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Showing papers by "Stéphane Laurent published in 2017"


Journal ArticleDOI
TL;DR: The methodological issues related to the measurement of drug adherence in a research setting and clinical practice, the prevalence and the impact of drug nonadherence on blood pressure control and thus in apparent resistant hypertension, and on cardiovascular, cerebrovascular and renal outcomes are discussed.
Abstract: Adherence to treatment is now well recognized as a crucial key in the effectiveness of antihypertensive drugs; however, it is often overlooked in the management of hypertension because methodology to assess it is partly unreliable and limits its use in clinical practice. The available evidence suggests that nonadherence is highly prevalent in a chronic asymptomatic condition such as hypertension. It may undermine benefits expected from antihypertensive agents and therefore, may negatively impact cardiovascular, cerebrovascular and renal outcomes. In this review, we discuss the methodological issues related to the measurement of drug adherence in a research setting and clinical practice, the prevalence and the impact of drug nonadherence on blood pressure control and thus in apparent resistant hypertension, and on cardiovascular, cerebrovascular and renal outcomes.

80 citations


Journal ArticleDOI
TL;DR: The concept of Early Vascular Ageing (EVA) is developed to establish primordial prevention, identifying individuals whose ageing path has been accelerated either by inherent features, interaction with the environment or arterial exposure to several types of insults that evolve to medial layer morphological changes.
Abstract: Arterial stiffness has been accumulating evidence as an intermediate cardiovascular endpoint. It has been established as an independent risk marker for cardiovascular disease, and reflects the dissociation between chronologic and biologic age of large arteries-attributing earlier the risk that a normal vascular ageing process had installed to occur several years later. The concept of Early Vascular Ageing (EVA) is developed to establish primordial prevention, identifying individuals whose ageing path has been accelerated either by inherent features, interaction with the environment or arterial exposure to several types of insults that evolve to medial layer morphological changes. Understanding the pathophysiology of vascular ageing, its consequences and therapeutic opportunities is therefore an advantage that could be translated in time of prevention and survival free of cardiovascular disease. As the EVA construct is advancing, new features appear as interesting to better translate it into clinical practice.

76 citations


Journal ArticleDOI
TL;DR: The increased aPWV reported in patients with inflammatory bowel disease is associated with inflammation, and this study followed the Preferred Reporting Items for Systematic Review and Meta‐Analyses of individual participant data 2015 guidelines.
Abstract: Background The recent finding that aortic pulse wave velocity (aPWV) is increased in patients with inflammatory bowel disease may explain why the cardiovascular risk is increased despite the low prevalence of traditional cardiovascular risk factors. We aimed to test whether inflammation is associated with aortic stiffening in this setting after adjustment for major confounders and to perform subgroup analyses. Methods and Results A systematic literature search for aPWV in inflammatory bowel disease was performed using PubMed, Scopus, Web of Science, and Google Scholar databases (last accessed May 7, 2017). Inclusion criterion was peer‐reviewed publications on clinical studies reporting original data. This study followed the Preferred Reporting Items for Systematic Review and Meta‐Analyses of individual participant data 2015 guidelines. Data were provided for 4 cohorts in 3 countries (151 participants with ulcerative colitis, 159 with Crohn9s disease, and 227 control patients). Using aPWV, cohort‐specific z scores were calculated after log e ‐transform and combined in meta‐analysis to form pooled effects using a random‐effects model. Compared with controls, aPWV was increased in patients with Crohn9s disease (mean difference 0.78 z score; 95% confidence interval, 0.56–1.00 z score [ P z score; 95% confidence interval, 0.52–0.97 z score [ P z score; 95% confidence interval, 0.02–0.08 z score [ P z score; 95% confidence interval, 0.02–0.11 z score [ P =0.002]) but not with markers of acute inflammation (C‐reactive protein and erythrocyte sedimentation rate), cardiovascular risk factors, and therapy. Conclusions The increased aPWV reported in patients with inflammatory bowel disease is associated with inflammation. Clinical Trial Registration URL: http://www.crd.york.ac.uk. Unique identifier: PROSPERO 2016: CRD42016053070.

