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Biomedical subjects

J Blacher

Publications and source records attributed to J Blacher.

At least 73 records · Page 4Linked to original sources
PubMed1999

[Blood pressure parameters and cardiovascular risk in the elderly].

The treatment decision must take into account the benefit and risks related to the intervention: the benefit demonstrated and quantified in many therapeutic trials in hypertension in the elderly, but also the patient's initial risk. It is now recognized that, in elderly hypertensive patients, systolic blood pressure is a better predictor of morbid and lethal events related to hypertension than diastolic blood pressure. Recent data in the medical literature attribute a predictive role to pulse pressure which is even greater than that of systolic blood pressure. From a pathophysiological point of view, the level of pulse pressure reflects the degree of rigidity of large arterial trunks. The arterial rigidity parameter could integrate the harmful effect of "cardiovascular risk factors" (hypertension, but also atherogenic dyslipidaemia, diabetes, smoking, homocysteine, genetic factors, etc.) on the years or decades of exposure, and pulsed pressure would therefore appear to be a better marker of cardiovascular risk than other blood pressure parameters. Pulse pressure should therefore be integrated into the benefit/risk ratio of antihypertensive treatment in the elderly.

Age Distribution↗
PubMed1998

[Conn adenoma manifesting as reversible tetraparesis and rhabdomyolysis].

INTRODUCTION: Primary hyperaldosteronism is an uncommon cause of hypertension which classically features hypokaliemia, metabolic alkalosis and excessive urinary potassium excretion. Clinical manifestations of hypokalemia rarely reveal the diagnosis. EXEGESE: We report the case of a hypertensive patient who developed quadriparesis and rhabdomyolysis induced by a severe hypokalemia. Clinical manifestations were reversible after potassium supplementation. Laboratory and radiological findings led to the diagnosis of an aldosterone-producing adenoma. Surgical treatment allowed correction of electrolyte abnormalities and improvement of hypertension. CONCLUSION: Although primary aldosteronism is rare, it should be systematically considered when arterial hypertension is associated with hypokalemia, even if the potassium depletion is due to diuretic therapy.

Adenoma↗
PubMed1998

Increased arterial distensibility in postmenopausal hypertensive women with and without hormone replacement therapy after acute administration of the ACE inhibitor moexipril.

Menopause and essential hypertension are associated with a decreased compliance and distensibility of the arteries. ACE inhibitors have been shown to improve arterial distensibility. Hormone replacement therapy (HRT), especially estrogens, could have a positive influence through their atheroprotective, vasodilative, and blood pressure-lowering effect. The vascular interactions of HRT and ACE inhibitors, like moexipril hydrochloride, have not been investigated so far. This trial was intended to assess the effect of combined sequential HRT for 25 days on acute changes in arterial distensibility after a single oral dose of 15 mg moexipril hydrochloride in postmenopausal women with borderline to mild essential hypertension. This study had a monocentric, randomized, parallel-group design, and was open for moexipril, and double-blind, and placebo-controlled for HRT. Assessment of arterial distensibility was by automatic noninvasive measurement of the carotid-femoral pulse wave velocity (PWV). The PWV and the pulse pressure decreased significantly after a single oral dose of 15 mg moexiprill. An influence of HRT on the changes in the PWV and pulse pressure could not be seen. The plasma concentrations of renin increased and of aldosterone decreased after moexipril administration. Arterial function improves after acute administration of 15 mg moexipril in postmenopausal women with mild to moderate essential hypertension. The changes in PWV and pulse pressure are of similar magnitude in women with and without HRT.

Aldosterone↗
PubMed1998

Endothelin and cardiovascular remodelling in end-stage renal disease.

