References of "PHILIPS, Jean-Christophe"
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See detailRecommandations europeennes pour la prise en charge du diabete, du pre-diabete et des maladies cardio-vasculaire. 1ere partie. Gestion du diabete et des facteurs de risque cardio-vasculaire.
Scheen, André ULg; RADERMECKER, Régis ULg; PHILIPS, Jean-Christophe ULg et al

in Revue medicale de Liege (2013), 68(11), 585-92

The patient with prediabetes or diabetes has a high or very high risk of cardiovascular diseases.We summarize the recent guidelines jointly published by the European Society of Cardiology and the European ... [more ▼]

The patient with prediabetes or diabetes has a high or very high risk of cardiovascular diseases.We summarize the recent guidelines jointly published by the European Society of Cardiology and the European Society for the Study of Diabetes. In this first article, we focus mainly on the preventive approaches of cardiovascular diseases in patients with prediabetes or (type 1 or type 2) diabetes. The crucial importance of a global multifactorial strategy is emphasized and the target levels of various risk factors are updated. The management of these cardiovascular complications in presence of diabetes will be considered in a second article. [less ▲]

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See detailL'Hypotension orthostatique: 1ere partie: definition, symptomatologie, evaluation et physiopathologie.
Tyberghein, Maelle; PHILIPS, Jean-Christophe ULg; Krzesinski, Jean-Marie ULg et al

in Revue Médicale de Liège (2013), 68(2), 65-73

Orthostatic hypotension (OH) is defined by a drop in arterial blood pressure (BP) of at least 20 mmHg for systolic BP and 10 mmHg for diastolic BP after standing. Symptoms are generally quite typical, but ... [more ▼]

Orthostatic hypotension (OH) is defined by a drop in arterial blood pressure (BP) of at least 20 mmHg for systolic BP and 10 mmHg for diastolic BP after standing. Symptoms are generally quite typical, but may also be rather vague. Diagnosis may be easily made by the physician in his/ her office, and confirmed, if necessary, by more sophisticated measurements. Pathophysiology is generally rather complex, but mostly involves a defect in the autonomic nervous system, in its sympathetic component. Failure of peripheral vasoconstriction seems to play a more important role than the defect in reflex tachycardia. Causes of OH are multiples. OH may occur in healthy subjects, when exposed to exceptional circumstances, but is more generally associated with various diseases, either neurological disorders or pathologies characterized by hypovolemia. Medications can also aggravate the risk of OH, among which some antihypertensive or psychotropic agents. Elderly people, especially frailty subjects, are exposed to a high risk of OH, whose origin is often multifactorial, and this complication may have serious medical consequences. [less ▲]

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See detailRelations entre gain baroreflexe et stress pulsatile chez le patient diabetique de type 1.
SCHEEN, André ULg; MARCHAND, Monique ULg; PHILIPS, Jean-Christophe ULg

in Annales de Cardiologie et d'Angeiologie (2012)

AIM OF THE STUDY: Cardiovascular autonomic neuropathy (CAN) and early arterial stiffness are frequent complications in type 1 diabetes. The aim of our work is to study the relationships between CAN ... [more ▼]

