Background: Hypertension is a polygenic disease. Various singlenucleotide gene polymorphisms of r... more Background: Hypertension is a polygenic disease. Various singlenucleotide gene polymorphisms of renin angiotensin system have been explored in hypertension. Angiotensin II, the major biologically active component of this system, exerts its effect via two pharmacologically distinct subtypes of angiotensin II receptors, the angiotensin II type 1 receptor and the angiotensin II type 2 receptor. Aim: To examine whether the 3123 C/A polymorphism of angiotensin II type 2 receptor gene is involved in hypertension in a sample of Tunisian population. Methods: Atotal of 403 normotensive subjects and 382 hypertensive patients were included in the study. Genotyping was performed by polymerase chain reaction followed by Alu I restriction digestion. Results: The frequency of "A" genotype was not significantly different between the two groups in men (¯2=1.18; p=0.16). The estimated odds prevalence for hypertension ("A" versus "C") was 0.77 (95% CI 0.49 to 1.22, p=0.27). After adjustment for confounding factors, the OR for hypertension remained no significant (OR: 1.49, 95% CI: 0.84-2.63, p=0.16). In women, genotype distributions for C3123A variant in hypertensive patients were not significantly different from normotensive subjects (¯2=3.16; p=0.20). Multiple logistic regression analysis showed that the AA genotype was not significantly associated with hypertension (OR: 1.09, 95% CI: 0.58-2.06, p=0.77). Conclusion: In the present study, we showed that the 3123 C/A polymorphism of AGT2R gene is not a significant factor for hypertension in a sample of Tunisian population.
Annales De Cardiologie Et D Angeiologie, Dec 1, 2015
OBJECTIFS The prevalence of the risk of CVD and hypertension in women increases when they reach m... more OBJECTIFS The prevalence of the risk of CVD and hypertension in women increases when they reach menopause. The aim of this study was to assess the prevalence and risk factors of hypertension in pre-menopausal (Pre-M) women and post-menopausal (Post-M) women and determine whether years since menopause are associated with hypertension. MéTHODES: This cross-sectional study was used a two-stage cluster sampling method to select a representative sample of the great Tunis population. A total of 1.484 women (776 Pre-M and 708 Post-M), aged 35 to 69 years were included. Definition and classification of hypertension was performed according to guidelines from the JNC-7 report RéSULTATS: The overall prevalence of hypertension among women in Great Tunis region was 40.7%, and it increased with age. Post-M had a higher prevalence of hypertension than Pre-M (58.5% vs 25.1%, p<0.001). Post-M had higher systolic and diastolic blood pressure, triglyceride, total cholesterol, fasting plasma glucose and body mass index than Pre-M. Regression analysis found that the ORs for hypertension increased with age and BMI. Also the personal history of diabetes (OR=2.18, 95% CI: 1.56-3.04, p<0.001) and dyslipidemia (OR=1.60, 95% CI: 1.20-2.13) were associated with hypertension in all participants. The age-adjusted OR (1.63, 95% CI: 1.51-1.76, p<0.001) for hypertension were significantly higher in Post-M than in Pre-M, and the risk of hypertension reached a peak level in the lower 5-year group (OR=1.54; 95% CI, 0.88-2.68, p=0.02). CONCLUSION After adjusting for confounders, this study showed that postmenopausal status was an independent risk factor for hypertension. The risk of hypertension was highest in Post-M with less than or equal to 5 years from menopause.
The present study aimed to determine the prevalence of prehypertension (preHTN) and its cardiomet... more The present study aimed to determine the prevalence of prehypertension (preHTN) and its cardiometabolic profile in Tunisians, and to estimate the risk for coronary heart disease (CHD) according to blood pressure status. This cross-sectional study was conducted in 2004-2005, and used a two-stage cluster sampling method to select a representative sample of the Great Tunis population. A total of 2712 individuals (1228 men and 1484 women), aged 35 to 69 years were included. Definition and classification of hypertension (HTN) was performed according to guidelines from the Joint National Committee on prevention, detection, evaluation and treatment of high blood pressure (JNC-7) report. The prevalence of preHTN and HTN was 56.8% and 25.0% in males, and 43.1% and 36.1% in females, respectively. Subjects with preHTN and those with HTN showed higher prevalence of diabetes, dyslipidemia, obesity and abdominal obesity than the normotensive (NT) group. The metabolic syndrome (MetS) was found in 8.0%, 17.8% and 53.8% of NT, preHT and HTN subjects, respectively. The risk of developing CHD within 10 years, as predicted by the Framingham-Anderson model, was above 15% for 3.9%, 31.1% and 65.0% among NT, preHTN and HTN subjects, respectively. In multivariate analysis, preHTN was associated with age (OR [95% CI], 1.02 [1.01-1.03]; 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;lt;0.01), male gender (2.51 [1.89-3.23]; 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;lt;0.001), obesity (2.36 [1.71-3.26]; 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;lt;0.01), abdominal obesity (1.53 [1.14-2.06]; 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;lt;0.01) and smoking (0.70 [0.53-0.92]; 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;lt;0.01). PreHTN is very common in Tunisians. It is associated with a higher prevalence of cardiometabolic risk factors and confers a higher risk for subsequent CHD. These findings support the recommendations of lifestyle modification for preHTN patients.
