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Une patiente diabétique de longue date, et traitée par la metformine, présente un syndrome métabolique, associant à son diabète de type 2 une hypertension artérielle difficile à contrôler par le traitement, une dyslipidémie et une insuffisance rénale chronique (IRC) qui s'aggrave régulièrement. Peu à peu le glucose en excès dans le plasma sanguin glycosyle les membranes glomérulaires rénales à l'origine de la néphropathie du diabétique. Elle peut se manifester par un syndrome néphrotique ici impur par la présence d'une hypertension artérielle résistante aux traitements. La crise d'insuffisance rénale aiguë s'inscrit dans le cadre d'une IRC s'aggravant avec baisse du débit de filtration glomérulaire (DFG), une forte augmentation de l'albuminurie ainsi qu'un lourd traitement antihypertenseur. Un cercle vicieux s'installe, l'IRC faisant augmenter la tension artérielle, menant à intensifier le traitement antihypertenseur lui-même toxique pour le rein. Afin de briser ce cercle vicieux, il faudra d'une part mieux contrôler son diabète et d'autre part sa tension artérielle en choisissant des médicaments protecteurs du rein. Toute nouvelle baisse du DFG, ou augmentation du rapport albuminurie/créatininurie, fait craindre une nouvelle crise d'insuffisance rénale aiguë qu'il faudra prendre en charge rapidement. Le diabète est la cause majeure de transplantation rénale. This clinical case shows bad household between diabetes and kidney, and when arterial hypertension gets in the way! A woman with diabetes for a long time and treated with metformin presents metabolic syndrome with type 2 diabetes, arterial hypertension difficultly controlled by antihypertensive drugs, dyslipidaemia and chronic kidney failure (CKF) which worsens regularly. Gradually, glucose in excess in blood plasma glycosylates renal glomerular membranes meaning to diabetes nephropathy, which can be revealed by a nephrotic syndrome, no pure as in the present case with an arterial hypertension resistant to therapy. Acute kidney failure crisis is in the frame of CKF, which worsens with decline of glomerular filtration rate (GFR), large increase in albuminuria and heavy antihypertensive therapy. Vicious circle sets in because CKF increases arterial tension meaning to enhance antihypertensive therapy itself toxic for the kidney. To break this vicious circle, on the one hand we have to better control diabetes and on the other hand, to control hypertension by choosing drugs protective for the kidney. Every new decrease in GFR or increase in albuminuria makes you fear of a new acute renal failure crisis that you have to take care quickly. Diabetes is the main cause of renal transplantation. [ABSTRACT FROM AUTHOR]

There are no studies on the association between high blood pressure and COVID-19 in South Kivu. to determine the influence of arterial hypertension on the clinical characteristics and prognosis of COVID-19 patients hospitalized in the city of Bukavu. Between June 2020 and June 2022, an open cohort of hypertensive and non-hypertensive COVID-19 patients admitted to two clinics in the city of Bukavu was formed. The primary endpoint was the occurrence of death. Thus, a prospective modeling of mortality by the Kaplan-Meier estimator was carried out. Among the 178 admissions for COVID-19, 68 (38.2%) patients were hypertensive. Compared to non-hypertensives, hypertensive patients were significantly older [61.0 (56.0–71.0) vs. 48.0 (32.7–64.0); p < 0,0001). During the observation period of 1059 patient-days, the incidence of death (3.2/100 patient-days) was non-significantly higher in hypertensive patients (4.3/100 patient-days) (p = 0.06). On the other hand, the independent predictors of death were Sepsis [adjusted HR = 3.7 (1.5–8.7)], CRP > 100 mg/L [adjusted HR = 3.0 (1.2–7, 0)] and SaO 2 < 90 % [adjusted HR = 3.9 (1.3–11.8)]. This study shows that hypertension was very common in patients admitted for COVID-19 in the city of Bukavu but did not influence the vital prognosis of the latter, thus confirming the finds of most authors who have addressed the question. [ABSTRACT FROM AUTHOR]

Résumé: L'endothélium est un régulateur clé de l'homéostasie et du tonus vasculaire ainsi que de diverses autres fonctions ; il contrôle notamment la prolifération des cellules musculaires lisses, la migration et la translocation des leucocytes, les mécanismes de thrombose et de thrombolyse. L'athérogenèse, le développement et l'instabilité de la plaque d'athérome sont, au premier chef, liés à des dysfonctions de l'endothélium. La dysfonction endothéliale intervient à tous les stades de l'athérosclérose et, une fois présente, prédispose le vaisseau à l'inflammation, à une vasoconstriction anormale, à un risque accru de thrombose et enfin à la rupture ou l'érosion de la plaque. La dysfonction endothéliale est étroitement liée aux facteurs de risque de l'athérosclérose, à leur intensité (niveau de pression ou d'hypercholestérolémie par exemple) et à la durée de l'exposition à ce ou ces facteurs de risque. Des études interventionnelles ont démontré une régression de la dysfonction endothéliale associée à une amélioration des résultats cliniques chez des patients recevant différents traitements. La coexistence d'une hypertension artérielle et d'une hypercholestérolémie a un impact négatif plus que cumulatif sur l'endothélium. Les traitements de l'hypertension et de l'hypercholestérolémie, en particulier les inhibiteurs de l'enzyme de conversion de l'angiotensine (IEC) et les statines, ont des effets bénéfiques allant au-delà de ceux observés après réduction isolée de la pression artérielle ou des taux de lipides ; l'association de ces deux classes thérapeutiques a des effets bénéfiques supérieurs à ceux obtenus avec les monothérapies respectives. Les médiateurs clés communs aux actions pléiotropiques des IEC et des statines sont l'angiotensine II (Ang II) et le monoxyde d'azote (NO), qui affectent principalement le stress oxydatif et les voies de l'inflammation. IEC et statines diminuent les risques de complications cardiovasculaires en réduisant la pression artérielle et les taux de lipides plasmatiques, mais aussi par leurs effets pléiotropiques agissant par d'autres voies. L'association d'un IEC et d'une statine constitue donc une stratégie simple pour maximiser les effets du traitement sur l'endothélium et améliorer les résultats chez les patients à risque d'événements cardiovasculaires. The endothelium is a key regulator of vascular homeostasis and tone as well as a variety of other functions, including control of smooth muscle cell proliferation, leukocyte migration and translocation, thrombosis and thrombolysis mechanisms. Atherogenesis, plaque development and instability are primarily related to endothelial dysfunction. Endothelial dysfunction occurs at all stages of atherosclerosis and, once present, predisposes the vessel to inflammation, abnormal vasoconstriction, increased risk of thrombosis, and finally plaque rupture or erosion. Endothelial dysfunction is closely related to the risk factors for atherosclerosis; their intensity (e.g. , blood pressure level or hypercholesterolemia) and the duration of exposure to the risk factors. Interventional studies have demonstrated regression of endothelial dysfunction associated with improved clinical outcomes in patients receiving different treatments. The coexistence of hypertension and hypercholesterolemia has more than a cumulative negative impact on the endothelium. Treatments for hypertension and hypercholesterolemia, particularly angiotensin-converting enzyme inhibitors (IEC) and statins, have beneficial effects beyond those observed after reduction of blood pressure or lipid levels alone; the combination of these two therapeutic classes has beneficial effects superior to those obtained with the respective monotherapies. The key mediators common to the pleiotropic actions of IEC and statins are Ang II and NO, which primarily affect oxidative stress and inflammation pathways. IEC and statins reduce the risk of cardiovascular complications by reducing blood pressure and plasma lipid levels but also by their pleiotropic effects acting through several other pathways. The combination of an IEC and a statin is therefore a simple strategy to maximize the effects of treatment on the endothelium and improve outcomes in patients at risk of cardiovascular events. [ABSTRACT FROM AUTHOR]

Le réninome, ou tumeur à cellules de l'appareil juxta-glomérulaire, est une tumeur rénale rare, généralement bénigne, sécrétant de la rénine. Nous rapportons ici le cas d'une jeune femme âgée de 18 ans, sans antécédents médicaux notables, qui a été référée aux urgences de notre hôpital pour un œdème papillaire bilatéral. Le bilan ophtalmologique a été fait en ambulatoire en raison de l'apparition progressive d'un flou visuel bilatéral depuis une semaine, associé à des céphalées en casque. L'IRM cérébrale et la ponction lombaire demandées par l'ophtalmologue et le neurologue permettent d'exclure une hypertension intracrânienne. La patiente présente une hypertension artérielle sévère. Le bilan biologique montre une hypokaliémie, une alcalose métabolique compensée et une microalbuminurie. Lors du séjour, apparaît également une insuffisance rénale aiguë AKIN 1. L'ultrason révèle une lésion tissulo-kystique du pôle supérieur rénal droit. L'IRM abdominale confirme cette lésion et évoque un carcinome rénal à cellules claires, sans invasion calicielle ni vasculaire. Le dosage de la rénine plasmatique est supérieur à 500 mUI/L, avec un dosage de l'aldostérone dans les normes. La biopsie rénale est compatible avec une tumeur de l'appareil juxta-glomérulaire. Après un traitement agressif initial, l'hypertension artérielle est bien contrôlée sous spironolactone seule, permettant finalement un sevrage complet des traitements antihypertenseurs. Une néphrectomie partielle par laparoscopie robot-assistée est effectuée. L'analyse de la pièce opératoire confirme le diagnostic de réninome bénin. Le suivi clinique montre une résolution totale des paramètres clinico-biologiques. Reninoma or juxtaglomerular cell tumor is a rare usually benign renal renin secreting tumor. We report the case of an 18-year old woman, without any medical history, investigated in our hospital's emergency department for a bilateral papilledema. Ambulatory ophthalmological investigations were performed because of a newly occurring blurry vision, associated with diffuse headaches. Cerebral mRI and lumbar puncture recommended by the ophthalmologist and neurologist excluded intra-cranial hypertension. The patient presented with severe hypertension. Laboratory values showed hypokalemia, compensated metabolic alkalosis and microalbuminuria. During the hospital stay, she developed AKIN 1 acute renal injury. Ultrasound revealed a tissular cystic lesion of the superior pole of the right kidney. Abdominal mRI confirmed the lesion and raised suspicion for a renal cell carcinoma without calicial or vascular invasion. Plasma renin value was >500 mUI/L with normal values for plasma aldosterone. Renal biopsy diagnosed a juxtaglomerular cell tumor. After an aggressive initial treatment, hypertension remained well controlled with spironolactone only, finally allowing for withdrawal of all antihypertensive medications. Robot-assisted laparoscopic partial nephrectomy was performed. Studies of the operative specimen confirmed the diagnosis of benign reninoma. Clinical follow-up showed complete resolution of clinical and biological parameters. [ABSTRACT FROM AUTHOR]

