Stéphane Laurent

Bio: Stéphane Laurent is an academic researcher from University of Paris. The author has contributed to research in topics: Blood pressure & Arterial stiffness. The author has an hindex of 83, co-authored 424 publications receiving 75440 citations. Previous affiliations of Stéphane Laurent include University of Lausanne & Paris Descartes University.

Arterial Stiffness and Cardiovascular Events in Hypertensives

Abstract: A major reason for measuring arterial stiffness routinely in clinical practice in hypertensive patients comes from the recent demonstration that arterial stiffness has predictive value for cardiovascular events, which is independent of classical risk scores. In primary prevention, some “imaging biomarkers,” such as arterial stiffness, enhance risk prediction to a higher extent than “circulating biomarkers.” The aim of the present brief review is to address the concept of “surrogate endpoint” and to determine whether aortic stiffness meets the criteria that are requested by international guidelines: (1) Proof of concept: Do novel marker levels differ between subjects with and without outcome? (2) Prospective validation: Does the novel marker predict development of future outcomes in a prospective cohort or nested case-cohort study? (3) Incremental value: Does the novel marker add predictive information to established, standard risk markers? (4) Clinical utility: Does the novel risk marker change predicted risk sufficiently to change recommended therapy? (5) Clinical outcomes: Does use of the novel risk marker improve clinical outcomes, especially when tested in a randomized clinical trial? (6) Cost-effectiveness: Does use of the novel risk marker improve clinical outcomes sufficiently to justify the additional costs? In conclusion, although aortic stiffness meets the first 4 criteria, there is still a need for studies comparing aortic stiffness-guided therapeutic strategies with classic guidelines-guided strategies for preventing cardiovascular events.

Radiofrequency-based wall tracking for noninvasive assessment of local carotid pulse pressure: comparison with applanation tonometry and association with organ damage.

Abstract: OBJECTIVES Central pulse pressure (PP) has been suggested a better predictor of cardiovascular risk than brachial PP, and its routine noninvasive assessment can be useful for risk stratification. The present study evaluated the capability of a radiofrequency-based carotid wall tracking to estimate central PP from distension curves, comparing the values of carotid PP as obtained by wall tracking with those provided by applanation tonometry. Furthermore, the associations of carotid PP with intermediate markers of cardiovascular risk, like carotid intima-media thickness (IMT) and left ventricular mass (LVM), were assessed. METHODS Carotid PP was measured by wall tracking and applanation tonometry during the same session in 346 individuals (healthy controls, patients with hypertension and diabetes). IMT was measured in all individuals and LVM was measured in 253. RESULTS Carotid PP values as measured by wall tracking and applanation tonometry were highly correlated [r = 0.87; slope 0.90 (0.85-0.95); P < 0.0001; mean difference = 3.1 ± 6.8 mmHg], and were independently determined by the same variables (age, heart rate, triglycerides, blood pressure-lowering therapy). Carotid IMT and LVM correlated more strongly with carotid PP (r = 0.44 and 0.50; P < 0.0001 for both) than with brachial PP (r = 0.34 and 0.42; P < 0.0001 for both). Patients with carotid PP at least 50 mmHg had higher IMT, LVM, and prevalence of LV hypertrophy than those with PP less than 50 mmHg (P = 0.0001 to <0.0001). CONCLUSIONS Local carotid PP as estimated by wall tracking is comparable to that obtained by applanation tonometry, and it shows a better association with target organ damage than brachial blood pressure. Assessment of carotid PP during routine ultrasound examination of extracranial carotid tree may provide additional information for individual risk stratification.

The common carotid circulation in patients with essential hypertension.

Abstract: We review carotid artery hemodynamics in hypertensive men, with particular reference to common carotid artery diameter and blood flow, and emphasize the changes in artery diameter and compliance implied by antihypertensive therapy.

Visit-to-visit blood pressure variability: added 'VALUE' as a risk marker in low- and high-risk patients.