AIM OF THE STUDY: Cardiovascular autonomic neuropathy (CAN) and early arterial stiffness are frequent complications in type 1 diabetes. The aim of our work is to study the relationships between CAN (estimated by baroreflex gain calculation) and arterial stiffness (estimated by pulsatile stress) in type 1 diabetic patients. PATIENTS AND METHODS: In a cross-sectional study, we calculated baroreflex gain and pulsatile stress in 167 type 1 diabetic patients and 160 matched non-diabetic subjects whose blood pressure was continuously monitored with a Finapres((R)) device in a postural test (squatting test). The baroreflex gain was calculated by plotting the pulse intervals (R-R) against systolic blood pressure values during the transition phase from squatting to standing. Pulsatile stress was estimated by the pulse pressurexheart rate product. In a longitudinal study, the baroreflex gain and pulsatile stress were calculated before and after a mean follow-up of 79+/-33 months in type 1 diabetic patients. RESULTS: Cross-sectional data showed a decrease in baroreflex gain and an increase in pulsatile stress in type 1 diabetic patients versus the matched non-diabetic subjects. A significant correlation between the baroreflex gain and pulsatile stress was present. Type 1 diabetic patients with lower baroreflex gain had a higher value of pulsatile stress when compared to those with higher baroreflex gain. During follow-up, a significant reduction in baroreflex gain (but without significantly increased pulsatile stress) was observed. A univariate analysis showed that the decrease of the baroreflex gain is not correlated with the time interval between the two tests, neither type 1 diabetes duration nor mean glycated hemoglobin values, but significantly with the pulsatile stress increase. CONCLUSION: In type 1 diabetic patients, the baroreflex gain is decreased and the pulsatile stress is increased when these markers are compared to age-matched non-diabetic subjects. There is a relationship between indices of CAN and arterial stiffness. Nevertheless, the baroreflex gain (marker of CAN) is impaired earlier than the pulsatile stress in this type 1 diabetic population with inadequate glycaemic control. [less ▲]

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See detailHaemodynamic changes during a squat test, pulsatile stress and indices of cardiovascular autonomic neuropathy in patients with long-duration type 1 diabetes.
PHILIPS, Jean-Christophe ULg; MARCHAND, Monique ULg; SCHEEN, André ULg

in Diabètes & Métabolism (2011)

AIM: Cardiovascular autonomic neuropathy (CAN) and pulsatile stress are considered to be independent cardiovascular risk factors. This study compared haemodynamic changes during an active orthostatic test ... [more ▼]

AIM: Cardiovascular autonomic neuropathy (CAN) and pulsatile stress are considered to be independent cardiovascular risk factors. This study compared haemodynamic changes during an active orthostatic test in adult patients with type 1 diabetes (T1DM), using low versus high RR E/I ratios as a marker of CAN. METHODS: A total of 20 T1DM patients with low RR E/I ratios were compared with 20 T1DM patients with normal RR E/I ratios, matched for gender (1/1 ratio), age (mean: 46years) and diabetes duration (22-26years); 40 matched healthy subjects served as controls. All subjects were evaluated by continuous monitoring of arterial blood pressure (Finapres((R))) and heart rate using a standardized posture test (1-min standing, 1-min squatting, 1-min standing), thus allowing calculation of baroreflex gain. RESULTS: Compared with controls, T1DM patients showed lower RR E/I ratios, reduced baroreflex gains, higher pulsatile stress (pulse pressurexheart rate), greater squatting-induced pulse pressure rises, orthostatic hypotension and reduced reflex tachycardia. Compared with T1DM patients with preserved RR E/I ratios, T1DM patients with low RR E/I ratios showed reduced post-standing reflex tachycardia and baroreflex gain, and delayed blood pressure recovery, but no markers of increased pulsatile stress. Interestingly, decreased baroreflex gain was significantly associated with both pulsatile stress and microalbuminuria. CONCLUSION: The use of RR E/I ratios to separate T1DM patients allows the detection of other CAN markers during an orthostatic posture test, but with no significant differences in pulsatile stress or microalbuminuria. In this context, squatting-derived baroreflex gain appears to be more informative. [less ▲]

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See detailSquatting, a posture test for studying cardiovascular autonomic neuropathy in diabetes.
PHILIPS, Jean-Christophe ULg; MARCHAND, Monique ULg; SCHEEN, André ULg

in Diabètes & Métabolism (2011), 37(6), 489-496

Cardiovascular autonomic neuropathy (CAN) is a frequent complication of diabetes mellitus, which is associated with increased morbidity and mortality. It involves both the parasympathetic and sympathetic ... [more ▼]