74 citations


Journal ArticleDOI
TL;DR: It is suggested that urine detection of antihypertensive drugs by ultraperformance liquid chromatography–tandem mass spectrometry is an accurate and practical tool for directly monitoring adherence in patients attending the outpatient clinics of a university hospital.
Abstract: BACKGROUND Nonadherence to antihypertensive therapy is an important cause of poor blood pressure control. However, to date, few effective and accurate tools exist to routinely evaluate drug nonadherence. METHODS In this observational study, performed under conditions of routine clinical practice, we included 174 patients (aged 67 ± 11 years) with treated essential hypertension who attended the outpatient hypertension clinic of a university hospital. Adherence to antihypertensive treatment was measured by using ultraperformance liquid chromatography-tandem mass spectrometry in spot urine at the time of clinical appointment and blood pressure measurement. Patients were also asked to report their adherence using a validated questionnaire (four-item Morisky Medication Adherence Scale). RESULTS The prevalence of directly measured nonadherence by urine drug detection was approximately 10%. Compared with adherent patients, those who did not adhere to their treatment (n = 15) had a higher number of antihypertensive pills and drugs (P = 0.02), cotreatment with cardiovascular drugs (P < 0.05), and total concurrent medications and pills (P < 0.01). After adjustment for age, SBP and DBP were higher in nonadherent than adherent group (SBP: 146 ± 18 vs. 131 ± 14, respectively, P < 0.01; and DBP: 77 ± 15 vs. 73 ± 9, respectively, P < 0.01). There was no significant association between four-item Morisky Medication Adherence Scale score and directly measured nonadherence. A longitudinal analysis, performed in a subpopulation of 105 patients after a median follow-up of 11 months, showed that the adherence status remained unchanged in 88% of patients. CONCLUSION These results indicate a good adherence to antihypertensive drugs in patients attending the outpatient clinics of a university hospital. They suggest that urine detection of antihypertensive drugs by ultraperformance liquid chromatography-tandem mass spectrometry is an accurate and practical tool for directly monitoring adherence. This direct information is not overlapping with self-report questionnaire.

35 citations


Journal ArticleDOI
TL;DR: Selecting the maximum of the second derivative algorithm for detecting the foot of the pressure waveform, and combining it with an optimized signal processing chain, improved the accuracy of ft-PWV measurement in the current population sample.
Abstract: BACKGROUND Carotid-femoral pulse wave velocity (PWV) (cf-PWV) is the gold standard for measuring aortic stiffness. Finger-toe PWV (ft-PWV) is a simpler noninvasive method for measuring arterial stiffness. Although the validity of the method has been previously assessed, its accuracy can be improved. ft-PWV is determined on the basis of a patented height chart for the distance and the pulse transit time (PTT) between the finger and the toe pulpar arteries signals (ft-PTT). METHOD The objective of the first study, performed in 66 patients, was to compare different algorithms (intersecting tangents, maximum of the second derivative, 10% threshold and cross-correlation) for determining the foot of the arterial pulse wave, thus the ft-PTT. The objective of the second study, performed in 101 patients, was to investigate different signal processing chains to improve the concordance of ft-PWV with the gold-standard cf-PWV. Finger-toe PWV (ft-PWV) was calculated using the four algorithms. RESULTS The best correlations relating ft-PWV and cf-PWV, and relating ft-PTT and carotid-femoral PTT were obtained with the maximum of the second derivative algorithm [PWV: r = 0.56, P < 0.0001, root mean square error (RMSE) = 0.9 m/s; PTT: r = 0.61, P < 0.001, RMSE = 12 ms]. The three other algorithms showed lower correlations. The correlation between ft-PTT and carotid-femoral PTT further improved (r = 0.81, P < 0.0001, RMSE = 5.4 ms) when the maximum of the second derivative algorithm was combined with an optimized signal processing chain. CONCLUSION Selecting the maximum of the second derivative algorithm for detecting the foot of the pressure waveform, and combining it with an optimized signal processing chain, improved the accuracy of ft-PWV measurement in the current population sample. Thus, it makes ft-PWV very promising for the simple noninvasive determination of aortic stiffness in clinical practice.

