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To improve the management of resistant hypertension, the French Society of Hypertension, an affiliate of the French Society of Cardiology, has published a set of eleven recommendations. The primary objective is to provide the most up-to-date information based on the strongest scientific rationale and that is easily applicable to daily clinical practice. Resistant hypertension is defined as uncontrolled blood pressure on office measurements and confirmed by out-of-office measurements despite a therapeutic strategy comprising appropriate lifestyle and dietary measures and the concurrent use of three antihypertensive agents including a thiazide diuretic, a renin-angiotensin system blocker (ARB or ACEI) and a calcium channel blocker, for at least 4 weeks, at optimal doses. Treatment compliance must be closely monitored, as must factors that are likely to affect treatment resistance (excessive dietary salt intake, alcohol, depression, drug interactions and vasopressor drugs). If the diagnosis of resistant hypertension is confirmed, the patient should be referred to a hypertension specialist to screen for potential target organ damage and secondary causes of hypertension. The recommended treatment regimen is a combination therapy comprising four treatment classes, including spironolactone (12.5–25 mg per day). In the event of a contraindication or a non-response to spironolactone, or if adverse effects occur, a β-blocker, an α-blocker, or a centrally acting antihypertensive drug should be prescribed. Because renal denervation is still undergoing assessment for the treatment of hypertension, this technique should only be prescribed by a specialist hypertension clinic.

Background: Doppler tissue imaging can now be used for the assessment of left atrial (LA) function. LA function was evaluated by this technique in a group of patients hospitalized for acute myocardial infarction and in a control population. Methods: Patients were all prospectively imaged with a scanner. To study the LA, a region of interest was located in the proximal part of the lateral and septal LA walls. Doppler tissue imaging, tissue tracking, strain, and delays were recorded. Results: In all, 12 patients with posterior (age 54 +/- 9 years) and 13 with anterior (age 64 +/- 16 years) acute myocardial infarction, along with 16 control patients (age 54 +/- 9 years), were analyzed. Early diastolic septal velocity was found to be the best parameter for discriminating among the 3 groups. Peak strain was also relevant and did not correlate with left ventricular function. Conclusions: LA is accessible to Doppler tissue imaging analysis. Strain can quantify LA function relatively independently of left ventricular function, and may provide new insights on LA function.

L'hypertrophie ventriculaire gauche (HVG) est fréquemment observée chez l'hypertendu. Son dépistage ne peut se faire que par l'échocardiogramme qui, sous réserve d'une bonne qualité technique (80% des cas) a une excellente sensibilité (93%) et une excellente spécificité (95%). Le plus souvent, l'HVG se présente sous une forme concentrique (rapport h/r supérieur à 0,45). Les mécanismes d'apparition de l'HVG chez l'hypertendu sont essentiellement de deux ordres : mécanique et hormonal ; les théories récentes de Weber et Brilla conduiraient à rendre le facteur mécanique responsable de l'hypertrophie myocitaire et les facteurs hormonaux, de la prolifération du tissu de soutien. Bien que correspondant au départ à un processus d'adaptation, l'HVG a des conséquences néfastes : troubles du rythme, ischémie myocardique, anomalies de la relaxation ventriculaire gauche. Elle est aujourd'hui classiquement reconnue comme un facteur de risque indépendant, grevant lourdement le pronostic de l'hypertendu. Il paraît donc logique de chercher non seulement à normaliser les chiffres tensionnels, mais aussi à réduire la masse ventriculaire gauche. Les études de régression actuellement publiées appellent toutefois un certain nombre de réserves d'ordre méthodologique.

The aim of this study was to evaluate the antihypertensive effect of drugs according to the initial ambulatory blood pressure (BP) level. After a 15-day placebo run-in period, 105 patients with moderate essential hypertension (mean age, 52 years) underwent 24-h BP monitoring (spacelabs: 1 measure/15 min). Patients were subdivided into two groups: the "High" group, with 24-h mean values of systolic BP (SBP) >137 or diastolic BP (DBP) >87 mm Hg, and the "Low" group, with SBP ≤ 137 and DBP ≤ 87 mm Hg. All patients received, in a random and double-blind design, either bisoprolol (10 mg q.d.) or lisinopril (20 mg q.d.) for 8 weeks. At the end of this active treatment period office and ambulatory BP measurements were performed. Casual measurements revealed similar BP decreases in all subgroups receiving bisoprolol and lisinopril; BP monitoring showed that the antihypertensive effect depended on the baseline mean 24-h value; −15/−12 mm Hg for bisoprolol and −18/−13 mm Hg for lisinopril in the High group; −7/−6 mm Hg for bisoprolol and −6/−6 mm Hg for lisinopril in the Low group. This study shows that the antihypertensive effect depended on initial ambulatory BP values, with a lower BP decrease in the Low group. Assessment of the antihypertensive effect on ambulatory BP is useful in clinical trials.

We report two cases of severe hypoxemia due to right-to-left shunt in acute asthmatic patients. During acute asthma, the transmural right atrial pressure can be higher than left atrial pressure during inspiration and then induce a right-to-left shunt through inter-atrial communication leading to hypoxemia. Contrast echography as well as Doppler analysis can easily confirm the diagnosis.

To assess the rates of controlled hypertension as per the 2009 Reappraisal of the 2007 European Society of CardiologyEuropean Society of Hypertension (ESCESH) guidelines.