BACKGROUND: Plasma endothelin (ET) is elevated in end-stage renal disease (ESRD), but the origin and consequences of this increase remain unclear. In the present study we analysed the relationships between plasma ET levels and cardiovascular alterations in ESRD. METHODS AND RESULTS: Common carotid artery (CCA) intima-media thickness (IMT) and diameter, atherosclerotic plaque occurrence, and left ventricular (LV) geometry and function were determined by ultrasound imaging in 76 haemodialysis patients and in 57 age-, sex-, and blood pressure-matched controls. Arterial stiffness was evaluated via carotid-femoral pulse wave velocity (CF-PWV), forearm post-ischaemic vasodilation was measured by venous plethysmography, and plasma ET levels were determined using a specific immunoenzymoassay. Compared with controls, ESRD patients had elevated plasma ET levels (1.6 +/- 1.4 vs 4.6 +/- 3.8 pg/ml; P < 0.001), increased LV mass (P < 0.001), increased CCA-IMT (P < 0.001), a higher prevalence of atherosclerotic plaques (P < 0.001) and increased CF-PWV (P < 0.01). Plasma ET levels correlated positively with LV outflow velocity integral (r = 0.57; P < 0.0001), stroke index (P < 0.01), and baseline forearm blood flow (P < 0.001) which were all significantly higher in ESRD patients than in controls (P < 0.01). After adjustment for age, blood pressure, haemoglobin levels, gender and body dimensions, plasma ET levels were significantly correlated to LV mass (r = 0.46; P < 0.001), CCA-IMT and CCA intima-media cross-sectional area (r = 0.41; P < 0.001), and CF-PWV (P < 0.05). Post-ischaemic forearm vasodilation was decreased in ESRD (85 +/- 31 vs 119 +/- 28%; P < 0.001) and there was a negative correlation between post-ischaemic flow recovery and ET levels (r = -0.49; P < 0.001). In ESRD patients, plasma ET levels were positively and independently correlated with the prevalence of CCA atherosclerotic plaque (P < 0.01). CONCLUSIONS: These results indicate that the increased plasma ET levels in ESRD patients are associated with left ventricular hypertrophy and arterial intima-media thickening, suggesting that increased ET concentrations in ESRD patients may be of pathophysiological significance in the process of cardiovascular remodelling.

Adaptation, Physiological↗
PubMed1998

Influence of biochemical alterations on arterial stiffness in patients with end-stage renal disease.

The incremental elastic modulus of the common carotid and radial arteries is increased in patients with end-stage renal disease (ESRD), independently of blood pressure, wall stress, and the presence of atherosclerotic alterations. Whether biochemical factors may be involved in the arterial changes and related to renal dysfunction remain largely ignored. To assess this question, we measured aortic (carotid-femoral), upper-limb (carotid-radial), and lower-limb (femoral-tibial) pulse wave velocity (PWV) in 74 ESRD patients undergoing hemodialysis in comparison with 57 control subjects similar in age, sex ratio, and mean blood pressure. We evaluated arterial blood pressure by sphygmomanometry, aortic calcifications and cardiac mass by echography, and routine biochemical parameters, total plasma homocysteine, and plasma endothelin levels by standard techniques. In the population of patients with ESRD, on the basis of multiple stepwise regression analysis, aortic PWV was positively and independently correlated with systolic blood pressure (P<.0001), age (P<.0001), prevalence of aortic calcification (P=.0004), and the prevalence of diabetes mellitus (P=.0043). Upper-limb PWV was influenced exclusively by mean blood pressure (P<.0001). Lower-limb PWV was positively and independently correlated with plasma total homocysteine (P=.0004) and plasma endothelin (P=.0187) only. At any vascular site, PWV was not independently correlated with tobacco consumption; plasma levels of cholesterol, triglyceride, fibrinogen, or hemoglobin; body mass index; or the presence of bilateral nephrectomy. Finally, plasma homocysteine was independently correlated with cardiac mass (P=.0022). This study provides evidence that in ESRD patients, the stiffness of the arterial wall and cardiac mass are strongly influenced by biochemical factors related to the kidney alterations and are independent of age and blood pressure level. Increased plasma endothelin and homocysteine may be specifically involved in the vascular damage of lower limbs.

