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J Belmin

Publications and source records attributed to J Belmin.

At least 37 records · Page 2Linked to original sources
PubMed1999

[Current aspects of arterial hypertension: hypertension in the aged].

HIGH PREVALENCE: In France, an estimated 5 million persons aged over 65 years have hypertension. Accepting a treatment threshold of systolic pressure 160 mmHg whatever the diastolic pressure, more than 3 million require antihypertension therapy. PATHOPHYSIOLOGY: During the aging process, the arterial trunks progressively loose their elasticity, becoming more and more rigid. Other age-related modifications of the vascular bed, as well as environmental factors (diet, sodium intake) also play a role. USEFUL TREATMENT: Several meta-analyses have demonstrated that active antihypertensive therapy can reduce overall mortality by 12%, the risk of cerebral vascular events by 36% and cardiac events by 25%. The risk of non-fatal cerebral vascular events can be reduced by 35%. POSITIVE DIAGNOSIS: Repeated blood pressure measurements are needed. Measurements should be made well after meals and take into account possible overestimation related to the rigidity of the humeral artery. THERAPEUTIC MODALITIES: Moderate salt intake and antihypertension drugs should be prescribed. A single drug regimen can be advised for initial treatment, avoiding long-action or high-dose regimens. Episodes of hypotension should be suspected if patients complain of malaise.

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PubMed1998

[Quality of the information collected during admission to a hospital geriatric service: importance of a structured medical record].

OBJECTIVES: The medical record (MR) is a key document for hospitalized patients. Several audits have however demonstrated that much important information is often missing in hospital MR. We conducted this survey with the aim of improving the quality of MR in a geriatric unit. PATIENTS AND METHODS: A structured MR was elaborated and implemented in order to guide and record the assessment of patients admitted in our geriatric ward. MR of 54 consecutive patients admitted after implementation of the structured MR were studied and compared to those of 108 consecutive patients admitted on the preceeding year (classical MR). Quality of data collected at admission was assessed using a 33-item guide, proposed by 3 experts in geriatric medicine unaware of the structured MR studies. For each item, a binary score (present/absent) and a precision score were used. A validation study was conducted using the same methods in another geriatric ward which has not participated to development of the structured charts MR studied. RESULTS: For most items studied, information was present in a significantly higher proportion in structured MR than in classical MR. Likewise, the precision score was significantly higher in structured MR. The validation survey found analogous results. CONCLUSION: Use of a structured MR significantly improves the quality of data collection at admission in geriatric units. This improvement appears to be related more to the use of the structured MR than the effect of developing a new tool.

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PubMed1996

Diabetic neuropathy in elderly patients. What can be done?

The prevalence of diabetes mellitus increases markedly with age. Furthermore, advancing age is a strong risk factor for diabetic neuropathy, independent of the duration of diabetes mellitus and glycaemic control. Several biological changes occurring during the aging process may account for the facilitating effect of age on diabetic neuropathy. These include an increase in the production of advanced glycosylation end-products (AGEs), a defect in the polyol pathway, nerve vascular alterations and impaired resistance to oxidative stress. The clinical diagnosis of diabetic neuropathy is often difficult in elderly patients. The relationship between symptoms and neuropathy and that between neuropathy and diabetes mellitus are more difficult to ascertain in elderly patients due to age-related changes in the peripheral and autonomic nervous system and associated diseases frequently encountered in this population. Diagnosis of diabetic neuropathy is based on nerve conduction studies, vibratory perception threshold determination and assessment of autonomic function. For most of these tests, reference values are markedly influenced by age and their interpretation should use carefully age-adjusted reference intervals. Identification of peripheral diabetic neuropathy indicates a high risk of foot complications, such as ulcers and gangrene, often resulting in amputation, whereas cardiovascular autonomic neuropathy is associated with an increased risk of postural hypotension and coronary events. All these risks increase markedly with aging. Therapeutic trials in elderly patients with diabetic neuropathy are lacking. Treatment of diabetic neuropathy consists of achievement of better glycaemic control and treatment of symptoms related to neuropathy. Specific treatments capable of preventing or curing neuropathy are under investigation. The interesting results obtained with aldose reductase inhibitors in animal studies contrast with disappointing results in patients with diabetes mellitus. Other metabolic approaches, like antioxidants and gamma-linolenic acid, seem promising. Clinical complications of diabetic neuropathy in the elderly are often severe. Early detection is required, since at the present time a preventive approach is the most effective way to avoid or postpone debilitating complications. More research is needed to make effective curative treatments of diabetic neuropathy available.

Age Factors↗
PubMed1995

Osler's maneuver: absence of usefulness for the detection of pseudohypertension in an elderly population.

