Showing papers by "Stéphane Laurent published in 2007"

2007 Guidelines for the Management of Arterial Hypertension : The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC).

Abstract: 2007 Guidelines for the Management of Arterial Hypertension : The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC).

2007 ESH-ESC Practice Guidelines for the Management of Arterial Hypertension: ESH-ESC Task Force on the Management of Arterial Hypertension.

Abstract: Authors/Task Force Members: Giuseppe Mancia, Co-Chairperson (Italy), Guy De Backer, Co-Chairperson (Belgium), Anna Dominiczak (UK), Renata Cifkova (Czech Republic), Robert Fagard (Belgium), Giuseppe Germano (Italy), Guido Grassi (Italy), Anthony M. Heagerty (UK), Sverre E. Kjeldsen (Norway), Stephane Laurent (France), Krzysztof Narkiewicz (Poland), Luis Ruilope (Spain), Andrzej Rynkiewicz (Poland), Roland E. Schmieder (Germany), Harry A.J. Struijker Boudier (Netherlands), Alberto Zanchetti (Italy)

2007 Guidelines for the management of arterial hypertension

Abstract: For several years the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC) decided not to produce their own guidelines on the diagnosis and treatment of hypertension but to endorse the guidelines on hypertension issued by the World Health Organization (WHO) and International Society of Hypertension (ISH)1,2 with some adaptation to reflect the situation in Europe. However, in 2003 the decision was taken to publish ESH/ESC specific guidelines3 based on the fact that, because the WHO/ISH Guidelines address countries widely varying in the extent of their health care and availability of economic resource, they contain diagnostic and therapeutic recommendations that may be not totally appropriate for European countries. In Europe care provisions may often allow a more in-depth diagnostic assessment of cardiovascular risk and organ damage of hypertensive individuals as well as a wider choice of antihypertensive treatment. The 2003 ESH/ESC Guidelines3 were well received by the clinical world and have been the most widely quoted paper in the medical literature in the last two years.4 However, since 2003 considerable additional evidence on important issues related to diagnostic and treatment approaches to hypertension has become available and therefore updating of the previous guidelines has been found advisable. In preparing the new guidelines the Committee established by the ESH and ESC has agreed to adhere to the principles informing the 2003 Guidelines, namely 1) to try to offer the best available and most balanced recommendation to all health care providers involved in the management of hypertension, 2) to address this aim again by an extensive and critical review of the data accompanied by a series of boxes where specific recommendations are given, as well as by a concise set of practice recommendations to be published soon thereafter as already done in 2003; …

2007 ESH-ESC guidelines for the management of arterial hypertension - The task force for the management of arterial hypertension of the European society of hypertension (ESH) and of the European society of cardiology (ESC)

Abstract: Authors/Task Force Members: Giuseppe Mancia, Co-Chairperson (Italy), Guy De Backer, Co-Chairperson (Belgium), Anna Dominiczak (UK), Renata Cifkova (Czech Republic) Robert Fagard (Belgium), Giuseppe Germano (Italy), Guido Grassi (Italy), Anthony M. Heagerty (UK), Sverre E. Kjeldsen (Norway), Stephane Laurent (France), Krzysztof Narkiewicz (Poland), Luis Ruilope (Spain), Andrzej Rynkiewicz (Poland), Roland E. Schmieder (Germany), Harry A.J. Struijker Boudier (Netherlands), Alberto Zanchetti (Italy)

Recent Advances in Arterial Stiffness and Wave Reflection in Human Hypertension

Abstract: In recent years, great emphasis has been placed on the role of arterial stiffness and wave reflection in the development of cardiovascular (CV) diseases. Arterial stiffness and wave reflections, which are now well accepted as the most important determinants of increasing systolic and pulse pressures in aging societies, are increasingly used in the clinical assessment of patients with hypertension and various CV risk factors.1,2 This review addresses recent advances in our understanding of the role played by arterial stiffness and wave reflection in the pathophysiology and treatment of human hypertension. According to the editorial rules for “Hypertension Highlights”, and to better focus on recent research, apart from large clinical trials, only articles published during the last 2 years are quoted in this review. Research on the molecular determinants of arterial stiffness has focused for years on the structure and amount of the main load bearing proteins: elastin and collagens.3 Indeed, aging and blood pressure, the two major determinants of arterial stiffness, are associated with a number of molecular changes of the load-bearing media of elastic arteries: the orderly arrangement of elastic fibers and laminae is gradually lost over time, and thinning, splitting, fraying, and fragmentation are observed. The degeneration of elastic fibers is associated with an increase in collagenous material and in ground substance, often accompanied by calcium deposition in ground substance and in degenerate elastic fibers.4 However, quantitative changes in elastin and collagen may not explain, by themselves, paradoxical observations. For instance, the changes in arterial wall material which accompany arterial hypertrophy in animal models of essential hypertension (SHRs and SHR-SPs) and in middle-age hypertensive patients are not necessarily associated with an increased isobaric stiffness.5 We suggested5 that adaptive mechanisms may include a rearrangement of the arterial wall material through cell–matrix connections, with a …

Arterial stiffness: a new surrogate end point for cardiovascular disease?