Adult↗
PubMed1998

Carotid arterial stiffness as a predictor of cardiovascular and all-cause mortality in end-stage renal disease.

Damage of large arteries is a major contributory factor to the high pulse pressure observed in patients with end-stage renal disease. Whether incremental modulus of elasticity (Einc), a classic marker of arterial stiffness, can predict cardiovascular mortality has never been investigated. A cohort of 79 patients with end-stage renal disease undergoing hemodialysis was studied between September 1995 and January 1998. Mean age at entry was 58+/-15 years. The duration of follow-up was 25+/-7 months, during which 10 cardiovascular and 8 noncardiovascular fatal events occurred. At entry, carotid Einc was calculated from measurements of diameter, thickness (echo-tracking technique), and pulse pressure (tonometry). Based on Cox analyses, 2 dominant factors emerged as predictors of all-cause and cardiovascular mortality: increased Einc and decreased diastolic blood pressure. Lipid abnormalities and the presence of previous cardiovascular events interfered to a smaller extent. After adjustment for confounding variables, the odds ratio for Einc >/=1 kPa-3 was 9.2 (95% confidence interval, 2.4 to 35.0) for all-cause mortality. These results provide the first direct evidence that in patients with end-stage renal disease undergoing hemodialysis, arterial alterations, as determined from carotid Einc, are strong independent predictors of all-cause and cardiovascular mortality.

Aged↗
PubMed1998

Predicting placement in families who have children with severe handicaps: a longitudinal analysis.

Effects of child characteristics and home environment on caregiver's behavioral intentions regarding placement were examined longitudinally for 100 families of children with severe mental retardation. Prior behavioral intentions significantly predicted actual placement, independent of other factors. Child characteristics, with one exception, failed to predict intentions or actual placement behavior. The more normative the child's appearance, the less likely caregivers were to seriously consider placement and to place. Higher socioeconomic standing of mothers promoted more serious consideration of placement as did larger numbers of siblings. Some factors of home quality promoted more active consideration but did not directly affect actual placements. Stress on caregiver contributed to both placement intentions and actual placements. Support resources, on the other hand, had little effect on placement intentions or placement.

Adaptation, Psychological↗
PubMed1998

Siblings of children with mental retardation living at home or in residential placement.

Severe retardation in a child surely has an effect on all family members. Studies of non-disabled siblings in these families have indicated both emotional risks and perceived benefits. Little is known about how out-of-home placement of the child with retardation affects the siblings. Adolescent siblings of children with retardation living at home (N = 25) or in residential placement (N = 20) were contrasted with siblings of children without retardation (N = 28), on measures obtained from their mothers and themselves. Despite their different situations, these siblings were highly similar on measures of psychological adjustment, self-esteem, and family environment. Sibling relationships, however, were less intense, with less warmth but also lower conflict, in families where the child lived out of the home. Most siblings of children with retardation reported positive personal growth experiences while also expressing realistic concerns about the future. Siblings of children with retardation had beliefs and attitudes about placement that were highly consistent with the child's current living situation.

Adolescent↗
PubMed1998

[Arterial hypertension, non-drug treatment and cardiovascular risk].

Four non-drug measures have been shown to be effective on reduction of blood pressure: low-salt diet, weight loss, reduction of alcohol consumption and sports activity. Other measures, mainly dietary (increased potassium intake, DASH diet), may also be effective. The two limits to non-drug treatment of HT are the absence of demonstrated benefit in terms of cardiovascular morbidity-mortality, and the difficulty to ensure good patient compliance with this type of often constraining measure. However, these non-drug measures could probably decrease the overall level of cardiovascular risk. The main drawback, related to the required modification of the patient's lifestyle, is poor compliance with these measures. Compliance can be improved by various methods which share in common their time-consuming nature.

Alcohol Drinking↗
PubMed1997

[Conn's syndrome. Study of systemic cardiovascular hemodynamics after medical treatment with spironolactone and after surgical treatment].