Overall, heart patients should be advised individually with respect to their tolerance of altitudes. However, the historical reflex that altitude 'per se' is bad for heart patients should become a thing of the past. Adequately treated and stable patients can usually go up to an altitude of 2500 m without any restrictions. Higher altitudes are also possible for a large number of patients, but may require an adaptation of the medication and further clarification. This is especially the case when physical work is to be performed at great heights. [ABSTRACT FROM AUTHOR]

La polykystose rénale autosomique dominante est la maladie rénale héréditaire la plus fréquente. Les atteintes cardiovasculaires de la polykystose rénale autosomique dominante sont nombreuses et apparaissent parfois précocement au cours de la vie des patients. Dans la polykystose rénale autosomique dominante, la morbidité et la mortalité cardiovasculaires sont liées aux conséquences non spécifiques de l'insuffisance rénale chronique et au phénotype particulier de cette maladie. Par rapport à la population générale, les patients atteints de polykystose rénale autosomique dominante présentent notamment une prévalence accrue d'hypertension artérielle, d'hypertrophie du ventricule gauche, de fibrillation auriculaire, de valvulopathies, d'anévrysmes et de dissections artérielles. Dans cette revue, nous proposons un état des lieux des connaissances actuelles sur les atteintes cardiovasculaires de la polykystose rénale autosomique dominante et sur les derniers développements contribuant à mieux en comprendre les mécanismes. Autosomal dominant polycystic kidney disease is the most frequent genetic kidney disease. Cardiovascular disorders associated with autosomal dominant polycystic kidney disease are multiple and may occur early in life. In autosomal dominant polycystic kidney disease cardiovascular morbidity and mortality are related both to the nonspecific consequences of chronic kidney disease and to the particular phenotype of autosomal dominant polycystic kidney disease. Compared to the general population, patients with autosomal dominant polycystic kidney disease present an increased prevalence of hypertension, left ventricular hypertrophy, atrial fibrillation, valvular diseases, aneurisms and arterial dissections. This review article provides an update on cardiovascular disorders associated with autosomal dominant polycystic kidney disease and recent pathophysiological developments. [ABSTRACT FROM AUTHOR]

Introduction: arterial hypertension is a major public health problem in sub-Saharan Africa due to its high frequency and to the cardiovascular risk that it entails. The purpose of this study was to assess the prevalence of clinical and biological risk factors of hypertension in Bamako (Mali). Methods: we conducted a case-control study, stratified in function of the sex, of 72 participants including 36 patients with hypertension and 36 controls. Twenty-two plasma biochemical parameters have been measured and analyzed using univariate and multivariate tests. Results: hyperhomocysteinemia was found in 55.6% of women (p = 0.03) and 100% of men (p = 0.007) with hypertension. High NT-proBNP was also found in 16.7% of women (VIP > 1 in multivariate model) and of men with hypertension (p = 0.00006). A good multivariate predictive model (OPLS-DA) was only obtained in women with high blood pressure, with Q²cum = 0.73, attesting severe sexual dimorphism associated with arterial hypertension. This model involved eight parameters whose plasma concentration was modified (homocysteine, NT-proBNP, potassium, urea, blood glucose, sodium, chlorine and total proteins). Conclusion: we registered a significant association between hyperhomocysteinemia and arterial hypertension. Therefore, the assay of homocysteine associated with good management would decrease the risk of cardiovascular diseases while improving the quality of life of hypertensive patients. [ABSTRACT FROM AUTHOR]

Full blood count is routinely performed in the evaluation of hypertensive patients. However, usefulness of leukocyte ratios in cardiovascular risk (CVR) assessment hasn't yet been proven in Cameroonians. Evaluate the contribution of leukocyte ratios in CVR assessment of non-diabetic hypertensive adults. We carried out a cross sectional study including non-diabetic hypertensive patients followed up at the cardiology unit of the Yaoundé Central Hospital from November to June 2022. We collected relevant clinical data with a pre-established questionnaire and blood samples from each patient for different biological analyses. The spearman correlation test was used to assess on the one hand the relationship between leukocyte ratios, highly sensitive CRP and the WHO 2019 risk score as our primary end point, and on the other hand between leukocyte indices and the other risk estimators as our secondary outcome. The significant threshold level was set as 0.05. We included 165 participants (102 females) with a mean age of 57.6 (10.4) years. The median duration of hypertension since diagnosis was 7 years and only 27% of participants on treatment had a controlled blood pressure. There was no significant correlation between leukocyte ratios and the WHO 2019 risk score. Highly sensitive CRP and the atherogenic index of plasma were significantly correlated respectively with the granulocyte to lymphocyte ratio (rho = 0.18, p = 0.03) and the eosinophil to lymphocyte ratio (rho = 0.28, p = 0.01). There exists a weak positive association between the granulocyte to lymphocyte ratio and the Reynolds risk score. Leukocyte ratios are not useful for CVR assessment in hypertensive Cameroonians with respect to the WHO 2019 risk score. Prospective studies are needed to assess their usefulness in combination with conventional risk factors to improve prediction of cardiovascular events. [ABSTRACT FROM AUTHOR]

To calculate the vascular age of hypertensive patients and assess the risk at 10 years of occurrence of an absolute cardiovascular event in outpatient consultation of the Abidjan Heart Institute. Patients and methodology: Cross-sectional study with descriptive and analytical purposes from June 2021 to September 2021, i.e. 4 months in patients at least 30 years of age followed in the outpatient department for arterial hypertension without cardiovascular complications. Data were collected using a questionnaire. We considered the parameters established in the D'Agostino chart for the calculation of vascular age. Each parameter was weighted and the total points obtained corresponded to the vascular age. The cardiovascular risk at 10 years was also obtained from another abacus established by D'Agostino by cross-referencing the total points of each patient with pre-established data. Three hundred hypertensive people were included in this study. The calendar average age was 62.0 ± 10 years with extremes of 30 and 95 years. The gender distribution showed female predominance and there was no significant difference in vascular age by sex. The mean vascular age of all patients was 73.4 ± 9.9 years. The mean difference between actual and vascular age was 11.4 years. Dyslipidemia (p = 0.0002), diabetes (p = 0.0004) and unstandardized BP (p = 0.0000) significantly influenced vascular age. There was no significant difference between smokers and non-smokers (p = 0.1349). All men had a greater than 30% risk of having a cardiovascular accident while women before the age of 35 had no risk. Over the age of 60, almost all patients (both men and women) had a greater than 30% risk of having a cardiovascular accident at 10 years. The calculation of vascular age made it possible to assess arterial aging and calculate the probability at 10 years of occurrence of a cardiovascular event. This study also highlights the importance of cardiovascular risk and vascular age assessment for management adaptation and therapeutic education. [ABSTRACT FROM AUTHOR]

In sub-Saharan Africa, the burden of non-communicable diseases (NCDs) remains under appreciated, but emerging evidence suggests it to be substantial. NCDs such as arterial hypertension, heart diseases, diabetes mellitus and chronic kidney diseases are especially relevant, and put additional strain on the already challenged health systems in this region. Moreover, NCDs appear to be associated with higher mortality and morbidity rates and are more common in younger population groups, in people from sub-Saharan Africa when compared to more developed countries. In this review, we summarize the current literature on the burden of NCDs in sub-Saharan Africa, and highlight the clinical implications of the most relevant etiologies, i.e. arterial hypertension, heart diseases, diabetes mellitus and chronic kidney diseases. [ABSTRACT FROM AUTHOR]

