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BACKGROUND Acute and diffuse microvascular damage characterizes malignant hypertension (MHT), the deadliest form of hypertension (HTN). Although its ophthalmological, renal and cardiological repercussions are well known, brain involvement is considered rare with few descriptions, although it is one of the main causes of death. We hypothesized that brain MRI abnormalities are common in MHT, even in patients without objective neurological signs. METHOD We analyzed retrospectively the brain MRI of patients admitted for acute MHT between 2008 and 2018 in Bordeaux University Hospital, regardless of their neurological status. A trained operator analyzed every brain MRI, looking for posterior reversible encephalopathy syndrome (PRES), ischemic stroke, intracerebral hematoma (ICH) and microangiopathy markers. We included 58 patients without neurological signs, 66% were men, and mean age was 45.6 ± 11.3 years. RESULTS Brain MRI were normal in 26% of patients but we found at least one acute abnormality on brain MRI in 29% and an Small Vessel Disease score (SVD score) of two or higher in 52%. In patients with neurological signs, these findings were 9, 53 and 70%, respectively. A PRES was found in 16% of asymptomatic patients and 31% had an ischemic stroke and/or a cerebral hematoma. CONCLUSION PRES, recent hematoma, ischemic stroke and severe cerebral microangiopathy are common findings in MHT patients without neurological signs on admission. The impact of these findings on patient management, and their cerebrovascular and cognitive prognostic value, should be established. Brain MRI might need to become systematic in patients suffering from MHT episodes.

Arterial stiffness, most often assessed with carotido-femoral pulse wave velocity predicts cardiovascular events but its use in clinical practice remains limited. The 24h ambulatory monitoring of Blood pressure and timing of Korotkoff sounds (QKD interval) allows an automatic assessment of arterial stiffness and is an independent predictor of cardiovascular events in hypertensive patients. The long term follow up of our cohort of hypertensive patients gave us the opportunity to test the consequences of increased arterial stiffness on the incidence of all causes deaths and to define the populations who could benefit of this measurement beyond risk scores. The sample includes 930 patients (502 males, age 53 ± 13 years, baseline risk SCORE2-OP = 6.70 ± 4.97%) with an average follow up of 12.11 ± 7.4 years (0.3–30). In this population 169 cardiovascular events and 155 deaths were recorded. SCORE2-OP, 24h Systolic Blood Pressure and arterial stiffness (QKDh) as a continuous or discontinuous variable (normal or reduced) were significantly and independently linked to the occurrence of cardiovascular events or all cause deaths in multivariate Cox model. ROC curves analysis show that measuring arterial stiffness with QKD method offers the best predictive value in patients with low or very low risk scores.

Ambulatory blood pressure monitoring (ABPM) is now considered the gold standard to evaluate BP, and predicts related cardiovascular risk. However, no study has reported the association of long-term changes in ABPM with the incidence of cardiovascular events, therefore the objective of this work. We included patients from the Bordeaux cohort of hypertensive patients, who had undergone at least two ABPM; the first was performed before or after antihypertensive treatment was started, and the second was the last recording available before any cardiovascular event. We included 591 patients (mean age, 54 years) with a 7-year average interval between the first and last ABPM, a 10-year average follow-up, and a total of 111 cardiovascular events. The patients were divided into four groups: G0, first and last 24 h systolic blood pressure (SBP)