OBJECTIVES: Assess hemodynamic effect of Conn's syndrome in order to better prepare patients for surgical resection of their adenoma. PATIENTS AND METHODS: Hemodynamic investigations were conducted before any treatment in 13 patients with Conn's syndrome. Results were compared with those in 13 control subjects with permanent primary hypertension. In the 13 patients with Conn's syndrome, the same hemodynamic parameters were studied in 13 after drug therapy using spironolactone and in 8 after surgery. RESULTS: Hypertension was associated with a significant increase in stroke volume and a non-significant increase in cardiac index. Blood pressure normalized after sprironolactone and after surgery in parallel with a significant decrease in blood volume. DISCUSSION: These hemodynamic disorders in Conn's disease patients suggest that the increase in stroke volume is a consequence of increased venous return and more likely, in myocardium contractility or a combination of both. CONCLUSION: These hemodynamic characteristics of Conn's disease should be useful in guiding monitoring schemes for these patients in the perioperative period.

Adolescent↗
PubMed1997

Plasma homocysteine and the extent of atherosclerosis in patients with coronary artery disease.

Homocysteine is a graded risk factor for the incidence of stroke and for the degree of carotid atherosclerosis. Homocysteine is also a graded risk factor for the incidence of myocardial infarction but we do not know its precise relations to the severity of atherosclerosis in coronary patients. Seventy five symptomatic coronary patients were recruited for the study. Fifty of these patients had coronary artery disease only and were compared in a case-control manner to 50 healthy controls matched for age and sex. The 25 other coronary patients had also symptoms in another atherosclerotic territory (cerebral, peripheral or both) and were also compared to 25 matched controls. Mean plasma homocysteine level was significantly higher in coronary patients than in controls (11.7 +/- 0.7 mumol l-1, n = 50 versus 9.9 +/- 0.5 mumol l-1, n = 50, p < 0.05). Homocysteine in patients with symptomatic atherosclerosis in two or three arterial sites was 15.7 +/- 1.5 mumol l-1 which differed significantly from matched controls and from patients with coronary artery disease only (p = 0.01). The extent of coronary atherosclerosis evaluated by an angiographic coronary score correlated weakly to plasma homocysteine levels (r = 0.25, p < 0.05). The patients with both hypertension and high levels of homocysteine (> 11.3 mumol l-1, median value) had more severe coronary atherosclerosis (coronary score of 16.3 +/- 2.3 versus 11.9 +/- 0.9, p < 0.05) and more diffuse atherosclerosis (number of atherosclerotic territories of 1.5 +/- 0.2 versus 1.2 +/- 0.7, p = 0.08) than the coronary patients without this association. There were no other high risk association when considering the other classical risk factors. Thus, the highest levels of homocysteine were present in patients with coronary disease and another symptomatic localisation of atherosclerosis. A small gradient in the extent of coronary atherosclerosis was found with increasing levels of homocysteine. The presence of both hypertension and hyperhomocysteinemia was associated with more severe coronary atherosclerosis.

Biomarkers↗
PubMed1997

Association between increased plasma levels of aldosterone and decreased systemic arterial compliance in subjects with essential hypertension.

We previously observed that, in subjects with essential hypertension, acute ouabain constricts the brachial artery diameter in the presence of spironolactone treatment, a finding that is not observed in the absence of aldosterone antagonist and therefore suggests a specific effect of aldosterone on the arterial wall. To evaluate whether aldosterone excess may contribute to modulate arterial function, we investigated 56 patients with sustained essential hypertension in comparison with 36 normotensive controls. Systemic arterial compliance was measured from intraarterial blood pressure and cardiac output measurements using a classical Windkessel model to determine the elasticity of the proximal arterial tree. Radial artery compliance was determined using a previously described echo tracking technique. In hypertensive, but not in normotensive, subjects, systemic arterial compliance was strongly and negatively correlated with plasma aldosterone. The correlation was observed even after adjustment for age and blood pressure. Plasma potassium and renin activity did not interfere in the correlation. Acute administration of diltiazem did not change systemic compliance but significantly decreased plasma aldosterone, suggesting that, in the presence of calcium blockade, the same compliance was achieved for a lower plasma aldosterone level. Taken together, these findings strongly suggest that significant interactions exist between aldosterone and central conduit arteries and that aldosterone might modulate arterial function in subjects with essential hypertension.

