Changement climatique, vulnérabilité des systèmes de production agricoles et impact sur la pauvreté au Maroc : Cas du Saïss

La perception de la pauvreté à la vulnérabilité des systèmes de production et le comportement des agriculteurs est en mesure d’enrichir la réflexion sur les indicateurs de mesure de la pauvreté en milieu rural. En fait, les objectifs fondamentaux de ce travail consistent en les questions suivantes: (i) quelles sont les caractéristiques géographiques des systèmes de production dans chaque site étudié? (ii) quels sont les pauvres ruraux vulnérables au changement climatiqueet qui sont affrontés à l’insécurité alimentaire ? et, enfin (iii) quelles sont les caractéristiques de distinction entre les ménages vulnérables et exposés à la pauvreté et ceux qui ne le sont pas dans les trois sites d’étude de la région de Saïss-Meknès ? Il est nécessaire de placer cette analyse dans son contexte national et aussi les tendances nationales et régionales en ce qui concerne la pauvreté compte tenu des documentations et données disponibles sur la région. La hiérarchisation des systèmes de production sur la base de données de structure et de fonctionnement pourra renseigner sur le comportement des agriculteurs, le niveau d’efficience et aussi permettre d’expliquer des phénomènes socioéconomiques comme la pauvreté et l’adaptation ou non au changement climatique. Les trois communautés étudiées ont montré des différences quant à la diversité des systèmes de production, le recours à l’irrigation, le capital humain, le capital financier et le capital foncier. Tous ces éléments sont à la base de différenciation des systèmes de production, des capacités d’adaptation ou de résilience, d’exposition à la pauvreté et à l’insécurité alimentaire. A partir des résultats de l’enquête, les évènements climatiques les plus fréquents dans cette région, sont la sécheresse, la perte de récolte, lestempêtes et les inondations. Ainsi, les agriculteurs ont développé des formes d’adaptation pour faire face aux effets de ces évènements. Dans ce sens, il a été constaté que la majorité des enquêtés (55% à 70%) ont affirmé qu’ils n’ont rien fait devant lesmajeurs chocs climatiques rencontrés. L’analyse de la sécurité alimentaire a montré une tendance à une insécurité alimentaire des trois communes avec une légère vulnérabilité de la commune de Sidi Slimane. Il faut noter que ce constat se confirme par l’estimation des indicateurs d’insécurité alimentaire. Combinés au changement climatique et à la vulnérabilité de l’activité, les ménages de ces trois localités sont exposés à l’insécurité alimentaire et par conséquence à la pauvreté. On ne peut se prononcer àce niveau d’analyse à une exposition à la famine mais on est plus à un niveau d’accessibilité aux aliments d’une manière régulière

Nondipping Pattern and Cardiovascular and Renal Damage in a Population-Based Study (The STANISLAS Cohort Study)

International audienceOBJECTIVE:The attenuation of physiological nocturnal decline of blood pressure (BP)-called nondipper pattern-has previously been reported to be associated with target organ damage in hypertensive subjects. However, this association remains debated and poorly studied in normotensive patients. This study aimed to investigate the association between nondipper pattern and subclinical cardiovascular and renal damage in an initially healthy population-based cohort study.METHODS:The STANISLAS Cohort is a single-center, familial longitudinal cohort composed of 1,006 families (4,295 subjects) recruited in 1993-1995 for a 5-year periodic health examination. A total of 1,334 subjects from the 4th visit (2011-2016) of the STANISLAS cohort were included. This 4th examination included estimated glomerular filtration rate, albumin/creatinine ratio, pulse wave velocity, central systolic BP, carotid intima-media thickness and distensibility, left ventricular mass index, left ventricular hypertrophy, diastolic dysfunction, and ambulatory blood pressure monitoring (ABPM). Nondipping status was defined as a mean reduction in systolic BP (SBP) or diastolic BP (DBP) lower than 10% during nighttime.RESULTS:Data were obtained from 798 normotensive subjects (45 ± 14 years, 395 [49%] nondippers, SBP/DBP mmHg 24 hours: 116/71 ± 7/5) and 536 hypertensive patients (56 ± 11 years, 257 [48%] nondippers, SBP/DBP mmHg 24 hours: 127/78 ± 10/7). Mean 24-hour and daytime ABPM measurements were within the normal range, even in hypertensive participants (19% treated). The nondipping pattern was not associated with cardiovascular or renal alterations in this population.CONCLUSION:In this middle-aged population with an overall 24-hour optimal BP control, the nondipper pattern was not associated with increased cardiovascular or renal damage.© American Journal of Hypertension, Ltd 2019. All rights reserved. For Permissions, please email: [email protected]

Twenty-Four-Hour Blood Pressure Monitoring to Predict and Assess Impact of Renal DenervationNovelty and Significance

