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J M Mallion

Publications and source records attributed to J M Mallion.

At least 109 records · Page 6Linked to original sources

[Baroreflex sensitivity and vascular involvement in hypertension].

UNLABELLED: Relationships between baroreflex sensitivity (BRS) and arterial distensibility are evaluated by continuous measurement of blood pressure (Finapres) and carotid-femoral pulse wave velocity measurement (PWV); 73 subjects are recruited on WHO criteria (age: 48 +/- 13). An ambulatory measurement of BP is also performed to evaluate the mean BP 24 level. The BRS is evaluated at rest during 20 min of acquisition data in a lying position, using a dedicated software [(automatic detection by of BP sequences were 3 or more systolic BP and RR interval increased of 1 mmHg for SBP and 4 ms for RR (PS+/RR+) or decreased (PS-/RR-)]. The BRS is the slope of the regression line between SBP and RR interval of each sequences (if correlation coefficient > 0.95). RESULTS: resting BP: SBP/DBP = 170 +/- 12 mmHg. HR 72 +/- 15 batt/min, PWV = 10.8 +/- 3.2 m/s. Mean BRS is 8.2 +/- 3.8 for PS+/RR+ and 8.7 +/- 3.8 ms/mmHg PS-/RR-. The coefficient of correlation (Pearson) between PWV and BRS is -0.59* for PS+/RR+ and -0.41* for PS-/RR- (*: p < 0.01). In multivariate analyses, these relations were statistically independent of age and BP for the sequences PS+/RR+ but not for the sequences PS-/RR- suggesting a predominant vagal alteration in hypertensive subjects associated with the alteration of carotido-femoral pulse wave velocity.

Arteries↗

[Behavior of patients with mild-to-moderate arterial hypertension in relation to their treatment. Contribution of an electronic pillbox].

The objective of the MACH1 study (MEMS for the Assessment of Compliance of Hypertensives) was to evaluate the real behaviour of patients in relation to antihypertensive treatment administered as a single daily dose. After a 2-week period during which no other antihypertensive was allowed to be administered, 590 patients with mild-to-moderate hypertension received 2 mg of trandolapril as a single daily dose in the morning between 7:00 a.m. and 9:00 a.m. for 4 weeks. Treatment was packaged in electronic pillboxes recording the date and time of each opening. Various profiles were distinguished on the basis of the individual chronograms for the 501 patients able to be analysed in terms of compliance, and as a function of the deviations observed in relation to the treatment regimen prescribed. One hundred and two patients (20%) omitted more than 20% of the prescribed doses, either consecutive doses or scattered throughout the month of treatment; these patients were referred to as "omitters". The other patients were classified according to the scatter of openings in relation to the mean time of the dose: 10 "metronome" patients (2%), 126 "regular" patients (25%), 221 "irregular" patients (44%) and 42 "anarchic" patients (8%). Irregularities of dose times were more frequent on public holidays than on week days and in patients living in Paris or the Paris region. "Metronome" patients were older than the overall patient population. The use of an electronic pillbox could allow the attending physician to more adequately adapt his therapeutic approach and management of specific problems of compliance observed in hypertensive patients.

Adolescent↗

Second-generation calcium antagonists and ambulatory blood pressure monitoring.

Ambulatory blood pressure monitoring (ABPM) is a particularly useful method for evaluating the effects of antihypertensive drugs. ABPM allows the therapeutic effect of an agent to be assessed continually by a large number of measurements, and the greater number of readings contributes to the higher degree of reproducibility associated with ABPM compared to other methods for measuring blood pressure. ABPM also enable measurements to be taken in "real-life" situations and removes the problem of observer bias. The number of patients required for clinical studies can be significantly reduced by using ABPM. It is still essential, however, to identify "white coat" subjects, placebo responders, and patients who do not respond to the treatment. ABPM studies have demonstrated that the novel dihydropyridine calcium antagonist, lacidipine, significantly reduces both systolic and diastolic blood pressures over a 24-h period, both during the day and at night. Furthermore, although the trough-to-peak ratios of many calcium antagonists have been shown to fall below the recommended level of 50%, lacidipine has a ratio above 60%. Other ABPM studies have also shown that lacidipine can correct the 'early morning increase' in blood pressure without effecting the 24-h nycthemeral profile.

