- Email: [email protected]
Non-occlusive lower limbs arteriopathy in hypertensive type 2 diabetes: Should we get interested?
e344
Evolution of the cardiovascular profile after renal transplantation in type 1 diabetic M. Malki Abidi ∗ , L. Ben Fatma , S. Damoué , I. Mami , H. Jebali , W. Smaoui , M. Krid , S. Beji , L. Raies , K. Zouaghi Nephrology Department, La Rabta Hospital, Tunis, Tunisia ∗ Corresponding author. E-mail address: [email protected] (M. Malki Abidi) Introduction Renal transplantation is the best treatment for endstage renal disease (ESRD). Diabetes and chronic kidney disease (CKD) are major cardiovascular (CV) risk factors. Our study focuses on the initial CV profile and its evolution after renal transplantation (RT) in type 1 diabetes (DT1) patients. Methods This is a retrospective study of 4 DT1 patients who benefited from a renal transplantation over the period from 2010 to 2017. Results In our series of 74 patients receiving a kidney from a living donor, 4 patients (5.4%) had DT 1. Our study concerned these 4 patients: 3 men and 1 woman, mean age: 36.25 years [30—43]. The average duration of diabetes was 25.25 years [13—33]. All patients were hypertensive, one had dyslipidemia and none of them was overweight. Diabetic nephropathy was the cause of endstage renal failure in all 4 cases and patients were treated with kidney replacement therapy for 2 years (hemodialysis in 2 cases and peritoneal dialysis in 2 cases). Prior to RT, all patients had normal echocardiography and stress testing, 2 patients underwent myocardial scintigraphy without abnormality. None of the patients had coronary angiography. Doppler ultrasonography of the iliac and aortic axes was normal in 1 case, atheromatous infiltration was noticed in 2 patients, and distal mediacalcosis with tight stenosis of both tibial axes was discovered in one case. All patients underwent immunosuppressive therapy with corticosteroids, ciclosporine and mycophenolate mofetil, and followed for an average of 3.25 years. The post RT evolution was marked by an immediate resumption of graft function. Echocardiography control was normal for all 4 patients. One patient presented 2 years later a gangrene of the foot that had been treated by angioplasty of the left superficial femoral artery and amputation of one toe. Conclusion In DT1 patients, renal transplantation is the best treatment for ESRD despite the use of corticosteroids and anticalcineurins. However, prior explorations of good cardiac function and adequate vascular compliance are essential to reduce the risk of CV. Disclosure of interest The authors have not supplied their declaration of interest. https://doi.org/10.1016/j.acvdsp.2019.05.030
Masked hypertension during prehypertension and anthropometric indices: Prospective study A. Mammeri ∗ , R. Guermaz , F. Kessal , S. Taharboucht , F. Hamrour , A. Hatri , M. Ammi , N. Ait Said , S. Zekri , M. Brouri , A. Tebaibia Department of Internal Medicine, El Biar hospital, Algiers, Algeria ∗ Corresponding author. E-mail address: [email protected] (A. Mammeri) Background Analysis of the ambulatory blood pressure profile of patients with prehypertension (PHT) and the assessment of their cardiovascular risk have rarely been studied. Our work aimed to establish the link between masked hypertension (MH) and the cardiovascular risk factors (CVR) associated with prehypertension. Method From 2015 to 2016, a cross-sectional study was conducted in primary care consultation in Algiers on a sample of 1086 adults, without known hypertension. They were screened for PHT (defined by the JNCVII as systolic BP between 120 and 139 mmHg or diastolic BP between 80 and 89 mm Hg). Pre-hypertensive patients
