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The use of an automatic blood pressure monitor with the help of a protocol given by an e-health application allows self-testing of blood pressure without the help of a health professional. Objective Conduct a screening campaign for high blood pressure in artisanal bakeries in France and develop a score to predict the observation of an increase in blood pressure during self-testing. Method Cross-sectional survey conducted in mainland France in 2018 using 1000 screening kits including a tablet, Predic’HTA® application and a connected electronic blood pressure monitor (BP Track, IHealth). Available for one week in 14,000 artisanal bakeries, in turn. Used in the workplace, on a voluntary basis, by bakery employees. Completion of a health questionnaire with an estimate of excessive salt consumption. Self-screening of 3 blood pressure measurements with centralization of data on a secure database for epidemiological analysis. The average of the last 2 measurements characterizes each subject. Results Full use of Predic’HTA® was obtained in 62.4% of users or 7502 subjects (44% under 35 years of age, 44% 35 to 54 years of age, 12% 55 years of age and over). Antihypertensive treatment was followed by 27% of those aged 55 and over and 1% of those under 35. Among untreated subjects, the prevalence of BP > 140/90 was 21.1%, increasing with age (13%, 27%, 33%) and higher among men (27.2%) than among women (15.4%). With the parameters age, sex, weight, IMC, family history of high blood pressure, excessive salt consumption, previous intake of an antihypertensive drug, a score is calculated to associate a probability of having an BP >120/80 with self-screening. The ROC curve shows an AUC at 0.723 with a PPV at 91% and a NPV at 41%. The depist’HTA® score is available at www.depisthta.net Conclusion Self-testing of blood pressure is possible with an electronic blood pressure monitor if a dedicated appliance is used at the same time. The development of the prediction score depist’HTA® for a blood pressure level > 120/80 would be useful to target subjects who need to self-test their blood pressure in the short term.

Le but de ce travail était de déterminer la prévalence de l'HTA chez les personnes âgées ainsi que leurs connaissances sur cette maladie. Il s'est agi d'une étude descriptive transversale qui s'est déroulée dans la ville de Bobo-Dioulasso d'Octobre à Novembre 2015 sur les sites d'intervention de l'association d'aide aux personnes âgées « KAFOLI ». Les sujets inclus étaient les personnes âgées de 60 ans et plus, hypertendus ou non et qui désiraient participer à l'étude. Les sujets étaient considérés comme hypertendus lorsqu'ils avaient une pression artérielle systolique ≥ 140mmHg et/ou une pression artérielle ≥ 90mmHg ou lorsqu'ils avaient un traitement antihypertenseur. Les données sociodémographiques, cliniques, les facteurs de risque associés ont été recueillis. Les connaissances sur l'HTA recueillies portaient sur les connaissances générales sur l'HTA, les sources d'informations sur l'HTA. 88 sujets ont été inclus dans notre étude. Il y avait 56 femmes et 32 hommes soit un sex-ratio de 0,57. L'âge médian était de 71 ans (IIQ: 66-76). La prévalence de l'HTA était de 61,36% et était associée à la connaissance de l'HTA et à la consommation d'alcool. 68,18% des patients avaient des connaissances sur l'HTA. La majorité était suivie dans les Centres de Santé de premier niveau par des infirmiers (64,81%). Cette étude a mis en évidence une forte prévalence de l'hypertension artérielle chez les personnes âgées à Bobo-Dioulasso. Ces personnes étaient en majorité sensibilisées sur la maladie. Leur suivi était assuré dans la majorité des cas par un personnel infirmier.

