Biomedical subjects

Jean-Pierre Fauvel

Publications and source records attributed to Jean-Pierre Fauvel.

7 recordsLinked to original sources

PubMed2006

[Proteinuria].

Several health organizations recommend that people be regularly checked for proteinuria to detect and treat kidney disease before it progresses. Proteinuria detected by a simple dipstick test should be confirmed by a quantitative measurement to assess persistent proteinuria. Most proteins are too big to pass through the kidneys' filters into the urine unless the kidneys are damaged. Markers of kidney damage in addition to proteinuria include abnormalities in the urine sediment, ultrasound of the kidneys and estimation of kidney function (creatinemia to calculate glomerular filtration rate). These assessments provide clues to the type (diagnosis) of chronic kidney disease and will the risk for developing progressive kidney failure. Thus, early detection of kidney disease will result in a more timely introduction of therapy that may slow the course of kidney disease. Microalbuminuria (albumin excretion above the normal range) that a marker of microvascular lesions in diabetes and hypertension is associated with a worth cardiovascular prognosis. Level of proteinuria in excess of 3,0 g/d in glomerular disease strongly determines the extent of kidney damage and renal prognosis.

Glomerular Filtration Rate↗

PubMed2006

Risk profile in hypertension genesis: A five-year follow-up study.

BACKGROUND: Pathogenesis of primary hypertension remains unclear, because many heterogeneous factors (diet, physiologic, and psychological factors) are simultaneously involved. We have conducted an original analysis to study the influence of the combination of these factors on BP evolution. METHODS: Seven homogeneous clusters were constituted from 213 healthy normotensive subjects taking into account 10 variables. Those variables used to cluster homogeneous "risk profiles" are usually considered as potential risk factors for hypertension: age, body mass index, alcohol consumption, sodium/potassium urinary ratio, systolic blood pressure (SBP) and heart rate response to mental stress, baroreflex sensitivity (BRS), job demand, job latitude, and behavioral pattern (personality score). Five-year BP evolution (DeltaSBP or Deltadiastolic BP [DBP]) was compared between risk profiles. RESULTS: Four clusters of subjects representing about 50% of the population had a significantly higher 5-year DeltaSBP (>or=5 mm Hg) compared to the 5-year DeltaSBP of the two clusters in which SBP did not increase. These four clusters had a low BRS. Two profiles that group six unfavorable risk factors had the most detrimental 5-year DeltaSBP. Interestingly, perceived high job demand in a cluster of younger subjects with a high personality score and a low BRS had also a detrimental SBP evolution. CONCLUSIONS: The major interest of this study is to highlight that hypertension development is not univocal between subjects and that different combinations of factors could explain differential BP evolution in groups of subjects sharing the same risk profile. A lower BRS was a consistent predictor for detrimental 5-year BP evolution.

Adolescent↗

PubMed2006

Is high job strain associated with hypertension genesis?

BACKGROUND: The aim of this analysis was to test, in a large sample of normotensive subjects, the short-term influence of job strain on the onset of hypertension. METHODS: According to the questionnaire of Karasek et al, job strain was divided into four modalities: (high strain, low strain, passive, and active) based on job demand (eg, the need to work hard and quickly) and job latitude (eg, control over skill use, time allocation, and organizational decisions) scores. High strain (HS) was defined by a high demand and a low job decision latitude. Individual data obtained in 926 (age 41 +/- 6 years) healthy normotensive or newly diagnosed hypertensive subjects were analyzed. Subjects participated in two prospective work site surveys designed to assess the influence of job strain on hypertension development. Relationships between job strain modalities and work site blood pressure (BP) levels were assessed using a general linear model. A complementary analysis using the the Pearson Phi coefficient (Z analysis) was implemented to explore nonlinear or scattered relationships between job strain and onset of hypertension. RESULTS: Systolic BP (SBP) was linearly related significantly to BMI and alcohol consumption, whereas diastolic BP (DBP) was related to age. The linear model did not find any relationship between SBP or DBP and job strain modalities. Using the Z analysis, development of systolic hypertension (SBP >140 mm Hg) was significantly associated with high job strain (P < .001). CONCLUSIONS: Our results suggest that there is no global relationship between job strain and BP levels. However our methodology revealed a significant association between job strain and work site BP in a predominantly male subgroup of newly diagnosed hypertensive subjects exposed to high job strain.

Adult↗

PubMed2006

[Hypertension in blacks].

Hypertension is more frequent and more severe in blacks than in other racial groups. Salt-sensitive and low-renin hypertension are both more frequent in blacks. Cardiovascular morbidity appears to be similar in blacks and whites and depends on the classic cardiovascular risk factors. Kidney damage leading to end-stage renal disease is more frequent in blacks. Reduced salt intake improves drug efficacy. Diuretics and calcium channel blockers are more effective in lowering blood pressure, while angiotensin-converting-enzyme inhibitors may be more effective in preventing organ damage. Specific trials are needed to evaluate therapeutic benefits in blacks.

Angiotensin-Converting Enzyme Inhibitors↗

PubMed2003

Predicted creatinine clearance to evaluate glomerular filtration rate in black Caribbean subjects.

