Stéphane Laurent

Université René Descartes - Paris 5, Lutetia Parisorum, Île-de-France, France

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Publications (478)1791.31 Total impact

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    ABSTRACT: Objectives: We assessed the influence of medication adherence on blood pressure (BP) control and target organ damage in a pre-specified analysis of a published trial comparing sequential nephron blockade (SNB) or sequential renin-angiotensin system blockade (SRASB) in patients with resistant hypertension. Methods: Patients were randomized to SNB (n = 82) or SRASB (n = 82) and studied at baseline and after 12 weeks. BP was measured by ambulatory blood pressure monitoring. Carotid-femoral pulse wave velocity (PWV) was measured by applanation tonometry and left ventricular mass (LVM) by echocardiography. Low medication adherence was assessed through plasma irbesartan concentration below 20 ng/ml; urinary N-acetyl-seryl-aspartyl-lysyl-proline/creatinine ratio below 4 nmol/mmol; last medication intake before visit greater than 24 h and pill counting below 80% of theoretical intake. Medication adherence score (sum of items, max = 4) is defined as low (medication adherence score <2) or acceptable (medication adherence score ≥2). Results: Among 164 patients, 134 (81.7%) had acceptable medication adherence and 30 (18.3%) low medication adherence, with similar proportions in the SNB and SRASB arms. After 12 weeks, in patients with acceptable medication adherence, BP was more frequently controlled in those treated with SNB (64%), than SRASB (18%; P < 0.001). The difference in daytime SBP was -11.5 mmHg [95% confidence interval (CI) -15.4 to -7.5, P < 0.0001] in patients with acceptable medication adherence. In contrast, in patients with low medication adherence, the difference between groups was smaller and not significant (-9.4 mmHg, 95% CI -20.4 to 1.7, P = 0.09). Independently of BP changes, PWV and LVM decreased more in the SNB than in the SRASB arm when medication adherence was acceptable (-0.52 m/s, 95% CI -1.3 to -0.007, P = 0.047; and -24 g/m, 95% CI -36 to -12, P = 0.0003), whereas no significant changes were observed in low medication adherence patients. Conclusion: Medication adherence contributes to BP-lowering and regression of target organ damage. The differential effects of SNB and SRASB is observed in patients with acceptable medication adherence, and not in patients with low medication adherence.
    Journal of Hypertension 09/2015; DOI:10.1097/HJH.0000000000000737 · 4.72 Impact Factor
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    ABSTRACT: Introduction and objective: Blood pressure variability (BPV) within 24 h or between visits has been found to represent an independent risk factor for cardiovascular disease. The present study was aimed at determining whether a clinical significance can be given also to the BP variations occurring within a single clinical visit. Methods: BPV was quantified as coefficient of variation and as standard deviation (SD) of the mean of three systolic SBP values within a visit in the context of a large-cross subclinical survey (BP-CARE) of treated hypertensive patients living in Eastern European countries. The study population was divided into coefficient of variation and SD quartiles and for each quartile a relationship was sought with a large number of cardiovascular risk factors based on patients' history, physical and laboratory examinations. Results: The 6425 hypertensive patients had an age of 59.2 ± 11 years (mean ± SD); they were equally distributed by sex and displayed an average SD and coefficient of variation amounting to 5.1 ± 6.2 mmHg and 3.5 ± 4.0%, respectively. Compared with the lowest coefficient of variation quartile (Q1), patients in the highest quartile (Q4) showed a significantly greater prevalence of several cardiovascular risk factors, such as age (Q1: 58.5 ± 11 vs. Q4: 60.3 ± 11 years, P < 0.001), serum total cholesterol (Q1: 213.0 ± 46 vs. Q4: 216.4 ± 51 mg/dl, P < 0.05), blood glucose (Q1: 106.2 ± 35 vs. Q4: 109.8 ± 39 mg/dl, P < 0.005), previous cardiovascular events (Q1: 57.4 vs. Q4: 63.9%, P < 0.001), and resistant hypertension (Q1: 26.3 vs. Q4: 34.1%, P < 0.001). They also showed higher office (Q1: 143.2 ± 18 vs. Q4: 154.3 ± 19 mmHg, P < 0.001) and 24-h ambulatory SBP values (Q1: 134.8 ± 17 vs. Q4: 141.2 ± 18 mmHg, P < 0.001). Similar results were obtained when BPV was expressed as SD. Conclusion: Our study provides evidence that greater within-visit BP variabilities are associated with a worse cardiovascular risk profile. This suggests that even this type of BPV may have clinical significance.