28 citations


Journal ArticleDOI
TL;DR: Computer model-based analyses demonstrate that for PWV methods based on peripheral signals, pulse transit time differences closely correlate with the aortic transit time, supporting the use of these methods in clinical practice.
Abstract: Pulse waveform analyses have become established components of cardiovascular research. Recently several methods have been proposed as tools to measure aortic pulse wave velocity (aPWV). The carotid-femoral pulse wave velocity (cf-PWV), the current clinical gold standard method for the noninvasive assessment of aPWV, uses the carotid-to-femoral pulse transit time difference (cf-PTT) and an estimated path length to derive cf-PWV. Objective: The heart-ankle PWV (ha-PWV), brachial-ankle PWV (ba-PWV) and finger-toe (ft-PWV) are also methods presuming to approximate aPWV based on time delays between physiological cardiovascular signals at two locations (similar to heart-ankle PTT, ha-PTT; similar to brachial-ankle PTT, ba-PTT; similar to finger-toe PTT, ft-PTT) and a path length typically derived from the subject's height. To test the validity of these methods, we used a detailed 1D arterial network model (143 arterial segments) including the foot and hand circulation. Approach: The arterial tree dimensions and properties were taken from the literature and completed with data from patient scans. We calculated PTTs with all the methods mentioned above. The calculated PTTs were compared with the aortic PTT (aPTT), which is considered as the absolute reference method in this study. Main results: The correlation between methods and aPTT was good and significant, cf-PTT (R-2 = 0.97; P < 0.001; mean difference 5 +/- 2 ms), ha-PTT (R-2 = 0.96; P < 0.001; 150 +/- 23 ms), ba-PTT (R-2 = 0.96; P < 0.001; 70 +/- 13 ms) and ft-PTT (R-2 = 0.95; P < 0.001; 14 +/- 10 ms). Consequently, good correlation was also observed for the PWV values derived with the tested methods, but absolute values differed because of the different path lengths used. Significance: In conclusion, our computer model-based analyses demonstrate that for PWV methods based on peripheral signals, pulse transit time differences closely correlate with the aortic transit time, supporting the use of these methods in clinical practice.

22 citations


Journal ArticleDOI
TL;DR: Sedentary time is associated with carotid-femoral pulse wave velocity independently of age and metabolic risk factors and a higher Sed in MetS individuals lead to a worse arterial stiffness profile.
Abstract: This study aimed to investigate whether sedentary time (Sed) and physical activity (PA) are associated with arterial stiffness in individuals with and without metabolic syndrome (MetS). This cross-sectional study comprised 197 individuals (47±13 years; 58% female) from a primary health care centre. Arterial stiffness was assessed using carotid-femoral pulse wave velocity (cfPWV). Metabolic syndrome was determined as clustering of at least 3 out of 5 risk factors (central obesity, hypertension, impaired glucose, triglycerides and high-density lipoprotein cholesterol). Daily PA was objectively assessed and classified in Sed, light and moderate-to-vigorous PA. Physical activity was used as a continuous variable for multiple regression analysis. For mean comparisons of cfPWV between subjects with and without MetS, a binary split at the median of Sed and PA was used. Sedentary time was associated with cfPWV (β=0.11; p=0.01) explaining 1.3% of its variance; independently of age (β=0.49; p

