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The use of an automatic blood pressure monitor with the help of a protocol given by an e-health application allows self-testing of blood pressure without the help of a health professional. Conduct a screening campaign for high blood pressure in artisanal bakeries in France and develop a score to predict the observation of an increase in blood pressure during self-testing. Cross-sectional survey conducted in mainland France in 2018 using 1000 screening kits including a tablet, Predic'HTA® application and a connected electronic blood pressure monitor (BP Track, IHealth). Available for one week in 14,000 artisanal bakeries, in turn. Used in the workplace, on a voluntary basis, by bakery employees. Completion of a health questionnaire with an estimate of excessive salt consumption. Self-screening of 3 blood pressure measurements with centralization of data on a secure database for epidemiological analysis. The average of the last 2 measurements characterizes each subject. Full use of Predic'HTA® was obtained in 62.4% of users or 7502 subjects (44% under 35 years of age, 44% 35 to 54 years of age, 12% 55 years of age and over). Antihypertensive treatment was followed by 27% of those aged 55 and over and 1% of those under 35. Among untreated subjects, the prevalence of BP > 140/90 was 21.1%, increasing with age (13%, 27%, 33%) and higher among men (27.2%) than among women (15.4%). With the parameters age, sex, weight, IMC, family history of high blood pressure, excessive salt consumption, previous intake of an antihypertensive drug, a score is calculated to associate a probability of having an BP >120/80 with self-screening. The ROC curve shows an AUC at 0.723 with a PPV at 91% and a NPV at 41%. The depist'HTA® score is available at www.depisthta.net Self-testing of blood pressure is possible with an electronic blood pressure monitor if a dedicated appliance is used at the same time. The development of the prediction score depist'HTA® for a blood pressure level > 120/80 would be useful to target subjects who need to self-test their blood pressure in the short term. [ABSTRACT FROM AUTHOR]

