Pierre Boutouyrie - Academia.edu (original) (raw)

Papers by Pierre Boutouyrie

Current hypertension reviews, Jan 12, 2017

Arterial stiffness has been accumulating evidence as an intermediate cardiovascular endpoint. It ... more Arterial stiffness has been accumulating evidence as an intermediate cardiovascular endpoint. It has been established as an independent risk marker for cardiovascular disease, and reflects the dissociation between chronologic and biologic age of large arteries - attributing earlier the risk that a normal vascular ageing process had installed to occur several years later. The construct of Early Vascular Ageing (EVA) is developed to establish primordial prevention, identifying individuals whose ageing path has been accelerated either by inherent features, interaction with the environment or arterial exposure to several types of insults that evolve to medial layer morphological changes. Understanding the pathophysiology of vascular ageing, its consequences and therapeutic opportunities is therefore an advantage that could be translated in time of prevention and survival free of cardiovascular disease. As the EVA construct is advancing, new features appear as interesting to better trans...

Sang Thrombose Vaisseaux, Oct 1, 2008

Le remodelage arteriel correspond a toute modification de la structure (epaisseur intima-media et... more Le remodelage arteriel correspond a toute modification de la structure (epaisseur intima-media et diametre arteriel) et de la fonction (i.e. rigidite) arterielle au cours de processus physiologiques et pathologiques. Au cours de l’hypertension, l’atteinte des arteres de gros calibre est caracterisee par une atteinte hypertrophique et une augmentation de la rigidite. Cette atteinte differe le long de l’arbre arteriel : elle est importante pour l’aorte, plus moderee pour les arteres elastiques comme l’artere carotide et paradoxalement diminuee pour les arteres musculaires de plus faible calibre. Il est bien demontre que la rigidite aortique est un facteur de risque independant de survenue d’evenements primaires. La valeur pronostique de l’hypertrophie et de l’augmentation de la rigidite pour le risque de survenue d’un evenement cardiovasculaire est maintenant bien etablie et l’hypertrophie parietale est reconnue comme un facteur d’atherosclerose. De meme, les plaques d’atherosclerose carotidienne sont plus frequentes chez les sujets dont l’epaisseur parietale est augmentee. Il s’avere donc que l’exploration fonctionnelle non invasive des gros troncs arteriels s’impose comme une methode d’identification des patients a haut risque cardiovasculaire. Les techniques actuelles d’exploration reposent sur l’echotracking haute definition, la tonometrie d’aplanation et la velocite de l’onde de pouls, permettant l’evaluation du risque a partir de methodes de mesure non invasives, peu contraignantes pour le patient.

Circulation: Cardiovascular Genetics, 2015

Background— We assess the contribution of common and rare putatively functional genetic variants ... more Background— 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. Methods and Results— Measurements were obtained from 2283 men and 1398 women, and after filtering and exclusion of monomorphic variants, 32 827 common (minor allele frequency >0.01) and 68 770 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)/ V p =31.4%, P <3.1×10 –11 ) and high-density lipoprotein cholesterol ( V (G)/ V p =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 de...

Circulation research, Jan 13, 2015

Pathophysiological studies have extensively investigated the structural factor in hypertension, i... more 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.

Arterial Disorders, 2015

Arteries are permanently exposed to mechanical stress. Mechanical stress can be divided according... more Arteries are permanently exposed to mechanical stress. Mechanical stress can be divided according to their nature, either tensile stress or shear stress. Tensile stress corresponds to changes in dimension according to changes in forces applied on the vessel. Shear stress is of a different nature; it corresponds to the friction of viscous fluid (here the blood) on the inner surface of the vessel (here the endothelium). It is to be noted that direct measurement of stress is difficult in vivo and that stress is most of the time deduced from stretch (elongation) and force (derived from pressure). Stress can also be derived from mechanical modelling.