02 - Heart and Ships were assessed for their anthropometric indices (height, weight and waist circumference) and an ambulatory blood pressure measurement (ABPM). The Pearson correlation test was used to investigate the relationship between MH and the major CVR factors in these patients. Results Three hundred and ninety-nine pre-hypertensive patients were identified (prevalence: 36.7%), concerning more men than women (50.0 vs. 31.5%, P < 0.001). ABPM was performed in 273 patients, and MH was treated in 52.4% of cases, affecting men and women equally (P = 0.29). Nighttime MH (≥ 120/70 mmHg) was significantly more frequent than daytime MH (≥ 135/85 mmHg) (57% vs. 36%, P = 0.0005). Patients with MH were older than those with normal ABPM (46 ± 13.33 vs. 42 ± 14.36 years, P = 0.01), had higher body mass index (BMI) (29.47 ± 5.507 vs. 26.6 ± 4.985 kg/m2 , P = 0.00001) and more frequent android obesity (64% vs. 43%, P = 0.0006). In MH patients, we found a positive correlation between daytime pressure and weight (r = 0.361), BMI (r = 0.283) and waist circumference (r = 0.374). This positive relationship was also valid for the night pressure values (r = 0.379, 0.399 and 0.410 respectively). Conclusion Masked hypertension is a recognized source of increased CVR, thus we suggest to record and monitor the ambulatory pressure in pre-hypertensive subjects, especially as they are overweight. Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.acvdsp.2019.05.031
Peripheral arterial disease of the lower limbs in Moroccan hypertensive non-diabetic patients M. Mouadili ∗ , C. Mbauchy , D. Benzeroual , S. Karimi , M. El Hattaoui Cardiology and Vascular Diseases, Mohammed the VIth University Hospital Center, Marrakesh, Morocco ∗ Corresponding author. E-mail address: [email protected] (M. Mouadili) Background Peripheral arterial disease (PAD) of the lower limbs is only an aspect of a general vascular disease; PAD announces cardiovascular accidents. Thus, the early screening of PAD is a major issue. Purpose To evaluate the prevalence of PAD of the lower limbs in asymptomatic patients with hypertension and to determine the risk factors or associations of risk factors most frequently responsible of pathological (< 0.9) ankle-brachial index (ABI). Methods We conducted a prospective survey including 273 patients from November 2016 to December 2017 in our department. Results The mean population’s age was 62.09 years (27—88 years), with a male predominance gender (67,76%). The prevalence of PAD was 28.94%. Risk factors or association of risk factors that were significantly associated with PAD (Chi2 Pearson test) were: the male gender (72%), tobacco use (56%), obesity (BMI ≥ 30) 15.8%, dyslipidemia and grade-3 hypertension (23.4%). Discussion and Conclusion PAD of the lower limbs is a particular location of the atheromatous process as well as a marker of its diffusion. As a result of this study, we recommend the screening of asymptomatic PAD in all hypertensive patients by measuring the ankle-brachial index. Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.acvdsp.2019.05.032
Non-occlusive lower limbs arteriopathy in hypertensive type 2 diabetes: Should we get interested?
02 - Heart and Ships Wafia-Nadia Nibouche ∗ , F. Zeraoulia , N. Lanasri , L. Makhlouf , A. Kaced , R. Kesraoui , H. Barki , A. Biad Service universitaire de Médecine Interne; Hôpital d’Ain-Taya 16019, Algiers, Algeria ∗ Corresponding author. E-mail address: [email protected] (W.-N. Nibouche) Background and aim of the study Occlusive peripheral artery disease (OPAD) is a strong marker of cardiovascular events. Screening for PAD is recommended by all guidelines; however, there is no consensus on the benefit for detecting the non-occlusive stage of PAD (NOPAD). Therefore, when screening for OPAD, all patients with NOPAD are usually merged with those having normal arteries. WE aimed to assess the bio-clinical profile and morbidity related to diabetes complications in patients with NOPAD and to compare them to those with OPAD and with normal arteries at ultrasonography (UNA). Method and material In a cross-sectional, observational, prospective study with a sub-group analysis, we recruited 327 consecutive newly diagnosed type 2 diabetics, aged from 40 to 70 year from January 2009 to December 2014. We collected clinical, biological data and screened exhaustively for macro and microvascular complications. All patients had an Ankle-Brachial Index measurement and a duplex ultrasonography (DUS). The diagnosis of PAD was done on DUS. We considered as NOPAD the presence of atherosclerosis plaque and/or medial artery calcifications without stenosis. We selected the sub-group of hypertensive diabetics for