Résumé Objectif L’utilisation d’une échelle visuelle pour évaluer l’observance des traitements antihypertenseurs a montré sa bonne concordance avec l’évaluation de l’observance par pilulier électronique. L’utilisation de l’échelle visuelle EvalObs ® dans une large population de sujets traités pour une HTA, une dyslipidémie ou un diabète est l’objectif de l’étude FLAHS 2017 ainsi que l’étude de la concordance entre EvalObs ® et le questionnaire d’observance de Girerd chez des 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 2017, FLAHS a été réalisé chez 4783 sujets âgés de 35 ans et plus. L’échelle visuelle EvalObs ® comporte une graduation de 0 à 15 et l’instruction d’utilisation est « combien de jours avez-vous pris le médicament au cours des 15 derniers jours ». Un score > 12 indique une « bonne observance ». Pour le questionnaire de Girerd, un score de 3 ou plus ou une absence de remplissage est considérée comme « mauvaise observance » et la concordance avec EvalObs ® a été évaluée chez les hypertendus. Résultats FLAHS 2017 a inclus 4783 sujets comportant 1308 hypertendus traités, 942 sujets traités pour le cholestérol et 405 sujets traités pour le diabète. Avec le questionnaire de Girerd, une « mauvaise observance » est notée chez 5,1 % des hypertendus et est plus élevée chez les hommes (6,7 %) que chez les femmes (3,5 %). La mauvaise observance est plus fréquente chez les sujets de 35 à 44 ans (11,3 %) et chez les 80 ans et plus (8,4 %) par comparaison aux sujets de 45 à 79 ans (4,2 %). Avec EvalObs ® , la « mauvaise observance » est de 8,2 % [IC 95 ; 6,5–9,9] au cours du traitement du cholestérol, de 6,0 % [CI 95 ; 3,9–8,1] au cours du traitement du diabète et de 3,6 % [CI 95, 2,5–4,7] au cours du traitement de l’hypertension. Chez l’hypertendu, la comparaison du questionnaire de Girerd et d’EvalObs ® trouve une concordance à 93,8 %. Conclusion L’usage d’une échelle visuelle d’observance dans la population de FLAHS 2017 indique que l’observance des traitements de l’hypertension, du diabète et du cholestérol est différente. L’échelle visuelle EvalObs ® en complément du questionnaire de Girerd permet une rapide évaluation de l’observance au cours des maladies. EvalObs est disponible gratuitement sur Appel store et Google play. Objective A Visual Analog Scale (VAS) is useful for diagnosing medication nonadherence and its validity has been evaluated using electronic pillbox as the gold standard. We have developed the EvaLobs ® scale for use on paper or on smartphone and the aim of the study was to administrate the scale among FLAHS 2017 participants treated for an hypertension, a dyslipidemia or diabetes. In subjects treated with antihypertensive medications, participants completed the 6-item Girerd Scale and EvaLobs ® . Methods The French League Against Hypertension Survey (FLAHS) are carried out by self-questionnaire sent by mail to individuals from the French Kantar Health sampling frame (representative panel of the population living in metropolitan France). In 2017, FLAHS was conducted in 4783 subjects aged 35 and over. The EvaLobs ® has a scale from 0 to 15 and the use instruction is “how many days have you taken the drug in the past 15 days”. A score > 12 indicates a “good compliance”. The 6-item Girerd scale was also completed. “Good adherence” was determined for a score of 0 to 2 and “nonadherence” for a score of 3 or more. The agreement between EvaLobs ® and the 6-item Girerd scale was evaluated in treated hypertensives. Results The survey included 4783 subjects with 1308 treated hypertensives, 942 subjects treated with lipid-lowering drugs and 405 subjects treated with anti-diabetics. EVALOBS ® indicates “Good adherence” in 96% of subjects and the 6 questions questionnaire indicates “good adherence” in 95% of subjects. An excellent agreement is noted in 93.8%. An EvaLobs ® score indicating nonadherence or an absence of response to EvaLobs ® is observed in 3.6% [CI 95, 2.5–4.7] of hypertensives, in 6.0% [CI 95, 3.9–8.1] of diabetics and in 8.2% [CI 95, 6.5–9.9] of dyslipidemic patients. Conclusion In the population living in France and in unselected patients treated for metabolic disease or hypertension, non-adherence is lowest for antihypertensive medications and highest for statins. EvaLobs ® , which shows good agreement with an adherence questionnaire, is a quick and simple tool for assessing adherence. The smartphone app EvaLobs ® is available for free on Google play and the Apple store. [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 L’enquête FLAHS 2015 a cherché des déterminants du contrôle de l’HTA chez les sujets traités par antihypertenseurs en France métropolitaine. Méthode Envoi d’auto-questionnaire par courrier à un panel représentatif de la population vivant en France métropolitaine (base Métascope, TNS SOFRES, France). Un sujet déclarant une prise actuelle d’antihypertenseur est considéré hypertendu traité. Une automesure sur 3 jours a été demandée chez ceux disposant d’un tensiomètre et la moyenne de 18 mesures a été calculée. Résultats Un total de 6379 sujets âgés de 55 ans et plus ont été inclus dont 2814 (44,1 %) traités par antihypertenseurs. Une automesure est obtenue chez 1455 sujets et montre une PAS/PAD à 129,3 ± 13,5/75,5 ± 9,0 mmHg. La PA est plus élevée chez les traités dans chaque catégorie d’âge. Une PA < 135/85 est notée chez 55,4 % et une PA < 140/90 chez 71,7 %. Les déterminants du contrôle (PA < 135/85) sont l’âge (55–64 ans vs 80 ans et plus ; 57,6 %/49,1 %), le sexe (femmes vs hommes ; 60,3 %/50,1 %), le BMI (< 25 vs > 30 ; 63,1 %/46,1 %). Chez les 80 ans et plus, une PAS < 145 est observée chez 74,7 % des sujets. Le contrôle est de 61 % lorsque l’on considère une PAS/PAD < 135/85 chez les 55–79 ans et une PAS < 145 chez les 80 ans et plus. Conclusion Le contrôle de l’HTA évalué par automesure sur une population représentative vivant en France métropolitaine est estimé entre 44,3 % et 74,7 % et plusieurs déterminants font varier le contrôle de la pression artérielle dont l’âge, le sexe et le BMI. Objective The FLASH 2015 survey sought the determinants of hypertension control in subjects treated with antihypertensive drugs in France. Method Sending self-administered questionnaire by mail to a representative sample of the population living in metropolitan France (MetaScope basis, TNS Sofres, France). Patients who declare taking antihypertensive drugs are considered treated hypertensives. A home blood pressure monitoring during 3 days was asked in subjects owing a blood pressure monitor and the average of 18 measurements was calculated. Results A total of 6379 subjects aged 55 and older were included with 2814 (44.1%) treated with antihypertensive drugs. Home blood pressure was obtained from 1455 subjects including 882 (60.6%) treated. SBP/DBP are 129.3 ± 13.5/75.5 ± 9.0 mmHg and are higher in treated subjects in each age category. BP < 135/85 was observed in 55.4% and BP < 140/90 in 71.7%. Determinants of BP control (< 135/85) are the number of measurement for averaging (18 measures over 3 days vs 3 measurements on a morning; 55.4%/44.3%), age (55–64 years vs 80 years old; 57.6%/49.1%), gender (women vs men; 60.3%/50.1%), BMI (< 25 vs > 30; 63.1%/46.1%). In the 80 and older, a SBP < 145 was observed in 74.7% of subjects. The control was 61% when considering an SBP/DBP < 135/85 in 55–79 years and SBP < 145 among 80 and older. Conclusion The control of hypertension evaluated by home blood pressure on a representative population living in metropolitan France is estimated at between 44.3% and 74.7% and several determinants influence the control of blood pressure like age, gender and BMI. [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]