Blood Pressure↗

Non-invasive ambulatory blood pressure variability and cardiac baroreflex sensitivity.

AIM: The objective of this study was to evaluate the relationship between non-invasive ambulatory blood pressure variability and cardiac baroreflex sensitivity in hypertensive patients. SUBJECTS AND METHODS: Ambulatory blood pressure measurements (15-min intervals for 24 h) and continuous blood pressure measurements (Finapres, 20 min at rest after a 10-min resting period) were performed in 123 untreated hypertensives (resting diastolic blood pressure > or = 90 mmHg; 80 males, 43 females; mean +/- SD age 49 +/- 12 years, range 19-73). Fourier series were used to model 24-h blood pressure profiles (four harmonics). Ambulatory blood pressure variability was assessed by determination of the residuals in each 24-h blood pressure profile (measured minus predicted pressures). Resting blood pressure variability was defined as the SD of the mean Finapres value. Baroreflex sensitivity was evaluated by automatic detection of blood pressure and pulse interval sequences of > or = 3 beats when systolic blood pressure and pulse interval sequences changed in the same direction (increase or decrease: 1 mmHg for systolic blood pressure and 4 ms for RR interval), and was assessed as the slope of the regression line for each sequence. RESULTS: Ambulatory systolic blood pressure variability increased with age (r = 0.28*) and systolic pressure (r = 0.44**). Baroreflex sensitivity (increasing systolic pressure/pulse interval) decreased significantly with age (r = -0.48**) and systolic pressure (r = -0.23**), and was significantly related to increased ambulatory blood pressure variability (r = -0.33**). In a multivariate stepwise analysis the relationship between ambulatory blood pressure variability and baroreflex sensitivity (increasing systolic pressure/pulse interval) was statistically independent of age and systolic pressure (R = 0.55, P<0.001); this relationship was not observed with the corresponding decreasing sequence. CONCLUSIONS: This study shows that in uncomplicated hypertension, ambulatory blood pressure variability is related to baroreflex sensitivity independently of the blood pressure level. This finding has prognostic implications for this non-invasive measurement, which needs to be confirmed by large longitudinal studies.

Adult↗

[Left ventricular hypertrophy and blood pressure variability during rest and ambulatory monitoring in the hypertensive patient].

To study the relationship between assessment of blood pressure (BP) variability measured by continuous measurement (Finapres) or discontinuous ambulatory (ABPM Spacelabs) in 70 untreated essential hypertensive subjects (mean age 51 +/- 12) and their relationship with the development of left ventricular hypertrophy (LVH). There is no relationship between the BP variability measurements either by Finapres nor by ABPM. Multiple regression analysis show that ambulatory systolic BP variability (standard deviation) and resting BP variability (spectral analysis of SBP in the medium frequency band 0.1 Hz) are related to LVH index when we take into account age and BP difference (to explain LVH) (p < 0.001) ABPM SBP variability increase with LVH, while resting SBP measurement of BP variability (Mayer waves) significantly decreased. The study points to the different role of BP variability measurements in the mechanisms related to left ventricular hypertrophy and to the interest of continuous BP resting spectral analysis measurements.

Blood Pressure↗

[Blood pressure variability during rest and left ventricular hypertrophy in the hypertensive patients. A spectrum analytic approach].

