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The optimization of the pharmacologic treatment in hypertensive patients is encouraged by four reports: the high prevalence of hypertension and more particularly in the elderly, the lack of blood pressure control in more than half of patients, the frequency of the association to other cardiovascular risk factors and the existence of a residual risk under treatment. All these factors are combined to raise the cardiovascular risk in hypertensive patients. Several interventional studies highlighted a reduction of the cardiovascular risk proportional to the reduction of blood pressure under treatment. Thus arose the question of the optimal blood pressure: the guidelines propose values lower than 140/90mmHg for the non-complicated essential hypertension and lower than 130/80 mmHg in secondary prevention, for the patients with diabetus or renal impairment. However this strict blood pressure goal for the high cardiovascular risk patients is not confirmed by clinical trials, strict blood pressure goal being potentially deleterious. The concept of «the lower the better» tends to be abandoned. Since more than three decades, the assumption of a paradoxical increase of the cardiovascular morbidity and mortality associated with a high reduction of blood pressure (the «J-Curve» concept) remains the subject of many studies and controversies. [ABSTRACT FROM AUTHOR]

Diabetes mellitus and end-stage renal disease are two pathologic entities associated with increased cardiovascular risk. Several studies have shown that arterial stiffness is increased in both cases and contributes to the increased risk. In order to determine the effect of diabetes and renal failure on arterial stiffness, we conducted a case-control study. One hundred and twenty-two diabetic patients were compared to 122 non-diabetic patients matched to the study group for sex, age, mean arterial pressure, number and localisation of the atherosclerotic alterations. Arterial stiffness was assessed by automatic measurement of the aortic pulse wave velocity (PWV) and by measuring the peripheral and carotid pulse pressure (PP) and reflected waves through analysis of the pulse wave using the principle of applanation tonometry. Aortic PWV was significantly higher in the diabetic subgroup as well as PP at the peripheral and central levels for the same age and mean arterial pressure. In addition, renal failure was independently associated with an increased aortic PWV but not PP in the general population. Independent of the degree of renal failure, a fall in the glomerular filtration rate was also associated with increased aortic PWV. No interaction was noted between renal failure and diabetes mellitus. In conclusion, this study shows that diabetic patients have higher arterial stiffness compared to non-diabetic ones having one or more cardiovascular risk factors, manifested by increased aortic PWV and PP. In addition, renal failure, irrespective of its degree and independent of diabetes mellitus, is associated with increased aortic PWV but not PP. [ABSTRACT FROM AUTHOR]

In subjects with essential hypertension, increased cardiac and radial artery mass are positively associated. The mechanical factor that contributes in the larger extent to their enhancement is pulse pressure, not mean arterial pressure. [ABSTRACT FROM AUTHOR]

Aims: Sleep disorders like obstructive sleep apnea in adults are associated with increased sympathetic activity, which induced high blood pressure and could be associated with resistant hypertension. Some studies have demonstrated that high urinary catecholamine levels in obstructive sleep apnea patients may be decreased with continuous positive airway pressure therapy. However, very few studies have demonstrated a correlation between apnea-hypopnea index and urinary catecholamine levels in hypertension patients. Methods: In this pilot study, 20 hypertensive patients referred for hypertension work-up including night-time polygraphy and 24 h urinary catecholamine dosage were included. Results: Mean age was 51 ± 11 years (30-76), 68% were males. Diagnosis of obstructive sleep apnea was confirmed in 13 patients at the end of the work-up. Mean apnea-hypopnea index was 14 ± 9 (2-32). The only urinary catecholamine parameter significantly increased in patients with obstructive sleep apnea was 24 h urinary normetanephrine (1931 ± 1285 vs 869 ± 293 nmol/24 h; P < 0.05). However, this difference was not significant when this parameter was adjusted to 24 h urinary creatinine. We observed a significant positive correlation between AHI and 24 h urinary normetanephine (r = 0.486; P = 0.035). Conclusion: This pilot study confirms an isolated elevation of 24 h urinary normetanephrine in hypertensive patients with obstructive sleep apnea and shows a significant correlation between sleep disorders expressed by apnea-hypopnea index and urinary catecholamines excretion. [ABSTRACT FROM AUTHOR]

Background In old individuals, regulation of blood pressure during postural changes is impaired. Several studies have assessed the clinical impact of orthostatic hypotension (OHypoT) during the aging process. By contrast, the prevalence and prognostic role of the increase in blood pressure in upright position (orthostatic hypertension, OHyperT) in very old adults remain unknown. We investigated the association of OHyperT with cardiovascular (CV) morbi-mortality in a population of very old institutionalized subjects. Abstract CO-45 – Figure Methods A 2-year follow-up longitudinal study was conducted on 972 subjects (mean age [SD] 88[5]) from the PARTAGE study, able to maintain a standing position. OHyperT was defined as an increase in SBP ≥20mmHg during the first and/or 3rd minute of standing. Three groups of subjects were compared: orthostatic normotension (ONT, n=540), OHypoT (n=157) and OHyperT (n=275). Results OHyperT prevalence (28%) was higher than OHypoT (16%). Sitting SBP was higher in OHypoT compared to ONT and OHyperT groups (146[23] vs. 136 [21] and 136[20] mmHg, respectively, p <0.001). The OHyperT group was associated with a greater risk of CV morbi-mortality than ONT (HR 1.51[1.09-2.08], p <0.01) and remained unchanged after adjustment for age, sex, sitting SBP and co-morbidities. No difference in CV morbi-mortality was observed between OHyperT and OHypoT groups. Conclusions In a very old frail population, the increase in SBP during upright position occurs frequently and is associated with higher CV morbi-mortality independently of sitting BP levels and major co-morbidities. Health professional should take into account not only the decrease but also the increase in BP when standing up. [ABSTRACT FROM AUTHOR]

Objectives Our objective was to investigate the actual incidence and clinical determinants of cough leading to discontinuation of ACE-inhibitors. Cough is the most frequent reason to stop ACE-inhibitor treatment. Methods We studied 27,492 ACE-inhibitor naïve patients randomized to the ACE-inhibitor perindopril or placebo using individual data of 3 clinical trials. Multivariate logistic regression analysis was used to study the incidence of cough in relation to baseline clinical characteristics including racial background. Results In 27,492 patients with cardiovascular disease, 1076 patients discontinued ACE-inhibitor perindopril due to cough (3.9%), 703 patients during run-in period of 4 weeks and 373 patients during a mean four years of follow-up. Significant determinants of cough were female gender (OR 1.92 95% CI 1.68-2.18), age above 65 years (OR 1.53 95% CI 1.35-1.73), and concomitant use of lipid-lowering agents (OR 1.37; 95% CI 1.18-1.59). A simple clinical risk score composed of these 3 predictors of cough mounted to an odds ratio of 4.4 (95% CI 3.1-5.4) in the subjects with highest score (i.e. all determinants present). Racial background was not related to a differential incidence of cough in patients of Caucasian or Asian descendent (OR 1.11 95% CI 0.92-1.39). Conclusion This large combined analysis of randomized clinical trials in 27,492 patients showed an overall lower incidence of cough leading to discontinuation of ACE-inhibitors (3.9%) as compared to literature. Clinical determinants of such cough are older age, female gender and concomitant use of lipid-lowering agents. In contrast, racial differences were not related to the incidence of cough. [ABSTRACT FROM AUTHOR]