La dégradation de la prise en charge de l'hypertension artérielle (HTA) en France est signalée depuis 2016 par la Société française de l'hypertension artérielle (SFHTA). L'HTA non contrôlée est due à la non-observance du traitement antihypertenseur, attribuée à l'absence d'information/confiance, le statut socio-économique, les représentations de la maladie. Comprendre la nature de ces représentations permettrait de mieux cibler les messages d'éducation thérapeutique et ainsi, d'accroître l'observance des traitements. Le « groupe infirmiers et acteurs de la SFHTA » a initié en France une étude exploratoire de type qualitatif des représentations de l'HTA dans trois villes françaises (Bordeaux, Lyon, Nancy). Des entretiens avec des patients hypertendus (définitions de l'HTA, ses causes et conséquences), réalisés par les membres du groupe, ont été transcrits et analysés avec l'aide du logiciel Nvivo pro® 11. L'HTA est découverte de manière fortuite. Les patients ignorent ce qu'est l'HTA et définissent la maladie en fonction de leur expérience (symptômes, risques, conséquences). Les seuils tensionnels sont non maîtrisés, la plupart ignore leur tension de base. La fluctuation des valeurs et les messages contradictoires sur « l'hygiène de vie » sont à l'origine de confusion. L'HTA reste associée au stress. En ce qui concerne le fardeau de la maladie, la prise quotidienne d'un traitement a généré quelques appréhensions avant d'être intégrée aux habitudes des patients qui ont le désir de « faire attention » à leur alimentation principalement. Ce travail montre la nécessité de renforcer la formation des professionnels de santé et d'harmoniser les messages éducatifs, pour permettre aux patients d'intégrer les recommandations de manière apaisée. Non-adherence to treatment is one of the problems practitioners face with regard to hypertension. This lack of compliance is often attributed to disease representations. Understanding their nature can therefore help to better target therapeutic education messages and thus, increase compliance. It is in this context that the « groupe infirmiers et acteurs de la SFHTA » initiated a qualitative exploratory study of the representations of arterial hypertension in France. The study covered three sites: Bordeaux, Lyon and Nancy. Interviews with patients were conducted by the members of the group. Questions included the disease definition, its causes and consequences. The interviews were recorded and transcribed verbatim; they were analyzed with Nvivo pro® 11 software. HTA is discovered accidentally. Patients define the disease according to their experience of symptoms, their perceptions of risks and the disease's consequences. The thresholds of systolic and diastolic blood pressure are unknown; most of the patients ignore their levels of both systolic and diastolic blood pressure. Besides, the fluctuating levels of blood pressure and conflicting messages about "lifestyle" generate confusion. HTA remains associated with stress. Regarding the burden of the disease, having to take a daily medication engendered anxieties, before being integrated into daily routines. The study also showed that patients have the desire to "pay attention" to their diet primarily. This study showed the need to strengthen the training of health professionals and harmonize educational messages, which would allow patients to integrate new recommendations without stress. [ABSTRACT FROM AUTHOR]

Posterior reversible encephalopathy syndrome (PRES) is a radioclinical entity associating a reversible central nervous system involvement with a common brain imaging feature. There is a great variability in the clinical presentation of this syndrome and in the features of its sometimes atypical imaging appearance. PRES is an unusual neurological complication occurring during pregnancy or in the post-partum period, other than any preexisting pathology occurred during pregnancy. Vasogenic edema due to the rupture of the blood-brain barrier seems to be its main cause. We here report the case of a primiparous patient with generalized tonic-clonic seizures associated with hypertensive peak occurred during the third trimester of pregnancy. Magnetic resonance imaging (MRI) of the brain showed posterior reversible encephalopathy. PRES should be suspected in patients with any sign of neurological disorder. It has a favorable outcome without sequelae under early and fast treatment. [ABSTRACT FROM AUTHOR]

Résumé But de l’étude Le syndrome de Cushing est une cause rare d’hypertension artérielle. La cause primitivement surrénalienne est retrouvée dans 15 % des cas. Nous décrivons le cas d’un patient ayant une hypertension artérielle associée à une paraparésie des membres inférieurs révélant un syndrome de cushing secondaire à un adénome surrénal gauche. Patient et méthode Un homme âgé de 23 ans, consulte pour une paraparésie des membres inférieurs. La mise en évidence d’une hypertension artérielle a conduit la réalisation d’examens complémentaires. Résultats La tomodensitométrie abdominale met en évidence une masse surrénalienne gauche. Une chirurgie exérèse de la masse a été réalisée et l’examen histologique conclu à un adénome surrénalien. Après intervention, le patient a normalisé ses chiffres tensionnels avec un recul de 3 ans. Conclusion Ce cas illustre une forme d’hypertension endocrine d’origine surrénalienne et la nécessité d’un examen clinique minutieux lors de la découverte d’hypertension chez le sujet jeune afin de réaliser les bilans adéquats pour rechercher une cause curable d’hypertension secondaire. Cushing's syndrome is a rare cause of high blood pressure. The originally adrenal cause is found in 15% of cases. We describe the case of a patient with hypertension associated with paraparesis of the lower limbs revealing a Cushing syndrome due to a left adrenal adenoma. A 23-year-old man consults for a paraparesis of the lower limbs. The highlighting of an arterial high blood pressure led to the realization of complementary examinations. Computed tomography of the abdomen shows a left adrenal mass. Chirurgical excision of the mass was performed and histological examination concluded with adrenal adenoma. After intervention, the patient normalized his blood pressure with 3 years of follow up. This case illustrates a form of endocrine hypertension of adrenal origin and the need for a careful clinical examination during the discovery of hypertension in the young subject in order to carry out adequate balance sheets to search for a curable cause of secondary hypertension. [ABSTRACT FROM AUTHOR]

Medicinal treatment of arterial hypertension (AH) may cause adverse effects which can be annoying and thus influence patient's compliance with treatment. Our study focused on these undesirable effects in patients followed up for AH on an ambulatory basis in the Department of Cardiology at the University Hospital Yalgado Ouédraogo from July to September 2015. Our aim was to determine their rates and their characteristics. Data were obtained from patients' interview, from the examination of patients' follow-up records and of medical consultation forms. A total of 278 patients were included in the study, 69.1% of them were women. The average age was 52.2 ranging between 23 and 86 years; 87.8% of patients lived in urban areas. Smoking, dyslipidemia and a family history of AH accounted for 9%, 35.6% and 57.2% of cases respectively. From a therapeutic perspective, 43.2% of patients were under monotherapy, 35.6% under bitherapy at the start of treatment. Calcium channel blockers (59.7%) were the most used therapeutic drugs. The overall incidence of adverse effects was 60.1%. Calcium channel blockers were involved in 53.6% of adverse events of patients, diuretics in 48.6%. Molecule-specific prevalence was 28.1% for the amlodipine and 24.5% for the hydrochlorothiazide. Excessive diuresis (13.7%), cough (12.9%) and vertigo (11.5%) were the most frequent adverse events reported by the patients. The central and peripheral nervous system and the osteo-muscular system were the most affected systems. Adverse effects are a major determinant of patient's compliance with antihypertensive treatments, because they may have a significant impact on patient's daily life. [ABSTRACT FROM AUTHOR]

Aim of the study We aimed to determine the prevalence of orthostatic hypertension (OHT) in normotensive, newly diagnosed type 2 diabetics, to assess clinical, biological characteristics of those patients and evaluate the evolution of their blood pressure, after one year of follow-up. Materials and methods It is an observational, prospective, cohort study, on 108 normotensive, newly diagnosed diabetics, 40 men and 68 women aged from 40 to 70 ans. OHT was defined as an increase of systolic blood pressure (SBP) ≥ 20 mmHg and/or diastolic blood pressure (DBP) ≥ 10 mmHg, after 1 and 2 min of standing from supine position. Arterial hypertension and metabolic syndrome were respectively defined according to WHO and AHA 2009 guidelines. Clinical and biological data were collected for all patients. They had a screening for diabetic complications and a follow-up during one year. Statistical analysis was performed with Epi-Info 6.04. Results We found OHT in 22 patients (20.4%). Patients with OHT had a higher SBP at lying position ( P = 0.029), a higher waist circumference ( P = 0.022) and LDL ( P = 0.041). They had more frequently obesity ( P = 0.036) left ventricular hypertrophy ( P = 0.024), metabolic syndrome ( P = 0.042) and cerebrovascular events ( P = 0.050) when compared with those with normal blood pressure response to orthostasis. One year after follow-up, the prevalence of permanent hypertension was significantly higher in the OHT group ( P = 0.0008). Conclusion Our study suggests that OHT is associated with insulin resistance syndrome and onset of sustained arterial hypertension in normotensive, newly diagnosed diabetics. [ABSTRACT FROM AUTHOR]