    Journal of Hypertension 09/2015; DOI:10.1097/HJH.0000000000000700 · 4.72 Impact Factor
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    ABSTRACT: -We assess the contribution of common and rare putatively functional genetic variants (most of them coding) present on the Illumina exome Beadchip to the variability of plasma lipids and stiffness of the common carotid artery. -Measurements were obtained from 2283 men and 1398 women, and after filtering and exclusion of monomorphic variants, 32827 common (minor allele frequency >0.01) and 68770 rare variants were analyzed. A large fraction of the heritability of plasma lipids is attributable to variants present on the array, especially for Triglycerides (fraction of variance attributable to measured genotypes: V(G)/Vp=31.4%, P<3.1×10(-11)) and HDLc (V(G)/Vp=26.4%, P<4.2×10(-12)). Plasma lipids were associated with common variants located in known candidate genes but no implication of rare variants could be established. Gene-sets for plasma lipids, blood pressure and coronary artery disease were defined on the basis of recent meta-analyses of genome wide association studies (GWAS). We observed a strong association between the plasma lipids gene-set and plasma lipid variables but none of the 3 GWAS gene-sets was associated with the carotid parameters. Significant V(G)/Vp ratios were observed for external (14.5%, P<2.7×10(-5)) and internal diameter (13.4%, P<4.3×10(-4)), stiffness (12.5%, P< 8.0×10(-4)), intima-media thickness (10.6%, P<7.9×10(-4)) and wall cross sectional area (13.2%, P<2.4×10(-5)). A significant association was observed between the common rs2903692 polymorphism of the CLEC16A gene and the internal diameter (P<4.3×10(-7)). -These results suggest an involvement of CLEC16A, a gene that has been reported to be associated with immune disorders, in the modulation of carotid vasodilatation.
    Circulation Cardiovascular Genetics 07/2015; 8(4). DOI:10.1161/CIRCGENETICS.114.000979 · 4.60 Impact Factor
  • Article: PP.20.36
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    ABSTRACT: Objective: Fibromuscular dysplasia (FD) is a rare idiopathic, segmental, non-atherosclerotic, non-inflammatory vascular disease, which occurs mostly in middle-aged patients and affects medium-sized arteries (renal and carotid arteries). We previously showed that renal FD is associated with supernumerary echo interfaces (triple signal pattern) detectable on echotracking tracings of the carotid artery (CA) compared to healthy subjects (HS), but we did not study patients with essential hypertension (EH). Design and method: In a cross sectional study, we compared the geometry and the mechanical properties of CA between 50 patients with multifocal FD of renal/carotid arteries, 50 patients with EH matched for age, sex, ethnicity and BP and 50 HS matched for age, sex and ethnicity. We used 1) a high-resolution radiofrequency-based echotracking system to perform a semiquantitative arterial phenotypic scoring and to detect additional interface at the level of the CA wall, and 2) Sphygmocor(R) to measure carotid-to-femoral pulse wave velocity (PWV). All measurements were performed blind to the diagnosis. Results: FD, EH and HS were well matched (52yrs, 85% women, 80%caucasian). SBP was higher in FD (125 +/- 15 mmHg) and EH (121 +/- 12 mmHg) than EH (113 +/- 10 mmHg) despite antihypertensive treatments. The FD score was significantly higher and the triple signal pattern was observed more frequently in both FD and EH than in HS, with no difference between FD and EH. This was also the case for PWV. All other parameters (CA diameter, distensibility and intima-media thickness [IMT]) did not significantly differ between the 3 groups. Copyright
    Journal of Hypertension 06/2015; 33:e316-e317. DOI:10.1097/01.hjh.0000468348.49727.30 · 4.72 Impact Factor
