Out-of-office blood pressure: from measurement to control

Hypertension is an important risk factor for the development of cardiovascular disease, and is a major cause of morbidity and mortality worldwide. Traditionally, hypertension diagnosis and treatment and clinical evaluations of antihypertensive efficacy have been based on office blood pressure (BP) measurements; however, there is increasing evidence that office measures may provide inadequate or misleading estimates of a patient’s true BP status and level of cardiovascular risk. The introduction, and endorsement by treatment guidelines, of 24-hour ambulatory BP monitoring and self (or home) BP monitoring has facilitated more reliable and reproducible estimations of true BP, including the identification of white-coat and masked hypertension, and evaluation of BP variability. In addition, ambulatory BP monitoring enables accurate assessment of treatment effectiveness over 24 hours and both ambulatory and self BP monitoring may lead to better tailoring of therapy according to BP profile and concomitant disease. This review describes the clinical benefits and limitations of out-of-office assessments and their applications for effective management of hypertension and attainment of BP control

Impact of telmisartan in modifying vascular risk

Telmisartan, a selective angiotensin II type 1 receptor blocker (ARB), has been investigated in many trials, in particular, in order to assess its antihypertensive effect in various situations and its ability to protect organs susceptible to hypertension. In addition to its antihypertensive properties, it has positive metabolic and vascular effects (partly because of its sustained action). Several large-scale trials have focused on the effect of telmisartan on cardiovascular morbidity and mortality, including comparisons of that with an angiotensin-converting enzyme inhibitor in subjects at high vascular risk. Telmisartan was used in the largest ARB research programme (the Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial [ONTARGET] and Telmisartan Randomized Assessment Study in ACE Intolerant Subjects with Cardiovascular Disease [TRANSCEND] trial)

Étude des caractéristiques vasculaires et tensionnelles des patients porteurs d une dysplasie fibromusculaire (à partir des patients inclus dans l étude ARCADIA-PROFILE au CHU de Grenoble)

Introduction. La dysplasie fibromusculaire (DFM) est une maladie idiopathique dont l atteinte préférentielle concerne les artères rénales. Les troncs supra-aortiques (TSA) sont le deuxième site le plus touché. La population concernée est habituellement la femme jeune. Méthode. Nous avons réalisé une étude descriptive afin d analyser les caractéristiques vasculaires et tensionnelles des patients porteurs d une DFM au CHU de Grenoble entre juin 2010 et juillet 2013. Durant cette période, nous avons inclus 101 patients. Résultats. Notre étude confirmait la prédominance féminine de la maladie (86,1%), touchant tous les âges de la vie (âge moyen 57,3 ans). Les circonstances de découverte étaient variées, avec une prévalence d HTA supérieure en cas de présentation rénale. La DFM était découverte pour deux tiers des patients à l étage abdomino-pelvien, avec une forme multifocale prédominante (77,2%). La localisation rénale était la plus fréquente (83,2%). Une atteinte abdomino-pelvienne et cervico-encéphalique était retrouvée chez 42,6% des patients, avec un nombre moyen de localisations de 3,11. Le bilan radiologique permettant d affirmer le diagnostic était la combinaison de la TDM et du doppler (47,5%, vs 34,7% pour la TDM seule). L artériographie n était réalisée que dans moins de 5% des cas pour un doute diagnostique persistant ; en revanche, cet examen était indispensable pour l angioplastie des artères rénales (44% des sténoses ont été dilatées). Conclusion. La population concernée par la DFM est majoritairement des femmes d âge intermédiaire. Des localisations multiples étaient fréquentes et l examen clé du bilan morphologique était la TDM.Introduction. Fibromuscular dysplasia (FMD) is an idiopathic disease which primarily affects the renal arteries followed by the supra-aortic trunks (SAT). Women are most affected by this disease. Method. We conducted a descriptive study to analyze vascular and blood pressure characteristics of the patients with FMD at Grenoble University Hospital between June 2010 and July 2013. During this period, we gathered data on 101 patients. Results. Our study confirmed the female predominance of the disease (86.1%), affecting all ages of life (mean age 57.3 years). The circumstances of discovery were varied, with a higher prevalence of hypertension in renal presentation. The FMD was found for two-thirds of patients in abdominal and pelvic territories, with a predominant multifocal form (77.2%). Renal localization was the most frequent (83.2%). Abdominopelvic and cervicoencephalic involvment was found in 42.6% of patients, with an average number of localisations of 3.11. The radiological assessment to confirm the diagnosis was a combination of CT and Doppler imaging (47.5% vs. 34.7% for CT only). Angiography was performed in less than 5% of cases in persistent diagnostic doubt, however, that examination was essential for angioplasty of the renal arteries (44% of stenoses were dilated). Conclusion. The population affected by the FMD is predominantly prime-aged women. Multiple locations were frequent and key review of morphological assessment was CT.GRENOBLE1-BU Médecine pharm. (385162101) / SudocSudocFranceF

