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Madhur MS, Elijovich F, Alexander MR, Pitzer A, Ishimwe J, Van Beusecum JP, Patrick DM, Smart CD, Kleyman TR, Kingery J, Peck RN, Laffer CL, Kirabo A. Hypertension: Do Inflammation and Immunity Hold the Key to Solving this Epidemic? Circ Res 2021; 128:908-933. [PMID: 33793336 PMCID: PMC8023750 DOI: 10.1161/circresaha.121.318052] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Elevated cardiovascular risk including stroke, heart failure, and heart attack is present even after normalization of blood pressure in patients with hypertension. Underlying immune cell activation is a likely culprit. Although immune cells are important for protection against invading pathogens, their chronic overactivation may lead to tissue damage and high blood pressure. Triggers that may initiate immune activation include viral infections, autoimmunity, and lifestyle factors such as excess dietary salt. These conditions activate the immune system either directly or through their impact on the gut microbiome, which ultimately produces chronic inflammation and hypertension. T cells are central to the immune responses contributing to hypertension. They are activated in part by binding specific antigens that are presented in major histocompatibility complex molecules on professional antigen-presenting cells, and they generate repertoires of rearranged T-cell receptors. Activated T cells infiltrate tissues and produce cytokines including interleukin 17A, which promote renal and vascular dysfunction and end-organ damage leading to hypertension. In this comprehensive review, we highlight environmental, genetic, and microbial associated mechanisms contributing to both innate and adaptive immune cell activation leading to hypertension. Targeting the underlying chronic immune cell activation in hypertension has the potential to mitigate the excess cardiovascular risk associated with this common and deadly disease.
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Affiliation(s)
- Meena S. Madhur
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center
- Department of Molecular Physiology and Biophysics, Vanderbilt University
| | - Fernando Elijovich
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Matthew R. Alexander
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center
| | - Ashley Pitzer
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jeanne Ishimwe
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Justin P. Van Beusecum
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - David M. Patrick
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center
| | - Charles D. Smart
- Department of Molecular Physiology and Biophysics, Vanderbilt University
| | - Thomas R. Kleyman
- Departments of Medicine, Cell Biology, Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Justin Kingery
- Center for Global Health, Weill Cornell Medical College, New York, NY, USA
- Department of Medicine, Weill Bugando School of Medicine, Mwanza, Tanzania
| | - Robert N. Peck
- Center for Global Health, Weill Cornell Medical College, New York, NY, USA
- Department of Medicine, Weill Bugando School of Medicine, Mwanza, Tanzania
- Mwanza Intervention Trials Unit (MITU), Mwanza, Tanzania
| | - Cheryl L. Laffer
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Annet Kirabo
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Molecular Physiology and Biophysics, Vanderbilt University
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Park S, Han K, Lee S, Kim Y, Lee Y, Kang MW, Park S, Kim YC, Han SS, Lee H, Lee JP, Joo KW, Lim CS, Kim YS, Kim DK. Cardiovascular or mortality risk of controlled hypertension and importance of physical activity. Heart 2021; 107:1472-1479. [PMID: 33402363 DOI: 10.1136/heartjnl-2020-318193] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/04/2020] [Accepted: 11/09/2020] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To investigate the risk of major adverse cardiac and cerebrovascular events (MACCEs) and all-cause death of patients with controlled hypertension and suggest the benefits of physical activity in their prognosis. METHODS People aged 40-69 years from the prospective UK Biobank cohort (UKB, n=220 026) and the retrospective Korean National Health Insurance Service cohort (KNHIS, n=3 593 202) were included in this observational cohort study, excluding those with previous cerebrocardiovascular diseases or hypertension without treatment. The study groups were stratified into normotension, controlled hypertension (patients with hypertension with systolic blood pressure <140 mm Hg and diastolic blood pressure <90 mm Hg) and uncontrolled hypertension groups. The outcomes were MACCEs and all-cause mortality, analysed by Cox regression analysis. RESULTS We included 161 405/18 844/39 777 and 3 122 890/383 828/86 484 individuals with normotension/controlled hypertension/uncontrolled hypertension state from the UKB and KNHIS cohorts, respectively. The controlled hypertension group showed significantly higher risk of MACCEs (UKB: adjusted HR 1.73 (95% CI 1.55 to 1.92); KNHIS: 1.46 (95% CI 1.43 to 1.49)) and all-cause mortality (UKB: adjusted HR 1.28 (95% CI 1.18 to 1.39); KNHIS: 1.29 (95% CI 1.26 to 1.32)) than individuals with normotension. The controlled hypertension group not involved in any moderate or moderate-to-vigorous physical activity showed high risk of adverse outcomes, which was comparable with or even higher than the risk of patients with uncontrolled hypertension who were engaged in physical activity. CONCLUSIONS Controlled hypertension is associated with residual risks of adverse outcomes. Clinicians may encourage physical activity for patients with controlled hypertension, not being reassured by their achieved target blood pressure values.
