Effects of blood pressure control in cardiovascular prevention

Background: High blood pressure is the main risk factor worldwide for mortality and morbidity. Subjects with uncontrolled hypertension increased in the last decades. Methods: This review is based on the material searched for and obtained via MEDLINE and PubMed up to June 2016. The search terms used were \u201chypertension, blood pressure control\u201d in combination with \u201cpathophysiology, lifestyle, antihypertensive drugs, target organ damage, target values and comorbidity\u201d. Results: This narrative review focused its attention on the diagnosis, the pathophysiology, the clinical consequences of arterial hypertension, and on the factors that must be considered for a better blood pressure control. In fact, the attainment of an adequate blood pressure control is a challenge at both a population and an individual level. Conclusion: The review will discuss the best strategy to reduce uncontrolled hypertension and cardiovascular events in hypertensive patients identifying the main conditions which determine and maintain uncontrolled hypertension also highlighting the new possible strategies for a better blood pressure control and including the results of very recent multicenter randomized controlled trials

Calcul des états atteignables de programmes ESTEREL partitionné selon la syntaxe

Le calcul symbolique des états atteignables d'un programme constitue un élément de base dans la compilation des programmes réactifs synchrones. Nous proposons d'améliorer la complexité parfois prohibitive de ce calcul en exploitant la structure des programmes. L'idée de base paraît extrêmement simple: pour le cas P;Q où deux blocs de programme sont combinés en séquence, nous cherchons à construire entièrement les états atteignables de P et de ne s'occuper de Q que lorsque P est complètement exploré. Si les comportements de P étaient de durée variable, le calcul symbolique Breadth First Search aurait combiné l'exploration de P et de Q dans un même mouvement. De ceci aurait résulté une irrégularité dans les représentations intermédiaires des états atteints. Les difficultés de notre approche apparaissent en présence de parallélisme et d'échange de signaux locaux où les blocs de programme peuvent se synchroniser de multiples façons en raison du comportement dynamique du programme. Considérer toutes ces possibilités mènerait à une forte complexité. Le but ici est de trouver un compromis satisfaisant entre l'approche globale Breadth First Search et l'approche compositionnelle partitionnée. Concrètement, nous nous appuyons sur des caractéristiques intéressantes de notre librairie de BDD pour développer une approche efficace. Nous employons des heuristiques permettant de partitionner notre programme et d'ordonnancer la construction des états atteignables afin de calculer exactement les mêmes résultats que par la méthode de base mais en appliquant des fonctions de transition plus localisées. Les premiers résultats expérimentaux montrent la pertinence de notre approche.We consider the issue of exploiting the structural form of Esterel programs to partition the algorithmic RSS (reachable state space) fix-point construction used in model-checking techniques. The basic idea sounds utterly simple, as seen on the case of sequential composition: in P;Q, first compute entirely the states reached in P, and then only carry on to Q, each time using only the relevant transition relation part. Here a brute-force symbolic breadth-first search would have mixed the exploration of P and Q instead, in case P had different behaviors of various lengths, and that would result in irregular BBD representation of temporary state spaces, a major cause of complexity in symbolic model-checking. Difficulties appear in our decomposition approach when scheduling the different transition parts in presence of parallelism and local signal exchanges. Program blocks (or "Macro-states") put in parallel can be synchronized in various ways, due to dynamic behaviors, and considering all possibilities may lead to an excessive division complexity. The goal is here to find a satisfactory trade-off between compositional and global approaches. Concretely we use some of the features of the BDD library, and heuristic orderings between internal signals, to have the transition relation progress through the program behaviors to get the same effect as a global RSS computation, but with much more localized transition applications. We provide concrete benchmarks showing the usefulness of the approach.NICE-BU Sciences (060882101) / SudocSudocFranceF