Une maladie professionnelle engage la responsabilité de l’employeur. Elle ouvre sur un contentieux dans lequel l’arbitrage scientifique est attendu essentiellement de l’épidémiologie. Cet enjeu pèse sur la compréhension des liens entre santé et travail, car il focalise l’attention sur les relations causales simples et tend à laisser dans l’ombre les effets liés au contexte et à l’histoire. Nous présentons pourtant le cas d’une salariée qui illustre l’importance de ces dimensions. À la suite d’une exposition prolongée à un stress psychosocial et à de fortes contraintes gestuelles et posturales, elle a été traitée pour une hypertension artérielle, pour une dépression et pour une longue série de troubles musculo-squelettiques. Ce cas permet d’attirer l’attention sur le rôle central de l’inflammation et du stress oxydant, non seulement en matière de liens entre souffrance psychique et atteintes du corps mais, au-delà, pour la compréhension des interactions entre les différentes contraintes et nuisances du travail, agressions toxiques comprises. Even though the concept of a link between occupational stress and musculoskeletal disorders is generally accepted, the exact nature of the link remains hazy. The information needed to examine the question is scattered across different scientific fields and has only partially been brought together. Nevertheless, the present inquiry emphasizes the echoes and hypothetical or proved links between phenomena such as the emotional repression described by occupational psychopathology, the notion of alexithymia in the field of psychosomatics, the disturbance of cortisol activity and secretion in chronic stress contexts, and the role of inflammation in the genesis of stress-related disorders. The purpose is to show that questions concerning this link can be more fruitfully developed by conducting multidisciplinary investigations. Una enfermedad profesional conlleva una responsabilidad de la parte del empleador. Esta abre una controversia en la que se espera un arbitraje científico basado fundamentalmente en la epidemiología. Este reto pesa sobre la comprensión de los vínculos entre la salud y el trabajo, ya que se centra la atención en las relaciones causales simples y se tiende a dejar en la sombra los efectos relacionados con el contexto y la historia. Sin embargo, presentamos el caso de una empleada que demuestra la importancia de estas dimensiones. Como resultado de la exposición prolongada a un estrés psicosocial y a fuertes limitaciones gestuales y posturales, esta fue tratada por presión arterial alta, por depresión y por una larga serie de trastornos músculo-esqueléticos. Este caso sirve para poner de relieve el rol central de la inflamación y del estrés oxidativo, no sólo en términos de vínculos entre el sufrimiento psicológico y el daño al cuerpo, pero, más allá de eso, para la comprensión de las interacciones entre las diversas exigencias y elementos nocivos del trabajo, incluyendo las agresiones tóxicas.

Summary Background The frequencies of treatment for cardiovascular risk factors are poorly documented in large populations, particularly according to the presence or absence of cardiovascular disease (CVD). Aims To assess frequencies of reimbursements for antihypertensive, lipid-lowering and antidiabetic medications in France among national health insurance beneficiaries in 2010 and their associations according to age, sex, French regions, level deprivation and the presence of certain CVD. Methods Treatment frequencies were calculated among the beneficiaries (58 million people) on the basis of reimbursements for three specific categories of medicinal products in 2010. The presence of CVD was defined by a diagnosis associated with chronic disease status and hospital stays in 2010. Results Among people aged greater or equal to 20 years, treatment frequencies were 22% (men 20% vs. women 23%) for antihypertensives, 15% (14% vs. 16%) for lipid-lowering agents and 6% (6% vs. 5%) for antidiabetic medications. These frequencies were, respectively, 33%, 23% and 8% in patients aged greater or equal to 40 years and 55%, 38% and 14% in patients aged greater or equal to 60 years. The frequency of at least one treatment for at least one of the three risk factors was 41% in patients aged greater or equal to 40 years and 66% in patients aged greater or equal to 60 years. Among patients aged greater or equal to 20 years, 22% were treated for at least one risk factor in the absence of CVD and 3% were treated for at least one risk factor in the presence of CVD. Regional differences were observed, with higher frequencies of antihypertensive and antidiabetic use in the North, North-East and Overseas regions. Treatment frequencies increased with level of deprivation, especially for antidiabetics. Conclusion This national study more clearly defines treatment frequencies and the populations and regions with the highest treatment frequencies.

