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Due to its sensitivity, selectivity, simplicity and costeffectiveness, the role of electrochemical analysis methods increases from year to year. This also applies to the use of various voltammetry options in the analysis of medicines. This mini-review is devoted to the analytical capabilities of cyclic voltammetry used in manufacturing technologies and clinical diagnostics of antihypertensive drugs. The main goal pursued by the authors of this article is to attract the attention of specialists to the problem of analytical control of medicines, and, first of all, antihypertensive drugs, using methods of voltammetric analysis. According to the authors, this will allow a deeper understanding of the cause of hypertension and the subsequent eradication of this disease, which will certainly affect the duration of a healthy human life.

INTRODUCTION: Several international guidelines are available on drug treatment for hypertension, but the control of hypertension remains very poor in sub-Saharan Africa (SSA). We investigated the commonly prescribed antihypertensive drugs and their association with blood pressure (BP) control in adult Cameroonians. METHODS: we consecutively recruited hypertensive outpatients attending the Buea and Limbe Regional Hospitals (Southwest Region of Cameroon). Controlled BP was defined as BP 140/90mmHg in hypertensive patients aged 60 years or younger, diabetics or patients with chronic kidney disease or a BP 150/90mmHg in non-diabetic hypertensive patients older than 60 years of age (JNC8). RESULTS: of the 408 participants included (mean age 61.1 years), 67% were female. The median duration of hypertension was 6 years and the median duration of the current treatment was 22 weeks. Commonly prescribed antihypertensives were calcium channel blockers (CCB, 35.1%), thiazide/thiazide-like diuretics (TD/TLD, 26.1%) and angiotensin-converting enzyme inhibitors (ACEI,19.5%). The median monthly cost of antihypertensive was 10279.6 CFA (approximately equal to US$ 172). 70% of participants were receiving at least 2 drugs, with ACEI+TD/TLD, CCB+TD/TLD, and ACEI+CCB+TD/TLD being the most frequent. The rate of BP control was 52% overall, and 60% in participants on monotherapy. CONCLUSION: CCBs were the most prescribed single antihypertensive drugs in this setting while ACEI+TD/TLD was the most common combination. About half of patients were at target BP control levels Improving availability and affordability of these medications may improve hypertension management and control.

Résumé La prise en charge adaptée des patients présentant une hypertension artérielle résistante est un enjeu majeur afin de limiter l’impact macro et microvasculaires sur les organes cibles. Cependant, l’inobservance thérapeutique reste souvent une des principales étiologies de l’hypertension artérielle résistante. Au travers d’un cas clinique d’inobservance thérapeutique complexe, nous reviendrons sur la fréquence, les moyens de dépistage et la prise en charge spécifique de la non-compliance thérapeutique médicamenteuse. Enfin, nous préciserons l’apport des dosages médicamenteux et de l’expertise psychologique dans l’aide au dépistage des patients non observants présentant une hypertension artérielle présumée résistante. The management of patients with resistant hypertension remains a major challenge in daily clinical practice in order to limit macro and microvascular impact. However, lack of compliance often remains one of the main etiologies of resistant hypertension. Through a clinical case of complex therapeutic non-compliance, we will detail the frequency, the screening and the management of therapeutic non-compliance. Finally, we will specify the contribution of drug dosages and psychological expertise in screening non-observant patients with presumed resistant hypertension. [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 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]

Background: Hypertension is a serious public health challenge in both economically developing and developed countries. Patients on outpatient medication for hypertension at Vanga Hospital in the Democratic Republic of Congo (DRC) often present with uncontrolled hypertension and some with hypertension emergencies. On enquiry, the problem appeared to revolve around compliance. Method: The study was a qualitative, descriptive study using the focus group interview technique for data collection. Subjects were purposely selected. Interviews were conducted from 23 March to 19 July 2006. Three focus groups were formed: The first was heterogeneous in terms of gender (five males and three females), the second homogeneous (six males) and the last also homogeneous (six females). The group members varied with respect to characteristics such as place of residence, occupation and educational standard. The data collected were analysed using the thematic analysis method within grounded theory. Results: Five themes emerged as possible explanations for non-compliance: Side effects discouraged patients from taking medication; patients took medication only when they experienced perceived symptoms of hypertension; poor knowledge of the disease and the medication used; lack of support by family members; and difficulty in obtaining antihypertensive medication. Conclusion: Side effects of the medication, lack of information and support, difficulty in obtaining the medication and the fact that the disease is mainly silent played a major role in the poor adherence to hypertension medication. Sustained health promotion and education should be undertaken at all levels of patient contact to ensure good compliance.

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]

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]

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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]

Copyright of Andrologie (11662654) is the property of Springer Nature 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.)

The management of patients with resistant hypertension remains a major challenge in daily clinical practice in order to limit macro and microvascular impact. However, lack of compliance often remains one of the main etiologies of resistant hypertension. Through a clinical case of complex therapeutic non-compliance, we will detail the frequency, the screening and the management of therapeutic non-compliance. Finally, we will specify the contribution of drug dosages and psychological expertise in screening non-observant patients with presumed resistant hypertension., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

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 55years 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 2years in 7% of subjects and the median follow-up duration of treatment was 10years. 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., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)

Competing Interests: C. Lafuente déclare n’avoir aucun lien d’intérêts.

Objective: To evaluate from studies conducted between 2002 and 2012, trends in the use of antihypertensive drugs in France., Method: French League Against Hypertension Survey (FLAHS) were conducted in a representative sample of subjects aged 35 and over living in France. A list including the names for all antihypertensive drugs marketed at the time of each survey made it possible to detail drug therapies employed. Data analysis has taken the patient as a unity. The data obtained in 2002, 2007 and 2012 are subject to this analysis., Results: In 2012, 30% of the French population aged 35 and older was treated with antihypertensive drugs (11.4 million), while 24% were treated in 2002 (8.2 million). On average, prescription of antihypertensive included 1.4 ± 0.7 pills in 2002, 1.5 ± 0.8 in 2007 and 1.8 ± 0.9 in 2012, which corresponds to a pharmacological monotherapy prescribed in 47% of subjects in 2012, a different percentage than in 2007 (46%) and 2002 (56%). Over the period, the percentage of prescriptions of diuretics (41% to 42%) and ACE inhibitors (24% to 23%) and beta-blockers (35% to 36%) is stable, but they are increasing with ARBs (23% to 47%) and calcium antagonists (24% to 34%). The prescriptions of fixed-dose combinations were also increased (19% to 30%). In 2012, fixed-dose combinations included a diuretic (79%), an ARB (65%), an ACEI (23%) and a calcium antagonist (20%). Blood pressure control estimated with home blood pressure monitoring increases from 38% in 2002 to 50% in 2007 and 2012., Conclusion: Changes in the use of antihypertensive drugs in France between 2002 and 2012 led to the prescription of antihypertensive treatment with associations in the majority. ARBs or ACEI are present on 70% of prescriptions with diuretics combined in 80%. Extensive use of fixed-dose combinations with diuretics and ARA2 characterizes this period in which it was observed an increase in blood pressure control in France., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)