analysis. Coronary risk was calculated by using the Framingham score. Results Among 327 newly diagnosed type 2 diabetics, 202 had hypertension, 129 women and 73 men; 12 patients had OPAD (5.9%), 111 had NOPAD (54.9%) and 79 had UNA (39.2%), aged respectively 54.8 ± 8.3, 57.1 ± 7.8 and 50.4 ± 7.9 years (P < 10−6 ). Arterial DUS showed both atherosclerosis and medial arterial calcifications in 90% in the PAD groups. We didn’t find significant difference between the three groups on smoking (P = 0.824), body mass index (P = 0.962), arterial blood pressure (P = 0.058), glycemic status (P = 0.975) and prevalence of metabolic syndrome (P = 0.431). OPAD and NOPAD patients had higher LDL (P = 0.005), higher coronary disease risk (P = 10−4 ), lower glomerular filtration rate (P = 0.011) and significantly more chronic kidney disease (P = 0.0009), coronary artery disease (P = 0.008), atherothrombotic events (P = 10−4 ), peripheral diabetic neuropathy (P = 0.024) and cognitive impairment (P = 0.006) than those with UNA. No significant difference has been found while comparing the OPAD and NOPAD groups on all studied parameters except for cardiovascular events that are more prevalent in the OPAD group (P = 0.009). Conclusion Non-occlusive as well as occlusive PAD, is associated with a high cardiovascular morbidity when associated with type 2 diabetes and hypertension. A screening of NOPAD could help to risk stratification in hypertensive diabetics allowing them to benefit of an earlier preventive action on cardiovascular events. Clinicaltrials.gov ID: NCT02002091 Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.acvdsp.2019.05.033
Mediacalcosis in hemodialysis, predictors and prognosis L. Sadaoui 1,∗ , W. Berrachdi 1 , S. Dekhoukh 1 , N. Boucherit 1 , N. Beneata 2 , D. Batouche 3 1 Nephrology, C.H.U 2 Cardiology E.H.U 3 Pediatric intensive cares E.H.U, Oran, Algeria ∗ Corresponding author. E-mail address: [email protected] (L. Sadaoui) Introduction Mediacalcosis is common in dialysis patients, due to vascular calcifications whose pathophysiology remains complex and multifactorial; calcifications are responsible for serious life-
e345 threatening cardiovascular morbidities. The purpose of our work was to identify the predisposing factors and discuss the evolutionary aspects of mediacalcose. Methods and patients We performed a retrospective, transversal and descriptive study. Collecting the files of 44 hemodialysis patients, who have been provided with standard sheets, including clinical information (co-morbidities, coronary events, heart failure, arrhythmias, arterial diseases, stroke..), biological (CRP, lipids, inorganic phosphate, calcium and phosphates balance (Ca × PO4), Vitamin D3, PTH) and complementary investigations (TT, ECG, echocardiography, Doppler, CT),during a 4-year follow-up period, going from June 2014 to July 2018. Results and discussion Our patients had an average age of 51.2 years old, the sex ratio (M/F) was 2.8, the average duration of dialysis was 17.4 years, diabetes was observed in 12.3% of patients, hypertension in 81.7%, dyslipidemia in 43.5%, tobacco and opiates in 15.6%, hyperparathyroidism in 71.2%, hyper phosphorus levels in 90.6%, hypercalcemia in 65.3%, and elevated CRP in 84.1%. The occurrence of major cardiovascular events included 9.3% hemorrhagic stroke, 6.2% MI, 12.3% AC/FA and 9.3% peripheral ischemic arterial disease responsible for leg amputation in 3.1% of patients; 9.3% of our patients died during the study. Extra-renal calcifications, especially cardiovascular calcifications, are frequent in dialysis patients, at the origin of serious complications: myocardial infarction, arrhythmias, calcified valves disorders, strokes, peripheral ischemic arteriopathy, sources of morbidity and mortality in more than 50% of cases. Many studies carried out so far, have confirmed the preponderant role of factors influencing the occurrence of vascular calcifications, increasing the risk of cardiovascular events in hemodialysis: inflammation, comorbidities, eating habits and lifestyle. In our study, these factors were found with variable incidence, but it is quite clear that their entanglement was at the origin of a high rate of morbidity and mortality among our hemodialysis population. Conclusion Mediacalcosis is a severe complication since it increases the risk of cardiovascular morbidity and mortality in hemodialysis patients, to this end, the individualization of entangled factors involved in its pathophysiology, will slow down or prevent its progression in the future. Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.acvdsp.2019.05.034