ERMA; International audience; BACKGROUND: Data supporting epidemiological transition from a predominant burden of infectious diseases to one of chronic diseases in Africa result mostly from hospital surveys. AIM: To estimate the cardiovascular disease (CVD) burden in Gabon. METHODS: The study was conducted in Ntoum (8765 inhabitants). All subjects aged greater or equal to 40 years were invited to participate. Participants were interviewed about CVD history and risk factors; they responded to questionnaires on claudication and angina and had a clinical examination, including lower limb pulse palpation and bilateral brachial pressure measurement. Subjects were considered to have CVD in case of history of CVD (coronary artery, cerebrovascular and peripheral arterial diseases), a positive questionnaire or an abnormal finding during clinical examination. RESULTS: The study included 736 subjects (313 men; 423 women). Systolic hypertension was highly prevalent (up to 47.7% and 53.7% in men and women aged 50 to 60 years, respectively). Of the 382 patients with hypertension, 74 (19.4%) were treated and only 22 (5.8%) were considered to have controlled hypertension. Overall, CVD was identified in 98 (13.3%) cases. Overall and newly diagnosed CVD prevalence rates were 14.7% and 11.5% for men and 14.9% and 8.9% for women, respectively. The presence of CVD was associated with hypertension (hazard ratio [HR] 3.69, 95% confidence interval [CI] 2.21-6.16; P

Summary Background Arterial hypertension is managed mainly by general practitioners. The blood pressure level of most patients treated in a general practice setting is greater than or equal to 140/90 mmHg. Aims To understand why a blood pressure level greater than or equal to 140/90 mmHg does not lead to a change of treatment. Methods Over a 2-week period, 479 hypertensive patients were included in a cross-sectional study by 27 general practitioners. Consultation data were collected, as were reasons why patients with a blood pressure level greater than or equal to 140/90 mmHg did not have their treatment changed. Results Blood pressure level was greater than or equal to 140/90 mmHg in 58% of patients; treatment was changed in 15% of these individuals. The lack of change in treatment was justified by the physicians as follows: the blood pressure measurements were not considered to be representative (about 30% of cases); the therapeutic result was considered to be satisfactory in the circumstances (about 30% of cases); change was not appropriate given the patient's specific context (the remaining third of cases). The proportion of uncontrolled hypertensive patients whose treatment remained the same was significantly higher among patients with a disease that affected their lifestyle or threatened their life expectancy. Conclusion The disappointing therapeutic results observed in the management of arterial hypertension do not arise only from poor application of guidelines by general practitioners. Reluctance to rely on blood pressure measurements, a perception that guidelines are revised frequently and are not always clear, and consideration of the general practitioner's activity in the patient's specific context are the main factors involved.

*Contexte : L’association d’une hypertension artérielle et d’une augmentation de l’excrétion des catécholamines et des métanéphrines est fortement évocatrice de phéochromocytome. Cependant, toute libération massive de catécholamines et dérivés métoxylés n’est pas synonyme de phéochromocytome. *Patients : Nous rapportons deux cas de patients atteints de pancréatite aiguë ayant présenté des fluctuations tensionnelles avec poussées hypertensives et élévations des catécholamines et métanéphrines dans les valeurs de celle d’un phéochromocytome. *Résultats : L’apparition au scanner d’une hétérogénéité d’une glande surrénale sans image tumorale orienta vers une nécrose unilatérale de la glande associée à une libération concomitante et massive de catécholamines et dérivés méthoxylés. *Conclusion : Au cours des atteintes multiviscérales associées aux pancréatites aiguës, le choc cardiogénique est fréquent. Cependant, les fluctuations tensionnelles peuvent aussi être en rapport avec des atteintes centrales (neurologiques) ou encore comme dans notre cas avec des atteintes nécrotiques des glandes surrénales. La prise en charge de ces fluctuations tensionnelles nécessite alors des thérapeutiques spécifiques.

Summary Objective Analysis of changes in blood pressure with a two-year interval, and of factors associated with this change, in a large cohort of elderly individuals. Methods Follow-up of a cohort of 9294 individuals aged 65 years and over recruited from the general population for Study 3C. Changes in blood pressure are defined as the difference in its averages between the inclusion visit and the follow-up visit at 2 years. The factors associated with changes in systolic blood pressure were identified by univariate and multivariate analyses. Results Systolic and diastolic blood pressure decreased on average by 7.60 mmHg and 4.45 mmHg respectively in 7659 individuals included in the study between the initial measurement and the follow-up at 2 years. The analyses revealed that the initial high blood pressure level was the main factor for this decrease that would be explained by a phenomenon of regression towards the mean. Conclusion These results confirm the importance of repeating blood pressure measurements during several examinations for a good estimate of individual blood pressure values in this age range. It is also important to consider this phenomenon in studies including specific blood pressure estimates only.