OBJECTIVE: To study the relationship between spectral analysis measurement of blood pressure (BP) and heart rate (HR) at rest, in untreated essential hypertension, and their relationship with the development of left ventricular hypertrophy (LVH). DESIGN AND METHODS: 41 untreated hypertensives (25M/16W, age 50 +/- 12, range 23-73) were measured at rest (WHO criteria DBP > 90 mmHg) by digital continuous photoplethysmography (Finapres 2300 (F), 6 mn of measurement in the dorsal decubitus position and standing up). Measurement of LVH (Devereux criteria, left ventricular mass index LVMI, g/m2) to analyse two groups (LVMI+: LVMI > 107 if women and 120 if men; n = 19; LVMI = 137 +/- 25), and (LVMI-; n = 22; LVMI = 92 +/- 17). The overall variability is standard deviation (SD), spectral analysis variability (SA) is FFT of 256 points over 3 periods low (LF: 0.004-0.07Hz), medium (MF: 0.07-0.13Hz), high (HF: 0.13-0.5Hz). Comparisons by Wilcoxon test and Anova (age, sex) (* p < 0.05, ** p < 0.01). RESULTS: By WHO criteria, the SBP was significantly lower in the LVMI-group (153 +/- 10 vs 165 +/- 18**), the DBP was not significantly different (94 +/- 6 vs 96 +/- 10). By continuous measure (F) at rest there was no significant difference for SBP or DBP. On standing up the SBP was significantly lower in the LVMI-group (148 +/- 20 vs 162 +/- 22**). The SD of the DBP at rest was more elevated in the LVMI-group (3.34 vs 3.06*), but not significantly different standing up. There was no significant difference in SBP at rest (6.7 vs 6.32) or standing (9.13 vs 11.5). The Spectral analysis of the MF was significantly elevated in the LVMI-group at rest for SBP (3.56 vs 3.01*), DBP (1.99 vs 1.19*), and HR (1.79 vs 1.77*). This was not significantly different in the LF and HF for SBP, DBP, HR. CONCLUSION: These results are different from those obtained by invasive ambulatory measures. The spontaneous variability in BP and HR at rest is increased when there is no cardiac effect (LVMI-). SA gives additional information in showing that the increase in variability is due to an increase in the Mayer waves, suggesting the existence of an elevation in adrenergic tone in hypertensive patients not having LVH.

Adult↗

[Changes in the morphology of the Doppler wave of the pulmonary venous blood flow in hypertensive heart diseases].

Analysis of pulmonary venous flow can contribute to understanding of ventricular diastole; 40 essential hypertensive subjects (HT) who had never been treated and 30 healthy normotensive subjects (NT) were studied by Doppler-echocardiography. All the subjects had normal systolic function on echocardiography. The analysis focussed on the velocity of transmitral flow as measured by pulsed Doppler, measuring E and A waves, and also on flow in the right superior pulmonary vein: S and D waves measured in the apical position. The D wave appeared to correlate with age (r = 0.62, p < 0.001), with systolic blood pressure (SBP) (r = -0.44, p < 0.05) a correlation which remained after adjustment for age, and for measures of diastolic function across the mitral valve: A wave, and to E wave in a less closely related fashion. The D wave was of a lower velocity with mitral Doppler type A than with normal mitral Doppler (46 +/- 9 vs 36 +/- 8 cm/s; p < 0.005). The S wave was weakly related to morphological measurements of LV such as end-diastolic diameter of LV(r = 0.3; p < 0.01). The Doppler of pulmonary venous flow may help in describing impairment in LV filling by giving complementary data on Doppler mitral flow. A type 1 mitral Doppler corresponds to a low amplitude D wave with the presence of elevation of LVEDP which limits LV filling. In difficult situations when E and A velocities are similar (normal or pseudonormal form) a weak velocity of D wave is in favour of type 1.

Adult↗

Home blood pressure: variability, comparison with office readings and proposal for reference values. Groupe de la Mesure, French Society of Hypertension.

PURPOSE: A multicentre study was performed on 390 healthy subjects (210 male, 180 female) to evaluate home blood pressure versus office blood pressure. METHODS: The patients, aged 20-59 years, not on antihypertensive treatment, were not preselected by blood pressure levels. Blood pressure was measured in the doctor's office, using a mercury manometer at the fifth, sixth and seventh minute of rest, and at home by self-measurement using a validated electronic oscillometric device at the fifth, sixth and seventh minute of rest, in the morning and evening, on three consecutive days. RESULTS: The analysis of office and home measurements at the fifth, sixth and seventh minute of rest showed a significant decrease in blood pressure, mostly between the fifth and sixth minute. There was no significant variation in home pressure over the three consecutive days of measurement. Blood pressures were significantly higher in the evening than in the morning; the mean differences were 3 mmHg for systolic and 1.5 mmHg for diastolic blood pressure. Compared with office blood pressure measurement, home measurement provided significantly lower systolic and diastolic blood pressure means. Of the subjects, 78% showed a higher systolic and 69.9% a higher diastolic blood pressure with office measurement than with home measurement. Systolic and diastolic blood pressure differences were non-significantly higher for females than for males and did not differ with age. CONCLUSIONS: The comparison of the office and home measurement distributions allowed us to propose reference values for home blood pressure measurement. These were established by choosing blood pressure at the identical percentile for home measurement as we found for office measurement using the World Health Organization criteria (140/90 and 160/95 mmHg). Using this approach, the upper limit for normotension by home measurement would be 127/83 mmHg and for hypertension 147/86 mmHg. Although this approach has no prognostic value, it could be useful for the interpretation of home blood pressure.