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Affiliation(s)
- Sehoon Park
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea (the Republic of).,Department of Internal Medicine, Armed Forces Capital Hospital, Gyeonggi-do, Korea (the Republic of)
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea (the Republic of)
| | - Soojin Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (the Republic of)
| | - Yaerim Kim
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea (the Republic of)
| | - Yeonhee Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (the Republic of)
| | - Min Woo Kang
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (the Republic of)
| | - Sanghyun Park
- Department of Medical Statistics, College of Medicine, Catholic University of Korea, Seoul, Korea (the Republic of)
| | - Yong Chul Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (the Republic of)
| | - Seung Seok Han
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (the Republic of)
| | - Hajeong Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (the Republic of)
| | - Jung Pyo Lee
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea (the Republic of).,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea (the Republic of).,Kidney Research Institute, Seoul National University, Seoul, Korea (the Republic of)
| | - Kwon Wook Joo
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (the Republic of).,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea (the Republic of).,Kidney Research Institute, Seoul National University, Seoul, Korea (the Republic of)
| | - Chun Soo Lim
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea (the Republic of).,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea (the Republic of).,Kidney Research Institute, Seoul National University, Seoul, Korea (the Republic of)
| | - Yon Su Kim
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea (the Republic of).,Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (the Republic of).,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea (the Republic of).,Kidney Research Institute, Seoul National University, Seoul, Korea (the Republic of)
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (the Republic of) .,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea (the Republic of).,Kidney Research Institute, Seoul National University, Seoul, Korea (the Republic of)
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Elijovich F, Kirabo A, Laffer CL. Hypothesis: Unrecognized actions of ENaC blockade in improving refractory-resistant hypertension and residual cardiovascular risk. Int J Cardiol Hypertens 2020; 7:100048. [PMID: 33447773 PMCID: PMC7803029 DOI: 10.1016/j.ijchy.2020.100048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 09/04/2020] [Indexed: 11/16/2022] Open
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Blood pressure and cognitive performances in middle-aged adults: the Aging, Health and Work longitudinal study. J Hypertens 2020; 37:1244-1253. [PMID: 30624363 DOI: 10.1097/hjh.0000000000002013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Our objective was to investigate the impact of both prevalent and incident hypertension on cognition in middle-aged individuals followed up for 10 years and to explore the extent to which blood pressure control by antihypertensive drugs could modify this relationship. METHOD Three thousand, two hundred and one participants from the Vieillissement Santé Travail (Aging, Health and Work) (VISAT) cohort study, aged 32, 42, 52 and 62 years at baseline were followed up 5 and 10 years later. Blood pressure, antihypertensive medication use as well as memory and speed cognitive performances were assessed at baseline and follow-up. Linear mixed models were used for analyses. RESULTS At 10-year follow-up, compared with nonhypertensive participants, prevalent hypertensive individuals showed poorer global cognitive performances (β = -2.99 ± 0.96, P = 0.002 for participants aged 32 or 42 years at baseline and β = -5.94 ± 1.00, P < 0.001 for those aged 52 or 62). Patients with incident hypertension had poorer global cognitive performances over time compared with patients without hypertension. When considering prevalent hypertension and blood pressure control status by antihypertensive therapy, untreated and uncontrolled hypertension were associated with poorer cognitive performances than controlled and no hypertension (untreated hypertension compared with no hypertension: β = -5.51 ± 0.75, P < 0.001; uncontrolled hypertension compared with no hypertension: β = -6.13 ± 1.40, P < 0.001). CONCLUSION Our findings showed that both prevalent and incident hypertension are associated with poorer global cognitive function in middle-aged individuals and suggested a potential preventive effect of antihypertensive therapy on cognition. Thus, for brain functioning, heightened efforts to detect hypertension and adequately treat it are of critical importance.