16 citations


Journal ArticleDOI
TL;DR: An update of the practical therapeutic platform for the treatment of hypertension is presented, which takes into account the results of the recently published studies and extends the applicability of the platform to common conditions that are often neglected or poorly considered in clinical practice guidelines.
Abstract: Despite the improvements in the management of hypertension during the last three decades, it continues to be one of the leading causes of cardiovascular morbidity and mortality worldwide. Effective and sustained reductions in blood pressure (BP) reduce the incidence of myocardial infarction, stroke, congestive heart failure and cardiovascular death. However, the proportion of patients who achieve the recommended BP goal (< 140/90 mmHg) is persistently low, worldwide. Poor adherence to therapy, complex therapeutic regimens, clinical inertia, drug-related adverse events and multiple risk factors or comorbidities contribute to the disparity between the potential and actual BP control rate. Previously we published a practical therapeutic platform for the treatment of hypertension based on clinical evidence, guidelines, best practice and clinical experience. This platform provides a personalised treatment approach and can be used to improve BP control and simplify treatment. It uses long-acting, effective and well-tolerated angiotensin receptor blocker (ARB) olmesartan, in combination with a calcium channel blocker amlodipine, and/or a thiazide diuretic hydrochlorothiazide. These drugs were selected based on the availability in most European Countries of single-pill, fixed formulations in a wide range of doses for both dual- and triple-drug combinations. The platform approach could be applied to other ARBs or angiotensin-converting enzyme inhibitors available in single-pill, fixed-dose combinations. Here, we present an update, which takes into account the results of the recently published studies and extends the applicability of the platform to common conditions that are often neglected or poorly considered in clinical practice guidelines.

16 citations


Journal ArticleDOI
TL;DR: The very recent American College of Physicians/American Academy of Family Practitioners guidelines were put together by a set of authors and consultants without any expertise in the topic under discussion, that is, hypertension.
Abstract: Several sets of guidelines have been published recently and more are in the works. The very recent American College of Physicians/American Academy of Family Practitioners guidelines were put together by a set of authors and consultants without any expertise in the topic under discussion, that is, hypertension. Although we are not maintaining that all guidelines should be written exclusively by experts, complete lack of expertise among guideline authors is not acceptable.

13 citations


Journal ArticleDOI
TL;DR: The aim was to apply the concept of ZC calculation to estimate ZVA from MR with carotid tonometry and to evaluate these indices through their associations with symptoms, LV diastolic function and aortic stiffness.
Abstract: Purpose Valvuloarterial impedance (ZVA), estimating left ventricle (LV) afterload, has been proposed in transthoracic echocardiography (TTE) as a predictor of mortality in aortic valve stenosis (AVS). However, its calculation differs from arterial characteristic impedance (ZC). Our aim was to apply the concept of ZC calculation to estimate ZVA from MR with carotid tonometry and to evaluate these indices through their associations with symptoms, LV diastolic function and aortic stiffness. Materials and Methods In 40 patients with AVS (76 ± 13 years), ZVA-TI derived from velocity time integral and E/Ea were estimated by TTE. ZVA-INS, based on ZC formula, calculated as the instantaneous pressure gradient to peak flow ratio and aortic compliance were estimated by using MRI at 1.5 Tesla. Results Both ZVA estimates were higher in symptomatic than asymptomatic patients (707 ± 22 versus 579 ± 53 dyne.s/cm5, P = 0.031 for ZVA-INS and 4.35 ± 0.16 versus 3.33 ± 0.38 mmHg.m2/mL, P = 0.018 for ZVA-TI). Although they were both associated with aortic compliance (r = -0.45; P = 0.006 for ZVA-INS and r = -0.43; P = 0.008 for ZVA-TI) only ZVA-INS was associated with E/Ea (r = 0.50; P < 0.001). In multivariate analysis to identify determinants of E/Ea, a model including age, mean blood pressure, LV ejection fraction, LV mass, and aortic valve area was performed (R2 = 0.41; P < 0.01). When ZVA-INS was added to the model, its overall significance was higher R2 = 0.56 (P < 0.01) and ZVA-INS and LV mass were the only significant determinants. Conclusion ZVA-INS was more strongly associated with diastolic dysfunction than usual parameters quantifying AVS severity. This new ZVA estimate could improve LV afterload evaluation. Level of Evidence: 1 J. Magn. Reson. Imaging 2017;45:795–803.