Adult↗

[Ambulatory measurement of blood pressure and efficacy of diltiazem. Influence of the timing of drug ingestion and initial blood pressure level].

Clinical and 24-hour ambulatory measurements were made in 46 patients with mild to moderate essential hypertension in order to confirm that the efficacy and safety of sustained-release diltiazem LP 300 mg were the same regardless of the time of day at which it was taken. After two weeks of placebo, patients were randomly assigned double-blind to take diltiazem LP 300 mg either morning or evening for four weeks. Diltiazem LP 300 mg significantly lowered diastolic and systolic blood pressure in both groups by clinical or 24-hour ambulatory measurement, and without any difference according to whether diltiazem LP 300 mg was administered morning or evening. A lesser fall in blood pressure during the night in both groups led to study of the effect of diltiazem LP 300 mg according to initial ambulatory diastolic blood pressure level. Diltiazem brought about a greater fall in blood pressure when patients had an ambulatory diastolic pressure of 90 mmHg or more. Clinical, laboratory and electrocardiographic parameters were all satisfactory, regardless of the time at which the drug was taken.

Adult↗

[Variation, variability of blood pressure. Study techniques].

Blood pressure (BP) is not a constant parameter, but exhibits variations, which involve a change in its value with time, and variability, which corresponds to the extent of this variation. A circadian pattern of BP, with higher values during the day than at night, is one expression of this variation in BP. This variation corresponding to the circadian pattern is dependent on both physical constraints and psychosensory factors. Investigation of variability implies consideration of both long-term and shorter term changes in BP. Long-term variability can be assessed by ambulatory determinations of BP, which can be carried out at intervals of 1/4 hour. This variability can be used to define the daytime/nighttime alteration of the circadian cycle, with the possible absence of the nocturnal reduction in BP or even a reversal of this circadian pattern. An abnormality of this type would be of prognostic importance, particularly in terms of impact on the left ventricle. Medium- or above all short-term variability can be assessed only from the change in beat/beat difference in BP and heart rate (HR) which depends on vagal tone and the orthosympathetic system. This variability can be detected by invasive methods and, more recently, using non-invasive methods (Finapres). It would seem that changes in this variability may reveal a defect in baroreceptor control which it is useful to identify for both diagnostic and therapeutic purposes.

Aging↗

[Delayed potentials and left ventricular hypertrophy].

Delayed potentials (DP) (ECGHA) are markers of the occurrence of ventricular rhythm disturbances, and have a prognostic value after myocardial infarction. In hypertensive heart disease, the prevalence of DP is variable according to the literature (1-40%) and their prognostic significance is not known. We examine the frequency of DP in hypertension (HT) and the relationship between DP and left ventricular hypertrophy (LVH) as defined by echocardiographic estimation of the LV mass index (LVMI). We investigated 50 consecutive patients with essential HT who were being assessed as regards cause and effects of HT. Exclusion criteria were coronary artery disease, bundle branch block and poor echocardiographic trace. ECGHA was registered by means of ART device. The presence of DP as defined according to the criteria of Kacet. LV mass was determine according to the method of Penn and LVH defined according to the criteria of Devereux. Besides LVMI, were examined age, sex, duration of HT, micro-albuminuria, LVH on ECG (Sokolow index and strain-ECG). There were no correlations between the different variables studied and the presence of DP. The results relating to LVMI are shown in Table. There were no correlation between DP and LVH on echography. Other explanations, electrophysiologic, ischemic and histological may explain the greater incidence of BP observed in hypertensive heart disease. [table: see text] The prevalence of DP was not significantly different as regard the presence or absence of LVH (35% vs 25%; p = 0.53). In the 10 patients with the highest LVMI, the DP were enregistered 3 times.

Action Potentials↗

[Non-invasive ambulatory measurement of arterial pressure. Recommendations of the measurement group of the French Society of Arterial Hypertension].

