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Objectives: To identify the socio-demographic, clinical, psycho-behavioural and therapeutic factors explaining uncontrolled blood pressure in a population of hypertensives in ambulatory practice., Methods: The DUO-HTA survey is a national, cross-sectional, mirrored, observational study, from a representative sample of 347 general practitioners (MG) and 210 cardiologists, and a population of 2022 hypertensive patients followed by these doctors. The data were collected by means of questionnaires completed by the hypertensives and their doctors., Results: The factors significantly discriminating patients for whom BP was controlled (C) from those patients whose BP was not controlled (NC) were an age less than 65 years, smoking, obesity, alcohol consumption, sedentary lifestyle and multiple anti-hypertensive treatment. On the psycho-behavioural front, the NC patients were more often anxious and irritable, claiming to lead a stressful life and for whom hypertension was often perceived as a "foreign entity" and a source of frustration and multiple deprivations. The factors discriminating the NC doctors from the C doctors were essentially psycho-behavioural, with the NC doctors considering the management of hypertension as being less gratifying, and hypertension as a condition with fluctuating progression, poorly understood and dramatized by patients., Conclusion: The DUO-HTA survey underlines the weight of reciprocal representation systems in hypertension for patients and their doctors, as well as the quality of the doctor-patient relationship in blood pressure control. It prompts the development of sensitisation actions for practitioners centered on improving the doctor-patient relationship.

The study of quality of life (QoL) in a French cohort of patients suffering from angina pectoris was one of the objectives of the ELAN longitudinal study. It concerned 3,954 subjects (76% males) mean age: 67 +/- 11 years, followed up by 613 cardiologists which were invited to complete a series of baseline sociodemographic and clinical data and to answer a series of questions upon one year outcome (3,261 medical records available). QoL was assessed at baseline via a self-administered 12-item general questionnaire, the Short-Form 12 (SF-12), enabling to compute a mental component summary (CS-12) and a physical component summary (PCS-12) score. Mean MCS-12 in the ELAN cohort (49 +/- 7.5) was very close to the standards derived from general American population (50 +/- 10) or to the data available in a general French population (51.2 +/- 7.4). Whereas mean PCS-12 was hardly lower (about one standard deviation) in comparison with general American population (50 +/- 10) or with a general French population (48.4 +/- 9.4). QoL was higher in males and linked to age in a contrasted way (higher MCS-12 and lower PCS-12 in elderly; p < 0.0001). It depended on the clinical condition (lower MCS-12 associated with mixed-type angina pectoris or with more severe angina and with persistent smoking; lower PCS-12 associated with mixed type or more severe angina, with cardiac failure episodes, arteritis obliterans, stroke antecedents or left ventricular hypertrophy). Both scores were negatively correlated, in multivariate regression analysis, with the severity of persisting angina at one year, after controlling for the severity of baseline angina and the other confounding variables. Above all, MCS-12 and especially PCS-12, predicted major coronary events at one year (death, myocardial infarction, angioplasty, coronary by-pass surgery). In a multivariate logistic regression analysis, low baseline PCS-12 was associated with higher risk for cardiovascular death at one year (OR = 2.44; 95% CI = 1.25-4.74; p < 0.01). These results confirm the clinical validity of SF-12 (cross sectional stage of the study) and stress its prognostic value independent from the other risk factors (longitudinal stage of the study).

The ELAN (Etude Longitudinale dans l'ANgor) study was carried out to evaluate factors influencing the occurrence of death, myocardial infarction and revascularization procedures in patients with known angina pectoris. Analysis of baseline data collected in January 1997 involves 4,035 patients throughout France, which were recruited by 613 cardiologists practising on a private, hospital or mixed basis. The study population comprised 75% of men with a mean age of 65 years and 25% of women with a mean age of 70 years. Eighty eight percent of the patients had at least one cardiovascular risk factor, and nearly half of them had two or more factors; hypercholesterolemia and hypertension were the two most frequent ones. Reported cardiovascular past events included myocardial infarction in 47% of patients, PTCA in 33% and aorto-coronary bypass in 24%. Angina pectoris had been diagnosed within the previous year in 39% of patients. Exertional angina was the most common type (66%), with grade I/II angina being most frequently found (more than 70% of all cases). Management strategies are especially described for angina patients diagnosed within the previous year. More than half of the patients had undergone exercise testing within the previous 12 months, while scanning and coronary arteriography had been performed in 15% and 72%, respectively. Ninety five percent of patients were under antianginal drug therapy, with combined therapies being used in 58% of them. The most frequently prescribed drugs were betablockers (63%) and nitrates (53%). In 74% of patients, aspirin was given in addition to conventional antianginal agents. These data will be reviewed in a one-year cohort analysis as potential predictive factors for the occurrence of cardiovascular events.

The ELAN (Etude longitudinale dans l'angor) study was carried out both to acquire better knowledge of the occurrence of major cardiovascular events (myocardial infarction, revascularization surgery, death) in patients followed up for angina pectoris, and to determine the factors influencing such events. A cohort of angina patients was formed in January 1997, and 3,284 patients were followed up by 488 French cardiologists during a one-year period. Of these 3,284 patients, 96 (29/1000) died; causes of death included underlying coronary heart disease in 31, sudden death in 8, other cardiac aetiologies in 35, and noncardiac causes in 22. Sixty-nine (21/1000) patients developed myocardial infarction, 240 (73/1000) underwent PTCA, and 119 (36/1000) underwent coronary bypass surgery. Factors associated with an increased risk of death were age, diabetes mellitus, heart failure and angina type, mixed and rest angina being associated with poorer prognosis compared to exertional angina. Infarction risk increased with age and a history of previous infarction. Analysis of therapeutic factors after adjustment for the above risk factors showed a beneficial effect of betablockers on both cardiovascular and all-cause mortality and of aspirin on all-cause mortality.