12 citations


Journal ArticleDOI
TL;DR: Their investigation evaluates presymptomatic stages of vascular disease, which could help identifying early subjects who are at high risk for future CVD and who could benefit the most from.

Journal ArticleDOI
TL;DR: It is offered here for the first time an in vivo detailed ultrasonographic characterization of the db/db mouse model, providing a useful tool for a thoughtful choice of the right rodent model for any experimental design.

Journal ArticleDOI
TL;DR: Nonadherence to antihypertensive drug treatment and lifestyle measures is a key factor underlying poor blood pressure control and treatment resistance, and overcoming this problem is a major public health challenge.
Abstract: See related article, pp 307–314 Hypertension remains a leading risk factor for cardiovascular morbidity and mortality.1 Its management is based on knowledge accumulated over more than a half a century, the availability of multiple orally active and potent antihypertensive drugs targeting different pathophysiological pathways, cumulative evidence from several randomized controlled trials and meta-analyses, and hundreds of pages of guidelines regularly updated by experts from around the world. Nevertheless, hypertension remains poorly controlled worldwide, and its incidence is increasing, because of the aging of the population and the obesity epidemic.2 Nonadherence to antihypertensive drug treatment and lifestyle measures is a key factor underlying poor blood pressure (BP) control and treatment resistance, and overcoming this problem is a major public health challenge.3,4 Nonadherence is associated with poor cardiovascular prognosis.5 Several diseases, physician-, treatment- and patient-related factors, either alone or in combination, promote nonadherence to treatment and are common to all chronic diseases, including hypertension.3,4 Various direct and indirect methods have been developed for assessing adherence to drug treatments.3,4 The direct methods include the direct observation of treatment intake in a medicalized setting, such as a BP clinic, the detection of a drug or its metabolite in blood or urine, and the determination of a pharmacodynamic marker.3,4 Indirect methods include patient questionnaires, self-reports, patient diaries, pill counts, prescription refill rates, the assessment of patient clinical response, electronic drug monitoring systems, and the determination of physiological markers. …

Journal ArticleDOI
TL;DR: A novel approach to estimate central (aortic) blood pressure noninvasively from aortic MRI data and a non-invasive peripheral (brachial) pressure measurement, using a one-dimensional (1-D) model of aorti blood flow is proposed.

Journal ArticleDOI
TL;DR: 24-hour ambulatory brachial systolic blood pressure was shown to be superior to bOSBP in predicting preclinical damage3 and cardiovascular outcome and another advancement in understanding cardiovascular risk represented by BP was the acknowledgment that SBP differs throughout the arterial tree, with higher pressures in the periphery than central arteries.
Abstract: See related article, pp 1157–1164 For over a century, office brachial blood pressure (BP) measurements have formed the cornerstone of clinical practice—which is still the case in most parts of the world. In the hands of healthcare practitioners, office systolic blood pressure (SBP) measured at the brachial artery (bOSBP) remains the most widely used and best predictor of cardiovascular outcome.1,2 However, in recent decades, the pros of conventional BP measurement—being ease of use, low cost, and noninvasiveness—have been challenged by its cons. The introduction of 24-hour ambulatory BP measurements highlighted the weaknesses of conventional measurements to overcome observer measurement errors, and the inability to detect white-coat and masked hypertension. More importantly, 24-hour ambulatory brachial systolic blood pressure (bASBP) was shown to be superior to bOSBP in predicting preclinical damage3 and cardiovascular outcome.4 Another advancement in understanding cardiovascular risk represented by BP was the acknowledgment that SBP differs throughout the arterial tree, with higher pressures in the periphery (brachial) than central (aortic) arteries. With technological developments, it is also possible to measure central pressure noninvasively and accurately, albeit not cheaply, and to determine normal …



Journal ArticleDOI
TL;DR: It is argued that the greater augmentation index associated with a lower heart rate implies but this cannot be translated “tout court” into increased arterial stiffness.