SummaryDementia is one of the most common neurological disorders in the elderly. Aging is associated with a large increase in the prevalence and incidence of degenerative (Alzheimer's disease) and vascular dementia, leading to a devastating loss of independence. In view of increasing longevity of populations worldwide, prevention and treatment of dementia has turned into a major public health challenge. In the past decade, longitudinal studies have shown a close association between high blood pressure in middle age, cognitive decline and dementia, including Alzheimer's disease, in the late life. Pathophysiologically, a summation of cerebrovascular damage, white matter changes and pre-existing asymptomatic Alzheimer's brain lesions may lead to dementia, even when each type of lesion individually is not sufficiently severe to cause it. Longitudinal studies assessing the beneficial role of antihypertensive drugs on cognitive decline and dementia have produced promising results. There are few randomised placebo controlled studies, although some of these have produced positive results. Results of three recent meta-analyses are inconsistent, possibly due to methodological issues. Further long-term randomised trials, designed especially to assess a link between antihypertensive therapy and cognitive decline or dementia are therefore needed.

Le syndrome d'encéphalopathie postérieure réversible (SEPR) est une entité rare, d'étiopathogénie inconnue; le diagnostic est radio-clinique qui associe des signes neurologiques avec des anomalies radiologiques cérébrales bilatérales classiquement réversibles. La principale cause est l'hypertension artérielle sévère. MA âgé de 5 ans est suivi pour insuffisance rénale terminale (IRT) sous dialyse péritonéale automatisée. L'étiologie de son IRT est un syndrome hémolytique et urémique atypique avec la présence d'anticorps anti-facteur H au bilan immunologique. Le patient a présenté 1 an après la découverte de sa pathologie un état de mal convulsif. L'examen trouvait après la résolution des crises, un enfant conscient, une hypertension artérielle sévère à 190/110 mmHg. Il ne présentait pas de déficit sensitvo-moteur. L'hypertension artérielle était équilibrée par du nicardipine, captopril et prazosine. L'imagerie cérébrale par résonnance magnétique a montré des anomalies du signal bilatérales asymétriques de la substance blanche profonde en regard de deux carrefours ventriculaires cadrant avec une encéphalopathie hypertensive. Une IRM de contrôle à 6 mois d'intervalle a montré une régression nette des anomalies. Le diagnostic de SEPR est ainsi retenu.Pan African Medical Journal 2015; 22

Introduction: le diabète constitue un problème de santé publique au Maroc. L'augmentation de sa prévalence se fait en parallèle avec l'augmentation des chiffres de l'obésité et de l'hypertension artérielle (HTA). Les facteurs environnementaux dont l'urbanisation influencent avec force cet état des lieux. En milieu rural, la tendance tend à s'inverser du fait du changement des habitudes de vie. Notre travail avait comme but de dépister la dysglycémie dans une commune rurale de la région de Marrakech. Méthodes: ce travail de dépistage fait sur une journée a concerné une population tout-venant de 200 personnes. La glycémie capillaire à jeun, la tension artérielle, le poids, la taille, l'indice de masse corporelle et le tour de taille ont été mesurés pour toutes les personnes qui se sont présentées.Résultats: deux cent sujets ont été examinés. 31% des sujets examinés étaient diabétiques. Chez les non diabétiques, 57,9% avaient une glycémie capillaire à jeun au-delà de 1,1g/l, 51,2% entre 1,1 g/l et 1,26 g/l et 48,7% au-delà de 1,26 g/l. Sur le plan tensionnel, 95% des patients examinés n'étaient pas connus hypertendus. L'obésité androïde touche 63,7% des patients examinés. Conclusion: les chiffres retrouvés lors de cette caravane médicale sont supérieurs à nos attentes. L'urbanisation du milieu rural a un impact sur le profil métabolique et tensionnel de cette population ; ce qui devrait impliquer une démarche préventive de santé publique.Key words: Diabète, dépistage, hypertension artérielle, obésité, milieu rural, Maroc