Résumé Objectif Développer un test pour dépister une consommation excessive de sel (CES) chez les patients hypertendus. Méthodes Des sujets hypertendus domiciliés en région parisienne ont été inclus. Une collection urinaire de sodium de 24 heures a été effectuée la veille de la visite d’un hôpital de jour. Un journal alimentaire a été réalisé le jour de la collecte de l’urine et validée après une entrevue avec une diététicienne. Une CES a été définie par un sodium urinaire ≥ 200 mmol/j. Les caractéristiques cliniques ou alimentaires associés à une CES ont été retenues pour définir les variables de l’ExSel Test. Une courbe ROC a été effectué pour déterminer le score optimal de détection d’une CES. Résultats L’étude a inclus 148 patients hypertendus, une CES est observée chez 19 % des sujets, mais est plus fréquente chez l’homme. Sept principaux déterminants d’une CES ont été identifiés et sont les questions qui constituent l’ExSel Test. Une réponse positive attribue des points : l’homme (1 point) ; l’IMC > 30 (2 points) ; pain 4 ou 5 morceaux par jour (1 point), plus de 6 morceaux (2 points) ; fromage au moins une fois par jour (2 points) ; charcuterie au moins deux fois par semaine (2 points) ; l’utilisation de bouillon cube (1 point) ; des aliments riches en sel caché (pizza, cheeseburger, quiche, crevettes, chips, poisson fumé, olives, graines salées, plat cuisiné par traiteur) au moins deux fois par semaine (1 point). La réalisation d’une courbe ROC pour le diagnostic de CES selon le score obtenue par l’ExSel Test montre une aire sous la courbe à 0,919. Le score de 5 indique le meilleur indice de Youden avec une sensibilité de 0,63, une spécificité de 0,95, une VPN à 0,92 et une VPP à 0,75. Conclusions Chez les sujets hypertendus, la réalisation de l’ExSel Test, un questionnaire basé sur des caractéristiques cliniques et sur la fréquence de prise de certains aliments, permet de calculer un score dont la valeur permet d’éliminer ou d’affirmer une CES. Pour une utilisation clinique du test ExSel, une version électronique est disponible sur http://www.comitehta.org . Objective Development of a test to screen excess salt intake (ESI) in hypertensive patients. Methods Hypertensive subjects living in Paris area have been included. A 24-hour urinary sodium collection has been performed the day before the visit for a day hospital. A food diary was completed on the day of the urine collection and validated after an interview with a dietetician. An ESI was defined by a urinary sodium ≥ 200 mmol/d. Clinical or food characteristics associated to an ESI were retained for the ExSel Test variables. A ROC curve was performed to determine the optimal score for the ExSel Test in detection of ESI in hypertensive patients. Results One hundred and forty-eight hypertensive patients have been included living in the Île-de-France area. ESI was observed in 19% with a higher frequency in men. Seven major determinants of ESI have been identified and are the questions that constitute the ExSel Test. A positive response assigns points: man (1); BMI > 30 (2); bread 4 or 5 pieces per day (1) or more than 6 pieces; cheese at least 1 time per day (2); charcuterie at least 2 times per week (2); use of processed broth or pilaf (1); food rich in hidden salt (pizza, cheeseburger, quiche, shrimp, potato chips, smoked fish, olive) at least 2 times per week (1). The ROC curve analysis shows that a score of 5 or more has the best Youden index with a sensitivity of 0.63, specificity of 0.95, PPV of 0.75, NPV of 0.92. Conclusions In hypertensive subjects, an excessive salt intake can be detected by the realization of the ExSel Test based only on a simple food-questionnaire and some clinical parameters. For a clinical use of the ExSel Test, an electronic version is available on http://www.comitehta.org . [ABSTRACT FROM AUTHOR]

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]

It is commonly accepted that adrenalectomy cures hypertension in secondary endocrine hypertensions. The purpose of this study was to evaluate the percentage of cure of hypertension after adrenal surgery in three causes of endocrine hypertension: Conn's adenoma, pheochromocytoma and cortisolic adenoma. Patients with hypertension with a radiological and hormonal check-up confirming the diagnosis of endocrine hypertension by Conn's adenoma (55 cases), pheochromocytoma (39 cases) or cortisolic adenoma (15 cases) have had unilateral adrenal surgery. Before the surgery, patients were treated with anti-anhypertensive drugs specific to each cause allowing the control of blood pressure in home blood pressure monitoring in 89% of subjects. In the 3 months following surgery, blood pressure was reassessed by home monitoring after stopping antihypertensive drugs. Healing of hypertension was observed in 69% of pheochromocytomas, 60% of Conn's adenomas and 40% of cortisolic adenomas. In subjects with Conn's adenoma the healing characteristics are: age less than 40 years, female sex, normalization of blood pressure before surgery with spironolactone treatment and normality of the opposite adrenal gland on CT. For pheochromocytoma, parameters linked with hypertension healing were normalization of blood pressure before surgery with specific medical treatment and age less than 40 years. For cortisol adenoma, young age at surgery is also linked with healing hypertension. This work indicates that in secondary hypertensions, adrenal surgery does not achieve a cure in all patients in the months following surgery. The characteristics that predict the cure of hypertension are the effectiveness of medical treatment before surgery, and a patient's age of less than 40 years. [ABSTRACT FROM AUTHOR]