Abstract: The growing interest in the variability of blood pressure is related to the repeated demonstration of its independent predictive value for organ damage and cardiovascular events. In particular, visit-to-visit blood pressure variability has gained attention from physicians since large blood pressure fluctuations from one visit to another are common observations in clinical practice, and have been related to high risk of cardiovascular complications. Several indices are available for the quantification of visit-to-visit blood pressure variability, such as standard deviation and coefficient of variation. Visit-to-visit blood pressure variability can be influenced by a number of factors, including the length of follow-up, number of measures, changes in blood pressure measurement procedures, antihypertensive drugs, patient drug adherence, and environmental conditions including seasonal changes. It is also likely to be influenced by intrinsic characteristics of the patient, among them increased arterial stiffness and/or altered baroreflex function that impairs the buffering of blood pressure changes. Visit-to-visit blood pressure variability can damage target organs, either directly in response to the mechanical effect of blood pressure variations or indirectly in association with the mechanisms at the origin of abnormal cardiovascular regulatory mechanisms leading to higher visit-to-visit blood pressure variability. Post hoc analyses of large randomized clinical trials have been performed since both office blood pressure values at repeated visits and outcomes were available. A consistent finding was that increased visit-to-visit blood pressure variability was predictive of fatal and nonfatal cardiovascular events independently of mean blood pressure. Not surprisingly, the higher the cardiovascular risk at baseline, the higher the predictive value of visit-to-visit blood pressure variability for cardiovascular events. Although the translation of these findings into clinical practice is obvious for high-risk patients, their clinical applicability remains limited in younger patients and those with a lower mean blood pressure. Indeed, these patients are generally considered as at low-risk, a statement that can revisited if visit-to-visit blood pressure variability is available. The article by Mehlum et al. published in this issue of the European Heart Journal provides an important contribution with regard to the issue of the predictive value of visit-to-visit variability in blood pressure for cardiovascular events. The authors analyzed the data of the Valsartan Antihypertensive Long-term Use Evaluation (VALUE) trial, a multinational randomized-controlled, double-masked trial of valsartan vs amlodipine, in 15 245 patients with hypertension and at least one additional risk factor for cardiovascular event, with a mean duration of follow-up of 4.0 years. They selected 13 803 patients who had no event during the first 6 months and had at least three visits. Visit-to-visit blood pressure variability was assessed by the standard deviation of at least three mean systolic blood pressures, each calculated from three measurements during the visit. An important finding is that patients in the highest quintile of visit-to-visit blood pressure variability had a twoto threefold higher risk of cardiovascular event than those in the lowest quintile, (ischaemic stroke, myocardial infarction, and congestive heart failure). These results were adjusted for a large number of variables, including mean systolic blood pressure during treatment. In that respect, the authors confirm and extend the findings of previous large randomized clinical trials, such as the Anglo-Scandinavian Cardiac Outcomes Trial Blood Pressure Lowering Arm (ASCOT-BPLA) and the Losartan Intervention For Endpoint reduction in hypertension (LIFE) studies, i.e. increased visit-to-visit blood pressure variability was predictive of fatal and nonfatal cardiovascular events independently of mean blood pressure. The findings of Mehlum et al. are also stimulating because associations between visit-to-visit blood pressure variability and cardiovascular events were stronger among the younger patients (i.e. aged 50–67 years) and patients with lower systolic blood pressure (i.e. <137.8