Posterior-reversible encephalopathy syndrome (PRES) is a rare clinicoradiological syndrome related to a huge elevation in blood pressure occurring most often in patients with chronic hypertension. However, PRES may sometimes be observed in association with other conditions, including central nervous system collagen diseases, vasculitis, ionic disturbances as well cytotoxic or immunosuppressive treatments. PRES is responsible for various but non specific neurological symptoms, including confusion, coma, seizures as well as visual disturbances. Diagnosis is performed using cerebral MRI which typically shows at the early stage, symmetric bilateral parieto-occipital hyperintensities on T2 and FLAIR sequences. They are usually reversible after treatment of the underlying cause and reduction of blood pressure, but such lesions can lead to permanent neurological deficit. We report a case of PRES complicating systemic lupus erythematosus., Le syndrome d'encéphalopathie postérieure réversible (PRES) est un syndrome clinico-radiologique rare observé dans le cadre d'affections diverses, comme les collagenoses ou les vascularites du système nerveux central, les troubles électrolytiques ou lors de l'utilisation de traitements cytotoxiques ou immunosuppresseurs. Il est responsable de manifestations neurologiques peu spécifiques, comme une confusion, un coma, des convulsions ou des troubles visuels. Le diagnostic est évoqué par l'imagerie par résonance magnétique (IRM) cérébrale qui objective, à un stade précoce, des lésions typiquement bilatérales et symétriques des lobes pariéto-occipitaux, sous forme d'hyperintensités en séquences T2 et FLAIR. Ces lésions correspondent à un oedème vasogénique et sont donc généralement réversibles après traitement étiologique et contrôle de la pression artérielle. Dans certains cas ces lésions peuvent être responsables de séquelles irréversibles. Nous rapportons un cas de PRES compliquant un lupus systémique.

INTRODUCTION: L'HTA du diabétique âgé est particulière par sa fréquence et sa gravité. Cette association HTA-diabète type 2 (DT2) est particulièrement fréquente chez les personnes âgées, et responsable d'une majoration du risque cardiovasculaire et d'une accélération de l'atteinte dégénérative du diabète. L'objectif de ce travail etait d'étudier les caractéristiques épidémiologiques, cliniques, biologiques et thérapeutiques de l'association HTA-DT2, et définir les facteurs associés aux complications dégénératives du diabète chez les sujets âgés. METHODES: Etude descriptive, concernant 100 patients diabétiques de type 2 hypertendus âgés de 65 ans ou plus, suivis au service d'endocrinologie-diabétologie du CHU de Marrakech, du mois de Novembre 2010 au mois de Juillet 2011. Le logiciel SPSS version 18 a été utilisé pour l'analyse statistique. RESULTATS: Le sex ratio des patients étudiés était de 0,26, l'âge moyen était de 69,2 , 4,3 ans, l'ancienneté du diabète était de 9,3 , 6,7 ans. Le diagnostic du diabète précédait celui de l'HTA dans 67,7 % des cas. Seulement 4,2% avaient une HbA1c ≤ 6,5%. 60% des patients avaient une HTA de grade I. L'IMC moyen était de 28,1 , 4,6 kg/m2. La dyslipidémie était présente chez 59,6% de nos patients avec essentiellement une hypoHDLémie (75,9%). La macroangiopathie était observée chez 40% des patients avec essentiellement une cardiopathie ischémique (29%). Elle était significativement plus fréquente chez les patients ayant une HbA1c supérieure à 9%, LDL-c ≥ 1 g/l et une hypoHDLémie. La microangiopathie présente dans 82% des cas était significativement en relation avec l'HbA1c, le DFG et le taux des triglycérides. CONCLUSION: Une prise en charge complète du risque cardio-vasculaire chez les sujets âgés se heurte à des problèmes objectifs en pratique courante, en particulier, la polymédication, source d'une mauvaise compliance et donc de mauvais résultats.