Abstract: Measurement of arterial stiffness is assuming an increasing role in the clinical assessment of patients. Indeed, arterial stiffness and wave reflections are now well accepted as the most important determinants of increasing systolic and pulse pressure in our aging community, and thus as the cause of cardiovascular (CV) complications and events, including stroke and myocardial infarction. Carotid-femoral pulse wave velocity (PWV), which is a direct measure of arterial stiffness, is the gold standard, since it requires little technical expertise and is supported by the greatest amount of epidemiological evidence. Indeed, aortic stiffness has independent predictive value for all-cause and CV mortality, CV disease, fatal and nonfatal coronary events and fatal strokes in patients with various levels of CV risk. Carotid pulse pressure and augmentation index are only indirect, surrogate measures of arterial stiffness. However, they provide additional information concerning wave reflections. They have demonstrated their predictive value in patients with end-stage renal disease (ESRD). Carotid stiffness was predictive of CV events in a small number of patients with ESRD or following renal transplantation, but had no independent predictive value in a larger number of patients with manifest arterial disease or in the healthy elderly patients of the Rotterdam study. To be not only an intermediate end point but also a surrogate end point, aortic stiffness has to demonstrate that its attenuation has an effect on CV mortality, coronary events and stroke. This remains to be established in populations at low to medium CV risk Eth i.e., with hypertension, dyslipidemia, diabetes and moderate chronic kidney disease.

Endothelial Function and Chronic Exposure to Air Pollution in Normal Male Subjects

Abstract: Exposure to urban air pollution, ultrafine particles or gases, is associated with acute cardiovascular mortality and morbidity. We investigated the effect of ambient air pollution on endothelial function in 40 healthy white male nonsmokers spontaneously breathing ambient air in Paris, France. Air pollutant levels (nitrogen, sulfur and carbon oxides, and particulate matter) were averaged during the 5 days preceding arterial measurements. Brachial artery endothelium-dependent flow-mediated dilatation and reactive hyperemia induced by hand ischemia and endothelium-independent glyceryl trinitrate dilatation were measured using a radiofrequency-based echo-tracking device at 2-week intervals. Flow-mediated dilatation was independently and negatively correlated with the average levels of sulfur dioxide (P<0.001) and nitrogen monoxide (P<0.01). Sulfur dioxide levels explained 19% of the variance of flow-mediated dilatation. An increase in gaseous pollutants, 2 weeks apart, was significantly associated with a decreased in flow-mediated dilatation. No association was found between air pollutants and glyceryl trinitrate-induced vasodilatation. Reactive hyperemia was significantly and positively correlated with particulate matter with aerodynamic diameters <10 microm and <2.5 microm (P<0.0001 and P<0.001, respectively) and nitrogen dioxide (P<0.01). An increase in particulate matter, 2 weeks apart, was significantly correlated with an increase in reactive hyperemia. Endothelial function was impaired by ordinary levels of pollution in healthy young males, in an urban area, and may be reduced by 50% between the least and the most polluted day. Gaseous pollutants affect large artery endothelial function, whereas particulate matter exaggerates the dilatory response of small arteries to ischemia.

Multiaxial mechanical characteristics of carotid plaque: analysis by multiarray echotracking system.

Abstract: Background and Purpose— Carotid plaque rupture depends on the various types of mechanical stresses. Our objective was to determine the multiaxial mechanical characteristics of atherosclerotic plaque and adjacent segment of the common carotid artery. Methods— A novel noninvasive echotracking system was used to measure intima-media thickness, diameter, pulsatile strain, and distensibility at 128 sites on a 4-cm long common carotid artery segment. The study included 62 patients with recent cerebrovascular ischemic event and either a plaque on the far wall of common carotid artery (n=25) or no plaque (n=37). Results— The mechanical characteristics of the carotid segment devoid of plaque did not differ between the two groups. Among patients with plaque, 16 had a larger radial strain at the level of plaque than at the level of adjacent common carotid artery (pattern A: outward-bending strain). The eight patients who had an opposite pattern (inward-bending strain) were more often dyslipidemic (100% versus 56% P=...

Arterial remodelling in Fabry disease.

Abstract: Aim: The enzymatic defect in Fabry disease results in the slow systemic deposition of uncleaved glycosphingolipids in the lysosomes of vascular endothelium and smooth muscle cells, leading to ischaemic strokes, cardiomyopathy and renal failure. Whereas it is known that Fabry disease affects small blood vessels, little is known about its effects on peripheral large arteries. We therefore set out to compare parameters of arterial wall structure and function in a cohort of patients with Fabry disease and an age-matched control group. Methods: Large artery phenotype was non-invasively investigated in 21 hemizygous patients with Fabry disease and 24 age-matched male controls. Common carotid and radial artery diameter, intima-media thickness (IMT) and distensibility were determined with high-definition echotracking systems and aplanation tonometry. Results: Patients with Fabry disease had a significant twofold increase in radial artery IMT and distensibility, independent of body surface area, age and mean blood pressure. In both groups, older age at the time of examination was significantly associated with larger radial artery IMT. The relationship between age and radial IMT was 2.3-fold higher in patients with Fabry disease than in controls (p > 0.01). Carotid IMT was mildly but significantly increased in patients with Fabry disease (+18%), whereas distensibility was unchanged. Conclusion: This study presents evidence of a major increase in arterial wall thickness and distensibility, measurable at the site of a medium-sized artery, in a cohort of patients with classic Fabry disease.