For the detection and monitoring of hypertension, several consecutive blood pressure measurements are recommended to account for variability in BP. The rule is to perform three consecutive measurements after a rest period of a few minutes. The objective of the study was to look for the threshold at which the 3 consecutive measurements are no longer useful for evaluating BP. In the PREDIC-HTA survey, consecutive taking of 3 measurements of BP in a seated position according to a standardized methodology was carried out using an automatic blood pressure monitor (BP5, iHealth, Paris) connected to a tablet and allowing the realization of a self-screening protocol for BP in volunteers. For each subject, the value of the first BP measurement was compared to the average of measures 2 and 3. The analysis focused on the difference between the "M1" and the "M2M3 average" with the search for a threshold of agreement. Two methods were used for threshold search. In 6527 subjects, 3 BP measurements can be analyzed. BP is different and decreasing between measurements: 125.0/82.8 (M1) and 122.2/82.2 (M3). Bland-altman plot observed a positive regression line with an intersection at the value 0 observed for a SBP at 134 mm Hg and a DBP at 84 mm Hg. Regression to the mean analysis indicates that if M1 SBP is > 135/85 then mean M2/M3 is − 9.1/− 2.2 mm Hg lower, and if M1 SBP is ≤ 135/85 then mean M2/M3 is − 0.8/− 0.3 mm Hg lower. When three BP measurements are performed with an automatic blood pressure monitor and in a standardized way, the first measurement is comparable to the average of the next two when the BP does not exceed the 135/85 values. When the first measure of BP does not exceed 135/85, there is no point in carrying out additional measurements. This result should be taken into account when the BP measurement is done by a health professional or a patient during self-measurement. [ABSTRACT FROM AUTHOR]

For the detection and monitoring of hypertension, several consecutive blood pressure measurements are recommended to account for variability in BP. The rule is to perform three consecutive measurements after a rest period of a few minutes. It is the average of the last 2 measurements carried out which determines the level of the BP at the visit (Protocol SPRINT) or in self-measurement (rule of the three). The objective of the study was to look for the threshold at which the 3 consecutive measurements are no longer useful for evaluating BP. In the PREDIC-HTA survey, consecutive taking of 3 measurements of BP in a seated position according to a standardized methodology was carried out using an automatic blood pressure monitor (BP5, IHealth, Paris) connected to a tablet and allowing the realization of a self-screening protocol for BP in volunteers. For each subject, the value of the first BP measurement was compared to the average of measures 2 and 3. The analysis focused on the difference between the "M1" and the "M2M3 average" with the search for a threshold of agreement. Two methods were used for threshold search: Bland-Altman plot and regression to the mean analysis. In 6527 subjects, 3 BP measurements can be analyzed. BP is different and decreasing between measurements: 125.0/82.8 (M1) and 122.2/82.2 (M3). Bland-altman plot observed a positive regression line with an intersection at the value 0 observed for a SBP at 134 mmHg and a DBP at 84 mmHg. Regression to the mean analysis indicates that if M1 SBP is > 135/85 then mean M2/M3 is − 9.1/− 2.2 mmHg lower, and if M1 SBP is ≤ 135/85 then mean M2/M3 is − 0.8/− 0.3 mmHg lower. When three BP measurements are performed with an automatic blood pressure monitor and in a standardized way, the first measurement is comparable to the average of the next two when the BP does not exceed the 135/85 values. When the first measure of BP does not exceed 135/85, there is no point in carrying out additional measurements. This result should be taken into account when the BP measurement is done by a health professional or a patient during self-measurement. [ABSTRACT FROM AUTHOR]

One of the modifiable risk factors for hypertension is excessive salt intake. In France, excesses are due to the consumption of bread, meats and cheese. The ExSel® test was designed and validated to detect excessive salt consumption. In the PREDIC-HTA survey The ExSel® test was administered on a large scale in a population of employees. The PREDIC-HTA survey is observational and multicenter and was conducted from June 2017 for a duration of one year. One thousand screening kits comprising a tablet with the PREDIC-HTA application and a connected electronic sphygmomanometer were delivered for a period of one week in turn in the 12 000 bakeries in metropolitan France. On a voluntary basis, employees of bakeries had the use of PREDIC-HTA at the workplace. The application included the filling of standardized health questionnaires including demographic characteristics, BP risk factors and the ExSel® test, which includes five questions concerning bread (Q1), delicatessen (Q2) and cheese (Q3), prepared meals (Q4), and broths and flavor enhancers (Q5). The anonymous data was transferred to a secure database allowing the secondary implementation of epidemiological analyzes. 6572 subjects were included in the study. Of the participants, 31% (95% CI: 29.9, 32.2) had a score indicating excess salt intake. ExSel® test responses were as follows: Q1 50.6%, Q2 50.1% (among those under 35 years of age 43.4% (95% CI: 41.6, 45.2) and among over 55 years 56.9% (95% CI 53.3, 60.4), Q3 43.1%, Q4 52.3% (among those under 35 years 63.1% (95% CI: 61.3; 8) and in the over-55s 27.1% (95% CI: 24.0, 30.3), Q5 42.8% Excess salt intake decreases with age, by 32.7% 95% CI 31.1, 34.5 (under 35 years) to 22.5% (95% CI 19.7, 25.7) (over 55 years). Of the subjects never treated with antihypertensive agents, 50.8% (95% CI 49.3, 52.3) had a low risk of hypertension at 5 years, 36.9% (95% CI: 35.4, 38.3) had a possible risk, and 12.3% (95% CI). %: 11.4, 13.4) were at high risk. Among the treated patients, the prevalence of non-blood pressure control (BP > 140/90) was 53.3%. In a bakery workforce, almost a third of the cohort is suspected of excessive salt intake and 49.2% had a possible or high risk of hypertension at 5 years. The differences in eating behavior call for adapting prevention messages to excessive salt intake in order to participate to the prevention of hypertension in the French population. [ABSTRACT FROM AUTHOR]