Summary Background While general practitioners treat most hypertensive patients in France, hypertension is the most frequent pathology treated by cardiologists, raising questions about the differing profiles of such patients. Poor control of hypertension is commonly reported, and yet has not improved over time. Better understanding of the determinants of control, at both patient and physician levels, is necessary to implement improvements in practice. Aims To describe the hypertensive population treated by independent cardiologists in France and to assess the prevalence and determinants of not-at-goal blood pressure (BP), at patient and physician levels. Methods The COLHYGE study was an observational cross-sectional epidemiological study. Consecutive patients ( n = 5798) were selected by 371 independent cardiologists in France. Data concerning patients and physicians were assessed. Results Our study population had an elevated cardiovascular risk, high prevalence of patients in secondary cardiovascular prevention (27.5%) and a high proportion of diabetic patients (22.8%). Only 20.8% of the population presented controlled BP. At the patient level, the following variables were negatively and independently associated with BP control: age; body mass index; heart rate; recently diagnosed hypertension; left ventricular hypertrophy; patient belief that they are taking too many pills; prescription of calcium channel blockers, lipid-lowering agents and antiplatelet agents. Presence of atrial fibrillation and the prescription of renin-angiotensin system blockers and fixed combinations correlated positively with BP control. At the physician level, working in big cities and having an exclusive independent practice were associated with good BP control. There was high heterogeneity among physicians in terms of BP control, independent of the patient and physician characteristics assessed. Conclusion The COLHYGE study has confirmed a high cardiovascular risk and poor BP control among hypertensive patients treated by cardiologists in France. Strategies aiming to control BP should focus on both patient and physician characteristics.

Summary Background Hypertensive patients with established cardiovascular or renal disease (ECVRD) have an added 10-year risk of cardiovascular events, classified by the European Society of Hypertension/European Society of Cardiology as ‘very high’. Aims To identify determinants of blood pressure (BP) outcomes in hypertensive patients with and without ECVRD treated in second-line with valsartan. Methods This was a subgroup analysis comparing patients with and without ECVRD who participated in the PREVIEW study, a 90-day observational prospective effectiveness study of valsartan, conducted in Belgium. Two-level (patients ‘nested’ under physicians) hierarchical linear and logistic modelling of BP values and BP control (140/90 mmHg; 130/80 mmHg for diabetics) at 90 days was applied to data from 1107 patients with and 2087 patients without ECVRD treated with valsartan by 504 general practitioners. Results Absolute reductions in BP were similar across subgroups, with minor variations in actual BP levels in general and by subgroup. Fewer patients with versus without ECVRD achieved targets for systolic BP, diastolic BP and combined systolic/diastolic BP control. Variability in BP values and control at 90 days attributable to a physician-level class effect ranged from 24.6% to 28.1% and 15.0% to 22.4%, respectively. Physician- and patient-related determinants of 90-day BP outcomes varied considerably between the two subgroups. Conclusion Several determinants of BP outcomes were identified comparing patients with and without ECVRD, including amenable physician-level and patient-level factors and warning signs for continued risk of uncontrolled BP. ECVRD patients present with differential characteristics, conditions and determinants that mandate individualized attention to complement general evidence-based antihypertensive treatment.

Summary Background Elevated blood pressure is one of the most important modifiable risk factors for cardiovascular diseases. Aim To evaluate blood pressure management in Cote d’Ivoire. Methods A retrospective study was conducted among 2575 hypertensive patients from the Institute of Cardiology of Abidjan, who were followed for at least 10 years, between January 2000 and December 2009. Results The patients’ mean age ± standard deviation was 59.1 ± 12.5 years; 54.3% were women. At first presentation, hypertension was stage 1 in 21.7%, stage 2 in 32.3% and stage 3 in 46.0% of patients. According to the European guidelines’ stratification of the cardiovascular risk-excess attributable to high blood pressure, 46.7% had a very high added risk, 37.8% had a high added risk and 14.9% had a low-to-moderate added risk. Pharmacological therapy was prescribed in 97.8% of patients; more than 66% were receiving at least two antihypertensive drugs, including fixed-dose combination drugs. The most common agents used were diuretics (59.7%) followed by angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (59.6%). The most common agents for monotherapy were calcium antagonists. When two or more drugs were used, diuretics and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers were most commonly used. Blood pressure control was achieved in 43.7% of cases. Conclusion In our series, severe hypertension with high added risk or very high added risk was very common. Treatment – mostly diuretics and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers – required at least two antihypertensive drugs to meet the recommended blood pressure target.

