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This study was designed to analyse the relationship between the different blood pressure (BP) variabilities obtained in a non-invasive way and to determine the potential contribution of aging, severity of hypertension and increased ventricular mass to these different BP variabilities. Two hundred and six hypertensive patients underwent a 24-h ambulatory BP measurement (ABPM) as well as a photoplethysmographic BP recording and a standard echocardiography. Nocturnal BP fall and standard deviations of hourly mean BP levels as well as post-prandial fall in BP were calculated from the 24-h ABPM and were considered as indexes of long-term variability. Baroreflex sensitivity (BRS) and spectral powers of systolic BP, diastolic BP and heart rate (HR) over the low frequency band (LF: 0.05-0.14 Hz) were obtained from photoplethysmographic recording and were used as indexes of short-term variability. Short-term variability indexes were shown to be significantly related to those of long-term variability. A decrease in LF spectral powers was associated with a particular profile characterised by an attenuation of nocturnal BP fall, an increase of daytime BP standard deviations, an increase in post-prandial BP fall, a decrease in BRS and to a lesser extent, a diminution in night-time HR standard deviation. Moreover, a negative significant relationship was found between standard deviation of daytime systolic BP and both night systolic BP fall and BRS. Age and nocturnal BP level were associated with all BP variability disorders, whereas left ventricular hypertrophy was associated only with a decrease in LF spectral powers and in night BP fall, and an increase in standard deviation of daytime BP. Finally, LF spectral power of SBP was identified as independently predicted by age and night SBP fall. [ABSTRACT FROM AUTHOR]

Background: Acetylsalicylic acid, or aspirin, is widely used in secondary prevention of coronary artery diseases, but the inhibition of platelet aggregation is not uniform in all individuals. Objective: To investigate the prevalence of aspirin resistance at rest and during exercise in coronary artery disease patients. Materials and methods: Fifty patients with stable coronary artery disease were prospectively studied. All patients received aspirin (75–300 mg/day for >1 month) and no other antiplatelet therapy. Aspirin resistance was studied, at rest and immediately after a stress test, using the standardized platelet function analyzer (PFA-100®, Dade-Behring). Aspirin resistance was defined as a normal collagen/epinephrine closure time (<186 s). Results: Ten patients (20%) were aspirin-resistant at rest. Out of the 40 patients who were aspirin-sensitive at rest, 9 (22%) were aspirin-resistant immediately after the exercise stress test. There were no differences in aspirin sensitivity regarding gender, age, diabetes, hypertension, dyslipidemia, platelet count, medical treatment or number of the coronary arteries involved. Conclusions: Aspirin resistance is detected, at rest, in 20% of our patients with stable coronary artery disease. Aspirin treatment does not seem to protect against exercise-induced platelet activation in 22% of such patients, despite aspirin sensitivity at rest. [Copyright &y& Elsevier]

The authors reviewed some of the most relevant studies dedicated to the assessment of the effects of the antihypertensive drugs on the stress-induced cardiovascular changes. The rises in both blood pressure and heart rate turned out not to be significantly altered by calcium channel blockers, ACE inhibitors, moxonidine, nor beta-blockers, whereas they seemed to be slightly blunted by alpha-blocking drugs. However, since baseline blood pressure was significantly lower in treated hypertensives than in placebo-given patients, all antihypertensive drugs eventually resulted in a lower blood pressure level during stress, as compared with untreated patients. Regarding white coat effect, which has to be considered as a very particular stress, it appeared to be lowered to the same extent by placebo and antihypertensive drugs; moreover, its changes were not associated with any clinical beneficial effect. [Copyright &y& Elsevier]

The effectiveness of regular exercise in decreasing both systolic and diastolic blood pressure ( BP) is well-established. Our purpose was to assess the impact of both subject and physical activity program characteristics on ambulatory BP through a meta-analysis of the existing literature. Three databases ( PubMed, Embase, Web of Science) were searched using relevant terms and strategies. From 637 identified records, 37 studies met inclusion criteria: details about training intervention and participant characteristics, pre- and post-training ambulatory BP measurements, at home ( HBPM) or during 24-h ( ABPM). The weighted mean difference was for 24-h systolic/diastolic ABPM ( n = 847 participants): −4.06/−2.77 mmHg (95% CI: −5.19 to −2.93/−3.58 to −1.97; P < 0.001), for daytime ( ABPM or HBPM, n = 983): −3.78/−2.73 mmHg (95% CI: −5.09 to −2.47/−3.57 to −1.89; P < 0.001) and nighttime ABPM periods ( n = 796): −2.35/−1.70 mmHg (95% CI: −3.26 to −1.44/−2.45 to −0.95; P < 0.001). Characteristics significantly influencing BP improvement were: an initial office BP ≥130/85 mmHg and diet-induced weight-loss. We found no differences according to sex, age, or training characteristics (intensity, number of sessions, training duration). Antihypertensive effects of aerobic training assessed by ambulatory BP measurements appear significant and clinically relevant for both daytime and nighttime periods, in particular for participants with an office BP ≥130/85 mmHg. [ABSTRACT FROM AUTHOR]