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Amar J. [Host-microbiota crosstalk and cardiovascular diseases]. Presse Med 2018; 47:775-779. [PMID: 29909161 DOI: 10.1016/j.lpm.2018.03.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 03/27/2018] [Indexed: 12/12/2022] Open
Abstract
When analyzing the microbiota-host crosstalk, we have to consider three participants in this dialogue: the gut microbiota, the intestinal barrier and bacterial translocation. Experimental data demonstrate that host microbiota crosstalk plays a causal on the regulation of blood pressure, glucose metabolism and the development of atherosclerosis. Host microbiota crosstalk is associated in humans with main cardiovascular risk factors notably hypertension and type 2 diabetes. Host microbiota crosstalk is associated in humans with the onset of cardiovascular diseases. The Mediterranean diet has proven as proven to be an effective strategy in improving cardiovascular prognosis and in changing gut microbiota.
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Affiliation(s)
- Jacques Amar
- CHU de Toulouse, ESH excellence center, fédération de cardiologie, service d'hypertension artérielle, 1, avenue du Professeur-Jean-Poulhès, TSA 50032, 31059 Toulouse cedex 9, France.
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Bérard E, Bongard V, Dallongeville J, Arveiler D, Amouyel P, Wagner A, Cottel D, Haas B, Ruidavets JB, Ferrières J. Impact of cardiovascular risk factor control on long-term cardiovascular and all-cause mortality in the general population. Ann Med 2016; 48:559-567. [PMID: 27558835 DOI: 10.1080/07853890.2016.1217035] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
PURPOSE In clinical trials, lowering cardiovascular risk factors (CVRFs) reduces cardiovascular (CV) morbidity and mortality. We assessed the impact of controlling CVRFs at baseline on long-term all-cause and CV mortality in the general population. METHODS Analysis was based on the Third French MONICA population-based survey (1994-1997). Vital status was obtained 18 years after inclusion. Statistical analysis was based on Cox-modelling. RESULTS About 3402 participants aged 35-64 were included and 569 (17%) presented with 2 or more uncontrolled CVRFs, 1194 (35%) had one uncontrolled CVRF, 770 (23%) had all CVRFs controlled under treatment (or were former smokers) and 869 (25%) exhibited no CVRF. During the follow-up, 389 deaths occurred (76 were due to CV causes). Considering all-cause mortality, the adjusted hazard ratios (aHR) for subjects with one uncontrolled CVRF and for those with two or more were 1.38 [1.03-1.83] (p = 0.029) and 1.80 [1.33-2.43](p < 0.001), respectively, as compared with subjects presenting with all their CVRFs controlled. For subjects exhibiting no CVRF, the aHR was 0.66 [0.44-0.98] (p = 0.042). Considering CV mortality, aHRs for subjects presenting with one and two or more uncontrolled CVRF were 1.70 [0.84-3.42] (p = 0.138) and 3.67 [1.85-7.29] (p < 0.001), respectively, as compared with subjects who had either all their CVRFs controlled or exhibited no CVRF. CONCLUSIONS Failing to control CVRFs significantly increases long-term all-cause and CV mortality in the French general population. Key messages Only 30% of patients with cardiovascular risk factors were controlled. Failing to control cardiovascular risk factors significantly increased long-term cardiovascular and all-cause mortality. A residual risk for all-cause mortality remained even when patients were controlled.
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Affiliation(s)
- Emilie Bérard
- a Department of Epidemiology, Health Economics and Public Health , UMR1027 INSERM- Toulouse III University, Toulouse University Hospital (CHU) , Toulouse , France
| | - Vanina Bongard
- a Department of Epidemiology, Health Economics and Public Health , UMR1027 INSERM- Toulouse III University, Toulouse University Hospital (CHU) , Toulouse , France
| | - Jean Dallongeville
- b Department of Epidemiology and Public Health , INSERM UMR744, Pasteur Institute of Lille, Lille Nord De France University - UDSL , Lille , France
| | - Dominique Arveiler
- c Department of Epidemiology and Public Health , EA 3430, FMTS, Strasbourg University , Strasbourg , France.,d Department of Public Health , Strasbourg University Hospital , Strasbourg , France
| | - Philippe Amouyel
- b Department of Epidemiology and Public Health , INSERM UMR744, Pasteur Institute of Lille, Lille Nord De France University - UDSL , Lille , France
| | - Aline Wagner
- c Department of Epidemiology and Public Health , EA 3430, FMTS, Strasbourg University , Strasbourg , France
| | - Dominique Cottel
- b Department of Epidemiology and Public Health , INSERM UMR744, Pasteur Institute of Lille, Lille Nord De France University - UDSL , Lille , France
| | - Bernadette Haas
- c Department of Epidemiology and Public Health , EA 3430, FMTS, Strasbourg University , Strasbourg , France
| | - Jean-Bernard Ruidavets
- a Department of Epidemiology, Health Economics and Public Health , UMR1027 INSERM- Toulouse III University, Toulouse University Hospital (CHU) , Toulouse , France
| | - Jean Ferrières
- a Department of Epidemiology, Health Economics and Public Health , UMR1027 INSERM- Toulouse III University, Toulouse University Hospital (CHU) , Toulouse , France.,e Department of Cardiology B , Toulouse University Hospital (CHU) , Toulouse , France
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Blacher J, Levy BI, Mourad JJ, Safar ME, Bakris G. From epidemiological transition to modern cardiovascular epidemiology: hypertension in the 21st century. Lancet 2016; 388:530-2. [PMID: 26856636 DOI: 10.1016/s0140-6736(16)00002-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Jacques Blacher
- Diagnosis and Therapeutic Centre, Hôtel-Dieu University Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Descartes University, Paris, France.