Résumé Objectif Rechercher les déterminants d’une inobservance aux traitements antihypertenseurs chez les participants de l’enquête FLAHS 2015 et mettre au point un calculateur de ce risque pour une population d’hypertendus. Méthode Les enquêtes FLAHS sont réalisées par autoquestionnaire envoyé par courrier à des individus issus de la base de sondage permanente Métascope de TNS SOFRES (panel représentatif de la population vivant en France métropolitaine). En 2015, FLAHS a été réalisé chez les sujets âgés de 55 ans et plus. Les sujets déclarant être sous traitement antihypertenseur et ayant répondu aux 6 questions du questionnaire de Girerd ont constitué la base pour l’analyse. La variable « parfaite observance » a été déterminée pour un score à 0 et « l’inobservance » pour un score de 1 ou plus. Une régression de Poisson a été menée en univarié et multivarié permettant d’estimer les rapports de risque pour chaque déterminant. Un calculateur de risque d’inobservance est construit à partir de l’analyse multivariée. Pour chaque sexe, une table de probabilité a été produite selon le calcul de l’équation multivariée et le risque relatif d’inobservance (RI) a été calculé en prenant comme référence le profil du patient avec la meilleure observance pour chaque sexe. Pour chaque sujet testé, il est attribué une des trois classes du risque d’inobservance : faible (RI < 1,5), élevé (RI ≥ 2) ou intermédiaire (RI > = 1,5 et < 2). Résultats L’enquête a inclus 6379 sujets et l’analyse basée sur 2370 hypertendus traités. Le début du traitement était inférieur à 2 ans chez 7 % des sujets et la médiane de durée de suivi d’un traitement était de 10 ans. Une parfaite observance est retrouvée chez 64 % des sujets. Les déterminants indépendants de l’inobservance sont : le sexe masculin, le jeune âge, le nombre élevé de comprimé antihypertenseur, la prise d’un traitement pour une maladie métabolique (diabète, dyslipidémie), la présence d’une maladie chronique autre (cancer, musculaire-articulaire-osseuse, psy), la situation de prévention secondaire d’une maladie cardiovasculaire. Le calcul du risque d’inobservance est disponible en ligne sur http://www.comitehta.org/flahs-observance-hta/ . Conclusion La mise au point de FLAHS Observance rend possible une estimation du risque d’inobservance en consultation. Cet outil fait partie de l’action « agir pour l’observance » proposé par Hypertension France en 2017. Objective To investigate the determinants of non-compliance with antihypertensive treatments among participants in the FLAHS 2015 survey and to develop a risk calculator for drug compliance in a hypertensive population. Methods The FLAHS surveys are carried out by self-questionnaire sent by mail to individuals from the TNS SOFRES (representative panel of the population living in metropolitan France) sampling frame. In 2015, FLAHS was performed in subjects aged 55 years and older. Using the Girerd questionnaire, the “perfect observance” was determined for a score of 0 and “nonobservance” for a score of 1 or higher. A Poisson regression was conducted in univariate and multivariate to estimate risk ratios for each determinant. A non-compliance risk calculator is constructed from multivariate analysis. A Poisson regression was performed in univariate and multivariate to estimate risk ratios. For each sex, a probability table is produced from the equation of the multivariate analysis and then the calculation of a nonobservance probability ratio (PR) using the profile with the best probability as a reference. Each subject is then classified into one of the three classes of risk of non-compliance: low (PR < 1.5), high (PR > = 2) and intermediate (PR > = 1.5 and < 2). Results The survey included 6379 subjects and analysis based on 2370 treated hypertensives. The onset of treatment was less than 2 years in 7% of subjects and the median follow-up duration of treatment was 10 years. Perfect compliance was observed in 64% of subjects. Independent determinants of non-compliance are: male sex, young age, number of antihypertensive tablet, treatment for a metabolic disease (diabetes, dyslipidemia), presence of other chronic illness, secondary prevention of cardiovascular disease. To get the risk class of nonobservance a web page is available at http://www.comitehta.org/flahs-observance-hta/ . Conclusion The development of the FLAHS Compliance Test is a tool whose use is possible during an office visit. Its free availability for French doctor will be one of the actions undertaken as part of the “call for action for adherence in hypertension” proposed by the French League Against Hypertension in 2017. [ABSTRACT FROM AUTHOR]

Résumé But de l’étude Le poids et la taille tels qu’ils étaient à différents âges de la vie sont difficiles à obtenir. Afin d’améliorer la connaissance de l’historique du poids, Sörensen et al. en 1983, ont développé un outil à partir de silhouettes permettant d’évaluer la corpulence à différents âges de la vie. Les études de validité ont montré que le poids et la taille mesurés étaient corrélés à 80 % à la silhouette rapportée. D’autres études ont montré que l’évaluation des silhouettes est un bon moyen de retracer l’historique du poids d’un individu. Très peu d’études épidémiologiques ont utilisé cet outil. Une étude française a permis de mettre en évidence une diminution du risque de cancer du sein chez les fillettes qui étaient obèses entre l’âge de 8 ans et l’adolescence. Une autre étude a montré qu’un faible poids de naissance ou une silhouette mince avant l’âge adulte sont associées à une augmentation du risque de diabète. À partir de ces constatations, il nous a semblé intéressant d’évaluer la relation entre la silhouette à 20 ans et le risque d’hypertension à l’âge de 60 ans. Résultats On a observé que la prévalence de l’hypertension à l’âge de 60 était plus élevée chez les sujets obèses à 20 ans que chez les sujets minces (45,3 % vs 36,7 % ; p < 0,05). Conclusion Cet outil permet une classification pertinente entre minceur et obésité. L’historique de la corpulence est un élément important à considérer dans les déterminants d’une pathologie, en particulier dans celle de l’hypertension artérielle. Purpose of the study In epidemiological studies, recall of weight and height are not readily available at different ages of life. In order to improve the knowledge of the weight history, Sörensen et al. in 1983, developed a tool from silhouettes allowing an individual to evaluate his corpulence at different ages of life. Validity studies showed that measured weight and size were correlated to 80% in the reported silhouette. Studies have also shown that silhouettes are a good way to trace the weight history in an individual's life. Very few epidemiological studies have used this tool. A French study revealed a decrease of the risk of breast cancer in obese girls between the age of 8 and adolescence. Another study showed that a low birth weight or a thin silhouette before adulthood was associated with an increased risk of diabetes. On the basis of these findings, it was interesting to evaluate the relationship between the silhouette at 20 years and the risk of hypertension at the age of 60 years. Results It was shown that the prevalence of hypertension at age 60 was higher among obese subjects at 20 years than among thin subjects (45.3% vs 36.7% ( P < 0.05). Conclusion The classification between slimness and obesity is relevant using this tool. The history of corpulence is an important element to consider in the determinants of pathology, especially in hypertension. [ABSTRACT FROM AUTHOR]

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Résumé Objectifs Évaluer les pressions de remplissage à l’aide de l’examen échocardiographie Doppler et Doppler Tissulaire Imaging (DTI) chez les patients en insuffisance cardiaque à fraction d’éjection préservée en unité hôpital de jour. Patients et méthode Dans une étude observationnelle prospective de 2004 à 2014, 200 patients (pts) hypertendus d’âge moyen 65 ± 11 ans dont 132 femmes (66 %) ont été suivis pour insuffisance cardiaque à fraction d’éjection préservée, en unité hôpital de jour. La présence de comorbidités incluant le diabète et la fibrillation atriale (FA) sont identifiées. L’échocardiographie est pratiquée selon les recommandations des sociétés américaines et européennes portant sur l’évaluation de la fraction d’éjection (FE) par la méthode Simpson biplan et de la fonction diastolique par l’estimation des pressions de remplissage du ventricule gauche (PRVG) (1). Résultats L’index de masse corporelle (IMC) > 30 kg/m 2 est présent chez 88 pts (44 %). Le tour de taille supérieur à 102 cm chez l’homme et supérieur à 88 cm chez la femme est retrouvé chez 164 pts (82 %). Un pt sur deux présente un diabète associé à l’hypertension artérielle. La dyslipidémie est retrouvée chez 78 pts (39 %). La cardiopathie ischémique est présente chez 64 pts (32 %) ; un antécédent d’accident thromboembolique est identifié chez 78 pts (39 %) ; une valvulopathie est observée chez 40 pts (20 %). L’ECG s’inscrit en fibrillation atriale chez 60 pts (32 %), un bloc de branche gauche (BBG) est observé chez 20 pts (10 %). L’échocardiographie met en évidence une hypertrophie ventriculaire gauche concentrique chez 126 pts (63 %) et une oreillette gauche dilatée chez 111 pts (55 %). La fraction d’éjection moyenne quantifiée selon la méthode Simpson biplan est de 55 ± 10 %. Un profil diastolique de type relaxation (Em/Am < 1) un temps de décélération (TD) > 150 ms est observé chez 80 pts (40 %), avec augmentation des pressions de remplissage du VG (Em/e′ > 8 et Ap > Am) chez 56 pts. Le profil diastolique pseudonormal (1 < Em < 2) avec un temps de décélération < 150 ms, est vu chez 80 pts (40 %). Un profil de type restrictif (Em/Am > 2) avec un TD < 100 ms chez 40 pts (20 %). Conclusion Les patients hypertendus avec insuffisance cardiaque référés pour échocardiographie sont souvent obèses, diabétiques et présentent une insuffisance cardiaque à fraction d’éjection préservée avec augmentation des pressions de remplissage. Cet examen est utile pour guider leur traitement utilisant les diurétiques, les inhibiteurs de l’enzyme de conversion (IEC) ou les antagonistes des récepteurs à l’angiotensine (ARA). Un programme de réhabilitation est alors entrepris. Objective To assess the left ventricular (LV) filling pressures by Doppler Tissulaire Imaging (DTI) in the management of hypertensive patients with heart failure and preserved systolic function (HF-PEF) in our outpatient clinic. To involve the patient on the basis of their clinical, biological and echocardiography data, in identifying the risk factors that need change. Patients and methods From 2004 to 2014, heart failure with preserved systolic function (HF-PEF) has been diagnosed in 200 consecutive hypertensive patients (pts) at our Algerian outpatient unit. Data were collected on blood pressure at the time of the examination, body mass index (BMI), waist, comorbid conditions including dyslipidemia, diabetes and atrial fibrillation (AF). LV ejection fraction > 50 % is taken as the including criteria with acquisition as described in the Chamber Quantification update. Left ventricular global systolic function by biplane disk summation Simpson method and diastolic function is assessed by the mitral inflow measurements regarding recommendations for the evaluation of left ventricular diastolic function by echocardiography from the European Association of Cardiovascular Imaging (EACVI) and the American Society of Echocardiography (ASE). Results Mean age was 65 ± 11 yrs; 66 % were female; waist circumference in men > 102 cm and in women > 88 cm was found in 82 % of the pts and 50 % were diabetics. Body weight (BMI) > 30 kg/m 2 is depicted in 88 (44 %). Dyslipidemia is depicted in 78 pts (39 %). Ischemic heart disease was diagnosed in 64 pts (32 %); history of thromboembolic event in 78 pts (39 %); valvular disease in 40 pts (20 %). ECG showed AF in 60 pts (30 %), complete left bundle branch block (LBBB) in 20 pts (10 %). The echographic findings were as follow: left ventricular hypertrophy (LVH) in 126 pts (63 %) and left atrial (LA) enlargement in 111 pts (55 %). Mean left ventricular ejection fraction (LVEF) is about 55 ± 10 %. Delayed relaxation (Em/Am < 1) and deceleration time > 150 ms (DT) in 80 pts (40 %), of them, 56 had increased filling pressures (Em/Ea > 8 and Ap > Am); pseudo-normal patterns (1 < Em/Am < 2 and DT < 150 ms) in 80 pts (40 %); restrictive filling pattern (Em/Am ≥ 2) and short DT < 100 ms in 40 pts (20 %). Conclusions The hypertensive pts referred for an echo examination are often diabetics and frequently demonstrate preserved left ventricular function with increased filling pressures. This is useful for managing their treatments in the context of a cardiac rehabilitation programme. [ABSTRACT FROM AUTHOR]

