the current epidemic.