Adult↗
PubMed1997

Depression in Latina mothers of children with mental retardation: a neglected concern.

Depression among 148 Latina women who have children with mental retardation was examined. Results showed that their depressive symptomatology was elevated, with almost half reporting negative experiences in excess of a commonly used cut-off for the Center for Epidemiologic Studies Scale (CES-D). Depression scores related to variables pertaining to the child, mother's health and level of acculturation, and aspects of stress and coping. When mothers were categorized in three groups by CES-D scores, discriminant analysis correctly classified 84% of the low and high group mothers. High CES-D membership was predicted by mothers' reporting more family problems, worse health, fewer interactions with English-speaking persons in their daily lives, and more negative feelings about parenting their child with mental retardation.

Adaptation, Psychological↗
PubMed1996

[First intention treatment of arterial hypertension using a combination of two drugs].

The limited efficacy of single-drug regimens in the treatment of high blood pressure has led to an evaluation of combination regimens for first intention treatment. Two-drug regimens favor the hypotensive efficacy and reduce the frequency of certain side effects. Medications combining two drugs in a single formulation would allow use as first line treatment although marketing authorizations have not yet been obtained. In addition, current good clinical practice recommendations do not allow combination therapy in this situation. A complete assessment based on medical results and cost effectiveness will undoubtedly confirm the usefulness of two-drug therapies as first line treatment for moderate hypertension.

Antihypertensive Agents↗
PubMed1996

Family involvement in residential treatment.

Social policy stresses the importance of the family's continuing involvement with members in residential placement. We studied involvement of families with 163 children and adults in residential treatment and with their programs. Parent and staff reports of family involvement showed high agreement. The average family had 21 contacts annually with the family members; these related only marginally to the extent of involvement with the residents' programs. There was no evidence of detachment, a lessening of involvement over time. Multiple regression found three variables that accounted for 52% of the variance in contacts: higher involvement related to less distance from the facility, greater expectations that the family member would return home, and lower levels of mental retardation. Implications of findings for increasing family involvement were discussed.

Adolescent↗
PubMed1996

[Hyperhomocysteinemia in coronary artery diseases. Apropos of a study on 102 patients].

Homocystein is at the crossroads of the metabolic pathways of sulphuric amino acids. Homocystinuria is a congenital autosomal recessive disease, usually related to cystathionine beta-synthetase deficiency. Children with homozygotic forms of the disease have early vascular complications which represent the main cause of death. Moderately elevated serum homocystein levels are related to two major genetic factors (heterozygotic cystathionine beta-synthetase deficiency and mutation of the 5-10 methylene tetrahydrofolate reductase) and several minor, genetic and non-genetic factors (folic acid, vitamins B6 and B12 and betain deficiencies). Previous studies have suggested that hyperhomocysteinaemia could be a cardiovascular risk factor. This study was based on 222 subjects including 102 consecutive patients with angiographically documented coronary artery disease and 120 control subjects without vascular disease. No relationship was observed between serum homocystein concentrations and the classical cardiovascular risk factors. Coronary patients had higher average homocystein concentrations than control subjects (11.27 +/- 0.52 vs 8.77 +/- 0.31 mumol/l); p < 0.0001): moreover, the prevalence of hyperhomocysteinaemia (> 15.67 mumol/l) was higher in the coronary group (15.7%) than in the controls (2.5%). A significant relationship was also observed between homocystein concentrations and the severity of the coronary disease (defined by a coronary score) and the number of diseased vascular territories. These results underline the relationship between homocystein and vascular risk, especially that of coronary artery disease. The treatment of hyperhomocysteinaemia by folic acid supplements is effective in correcting plasma levels, without side effects and at a relatively low cost.

Adult↗