Hypertension: Do not forget the occupational etiology Hana Zoubeidi 2,∗ , Mohamed Khalil Boussema 2 , Sonia Karma 1 , Lilia Lammouchi 1 , Sonia Slaoui 1 , Fatma Boussema 2 1 SAMU, Tunis, Tunisia 2 Habib Thameur Hospital, Department of Internal Medicine, Tunis, Tunisia ∗ Corresponding author. E-mail address: [email protected] (H. Zoubeidi) Background and aims :The etiological diagnosis of arterial hypertension remains rare. The purpose of the study was to analyse the occupational hypertension characteristics in workers exposed to lead excluding other causes of hypertension. Results We included 13 workers of average age of 37 years (with extremes of 28 to 48 years). They were welders (6 cases), mechanics (3 cases), workers in electrical cable manufacturing industries (2 cases) and workers in dental amalgam plants (2 cases). The average duration of work and exposure was 8 hours/day for an average period of 5 to 7 years. The signs leading to consultation were various: urinary, digestive, neurosensory or general signs. The physical examination confirmed the presence of hypertension in both arms in standing and supine position. The complementary examinations were normal. The search for toxics was performed.
Evolution of the cardiovascular profile after renal transplantation in type 1 diabetic M. Malki Abidi ∗ , L. Ben Fatma , S. Damoué , I. Mami , H. Jebali , W. Smaoui , M. Krid , S. Beji , L. Raies , K. Zouaghi Nephrology Department, La Rabta Hospital, Tunis, Tunisia ∗ Corresponding author. E-mail address: [email protected] (M. Malki Abidi) Introduction Renal transplantation is the best treatment for endstage renal disease (ESRD). Diabetes and chronic kidney disease (CKD) are major cardiovascular (CV) risk factors. Our study focuses on the initial CV profile and its evolution after renal transplantation (RT) in type 1 diabetes (DT1) patients. Methods This is a retrospective study of 4 DT1 patients who benefited from a renal transplantation over the period from 2010 to 2017. Results In our series of 74 patients receiving a kidney from a living donor, 4 patients (5.4%) had DT 1. Our study concerned these 4 patients: 3 men and 1 woman, mean age: 36.25 years [30—43]. The average duration of diabetes was 25.25 years [13—33]. All patients were hypertensive, one had dyslipidemia and none of them was overweight. Diabetic nephropathy was the cause of endstage renal failure in all 4 cases and patients were treated with kidney replacement therapy for 2 years (hemodialysis in 2 cases and peritoneal dialysis in 2 cases). Prior to RT, all patients had normal echocardiography and stress testing, 2 patients underwent myocardial scintigraphy without abnormality. None of the patients had coronary angiography. Doppler ultrasonography of the iliac and aortic axes was normal in 1 case, atheromatous infiltration was noticed in 2 patients, and distal mediacalcosis with tight stenosis of both tibial axes was discovered in one case. All patients underwent immunosuppressive therapy with corticosteroids, ciclosporine and mycophenolate mofetil, and followed for an average of 3.25 years. The post RT evolution was marked by an immediate resumption of graft function. Echocardiography control was normal for all 4 patients. One patient presented 2 years later a gangrene of the foot that had been treated by angioplasty of the left superficial femoral artery and amputation of one toe. Conclusion In DT1 patients, renal transplantation is the best treatment for ESRD despite the use of corticosteroids and anticalcineurins. However, prior explorations of good cardiac function and adequate vascular compliance are essential to reduce the risk of CV. Disclosure of interest The authors have not supplied their declaration of interest. https://doi.org/10.1016/j.acvdsp.2019.05.030