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    ABSTRACT: Arterial stiffness has been demonstrated to predict and be related to cardiovascular disease (CVD). Reference values of carotid-femoral pulse wave velocity (cf-PWV), the gold standard measure of arterial stiffness, and local carotid and femoral arterial stiffness, derived from the distensibility coefficient (DC), have been established. The use of different devices and methods, however, still hampers the widespread clinical use of these reference values. The aim of this work was therefore to create a web-based application that allows easy assessment - for different methodological approaches - of a given measured value of arterial stiffness, with the application providing the percentile reference associated with that specific value. Reference values of cf-PWV (11,092 individuals; age range: 15-97 years, 49.8% men) and local carotid (22,708 individuals; age range 15-99 years; 54% men) and femoral (5,069 individuals; age range: 15-87 years; 49.5% men) arterial stiffness were obtained from literature (The Reference Values for Arterial Stiffness' Collaboration 2010) and the database of The Reference Values for Arterial Stiffness' Collaboration. Individuals without CVD and established cardiovascular risk factors (CV-RFs) constituted a healthy subpopulation and were used to establish equations for percentiles of cf-PWV and sex-specific percentiles of carotid and femoral DC across age. Using these established equations, an application was created (in JavaScript) to provide the percentile reference value from routine parameters obtained in clinical practice. The tool can be found at:∼flondono/ and consists of two panels (see figure). The first panel (1) presents a menu, where the user selects the parameter to be determined (or standardized). Then an application is displayed in the second panel (2): a. Carotid DC; b. Femoral DC; c. cf-PWV, or d. cf-PWV conversion. Subsequently, the user provides a number of inputs which are used to calculate the selected parameter, the percentile and, when relevant, additional information. An easy and intuitive interface was created to assess a given measurement of arterial stiffness relative to know reference values.(Figure is included in full-text article.).
    Journal of Hypertension 06/2015; 33 Suppl 1 - ESH 2015 Abstract Book:e60-e. DOI:10.1097/01.hjh.0000467505.60342.95 · 4.72 Impact Factor
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    ABSTRACT: Adherence to antihypertensive treatment (AHT) is usually assessed by scales such as Morisky Medication Adherence Scale questionnaire (MMAS-4) but objective urinary drug levels quantification by liquid chromatography mass spectrometry (LCMS-MS) is now available. Our aim was to compare adherence assessed by LCMS-MS or MMAS-4, in patients with resistant hypertension (RH), compared to patients with well controlled hypertension (CH). RH cohort consisted in 82 patients with daytime ABPM > 135/85 mmHg after 4 weeks treatment with a standardised triple AHT participating to a clinical trial. The CH cohort consisted in 91 patients followed in a routine care practice with controlled office BP (<140/90 mmHg) by a median of 2 (range 1-4) AHT. Urinary levels of 14 AHT or their metabolites were evaluated by LC/MS-MS. MMAS-4 was only available in CH. Patients were aware (RH) or not (CH) of the measurement. Non-adherence was defined as a urinary level of at least one AHT below the limit of quantification. LCMS-MS results: in the RH cohort, 63 patients (77%) were adherent, 11 (13%) were partly non-adherent and 8 (10%) were fully non-adherent. In the CH cohort, 86 (93%) were adherent, 5 (6%) were partly non-adherent, and 1 (1%) was fully non-adherent. Office SBP in the CH cohort was significantly higher in non-adherent (partially or fully) than in fully adherent patients (median: 140 vs. 130 mmHg, respectively; p = 0.01). Office DBP did not differ. According to LCMS-MS, the full adherence rate was significantly higher in CH compared to RH cohort (p = 0.002). According to MMAS-4 available in 88 CH patients, 76 (86%) were fully adherent, and 12 (14%) were medium or low adherent and no significant difference in office SBP/DBP was observed between the two subgroups. There was low or no agreement between LCMS-MS and MMAS-4, with 15/88 non concordant tests. In conclusion, measurement of urinary AHT by LCMS-MS gives relevant information on adherence to treatment in patients attending an outpatient clinic. This information is not overlapping with questionnaire tests. It confirms the role of objective non-adherence to treatment in resistance to treatment.