Résumé Objectifs Cette étude avait pour objectifs : (1) de mesurer l’observance des hommes et des femmes ayant une hypertension artérielle (HTA) non contrôlée, et (2) d’identifier, dans chaque sexe, les facteurs associés à la non-observance aux anti-HTA. Patients et méthodes Les médecins généralistes (MG) devaient inclure les deux premiers patients des 2 sexes ayant une HTA non contrôlée sous traitement. L’observance était estimée par le MG et avec l’auto-questionnaire (AQ) du Comité français de lutte contre l’HTA. Les facteurs associés à la non-observance selon l’AQ ont été sélectionnés par analyse de régression logistique en pas à pas type stepwise , analyse réalisée indépendamment chez les hommes et chez les femmes. Résultats Au total, 1630 hommes et 1612 femmes ont été inclus dans l’analyse. L’observance au traitement était significativement meilleure chez les femmes ou quand elle était estimée par les MG. Le manque de motivation était le premier facteur associé à une mauvaise observance dans les deux sexes. Considérer l’HTA comme une simple anomalie et non comme une maladie pouvant conduire à des troubles cardiaques ou cérébraux était le deuxième paramètre commun aux deux sexes. Les autres facteurs communs étaient : rencontrer des difficultés financières à faire face à ses besoins dans le mois et l’absence d’un dépistage régulier du cancer du côlon. Conclusion L’observance au traitement est meilleure chez les femmes hypertendues non contrôlées. La mauvaise observance est principalement associée à des facteurs non cliniques. Le manque de motivation est l’élément le plus important. Objectives The aim of this study was (1) to measure adherence in males and females with uncontrolled hypertension, and (2) to identify factors associated with non-adherence to antihypertensive medication. Patients and methods Each general practitioner (GP) should include the first two male and the first two female patients with uncontrolled treated hypertension. Adherence to antihypertensive treatment was estimated by the GP and using the French League Against High blood pressure (FLAH) self-administered questionnaire. A stepwise logistic regression analysis was used to identify factors associated with non-adherence on the FLAH scale, independently in males and in females. Results A total of 1630 males and 1612 females were included in the analysis. Adherence to treatment was significantly better in females or when estimated by the GP. Lack of motivation was the first factor associated with poor adherence in both sexes. Considering hypertension as a simple anomaly and not a disease that can lead to cardiac or cerebral disorders was the second common parameter in both sexes. Other common factors were: having monthly periods of financial difficulties in facing his/her needs and absence of regular screening for colon cancer. Conclusion Adherence to treatment is better in uncontrolled hypertensive females. Poor adherence is mainly associated with non-clinical factors. The lack of motivation is the most important element. [ABSTRACT FROM AUTHOR]

High blood pressure is a frequent pathology with many cardiovascular complications. As highlighted in guidelines, the therapeutic management of hypertension relies on non-pharmacological measures, which are diet and regular physical activity, but both patients and physicians are reluctant to physical activity prescription. To acquire the conviction that physical activity is beneficial, necessary and possible, we can take into account some fundamental and clinical studies, as well as the feedback of our clinical practice. Physical inactivity is a major risk factor for cardiovascular morbidity and mortality, and hypertension contributes to increase this risk. Conversely, regular practice of physical activity decreases very significantly the risk by up to 60%. The acute blood pressure changes during exercise and post-exercise hypotension differs according to the dynamic component (endurance or aerobic and/or strength exercises), but the repetition of the sessions leads to the chronic hypotensive benefit of physical activity. Moreover, physical activity prescription must take into account the assessment of global cardiovascular risk, the control of the hypertension, and the opportunities and desires of the patient in order to promote good adherence and beneficial lifestyle change. [ABSTRACT FROM AUTHOR]

Abstract: The use of “snus” (smokeless tobacco) can be detrimental to health. Snus delivers rapidly high doses of nicotine which can lead to addiction. The use of snus increases the risk of myocardial infarction and stroke. Nicotine substitution therapy as well as bupropion and varenicline reduce withdrawal symptoms and tobacco craving during snus cessation. However, they have been shown not to assist in long-term abstinence. Information concerning potential cardiovascular hazards of snus must be incorporated into health educational programs in order to discourage its use. Snus is not a recommended product to help stop smoking. [Copyright &y& Elsevier]