Résumé Objectifs Notre étude a pour but de déterminer la prévalence de l’hypertension artérielle et des complications dégénératives qui s’y associent chez des diabétiques de type 2 nouvellement diagnostiqués, à travers une étude observationnelle, prospective. Patients et méthodes Nous avons recruté 327 diabétiques de type 2 nouvellement diagnostiqués, âgés de 40 à 70 ans, en médecine générale. La tension artérielle est mesurée selon les recommandations de l’OMS. Nous avons recueilli les données cliniques, biologiques et recherché les complications dégénératives du diabète. L’analyse statistique a été réalisée à l’aide du logiciel Epi-Info 6.04. Résultats Parmi les patients, 66,7 % avaient une hypertension artérielle au diagnostic du diabète sucré, 28 % d’entre eux étaient déjà connus. Ils ont un âge moyen de 54,3 ± 8 ans et présentent un syndrome métabolique dans 88,4 %. L’homme présente un risque coronarien, une glycémie et une fréquence de l’albuminurie plus élevés, tandis que la femme est plus obèse. La tension artérielle augmente avec le risque coronarien et les critères du syndrome métabolique. Une microangiopathie est retrouvée dans 65,7 %, une athérosclérose dans 59,4 % et 71,2 % des hypertendus ayant une athérosclérose ont également une microangiopathie ( p = 0,018). Conclusion La prévalence l’hypertension artérielle est élevée chez les nouveaux diabétiques. Elle s’associe à un degré de morbidité très élevé. Le dépistage de ces deux maladies passe par l’implication et la motivation du soignant et du soigné. Clinicaltrials.gov ID : NCT02002091 . Aim of study Our aim was to determine the prevalence of arterial hypertension and evaluate its association with vascular chronic complications in newly diagnosed type 2 diabetes patients, in an observational, prospective study. Material and methods We have recruited 327 newly diagnosed type 2 diabetics aged from 40 to 70 years, in general practice units. Arterial blood pressure has been measured according to WHO guidelines. All data on clinical examination, diabetes's chronic complications were collected during 6 months and statistically analyzed with Epi-Info 6.04 database program. Results Among the patients, 66.7% had arterial hypertension at diagnosis of diabetes, 28% were known as hypertensive. They were 54.3 ± 8.4 years old and have metabolic syndrome in 88.4%. Men have more frequently a higher cardiovascular risk, higher glycaemia and albuminuria; women were more likely to have a metabolic syndrome and a higher BMI. Blood pressure increases with cardiovascular risk and metabolic syndrome components. Microangiopathy is present in 65.7%, atherosclerosis in 59.4 and 71.2% of hypertensive patients who have atherosclerosis have also microvascular complications. Conclusion The prevalence of arterial hypertension in newly diagnosed type 2 diabetes is high. This association is linked with an alarming level of vascular morbidity. Early detection and treatment of these two diseases need a better implication and motivation of patients and health care providers. Clinicaltrials.gov ID: NCT02002091 . [ABSTRACT FROM AUTHOR]

Résumé Objectif L’enquête FLAHS 2015 a cherché des déterminants du contrôle de l’HTA chez les sujets traités par antihypertenseurs en France métropolitaine. Méthode Envoi d’auto-questionnaire par courrier à un panel représentatif de la population vivant en France métropolitaine (base Métascope, TNS SOFRES, France). Un sujet déclarant une prise actuelle d’antihypertenseur est considéré hypertendu traité. Une automesure sur 3 jours a été demandée chez ceux disposant d’un tensiomètre et la moyenne de 18 mesures a été calculée. Résultats Un total de 6379 sujets âgés de 55 ans et plus ont été inclus dont 2814 (44,1 %) traités par antihypertenseurs. Une automesure est obtenue chez 1455 sujets et montre une PAS/PAD à 129,3 ± 13,5/75,5 ± 9,0 mmHg. La PA est plus élevée chez les traités dans chaque catégorie d’âge. Une PA < 135/85 est notée chez 55,4 % et une PA < 140/90 chez 71,7 %. Les déterminants du contrôle (PA < 135/85) sont l’âge (55–64 ans vs 80 ans et plus ; 57,6 %/49,1 %), le sexe (femmes vs hommes ; 60,3 %/50,1 %), le BMI (< 25 vs > 30 ; 63,1 %/46,1 %). Chez les 80 ans et plus, une PAS < 145 est observée chez 74,7 % des sujets. Le contrôle est de 61 % lorsque l’on considère une PAS/PAD < 135/85 chez les 55–79 ans et une PAS < 145 chez les 80 ans et plus. Conclusion Le contrôle de l’HTA évalué par automesure sur une population représentative vivant en France métropolitaine est estimé entre 44,3 % et 74,7 % et plusieurs déterminants font varier le contrôle de la pression artérielle dont l’âge, le sexe et le BMI. Objective The FLASH 2015 survey sought the determinants of hypertension control in subjects treated with antihypertensive drugs in France. Method Sending self-administered questionnaire by mail to a representative sample of the population living in metropolitan France (MetaScope basis, TNS Sofres, France). Patients who declare taking antihypertensive drugs are considered treated hypertensives. A home blood pressure monitoring during 3 days was asked in subjects owing a blood pressure monitor and the average of 18 measurements was calculated. Results A total of 6379 subjects aged 55 and older were included with 2814 (44.1%) treated with antihypertensive drugs. Home blood pressure was obtained from 1455 subjects including 882 (60.6%) treated. SBP/DBP are 129.3 ± 13.5/75.5 ± 9.0 mmHg and are higher in treated subjects in each age category. BP < 135/85 was observed in 55.4% and BP < 140/90 in 71.7%. Determinants of BP control (< 135/85) are the number of measurement for averaging (18 measures over 3 days vs 3 measurements on a morning; 55.4%/44.3%), age (55–64 years vs 80 years old; 57.6%/49.1%), gender (women vs men; 60.3%/50.1%), BMI (< 25 vs > 30; 63.1%/46.1%). In the 80 and older, a SBP < 145 was observed in 74.7% of subjects. The control was 61% when considering an SBP/DBP < 135/85 in 55–79 years and SBP < 145 among 80 and older. Conclusion The control of hypertension evaluated by home blood pressure on a representative population living in metropolitan France is estimated at between 44.3% and 74.7% and several determinants influence the control of blood pressure like age, gender and BMI. [ABSTRACT FROM AUTHOR]

Résumé Une patiente de 31 ans est suivie pour une cystinurie, justifiant des scanners réguliers. En 2006 une masse tissulaire de 3 cm de la surrénale droite, homogène, mesurée à 3,5 cm était notée. En 2007, cette masse présentait un caractère hétérogène. La pression artérielle était à 90/61 mmHg, sans hypotension orthostatique. À l’interrogatoire, absence de malaise, de crise sudorale, de céphalée, de palpitation. L’aldostérone, le cortisol, les androgènes étaient normaux. La normétanéphrine urinaire et la somme des dérivés méthoxylés urinaires rapportés à la créatininurie étaient élevés. Un an plus tard, la patiente était toujours asymptomatique et normotendue. Les taux plasmatiques de normétanéphrine et de métanéphrine s’étaient majorés, devenant hautement pathologiques. La tumeur mesurait 5 cm de grand axe et fixait isolément sur la scintigraphie au MIBG et le PET scan. Une surrénalectomie droite a été réalisée. Le phéochromocytome a été confirmé histologiquement. La particularité ici était l’absence de symptôme, en particulier d’hypertension artérielle. Cela concerne actuellement jusqu’à 47 % des cas, notamment dans le cadre d’explorations d’incidentalomes et de dépistage familial. En effet, 35 à 40 % des phéochromocytomes sont associés à une mutation germinale, justifiant une analyse génétique chez cette patiente. L’analyse génétique ne montrera ici aucune mutation associée au phéochromocytome. Le suivi à 6 ans montrait l’absence de récidive du phéochromocytome mais l’apparition d’une hypertension ! Les seules récidives documentées étaient... lithiasiques. A 31-year-old patient was followed for cystinuria, justifying CT scans. In 2006, a tissue mass of 3 cm of the right adrenal gland, homogeneous, measured at 3.5 cm in 2007 was noted. Blood pressure was 90/61 mmHg, without orthostatic hypotension. During the clinical interview, no discomfort, sweat attack, headache, or palpitation was reported by the patient. Hormonal assays did not favor a primary hyperaldosteronism, or a hypercortisolism. Adrenal androgens were normal. 24 h normetanephrines urinary excretion and metanephrines to creatinine ratio were elevated. One year later, the patient remained asymptomatic and normotensive. Plasma levels of normetanephrine and metanephrine were increased and highly pathological. The tumor was 5 cm long and fixed individually on MIBG scintigraphy and PET scan. Right adrenalectomy was performed. A pheochromocytoma was confirmed histologically. The peculiarity here was the absence of symptoms, especially arterial hypertension. This currently affects up to 47% of cases, particularly in the context of incidentaloma investigations and family screening. Indeed, 35 to 40% of pheochromocytomas are associated with a germline mutation, justifying a genetic analysis in this patient. Genetic analysis did not show any mutation associated with pheochromocytoma. At a 6-year interval pheochromocytoma did not reappeared while BP increased reaching hypertension threshold. The only documented recurrence was lithiasis. [ABSTRACT FROM AUTHOR]