    Journal of Hypertension 06/2015; 33 Suppl 1 - ESH 2015 Abstract Book:e93. DOI:10.1097/01.hjh.0000467603.33785.69 · 4.72 Impact Factor
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    ABSTRACT: Fibromuscular dysplasia (FD) is a rare idiopathic, segmental, non-atherosclerotic non-inflammatory vascular disease. We previously showed that FD is a general arterial disease with focal exacerbation of the trait. However, whether endothelial dysfunction may be involved in the pathophysiology of FD is unclear. In a cross sectional study, we compared the endothelial function between 50 patients with multifocal FD of renal/carotid arteries confirmed by CT-angiography, 50 essential hypertensive (EH) patients matched for age, sex, ethnicity and BP and 50 healthy subjects (HS) matched for age, sex and ethnicity. Exclusion criteria were: tobacco consumption, hypercholesterolemia, diabetes, aspirin or statin treatment. Brachial artery (BA) FMD after release of hand ischemia and glyceryl trinitrate (GTN)-induced EID was measured using a high-resolution radiofrequency-based echotracking system blind to the diagnosis. FD, EH and HS were well matched (52yrs, 85% women, 80% caucasian). SBP was higher in FD (125 ± 15mmHg) and EH (121 ± 12mmHg) than EH (113 ± 10mmHg) despite antihypertensive treatments. BA external diameter was significantly lower in FD than in both HS and EH before, during and after hand ischemia and after GTN. BA intima media thickness (IMT), internal diameter did not differ between the 3 groups. FMD (%) or EID (%) did not significantly differ between the 3 groups. BA flow velocity did not significantly differ in any experimental condition.(Figure is included in full-text article.) CONCLUSIONS:: In conclusion, despite showing similar acute vasodilatory responses to flow and GTN, FD patients differed from EH and HS in terms of arterial morphology with smaller BA diameter associated with similar IMT. This paradoxical remodeling may suggest a chronic defect in the endothelium-dependent pathways involved in arterial remodeling in FD patients.
    Journal of Hypertension 06/2015; 33 Suppl 1 - ESH 2015 Abstract Book:e82-e83. DOI:10.1097/01.hjh.0000467574.64325.90 · 4.72 Impact Factor
  • Article: PP.03.16
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    ABSTRACT: Objective: Magnetic resonance imaging (MRI) offers the possibility to measure local and regional indices of aortic function. However calculations of these indices usually require blood pressure (BP) values. Up to now, because of its easier availability, brachial BP was used instead of local aortic pressure. The SphygmoCor Xcel system (AtCor Medical, Australia) estimates aortic pressure non-invasively. It consists in a MRI compatible brachial cuff connected via a hose to a recording unit and computer. The aim of this study was to compare brachial and central BP values given by SphgymoCor Xcel with the standard 2 meters hose and a 6 meters hose more suitable for central BP assessment during MRI. Design and method: After 5 min rest supine, BP was measured simultaneously on both arms with one 2m SphgymoCor Xcel and one 6m SphgymoCor Xcel. Arms were randomly assigned. Tubing were then interchanged (cuffs unchanged) and recordings repeated. Results: 38 patients were studied (63% men). Seven (18%) were treated for hypertension, 2 (5%) for diabetes and 3 (11%) for dyslipidaemia. Median age was 36.8 years (28.5-58.4). Brachial systolic (bSBP2), diastolic (bDBP2) and central systolic BP (cSBP2) with the standard 2m hose varied from 95 to 158, from 57 to 96 and from 85 to 145 mmHg respectively. The difference between left and right arm was 3.1 +/- 7.8 (mean +/- SD, p = 0.02), 1.1 +/- 5.3 (p = 0.2) and 2.5 +/- 7.2 mmHg (p = 0.04) for bSBP2, bDBP2 and cSBP2 respectively. Values obtained on left and right sides were then averaged. There was no difference between bSBP, bDBP and cSBP obtained with the 2 and 6m tubing (-1.2 +/- 3.0 mmHg, p = 0.02, -0,7 +/- 2,6 mmHg, p = 0.07 and 0.2 +/- 2,4 mmHg p = 0.56, respectively). Augmented pressure (AP) and augmentation index (Aix) with 2m and 6m tubing were statistically different (2.7 +/- 4.0 mmHg, p < 0.001 and 5.3 +/- 7.6 %, p < 0.001, respectively). Conclusions: Brachial and central BP recorded with SphygmoCor Xcel and a 6m hose are in agreement with measurements done with the standard 2m hose. Assessing central BP during MRI exam is hence feasible. Other parameters (AP and Aix) based on higher frequency content are however less reliable. Copyright
    Journal of Hypertension 06/2015; 33:e157. DOI:10.1097/01.hjh.0000467799.39142.06 · 4.72 Impact Factor
  • Article: 4C.08
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    ABSTRACT: Ischemic stroke may be the first manifestation of cerebrovascular disease. However, subclinical organ complications of underlying arterial stiffness and hypertension may coexist and stratify outcome. The study aimed to examine measures of arterial stiffness and blood pressure (BP) on subclinical brain damage in acute ischemic stroke patients. In a prospective study, we enrolled 132 (68,6% males) patients with acute ischemic stroke, AIS (age 62.2 ± 12.2 years, admission National Institutes of Health Stroke Scale score 7.1 ± 6.5, mean ± SD). Carotid-femoral pulse wave velocity (CF-PWV), central augmentation index (cAIx), as well as central and peripheral BPs were measured (SphygmoCor, Omron, respectively) one week after stroke onset. The presence of brain subclinical lesions was graded on admission computed tomography scans using van Swieten criteria with any relevant cerebral small vessel disease considered as brain microvascular damage. In univariate analysis, high carotid-femoral PWV (p = 0.00005), and high cAIx (p = 0.02) were significantly associated with brain microvascular damage. Age, presence of hypertension, diabetes mellitus, previous ischemic stroke, but not BP values, also predicted brain outcome. In multivariate analysis, the predictive value of carotid-femoral PWV remained significant (OR, 1.30; 95% CI, 1.04-1.62; p = 0.02). By contrast, cAIx had no significant predictive value after adjustment. Increased aortic stiffness is associated with brain microvascular disease in patients with acute ischemic stroke, beyond and above classical risk factors. PWV provides a useful new tool for identification of subclinical brain damage in AIS.
    Journal of Hypertension 06/2015; 33 Suppl 1 - ESH 2015 Abstract Book:e58. DOI:10.1097/01.hjh.0000467502.75589.a8 · 4.72 Impact Factor
  • Stéphane Laurent
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    ABSTRACT: Both monotherapy and combination therapy options are appropriate for antihypertensive therapy according to the 2013 European Society of Hypertension (ESH)/European Society of Cardiology (ESC) guidelines. Most patients require more than one agent to achieve blood pressure (BP) control, and adding a second agent is more effective than doubling the dose of existing therapy. The addition of a third agent may be required to achieve adequate BP reductions in some patients. Single-pill fixed-dose combinations (FDCs) allow multiple-drug regimens to be delivered without any negative impact on patient compliance or persistence with therapy. FDCs also have documented beneficial clinical effects and use of FDCs containing two or three agents is recommended by the 2013 ESH/ESC guidelines.