International audienceThe DENERHTN trial (Renal Denervation for Hypertension) confirmed the blood pressure (BP) lowering efficacy of renal denervation added to a standardized stepped-care antihypertensive treatment for resistant hypertension at 6 months. We report here the effect of denervation on 24-hour BP and its variability and look for parameters that predicted the BP response. Patients with resistant hypertension were randomly assigned to denervation plus stepped-care treatment or treatment alone (control). Average and standard deviation of 24-hour, daytime, and nighttime BP and the smoothness index were calculated on recordings performed at randomization and 6 months. Responders were defined as a 6-month 24-hour systolic BP reduction ≥20 mm Hg. Analyses were performed on the per-protocol population. The significantly greater BP reduction in the denervation group was associated with a higher smoothness index (P=0.02). Variability of 24-hour, daytime, and nighttime BP did not change significantly from baseline to 6 months in both groups. The number of responders was greater in the denervation (20/44, 44.5%) than in the control group (11/53, 20.8%; P=0.01). In the discriminant analysis, baseline average nighttime systolic BP and standard deviation were significant predictors of the systolic BP response in the denervation group only, allowing adequate responder classification of 70% of the patients. Our results show that denervation lowers ambulatory BP homogeneously over 24 hours in patients with resistant hypertension and suggest that nighttime systolic BP and variability are predictors of the BP response to denervation. CLINICAL TRIAL REGISTRATION : URL: https://www.clinicaltrials.gov. Unique identifier: NCT0157077

Abdominal Aortic Calcifications Influences the Systemic and Renal Hemodynamic Response to Renal Denervation in the DENERHTN (Renal Denervation for Hypertension) Trial

URL: http://www.clinicaltrials.gov. Unique identifier: NCT01570777.International audienceBACKGROUND : The DENERHTN (Renal Denervation for Hypertension) trial confirmed the efficacy of renal denervation (RDN) in lowering daytime ambulatory systolic blood pressure when added to standardized stepped-care antihypertensive treatment (SSAHT) for resistant hypertension at 6 months.METHODS AND RESULTS : This post hoc exploratory analysis assessed the impact of abdominal aortic calcifications (AAC) on the hemodynamic and renal response to RDN at 6 months. In total, 106 patients with resistant hypertension were randomly assigned to RDN plus SSAHT or to the same SSAHT alone (control group). Total AAC volume was measured, with semiautomatic software and blind to randomization, from the aortic hiatus to the iliac bifurcation using the prerandomization noncontrast abdominal computed tomography scans of 90 patients. Measurements were expressed as tertiles. The baseline-adjusted difference in the change in daytime ambulatory systolic blood pressure from baseline to 6 months between the RDN and control groups was -10.1 mm Hg (P=0.0462) in the lowest tertile and -2.5 mm Hg (P=0.4987) in the 2 highest tertiles of AAC volume. Estimated glomerular filtration rate remained stable at 6 months for the patients in the lowest tertile of AAC volume who underwent RDN (+2.5 mL/min per 1.73 m2) but decreased in the control group (-8.0 mL/min per 1.73 m2, P=0.0148). In the 2 highest tertiles of AAC volume, estimated glomerular filtration rate decreased similarly in the RDN and control groups (P=0.2640).CONCLUSIONS : RDN plus SSAHT resulted in a larger decrease in daytime ambulatory systolic blood pressure than SSAHT alone in patients with a lower AAC burden than in those with a higher AAC burden. This larger decrease in daytime ambulatory systolic blood pressure was not associated with a decrease in estimated glomerular filtration rate

Adherence to Antihypertensive Treatment and the Blood Pressure–Lowering Effects of Renal Denervation in the Renal Denervation for Hypertension (DENERHTN) TrialClinical Perspective

International audienceBACKGROUND:The DENERHTN trial (Renal Denervation for Hypertension) confirmed the blood pressure-lowering efficacy of renal denervation added to a standardized stepped-care antihypertensive treatment for resistant hypertension at 6 months. We report the influence of adherence to antihypertensive treatment on blood pressure control.METHODS:One hundred six patients with hypertension resistant to 4 weeks of treatment with indapamide 1.5 mg/d, ramipril 10 mg/d (or irbesartan 300 mg/d), and amlodipine 10 mg/d were randomly assigned to renal denervation plus standardized stepped-care antihypertensive treatment, or the same antihypertensive treatment alone. For standardized stepped-care antihypertensive treatment, spironolactone 25 mg/d, bisoprolol 10 mg/d, prazosin 5 mg/d, and rilmenidine 1 mg/d were sequentially added at monthly visits if home blood pressure was ≥135/85 mm Hg after randomization. We assessed adherence to antihypertensive treatment at 6 months by drug screening in urine/plasma samples from 85 patients.RESULTS:The numbers of fully adherent (20/40 versus 21/45), partially nonadherent (13/40 versus 20/45), or completely nonadherent patients (7/40 versus 4/45) to antihypertensive treatment were not different in the renal denervation and the control groups, respectively (P=0.3605). The difference in the change in daytime ambulatory systolic blood pressure from baseline to 6 months between the 2 groups was -6.7 mm Hg (P=0.0461) in fully adherent and -7.8 mm Hg (P=0.0996) in nonadherent (partially nonadherent plus completely nonadherent) patients. The between-patient variability of daytime ambulatory systolic blood pressure was greater for nonadherent than for fully adherent patients.CONCLUSIONS:In the DENERHTN trial, the prevalence of nonadherence to antihypertensive drugs at 6 months was high (≈50%) but not different in the renal denervation and control groups. Regardless of adherence to treatment, renal denervation plus standardized stepped-care antihypertensive treatment resulted in a greater decrease in blood pressure than standardized stepped-care antihypertensive treatment alone.CLINICAL TRIAL REGISTRATION:URL: http://www.clinicaltrials.gov. Unique identifier: NCT01570777