The monitoring of hypertensives with a computerized medical file generates a quantity of data imposing the use of digital tools of Big data. The aim of this work was to describe a therapeutic change score (TCS) in hypertensives treated and followed in the long term in a specialized service in hypertension, and to develop a model for predicting the TCS. In 1,293 hypertensive patients followed for a median of 5.1 years, in a hospital consultation specialized in hypertension, 13 271 consultations were made. At each visit, the list of current antihypertensive treatments has been completed. Demographic data, medical history, clinical parameters with blood pressure measured in a standardized way with an electronic device by "automatic measurement" (SPRINT methodology) were obtained at each visit. The TCS was calculated at each visit with 0 in case of therapeutic stability and 1 in the case of change of at least one antihypertensive treatment or its dosage. Data has been anonymized and organized with the implementation of artificial intelligence tools (gradient tree boosting trees, neuronal network, Long Short Term Memory). A prediction model for the TCS has been developed and tested. The cohort included subjects aged 60 years with 57% men with 3 or more visits completed for 46% of subjects. At the initial visit 9.5% of the patients were in secondary prevention. The incidence of cardiovascular complications was 3.4% per year. Kaplan-Meyer analysis indicated a positive CTS in 70% of the subjects in the first year and 98% in the total duration of follow-up. The prediction model for the CTS retained 160 variables. This model allows the prediction of a change in antihypertensive prescription at the next visit with a true positive value of 92% and a negative predictive value of 77%. It was possible to create an artificial intelligence model from a hypertensive patient database followed-up in a hypertension excellence center. This model predicts a change in antihypertensive prescription at the next visit with an accuracy of 92%. The most relevant variables can be selected to integrate an e-health application which will aim, in treated hypertensives, to optimize the date of the next consultation to the doctor in charge of the follow-up of hypertension. [ABSTRACT FROM AUTHOR]

Objectifs L'hypertension du sujet noir est réputée comme étant plus difficile à prendre en charge. L'objectif de cette étude est d'évaluer si chez l'hypertendu la couleur de la peau est associée à des difficultés d'obtention du contrôle de la pression artérielle. Méthodes En 2015, des patients vus de façon consécutive pour la première fois en consultation dans une unité spécialisée en HTA d'un CHU d'Île-de-France ont été inclus. Chez 108 patients un suivi a été proposé comportant un bilan étiologique et du retentissement. Une adaptation des traitements a été réalisée si la PA n'était pas contrôlée en automesure (règle des 3). Le contrôle tensionnel a été jugé 4 semaines au moins après la première visite par la réalisation d'une deuxième automesure. Résultats La population a inclus 24 % de sujets noirs (N) originaire d'Afrique de l'Ouest ou des Antilles âgés de 50,3 ans, et 76 % de blancs (B) d'origine Européenne âgés de 55,2 ans. À la visite initiale, la PA en consultation était de 148,3/87,1 (N) vs 148,7/82,0 (B) (p < 0,001 pour la PAD) et en automesure de 143,5/90,1 (N) vs 135,6/82,2 (B) (p < 0,001 pour la PAS/PAD). Le bilan retrouve une HTA secondaire de façon comparable 7,6 % (N) vs 7,3 % (B) mais l'atteinte d'un organe cible est plus fréquente chez l'hypertendu noir 30,7 % vs 14,6 % (B). Au terme du suivi, la PA en automesure est à 129,3/83,3 (N) et 130,0/78,5 (B) (p < 0,001 pour la PAD), alors que le contrôle en automesure (PA < 135/85) est observé chez 41,7 % des hypertendus noirs et chez 54,3 % des hypertendus blancs. Conclusion Les hypertendus noirs qui consultent dans une unité spécialisée d'un CHU d'Île-de-France ont une PA plus élevée et une atteinte d'organe cible plus fréquente que les hypertendus blancs. Le contrôle de la PAD étant moindre, le pourcentage des patients contrôlés en automesure reste plus faible chez les hypertendus noirs. [ABSTRACT FROM AUTHOR]

Objectifs En 2010, l'enquête FLAHS a indiqué un contrôle de 50 % chez les hypertendus traités. Dans FLAHS 2015, l'objectif a été de réaliser une nouvelle estimation du contrôle de l'HTA chez les sujets âgés de 55 ans et plus vivant en France métropolitaine. Méthodes Les enquêtes FLAHS sont réalisées par auto-questionnaire 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). Un sujet indiquant la prise actuelle d'un antihypertenseur est considéré comme hypertendu traité. Chez les sondés disposant d'un appareil d'auto-mesure il a été demandé de réaliser un relevé sur 3 jours (règle des 3). La moyenne d'au moins 12 mesures sur 3 jours a conduit à classer chaque sujet comme « contrôlé » selon les seuils de 140/90 ou de 135/85. Résultats L'enquête a inclus 6 379 sujets dont 2 814 (44,1 %) traités par antihypertenseur. Une automesure a été obtenue chez 1 455 sujets dont 882 (60,6 %) traités par antihypertenseurs. Chez les HTA traitées, 55,4 % sont contrôlées avec une moyenne < 135/85 et 71,7 % avec une moyenne < 140/90. L'âge et le sexe sont deux déterminants de la performance du contrôle de la tension. Le contrôle est meilleur chez les femmes (60,3 %) que chez les hommes (50,1 %) et chez les sujets de 55-64 ans (57,6 %) que chez ceux de 80 ans et plus (49,1 %). Lorsque le seuil du contrôle en automesure est fixé chez les sujets de 80 ans et plus à une PAS < 145 la proportion de sujets contrôlés s'élève pour cette tranche d'âge à 74,7 % et le contrôle de l'HTA pour l'ensemble de la population des hypertendus traités et âgés de 55 ans plus vivant en France métropolitaine est de 61 %. Conclusion Le contrôle de l'HTA évalué par automesure sur une population représentative de sujets âgés de 55 ans et plus, vivant en France métropolitaine, est estimé entre 50,1 % et 74,7 % en relation avec l'âge et le sexe des sujets. Ces données indiquent une amélioration du contrôle tensionnel chez les hypertendus traités depuis l'enquête FLAHS réalisée en 2010. [ABSTRACT FROM AUTHOR]