Objective Short-term blood pressure variability derived from 24-h ambulatory monitoring is associated with poor cardiovascular prognosis. However, previous analyses of this have clearly been influenced by clinical cofounders, particularly blood pressure (BP) level. Arterial stiffness is a powerful marker of cardiovascular risk, which may influence BP variability. In this study, we assessed the prognostic value of BP variability based on 24-h ambulatory measurements and adjusted for arterial stiffness. Methods Population: Bordeaux cohort of hypertensive patients. Inclusion criteria were 24-h ambulatory BP monitoring at baseline with measurements every 15' day and night, determination of wake-up time and bedtime, and assessment of arterial stiffness with monitoring of Korotkoff sound arrival time. A total of 969 patients (age 54 ± 14 years) with an average follow up of 120 ± 78 months and 178 cardiovascular recorded events were included. Results In univariate survival analyses, the standard deviations of day, night, and 24-h SBP were associated with the occurrence of cardiovascular events. The standard deviation of night-time SBP showed the strongest association with the outcome variable and was entered into multivariate analyses. In multivariate analyses, night-time SBP variability remained significantly associated with the occurrence of cardiovascular events after adjusting for major cardiovascular risk factors, 24-h SBP, and arterial stiffness. BP variability and arterial stiffness showed no significant association. Conclusion Our results suggest that variability of night-time SBP is an important marker of the risk of cardiovascular events in hypertensive patients, independently of average 24-h BP and arterial stiffness.

Primary Aldosteronism (PA) is increasingly considered as a common disease affecting up to 10% of the hypertensive population. Standard of care comprises laparoscopic total adrenalectomy but innovative treatment such as RadioFrequency Ablation (RFA) constitutes an emerging promising alternative to surgery. The main aim of this study is to analyse the cost of RFA versus surgery on aldosterone-producing adenoma patient from the French National Health Insurance (FNHI) perspective.The ADERADHTA study was a prospective pilot study aiming to evaluate both safety and efficacy of the novel use of adrenal RFA on the patients with PA. This study conducted on two French sites and enrolled adult patients, between 2016 and 2018, presenting hypertension and underwent the RFA procedure. Direct medical (inpatient and outpatient) and non-medical (transportation, daily allowance) costs were calculated over a 6-month follow-up period. Moreover, the procedure costs for the RFA were calculated from the hospital perspective. Descriptive statistics were implemented.Analysis was done on 21 patients in RFA groups and 27 patients in the surgery group. The difference in hospital costs between the RFA and surgery groups was €3774 (RFA: €1923; Surgery: €5697 p 0.001) in favour of RFA. Inpatient and outpatient costs over the 6-month follow-up period were estimated at €3,48 for patients who underwent RFA. The production cost of implementing the RFA procedure was estimated at €1539 from the hospital perspective.Our study was the first to show that RFA is 2 to 3 times less costly than surgery. The trial is registered at ClinicalTrials.gov under the number NCT02756754.

Resume But de l’etude Une etude realisee en IRM cardiaque suggere que l’exposition chronique a un pheochromocytome « stable » induit des plages de fibrose et de myocardite ventriculaires gauches. Ces anomalies etant classiquement associees a une alteration de la deformation systolique longitudinale, nous emettons l’hypothese que cette deformation est alteree chez les patients porteurs d’un pheochromocytome. Patients et methode Cette etude cas-temoin retrospective a ete realisee a partir des patients de la base de donnees du CHU de Bordeaux, inclus entre 2008 et 2016. Nous avons compare le global longitudinal strain (GLS), les autres parametres de deformation systolique et les parametres echocardiographiques classiques entre un groupe de patients porteurs de pheochromocytome et un groupe de temoins apparies pour l’âge, le sexe, l’indice de masse corporelle et la pression arterielle systolique moyenne. Resultats L’analyse a porte sur 47 patients et 47 temoins correctement apparies. Nous n’avons pas retrouve de difference statistiquement significative entre les 2 groupes en termes de GLS (−20,7 ± 2,4 % vs −20,2 ± 2,7 %, p = 0,40), de deformation radiale, de masse ventriculaire gauche ou de fonction diastolique. La fraction d’ejection ventriculaire gauche et la deformation circonferentielle etaient significativement plus elevees chez les patients que chez les temoins, le diametre telediastolique significativement plus bas. Conclusion Aucune alteration significative du GLS n’a ete identifiee chez nos patients porteurs d’un pheochromocytome. Plusieurs hypotheses peuvent expliquer ces resultats. La presence de foyers de fibrose et de myocardite etant associes a un pronostic cardiologique pejoratif, une IRM cardiaque systematique pourrait se discuter, dans l’attente d’etudes complementaires.