Résumé Objectif Décrire les hypertendus traités en 2014 en France selon leur âge et estimer la plainte cognitive chez ceux âgés de plus de 55 ans. Méthode L’enquête French League against Hypertension Survey (FLAHS) a été menée par voie postale au sein d’un échantillon représentatif de sujets âgés de 35 ans et plus vivant en France métropolitaine. Les données du traitement antihypertenseur ont été obtenues par auto-questionnaire. Chez les possesseurs d’un appareil d’automesure, la pression artérielle a été considérée comme contrôlée si la moyenne de 3 mesures effectuées le matin était inférieure à 135/85 mmHg. La plainte cognitive a été dépistée par le questionnaire de plainte cognitive (QPC) de Thomas-Antérion et analysée selon l’âge et les antécédents médicaux de chaque sujet. Résultats En 2014, 30 % de la population âgée de 35 ans et plus (11,6 millions) est traitée par médicaments antihypertenseurs. Le nombre des hypertendus traités est de 3,45 millions chez les 75 ans et plus, de 2,96 millions chez les 65–74 ans, de 3,24 millions chez les 55–64 ans, de 1,58 millions chez les 45–54 ans, et de 0,441 million chez les 35–44 ans. La mono-/bi-/tri-/quadri-thérapie est utilisée chez 46 %/35 %/14 %/5 % des patients. Cette répartition varie avec l’âge avec une monothérapie utilisée chez 63 % des moins de 55 ans mais chez 40 % des 75 ans et plus. Un QPC positif était noté chez 11 % des 55–64 ans, chez 21 % des 75 ans et plus ( p < 0,001), chez 20 % des hypertendus non contrôlés et chez 34 % des sujets ayant un antécédent personnel d’AVC. Conclusion En France, l’HTA est une maladie qui touche en majorité les sujets âgés. Les modalités du traitement sont différentes selon l’âge. Les plaintes cognitives sont plus fréquentes chez les hypertendus non contrôlés et chez les patients ayant un antécédent d’AVC. Objective Describe hypertensive patients treated in 2014 in France by age and estimate the degree of cognitive complaint among subjects aged 55 and over. Method French League against Hypertension Survey (FLAHS) was conducted by mail in a representative sample of subjects aged 35 and over living in metropolitan France. Antihypertensive treatment data were obtained by self-administered questionnaire. Among the owners of a self-measurement device, blood pressure was considered to be controlled if the average of three measurements in the morning was below 135/85 mmHg. Cognitive complaint was detected by the cognitive complaint questionnaire (QPC) and analyzed by age and medical history of each subject. Results In 2014, 30% of the population aged 35 and over (11.6 million) was treated with antihypertensive drugs. The number of treated hypertensive was: 3.45 million in the 75 and older, 2.96 million in 65–74 years, 3.24 million in 55–64 years, 1.58 million in the 45–54 years and 0.441 million in 35–44. The mono/bi/tri/quad-therapy is used in 46%/35%/14%/5% of patients. This distribution varies with age with monotherapy used in 63% of subjects under 55 years but in 40% of subjects 75 years and over. A positive QPC was noted in 11% of 55–64 years, in 21% of 75 years and older ( P < 0.001), in 20% of uncontrolled hypertensive patients, and in 34% of subjects with a personal history of stroke. Conclusion In France, hypertension is a disease that affects mainly the elderly. The modalities of treatment are different depending on age. Cognitive complaints are more common in uncontrolled hypertensive patients and in patients with a history of stroke. [ABSTRACT FROM AUTHOR]

Résumé Contexte et objectif En Guadeloupe, les caractéristiques sur l’association hypertension artérielle–syndrome d’apnée obstructive du sommeil ne sont pas connues. Objectifs Évaluer la fréquence de l’hypertension et du profil non dipper par la mesure ambulatoire de la pression artérielle des 48 heures chez des patients identifiés apnéiques/non apnéiques lors de la polygraphie nocturne. Déterminer les facteurs cardio-métaboliques associés à l’apnée du sommeil. Patients et méthodes Étude transversale réalisée, à l’hôpital de Pointe-à-Pitre, chez des patients adressés en consultation du sommeil pour suspicion d’apnée du sommeil et ayant bénéficié d’une polygraphie nocturne. Le diagnostic était retenu si l’index d’apnée hypopnée était ≥ 5. Deux groupes étaient constitués : apnéique/non apnéique. Les patients avaient une mesure ambulatoire de la pression artérielle des 48 heures. Les facteurs cardio-métaboliques étaient identifiés et mesurés (index Homa-IR, CRP us). Résultats Au total, 204 patients inclus, âge moyen 54 ± 10 ans, 62,7 % de femmes. Une apnée obstructive du sommeil était présente dans 69,6 % des cas, elle était plus fréquente chez les hommes. La différence n’était pas significative entre les deux groupes pour les fréquences de l’hypertension (84,5 % vs 77 % ; p = 0,22), du profil non dipper (77,5 % vs 76 % ; p = 0,79), et la CRP us. Elle était significative pour : l’âge, les ronflements, l’indice de masse corporelle, le tour de taille, l’index Homa-IR, l’obésité, la dyslipidémie et le diabète. Conclusions Ces résultats mettent en exergue des fréquences plus élevées des facteurs cardio-métaboliques chez les patients ayant un syndrome d’apnée obstructive du sommeil et confirment leur haut risque cardiovasculaire. Background and purpose In Guadeloupe, data on the relationships between arterial hypertension and obstructive sleep apnea are unavailable. The aim of this study was: to assess the frequency of hypertension and non-dipper pattern evaluated by 48-hour ambulatory blood pressure monitoring in an adult population identified obstructive sleep apnea/non-obstructive sleep apnea during overnight polygraphy ; to determine the cardio-metabolic factors associated with obstructive sleep apnea. Design and method A cross-sectional study was realized at Pointe-à-Pitre Hospital. Patients were referred for suspected sleep apnea to sleep specialist and performed a nocturnal polygraphy. Diagnosis was confirmed if the apnea-hypopnea index was ≥ 5. We obtained two groups: sleep apnea/non-sleep apnea. All patients underwent 48-hour ambulatory blood pressure monitoring. The cardio-metabolic factors were identified and assessed (fasten level of hs-CRP and Homa-IR index). Results A total of 204 patients were included. Mean age at diagnosis was 54 ± 10 years, 63% were women. OSA was present in 69.6% with a higher frequency in men than in women. Difference was not significant between the two groups for hypertension frequency (84.5% vs 77%; P = 0.22), non-dipper pattern (77.5% vs 76%; P = 0.79) and hs-CRP. Differences for age, snoring, body max index, mean waist circumference, Homa-IR index, obesity, dyslipidemia, and type 2 diabetes were significant. Conclusions Our data highlight raised frequency of cardiovascular metabolic factors in patients with obstructive sleep apnea and confirm their high cardiovascular risk. [ABSTRACT FROM AUTHOR]

Hypertension, defined as office blood pressure of ≥140 mmHg systolic and/or ≥90 mmHg diastolic, is prevalent and one of the most important risk factors for disease and premature death. Diagnostic evaluation includes risk stratification regarding other cardiovascular risk factors, cardiovascular disease and asymptomatic organ damage. Currently, treatment is generally recommended with blood pressure ≥140/90 mmHg with the goal of reducing values below these limits also in high risk patients. Exceptions concern patients with advanced age or diabetes. Treatment involves lifestyle changes, anthypertensive drugs and in the future probably interventional techniques. This mini-review summarizes selected and practically relevant diagnostic and therapeutic aspects from recent international guidelines. [ABSTRACT FROM AUTHOR]