Journal de Radiologie, 2009

Archives of Cardiovascular Diseases Supplements, 2014

Hypertension, 2014

Whether angiotensin receptor blockers can dose-dependently remodel the arterial wall during long-... more Whether angiotensin receptor blockers can dose-dependently remodel the arterial wall during long-term treatment has been largely debated. In this phase III, multicenter, randomized, double-blind, parallel-group study, 133 subjects with hypertension and metabolic syndrome were assigned to olmesartan, either 20 mg (n=44), 40 mg (n=42), or 80 mg (n=47) once a day, according to a force titration design during a 1-year period. Office blood pressure, 24-hour blood pressure, aortic stiffness (carotid-femoral pulse wave velocity), and carotid parameters were measured at baseline, 24 weeks, and 52 weeks. Pulse wave velocity significantly decreased (P<0.001) with time in each group, with no significant time-dose interaction, despite a tendency (P=0.0685) for a smaller effect of 20 mg, compared with 40 and 80 mg at week 52. When the 40 and 80 mg doses were combined (40/80 mg versus 20 mg), a significant blood pressure-independent reduction in pulse wave velocity (-0.61 m/s) was observed at ...

Blood Pressure and Arterial Wall Mechanics in Cardiovascular Diseases, 2014

Change in arterial stiffness with drugs is a major end point in clinical trials, although evidenc... more 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.

American journal of nephrology, 2014

Recently, we reported that small renal arteries, defined by a low reference diameter (RD) or mini... more Recently, we reported that small renal arteries, defined by a low reference diameter (RD) or minimal luminal diameter (MD), are independently associated with a low GFR, resistant hypertension, and onset of contrast-induced nephropathy and suggested a post-hoc analysis of CORAL trial based on RD categories. Here we hypothesized that RD and MD are markers of nontraditional cardiovascular risk factors and tested whether low RD and MD could impact the prognosis of patients with ischemic heart disease. Prospective cohort study. We used proportional hazards models to analyze the first onset of cardiovascular events in relation with RD, MD, or percentage of renal artery stenosis (RAS) in those with low-to-moderate RAS (10-70%) (n = 181). During the median follow-up of 4.5 (range, 0.1-5) years, 27.8% participants (n = 623; mean age, 64 years; 29% women) experienced a cardiovascular event (35.4% in those with RAS 10-70%). The presence of low-to-moderate RAS was associated with cardiovascular...

Journal of Hypertension, 2010

Background: Vascular Ehlers-Danlos syndrome (vEDS) resulting from mutations in the gene encoding ... more Background: Vascular Ehlers-Danlos syndrome (vEDS) resulting from mutations in the gene encoding type III procollagen (COL3A1) is clinically characterized by four major and nine minor criteria. The diagnosis is improved by genetic detection of COL3A1 mutations. We aim to assess the genotype-phenotype relationship in vEDS patients. Methods: 132 vEDS patients, diagnosed from clinical criteria, had carotid measurement. Genetic testing was realized in all patients. 57 patients (43%) presented COL3A1 mutations (COL3A1+). Arterial parameters were determined with high-resolution echo-tracking system coupled with applanation tonometry. Statistical analysis was performed using general linear model ANOVA, logistic regression and receiver-operating characteristic (ROC) curves. Results: Demographic data did not differ between COL3A1+ and COL3A1- patients. Patients with COL3A1+ were significantly leaner than COL3A1- patients (-6 kg, p < 0.05). Heart rate, brachial BP, central PP, carotid diameter, distensibility, and Young's elastic modulus were not significantly different between the two groups. Carotid intima-media thickness (IMT) and carotid wall cross-sectional area (WCSA) were significantly lower (-12%, p < 0.001; and -15%, p < 0.001, respectively) in COL3A1+ than COL3A1- patients. Carotid circumferential wall stress was higher (+17%, p < 0.001) in COL3A1+ than COL3A1- patients. Carotid WCSA and circumferential wall stress independently discriminated between COL3A1+ and COL3A1- patients. They were scored from 1 to 3 depending on their threshold values for sensitivity/specificity, and then combined into a total ultrasound (US) score (from 2 to 6). A total US score ≥5 had a high positive predictive value (>75% certainty of COL3A1+ mutations). The area under the ROC curves for the total US score was 0.73 (95% CI, 0.64 to 0.81). Odds ratio for total US score ≥5 was 7.1 (95% CI, 3 to 16.9). Conclusions: An ultrasound score combining carotid WCSA and circumferential wall stress is highly predictive of a COL3A1 mutation in vEDS patients.