ISIS tutorial program (French abbreviation for Animated and Computerized Initiation into Health) was carried out for Macintosh type computers to place a modern and interactive learning device at cardiovascular risk patients' disposal. Such a program combines strict scientific explanations and aesthetic attractiveness of multimedia communication. To test the effect of this device on health knowledge gain, 158 hypertensives admitted in one-day or in half-week clinics for an initial check-up or for a therapeutic adjustment were randomised into two groups: a control group (n = 79), receiving usual education (contacts with physicians, nurses, dieticians, health oriented booklets), and an experimental or "ISIS" group (n = 79) undergoing an interactive session with the computer during 30 to 60 minutes, in addition to usual education. Health knowledge of both groups was assessed through a 28-item questionnaire, before any education procedure, two months after the discharge, through a standardized interview by phone, thanks to the same investigator. On the whole, 69 + 69 = 138 complete case records could be analysed. Initial health knowledge mean score, at admission to the hospital, was 14.3 +/- 4.2 (range: 4 to 25). This score significantly improved among the whole population (difference between the two evaluations: 3.7 +/- 3.5 points; p = 0.0001). Improvement was greater in ISIS group than in controls (p = 0.02). Among hypertensives with initial scores < or = 16, improvement was respectively 4.5 +/- 3.6 and 2.9 +/- 3.0 for ISIS and control groups (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

This study was conducted with 58 subjects (31 males and 27 females): a sample of 37 normotensives (NT) (mean age 36 +/- 11) and a sample of 21 hypertensives (HT) without any antihypertensive medication (mean age 46 +/- 9). Cardiovascular reactivity was measured during a sequence of 3 computer assisted mental stress tasks (visual-motor tasks, maze test). Before and following the stress tasks the subjects were asked to respond on the same computer to psychological test and questionnaires measuring anxiety, depression (H.A.D. inventory) type A behavior (impatience, competition and drive for success; Bortner's scale), locus of control (attribution of success or failure to internal or external factors; Levenson's scale), and coping mechanisms used in response to everyday life stresses (Rosenzweig Picture Frustration Test, adapted by S. Consoli and E. Albert). Measurements of systolic (SBP) and diastolic blood pressure and heart rate were obtained automatically every minute during the entire computer session with a Colin Press-Mate BP 8800 sphygmomanometer. Pressure reactivity (PR) was defined as the relative difference between BP measured during mental stress and BP measured during non-stress condition (the reference period). Our hypotheses were that PR would be greater in HT than in NT, and that PR would be correlated with various psychological and behavioral characteristics. During the stress session, SBP in NT increased from 119.8 to 123.7 mmHg (p < 0.001) and in HT from 147.4 to 152 mmHg (p < 0.05): there was no significant difference between the two samples but in HT, SBP elevation persisted after the stress session, contrary to the NT, whose SBP quickly decreased to the reference values.(ABSTRACT TRUNCATED AT 250 WORDS)

The author analyses the outcome and emotional repercussions of myocardial infarction in the patient, his or her partner, and of the medical team who manages the infarct (coronary care and cardiac rehabilitation). The adaptive value of certain psychological attitudes is emphasised, for example the denial of illness, and the poor prognosis associated not so much with "type A" behaviour reputed to cause coronary disease but more with post-infarction depression or even with a more stable tendency to hostility in the emotional control. Some of these psychological characteristics may explain the difficulties encountered in designing educative programmes or in poor therapeutic observance by patients despite being aware of the risks they run. These considerations led to therapeutic implication ranging from the strategy of communication with the coronary patient to specific relaxation techniques or with help, to the gestion of stress, to the judicious prescription of psychotropic agents.

The files of 4614 hypertensive patients monitored by general practitioners (GP) were methodically analyzed. 49 p. 100 of these subjects had received no previous treatment. The protocol consisted of obligatory consultations 2, 6 and 12 months after inclusion, and questionnaires requiring specific answers, designed to describe the patient-practitioner relationship. The GP provided a psychological evaluation upon inclusion. Four main compliance classes were defined according to the data collected over 12 months: patients present at all times of the study and scrupulously respecting the medical prescription (class A: 36 p. 100 of the studied population) or neglecting the prescription (B: 33 p. 100), patients omitting one or several appointments but reestablishing contact (C: 2 p. 100) and patients lost to follow-up (D: 18 p. 100). Blood pressure parameters were better in class A as of the consultation at 2 months (ANOVA). Paradoxically, a self-assured, outgoing, serene character is a prediction factor for less satisfactory compliance than a passive, hesitant, reserved, worried character. GP behaviors were classified into homogeneous groups by principal component factorial analysis: positive prognosis factors as regards compliance are an attitude of "building up confidence" (reassuring the patient, announcing that treatment will allow him to relax, evoking possible side-effects in advance) or "medicalization of hypertension" (presented as a pathology rather than merely as a risk factor, with life-long treatment as a corollary). On the other hand, a poor prognosis factor is an attitude of "dramatization" (frightening the patient). "Building up confidence" is linked to better compliance, whatever the associated risk factors. This study statistically confirms the role of the patient-practitioner relationship in compliance.