Prevalence, awareness, treatment, and control of hypertension in the elderly: the Three City study

OBJECTIVE: To study management of hypertension in the elderly in a large population-based study and to evaluate the prevalence of hypertension and factors related to awareness, treatment, and control. DESIGN: The Three City study, a population-based study among 9693 non-institutionalized individuals aged 65 years and over. METHODS: Blood pressure was measured with an automated electronic device, and treatment assessed, during home interview. Hypertension was defined by a mean blood pressure of two measurements superior to or equal to 160/95 mmHg and/or the intake of antihypertensive medications. RESULTS: In the final working sample of 9090 people, 62% were hypertensive. More than two-thirds were aware of their hypertension and 81% were treated with antihypertensive drugs. Among 4573 treated hypertensive participants, 35% had a blood pressure over 160/95 mmHg and 69% over 140/90 mmHg. Women were more frequently aware of their hypertension, more frequently treated, and more frequently controlled than men. A history of cardiovascular disease, high body mass index, diabetes and high frequency of visits to the general practitioner were related to higher percentages of awareness and treatment. Among treated hypertensive patients, those with a history of cardiovascular events or who visited their general practitioner more often or who more often had their blood pressure measured were more frequently controlled. Awareness was strongly associated with treatment, but was inversely related to control of hypertension among treated hypertensive patients. CONCLUSIONS: Management of hypertension, and particularly its control among treated hypertensive patients, needs to be improved in people aged 65 years and over.     

Changes in the tonic activity of wrist extensor motor units induced by stimulating antagonistic group I afferents in humans

The question as to whether the firing patterns of low- and high-threshold motor units in the extensor carpi radialis muscles are affected differently by group I afferents from the wrist flexors depending on the motor task being performed was investigated in six subjects. The motor units were voluntarily activated during a task consisting of either selectively contracting the wrist extensor muscles or co-activating the wrist and finger antagonist muscles by clenching the hand around a manipulandum. The motor units (n=40) were identified on the basis of their firing thresholds, their macro-potential areas, and their twitch contraction times. The effects on the motor-unit tonic activity of stimulating the wrist flexor afferents were assessed in terms of the changes in the firing probability, which were analysed after computing peri-stimulus time histograms using the cumulative sum procedure. Median nerve stimulation induced four main changes in the tonic firing pattern of the extensor motor units. An early, short-lasting increase in the firing probability (event E1) was found to occur in the high-threshold motor units, either in both tasks (6/13) or only during hand clenching (2/13). A short-latency decrease in the firing probability (event E2) was found to occur in all the motor units, the amount of which increased from the fast- to slowly contracting motor units, especially during hand clenching. A later decrease (event E3) followed by a large, late increase (event E4) in the tonic activity of the motor units was found to occur in all the motor units, without any task-dependent effects. All these various events were consistently observed in 12 pairs of motor units, each consisting of one slowly and one fast-contracting motor unit, which were tested simultaneously. These findings suggest that median nerve stimulation may selectively alter the tonic firing patterns of identified extensor motor units, depending on their functional characteristics (recruitment threshold, motor unit macro-potential area, contraction time) rather than on the excitatory drive to the motoneurone pool. The possible origins of these various events are discussed, and it is argued that, in the wrist extensor and flexor muscles that act as synergists during manipulatory finger movements and gripping tasks, the spinal pathways which assist the voluntary command may selectively modulate the firing patterns of identified motor units, to fit the requirements of the on-going motor task.     

Autoimmune diseases in myelodysplastic syndrome favors patients survival: A case control study and literature review

Background

We conducted a monocentric retrospective study of patients with myelodysplastic syndromes (MDS) and autoimmune or inflammatory disorders (AIMs) and a literature review. We analyzed the association with subgroups of the WHO 2016 MDS classification and patient's survival in a case control study. Risk factors associated with survival were analyzed by uni- and multivariate analysis.

Giant hemangioma of the liver revealed by an inflammatory syndrome

We report two cases of giant hemangioma of the liver revealed by a clinico-biological syndrome including fever, right upper quadrant pain and a biological inflammatory syndrome, whereas liver function tests and blood cell count were normal. This clinical presentation may help in the diagnosis of giant hemangioma of the liver.     

Validation of the Friedewald formula for the determination of low-density lipoprotein cholesterol compared with beta-quantification in a large population

Lipoprotein data from 9477 subjects, covering a wide range of total plasma cholesterol levels, were used to examine the validity of the Friedewald formula for estimating plasma concentrations of low-density lipoprotein cholesterol (LDL-C) using high-density lipoprotein cholesterol (HDL-C) and triglyceride (TG) concentrations. Values of LDL-C obtained from the Friedewald formula were compared with values of LDL-C derived from preparative ultracentrifugation used as a reference method. We found that the bias associated with the Friedewald formula was not related to plasma LDL-C levels and was smaller than −4.0% even for plasma LDL-C values <3.0 mmol/l. Moreover, in the subgroup of individuals with plasma TG levels ≤4.5 mmol/l, the Friedewald formula underestimated LDL-C levels with a bias between −3.1% and −1.9% according to TG quartiles. Interestingly, the Friedewald formula showed no significant bias in patients with plasma TG levels between 4.51 and 8.82 mmol/l, suggesting that the calculated LDL-C are reliable and could be clinically useful in patients with plasma TG levels higher than 4.5 mmol/l which is the reference cut-point value used by most clinical laboratories. Finally, multiple regression analyses showed that the very low-density lipoprotein cholesterol (VLDL-C)/TG ratio represented nearly 63% (P < 0.0001) of the variance of the bias associated with the Friedewald formula. We concluded that the Friedewald formula may be reliable at low LDL-C levels and at TG levels up to 9 mmol/l but may be used with caution when the VLDL-C/TG ratio is high as observed in patients with type III dysbetalipoproteinemia.     

Effects of differential blockade of the renin-angiotensin system in postinfarcted rats

The present study compared short-term effects of the AT(1)-receptor antagonist, irbesartan with the angiotensin-converting enzyme (ACE) inhibitor, enalapril on systemic haemodynamics and cardiac remodelling in post-myocardia-infarcted (MI) rats. MI Sprague-Dawley rats were orally treated for 4 weeks with irbesartan (50 mg/kg/day) or enalapril (10 mg/kg/day). Then, cardiac and systemic haemodynamics were measured. Compared with the sham-operated group, left ventricular end-diastolic pressure (LVEDP), diastolic pressure (LVDP), heart weight to body weight ratio were all significantly increased in the MI group while the LV contractility (dP/dt) and pulsatile arterial pressure were significantly reduced. Both drugs reduced the elevated LVEDP and LVDP and prevented cardiac hypertrophy. Furthermore, irbesartan attenuated the right shift of the pressure-volume curves, prevented postinfarction-induced increase in urinary cyclic guanosine monophosphate and reduced urinary aldosterone excretion. Although both drugs were able to prevent further cardiac hypertrophy and improved cardiac filling pressure, only irbesartan limited LV dilatation. These data indicate that blockade of the renin-angiotensin system at the level of AT1 receptors may have a better cardioprotective benefit than reducing angiotensin II levels by ACE inhibition.