Résumé Introduction L’hypertension artérielle (HTA) est un problème majeur de santé publique dans le monde. Le contrôle des chiffres tensionnels et la réduction du risque cardiovasculaire global constituent des objectifs cardinaux du traitement de l’hypertendu. L’objectif de la présente étude est de déterminer la proportion et les facteurs associés à l’HTA non contrôlée chez des hypertendus suivis par des cardiologues libéraux à Oran. Patients et méthodes L’étude a porté sur 253 hypertendus connus et suivis par sept cardiologues libéraux à Oran. Était considérée comme tension artérielle non contrôlée une pression artérielle systolique (PAS) supérieure ou égale 140 mmHg et/ou une pression artérielle diastolique (PAD) supérieure ou égale 90 mmHg. Une analyse par régression logistique a été réalisée pour déterminer les facteurs associés au mauvais contrôle tensionnel. Résultats La proportion d’HTA non contrôlée était de 69,6 % (75,8 % chez les hommes et 65,8 % chez les femmes). En analyse multivariée, le mauvais contrôle tensionnel était associé au régime alimentaire sodé (OR a = 2,71 ; IC 95 % = [1,42–5,18]). Conclusion Des actions d’ordre nutritionnelles doivent être déployées pour un meilleur contrôle tensionnel. Introduction Hypertension is a major public health problem throughout the world. The blood pressure control and the decrease of global cardiovascular risk are two main goals of the treatment of hypertension. The purpose of this study was to determine the proportion and associated factors of uncontrolled hypertension in hypertensive patients followed by private cardiologists in Oran. Materials and methods This study included 253 hypertensive patients followed by 7 private cardiologists in Oran. Was regarded as uncontrolled high blood pressure, a systolic blood pressure (SBP) superior or equal to 140 mmHg and/, or a diastolic blood pressure (DBP) superior or equal to 90 mmHg. A logistic regression analysis was performed to determine the associated factors with poor blood pressure control. Results The proportion of uncontrolled hypertension was 69.6 % (75.8 % of men and 65.8 % of women). Using multivariate analysis, poor blood pressure control was found to be associated with salt consumption (OR a = 2.71; CI 95 % = [1.42–5.18]). Conclusion Nutritional actions are required for better blood pressure control. [ABSTRACT FROM AUTHOR]

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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]

Hydrogen sulfide (H2S) is synthesized from l-cysteine by cystathionine β-synthase (CBS) or cystathionine γ-lyase (CSE), and is enzymatically metabolized in mitochondria by sulfide:quinone oxidoreductase (SQR). Recent studies have indicated that H2S is synthesized by CSE in perivascular adipose tissue (PVAT), and is responsible for the anticontractile effect of PVAT on adjacent vessels. The lipophilic statin atorvastatin increases PVAT-derived H2S by suppressing its mitochondrial oxidation; the effect that results from statin-induced depletion of ubiquinone. Experimental obesity induced by a highly palatable diet has a time-dependent effect on H2S in PVAT. Adipose tissue hypoxia suppresses H2S oxidation and increases its level in short-term obesity not associated with insulin resistance. In contrast, in long-term obesity, insulin resistance and (or) hyperinsulinemia result in the down-regulation of CSE and H2S deficiency, which is corrected by treatment with the insulin sensitizer rosiglitazone. In addition, cannabinoid CB1 receptor agonist administered for 2 weeks increases H2S by impairing mitochondria biogenesis. This indicates that the rate of mitochondrial H2S oxidation plays an important role in the regulation of H2S level in PVAT. Up-regulation of H2S signaling in short-term obesity and (or) by elevated endocannabinoids may be a compensatory mechanism that maintains vascular tone, despite endothelial dysfunction. [ABSTRACT FROM AUTHOR]

Résumé: La surcharge hydrosodée est un facteur de morbi-mortalité et son traitement fait partie des marqueurs d’adéquation du traitement par hémodialyse. Son évaluation clinique en premier lieu a été améliorée par des outils tels que l’échographie cardiaque et de la veine cave inférieure, la courbe de volume plasmatique, la mesure du BNP ou du proBNP et par l’impédancemétrie. La combinaison de l’évaluation de ces paramètres et de la situation clinique permet de juger de la surcharge extracellulaire, de l’état de la volémie et des possibilités du remplissage plasmatique. Ce dernier est un facteur clé de la tolérance hémodynamique per-dialytique. Celle-ci étant elle-même déterminante dans le poids pouvant être atteint en fin de séance. Arriver au poids « sec » peut nécessiter des modifications de prescription de séances d’hémodialyse, un remplissage par albumine ou colloïdes voire un support médicamenteux. Enfin, le traitement de la surcharge est la partie centrale du traitement de l’hypertension artérielle qui doit cependant souvent bénéficier d’un traitement antihypertenseur dont le bénéfice est démontré. [Copyright &y& Elsevier]

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Copyright of Les Cahiers de l'Année Gérontologique is the property of Lavoisier and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Résumé: Objectif: Évaluer à partir des études FLAHS réalisées entre 2002 et 2012, les évolutions dans l’usage des médicaments antihypertenseurs en France. Méthode: Les enquêtes French League Against Hypertension Survey (FLAHS) ont été menées par voie postale au sein d’un échantillon représentatif de sujets âgés de 35ans et plus vivant en France métropolitaine. La liste comportant les noms de tous les médicaments antihypertenseurs commercialisés à la date de chaque enquête a permis de détailler les traitements pharmacologiques utilisés et d’analyser ces données en prenant comme unité le patient. Les données obtenues en 2002, 2007 et 2012 font l’objet de cette analyse. Résultats: En 2012, 30 % de la population âgés de 35ans et plus (11,4 millions) sont traités par médicaments antihypertenseurs alors que 24 % sont traités en 2002 (8,2 millions). En moyenne, la prescription d’antihypertenseur comportait 1,4±0,7 comprimés en 2002, 1,5±0,8 en 2007 et 1,8±0,9 en 2012, ce qui correspond à une monothérapie pharmacologique prescrite chez 47 % des hypertendus en 2012 un pourcentage différent de celui de 2007 (46 %) et 2002 (56 %). Sur la période, le pourcentage sur les prescriptions de diurétiques (41 % à 42 %) et des IEC (24 % à 23 %) et des bêta-bloquants (34 % à 36 %) est stable, mais il y a une augmentation pour les ARA2 (23 % à 47 %) et les antagonistes calciques (24 % à 34 %). Les prescriptions des combinaisons fixes sont en augmentation (19 % à 30 %). En 2012, les combinaisons fixes utilisées contiennent un diurétique (79 %), un ARA2 (65 %), un IEC (23 %), un antagoniste calcique (20 %). Le contrôle tensionnel par automesure au domicile indique 38 % en 2002 et 50 % en 2007 et 2012. Conclusion: Les changements dans l’usage des médicaments antihypertenseurs entre 2002 et 2012 ont conduit à observer une majorité de traitements en associations. Alors qu’un ARA2 ou un IEC sont les classes pharmacologiques présentes pour 70 % des prescriptions, l’usage de combinaisons fixes comportant un diurétique dans 80 % des cas et un antagoniste calcique dans 20 % des prescriptions caractérise la période actuelle qui a, en parallèle de ces changements, observé une amélioration du contrôle des hypertendus traités. [ABSTRACT FROM AUTHOR]

Résumé: Objectifs: L’optique adaptative est une nouvelle technique non invasive permettant d’obtenir une imagerie des vaisseaux rétiniens dont la résolution de deux microns autorise la mesure du diamètre et de l’épaisseur des artérioles. L’objectif de cette étude a été d’évaluer la faisabilité et la reproductibilité de la méthode en clinique chez l’homme. Méthodes: Chez 23 sujets avec une hypertension artérielle non traitée et chez 14 sujets sains, les artères rétiniennes ont été visualisées par optique adaptative et l’analyse des images a été automatisée permettant la mesure du diamètre interne et de l’épaisseur pariétale sur un segment artériolaire de l’artère rétinienne temporale. À partir de ces paramètres, le rapport paroi/lumière (wall to lumen ratio [WLR]) et la surface cross-sectionelle de la paroi du vaisseau (wall cross sectional area [WCSA]) sont calculés. La reproductibilité intra-observateur a été évaluée en réalisant trois acquisitions consécutives chez 14 sujets. La reproductibilité inter-observateur a été évaluée en réalisant deux lectures indépendantes chez 17 sujets. Le coefficient de variation (CV) a été calculé comme SD/moyenne. Une comparaison des paramètres de l’artériole rétinienne entre les sujets hypertendus et les sujets sains a été réalisée. Résultats: Chez les 14 sujets sains, pour un diamètre interne de 56,1±9,6μm le WLR est à 0,259±0,035. La reproductibilité inter-observateur indique un CV à 1,3 % pour le diamètre interne, à 3,7 % pour le WCSA et à 3,2 % pour le WLR. La reproductibilité intra-observateur indique un CV à 3,2 % pour le WLR. Chez les hypertendus le WLR est significativement plus élevé (0,348±0,071 ; p <0,05) alors que le diamètre interne est comparable. Conclusion: L’évaluation de la morphologie des artérioles rétiniennes est faisable par l’optique adaptative. La reproductibilité inter- et intra-observateur est satisfaisante et compatible avec la réalisation d’études prospectives dans des pathologies comme l’HTA au cours de laquelle des propriétés structurales des vaisseaux rétiniens sont connus. [ABSTRACT FROM AUTHOR]