| | - Bernard I Levy
- Vessels and Blood Institute, Lariboisière University Hospital, Paris, France; Paris Cardiovascular Research Centre, INSERM U970, Paris, France
| | - Jean-Jacques Mourad
- Department of Internal Medicine, Avicenne University Hospital, Assistance Publique-Hôpitaux de Paris, University Paris 13, Bobigny, France
| | - Michel E Safar
- Diagnosis and Therapeutic Centre, Hôtel-Dieu University Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Descartes University, Paris, France
| | - George Bakris
- Department of Medicine, American Society of Hypertension Comprehensive Hypertension Center, University of Chicago Medicine, IL, USA
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Kong D, Wang Y, Liu Y, Zhang Z, Liu G, Qi W, Xiao L, Yuan D, Yang G. The association between blood lipid and phlegm turbidity syndrome of angina pectoris: a systematic review and meta-analysis. Complement Ther Med 2014; 22:801-13. [PMID: 25146084 DOI: 10.1016/j.ctim.2014.05.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 05/08/2014] [Accepted: 05/14/2014] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND A series of case-control studies have been conducted to investigate the association between blood lipid and phlegm turbidity syndrome of angina pectoris, but produced inconsistent results. OBJECTIVE We performed a meta-analysis to determine the association between blood lipid and phlegm turbidity syndrome of angina pectoris more precisely. METHODS Manual screening as well as screening of the China National Knowledge Infrastructure (CNKI), Chinese Journal full-text database (VIP), Wanfang database (WF), ScienceDirect, Pubmed, the Cochrane Library, and Embase were carried out for relevant literature. The formula was translated to calculate the pooled mean value and standard deviation value. The "Newcastle-Ottawa Quality Assessment Scale: Case-Control Studies" (NOS) was taken to assess the quality of the included studies. The Revman 5.2.6 software provided by "The Cochrane Collaboration" was used to analyze the collected data. The subgroup analysis was established according to the sample size proportion between the test group and the control group. Sensitivity analysis was constructed by using two different effect models. Besides, a funnel plot was created to analyze potential publication bias. RESULTS No statistically meaningful difference existed between the test group and control group of total cholesterol (TC) and low-density lipoprotein-cholesterol (LDL-C) in non-Qi and yin deficiency syndrome (QYDS) and non-Yang deficiency syndrome (YDS) subgroup, whereas the two biotic indicators in the test group were higher than the non-phlegm syndrome group in other subgroups. Triglyceride (TG) in phlegm syndrome group showed superior to non-phlegm syndrome group in the rest subgroups except for the non-CCS (Cold coagulating syndrome)-non-YDS subgroup. High-density lipoprotein-cholesterol (HDL-C) levels of the phlegm group were lower than that of the non-phlegm group in all subgroups. CONCLUSION When comparing with Traditional Chinese Medicine (TCM) syndromes of asthenia nature, such as YDS, QYDS, and heart qi deficiency syndrome), the levels of TG, TC, and LDL-C were higher in phlegm turbidity syndrome. However, for sthenia syndromes such as Qi stagnation syndrome (QSS), heart blood stasis syndrome (HBSS), and CCS, there was no obvious difference. Furthermore, HDL-C levels in the phlegm turbidity group were lower than those of the non-phlegm group. Nevertheless, these results should be confirmed with further studies.