Résumé Objectif Évaluer les conséquences du test ExSel ® sur la consommation de sel chez des hypertendus suivis en médecine générale. Méthode Dans un cabinet de médecine générale d’Île-de-France, le test ExSel ® http://www.comitehta.org/testez-vous/consommez-vous-du-sel-en-exces-test-exsel/ a été proposé à 329 consultants. Le questionnaire était rempli en salle d’attente, puis commenté par le médecin. Chez les hypertendus traités, le sodium urinaire sur recueil des 24 heures était demandé au décours de la consultation. La consommation excessive de sel (CES) était définie par un sodium urinaire ≥ 200 mmol/j. Résultats Des sujets âgés de 57 ans avec 43 % d’hypertendus ont été inclus. Selon ExSel ® , une CES est suspectée chez 36 % des patients et plus fréquente chez les hypertendus traités (44 % [36–52]) que chez les non-hypertendus (31 % [24–38]). La positivité est plus fréquente chez les hommes hypertendus (57 % [46–68]) que chez les femmes non hypertendus (18 % [11–25]). Le Na urinaire n’a été réalisé secondairement que par 63 % des hypertendus indiquant 157 ± 56 mmol chez les hommes et 123 ± 39 mmol chez les femmes. Sur cette évaluation du Na urinaire postérieure à ExSel ® , la fréquence de CES est plus faible chez les hommes (19 %) et très faible chez les femmes (5 %). Conclusion Pour estimer une CES, le test ExSel ® est facilement réalisé en médecine générale alors que le sodium urinaire des 24 heures est plus difficile à obtenir. La réalisation d’un questionnaire ExSel ® s’accompagne d’une diminution de la fréquence des consommateurs excessifs de sel avec un effet plus marqué chez les femmes. Objective To evaluate the impact of the Exsel ® test administration on salt intake in hypertensive subjects followed in general practice. Method In a group practice of general practitioners in the Île-de-France, the ExSel ® test http://www.comitehta.org/testez-vous/consommez-vous-du-sel-en-exces-test-exsel/ was administered to 329 outpatients. The questionnaire was filled in the waiting room and then commented by the doctor. In patients treated for hypertension, 24 hours urinary Na was prescribed after the consultation. Excessive salt consumption (ESC) was defined as a urinary Na ≥ 200 mmol/day. Results The population included subjects aged on average 57 years with 43 % of hypertensive patients. According Exsel ® , an ESC was suspected in 36 % of patients and was more common in treated hypertensive patients (44 %; [36–52]) in hypertensive men (57 %; [46–68]) than among non-hypertensive (31 %; [24–38]) and non hypertensive women (18 % [11–25]). Urinary Na has been finally performed by 63 % of subjects and 24 hours excretion was 157 ± 56 mmol in men and 123 ± 39 mmol in women. After this 24 hours urinary sodium evaluation, subsequent to ExSel ® test, ESC frequency was lower among men (19 %) and very low among women (5 %). Conclusion To estimate the ESC, the ExSel ® test is easily performed in general practice while 24 hours urinary sodium is more difficult to obtain. Achieving an ExSel ® test was accompanied by a decrease in the frequency of excessive salt consumers with a greater effect in women. [ABSTRACT FROM AUTHOR]

Résumé: L’objectif de cette enquête et de décrire les caractéristiques des possesseurs d’appareils de mesure de la pression artérielle (PA), représentatifs de la population française en 2012. Méthodes: Auto-questionnaire de quatre pages administrées par voie postale à 4500 individus de 35ans et plus. Résultats: Trois mille quatre cent soixante-deux sujets âgés de 56ans ont répondu au questionnaire : 1054 sujets étaient des hypertendus traités d’âge moyen 65,9ans et 2388 étaient non traités. Chez les individus traités, 41 % possèdent un appareil d’automesure tensionnelle (36 % en 2010), 15 % utilisent un appareil huméral et 26 % un appareil de poignet. Seulement 2 % des hypertendus traités mesurent leur PA avant une visite médicale, 49 % une fois de temps en temps, 11 % plusieurs fois par semaine et 4 % tous les jours ! Chez les 569 sujets possesseurs d’une automesure, 61 % sont hypertendus traités, 26 % normotendus, et 13 % hypertendus non traités. Les patients hypertendus traités sont contrôlés en automesure dans 50 % des cas (PA<135 et 85mmHg) (49 % en 2010). Conclusions: En 2012, on estime à sept millions le nombre d’appareils d’automesure utilisés en France dont quatre millions chez les hypertendus traités. Seulement 2 % des hypertendus possédant un appareil d’automesure l’utilisent correctement. Une meilleure éducation des hypertendus à l’automesure est donc nécessaire. Le contrôle des sujets hypertendus utilisant une automesure stagne à 50 %, incitant à améliorer notre stratégie thérapeutique en favorisant les plurithérapies. [ABSTRACT FROM AUTHOR]