Cardiovascular autonomic neuropathy (CAN) is a frequent complication of diabetes mellitus, which is associated with increased morbidity and mortality. It involves both the parasympathetic and sympathetic nervous systems, and may be diagnosed by classical dynamic tests with measurements of heart rate (HR) and/or arterial blood pressure (BP). An original squat test (1-min standing, 1-min squatting, 1-min standing) was used with continuous monitoring of HR and BP, using a Finapres((R)) device. This active test imposes greater postural stress than the passive head-up tilt test, and provokes large changes in BP and HR that can be analyzed to derive indices of CAN. In healthy subjects, squatting is associated with BP increases and HR decreases (abolished by atropine: SqTv index), whereas the squat-stand transition is accompanied by a deep but transient drop in BP associated with sympathetic-driven tachycardia (abolished by propranolol: SqTs index). In diabetic patients with CAN, BP increases are accentuated during squatting whereas reflex bradycardia is reduced. When standing from squatting position, the fall in BP tends to be more pronounced and orthostatic hypotension more prolonged, while reflex tachycardia is markedly dampened. The baroreflex gain, similar to that calculated during pharmacological testing with vasodilator/vasopressor agents, can be derived by plotting pulse intervals (R-R) against systolic BP levels during the biphasic response following the squat-stand transition. The slope, which represents baroreflex sensitivity, is significantly reduced in patients with CAN. This discriminatory index allows study of the natural history of CAN in a large cohort of diabetic patients. [less ▲]

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See detailRELATIONS ENTRE GAIN BARO-REFLEXE ET STRESS PULSATILE CHEZ LE PATIENT DIABETIQUE DE TYPE 1
SCHEEN, André ULg; MARCHAND, Monique ULg; PHILIPS, Jean-Christophe ULg

in Archives des Maladies du Coeur et des Vaisseaux (2011), hors série 3

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See detailSquatting test: a dynamic postural manoeuvre to study baroreflex sensitivity.
SCHEEN, André ULg; PHILIPS, Jean-Christophe ULg

in Clinical autonomic research : official journal of the Clinical Autonomic Research Society (2011)

INTRODUCTION: Squatting is an active posture test that can be used to assess baroreflex sensitivity. Indeed, the shift from squatting to standing imposes a major orthostatic stress leading to rapid and ... [more ▼]

INTRODUCTION: Squatting is an active posture test that can be used to assess baroreflex sensitivity. Indeed, the shift from squatting to standing imposes a major orthostatic stress leading to rapid and large changes in arterial blood pressure (BP) and heart rate (HR) allowing precise baroreflex assessment. MATERIAL AND METHODS: BP and HR can be continuously and non-invasively monitored with a Finapres device. RESULTS: The standing to squatting transition is accompanied by rises in BP, pulse pressure and cardiac output, mainly due to increased venous return, and by a secondary reduction in HR. Conversely, the squatting to standing transition is associated with an immediate drop in BP and both reflex tachycardia and vasoconstriction. This mirror changes in BP and HR, mimicking those observed with the classical pharmacological approach using vasopressor/vasodilating agents, allows the calculation of the so-called baroreflex gain. DISCUSSION: The present review describes the haemodynamic changes occurring in normal subjects during the shifts from standing to squatting and from squatting to standing and discusses the underlying cardiovascular and autonomic mechanisms. CONCLUSION: This careful analysis in healthy individuals should help in the understanding of disturbances that may be observed in patients with autonomic dysfunction, such as in diabetic patients with cardiovascular autonomic neuropathy. [less ▲]

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See detailDiagnostic differentiel d'un malaise: hypoglycemie, hypotension ou spasmophilie?
SCHEEN, André ULg; PHILIPS, Jean-Christophe ULg; Krzesinski, Jean-Marie ULg

in Revue Médicale de Liège (2011), 66(1), 48-54

The consultation for dizziness is a common problem in clinical practice. Because of the apparent lack of specificity of the complaints, there is a rather high risk to prescribe a variety of sophisticated ... [more ▼]

The consultation for dizziness is a common problem in clinical practice. Because of the apparent lack of specificity of the complaints, there is a rather high risk to prescribe a variety of sophisticated exams, which will not be very helpful in absence of a well oriented anamnesis and a pertinent clinical examination. The present paper aims at describing a global medical approach, essentially based upon a detailed anamnesis (semiological, chronological and therapeutical arguments), to which may be added a few simple clinical and technical complementary data. This strategy should allow obtaining quite easily pertinent arguments for a differential diagnosis between reactive hypoglycaemia, (orthostatic) hypotension, and hyperventilation crisis (spasmophilia). [less ▲]