The need for combination antihypertensive therapy to reach target blood pressures: what has been learned from clinical practice and morbidity-mortality trials?

Abstract: Summary Pharmacological treatment of hypertension represents a cost-effective way for preventing cardiovascular and renal complications. To benefit maximally from antihypertensive treatment blood pressure (BP) should be brought to below 140/90 mmHg in every hypertensive patient, and even lower (< 130/80 mmHg) if diabetes or renal disease co-exists. Most of the time such targets cannot be reached using monotherapies. This is especially true in patients who exhibit a high cardiovascular risk. The co-administration of two agents acting by different mechanisms considerably increases BP control. Such preparations are not only efficacious, but also well tolerated, and some fixed low-dose combinations have a tolerability profile similar to placebo. This is for instance the case for the preparation containing the angiotensin-converting enzyme inhibitor perindopril (2 mg) and the diuretic indapamide (0.625 mg), a fixed low-dose combination that has recently been shown in controlled interventional trials to be more effective than monotherapies in reducing albuminuria, regressing cardiac hypertrophy and improving macrovascular stiffness. Fixed-dose combinations are becoming more and more popular and are even proposed by current hypertension guidelines as a first-line option to treat hypertensive patients.

How to estimate central pressure augmentation

Abstract: The CAFE study [1], an ancillary study of the ASCOT study [2], showed in 2073 hypertensive patients that the reduction in central systolic blood pressure (SBP), pulse pressure (PP) and augmentation index (AIx) was higher in patients receiving vasodilating drugs [calcium channel blocker (CCB)þ angiotensin-converting enzyme inhibitor (CEI)] than in patients receiving a nonvasodilating beta-blocker and a diuretic, despite similar reduction in SBP and PP at the brachial level. Because, in the ASCOT study [2], amlodipine-based treatment proved to be more effective than atenolol-based treatment for reducing cardiovascular (CV) events, the question arises whether the reduction in CV events is better predicted by central blood pressure (BP) (SBP, PP and AIx) than brachial BP. Unfortunately, because central PP and AIx were not measured at baseline in the CAFÉ study [1] but only after 1 year of treatment, it was not possible to deter-mine the amplitude of central PP and AIx reduction, and thus its influence on CV events.

Estimation of central pressure augmentation using automated radial artery tonometry. Commentary

Abstract: Background Peripheral wave reflection augments central blood pressure and contributes to cardiac load. This pressure augmentation is not quantifiable from brachial cuff pressure but can be determined from carotid pulsations using the augmentation index (Al). However, carotid tonometry is technically challenging and difficult to standardize in practice. We tested whether automated radial pressure analysis provides a viable alternative. Methods and results Carotid and radial Al (CAI, rAl) were measured in 46 volunteers with a broad range of arterial properties. Data were assessed at rest, during a cold-pressor test, and following 0.4 mg of sublingual nitroglycerin. cAI correlated with rAI independent of age, mean blood pressure (BP), gender or body mass (cAI = 0.79 X rAl - 0.467, r = 0.81, P< 0.00001), with zero mean bias. There was individual variability in the prediction (difference ofe -4 + 23%), though 65% of the estimates fell within 15% of each other. Change in rAI and cAI with provocative maneuvers also correlated (r= 0.77, P< 0.001). Both CAI and rAI were nonlinearly related to late-systolic pressure-time integral (PTI), an index of cardiac load. At cAl<0.1 or rAI < 0.69, PTI was unaltered, while greater values correlated with increased PTI. rAI accurately predicted this cut-off in 88% of cases, with a 5.5% false negative rate. Conclusions Automated rAI analysis is an easily applied method to assess basal and dynamic central pressure augmentation. While individual predictive accuracy of cAI was variable, overall population results were consistent, supporting use of rAI in clinical trials. Its prediction of when Al is associated with greater LV loading (i.e. cardiac risk) is good and may help stratify individual risk along with brachial cuff pressure.

The Role of Arterial Stiffness in Stratifying the Overall Cardiovascular Risk

Abstract: Overall cardiovascular risk seems not to be completely predicted by common risk factors and scores In recent years, evidence suggested an additional prognostic value for cardiovascular and cerebrovascular disease by integrating the measurement of arterial stiffness into traditional risk profiles Such correlation is due to the haemodynamic consequences of the stiffening process, such as a decreased diastolic flow of coronary perfusion and an increase in left ventricle afterload, thus in myocardial oxygen demand This can lead to the development of sudendocardial ischaemia and congestive heart failure Effects of arterial stiffness may be detected by measuring different vascular parameters: pulse pressure, pulse wave velocity and augmentation index Several trials have demonstrated these values to be significant and independent risk factors for both coronary artery disease and stroke In the near future, such non-invasive vascular diagnostics could lead to better primary and secondary prevention in high-risk patients