Doctor-patient communication about nutrition on related secondary preventive behaviours, especially for hypertension

in Hypertension (2016)

Inadequate consumption of fruit and vegetables and salt intake are two major factors that can play a role in increased to secondary prevention behaviours. Doctor-patient relationship intervenes on the ... [more ▼]

Inadequate consumption of fruit and vegetables and salt intake are two major factors that can play a role in increased to secondary prevention behaviours. Doctor-patient relationship intervenes on the adherence of these advices. For hypertension, hypercholesterolemia, diabetes, overweight and obesity, our study’s aim was to analyse the associations between the quality of the doctor-patient communication, evaluated in 2013, and patients’ adherence to their general practitioner (GP)’s nutritional advices, between 2008 and 2013. Methods Performed by the National Institute of Cardiac Surgery and Interventional Cardiology in Luxembourg, 4391 patients were contacted. Five years after a coronary angiography, 1289 completed a self-rating questionnaire assessing the GP’Com-5 items scale (Cronbach 0.87). The variables were analysed with a multiple logistic regression model. Results Patients declared that 57.9% reduced or stopped their consumption of salt intake, whereas 65% increased their consumption of fresh fruits and vegetables. Around 37% of the patients reported having made changes following the advice of their doctor. An increased consumption of fresh fruits and vegetables was linked with the quality of doctor-patient communication when patients were hypertension (odd ratio (OR) = 1.084, IC 95%, [1.017-1.157]), overweight (1.081 [1.013-1.155]), obesity (OR = 1.130 [1.056-1.209]), hypercholesterolemia (OR = 1.102 [1.033–1.175]) and diabetes (OR = 1.103 [1.029-1.181]). The decreased of salt intake consumption was associated with the quality of physician-patient communication when the patient was hypertension (OR = 1.102 [1.034 – 1.176]). Conclusion Doctor-patient communication is a relevant determinant in obtaining a favourable behavioural outcome, especially on nutrition. The rehabilitation program must promote more exchange and telephone assistance to develop a mutual engagement. [less ▲]

Medroxyprogesterone acetate but not drospirenone ablates the protective function of 17 beta-estradiol in aldosterone salt-treated rats.

in Hypertension (2006), 48(5), 994-1001

Controversial results obtained from human and animal studies on the prevention of heart disease by estrogens and progestins warrant a better understanding of nuclear hormone receptor function and ... [more ▼]

Controversial results obtained from human and animal studies on the prevention of heart disease by estrogens and progestins warrant a better understanding of nuclear hormone receptor function and interaction. To address this issue and taking into account that effects of synthetic progestins are not only referable to action through the progesterone receptor but may also be mediated by other steroid receptors, we characterized cardiovascular function and inflammatory gene expression in aldosterone salt-treated rats on long-term administration of 17beta-estradiol, medroxyprogesterone acetate, and drospirenone, a new progestogen exhibiting antimineralocorticoid activity. The complex pattern of cardiovascular injury in ovariectomized Wistar rats induced by chronic aldosterone infusion plus a high-salt diet was significantly attenuated in sham-ovariectomized rats and by coadministration of 17beta-estradiol in ovariectomized animals after 8 weeks of continuous treatment. The beneficial role of 17beta-estradiol on blood pressure, cardiac hypertrophy, vascular osteopontin expression, perivascular fibrosis, and impaired NO-dependent relaxation of isolated aortic rings was completely abrogated by coadministration of medroxyprogesterone acetate. In contrast, drospirenone was either neutral or additive to 17beta-estradiol in protecting against aldosterone salt-induced cardiovascular injury and inflammation. The current results support the hypothesis of complex interactions among estrogen, progesterone, glucocorticoid, androgen, and mineralocorticoid receptor signaling in cardiovascular injury and inflammation. Novel progestins, such as drospirenone, confer superior effects compared with medroxyprogesterone acetate in a model of aldosterone-induced heart disease because of its antimineralocorticoid properties. [less ▲]

Improvement of endothelial dysfunction by selective estrogen receptor-alpha stimulation in ovariectomized SHR.

in Hypertension (2003), 42(5), 991-6

Both known estrogen receptors, ERalpha and ERbeta, are expressed in blood vessels. To gain further insight into the role of ERalpha in a functional setting, we investigated the effect of the novel highly ... [more ▼]

Both known estrogen receptors, ERalpha and ERbeta, are expressed in blood vessels. To gain further insight into the role of ERalpha in a functional setting, we investigated the effect of the novel highly selective ERalpha agonist Cpd1471 on vascular reactivity in ovariectomized spontaneously hypertensive rats (SHR). After ovariectomy or sham operation, 12-week-old female SHR received either 17beta-estradiol (E2, 2 microg/kg body wt per day), the selective ERalpha agonist Cpd1471 (30 microg/kg body wt per day), or placebo. Acetylcholine-induced endothelium-dependent vasorelaxation was significantly blunted in aortas from ovariectomized rats (Rmax, 53%+/-3% versus sham, 79%+/-2%; P<0.001). Treatment with E2 or Cpd1471 significantly augmented acetylcholine-induced relaxation in ovariectomized rats (Rmax, 70%+/-2%; resp, 73%+/-2%). Endothelium-independent relaxation induced by sodium nitroprusside was not different among the four groups. The contractile response induced by the nitric oxide (NO) synthase inhibitor Nomega-nitro-l-arginine, an index of basal NO formation, was significantly lower in ovariectomized rats compared with sham-operated animals (53+/-2% versus 77%+/-5%; P<0.01) and was normalized by both E2 (70%+/-2%) and Cpd1471 (70%+/-3%). Aortic endothelial NO synthase (eNOS) expression and phosphorylation of the vasodilator-stimulated phosphoprotein, an index of NO/cGMP-signaling, was reduced in ovariectomized SHR and normalized by E2 and Cpd1471. In SHR after ovariectomy, endothelium-dependent NO-mediated vasorelaxation and eNOS expression are attenuated. The novel selective ERalpha agonist Cpd1471 prevented these pathophysiological changes to a similar extent as E2. Thus, the pharmacological principle of selective ERalpha activation mediates positive vascular effects. [less ▲]