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Affiliation(s)
- Dezhao Kong
- The Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Liaoning 110032, China
| | - Yang Wang
- The Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Liaoning 110032, China
| | - Yue Liu
- The Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Liaoning 110032, China
| | - Zhe Zhang
- The Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Liaoning 110032, China
| | - Guanghui Liu
- The Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Liaoning 110032, China
| | - Wencheng Qi
- The Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Liaoning 110032, China
| | - Lei Xiao
- The Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Liaoning 110032, China
| | - Dongchao Yuan
- Liaoning University of Traditional Chinese Medicine, Liaoning 110032, China
| | - Guanlin Yang
- Liaoning University of Traditional Chinese Medicine, Liaoning 110032, China.
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Amar J, Lange C, Payros G, Garret C, Chabo C, Lantieri O, Courtney M, Marre M, Charles MA, Balkau B, Burcelin R. Blood microbiota dysbiosis is associated with the onset of cardiovascular events in a large general population: the D.E.S.I.R. study. PLoS One 2013; 8:e54461. [PMID: 23372728 PMCID: PMC3555817 DOI: 10.1371/journal.pone.0054461] [Citation(s) in RCA: 152] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2012] [Accepted: 12/11/2012] [Indexed: 02/07/2023] Open
Abstract
Aim We recently described a human blood microbiome and a connection between this microbiome and the onset of diabetes. The aim of the current study was to assess the association between blood microbiota and incident cardiovascular disease. Methods and Results D.E.S.I.R. is a longitudinal study with the primary aim of describing the natural history of the metabolic syndrome and its complications. Participants were evaluated at inclusion and at 3-, 6-, and 9-yearly follow-up visits. The 16S ribosomal DNA bacterial gene sequence, that is common to the vast majority of bacteria (Eubac) and a sequence that mostly represents Proteobacteria (Pbac), were measured in blood collected at baseline from 3936 participants. 73 incident cases of acute cardiovascular events, including 30 myocardial infarctions were recorded. Eubac was positively correlated with Pbac (r = 0.59; P<0.0001). In those destined to have cardiovascular complications, Eubac was lower (0.14±0.26 vs 0.12±0.29 ng/µl; P = 0.02) whereas a non significant increase in Pbac was observed. In multivariate Cox analysis, Eubac was inversely correlated with the onset of cardiovascular complications, (hazards ratio 0.50 95% CI 0.35–0.70) whereas Pbac (1.56, 95%CI 1.12–2.15) was directly correlated. Conclusion Pbac and Eubac were shown to be independent markers of the risk of cardiovascular disease. This finding is evidence for the new concept of the role played by blood microbiota dysbiosis on atherothrombotic disease. This concept may help to elucidate the relation between bacteria and cardiovascular disease.
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Affiliation(s)
- Jacques Amar
- INSERM U1048, Institute of Research on Metabolic and Cardiovascular Diseases, CHU Toulouse, Toulouse, France.
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Blacher J, Evans A, Arveiler D, Amouyel P, Ferrières J, Bingham A, Yarnell J, Haas B, Montaye M, Ruidavets JB, Ducimetière P. Residual cardiovascular risk in treated hypertension and hyperlipidaemia: the PRIME Study. J Hum Hypertens 2009; 24:19-26. [DOI: 10.1038/jhh.2009.34] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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The Data from an Epidemiologic Study on the Insulin Resistance Syndrome Study: the change and the rate of change of the age–blood pressure relationship. J Hypertens 2008; 26:1903-11. [DOI: 10.1097/hjh.0b013e32830b8937] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Arterial stiffness and central hemodynamics in treated hypertensive subjects according to brachial blood pressure classification. J Hypertens 2008; 26:130-7. [PMID: 18090550 DOI: 10.1097/hjh.0b013e3282f16a9c] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND International recommendations have classified brachial blood pressure (BP) in subgroups enabling better cardiovascular risk stratification. Central BP is an independent predictor of cardiovascular risk, differing from brachial BP through the predominant influence of arterial stiffness and wave reflections. Central BP has never been studied in relation to international guidelines for brachial BP classification. METHODS In 580 chronically treated hypertensive subjects we measured: carotid-femoral pulse wave velocity (PWV), carotid artery augmentation index (AI) and carotid blood pressures, using applanation tonometry and pulse wave analysis, and using brachial BP for carotid pressure wave calibration. RESULTS For each given brachial value, carotid systolic blood pressure (SBP) and PP were significantly lower than the corresponding brachial SBP and PP. This pressure amplification was significantly lower in the 'optimal' and 'normal' BP ranges (6.8-7.4 mmHg) than in the higher BP ranges (10.1-11.3 mmHg), mainly depending on heart rate (HR) and PWV levels. PWV gradually increased as a function of brachial BP classification and was a significant predictor of this classification independently of age, drug treatment, atherosclerotic lesions and even mean BP. Finally, PWV was a highly sensitive marker of the effective BP control throughout all decades of age. CONCLUSION Under chronic antihypertensive therapy, central BP does not strictly parallel the corresponding brachial BP classification, depending on differences in aortic stiffness and HR. Whether aortic PWV might predict the brachial BP classification and/or the presence of effective BP control, as suggested in this study, needs further confirmation.