    High Blood Pressure & Cardiovascular Prevention 05/2015; 22 Suppl 1(S1). DOI:10.1007/s40292-015-0099-y
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    ABSTRACT: While risk scores are invaluable tools for adapted preventive strategies, a significant gap exists between predicted and actual event rates. Additional tools to further stratify the risk of patients at an individual level are biomarkers. A surrogate endpoint is a biomarker that is intended as a substitute for a clinical endpoint. In order to be considered as a surrogate endpoint of cardiovascular events, a biomarker should satisfy several criteria, such as proof of concept, prospective validation, incremental value, clinical utility, clinical outcomes, cost-effectiveness, ease of use, methodological consensus, and reference values. We scrutinized the role of peripheral (i.e. not related to coronary circulation) noninvasive vascular biomarkers for primary and secondary cardiovascular disease prevention. Most of the biomarkers examined fit within the concept of early vascular aging. Biomarkers that fulfill most of the criteria and, therefore, are close to being considered a clinical surrogate endpoint are carotid ultrasonography, ankle-brachial index and carotid-femoral pulse wave velocity; biomarkers that fulfill some, but not all of the criteria are brachial ankle pulse wave velocity, central haemodynamics/wave reflections and C-reactive protein; biomarkers that do no not at present fulfill essential criteria are flow-mediated dilation, endothelial peripheral arterial tonometry, oxidized LDL and dysfunctional HDL. Nevertheless, it is still unclear whether a specific vascular biomarker is overly superior. A prospective study in which all vascular biomarkers are measured is still lacking. In selected cases, the combined assessment of more than one biomarker may be required. Copyright © 2015 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.
    Atherosclerosis 05/2015; 241(2). DOI:10.1016/j.atherosclerosis.2015.05.007 · 3.99 Impact Factor
  • Stéphane Laurent · Pierre Boutouyrie · Elie Mousseaux
    Hypertension 04/2015; 66(1). DOI:10.1161/HYPERTENSIONAHA.115.05357 · 6.48 Impact Factor
  • Journal of the American Society of Hypertension 04/2015; 9(4):e71. DOI:10.1016/j.jash.2015.03.164 · 2.61 Impact Factor
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    ABSTRACT: By contrast with other southern European people, north Portuguese population registers an especially high prevalence of hypertension and stroke incidence. We designed a cohort study to identify individuals presenting accelerated and premature arterial aging in the Portuguese population. Pulse wave velocity (PWV) was measured in randomly sampled population dwellers aged 18-96 years from northern Portugal, and used as a marker of early vascular aging (EVA). Of the 3038 individuals enrolled, 2542 completed the evaluation. Mean PWV value for the entire population was 8.4 m/s (men: 8.6 m/s; women: 8.2 m/s; P < 0.02). The individuals were classified with EVA if their PWV was at least 97.5th percentile of z-score for mean PWV values adjusted for age (using normal European reference values as comparators). The overall prevalence of EVA was 12.5%; 26.1% of individuals below 30 years presented this feature and 40.2% of individuals in that same age strata were placed above the 90th percentile of PWV; and 18.7% of the population exhibited PWV values above 10 m/s, with male predominance (17.2% of men aged 40-49 years had PWV > 10 m/s). Logistic regression models indicated gender differences concerning the risk of developing large artery damage, with women having the same odds of PWV above 10 m/s 10 years later than men. The population PWV values were higher than expected in a low cardiovascular risk area (Portugal). High prevalence rates of EVA and noteworthy large artery damage in young ages were found.
    Journal of Hypertension 03/2015; 33(7). DOI:10.1097/HJH.0000000000000565 · 4.72 Impact Factor
  • Stéphane Laurent · Pierre Boutouyrie
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    ABSTRACT: Pathophysiological studies have extensively investigated the structural factor in hypertension, including large and small artery remodeling and functional changes. Here, we review the recent literature on the alterations in small and large arteries in hypertension. We discuss the possible mechanisms underlying these abnormalities and we explain how they accompany and often precede hypertension. Finally, we propose an integrated pathophysiological approach to better understand how the cross-talk between large and small artery changes interacts in pressure wave transmission, exaggerates cardiac, brain and kidney damage, and lead to cardiovascular and renal complications. We focus on patients with essential hypertension because this is the most prevalent form of hypertension, and describe other forms of hypertension only for contrasting their characteristics with those of uncomplicated essential hypertension. © 2015 American Heart Association, Inc.