The aim of this study was to evaluate the frequency of cardiovascular disease and risk factors as... more The aim of this study was to evaluate the frequency of cardiovascular disease and risk factors associated in patients hospitalised in coronary care units at Military Hospital, Tunis, over the period 1994-1998. The clinical features of 3513 patients (2389 men and 1124 women) on hospital admission were analysed. 47.3% of patients were hospitalised for coronary disease, 12.5% for valvular heart disease, 5.2% for cardiomyopathy, 16.2% for arrhythmia and conduction disturbance, 6.4% for hypertension and 12.2% for other pathologies. With this risk factor profile Tunisia has to implement a national strategy of primary prevention and heart heath promotion in addition to the efforts recently made in secondary prevention of some chronic disease such as hypertension and diabetes.
The Tunisian epidemiological data on cardiovascular disease in the hospital environment are scarc... more The Tunisian epidemiological data on cardiovascular disease in the hospital environment are scarce. The aim of this study was to evaluate the frequency of cardiovascular risk factors and their association in patients hospitalised for coronary disease in coronary care units at Rabta, Charles Nicolle, Habib Thameur and Military hospitals, Tunis, over the period 1994-1998. The clinical features of 6901 patients (75.7% men, 3760 myocardial infarction, 3141 unstable angina) on hospital admission were analysed. The prevalence of smoking, dyslipidemia, hypertension, diabetes and obesity was 86; 49.8; 33.9; 40.7 and 15.2% respectively in the men and 12.9; 52.4; 64.6; 53.4 and 29.8% respectively in women. With this risk factor profile Tunisia has to implement a national strategy of primary prevention and heart health promotion in addition to the efforts recently made in secondary prevention of some chronic disease such as hypertension, diabetes and smoking.
Apolipoprotein B (apoB) is the major proteic component of LDL, VLDL and chylomicrons. Numerous po... more Apolipoprotein B (apoB) is the major proteic component of LDL, VLDL and chylomicrons. Numerous polymorphisms of the apolipoprotein B gene have been described. Particularly, a polymorphism of insertion/deletion located in the coding part of the signal peptide of apoB, associated with modifications of lipid concentrations and the risk of cardiovascular disease, has been reported in the general population. Since obesity is frequently associated with dyslipidemias, the aim of our study was to assess the effect of the insertion/deletion polymorphism of the apolipoprotein B gene on lipid levels in obese subjects. 234 unrelated caucasian obese subjects (74 men and 160 women, aged 39.3 +/- 10.5, BMI : 32.8 +/- 4.7) were recruited. The insertion/deletion polymorphism was determined by electrophoresis in polyacrylamide gels after PCR amplification. The relative frequencies of the Ins and Del alleles were 0.71 and 0.29 respectively. These frequencies were similar to those found in other Caucas...
Multiple infarcts were produced in cerebral hemispheres of rats by injecting calibrated 50-micron... more Multiple infarcts were produced in cerebral hemispheres of rats by injecting calibrated 50-micron microspheres into the left internal carotid artery, and alterations in lipid and energy metabolism were evaluated 24 hours later in the embolized hemisphere. Total phospholipid content was decreased by 26%, but the different classes of phospholipids were not equally affected. Phosphatidylinositol and phosphatidylserine levels were decreased by about 40% and phosphatidylcholine and phosphatidylethanolamine by 25%, while sphingomyelin level remained unchanged. There was a 3.2-fold increase in total free fatty acid content with a relatively larger rise in polyunsaturated free fatty acids 20:4 and 22:6 (20-fold increase). Determination of enzyme activities showed decreases in Na+,K+-ATPase (-21%) and hexokinase (-14%) but no changes in phosphofructokinase and pyruvate kinase. Study of energy metabolism using the closed system method of Lowry et al showed a significant depression (-36%) of t...