Abstract: Background: The prevalence of hypertension in the Sub-Saharan Africa region is increasing as a manifestation of the epidemiological transition, and this fact will oblige these countries to mobilize significant resources. World Bank estimates cheaper to prevent cardiovascular disease than to treat people once these diseases are established suggesting the need to know the prevalence of hypertension in order to allow prevention programs in our population. However, data in Togolese populations are rare. The purpose of the present study was to determine the prevalence of high blood pressure and its risk factors in Lomé. Methods: We performed a cross-sectional survey among 2002 unselected respondents of the municipality of Lomé in May 2011. A questionnaire has been filled about family history of hypertension, habits and practices that affect hypertension on behalf of each respondent and anthropometric data and blood pressure has been measured. Results: The prevalence of high blood pressure was 36.7% (34.6% of male vs. 38.4% of female, OR=0.85; 95%CI=0.7–1.02; P =0.08); 42.4% of the hypertensive respondents have been diagnosed at the screening. Blood pressure was positively correlated to the age (SBP: r =+0.46; P =0.001; DBP: r =+0.36; P <0.001), the body mass index (SBP: r =+0.7; P <0.001; DBP: r =+0.89; P <0.001) and waist circumference (SBP: r =+0.28; P <0.001; DBP: r =+0.3; P <0.001). There was a significant relationship between arterial hypertension and obesity (OR=1.65; 95%CI=1.47–1.84; P =0.003), salt consumption (OR=1.4; 95%CI=1.13–1.72; P <0.001) and oral contraception (OR=2.1; 95%CI=1.29–3.43; P =0.002). Conclusion: There was a high prevalence and low awareness of arterial hypertension in the municipality of Lomé with a female prevalence. This affection was correlated to age, salt consumption and obesity. This study raises the need for accentuating the prevention in our poor populations which are unable to face adverse outcomes which can occur. [Copyright &y& Elsevier]

Copyright of Phytothérapie is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Néphrologie & Thérapeutique is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Analgesic drugs, non-steroidal antiinflammatory drugs and paracetamol (acetaminophen) in particular, belong to the most widely prescribed therapeutic agents. Beside their efficacy in pain relief, these drugs were recently linked to increased cardiovascular risk. Indeed, epidemiological and clinical studies showed that non-selective nonsteroidal anti-inflammatory drugs, as well as selective cyclooxygenase-2 inhibitors both may increase blood pressure and cardiovascular events. However, the effect of paracetamol (acetaminophen) on blood pressure and cardiovascular health should not be neglected, too.Unfortunately, longterm randomized controlled trials appropriately powered to evaluate cardiovascular outcomes are lacking. This review summarizes the available data about the effect of paracetamol in particular, on blood pressure and other cardiovascular outcomes. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Describe how antihypertensive drugs are prescribed in France in 2009 and 2010 and assess the effect of the presence of cardiovascular disease on the characteristics of the treatment. Methods: The French League Against Hypertension Surveys (FLAHS) are conducted among a representative sample of individuals aged 35 years and older living in France. For the 2009 and 2010 surveys, a sample of 2292 subjects who declared to take one or more antihypertensive drug has been studied. In addition to the details of antihypertensive medications taken the day of the survey, the personal history for cardiovascular diseases was compiled. Results: Of the 2292 prescriptions with at least one antihypertensive prescription frequencies are: ARB (43%), diuretics (43%), beta-blockers (34%), CCB (26%), ACEI (26%), spironolactone (8%), central and alpha (7%), DRI (1%). The prescription is performed as monotherapy (42%), bitherapy (37%), triple therapy (16%) and quadruple or more (5%). When triple therapy is prescribed, there is an association ACEI or ARB or DRI+Diu+BB in 46%, and an association ACEI or ARB or DRI+Diu+AC in 30%. Cardiovascular disease is present or past reported by 24% of hypertensive patients: coronary artery disease (13%), heart failure (6%), arrhythmias (5%), stroke (4%), PAD (4%). The use of BB is more common in hypertensive patients who have coronary artery disease, heart failure and arrhythmia. ACE inhibitors are more common in hypertensive patients with coronary artery disease, heart failure or stroke. CCB are more frequent in cases of coronary artery disease or PAD. The ARB are less frequent in patients with coronary artery disease. Conclusion: The ARB, diuretics and beta-blockers are the most prescribed antihypertensives in France in 2009 to 2010. Cardiovascular diseases declared in 24% of hypertensives led to a preferential prescription of an ACE inhibitor or BB. [Copyright &y& Elsevier]

Abstract: Diabetes-driven cardiovascular diseases represent a high challenge for developed countries. Periodontal disease is strictly linked to the aforementioned diseases, due to its Gram negative–driven inflammation. Thus, we investigated the effects of periodontal disease on arterial pressure during the development of diabetes in mice. To this aim, C57BL/6 female mice were colonized with pathogens of periodontal tissue (Porphyromonas gingivalis, Prevotella intermedia and Fusobacterium nucleatum) for 1month, whereas another group of mice did not undergo the colonization. Subsequently, all mice were fed a high-fat carbohydrate-free diet for 3months. Then, arterial pressure was measured in vivo and a tomodensitometric analysis of mandibles was realized as well. Our results show increased mandibular bone-loss induced by colonization with periopathogens. In addition, periodontal infection augmented glucose-intolerance and systolic and diastolic arterial pressure, parameters already known to be affected by a fat-diet. In conclusion, we show here that periodontal disease amplifies metabolic troubles and deregulates arterial pressure, emerging as a new axis of metabolic investigation. [Copyright &y& Elsevier]

Abstract: Objectives: To evaluate the influence of hospitalization on drug prescription in chronic conditions. Methods: Admission and discharge prescriptions from 92 patients consecutively admitted in a specialized department of the Assistance Publique–Hôpitaux de Paris hospital were recorded in a prospective two-month study. A Qualitative Therapeutical Score (QTS) was calculated as an estimation of qualitative modifications in the prescription. Results: Patients admitted for an hospital stay of over 24h have more lines of prescription than patients admitted for an hospitalization shorter than 24h (5.7±4.2/d vs 2.9±2.5/d, P <0.01). For all the patients enrolled, the hospital stay is not associated with any change in the global number of treatments. However, in patients treated with antihyperstensive drug, the number of drug intakes decreases (2.6±1.5/d vs 1.9±1.4/d, P <0.05) as a consequence of an increase in the prescription of fixed-dose combinations. In patients with cardiovascular diseases, the QTS is higher and qualitative modifications are more often found in patients admitted for an hospital stay of over 24h than for those admitted for a an hospitalization shorter than 24h (0.57 vs 0.11; P <0.01 and 31% vs 11%; P <0.05 respectively). Antihypertensive drugs are the most represented drugs within these qualitative modifications. Conclusion: In patients with drug treatments for arterial hypertension or chronic conditions, hospitalization is not associated with quantitative but with qualitative modifications, especially for an over 24h hospital stay. [Copyright &y& Elsevier]

Abstract: The prevalence of hypertension resistant to treatment to indicate for renal denervation. Objective: To evaluate the efficiency for imaging the adrenal glands with an abdominal CT scan in first-line in subjects with resistant hypertension suspected to have an adrenal cause. Methods: On 75 hypertensive patients uncontrolled by at least a combination therapy, but suspected to have secondary hypertension due to adrenal cause, an abdominal CT scan was performed in first intention. In all subjects, an exploration of the renin-aldosteron axis in standardized conditions, a 24-hour urinary cortisol and a WHO recommended biological analysis were also performed. Results: An abnormal morphology of adrenal was found by abdominal CT in 64% of patients. The abnormalities observed were: bilateral hyperplasia (27%), unilateral adenoma (15%), unilateral hyperplasia (15%), bilateral adenoma (7%). Abnormal biological and/or hormonal tests for adrenal disease were found in 29% of patients, with a primary aldosteronism (A/R corrected>23) in 11% or K less than 3.5mmol/L in 20%. According to the assessment conducted in first-line, indication to spironolactone is selected in 48% of patients investigated with CT as first-line and in 17% of patients investigated with biological tests (P <0.01) while the indication to adrenal surgery would be held in 15% and 11% of patients respectively. Conclusion: In a population of subjects with uncontrolled hypertension in which an adrenal cause is suspected, achieving a first-line abdominal CT leads to adrenal abnormality observed in 64% of patients while a specific biological abnormality is noted in 29% of subjects. This study shows that assessment that starts with an abdominal CT scan allows to indicate treatment with spironolactone more frequently than when the first assessment is limited to a biological investigation. [Copyright &y& Elsevier]

Abstract: Objective: To evaluate in hypertensive patients followed in a specialized hypertension unit, the prevalence of subjects uncontrolled despite triple therapy including a diuretic. The aim is to estimate the percentage of hypertensive patients with an indication to renal denervation. Method: From a database of computerized medical records of a unit specialized in hypertension, it was extracted 144 consecutive cases of subjects treated and followed for at least 1year and having had a home pressure monitoring (HPM) on treatment, and if necessary a work-up for a secondary hypertension. The blood pressure (BP) was evaluated in office by automated method (after 2 and 8minutes) and with HPM (average of three measurements in the morning and evening for three consecutive days). Results: The population has the following characteristics: age 62 with 26% over 70years, treated dyslipidemia (39%), treated diabetes (11%), adrenal hypertension treated medically (14%), severe renal failure (3%). The means of treatment are: a monotherapy (33%), bitherapy (35%), triple therapy (17%), quadritherapy (7%), pentatherapy or more (1%), spironolactone (45%), thiazide diuretics (49%). The uncontrolled hypertension was observed in 26% if the BP is evaluated with HPM, in 52% if the BP is evaluated at the office after 2minutes of rest and 7% if the BP is evaluated after 8minutes of rest (P <0.01). In patients treated with at least a tritherapy in association with a diuretic, an uncontrolled hypertension was observed in 5% if the BP is evaluated with HPM. Failure to control for the SBP is the cause of 80% of resistant hypertension. Conclusion: The frequency of resistant hypertension is 5% of hypertensive patients followed in a specialized hypertension unit when guidelines are applied in the case of uncontrolled hypertension. These results indicate that the indication for renal denervation affects only a small percentage of patients treated for hypertension. [Copyright &y& Elsevier]