Summary Background Uncontrolled hypertension is a major primary healthcare problem. Aim To investigate whether blood pressure (BP) control in primary care could be improved by nurses taking responsibility for managing hypertensive patients. Methods Randomized trial with two groups: usual or intensive care. Patients diagnosed previously as hypertensive and with a systolic office BP greater than 140 mmHg were randomized to an intensive care programme managed by trained nurses or to usual care. The intensive care programme included a visit every 6 weeks to the general practitioner's office, with standardized BP measurement, self-measurement training, risk factor checks and advice on BP reduction. The intervention lasted for 1 year. The primary endpoints were systolic BP obtained by 24-hour ambulatory BP monitoring after 1 year and the change compared with baseline. Results Two hundred patients from 19 physicians were enrolled (102 in the intensive care group). Data on ambulatory BP were available from 140 patients. Systolic BP declined from 134.4 ± 14.0 to 126.3 ± 10.4 mmHg in the intensive care group and from 132.4 ± 13.5 to 128.2 ± 13.0 mmHg in the usual care group. There was no statistically significant difference in values after 1 year ( p = 0.332). The reduction in systolic BP was significantly greater in the intensive care group (7.6 vs 3.3 mmHg in the usual care group; p = 0.036). Similar results were observed for diastolic BP and day- and night-time measurements. Conclusions An intensive medical care programme in the office setting managed by trained nurses can improve BP control effectively. Nurses could take more responsibility for managing hypertensive patients.

Summary Introduction Atrial fibrillation is, to date, a major problem of public health with an important cost in the health care system. Discussion The therapeutic strategies for atrial fibrillation are complex and their outcomes have been disappointing globally. New ablative techniques have brought important advances but the patient's profile has to be taken into account in the choice of the therapeutic strategies. The renin-angiotensin system plays a major role in the phenomena of remodelling following the onset of atrial fibrillation. Conclusion Drugs blocking the renin-angiotensin system can have a real place in the treatment of atrial fibrillation, not only to maintain sinus rhythm but primarily to prevent cardiovascular accidents in these patients with atrial fibrillation and in some cases to prevent the occurrence of atrial fibrillation, for example in hypertensive patients.

SummaryCardiovascular complications in Turner's syndrome are the most common cause of excess early mortality, with a life expectancy that may be reduced by more than 10 years. Congenital cardiac abnormalities are described in approximately one third of patients. These abnormalities are mostly left heart obstructions, the most common of which are bicuspid aortic valve (16%) and coarctation of the aorta (11%). Dilatations of the ascending aorta are often described and may occur in isolation from any heart disease, suggesting a vasculopathy specific to the syndrome, probably predisposed to by extracardiac risk factors such as oestrogen deficiency, diabetes, dysplidaemia and overweight. The most feared complication is aortic dissection with around a 100 cases, described at average age of approximately 35-years-old. This is believed to complicate 2% of induced pregnancies. Hypertension (HBP) usually essential, affects up to 50% of patients with Turner's syndrome. This is an important risk factor for cardiovascular complications and justifies aggressive treatment. On the other hand, retrospective studies have not demonstrated adverse cardiological effects due to growth hormone treatments. Patients with Turner's syndrome merit regular cardiology follow-up from childhood onwards, particularly if they have treated heart disease. The merits of preventative treatments for aortic dilatation have not been demonstrated in Turner's syndrome and justify prospective trials.

SummaryIntroductionNo agreement has been reached regarding the best strategy to detect left ventricular hypertrophy (LVH). This study examined the role of N-terminal pro-brain natriuretic peptide (NT-proBNP) in the diagnosis of LVH in hypertensive patients and the potential factors that may influence its diagnostic performance.MethodsThe global accuracy of NT-proBNP in diagnosing LVH was assessed using a receiver-operating characteristic (ROC) curve. The influence of patients’ characteristics on test accuracy was studied with a ROC regression based on a probit model. Ninety-three subjects were included. All had NT-proBNP measured and underwent electrocardiography and echocardiography, with calculation of the left ventricular mass index (LVMI).ResultsThe diagnostic performance of NT-proBNP in LVH varied slightly depending on the indexation mode of LVMI. In cases of body surface area indexation, the area under the ROC curve of 81.6% suggested a good performance. The accuracy of the marker was significantly higher in women than in men (p