Masked hypertension during prehypertension and anthropometric indices: Prospective study A. Mammeri ∗ , R. Guermaz , F. Kessal , S. Taharboucht , F. Hamrour , A. Hatri , M. Ammi , N. Ait Said , S. Zekri , M. Brouri , A. Tebaibia Department of Internal Medicine, El Biar hospital, Algiers, Algeria ∗ Corresponding author. E-mail address: [email protected] (A. Mammeri) Background Analysis of the ambulatory blood pressure profile of patients with prehypertension (PHT) and the assessment of their cardiovascular risk have rarely been studied. Our work aimed to establish the link between masked hypertension (MH) and the cardiovascular risk factors (CVR) associated with prehypertension. Method From 2015 to 2016, a cross-sectional study was conducted in primary care consultation in Algiers on a sample of 1086 adults, without known hypertension. They were screened for PHT (defined by the JNCVII as systolic BP between 120 and 139 mmHg or diastolic BP between 80 and 89 mm Hg). Pre-hypertensive patients
02 - Heart and Ships were assessed for their anthropometric indices (height, weight and waist circumference) and an ambulatory blood pressure measurement (ABPM). The Pearson correlation test was used to investigate the relationship between MH and the major CVR factors in these patients. Results Three hundred and ninety-nine pre-hypertensive patients were identified (prevalence: 36.7%), concerning more men than women (50.0 vs. 31.5%, P < 0.001). ABPM was performed in 273 patients, and MH was treated in 52.4% of cases, affecting men and women equally (P = 0.29). Nighttime MH (≥ 120/70 mmHg) was significantly more frequent than daytime MH (≥ 135/85 mmHg) (57% vs. 36%, P = 0.0005). Patients with MH were older than those with normal ABPM (46 ± 13.33 vs. 42 ± 14.36 years, P = 0.01), had higher body mass index (BMI) (29.47 ± 5.507 vs. 26.6 ± 4.985 kg/m2 , P = 0.00001) and more frequent android obesity (64% vs. 43%, P = 0.0006). In MH patients, we found a positive correlation between daytime pressure and weight (r = 0.361), BMI (r = 0.283) and waist circumference (r = 0.374). This positive relationship was also valid for the night pressure values (r = 0.379, 0.399 and 0.410 respectively). Conclusion Masked hypertension is a recognized source of increased CVR, thus we suggest to record and monitor the ambulatory pressure in pre-hypertensive subjects, especially as they are overweight. Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.acvdsp.2019.05.031
Peripheral arterial disease of the lower limbs in Moroccan hypertensive non-diabetic patients M. Mouadili ∗ , C. Mbauchy , D. Benzeroual , S. Karimi , M. El Hattaoui Cardiology and Vascular Diseases, Mohammed the VIth University Hospital Center, Marrakesh, Morocco ∗ Corresponding author. E-mail address: [email protected] (M. Mouadili) Background Peripheral arterial disease (PAD) of the lower limbs is only an aspect of a general vascular disease; PAD announces cardiovascular accidents. Thus, the early screening of PAD is a major issue. Purpose To evaluate the prevalence of PAD of the lower limbs in asymptomatic patients with hypertension and to determine the risk factors or associations of risk factors most frequently responsible of pathological (< 0.9) ankle-brachial index (ABI). Methods We conducted a prospective survey including 273 patients from November 2016 to December 2017 in our department. Results The mean population’s age was 62.09 years (27—88 years), with a male predominance gender (67,76%). The prevalence of PAD was 28.94%. Risk factors or association of risk factors that were significantly associated with PAD (Chi2 Pearson test) were: the male gender (72%), tobacco use (56%), obesity (BMI ≥ 30) 15.8%, dyslipidemia and grade-3 hypertension (23.4%). Discussion and Conclusion PAD of the lower limbs is a particular location of the atheromatous process as well as a marker of its diffusion. As a result of this study, we recommend the screening of asymptomatic PAD in all hypertensive patients by measuring the ankle-brachial index. Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.acvdsp.2019.05.032
Non-occlusive lower limbs arteriopathy in hypertensive type 2 diabetes: Should we get interested?