Journal of Hypertension, 2011

Journal of Hypertension, 2004

Journal of Hypertension, 2012

Atherosclerotic renovascular disease is associated with resistant hypertension and chronic kidney... more Atherosclerotic renovascular disease is associated with resistant hypertension and chronic kidney disease, although the causal relationship is discussed. To date, the role of renal artery diameter on these pathological conditions was not clearly studied. We aimed to identify the association of reference diameter and minimal luminal renal artery diameter with glomerular filtration rate (GFR) and resistant hypertension in a high cardiovascular risk population. In this cross-sectional, single-center study, we enrolled 734 patients who underwent a renal angiography immediately after a coronary angiography indicated for a diagnosis of ischemic heart disease. Mean age was 64 ± 10 years (men 72%). GFR was 79 ± 22 ml/min per 1.73 m(2). Five hundred and eighteen patients had no luminal narrowing and 216 patients had low-to-moderate luminal narrowing (10-70%, mean 36%). A positive significant association between reference diameter and GFR was detected in patients without luminal narrowing [beta 2.2 ml/min per 1.73 m(2) for 1 mm increase, 95% confidence interval (CI) 0.3-4.0, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05] and in those with low-to-moderate luminal narrowing (beta 7.7 ml/min per 1.73 m(2) for 1 mm increase, 95% CI 4.2-11.1, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). The lowest quartile of reference diameter (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;5.2 mm) was associated with GFR less than 60 ml/min per 1.73 m(2) [odds ratio (OR) 3.18, 95% CI 1.61-6.29, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001]. Patients with resistant hypertension had low minimal diameter and reference diameter. Reference diameter less than 5.2 mm was associated with an increased risk of resistant hypertension (OR 2.63, 95% CI 1.02-6.77, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). Small renal arteries, defined by a low reference diameter or minimal luminal diameter, are independently associated with low GFR and resistant hypertension, independent of the degree of stenosis and major confounders.

Journal of Clinical Investigation, 2005

Hypertension, 2007

Exposure to urban air pollution, ultrafine particles or gases, is associated with acute cardiovas... more Exposure to urban air pollution, ultrafine particles or gases, is associated with acute cardiovascular mortality and morbidity. We investigated the effect of ambient air pollution on endothelial function in 40 healthy white male nonsmokers spontaneously breathing ambient air in Paris, France. Air pollutant levels (nitrogen, sulfur and carbon oxides, and particulate matter) were averaged during the 5 days preceding arterial measurements. Brachial artery endothelium-dependent flow-mediated dilatation and reactive hyperemia induced by hand ischemia and endothelium-independent glyceryl trinitrate dilatation were measured using a radiofrequency-based echo-tracking device at 2-week intervals. Flow-mediated dilatation was independently and negatively correlated with the average levels of sulfur dioxide ( P <0.001) and nitrogen monoxide ( P <0.01). Sulfur dioxide levels explained 19% of the variance of flow-mediated dilatation. An increase in gaseous pollutants, 2 weeks apart, was sig...

Hypertension, 2012

Chronic kidney disease, even at moderate stages, is characterized by a high incidence of cardiova... more Chronic kidney disease, even at moderate stages, is characterized by a high incidence of cardiovascular events. Subclinical damage to large arteries, such as increased arterial stiffness and outward remodeling, is a classical hallmark of patients with chronic kidney disease. Whether large artery stiffness and remodeling influence the occurrence of cardiovascular events and the mortality of patients with chronic kidney disease (stages 2–5) is still debated. This prospective study included 439 patients with chronic kidney disease (mean age, 59.8±14.5 years) with a mean measured glomerular filtration rate of 37 mL/min per 1.73 m 2 . Baseline aortic stiffness was estimated through carotid-femoral pulse wave velocity measurements; carotid stiffness, diameter, and intima-media thickness were measured with a high-resolution echotracking system. For the overall group of patients, the 5-year estimated survival and cumulative incidence of cardiovascular events were 87% and 16%, respectively. ...

European Journal of Preventive Cardiology, 2011