Background: Hypertension is a polygenic disease. Various singlenucleotide gene polymorphisms of r... more Background: Hypertension is a polygenic disease. Various singlenucleotide gene polymorphisms of renin angiotensin system have been explored in hypertension. Angiotensin II, the major biologically active component of this system, exerts its effect via two pharmacologically distinct subtypes of angiotensin II receptors, the angiotensin II type 1 receptor and the angiotensin II type 2 receptor. Aim: To examine whether the 3123 C/A polymorphism of angiotensin II type 2 receptor gene is involved in hypertension in a sample of Tunisian population. Methods: Atotal of 403 normotensive subjects and 382 hypertensive patients were included in the study. Genotyping was performed by polymerase chain reaction followed by Alu I restriction digestion. Results: The frequency of "A" genotype was not significantly different between the two groups in men (¯2=1.18; p=0.16). The estimated odds prevalence for hypertension ("A" versus "C") was 0.77 (95% CI 0.49 to 1.22, p=0.27). After adjustment for confounding factors, the OR for hypertension remained no significant (OR: 1.49, 95% CI: 0.84-2.63, p=0.16). In women, genotype distributions for C3123A variant in hypertensive patients were not significantly different from normotensive subjects (¯2=3.16; p=0.20). Multiple logistic regression analysis showed that the AA genotype was not significantly associated with hypertension (OR: 1.09, 95% CI: 0.58-2.06, p=0.77). Conclusion: In the present study, we showed that the 3123 C/A polymorphism of AGT2R gene is not a significant factor for hypertension in a sample of Tunisian population.
Annales De Cardiologie Et D Angeiologie, Dec 1, 2015
OBJECTIFS The prevalence of the risk of CVD and hypertension in women increases when they reach m... more OBJECTIFS The prevalence of the risk of CVD and hypertension in women increases when they reach menopause. The aim of this study was to assess the prevalence and risk factors of hypertension in pre-menopausal (Pre-M) women and post-menopausal (Post-M) women and determine whether years since menopause are associated with hypertension. MéTHODES: This cross-sectional study was used a two-stage cluster sampling method to select a representative sample of the great Tunis population. A total of 1.484 women (776 Pre-M and 708 Post-M), aged 35 to 69 years were included. Definition and classification of hypertension was performed according to guidelines from the JNC-7 report RéSULTATS: The overall prevalence of hypertension among women in Great Tunis region was 40.7%, and it increased with age. Post-M had a higher prevalence of hypertension than Pre-M (58.5% vs 25.1%, p<0.001). Post-M had higher systolic and diastolic blood pressure, triglyceride, total cholesterol, fasting plasma glucose and body mass index than Pre-M. Regression analysis found that the ORs for hypertension increased with age and BMI. Also the personal history of diabetes (OR=2.18, 95% CI: 1.56-3.04, p<0.001) and dyslipidemia (OR=1.60, 95% CI: 1.20-2.13) were associated with hypertension in all participants. The age-adjusted OR (1.63, 95% CI: 1.51-1.76, p<0.001) for hypertension were significantly higher in Post-M than in Pre-M, and the risk of hypertension reached a peak level in the lower 5-year group (OR=1.54; 95% CI, 0.88-2.68, p=0.02). CONCLUSION After adjusting for confounders, this study showed that postmenopausal status was an independent risk factor for hypertension. The risk of hypertension was highest in Post-M with less than or equal to 5 years from menopause.
The present study aimed to determine the prevalence of prehypertension (preHTN) and its cardiomet... more The present study aimed to determine the prevalence of prehypertension (preHTN) and its cardiometabolic profile in Tunisians, and to estimate the risk for coronary heart disease (CHD) according to blood pressure status. This cross-sectional study was conducted in 2004-2005, and used a two-stage cluster sampling method to select a representative sample of the Great Tunis population. A total of 2712 individuals (1228 men and 1484 women), aged 35 to 69 years were included. Definition and classification of hypertension (HTN) was performed according to guidelines from the Joint National Committee on prevention, detection, evaluation and treatment of high blood pressure (JNC-7) report. The prevalence of preHTN and HTN was 56.8% and 25.0% in males, and 43.1% and 36.1% in females, respectively. Subjects with preHTN and those with HTN showed higher prevalence of diabetes, dyslipidemia, obesity and abdominal obesity than the normotensive (NT) group. The metabolic syndrome (MetS) was found in 8.0%, 17.8% and 53.8% of NT, preHT and HTN subjects, respectively. The risk of developing CHD within 10 years, as predicted by the Framingham-Anderson model, was above 15% for 3.9%, 31.1% and 65.0% among NT, preHTN and HTN subjects, respectively. In multivariate analysis, preHTN was associated with age (OR [95% CI], 1.02 [1.01-1.03]; 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;lt;0.01), male gender (2.51 [1.89-3.23]; 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;lt;0.001), obesity (2.36 [1.71-3.26]; 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;lt;0.01), abdominal obesity (1.53 [1.14-2.06]; 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;lt;0.01) and smoking (0.70 [0.53-0.92]; 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;lt;0.01). PreHTN is very common in Tunisians. It is associated with a higher prevalence of cardiometabolic risk factors and confers a higher risk for subsequent CHD. These findings support the recommendations of lifestyle modification for preHTN patients.