Malignant hypertension (MHT) still remains a severe condition that requires early recognition and treatment. Over the years, the prevention and treatment of MHT have significantly advanced through the introduction of modern antihypertensive agents. However, in the absence of robust clinical trials, there remain no formal guidelines on the treatment of MHT. This review summarizes the historical background and pathophysiological evidence of MHT, which has led to common practices in its pharmacological management but can also introduce challenges. The current consensus for treatment involves early intravenous infusion of antihypertensive agents, but oral blockers of the renin-angiotensin system may improve the management of MHT, and it offers a suitable treatment option in low-income countries where the condition remains relatively prevalent.

Primary aldosteronism is responsible for a major cardiovascular risk that can be avoided by specific treatment. A better characterization of the hypertensive population with primary aldosteronism would not only improve the overall diagnosis but also allows a better selection of patients requiring adrenal vein sampling (AVS).Creation of a prospective single-center Bordeaux ABORDAGE study of hypertensive patients with primary aldosteronism who underwent AVS. Primary aldosteronism was diagnosed according to the recommendations of the SFE/SFHTA. Peripheral and central blood pressure measurements were performed with mercury sphygmomanometer, SphygmoCor applanation tonometer and ambulatory blood pressure measurement. An adrenal computed tomography and an unstimulated AVS were performed in each patient.One hundred and eighty-eight patients were included in our study. They were mostly men (61.7%), with a mean age of 48.7 ± 10.5 years, BMI of 29.7 ± 5 kg/ m2 and duration of hypertension of 101.5 ± 84 months. AVS was selective in 82.3% of patients and lateralization was concordant with CT in only 35.4% of patients. Lateralized secretion was significantly associated with a marked biological primary aldosteronism and hypertension. In multivariate analysis, no variable specifically differentiated patients with aldosterone lateralization.The ABORDAGE population description is consistent with the data found in the literature. These characteristics are ultimately those expected in essential hypertension population, which therefore, could explain part of the underdiagnosis of primary aldosteronism. Only AVS is able to predict the lateralization of secretion with a post adrenalectomy recovery of about 90% in case of lateralization. The generalization of AVS would, therefore, increase the proportion of patients with primary aldosteronism cured.

Malignant hypertension, the most severe form of hypertension, is defined by high blood pressure and acute ischemic organ damage. It has a worse prognosis than other forms of hypertension, especially in black patients. New tools to assess organ damage, especially that of the heart and brain, are now available and may contribute to a better evaluation of these patients. This report improves knowledge of the characteristics of involved organs to facilitate diagnosis and to evaluate the effectiveness of our treatment protocol.The Bordeaux registry, started in 1995, recruited 168 patients. In addition to evaluations of their eyes and kidneys, these patients had a systematic evaluation of their hearts with ECG and echocardiography and, since 2007, a systematic brain MRI. Blood pressure was lowered with a protocol based on blockers of the renin-angiotensin system started at a very low-dose with forced titration over 48 h. Only an oral route was used for antihypertensive medication.Systematic MRIs found significant brain damage in 93% of patients. Heart involvement was highly prevalent: 82% had left ventricular mass more than 60 g/m, and 56% had systolic dysfunction (estimated by global longitudinal strain). Renal involvement and thrombotic microangiopathy were respectively present in 55 and 15% of patients. Median follow-up was 48 months. Renal survival at 5 years was 90.8%, similar to other studies.Malignant hypertension is a systemic disease causing severe damage to the brain, heart, kidneys and eyes, even in absence of symptoms. Renin-angiotensin system blockers seem to be the cornerstone of treatment.