    Circulation Research 03/2015; 116(6):1007-1021. DOI:10.1161/CIRCRESAHA.116.303596 · 11.02 Impact Factor
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    ABSTRACT: In recent years, many studies emphasized the role of arterial remodeling in the development of cardiovascular diseases, and it was shown that stiffening of arteries is associated with increased cardiovascular mortality and morbidity. Moreover, arterial stiffening is linked to decreased glomerular filtration rate, and is predictive of kidney-disease progression and the patient's cardiovascular outcome. Early vascular aging and arterial stiffening are observed with progression of chronic kidney disease (CKD) and in end-stage renal disease (ESRD). This accelerated aging is associated with outward remodeling of large vessels, characterized by increased arterial radius not totally compensated for by artery wall hypertrophy. The mechanisms involved in large artery remodelling associated with CKD are complex including arterial calcification, inflammation, oxidative stress in association with mineral and bone metabolism disorders. Arterial stiffening in CKD and ESRD patients is of multifactorial origin with extensive arterial calcifications representing a major covariate. With aging, arterial stiffening is more pronounced in the aorta than peripheral conduit arteries, leading to the disappearance or inversion of the arterial stiffness gradient and less protection of the microcirculation from high-pressure transmission. Various non-pharmacological or pharmacological interventions can modestly slow the progression of arterial stiffness, but arterial stiffness is, in part, pressure-dependent and treatments able to stop the process mainly include antihypertensive drugs.
  • P. Boutouyrie · L. Macron · E. Mousseaux · S. Laurent
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    ABSTRACT: Large artery stiffness can be measured through direct and indirect techniques. Measurement of pulse wave propagation is among the most direct techniques, either through pulse wave velocity or through artificial pressure wave propagation. Measurement of strain and stress through echotracking techniques gives also direct, hypothesis-free measurement of arterial stiffness. Other techniques are derived from models of circulation and can approximate arterial stiffness. Details about techniques, parameter definition, are given here to help researchers and practitioners to make the best choice of technique for their applications.
  • H. Beaussier · S. Laurent · P. Boutouyrie
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    ABSTRACT: Change in arterial stiffness with drugs is a major end point in clinical trials, although evidence for arterial stiffness as a therapeutic target still needs to be confirmed. Drugs which affect arterial stiffness include antihypertensive drugs, mostly blockers of the renin-angiotensin-aldosterone system. Other drugs will be addressed in Chap. 40. Whether the reduction in arterial stiffness after antihypertensive treatment is only due to the blood pressure (BP) lowering which unloads the stiff components of the arterial wall such as collagen, or additional BP-independent effects are involved, has been largely debated. Currently, an increasing body of evidence, including theoretical aspects of arterial mechanics, long-term observational studies in humans and recent meta-analyses of double-blind, randomized, controlled trials, suggests that only part of aortic stiffness could be reduced through the normalization of BP by pharmacological treatment, and further reduction of aortic stiffness would require arterial structural changes, including reduction in collagen density and rearrangement of the wall materials. Mechanistic pharmacological studies are required to demonstrate that novel pharmacological classes have true de-stiffening properties.
  • S. Laurent · P. Boutouyrie · F.M. Raso
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    ABSTRACT: A major reason for measuring arterial stiffness routinely in clinical practice comes from the recent demonstration that arterial stiffness has an independent predictive value for cardiovascular events. Several longitudinal epidemiological studies have demonstrated the predictive value of arterial stiffness as intermediate endpoints, i.e. The higher the arterial stiffness, the higher the number of cardiovascular events. The largest amount of evidence has been given for aortic stiffness, measured through carotid-femoral pulse wave velocity which is considered as gold standard. Aortic stiffness has independent predictive value for all-cause and cardiovascular mortality, fatal and nonfatal coronary events and fatal strokes not only in patients with uncomplicated essential hypertension but also in patients with type 2 diabetes or end-stage renal disease, in elderly subjects and in the general population. Currently, as many as 21 studies consistently showed the independent predictive value of aortic stiffness for fatal and nonfatal cardiovascular events in various populations. Aortic stiffness can thus be considered as an intermediate endpoint for cardiovascular events.