02 - Heart and Ships Wafia-Nadia Nibouche ∗ , F. Zeraoulia , N. Lanasri , L. Makhlouf , A. Kaced , R. Kesraoui , H. Barki , A. Biad Service universitaire de Médecine Interne; Hôpital d’Ain-Taya 16019, Algiers, Algeria ∗ Corresponding author. E-mail address: [email protected] (W.-N. Nibouche) Background and aim of the study Occlusive peripheral artery disease (OPAD) is a strong marker of cardiovascular events. Screening for PAD is recommended by all guidelines; however, there is no consensus on the benefit for detecting the non-occlusive stage of PAD (NOPAD). Therefore, when screening for OPAD, all patients with NOPAD are usually merged with those having normal arteries. WE aimed to assess the bio-clinical profile and morbidity related to diabetes complications in patients with NOPAD and to compare them to those with OPAD and with normal arteries at ultrasonography (UNA). Method and material In a cross-sectional, observational, prospective study with a sub-group analysis, we recruited 327 consecutive newly diagnosed type 2 diabetics, aged from 40 to 70 year from January 2009 to December 2014. We collected clinical, biological data and screened exhaustively for macro and microvascular complications. All patients had an Ankle-Brachial Index measurement and a duplex ultrasonography (DUS). The diagnosis of PAD was done on DUS. We considered as NOPAD the presence of atherosclerosis plaque and/or medial artery calcifications without stenosis. We selected the sub-group of hypertensive diabetics for analysis. Coronary risk was calculated by using the Framingham score. Results Among 327 newly diagnosed type 2 diabetics, 202 had hypertension, 129 women and 73 men; 12 patients had OPAD (5.9%), 111 had NOPAD (54.9%) and 79 had UNA (39.2%), aged respectively 54.8 ± 8.3, 57.1 ± 7.8 and 50.4 ± 7.9 years (P < 10−6 ). Arterial DUS showed both atherosclerosis and medial arterial calcifications in 90% in the PAD groups. We didn’t find significant difference between the three groups on smoking (P = 0.824), body mass index (P = 0.962), arterial blood pressure (P = 0.058), glycemic status (P = 0.975) and prevalence of metabolic syndrome (P = 0.431). OPAD and NOPAD patients had higher LDL (P = 0.005), higher coronary disease risk (P = 10−4 ), lower glomerular filtration rate (P = 0.011) and significantly more chronic kidney disease (P = 0.0009), coronary artery disease (P = 0.008), atherothrombotic events (P = 10−4 ), peripheral diabetic neuropathy (P = 0.024) and cognitive impairment (P = 0.006) than those with UNA. No significant difference has been found while comparing the OPAD and NOPAD groups on all studied parameters except for cardiovascular events that are more prevalent in the OPAD group (P = 0.009). Conclusion Non-occlusive as well as occlusive PAD, is associated with a high cardiovascular morbidity when associated with type 2 diabetes and hypertension. A screening of NOPAD could help to risk stratification in hypertensive diabetics allowing them to benefit of an earlier preventive action on cardiovascular events. Clinicaltrials.gov ID: NCT02002091 Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.acvdsp.2019.05.033
Mediacalcosis in hemodialysis, predictors and prognosis L. Sadaoui 1,∗ , W. Berrachdi 1 , S. Dekhoukh 1 , N. Boucherit 1 , N. Beneata 2 , D. Batouche 3 1 Nephrology, C.H.U 2 Cardiology E.H.U 3 Pediatric intensive cares E.H.U, Oran, Algeria ∗ Corresponding author. E-mail address: [email protected] (L. Sadaoui) Introduction Mediacalcosis is common in dialysis patients, due to vascular calcifications whose pathophysiology remains complex and multifactorial; calcifications are responsible for serious life-