The Role of Inflammation in Cardiovascular Outcome

PURPOSE OF REVIEW: The aim of this review is to update the pathophysiological role of innate immune response in the cardiovascular (CV) disease outcomes, particularly focusing on coronary atherosclerosis and heart failure. RECENT FINDINGS: Inflammatory processes comprised with the innate immunity reaction are believed to actively trigger CV disease development and final clinical events. For instance, by releasing proteases and neutrophil extracellular traps, neutrophil recruitment and activation might strongly influence atherosclerotic plaque stability. Similarly, neutrophils drive the early inflammatory response following a myocardial infarction. However, these cells contribute themselves to infarct healing by orchestrating monocyte/macrophage recruitment and polarization within the ischemic myocardium. Given their heterogeneity and plasticity, the balance between recruitment, proliferation, and polarization of monocyte/macrophage is a further leading determinant of advanced plaque maturation. Moreover, timely shift from a pro-inflammatory to a resolving macrophage phenotype may influence cardiac remodeling as well as development of heart failure (HF). Alongside macrophage recruitment and activation into the remote, non-ischemic myocardium also contributes to cardiac remodeling and HF development. Innate immune response is a tightly regulated process where a timely modulation of the balance between damaging and resolving properties critically impacts on CV outcome. Further progress may improve the determination of the prognostic relevance of inflammatory biomarkers on clinical CV outcome

The Impact of the Angiotensin-Converting Enzyme Inhibitor Lisinopril on Metabolic Rate in Drosophila melanogaster

Evidence suggests that angiotensin-converting enzyme inhibitors (ACEIs) may increase metabolic rate by promoting thermogenesis, potentially through enhanced fat oxidation and improved insulin. More research is, however, needed to understand this intricate process. In this study, we used 22 lines from the Drosophila Genetic Reference Panel to assess the metabolic rate of virgin female and male flies that were either fed a standard medium or received lisinopril for one week or five weeks. We demonstrated that lisinopril affects the whole-body metabolic rate in Drosophila melanogaster in a genotype-dependent manner. However, the effects of genotypes are highly context-dependent, being influenced by sex and age. Our findings also suggest that lisinopril may increase the Drosophila metabolic rate via the accumulation of a bradykinin-like peptide, which, in turn, enhances cold tolerance by upregulating Ucp4b and Ucp4c genes. Finally, we showed that knocking down Ance, the ortholog of mammalian ACE in Malpighian/renal tubules and the nervous system, leads to opposite changes in metabolic rate, and that the effect of lisinopril depends on Ance in these systems, but in a sex- and age-specific manner. In conclusion, our results regarding D. melanogaster support existing evidence of a connection between ACEI drugs and metabolic rate while offering new insights into this relationship

The Role of Adipocytokines in Coronary Atherosclerosis

PURPOSE OF REVIEW: The aim of this review is to overview the pathophysiological role of adipocytokines in atherogenesis, focusing on their potential role as biomarkers of coronary disease. RECENT FINDINGS: Several lines of evidence indicated adipose tissue not only as depot but rather as an endocrine organ. In this context, the balance between pro- and anti-inflammatory adipocytokines has been shown to critically regulate vascular homeostasis in both physiological and pathophysiological conditions. Overweight and obesity are characterized by dysfunctional adipose tissue and then the prevalence of pro-inflammatory mediators, with a detrimental effect on vascular health. As opposite to adiponectin, pro-inflammatory adipocytokines, such as leptin and resistin, promote endothelial dysfunction and inflammatory processes involved in atherosclerotic plaque progression and vulnerability. Therefore, many adipocytokines have been investigated as potential biomarkers of cardiovascular (CV) risk, but their role has not yet been clearly established. Furthermore, the perivascular adipose tissue recently emerged as a critical modulator of atherosclerotic processes, due to the close interaction with the underlying vascular tissue. The ongoing discovery of new adipocytokines and the complex pathophysiological role of the different adipose tissue depots strongly contribute to define the complexity of adipocytokines network. Understanding those complex interactions may allow determining new potential biomarkers of CV risk and potential therapeutic targets