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Pulse pressure amplification, adiposity and metabolic syndrome in subjects under chronic antihypertensive therapy: The role of heart rate. Atherosclerosis 2008; 199:222-9. [DOI: 10.1016/j.atherosclerosis.2007.09.033] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2007] [Revised: 09/03/2007] [Accepted: 09/24/2007] [Indexed: 11/23/2022]
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Cardiovascular impact of exercise and drug therapy in older hypertensives with coronary heart disease: PREHACOR study. Heart Vessels 2008; 23:20-5. [DOI: 10.1007/s00380-007-1004-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2006] [Accepted: 07/13/2007] [Indexed: 11/25/2022]
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Affiliation(s)
- Michel E Safar
- Paris Descartes University, Faculty of Medicine, AP-HP, Diagnosis Center, Hôtel-Dieu Hospital, Paris, France.
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Abstract
PURPOSE OF REVIEW Cardiovascular risk scoring is incorporated in guidelines and recommended for targeting preventive treatment. Evidence is required on the most appropriate method, its accuracy in a given population, and its effectiveness in favourably influencing clinical behaviour and health outcomes. RECENT FINDINGS Recent risk scores address inaccuracies that arise when methods are transferred between populations, and specific methods and recalibrations are described for use in low-risk populations. Ethnic and social differences in risk are also recognized in the context of cardiovascular risk scoring. More sensitive measures of known risk factors and numerous emerging risk factors are reported and new statistical methods and sources of data suggested. Little emphasis has been placed on evaluation of the clinical effectiveness of cardiovascular risk scores. Education in cardiovascular risk assessment may help improve uptake of methods by healthcare professionals. SUMMARY Numerous risk scoring methods are available to the healthcare professional but use is patchy. Accuracy varies between populations and methods have been developed to compensate for some of this variability. If risk scoring methods are to be widely used in general practice, evidence is required on both the accuracy of methods in appropriate populations and their effectiveness in improving health outcomes.
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Affiliation(s)
- Andrew Beswick
- MRC Health Services Research Collaboration, University of Bristol, UK.
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Blacher J, Baes M, Marchal A, Younes W, Legedz L, Safar M. Nouvelles stratégies thérapeutiques dans l’hypertension artérielle. Presse Med 2005; 34:1279-85. [PMID: 16269990 DOI: 10.1016/s0755-4982(05)84174-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The diagnosis of hypertension by blood pressure measurements taken in the physician's office has been called into question by several studies. The onset of cardiovascular events appears to correlate better with ambulatory blood pressure measurements than with those taken during consultation (either "white coat" or masked hypertension). While the US, WHO, French and European guidelines diverge as to the specific antihypertensive drug among the seven classes available should be chosen for first-line treatment, there is a consensus for specific choices as a function of the type of hypertension. In any case, most treatment trials show that more than two antihypertensive drugs are often necessary. Treatment can thus begin with two drugs. The optimal target blood pressure is defined by the US JNC7 according to whether the patient also has diabetes or a nephropathy. When hypertension is uncomplicated, the target level is 140/90 mmHg. In the case of diabetes or nephropathy, it is 130/80 mmHg. In all cases, diet and exercise changes are also necessary and it is essential that patients understand them if they are to comply with them. Diastolic blood pressure remains the most important figure for those younger than 50 years, but afterwards, systolic pressure is more relevant. Aortic pressure may be more closely associated with cardiovascular risk than the blood pressure measured at the brachial artery. The concept of comprehensive management is radically modifying our behavior : the hypertensive patient is now above all a patient at high cardiovascular risk and the treatments to consider must not be limited to antihypertensive drugs but must also include treatment of other cardiovascular risk factors (aspirin, statins, smoking cessation, etc.).
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Affiliation(s)
- J Blacher
- Unité hypertension artérielle, soins et prévention cardiovasculaires, centre de diagnostic, Hôtel-Dieu, APHP, Paris.
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