Primary aldosteronism is characterized by hypertension, frequent hypokalemia, and an inappropriately high aldosterone-to-renin ratio (ARR) [1,2]. Aldosterone-producing adenoma (APA or Conn syndrome) is one of the main causes of primary aldosteronism [3]. Laparoscopic total-adrenalectomy is an option to normalize or at least improve blood pressure (BP) control, hypokalemia, and normalize the ARR [4,5]. However, the reported result of surgery is around 50% of clinical cure rate with an overall complication rate of 9.5% [2,6–8]. An efficient but less invasive alternative technique could be the use of radiofrequency ablation (RFA). RFA is widely used to treat solid neoplasms, especially in patients not only with primary or secondary malignancies of the liver, the lung, the kidney, and the breast but also for primary and metastatic adrenal neoplasms, including adrenocortical carcinomas [9–15]. More recently, RFA has been used for patients with primary aldosteronism and unilateral adenoma [16–25]. These studies focused on hormonal resolution of primary aldosteronism, computed tomography (CT) aspects, and safety data after RFA but the putative positive impact on BP control was not clearly depicted [16–25]. The aim of this study is, therefore, to assess whether RFA improves ambulatory BP control in patients with hypertension because of primary aldosteronism and unilateral adrenal adenoma. Normal potassium, ARR values and safety of the procedure are the secondary outcomes.

In France, 1 adult out of 3 is affected by hypertension and only 1 hypertensive out of 4 achieves blood pressure targets (140/90mmHg). This proportion is significantly better in similar countries (e.g. England, Germany, the USA). Nephrologists are particularly concerned since although more than 90 % of Chronic Kidney Disease (CKD) stages 3 and 4 patients are hypertensive, the CKD-REIN cohort shows that in France more than 1 out of 2 patients with CKD remains with a blood pressure above 140/90mmHg. This report, based on the latest French studies and surveys, raises an important warning about the situation in France, discusses the main reasons for these results and offers some suggestions for improvement. Otherwise we risk a dramatic increase in the incidence of myocardial infarction, stroke, dependency and dementia in the coming years.

Coronavirus Disease 2019 (COVID‐19) has infected more than 3.0 million people worldwide and killed more than 200,000 as of April 27, 2020. In this White Paper, we address the cardiovascular co‐morbidities of COVID‐19 infection; the diagnosis and treatment of standard cardiovascular conditions during the pandemic; and the diagnosis and treatment of the cardiovascular consequences of COVID‐19 infection. In addition, we will also address various issues related to the safety of healthcare workers and the ethical issues related to patient care in this pandemic.

Resume En France, 1 adulte sur 3 est atteint d’hypertension arterielle et seulement 1 hypertendu sur 4 est a l’objectif de pression arterielle (

International audience

Data on the long term evolution of renal function in essential hypertensive patients are scarce, showing a low incidence of end stage renal diseases but without information on how the renal function evolves. Our aim is to describe the long term evolution of renal function and possible trajectories in hypertensive patients. We included patients from an ongoing cohort with essential hypertension, no proteinuria at baseline and no diabetes during follow-up and with at least two creatinine dosages 4 years apart. A long term (average 16 years) follow-up was available in 609 patients (baseline age 51.8 ± 11.1 years, 52 % male, mean office BP 156//95 mmHg). The trajectories of creatinine were modeled through a flexible latent class mixed model. The analysis identified three classes of significantly different trajectories. In the first (n = 560), there was no significant variation of creatinine over time. In the second (n = 40), there was a significant rise of creatinine (117 ± 20 vs 85 ± 17 µmol/l, p

