Halima Benjelloun

Cardiovascular Autonomic Response to Amlodipine in Primary Hypertension

Sympathetic hyperactivity may be involved in primary hypertension. The purpose of this study was to evaluate both sympathetic and vagal activity responses in patients receiving amlodipine as antihypertensive agent. Patients and Methods. This prospective study included a group of primary hypertensive patients (N = 32, mean age 54.6 ± 7.6 years). The cardiovascular autonomic tests performed in this group, before and after 3 months of daily oral administration of amlodipine, included deep breathing, hand-grip, and mental stress tests. Statistical analysis was done using the Students t-test. Results. Cardiovascular autonomic reflexes responses before and after 3 months of amlodipine oral administration were as follows: the mental stress test stimulation method produced a central alpha adrenergic response of 23.9 ± 8.7% versus 11.2 ± 2.0% (P < 0.05), a central beta sympathetic response of 16.7 ± 9.2% versus 10.4 ± 1.3% (P < 0.05), a blood pressure increase in response to hand grip test of 20.5 ± 7.3% versus 10.7 ± 2.4% (P < 0.05), vagal response to deep breathing test was 21.2 ± 6.5% versus 30.8 ± 2.9%, (P < 0.05). Conclusion. The results attest that amlodipine may have an anti-sympathetic effect.

HIGH SYMPATHETIC RESPONSE AND PHENOBARBITAL IN PRIMARY HYPERTENSIVE PATIENTS

Objective: The literature showed that the high sympathetic activity can be considered as a cardiovascular risk factor. This phenomenon has been well found in primary hypertensive patients (PHP). The purpose of this study was to see if phenobarbital in small doses (10 mg) is able to decrease the sympathetic hyperactivity in primary hypertensive patients (PHP) using cardiovascular autonomic reflexes before and after treatment. Figure. No caption available. Design and method: This prospective study was conducted on a total of 123 primary hypertensive patients (PHP) in whom we noted a high central and/or peripheral sympathetic response diagnosed by mental stress and orthostatic tests. Inclusion criteria: All primary hypertensive patients who had shown a sympathetic hyperactivity were included in this study. Exclusion criteria. The patients with an abnormal electrocardiogram, severe arterial hypertension, secondary or complicated hypertension or having over-sensitiveness to the molecule were excluded from this study. This is a prospective study comparing two cardiac autonomic evaluations: pre and post-therapeutic, carried out in the unit of exploration of the autonomic nervous system, service of cardiology “A” at the University hospital Ibn Sina. A written consent form was obtained from each patient before the tests. Statistical analysis: Group comparisons were carried out by independent samples Students t-test for interval variables and the khi squart test for categorical variables, with 95% confidence intervals (CIs) calculated where appropriate. P significant if < 0.05. All analyses were performed using SPSS, version 15.0 (SPSS Inc., Chicago, Il). Results: Table 1: Alpha peripheral sympathetic response (alpha SP) obtained on hand grip test. Alpha central sympathetic response (alpha SC), beta central sympathetic response (beta SC) obtained during mental stress, and alpha peripheral adrenergic sympathetic (alpha PAS). Parameters were measured before and after treatment by phenobarbital, and expressed as mean ± SE; P is significative if < 5%. Conclusions: In hypertensive patients, use of Phenobarbital (10 mg) showed a significant decrease of the sympathetic activity.