e345 threatening cardiovascular morbidities. The purpose of our work was to identify the predisposing factors and discuss the evolutionary aspects of mediacalcose. Methods and patients We performed a retrospective, transversal and descriptive study. Collecting the files of 44 hemodialysis patients, who have been provided with standard sheets, including clinical information (co-morbidities, coronary events, heart failure, arrhythmias, arterial diseases, stroke..), biological (CRP, lipids, inorganic phosphate, calcium and phosphates balance (Ca × PO4), Vitamin D3, PTH) and complementary investigations (TT, ECG, echocardiography, Doppler, CT),during a 4-year follow-up period, going from June 2014 to July 2018. Results and discussion Our patients had an average age of 51.2 years old, the sex ratio (M/F) was 2.8, the average duration of dialysis was 17.4 years, diabetes was observed in 12.3% of patients, hypertension in 81.7%, dyslipidemia in 43.5%, tobacco and opiates in 15.6%, hyperparathyroidism in 71.2%, hyper phosphorus levels in 90.6%, hypercalcemia in 65.3%, and elevated CRP in 84.1%. The occurrence of major cardiovascular events included 9.3% hemorrhagic stroke, 6.2% MI, 12.3% AC/FA and 9.3% peripheral ischemic arterial disease responsible for leg amputation in 3.1% of patients; 9.3% of our patients died during the study. Extra-renal calcifications, especially cardiovascular calcifications, are frequent in dialysis patients, at the origin of serious complications: myocardial infarction, arrhythmias, calcified valves disorders, strokes, peripheral ischemic arteriopathy, sources of morbidity and mortality in more than 50% of cases. Many studies carried out so far, have confirmed the preponderant role of factors influencing the occurrence of vascular calcifications, increasing the risk of cardiovascular events in hemodialysis: inflammation, comorbidities, eating habits and lifestyle. In our study, these factors were found with variable incidence, but it is quite clear that their entanglement was at the origin of a high rate of morbidity and mortality among our hemodialysis population. Conclusion Mediacalcosis is a severe complication since it increases the risk of cardiovascular morbidity and mortality in hemodialysis patients, to this end, the individualization of entangled factors involved in its pathophysiology, will slow down or prevent its progression in the future. Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.acvdsp.2019.05.034
Hypertension: Do not forget the occupational etiology Hana Zoubeidi 2,∗ , Mohamed Khalil Boussema 2 , Sonia Karma 1 , Lilia Lammouchi 1 , Sonia Slaoui 1 , Fatma Boussema 2 1 SAMU, Tunis, Tunisia 2 Habib Thameur Hospital, Department of Internal Medicine, Tunis, Tunisia ∗ Corresponding author. E-mail address: [email protected] (H. Zoubeidi) Background and aims :The etiological diagnosis of arterial hypertension remains rare. The purpose of the study was to analyse the occupational hypertension characteristics in workers exposed to lead excluding other causes of hypertension. Results We included 13 workers of average age of 37 years (with extremes of 28 to 48 years). They were welders (6 cases), mechanics (3 cases), workers in electrical cable manufacturing industries (2 cases) and workers in dental amalgam plants (2 cases). The average duration of work and exposure was 8 hours/day for an average period of 5 to 7 years. The signs leading to consultation were various: urinary, digestive, neurosensory or general signs. The physical examination confirmed the presence of hypertension in both arms in standing and supine position. The complementary examinations were normal. The search for toxics was performed.