Resume But de l’etude L’hyperaldosteronisme primaire est la premiere cause d’hypertension arterielle secondaire, et entraine de frequentes complications cardiovasculaires. De nombreuses etudes ont etudie la geometrie et la fonction ventriculaire gauche dans cette population, mais la fonction systolique longitudinale est encore mal decrite. Patients et methode Nous avons etudie 35 patients hypertendus porteurs d’un hyperaldosteronisme primaire et 35 d’une hypertension essentielle apparies pour l’âge, le sexe, l’indice de masse corporelle et la pression arterielle sur 24 heures. Ces patients ont beneficie d’une echocardiographie pour mesurer la masse, la geometrie la fraction d’ejection du ventricule gauche, sa deformation systolique longitudinale, circonferentielle et radiale, et sa fonction diastolique. Resultats Les patients atteints d’ hyperaldosteronisme primaire presentaient une masse ventriculaire gauche indexee et une epaisseur relative des parois significativement plus elevees (60,3 ± 16,1 g/m2,7 vs 47,3 ± 18,6, p = 0,003 et 0,44 ± 0,08 vs 0,36 ± 0,06, p = 5 × 10−5), ainsi qu’une fonction systolique longitudinale par le strain bidimensionnel significativement reduite (−17,8 ± 3,4 vs − 20,3 ± 3,6 %, p = 0,004). Il n’y avait pas de differences significatives dans les autres parametres. Conclusion L’hyperaldosteronisme primaire est associe a une deterioration de la fonction systolique longitudinale du ventricule gauche par rapport aux patients hypertendus essentiels. Ce parametre simple et reproductible pourrait etre un marqueur d’atteinte cardiaque et aider au depistage de ces patients.

Hypertensive emergency. Stable incidence for several decades or even increasing (under diagnosed). Early and specific management improves prognosis. Absence of eye damage or lack of access to fundus should not delay or prevent the diagnosis. Multi Organ Damage Hypertension: new definition for an old entity: unusual, sudden and persistent blood pressure rise without threshold and ocular involvement or involvement of at least 3 target organs among brain, heart, kidney or endothelial disease.

International audience; Since 2016, the French Society of Hypertension has warned about the decline in the management of high blood pressure in France: stagnation, or even decreased number of people who know their blood pressure level, take a treatment and are controlled. These results are lower than those observed in many other countries. Blood pressure is measured with an old method in the doctor's office. Accepted, simple and cost-effective, this method is currently unavoidable for reasons of feasibility and social habit. It has been used in observational and intervention studies that are the basis of the medical reasoning for screening, treatment and drug control of hypertension. In practice, it is too often poorly applied and unpredictable. It is now necessary to measure blood pressure in mmHg using a validated oscillometric automatic device coupled to a specific upper arm cuff adapted to the arm circumferences for the diagnosis and monitoring of high blood pressure in the doctor's office and at home. The auscultatoric measurement is only recommended if any doubt about the reliability of the electronic measurement. Blood pressure measurement is basically performed on both arms to detect asymmetry and then on the arm with the highest blood pressure. It is performed in sitting or lying position after a few minutes of rest without speaking and without having smoked and then in standing position to diagnose orthostatic hypotension, especially in elderly, diabetic and multi-medicated subjects. The blood pressure measurement during the consultation must be repeated and include at least 3 consecutive measurements at one minute intervals. The average of the last 2 measurements determines the blood pressure level. It is recommended to perform BP measurements outside the medical environment for the diagnosis and monitoring of hypertension; Home BP measurement is preferred to ambulatory blood pressure measurement for practical reasons unless otherwise specified. The home blood pressure measurement should include three measurements in the morning at breakfast and three measurements in the evening before bedtime at one minute intervals for at least three days. Prior training must be provided. In treated hypertensive patients, a masked hypertension should be considered as an uncontrolled hypertension and antihypertensive therapy adapted accordingly. The measurement of central BP pressure (aorta) should be limited to clinical research.

Kidney is a highly adenosine triphosphate dependent organ in human body. Healthy and functional mitochondria are essential for normal kidney function. Clinical and genetic variability are the hallmarks of mitochondrial disorders. We report here the involvement of two MT-ND5 pathogenic variants encoding for ND5 subunit of respiratory chain complex I, the m.13513G>A and the m.13514A>G, in adult-onset kidney disease in three unrelated patients. The first patient had myopathy encephalopathy lactic acidosis and stroke syndrome, left ventricular hypertrophy with Wolff-Parkinson-White syndrome and tubulo-interstitial kidney disease. The second presented Leber hereditary optic neuropathy associated with tubulo-interstitial kidney disease. The third presented with an isolated chronic tubulo-interstitial kidney disease. These mutations have never been associated with adulthood mitochondrial nephropathy. These case reports highlight the importance to consider mitochondrial dysfunction in tubulo-interstitial kidney disease.