Résumé: Objectifs: L’optique adaptative est une nouvelle technique non invasive permettant d’obtenir une imagerie des vaisseaux rétiniens dont la résolution de deux microns autorise la mesure du diamètre et de l’épaisseur des artérioles. L’objectif de cette étude a été d’évaluer la faisabilité et la reproductibilité de la méthode en clinique chez l’homme. Méthodes: Chez 23 sujets avec une hypertension artérielle non traitée et chez 14 sujets sains, les artères rétiniennes ont été visualisées par optique adaptative et l’analyse des images a été automatisée permettant la mesure du diamètre interne et de l’épaisseur pariétale sur un segment artériolaire de l’artère rétinienne temporale. À partir de ces paramètres, le rapport paroi/lumière (wall to lumen ratio [WLR]) et la surface cross-sectionelle de la paroi du vaisseau (wall cross sectional area [WCSA]) sont calculés. La reproductibilité intra-observateur a été évaluée en réalisant trois acquisitions consécutives chez 14 sujets. La reproductibilité inter-observateur a été évaluée en réalisant deux lectures indépendantes chez 17 sujets. Le coefficient de variation (CV) a été calculé comme SD/moyenne. Une comparaison des paramètres de l’artériole rétinienne entre les sujets hypertendus et les sujets sains a été réalisée. Résultats: Chez les 14 sujets sains, pour un diamètre interne de 56,1±9,6μm le WLR est à 0,259±0,035. La reproductibilité inter-observateur indique un CV à 1,3 % pour le diamètre interne, à 3,7 % pour le WCSA et à 3,2 % pour le WLR. La reproductibilité intra-observateur indique un CV à 3,2 % pour le WLR. Chez les hypertendus le WLR est significativement plus élevé (0,348±0,071 ; p <0,05) alors que le diamètre interne est comparable. Conclusion: L’évaluation de la morphologie des artérioles rétiniennes est faisable par l’optique adaptative. La reproductibilité inter- et intra-observateur est satisfaisante et compatible avec la réalisation d’études prospectives dans des pathologies comme l’HTA au cours de laquelle des propriétés structurales des vaisseaux rétiniens sont connus. [ABSTRACT FROM AUTHOR]

Objective Since January 2017, olmesartan-based treatments are no longer reimbursed by French health insurance. Health authorities have recommended switch to one of the “many effective, better tolerated and reimbursed alternatives”. The objective of this study was to evaluate the consequences on the prescription of antihypertensive drugs in France and to evaluate the blood pressure control of treated hypertensive patients after the switch from olmesartan to another Angiotensin receptor blocker (ARB). Methods To evaluate antihypertensive prescriptions, the French League Against Hypertension Survey (FLAHS) was conducted in 2007, 2012 and 2017 by self-questionnaire sent by mail to a representative panel of the population living in metropolitan France aged 35 years and over. Antihypertensive treatments were grouped by pharmacological class. To evaluate blood pressure control in hypertensive patients treated with olmesartan alone or in combination, 3 home blood pressure monitoring (HBPM) were performed. The first and the second were performed without modification of the dose of olmesartan. The third was performed 1 month after the switch to another ARB. Results Antihypertensive prescriptions changed between 2007 and 2017. Beta-blockers decreased between 2007 and 2012 and then increased slightly. Between 2012 and 2017, ARB and diuretics decreased and ACE inhibitors (ACE-I) and calcium antagonist (CA) drugs increased. Blood pressure control was assessed in 82 hypertensive patients aged 63 ± 11 years treated with olmesartan. The difference in SBP/DBP between the first 2 self-measurements was −0.96/−0.83 mmHg. After therapy switch, the 3rd self-measurement showed an increase in SBP/DBP of 3.4/1.2 mmHg. In the subgroup of olmesartan-treated controlled hypertensive patients, the switch to another ARB lead to uncontrolled hypertension for 20% of patients with a 12.1 mmHg increase in SBP. Conclusion With the halt of reimbursement of olmesartan, there was a decrease in the prescription of ARB in France. When olmersartan was replaced by another ARB, a worse blood pressure control was observed in treated hypertensive patients. The cessation of the reimbursement of olmesartan has had consequences on the treatment of hypertension in France. [ABSTRACT FROM AUTHOR]