AUTONOMIC DYSREGULATION IN PRIMARY HYPERTENSION

Objective: Introduction: Would cardiovascular autonomic reflexes help in understanding the diagnosis and the management of primary hypertension (PHT). The purpose of this study was to evaluate the cardiovascular autonomic reflexes in patients with primary hypertension (PHT), including masked hypertension (MHT), hypertension with type 2 diabetes (DHT), orthostatic hypertension (OHT) and orthostatic hypotension (OHypoT). Design and method: Patients and Methods. This prospective study included two groups: normotensive group, NT (N = 120) and primary hypertensive group, PHT (N = 120). The PHT group was divided in different subgroup: N1 = subgroup of MHT, N2 = subgroup of DHT, N3 = subgroup of OHT and N4 = subgroup of OHypoT. The PHT group as well as the subgroups were compared to NT group. The cardiovascular autonomic tests performed in these groups, included deep breathing (DB), hand-grip (Hg), mental stress (MS) and orthostatic (Orth) tests. Statistical analysis was done using the Students t-test. Results: Results. Cardiovascular autonomic reflexes responses were as follows: Compared to NT, 1. Central alpha adrenergic response to mental stress test was of 20,0 ± 9,8% vs 15,2 ± 8,6% (p < 0,001) in PHT; 24,7 ± 7,2% vs 15,2 ± 4,5% (p < 0,001) in MHT; and 23,48 ± 9,82% vs 20,28 ± 9,60%(p = 0,243) in DHT. 2. Peripheral alpha adrenergic response to hand grip test of 16,7 ± 7,5% vs 13,3 ± 6,5% (p < 0,001) in PHT; 27,0 ± 5,4% vs 16,4 ± 4,5% (P < 0,001) in MHT; and 20,03 ± 8,05 vs 21,71 ± 11,23% (p = 0,588) in DHT. 3. Vagal response to deep breathing test was of 30,2 ± 8,1% vs 46,1 ± 2,1% (p < 0,001) in PHT; 30,5 ± 10,4% vs 32,7 ± 11,3% (p = 0,1) in MHT; and 23,09 ± 11,06% vs 34,15 ± 17,7% (p < 0,001) in DHT. Of interest orthostatic test showed that 70% of PHT had orthostatic hypertension and 15% orthostatic hypotension. Conclusions: Conclusion. PHT, hypertensive with type 2 diabetes, MHT have a significantly higher sympathetic response when compared to controls and vagal response significantly lower. The latter is accentuated by the association of diabetes to hypertension. The results attest that cardiovascular autonomic reflexes study is of high interest in assessing PHT

Aneurysm of the Pulmonary Artery in Fallot’s Tetralogy

Introduction Pulmonary artery aneurysms are a rare entity. Etiologies of these findings are multiple, but they are exceptionally associated with Fallots Tetralogy. In this study, we present an unusual case of an important aneurysm of the left pulmonary artery associated with Fallots Tetralogy disease. Case Presentation A 30-year-old woman has been admitted for dyspnea and cyanosis. The data which had been obtained from echocardiography, cardiac catheterization, and angio-magnetic resonance imaging (MRI) suggested the existence of an important aneurysm of the left pulmonary artery associated with a regular Fallots disease with a pulmonic stenosis. We have noticed the presence of a small restrictive patent ductus arteriosus (PDA). Therefore, the patient was referred to surgical correction. Conclusion Pulmonary artery aneurysms associated with Fallots Tetralogy are rarely reported. The natural history of these rare arterial aneurysms has to be clarified.

Independent predictor factors of supine tachycardia in patients with type 2 diabetes mellitus

INTRODUCTION Supine tachycardia, frequently encountered in diabetic patients, is usually considered as an isolated diabetic complication in cardiac autonomic neuropathy. The objective of this study was to determine independent predictor factors of supine tachycardia among the clinical characteristics of type 2 diabetes mellitus. METHODS This prospective study included type 2 diabetic patients. Supine tachycardia was considered as 10 minutes resting heart rate equal or higher than 80 beats/minutes. According to presence or not of supine tachycardia, two groups were identified: tachycardia diabetic patients and none tachycardia diabetic patients. Cardiovascular autonomic tests: deep breathing, hand-grip, and mental stress tests and blood tests were performed in all patients. Statistical analysis was done using the Students t-test, and univariate and multivariate logistic regression analysis. RESULTS We included 91 patients. The vagal response measured by the deep breathing test was 24.5 ± 5.7% in tachycardia diabetic patients vs 35.6 ± 6.8% in none tachycardia diabetic patients (P=0.007). The odds of supine tachycardia increased with serum creatinine (OR=1.350, 95% CI: 1.065-1.712, P=0.013) and serum uric acid levels (OR=1.034, 95% CI: 1.005-1.064, P=0.02) respectively, in diabetic patients. The prevalence of moderate renal failure was 45.5% in tachycardia diabetic patients vs. 21.6% in none tachycardia diabetic patients (P=0.034). CONCLUSION A high frequency of supine tachycardia in type 2 diabetic patients was significantly related with an impairment of the parasympathetic nervous system but other independent predictor factors were associated to the occurrence of this supine tachycardia, such as higher levels of serum creatinine and uric acid and moderate renal failure.