L’hypertension artérielle (HTA) maligne n’a pas disparu, elle a été oubliée. Son incidence augmente à nouveau. Elle assombrit considérablement le pronostic de jeunes patients (35 à 55 ans en moyenne). Il existe probablement des facteurs de prédisposition, plusieurs hypothèses sont à l’étude. De nouveaux critères diagnostiques et de nouvelles options thérapeutiques ont été proposés, ils devront être validés. Devant ces enjeux importants pour les patients, le premier registre prospectif multicentrique sur cette pathologie va être mis en place en France en Septembre 2019. [Malignant hypertension: A bright future] Malignant hypertension has not disappeared, it has been forgotten. Its incidence is increasing again. It considerably worsens the prognosis of young patients (35 to 55 years old on average). There might be susceptibility factors, several hypotheses are under study. New diagnostic criteria and therapeutic options have been proposed and will have to be validated. Faced with these important challenges for patients, the first prospective multicentric register on this pathology will be set up in France in September 2019.

Introduction Malignant hypertension, the most severe form of hypertension, is characterized by acute and diffuse microvascular damage. The ophthalmological, renal and cardiological consequences are well described. Brain damage is considered rare and poorly known, although it is one of the main causes of death. Method We performed a systematic cerebral MRI on patients of the Bordeaux cohort with malignant hypertension between 2008 and 2018, regardless of their neurological symptoms. A subgroup of patients benefited from a second cerebral MRI. All MRI were analysed by the same trained operator. Results 92 patients were included, 67.5% male, mean age 47.8 ± 12 years. On admission, 41.5% of the patients were totally asymptomatic from a neurological aspect. Cerebral MRI was normal in 18.5% of patients. A posterior reversible encephalopathy syndrom was found in 16.5% of patients, 33.5% had an ischemic or hemorrhagic stroke. Patients had marked microvascular impairment (SVD score 2 or higher) in 59% of cases. In asymptomatic patients or patients with headaches only, MRI found PRES in 15.5% of cases, recent ischemic or hemorrhagic stroke in 29% of cases, and SVD score 2 or higher in 51.5% of cases. Conclusion Most patients with malignant hypertension have brain injuries, regardless of their symptoms. This warrants systematic cerebral MRI, as the results may impact on their management. The consequences of these severe lesions, which are disproportionately severe for young patients, raise questions about the need for cognitive assessment and management.

Introduction Malignant hypertension still remains a severe condition that requires early recognition and treatment. The therapy has evolved from extreme measures in the first 70 years of the last century to intravenous treatment with modern antihypertensive treatment. Today, in the absence of trials and solid evidences, there are no formal guidelines on how to treat MHT. There is a relative consensus on a treatment based on intravenous infusion of antihypertensive treatments in the first days. This review summarizes the historical background and pathophysiological evidences which led to the actual most common pharmacological management of this condition but also can contribute to challenge this management. Oral treatment starting with low dose angiotensin converting enzyme inhibitors appears as a solid option and may improve the management of malignant hypertension in low-income countries where this form of hypertension remains relatively frequent. Future developments are considered according to the latest progress on the topic.