BACKGROUND AND METHODS: Although Caribbean people have been a lesser-studied ethnic group than other populations, they have a high burden of hypertension and renal disease. Because Caribbean people have a greater muscle mass than Caucasians, this study examined the accuracy of creatinine-based estimates (creatinine clearance; C(cr) and Cockcroft-Gault formula; C-G Cl) of glomerular filtration rate (GFR) in 38 Caribbeans who were matched for age, gender, and GFR, with 38 Caucasian subjects. Patients were considered black Caribbean if at least one of two parents was of black Caribbean origin. GFR values ranging from 5 to 140 ml/min/1.73 m(2) were measured by inulin clearance. Results were compared using linear correlations and the Bland and Altman methodology to provide better estimates of value dispersion. RESULTS: Correlation coefficients between C-G Cl and GFR were highly significant in both black Caribbean subjects (r=0.83, P<0.001) and Caucasians (r=0.84, P<0.001). Similar coefficients were obtained between C(cr) and GFR (r=0.89, P<0.001 and r=0.90, P<0.001, respectively). In spite of these strong correlations, the Bland and Altman representation highlighted huge intra-individual variations in GFR estimation by C-G Cl and by C(cr) in both ethnic groups. The underestimation of GFR by C-G Cl was significant in black Caribbeans (-8.6+/-20 ml/min/1.73 m(2), P<0.001) but not in Caucasians (-5.6+/-20.7 ml/min/1.73 m(2)). C(cr) overestimation of GFR was significant both in Caribbeans (8.7+/-16.8 ml/min/1.73 m(2), P<0.001) and in Caucasians (7.2+/-15.7 ml/min/1.73 m(2), P<0.01). CONCLUSIONS: The C-G formula for estimating GFR yields similar clinical values in black Caribbeans and in Caucasians, but the same limitations were observed in both ethnic groups.

Adult↗

PubMed2003

Sodium intake and blood pressure in healthy individuals.

OBJECTIVE: To investigate further the relationships between blood pressure and sodium intake, which have been claimed to exist, but have not been clearly established, in epidemiological studies. DESIGN AND PARTICIPANTS: A 2-year follow up study of a cohort of 296 healthy volunteers working in the same company. RESULTS: Consistent with previously reported findings, covariance analysis in the entire population, including multivariate analysis to examine the potential influence of confounding variables, failed to identify a significant relationship between blood pressure and sodium intake or between their respective changes within 2 years. To test the hypothesis of a heterogeneous distribution of salt sensitivity, we calculated the statistical dependence between blood pressure and sodium intake using the coefficient analysis that quantifies the prevalence of a statistical link between two variables. A significant dependence (P < 0.05) between diastolic (DBP) or systolic (SBP) blood pressure and sodium intake was found in 16 and 5% of the participants, respectively. The analysis of the 2-year changes in blood pressure and sodium intake reinforced our findings. Our finding of a relationship between blood pressure and sodium intake in only a few individuals may explain the lack of a global relationship between these two variables investigated by the covariance analysis in our study.(Rho) CONCLUSION: Our results suggest that 5-16% of healthy individuals have a 'salt-dependent blood pressure' and might benefit from a reduction in dietary salt intake.

Adult↗

PubMedDate not supplied

How to limit screening of patients for atheromatous renal artery stenosis in two-drug resistant hypertension?

BACKGROUND: The DRASTIC model based on nine variables (age, gender, recent onset of hypertension, smoking status, body mass index (BMI), abdominal bruit, atherosclerosis, dyslipidemia and creatininemia) has been proposed to predict renal artery stenosis (RAS) occurrence. METHODS: In a prospective multicenter study, the clinical usefulness of the DRASTIC model was checked in 336 patients with two-drug resistant hypertension. RAS was excluded using at least color Doppler sonography. RAS was diagnosed using at least renal angiography. The statistical dependence (Z(Rho)) analysis was applied to investigate further the relationships between each variable and presence of RAS. RESULTS: The prevalence of RAS (n=51) was 15%. The goodness-of-fit test that compared observed RAS to predicted RAS using the DRASTIC model was not significant. Accordingly, the multivariate logistic regression indicated that only three parameters (abdominal bruit, atherosclerotic vascular disease and BMI <25 kg/m2) were significantly linked to RAS. The Z(Rho) methodology revealed that calculated renal function <60 ml/min and age >58 yrs (median) were also significantly linked to RAS. No variable or combination of variables offered satisfactory positive predictive values for the RAS diagnosis. The combination of the five significantly linked variables had a negative predictive value of 98%, and allowed RAS detection with a sensitivity of 96%. In our population, RAS screening could have been avoided in 30% of our patients screened. CONCLUSIONS: The DRASTIC model was unsuitable for clinical use in our sample population. In our population, renal arteries were considered stenosis free with a probability of 98% in refractory hypertensive overweight patients, aged < or = 58 yrs, with satisfactory renal function and without both abdominal bruit and atherosclerotic vascular disease.

Abdominal Pain↗