2013 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: ABCD : Appropriate Blood pressure Control in Diabetes ABI : ankle–brachial index ABPM : ambulatory blood pressure monitoring ACCESS : Acute Candesartan Cilexetil Therapy in Stroke Survival ACCOMPLISH : Avoiding Cardiovascular Events in Combination Therapy in Patients Living with Systolic Hypertension ACCORD : Action to Control Cardiovascular Risk in Diabetes ACE : angiotensin-converting enzyme ACTIVE I : Atrial Fibrillation Clopidogrel Trial with Irbesartan for Prevention of Vascular Events ADVANCE : Action in Diabetes and Vascular Disease: Preterax and Diamicron-MR Controlled Evaluation AHEAD : Action for HEAlth in Diabetes ALLHAT : Antihypertensive and Lipid-Lowering Treatment to Prevent Heart ATtack ALTITUDE : ALiskiren Trial In Type 2 Diabetes Using Cardio-renal Endpoints ANTIPAF : ANgioTensin II Antagonist In Paroxysmal Atrial Fibrillation APOLLO : A Randomized Controlled Trial of Aliskiren in the Prevention of Major Cardiovascular Events in Elderly People ARB : angiotensin receptor blocker ARIC : Atherosclerosis Risk In Communities ARR : aldosterone renin ratio ASCOT : Anglo-Scandinavian Cardiac Outcomes Trial ASCOT-LLA : Anglo-Scandinavian Cardiac Outcomes Trial—Lipid Lowering Arm ASTRAL : Angioplasty and STenting for Renal Artery Lesions A-V : atrioventricular BB : beta-blocker BMI : body mass index BP : blood pressure BSA : body surface area CA : calcium antagonist CABG : coronary artery bypass graft CAPPP : CAPtopril Prevention Project CAPRAF : CAndesartan in the Prevention of Relapsing Atrial Fibrillation CHD : coronary heart disease CHHIPS : Controlling Hypertension and Hypertension Immediately Post-Stroke CKD : chronic kidney disease CKD-EPI : Chronic Kidney Disease—EPIdemiology collaboration CONVINCE : Controlled ONset Verapamil INvestigation of CV Endpoints CT : computed tomography CV : cardiovascular CVD : cardiovascular disease D : diuretic DASH : Dietary Approaches to Stop Hypertension DBP : diastolic blood pressure DCCT : Diabetes Control and Complications Study DIRECT : DIabetic REtinopathy Candesartan Trials DM : diabetes mellitus DPP-4 : dipeptidyl peptidase 4 EAS : European Atherosclerosis Society EASD : European Association for the Study of Diabetes ECG : electrocardiogram EF : ejection fraction eGFR : estimated glomerular filtration rate ELSA : European Lacidipine Study on Atherosclerosis ESC : European Society of Cardiology ESH : European Society of Hypertension ESRD : end-stage renal disease EXPLOR : Amlodipine–Valsartan Combination Decreases Central Systolic Blood Pressure more Effectively than the Amlodipine–Atenolol Combination FDA : U.S. Food and Drug Administration FEVER : Felodipine EVent Reduction study GISSI-AF : Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico-Atrial Fibrillation HbA1c : glycated haemoglobin HBPM : home blood pressure monitoring HOPE : Heart Outcomes Prevention Evaluation HOT : Hypertension Optimal Treatment HRT : hormone replacement therapy HT : hypertension HYVET : HYpertension in the Very Elderly Trial IMT : intima-media thickness I-PRESERVE : Irbesartan in Heart Failure with Preserved Systolic Function INTERHEART : Effect of Potentially Modifiable Risk Factors associated with Myocardial Infarction in 52 Countries INVEST : INternational VErapamil SR/T Trandolapril ISH : Isolated systolic hypertension JNC : Joint National Committee JUPITER : Justification for the Use of Statins in Primary Prevention: an Intervention Trial Evaluating Rosuvastatin LAVi : left atrial volume index LIFE : Losartan Intervention For Endpoint Reduction in Hypertensives LV : left ventricle/left ventricular LVH : left ventricular hypertrophy LVM : left ventricular mass MDRD : Modification of Diet in Renal Disease MRFIT : Multiple Risk Factor Intervention Trial MRI : magnetic resonance imaging NORDIL : The Nordic Diltiazem Intervention study OC : oral contraceptive OD : organ damage ONTARGET : ONgoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial PAD : peripheral artery disease PATHS : Prevention And Treatment of Hypertension Study PCI : percutaneous coronary intervention PPAR : peroxisome proliferator-activated receptor PREVEND : Prevention of REnal and Vascular ENdstage Disease PROFESS : Prevention Regimen for Effectively Avoiding Secondary Strokes PROGRESS : Perindopril Protection Against Recurrent Stroke Study PWV : pulse wave velocity QALY : Quality adjusted life years RAA : renin-angiotensin-aldosterone RAS : renin-angiotensin system RCT : randomized controlled trials RF : risk factor ROADMAP : Randomized Olmesartan And Diabetes MicroAlbuminuria Prevention SBP : systolic blood pressure SCAST : Angiotensin-Receptor Blocker Candesartan for Treatment of Acute STroke SCOPE : Study on COgnition and Prognosis in the Elderly SCORE : Systematic COronary Risk Evaluation SHEP : Systolic Hypertension in the Elderly Program STOP : Swedish Trials in Old Patients with Hypertension STOP-2 : The second Swedish Trial in Old Patients with Hypertension SYSTCHINA : SYSTolic Hypertension in the Elderly: Chinese trial SYSTEUR : SYSTolic Hypertension in Europe TIA : transient ischaemic attack TOHP : Trials Of Hypertension Prevention TRANSCEND : Telmisartan Randomised AssessmeNt Study in ACE iNtolerant subjects with cardiovascular Disease UKPDS : United Kingdom Prospective Diabetes Study VADT : Veterans' Affairs Diabetes Trial VALUE : Valsartan Antihypertensive Long-term Use Evaluation WHO : World Health Organization ### 1.1 Principles The 2013 guidelines on hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology …

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).

Standards of Medical Care in Diabetes

Abstract: XI. STRATEGIES FOR IMPROVING DIABETES CARE D iabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, treatment goals, and tools to evaluate the quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. These standards are not intended to preclude more extensive evaluation and management of the patient by other specialists as needed. For more detailed information, refer to Bode (Ed.): Medical Management of Type 1 Diabetes (1), Burant (Ed): Medical Management of Type 2 Diabetes (2), and Klingensmith (Ed): Intensive Diabetes Management (3). The recommendations included are diagnostic and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. A grading system (Table 1), developed by the American Diabetes Association (ADA) and modeled after existing methods, was utilized to clarify and codify the evidence that forms the basis for the recommendations. The level of evidence that supports each recommendation is listed after each recommendation using the letters A, B, C, or E.