PURPOSE: To investigate the prevalence and clinical relevance of Osler's maneuver for detecting pseudohypertension in the elderly. PATIENTS AND METHODS: Osler's maneuver was performed by one investigator in 205 consecutive inpatients of a French geriatric hospital (40 men and 165 women; mean age 84.2 +/- 6.2 years). In 12 Osler-positive and 12 Osler-negative patients matched for age, sex, and presence of hypertension, the blood pressure values measured directly at the radial artery were compared to those measured indirectly with a standard mercury sphygmomanometer. Aortic and upper limb pulse wave velocities (PWV) were also measured in these 24 patients. RESULTS: Twenty-three of 205 patients (11%) were Osler-positive. Age, sex ratio, and prevalence of hypertension or other cardiovascular diseases did not differ significantly in Osler-positive and Osler-negative patients. Systolic blood pressure (SBP), measured by standard mercury sphygmomanometer, was significantly greater in Osler-positive than Osler-negative patients (157 +/- 37 versus 132 +/- 28 mm Hg; P < 0.01). Diastolic blood pressure (DBP) did not differ significantly (78 +/- 18 versus 74 +/- 14 mm Hg). Interobserver agreement concerning Osler's sign, studied in 40 patients, was good (kappa = 0.72). In 12 Osler-positive and 12 Osler-negative patients, the mean differences between SBP obtained by cuff-manual indirect blood pressure and direct measurements were -3.71 +/- 22.85 mm Hg and -8.59 +/- 14.40 mm Hg (P = NS). For DBP, these differences were 18.40 +/- 15.72 and 12.01 +/- 5.80 mm Hg (P = NS). The differences between the indirect and direct blood pressure measurements were significantly correlated to upper limb PWV, but not aortic PWV, for both SBP and DBP. Pseudohypertension, defined as the indirect measurement overestimation of SBP or DBP by 10 mm Hg or more, was found in 15 of the 24 patients (63%). In these patients, upper limb PWV was significantly greater than in those with no pseudohypertension (7.0 +/- 2.2 versus 5.4 +/- 1.3 m/s; P < 0.05). CONCLUSION: The Osler-positive maneuver is frequently found in elderly hospital inpatients, but its ability to detect pseudohypertension in clinical practice is poor. Measurement of upper limb PWV might be a more appropriate way of screening for this condition.

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PubMed1995

Increased production of tumor necrosis factor and interleukin-6 by arterial wall of aged rats.

Plasma cytokine levels are enhanced in aged animals and in elderly people. Vascular cells are known to be both targets and sources of cytokines. To investigate the effect of aging on vascular cytokine synthesis, we studied tumor necrosis factor (TNF), interleukin-6 (IL-6), and prostacyclin (PGI2) production by the arterial wall using organoid culture of aorta from 10- (n = 8) and 30-mo-old (n = 8) rats, after activation by lipopolysaccharide (LPS). Biological activity of TNF and IL-6 was measured in supernatant from incubated vessels. 6-Ketoprostaglandin F1 alpha (6-keto-PGF1 alpha), a stable metabolite of PGI2, a secondary inflammatory mediator, was measured using enzyme immunoassay. In the absence of LPS, TNF production was undetectable in most animals and was not significantly increased in the aged group. By contrast IL-6 and 6-keto-PGF1 alpha productions, in the absence of LPS, were significantly greater in 30- (8,140 +/- 1,350 U/micrograms DNA and 23.2 +/- 6.4 ng/micrograms DNA, respectively) than in 10-mo animals (3,060 +/- 350 U/micrograms DNA and 8.4 +/- 1.6 ng/micrograms DNA, P < 0.01 and P < 0.05, respectively). LPS-induced production of TNF, IL-6, and 6-keto-PGF1 alpha was significantly increased in old rats, being increased respectively by 3.2-, 3.5-, and 2.4-fold at 1 ng/ml LPS, compared with the production in young rats. Because TNF and IL-6 are capable of regulating vascular cell function such as proliferation protein synthesis and contractility, these cytokines might play a major role in age-related remodeling of arteries and age-related vascular diseases.

6-Ketoprostaglandin F1 alpha↗
PubMed1994

Changes in the renin-angiotensin-aldosterone axis in later life.

The renin-angiotensin-aldosterone system (RAAS) is one of the main systems involved in the regulation of blood pressure and sodium homeostasis. In animal experiments and in humans, the plasma renin activity and aldosterone levels are reduced with aging. The age-related differences in plasma renin activity and aldosterone are more pronounced in stimulated conditions (when sitting in an upright position, when salt intake is restricted and when plasma volume is depleted) than under basal conditions. Age-related alterations of the kidney (glomerulosclerosis, decreased number of functional nephrons) might account for the age-related differences in the active to inactive plasma renin ratio. In the same way, a diminished synthesis of angiotensinogen by the liver could contribute to the decrease in the activity of the RAAS in aging. This is partially compensated for by increases in the density of angiotensin II receptors reported in elderly patients. Furthermore, aging is associated with a reduced adrenal responsiveness to angiotensin II, contributing to lower production of aldosterone and alterations of sodium homeostasis. Estradiol and progesterone help stimulate the secretion of renin. Reduced levels of these hormones at menopause also lead to reduced plasma renin activity. In relation to these findings, several studies have shown that reductions in blood pressure, induced by short or long term treatment with angiotensin converting enzyme (ACE) inhibitors, were more pronounced in old than young hypertensive patients. An insertion/deletion polymorphism in the ACE gene has been described; the genotype deletion/deletion of this gene has been reported to be closely associated with longevity. This result was unexpected since the same deletion polymorphism was also shown to represent a potent risk factor for myocardial infarction.

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