High rates of uncontrolled hypertensives have been reported in France as well as in other countries, partly owing to an inadequate management of hypertension by clinicians. The objectives of the study were (1) to describe the therapeutic decisions faced by general practitioners (GP) in hypertensives not controlled by fixed-dose combination antihypertensive therapy with a renin–angiotensin system (RAS) inhibitor and a diuretic (D) and (2) to evaluate the frequency with which ambulatory blood pressure monitoring (ABPM) is used in these patients. Each GP had to include five uncontrolled hypertensives on fixed-dose RAS inhibitor and D combination. A total of 2118 GPs included 9551 patients; 8643 patients were receiving at least one of the two drugs at a low dose (group 1) and the remaining 908 patients were receiving high doses of both drugs (group 2). The most common therapeutic choice was that of a new combination, either a fixed-dose in one pill or with separate preparations: 65% (n=5621) in group 1 and 56% (n=505) in group 2. An increase in dose was chosen in 28% of patients in group 1 (n=2467) and continuation of treatment without modification in 27% of patients in group 2 (n=242). A third active principle was only added in 2.5% of patients in group 1 (n=219) and 11% in group 2 (n=103). Ambulatory blood pressure monitoring was employed in 25% of patients (n=2413). An improvement in hypertension management should be expected from the implementation of the 2005 French guidelines.Journal of Human Hypertension (2006) 20, 407–418. doi:10.1038/sj.jhh.1002000; published online 30 March 2006 [ABSTRACT FROM AUTHOR]

The objectives of the study were to appraise the knowledge which the patients have about their hypertension, and to assess the knowledge and involvement of pharmacists in the management of the hypertensive patient. All the pharmacies in the Poitou-Charentes area were invited both to participate in a training session about arterial hypertension and asked to fill in a pharmacist's questionnaire. Furthermore, each participant was required to submit a patient's questionnaire to 20 consecutive hypertensives. A total of 104 pharmacies and 1015 hypertensive patients participated in the survey. In all, 88% of the patients (n=893) were aware of their blood pressure (BP) figures, but 68% (349/515) considered themselves wrongly, to be normalized; 39% (n=350) only had BP figures <140/90 mmHg. They said they had been poorly informed about recommended lifestyle changes. In all, 18% (n=185) were equipped with an automatic device. A total of 77% (n=779) were able to give the names of their drugs without the help of the pharmacist. Treatment-related unwanted effects were reported by 8% of the patients (n=79). Only 18% (n=29) of the pharmacists were able to provide a correct definition of hypertension. Most of them thought hypertension was well controlled in the general population and considered that both tolerance of and compliance with antihypertensive treatment were satisfactory. They could most often (80%, n=135) supply a SBPM device, but 58 (36%) only were able to provide relevant advice regarding the recommended procedures. In conclusion, The BP goals and the lifestyle modifications are poorly known by the hypertensives. Pharmacists' knowledge is frequently wrong and should be improved by appropriate training programmes.Journal of Human Hypertension (2005) 19, 577–584. doi:10.1038/sj.jhh.1001859 Published online 14 April 2005 [ABSTRACT FROM AUTHOR]

OBJECTIVE: Stress hyperglycaemia increases the risk of mortality after acute myocardial infarction in diabetic and in non-diabetic patients. We aimed to determine the contribution of admission plasma glucose and HbA(1c) on post-acute myocardial infarction prognosis. PATIENTS AND METHODS: Admission plasma glucose and HbA(1c) were simultaneously measured in all patients consecutively hospitalized for acute myocardial infarction. Patient survival was measured on 5 and 28 days after admission. Patients were defined as having 'previously diagnosed diabetes' (personal history of diabetes defined using ADA 1997 criteria), 'no diabetes', those without previously diagnosed diabetes and HbA(1c) below 6.5%, or 'possible diabetes', i.e. those without previously diagnosed diabetes and HbA(1c) above 6.5%. RESULTS: Of the 146 patients included, four had died by day 5 and 14 by day 28. Admission plasma glucose was higher in patients who had died by day 28 (11.7 +/- 5.8 vs. 8.0 +/- 3.3 mmol/l, P = 0.002), whereas HbA(1c) was not (6.4 +/- 1.9 vs. 6.1 +/- 0.8%, NS). Admission plasma glucose was significantly higher in those who had died by day 28 after adjustment on HbA(1c). A multivariate analysis, including sex, age and heart failure prior to acute myocardial infarction, showed that admission plasma glucose concentration was an independent predictor of survival after acute myocardial infarction. Twenty-seven of the patients had previously diagnosed diabetes and 119 had no history of diabetes. Eleven were found to have possible diabetes. Admission plasma glucose was significantly higher in previously diagnosed diabetes (11.1 +/- 5.6) than in the other groups: 7.7 +/- 2.9 in non-diabetes, 8.2 +/- 2.1 in possible diabetes (P < 0.0001). The relationship between HbA(1c)-adjusted admission plasma glucose and mortality after acute myocardial infarction was also found in the non-diabetes group. CONCLUSIONS: Admission plasma glucose, even after adjustment on HbA(1c), is a prognostic factor associated with mortality after acute myocardial infarction. Acute rather than the chronic pre-existing glycometabolic state accounts for the prognosis after acute myocardial infarction. [ABSTRACT FROM AUTHOR]