The aim of this study was to evaluate the frequency of cardiovascular disease and risk factors as... more The aim of this study was to evaluate the frequency of cardiovascular disease and risk factors associated in patients hospitalised in coronary care units at Military Hospital, Tunis, over the period 1994-1998. The clinical features of 3513 patients (2389 men and 1124 women) on hospital admission were analysed. 47.3% of patients were hospitalised for coronary disease, 12.5% for valvular heart disease, 5.2% for cardiomyopathy, 16.2% for arrhythmia and conduction disturbance, 6.4% for hypertension and 12.2% for other pathologies. With this risk factor profile Tunisia has to implement a national strategy of primary prevention and heart heath promotion in addition to the efforts recently made in secondary prevention of some chronic disease such as hypertension and diabetes.
The Tunisian epidemiological data on cardiovascular disease in the hospital environment are scarc... more The Tunisian epidemiological data on cardiovascular disease in the hospital environment are scarce. The aim of this study was to evaluate the frequency of cardiovascular risk factors and their association in patients hospitalised for coronary disease in coronary care units at Rabta, Charles Nicolle, Habib Thameur and Military hospitals, Tunis, over the period 1994-1998. The clinical features of 6901 patients (75.7% men, 3760 myocardial infarction, 3141 unstable angina) on hospital admission were analysed. The prevalence of smoking, dyslipidemia, hypertension, diabetes and obesity was 86; 49.8; 33.9; 40.7 and 15.2% respectively in the men and 12.9; 52.4; 64.6; 53.4 and 29.8% respectively in women. With this risk factor profile Tunisia has to implement a national strategy of primary prevention and heart health promotion in addition to the efforts recently made in secondary prevention of some chronic disease such as hypertension, diabetes and smoking.
Apolipoprotein B (apoB) is the major proteic component of LDL, VLDL and chylomicrons. Numerous po... more Apolipoprotein B (apoB) is the major proteic component of LDL, VLDL and chylomicrons. Numerous polymorphisms of the apolipoprotein B gene have been described. Particularly, a polymorphism of insertion/deletion located in the coding part of the signal peptide of apoB, associated with modifications of lipid concentrations and the risk of cardiovascular disease, has been reported in the general population. Since obesity is frequently associated with dyslipidemias, the aim of our study was to assess the effect of the insertion/deletion polymorphism of the apolipoprotein B gene on lipid levels in obese subjects. 234 unrelated caucasian obese subjects (74 men and 160 women, aged 39.3 +/- 10.5, BMI : 32.8 +/- 4.7) were recruited. The insertion/deletion polymorphism was determined by electrophoresis in polyacrylamide gels after PCR amplification. The relative frequencies of the Ins and Del alleles were 0.71 and 0.29 respectively. These frequencies were similar to those found in other Caucas...
Multiple infarcts were produced in cerebral hemispheres of rats by injecting calibrated 50-micron... more Multiple infarcts were produced in cerebral hemispheres of rats by injecting calibrated 50-micron microspheres into the left internal carotid artery, and alterations in lipid and energy metabolism were evaluated 24 hours later in the embolized hemisphere. Total phospholipid content was decreased by 26%, but the different classes of phospholipids were not equally affected. Phosphatidylinositol and phosphatidylserine levels were decreased by about 40% and phosphatidylcholine and phosphatidylethanolamine by 25%, while sphingomyelin level remained unchanged. There was a 3.2-fold increase in total free fatty acid content with a relatively larger rise in polyunsaturated free fatty acids 20:4 and 22:6 (20-fold increase). Determination of enzyme activities showed decreases in Na+,K+-ATPase (-21%) and hexokinase (-14%) but no changes in phosphofructokinase and pyruvate kinase. Study of energy metabolism using the closed system method of Lowry et al showed a significant depression (-36%) of t...
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