Ambulatory blood pressure monitoring is being widely used now that relatively simple, reliable and well-tolerated, non-invasive blood pressure measuring devices have become available. The following recommendations are only to help physicians to use this technique in their daily practice: only use homologated devices; ambulatory monitoring should be performed during normal, everyday activities; at least one measurement of blood pressure should be taken every 1/4 hour during the day time (7 h-22 h) and every 1/2 hour during the night (22 h-7 h); the arm must be absolutely still and relaxed during the measurement; the function of the measuring device should be checked when the patient is fitted up and when the device is removed; data processing should provide at least: all values of blood pressure and heart rate, and their times of measurement, the mean values of systolic end diastolic blood pressure and heart rate during the day and during the night, the maximal and minimal systolic and diastolic blood pressure values, a chronogramme of the values. Reasonable indications of ambulatory blood pressure monitoring include: elimination of the "white coat" effect: to confirm the diagnosis of borderline hypertension; to demonstrate inversion of diurnal rhythm in severe hypertension; to demonstrate episodic hyper or hypotension; to confirm certain cases of toxaemia of pregnancy. It is also justified in the evaluation of antihypertension therapy, especially in cases of suspected drug resistance.

Ambulatory Care↗

[Baroreflex regulation and blood pressure variability during rest in the hypertensive patient].

The object of this study was to compare the variability of blood pressure measured non-invasively with the Finapres under resting conditions in hypertensive patients with non-hypertensive subjects matched for age, and to evaluate the relationship between resting blood pressure, i.e. without any stimulation, and the sensitivity of the baroreflex evaluated by crossed spectral analysis (SA). Thirty-four hypertensives (WHO criteria) untreated for three weeks, with a mean age of 50 +/- 7 years, were compared with 60 control subjects with a mean age of 50 +/- 9 years. The blood pressure and heart rate were measured continuously in the dorsal decubitus and standing positions. The direct and crossed SA was undertaken by a specific programme using the fast Fourier method. The average blood pressure of controls differed significantly from that of the hypertensive population (118 +/- 15/65 +/- 10 mmHg vs 157 +/- 20/86 +/- 11 mmHg). The mean heart rate of the hypertensives was faster: 76 +/- 11 vs 67 +/- 10 beats/min (p < 0.001). Under basal conditions, there was greater absolute variability in the hypertensive subjects but the relative variability and heart rate were the same as those of the controls. Direct SA provided additional data by showing that this variability was due to LF oscillations. Crossed SA showed a change in the sensitivity of the slope of regulation of the baroreflex in hypertensives, 7.35 vs 8.68 ms/mmHg (p < 0.05). These results show that, under basal conditions, it is possible to demonstrate an increase in the absolute variability in blood pressure in hypertensive patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

[Evaluation of the aging change in cardiac autonomic nervous system by automated clinical measurement].

The object of this study was to establish normal values for age of clinical tests of autonomic nervous system activity based on an automatic measuring system. Ninety-seven subjects (50 M/47 F) aged 20 to 85 years (average 45 +/- 13 years) with a normal clinical examination and no medication were included in the study. The blood pressure (BP) and heart rate (HR) were measured continuously with the Finapres system. After a resting period, the BP and HR were measured continuously in 5 different situations: dorsal decubitus position for 7 minutes; on getting up actively in less than 3 seconds and for 9 minutes in the upright positions, during deep breathing at 6c/min and Valsalva manoeuvre during a handgrip test at 30% of maximal voluntary strength for 3 minutes. A specific programme (ISN-CNRS) initiated the calculations of the test and performed direct and crossed spectral analysis in the lying and standing positions. The average BP was 120 +/- 18/66 +/- 11 mmHg and HR was 67 +/- 9 b/min. A negative linear correlation was observed with age with respect to the 3 tests investigating vagal activity: 30/15 ratio, spontaneous variations of respiration and HR, ratio of HR at the end of Valsalva with r = -0.43, r = -0.60, r = -0.34 (p < 0.001). The other two tests: variation of systolic BP 1 min 30 after standing and variation of diastolic BP during the handgrip did not change with age.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

[Comparative effects of angiotensin converting enzyme inhibitors and calcium antagonists on pulse pressure and blood pressure variability, based on ambulatory measurements in 236 mild to moderate hypertensive patients].