Stress hyperglycaemia increases the risk of mortality after acute myocardial infarction in diabetic and in non-diabetic patients. We aimed to determine the contribution of admission plasma glucose and HbA1c on post-acute myocardial infarction prognosis. Admission plasma glucose and HbA1c were simultaneously measured in all patients consecutively hospitalized for acute myocardial infarction. Patient survival was measured on 5 and 28 days after admission. Patients were defined as having ‘previously diagnosed diabetes’ (personal history of diabetes defined using ADA 1997 criteria), ‘no diabetes’, those without previously diagnosed diabetes and HbA1c below 6.5%, or ‘possible diabetes’, i.e. those without previously diagnosed diabetes and HbA1c above 6.5%. Of the 146 patients included, four had died by day 5 and 14 by day 28. Admission plasma glucose was higher in patients who had died by day 28 (11.7 ± 5.8 vs. 8.0 ± 3.3 mmol/l, P = 0.002), whereas HbA1c was not (6.4 ± 1.9 vs. 6.1 ± 0.8%, NS). Admission plasma glucose was significantly higher in those who had died by day 28 after adjustment on HbA1c. A multivariate analysis, including sex, age and heart failure prior to acute myocardial infarction, showed that admission plasma glucose concentration was an independent predictor of survival after acute myocardial infarction. Twenty-seven of the patients had previously diagnosed diabetes and 119 had no history of diabetes. Eleven were found to have possible diabetes. Admission plasma glucose was significantly higher in previously diagnosed diabetes (11.1 ± 5.6) than in the other groups: 7.7 ± 2.9 in non-diabetes, 8.2 ± 2.1 in possible diabetes ( P < 0.0001). The relationship between HbA1c-adjusted admission plasma glucose and mortality after acute myocardial infarction was also found in the non-diabetes group. Admission plasma glucose, even after adjustment on HbA1c, is a prognostic factor associated with mortality after acute myocardial infarction. Acute rather than the chronic pre-existing glycometabolic state accounts for the prognosis after acute myocardial infarction. Diabet. Med. 21, 305–310 (2004) [ABSTRACT FROM AUTHOR]

This multicentre study was aimed at comparing the trough effect of telmisartan and perindopril on diastolic blood pressure (DBP), using self blood pressure measurement (SBPM). A second objective was to compare the data obtained from SBPM with those provided by automatic office BP measurement. A total of 441 mild-to-moderate hypertensive patients were randomised to receive either telmisartan 40 mg or perindopril 4 mg for a period of 12 weeks. Patients whose clinic DBP remained higher than or equal to 90 mmHg at the end of the 6th week (W6) were given a double-dose regimen. Office BP and SBPM were performed at baseline (W0), at W6 and at week 12 (W12), both with the same automatic device. A greater diminution of trough DBP was obtained with telmisartan (-6.6 ± 6.7 mmHg) than with perindopril (-5.1 ± 7.0 mmHg; P = 0.018). Regarding clinic BP, the same results were observed. Doubling dose was significantly less frequent with telmisartan (41%; n = 85) than with perindopril (55%; n = 115, P = 0.005). Mean values of SBPM were lower than office BP values, with a difference of a greater importance at W0 than at W12: 6.6 vs 4.7 mmHg for systolic blood pressure (P < 0.005) and 3.2 vs 1.4 mmHg for DBP (P < 0.0001). At W12, isolated office hypertension was found in 9% of the patients (n = 37), while there were 14% of the patients (n = 55) with isolated home hypertension. In conclusion, the trough effect on DBP was statistically higher with telmisartan than with perindopril. SBPM values were lower than office BP values, with greater differences before than after treatment. About a quarter of the patients were found to be controlled with a method but not with the other one. [ABSTRACT FROM AUTHOR]