Background Malignant arterial hypertension is a poorly known pathology, with a poor prognosis in absence of adequate emergency care. Since 1995, the excellence center in Bordeaux University Hospital has been implementing a therapeutic protocol based on rapid titration of angiotensin converting enzyme inhibitor for the management of these acute patients. This “Bordeaux protocol” has demonstrated its effectiveness and safety but its widespread use is limited by the fear of complications in patients with renal artery stenosis. Objectives The objective of this study is to compare the protocol safety and efficacy in patients with renovascular and non-renovascular malignant hypertension. Method Our retrospective case-control study compared 2 groups of patients from the Bordeaux cohort of malignant hypertension since 2008. The first group included patients with renovascular malignant hypertension and the second one the rest of the cohort. We excluded patients managed in non-urgent basis. Results We included 10 patients with renovascular malignant hypertension and 74 control patients. No serious adverse events occurred in both groups (acute kidney failure requiring dialysis, threatening hyperkalemia, sudden drop in blood pressure requiring immediate attention). Discontinuation of ACE inhibitors for significant elevation of creatinine occurred once in each group (P = 0.22). Blood pressure drop between admission and discharge was similar in the 2 groups (-73mmHg ± 43 mmHg vs. −75mmHg ± 31.7 in the control group, P = 0.9). One-month prevalence of normotensive patients was also comparable (85% vs. 73% in the control group, P = 0.67). Conclusions Efficacy and safety of the “Bordeaux Protocol” is maintained in patients with renovascular malignant hypertension, thanks to close monitoring. These results need to be replicated to be widespread.

Malignant hypertension (MHT) still exists, leading young people to a poor prognosis. Yet, we lack clear guidelines, mainly because data are scarce. We initiated the first MHT multicentric network to assess these issues. We built a 28 centers network so far, aiming for 40–50 French centers end 2020, and European participation in 2021. We prospectively recruit patients with severe hypertension (> 180/110) and severe hypertensive retinopathy (common definition) or 3-target organ damage among heart, kidney, brain and thrombotic microangiopathy (MOD HTN definition). We hope to recruit 500 patients in 5 years, with a 5 years follow up. We currently collect clinical and examination data, aiming for building a biobank and a target organ damage corelab to entirely reconsider the disease. During the first 6 months, we recruited as planned 58 patients, 41% were male, 49.1 ± 15 years old. Half of them were not known hypertensive, and one third presented a secondary hypertension. Non-observance was reported in 25% of patients as a trigger. Mean blood pressure was 219 ± 29//119 ± 20 mmHg. Patient care pathway was very different according to initial symptoms, target organ damage and centers: hypertension, neurology, nephrology, cardiology, internal medicine, intensive care unit and emergency department. Target organ damage was respectively 70%, 33%, 25% and 25% for kidney, heart, brain and thrombotic microangiopathy, mostly improving during follow up. Most of patients (70%) benefited from intravenous antihypertensive treatment and saline infusion. Length of stay was on average 8 days. Malignant Hypertension clearly didn’t disappear, but was diluted between the different specialities and forgotten. This most severe presentation has to be considered once again to better manage our patients. The unique HAMA network should make it possible to gather high-quality data to improve our knowledge and rediscover the disease.

Objective Orthostatic hypotension is a common condition associated with adverse cardiovascular and cognitive prognosis. Screening for orthostatic hypotension consists of blood pressure measurements in supine (or sitting) and standing position during clinical consultations. As orthostatic hypotension is a poorly reproducible clinical condition, it is likely that the simple measurement carried out during consultations underestimates the true prevalence of the condition. The objective of this study is, therefore, to determine whether screening for orthostatic hypotension with home blood pressure measurements (HBPM) may improve orthostatic hypotension diagnosis without compromising the quality of the blood pressure readings. Materials and methods We asked all patients with indications for HBPM in the hypertension unit and in a general medical practice to perform a series of home blood pressure measurements, ending each series with a measurement in standing position. Results We recruited 505 patients of mean age 68 years of which 93% were hypertensive patients. The success rate of HBPM complying with the ESH criteria (12 out of 18 measurements) was 94.5%, which is comparable with previously published series of measurements. Ninety-one percent of patients measured their blood pressure at least once in standing position, and 88% of patients recorded all six standing measurements. Orthostatic hypotension prevalence defined as the presence of one episode of orthostatic hypotension was 37.47%, much higher than orthostatic hypotension prevalence measured in the same cohort in a clinic setting (15%). Conclusion The measurement of blood pressure in standing position during HBPM is feasible without altering the quality of the blood pressure readings in seated position. Our findings show that orthostatic hypotension is significantly more often detected at home by the patient than at the doctor's office, which may allow quicker initiation of preventive and therapeutic strategies.