Analyse descriptive du traitement médicamenteux chez des patients hospitalisés pour décompensation cardiaque au CHU de Grenoble

Malgré une évolution des connaissances sur le traitement de l insuffisance cardiaque au cours de ces dernières années, une forte proportion de patients ne sont pas toujours traités de manière optimale. L European Society of Cardiology a publié en 2012 les dernières recommandations visant à améliorer la prise en charge de cette pathologie chronique et fréquente (prévalence entre 1 et 2% de la population adulte, plus de 10% chez les personnes de 70 ans ou plus). Au cours de cette étude, les prescriptions de 50 patients hospitalisés au CHU de Grenoble pour décompensation cardiaque sont analysées et comparées à ces recommandations dans le but d en étudier les éventuelles discordances.Despite the improvement of the treatment for heart failure over last years, a large part of patients are not still treated on an optimal way. The European Society of Cardiology (ESC) has published guidelines on chronic heart failure in 2012. The prevalence of this disease is very high, 1-2 % of the adult population having chronic heart failure and more than 10% of subjects aged of 70 years or more having this disease. The aim of the present study was to analyze the medical prescription for heart failure in patients hospitalized at the Grenoble University Hospital for heart failure. Data were compared to those recommended by the ESC in order to determine and explain potential discrepancies.GRENOBLE1-BU Médecine pharm. (385162101) / SudocSudocFranceF

DNA demethylation agent 5azadC downregulates HPV16 E6 expression in cervical cancer cell lines independently of TBX2 expression

HPV16 is the most carcinogenic human papillomavirus and causes >50% of cervical cancers, the majority of anal cancers and 30% of oropharyngeal squamous cell carcinomas. HPV carcinogenesis relies on the continuous expression of the two main viral oncoproteins E6 and E7 that target >150 cellular proteins. Among them, epigenetic modifiers, including DNA Methyl Transferases (DNMT), are dysregulated, promoting an aberrant methylation pattern in HPV-positive cancer cells. It has been previously reported that the treatment of HPV-positive cervical cancer cells with DNMT inhibitor 5-aza-2'-deoxycytidine (5azadC) caused the downregulation of E6 expression due to mRNA destabilization that was mediated by miR-375. Recently, the T-box transcription factor 2 (TBX2) has been demonstrated to repress HPV LCR activity. In the current study, the role of TBX2 in E6 repression was investigated in HPV16 cervical cancer cell lines following 5azadC treatment. A decrease of E6 expression was accompanied by p53 and p21 restoration. While TBX2 mRNA was upregulated in 5azadC-treated SiHa and Ca Ski cells, TBX2 protein was not detectable. Furthermore, the overexpression of TBX2 protein in cervical cancer cells did not allow the repression of E6 expression. The TBX2 transcription factor is therefore unlikely to be associated with the repression of E6 following 5azadC treatment of SiHa and Ca Ski cells. © 2020 Spandidos Publications. All rights reserved

Choroidal Blood Flow Regulation after Posture Change or Isometric Exercise in Men with Obstructive Sleep Apnea Syndrome

PURPOSE. Obstructive sleep apnea (OSA) syndrome generates hypertension, atherosclerosis, and endothelial and autonomic dysfunction, which may mutually interact with ocular vascular regulation. Exercise and posture changes can be used to manipulate blood pressure, ocular perfusion pressure (OPP), or both. It was hypothesized that choroidal vascular reactivity in response to isometric exercise and posture changes could be altered in OSA patients. METHODS. Healthy men were matched 1:1 for body mass index, sex, and age with patients with newly diagnosed OSA without cardiovascular comorbidities. All subjects underwent sleep studies and cardiovascular phenotyping (24-hour blood pressure monitoring, arterial stiffness measurements, and cardiac and carotid echography). Choroidal reactivity was assessed by laser Doppler flowmetry, which measured subfoveal choroidal blood flow. RESULTS. During exercise, blood pressure parameters increased significantly within the same range, with a similar profile over time in OSA patients and control subjects. A significant linear relationship (P ϭ 0.0003) was noted between choroidal vascular resistance and the OPP changes during exercise in OSA patients and control subjects. From the sitting to the supine position, a significant decrease in mean arterial pressure occurred in both groups (10.9%-13.4%; P Ͻ 0.001). In both populations, no significant change in choroidal blood flow or vascular resistance was found during the posture change. Choroidal blood flow responses to exercise and posture changes were unchanged after 6 to 9 months of continuous positive airway pressure treatment. CONCLUSIONS. This study strongly suggests that the regulation of choroidal blood flow, which depends on the orthosympathetic and parasympathetic systems, is unaltered in men with OSA who have no comorbidities. (ClinicalTrials.gov number, NCT00874913.) (Invest Ophthalmol Vis Sci. 2011; 52:9489 -9496