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See detailSquatting test: A posture to study and counteract cardiovascular abnormalities associated with autonomic dysfunction.
PHILIPS, Jean-Christophe ULg; SCHEEN, André ULg

in Autonomic neuroscience : basic & clinical (2011)

The squatting test is an active posture manoeuvre that imposes one of the most potent orthostatic stresses. In normal subjects, the changes in blood pressure and heart rate are transient because of ... [more ▼]

The squatting test is an active posture manoeuvre that imposes one of the most potent orthostatic stresses. In normal subjects, the changes in blood pressure and heart rate are transient because of appropriate baroreflex homeostasis and do not provoke symptoms. However, in various pathological conditions, both the increase in blood pressure during squatting and the decrease in blood pressure during standing may be more important and sustained, potentially leading to complaints and adverse events. Squatting has been used to evaluate patients with tetralogy of Fallot, heart transplant, dysautonomia, including diabetic cardiovascular autonomic neuropathy, and individuals prone to vasovagal syncope. Careful analysis of changes in blood pressure and heart rate during the transition from standing to squatting and from squatting to standing allows the early detection of altered vagal and/or sympathetic function. Of note squatting position has been proposed as a therapeutic means to counteract the fall in blood pressure in patients suffering from dizziness due to dysautonomia and orthostatic hypotension or presenting pre-syncope symptoms, such as soon after exercise. The aims of the present review are to analyse the haemodynamic pattern during a squatting test in various pathological situations and to describe what may be the negative and positive haemodynamic changes associated with this posture. We were especially interested in using the squatting test for the assessment of cardiovascular autonomic neuropathy associated with diabetes mellitus. [less ▲]

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See detailAre the complications of arteriovenous fistulas associated with an abnormal Ankle-Brachial Index in hemodialysis patients?
Xhignesse, Patricia ULg; Saint-Remy, Annie ULg; Dubois, Bernard ULg et al

in Acta Clinica Belgica (2010), 65(1), 65

The peripheral artery disease is frequent among patients undergoing hemodialysis much more than in the general population. The ankle-brachial index (AB!) is a potent tool to screen this pathology. We ... [more ▼]

The peripheral artery disease is frequent among patients undergoing hemodialysis much more than in the general population. The ankle-brachial index (AB!) is a potent tool to screen this pathology. We analysed the relationship between ABI abnormal values and arteriovenous fistulas (AVF) complications such as stenosis and thrombosis among chronically hemodialysis pat ients (HD). [less ▲]

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See detailMieux traiter le diabète : combattre l’inertie et améliorer l’adhésion au traitement.
SCHEEN, André ULg; PHILIPS, Jean-Christophe ULg; PAQUOT, Nicolas ULg

in Association belge du diabète (2010), 53

Le diabète est une maladie chronique par excellence. Comme beaucoup d’autres maladies chroniques, le diabète, qu’il soit de type 1 ou plus encore de type 2, est d’origine complexe, combinant l’infl uence ... [more ▼]

Le diabète est une maladie chronique par excellence. Comme beaucoup d’autres maladies chroniques, le diabète, qu’il soit de type 1 ou plus encore de type 2, est d’origine complexe, combinant l’infl uence de facteurs génétiques et environnementaux. Le but du traitement est de corriger au mieux l’hyperglycémie chronique, mais aussi d’autres facteurs de risque (hypertension artérielle, hypercholestérolémie,…), de façon à prévenir la survenue de complications, garantir une bonne qualité de vie et améliorer l’espérance de vie. [less ▲]

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See detailEtude de la pression artérielle, rigidité artérielle et neuropathie autonome cardiovasculaire chez les patients diabétiques de type 1
Philips, Jean-Christophe ULg; Xhignesse, Patricia ULg; Marchand, Monique ULg et al

in Vaisseaux, Coeur, Poumons [=VCP] (2010), 15(3), 70-73

Nous avons récemment eu l'honneur de recevoir l'Hypertension Young Investigator Award 2009 adressé par le Comité belge de Lutte contre l'Hypertension et soutenu par la fondation Astra Zeneca. Notre projet ... [more ▼]