Hypertensive emergency. Stable incidence for several decades or even increasing (under diagnosed). Early and specific management improves prognosis. Absence of eye damage or lack of access to fundus should not delay or prevent the diagnosis. Multi Organ Damage Hypertension: new definition for an old entity: unusual, sudden and persistent blood pressure rise without threshold and ocular involvement or involvement of at least 3 target organs among brain, heart, kidney or endothelial disease.

The hypothesis that vitamin D (25(OH)D) insufficiency plays a role in occurring of various disease has led to a rise in requests of dosages and to an increase of health-care costs. 25(OH)D insufficiency is associated with increased risk of cardiovascular disease and hypertension in many studies. Animal studies demonstrated that 25(OH)D insufficiency activates renin angiotensin system but corresponding humans data are limited. The aim of the study was to document relationship between 25(OH)D, blood pressure, and renin angiotensin system in hypertensive subjects. In all, 248 hypertensive individuals, 46.8 years (±14), were hospitalized for an etiological assessment of hypertension in this cross-sectional study over two calendar years. 25(OH)D, plasma renin activity, and aldosterone were determined in stringent conditions and blood pressure was measure. Statistical analyses were carried out to analyze the association between 25(OH)D, blood pressure, and renin angiotensin system using linear and logistic regressions with adjustments on relevant variables. In all, 80% of the studied population had a 25(OH)D insufficiency. There were no significant association between 25(OH)D and levels of systolic or diastolic blood pressure, plasma renin activity, and aldosterone whatever the statiscal method used after adjustment. 25(OH)D is not associated with blood pressure and renin angiontensin component in hypertensive subjects. These results corroborate the interventional studies which are for a large majority negatives. A new definition of the 25(OH)D insufficiency in general population is necessary.

Objective:Prognostic data on short-term blood pressure variability derived from 24-hour ambulatory monitoring are still limited, even though the prognostic value of long-term visit-to-visit variability in blood pressure seems to be established. The main objective of this study is to assess the progn

Objectif L’hypertension arterielle (HTA) maligne est la forme la plus severe d’HTA, rapidement mortelle avant l’existence des traitements antihypertenseurs. Depuis, sa prevalence a nettement diminue mais elle n’a pas disparu. Elle touche des patients jeunes (entre 35 et 55 ans), qui vont subir un taux de complications eleve (15 % d’evenements cardiovasculaires et renaux a 5 ans). Pourtant, nous disposons de peu de donnees sur cette forme d’hypertension arterielle, sa physiopathologie, son epidemiologie actuelle. Les recommandations diagnostiques et therapeutiques actuelles sont essentiellement empiriques. Methode Avec le soutien de la societe francaise d’hypertension arterielle, nous mettons en place un registre multicentrique prospectif pour repondre a ces questions. L’objectif est d’inclure 500 patients en 5 ans, suivis 5 ans, sur environ 30 centres. Le projet est promu par le CH de Pau, et pilote par un comite scientifique compose de cardiologues et nephrologues de 4 centres francais differents, experimentes dans cette thematique, un chercheur a l’Inserm et un biostatisticien. Un an apres le debut de l’etude, nous ajouterons une bio-banque pour ameliorer nos connaissances physiopathologiques et nous ouvrirons le registre aux centres europeens interesses. Resultats attendus Preciser le pronostic actuel des patients atteints d’une HTA maligne a 5 ans en terme d’evenements renaux, cardiovasculaires. Preciser l’epidemiologie actuelle de la maladie. Moderniser la definition et les criteres diagnostiques. Decrire les prises en charge dans les centres, les filieres de soin et preparer le terrain pour des essais controles permettant des recommandations therapeutiques appuyer sur des preuves. Conclusion Le registre Hypertension Arterielle MAligne (HAMA) devrait fournir une base de donnees solide pour repondre aux questions en suspens sur l’HTA maligne. Il demarrera en 2019. N’hesitez pas a nous contacter si vous souhaitez plus d’information.