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    ABSTRACT: Systemic hypertension is a frequent side effect of antiangiogenic drugs (AADs) and may represent a marker of efficacy on cancer. We hypothesized that large artery properties are affected by AADs, and contribute to the rise of blood pressure and may be better related to cancer progression and mortality than hypertension. Participants were studied before AADs (V0), 10 days later (V1) and then every 2 weeks for 6 weeks (V1-V4). We included 57 consecutive patients in whom treatment with sorafenib (400 mg twice daily) or sunitinib (37.5-50 mg once daily) was indicated. The target dose could be adjusted according to tolerance and response. Aortic and carotid stiffness, brachial and central blood pressure and augmentation index were measured noninvasively at each visit. Data regarding cancer progression and mortality were collected at 6 months. Twenty-eight patients (49%) developed hypertension. Brachial SBP significantly increased during follow-up (V0-V1: +9.6 ± 15.2 mmHg, P < 0.001; V0-V4: +6.0 ± 17.8 mmHg, P = 0.04). Central BP, and aortic and carotid stiffness increased independently of brachial BP changes. Aortic and carotid stiffening were associated with cancer progression independently of BP changes [hazard risk 1.24 (1.01-1.51) and 1.34 (1.03-1.73), respectively; P < 0.05], but not with cancer mortality. Brachial SBP had no predictive value. Large arteries stiffen during AAD treatment partly independently of BP changes. Arterial mechanical properties are associated with BP rise. Arterial stiffening is related with the effects of AAD on cancer progression independently of BP changes. Large artery properties might help monitor AAD therapy in cancer patients.
    Journal of Hypertension 02/2015; 33(6). DOI:10.1097/HJH.0000000000000550 · 4.72 Impact Factor

Publication Stats

23k Citations
1,791.31 Total Impact Points


  • 2006–2015
    • Université René Descartes - Paris 5
      • • Faculty of medicine
      • • Faculté de Médecine
      Lutetia Parisorum, Île-de-France, France
  • 2005–2015
    • Assistance Publique – Hôpitaux de Paris
      Lutetia Parisorum, Île-de-France, France
  • 2001–2015
    • Hôpital Européen Georges-Pompidou (Hôpitaux Universitaires Paris-Ouest)
      • • Service de Pharmacie
      • • Service de Pharmacologie
      Lutetia Parisorum, Île-de-France, France
  • 1987–2014
    • Unité Inserm U1077
      Caen, Lower Normandy, France
  • 2013
    • Lund University
      • Department of Clinical Sciences, Malmö
      Lund, Skåne, Sweden
  • 1988–2012
    • French Institute of Health and Medical Research
      Lutetia Parisorum, Île-de-France, France
  • 2010
    • Università degli Studi di Perugia
      Perugia, Umbria, Italy
  • 2008–2010
    • Pierre and Marie Curie University - Paris 6
      • Centre de recherche des Cordeliers - UMR_S 872
      Lutetia Parisorum, Île-de-France, France
  • 2007–2010
    • Università degli Studi di Milano-Bicocca
      Milano, Lombardy, Italy
  • 1988–1999
    • Hôtel-Dieu de Paris – Hôpitaux universitaires Paris Centre
      Lutetia Parisorum, Île-de-France, France
  • 1998
    • ICPS - Institut Cardiovasculaire Paris Sud
      Île-de-France, France
  • 1990–1998
    • American Hospital of Paris
      Lutetia Parisorum, Île-de-France, France