Nous avons récemment eu l'honneur de recevoir l'Hypertension Young Investigator Award 2009 adressé par le Comité belge de Lutte contre l'Hypertension et soutenu par la fondation Astra Zeneca. Notre projet propose d'étudier différents indices cardiovasculaires au sein d'une population constituée de patients diabétiques de type 1. L'étude de la pression artérielle, estimée par différentes méthodes, ainsi que l'estimation de la rigidité artérielle chez ces patients pourraient être utiles afin d'apprécier le statut cardiovasculaire chez ces patients à haut risque. Notre service possède une certaine expérience dans la recherche et l'estimation de la neuropathie autonome cardiovasculaire (NAC) chez les patients diabétiques de type 1. Cette complication du diabète est associée à une morbi-mortalité d'origine cardiovasculaire accrue. Nous allons proposer une batterie de tests classiquement effectués dans le cadre de la recherche d'une NAC (en utilisant la technique du Finapress°). Ceux-ci seront combinés à d'autres explorations réalisées par nos confrères néphrologues (mesure ambulatoire de 24 heures de la pression artéielle ou MAPA et Sphygmocor°). Tous ces examens ont l'avantage d'être non-invasifs et peuvent être réalisés en routine clinique. Le recrutement de cette étude devrait permettre d'inclure une soixantaine de patients diabétiques de type 1 âgés de 20 à 50 ans et dont la durée de diabète varie entre 10 et 30 années. Cette population sera comparée à une cohorte de sujet sains apariés pour l'âge, l'indice de masse corporelle et le sexe. Plusieurs mesures sont effectuées et certains indices pourront être calculés après la réalisation des différents examens. Une comparaison entre les deux cohortes (diabétiques versus non-diabétiques) sera effectuée. L'évolution de certains paramètres au sein de la population diabétique sera aussi analysée (en fonction de l'âge et la durée du diabète par exemple). [less ▲]

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See detailChanges in pulse pressure, heart rate and the pulse pressure x heart rate product during squatting in Type 1 diabetes according to age.
Philips, Jean-Christophe ULg; Marchand, Monique ULg; Scheen, André ULg

in Diabetic Medicine : A Journal of the British Diabetic Association (2010), 27(7), 753-61

AIMS: We assessed changes in pulse pressure and heart rate during a squatting test, as indirect markers of arterial stiffness and cardiovascular autonomic neuropathy, respectively, according to age and ... [more ▼]

AIMS: We assessed changes in pulse pressure and heart rate during a squatting test, as indirect markers of arterial stiffness and cardiovascular autonomic neuropathy, respectively, according to age and sex in patients with Type 1 diabetes mellitus. METHODS: We evaluated 160 diabetic patients, divided into four groups of 20 men and 20 women according to age (G1, 20-30 years old; G2, 31-40 years old; G3, 41-50 years old; and G4, 51-60 years old), and 160 non-diabetic matched control subjects. Each subject underwent a 3 min posture test (standing-squatting-standing) with continuous measurement of arterial blood pressure and heart rate by a Finapres device. Overall values throughout the test, baseline levels in initial standing position and squatting-induced changes in pulse pressure, heart rate and the pulse pressure x heart rate product were compared between diabetic patients and healthy control subjects. RESULTS: In the standing position, a greater increase in pulse pressure and lower reduction in heart rate with age led to a significantly higher pulse pressure x heart rate product in diabetic patients compared with control subjects. In the squatting position, a more marked pulse pressure increase in the absence of appropriate reduction in heart rate resulted in a greater rise in the pulse pressure x heart rate product in diabetic patients than in healthy subjects. No major differences were noted between the sexes, with the exception of a stronger relationship between pulse pressure and age in the female population with diabetes. Squatting-derived indices of cardiovascular autonomic neuropathy were also noted with increasing age in diabetic patients. CONCLUSIONS: The marked increase in the pulse pressure x heart rate product ('pulsatile stress') according to age, combined with cardiovascular autonomic neuropathy, may contribute to the higher cardiovascular risk of patients with Type 1 diabetes. [less ▲]

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