OBJECTIVE: this retrospective study was aimed: at comparing the effects of angiotensin converting enzyme inhibitors (ACEI) and those of calcium antagonists (CA) on the pulse pressure of mild to moderate hypertensive patients; at assessing whether these effects were associated with some modifications of blood pressure variability or not. METHODS: the ambulatory blood pressure (ABP) recordings of 236 patients who previously entered clinical trials with a mean run-in placebo period of 2 weeks and a mean active treatment phase of 6 weeks (ACEI, n = 115; CA, n = 121) were reviewed. Baseline ABP has been analysed both as a continuous variable and as a categorical one (high when > 139/87 mmHg, low otherwise). Pulse pressure was calculated by the difference systolic ABP-diastolic ABP, whereas BP variability was estimated by the standard deviation and the variation coefficient of each recording. The results are given as percentage (mean +/- standard deviation). In the patients with high baseline systolic ABP, ACEI and CA did not significantly differ regarding their effects on pulse pressure (-11.1 +/- 17.2 vs -6.3 +/- 14.0, NS). By contrast, in the other patients, pulse pressure was lowered to a significantly greater degree by ACEI than by CA (-5.5 +/- 18.7 vs +1.8 +/- 18.8, p = 0.04). These differences were not related to baseline diastolic ABP. No difference at all was found with regard to BP variability which was altered by none of the drugs. In conclusion, pulse pressure, a reliable indicator of arterial compliance, seemed to be more decreased by ACEI than by CA, the difference being significant only in patients with apparent hypertension.

Adult↗

[Relationships between ambulatory blood pressure and carotid artery diseases].

UNLABELLED: We studied in a retrospective study 138 consecutive hypertensive patients, the relationship between atherosclerosis lesions in carotid-artery and the ambulatory blood pressure. Only 93 of the 138 patients were finally included in this study because of the quality of information. They were 50 women and 43 men, aged 57.2 +/- 12.6 years. METHODOLOGY: The ambulatory blood pressure was recorded by oscillometric method (Spacelab monitor). The carotid artery were studied by echography and doppler. RESULTS: Carotid lesions in hypertensive patients didn't differ significantly when ambulatory systolic blood pressure increased (147,1 mmHg vs 145.2 in the day, and 135.5 mmHg vs 131.7 in the night; ns); Ambulatory diastolic blood pressure was lower during the day when carotid lesions where present (86.5 mmHg vs 93.2; p < 0.05). Ambulatory diastolic blood pressure decreased also with age; Ambulatory pulsed blood pressure increased when carotid lesions where present (59.3 mmHg vs 52.8 in the day and 58 mmHg vs 51.7 in the night; p < 0.05). Ambulatory pulsed blood pressure increased also with age and body mass index. CONCLUSION: This results suggest a predictive character of the pulsed pressure measure on the existence of carotid artery lesions in hypertensive patients and that a non invasive study of the carotid artery is opportune when pulsed pressure ambulatory measure is high.

Aged↗

[Segmental arterial compliance of the radial artery: physiological role of age, hypertension and type I insulin-dependent-diabetes].

OBJECTIVE: To study the structural modifications of a muscular and medium-size radial artery as regards age, in normal subjects (NT) and HT and DTI. MATERIAL AND METHODS: Transverse study with 39 NT aged 48 +/- 16 years, were compared to 22 HT, aged 50 +/- 11 years, and to 22 DT aged 37 +/- 12 years. An echo-tracking system (NIUS 01, Asulabs, Neuchatel, Switzerland) were used to measure the systolic (Ds) and diastolic diameter (Dd) and derive three indices of compliance and storage capacity: systolo-diastolic variation of cross sectional area VSCA = tau [(Ds2/4)-(Dd2/4)] mm2, operative arterial compliance CA = tau Dd (Ds-Dd)/2 (PAS-PAD) in mm2/mmHg. RESULTS: 1. In NT, Ds and Dd increased significantly with age (p < 0.01), likewise the VSCA, and CA (p < 0.002). 2. In HT and DTI, when age was taken into account, the Ds and Dd were significantly greater than in control but VCSA and CA were higher in HT and lower in DT. CONCLUSION: Similar to ageing changes in NT, HT lead to increase in medium-size radial artery the diameter and storage capacity, while to decrease in DT. This suggests that opposite cardiovascular load induce opposite modifications in arterial wall structure leading to reduce the wall stress.

Adult↗