Background and aim Baroreceptor activation therapy (BAT) leads to a decrease in blood pressure (BP) in patients affected by resistant hypertension (RH) by reducing sympathetic outflow. This study aimed at evaluating the effects of BAT on RH patients’ retinal arteriolar microvasculature, a territory devoid of adrenergic innervation. Patients and methods Five patients defined as affected by RH after excluding secondary causes of hypertension and based on number of antihypertensive treatments, underwent the implantation of Barostim™ neo ™. Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP) were assessed by office and 24-hours ambulatory BP monitoring (ABPM). Adaptive Optics Camera RTX1 ® (ImagineEye, Orsay, France) was used to measure wall thickness (WT), internal diameter (ID), wall cross-sectional area (WCSA) and wall-to-lumen ratio (WLR). A cohort of 21 not-controlled hypertensive patients matched for age, gender and follow-up time, undergoing standard-antihypertensive therapy changes, was selected as a control group. SBP and DBP were assessed by office and home BP monitoring (HBPM). Evaluations were performed at baseline and after 6 months mean follow-up. Results Office SBP decreased by 9.7 ± 12.3% and 29.7 ± 12.4% in standard-therapy and BAT group respectively, while office DBP decreased by 7.6 ± 17.4% and 14.8 ± 15.7%. Concerning ABPM/HBPM, a mean reduction of both SBP and DBP of 7.9 ± 11% was observed for the standard-therapy while a reduction of 15.8 ± 10.5% and 15.8% ± 5.3% was observed for SBP and DBP respectively in BAT group. While in the standard-therapy group a significant reduction in WLR (–5.9%) due to both ID increase (+2.3%) and WT reduction (–5.7%) was observed, without changes in WCSA (–0.3%), RH patients had a significant reduction in WCSA (–12.1%), due to a trend in both WT and ID reduction (–6.5% and –1.7% respectively), without significant changes in WLR (–2%). Conclusion While a reverse eutrophic remodeling was observed in patients undergoing a standard-antihypertensive treatment, hypotrophic changes were found in RH patients undergoing BAT. Despite the lack of adrenergic receptors on retinal vessels, chronic baroreflex stimulation may exert an effect on retinal microvasculature in RH patients by more systemic than local mechanisms. [ABSTRACT FROM AUTHOR]

Aim To research a retinal arterioles wall-to-lumen ratio or lumen diameter cut-off that would discriminate hypertensive from normal subjects using adaptive optics camera. Patients and methods One thousand and five hundred subjects were consecutively recruited and Adaptive Optics Camera rtx1™ (Imagine-Eyes, Orsay, France) was used to measure wall thickness, internal diameter, to calculate wall-to-lumen ratio (WLR) and wall cross-sectional area of retinal arterioles. Sitting office blood pressure was measured once, just before retinal measurements and office blood pressure was defined as systolic blood pressure > = 140 mmHg and diastolic blood pressure > = 90 mmHg. ROC curves were constructed to determine cut-off values for retinal parameters to diagnose office hypertension. In another population of 276 subjects office BP, retinal arterioles evaluation and home blood pressure monitoring were obtained. The applicability of retinal WLR or diameter cut-off values were compared in patients with controlled, masked, white-coat and sustained hypertension. Results In 1500 patients, a WLR > 0.31 discriminated office hypertensive subjects with a 0.57 sensitivity and 0.71 specificity. Lumen diameter < 78.2 μm discriminated office hypertension with a 0.73 sensitivity and a 0.52 specificity. In the other 276 patients, WLR was higher in sustained hypertension vs normotensive patients (0.330 ± 0.06 vs 0.292 ± 0.05; P < 0.001) and diameter was narrower in masked hypertensive vs normotensive subjects (73.0 ± 11.2 vs 78.5 ± 11.6 μm; P < 0.005). Conclusion A WLR higher than 0.31 is in favour of office arterial hypertension; a diameter under < 78 μm may indicate a masked hypertension. Retinal arterioles analysis through adaptive optics camera may help the diagnosis of arterial hypertension, in particular in case of masked hypertension. [ABSTRACT FROM AUTHOR]

Objectifs Le questionnaire X-SALT ® a été mis au point sur une population d'hypertendus suivis dans un service hospitalier. Sa positivité permet de dépister une consommation excessive de sel (CES) de plus de 12 g par jour avec une VPP à 0,75 et une VPN à 0,92. Evaluer la performance du X-SALT ® sur une population de sujets suivis en médecine générale et au cours de la consultation est l'objectif de cette étude. Méthodes Au cours du premier semestre de 2015, X-SALT ® a été proposé à 329 patients consultants dans un cabinet de groupe de médecins généralistes d'Île-de-France. Le questionnaire était distribué dans la salle d'attente. Chez les sujets traités pour une HTA, un diabète ou en prévention secondaire, une prescription pour réaliser un recueil urinaire sur 24 heures était effectuée, et il était demandé de la réaliser dans les jours suivants la consultation. Le sodium et la créatinine urinaire par litre et par 24 heures étaient dosés. Une consommation excessive de sel (CES) était suspectée si la valeur du test X-SALT ® était supérieure ou égale à 5. Si le sodium urinaire des 24 heures était supérieur ou égal à 200 mmol, la CES était affirmée. Résultats La population a inclus des sujets âgés en moyenne de 57 ans avec 43 % d'hypertendus et 12 % de DT2 et 9 % de patients en prévention secondaire. Selon X-SALT ® , une consommation excessive de sel est suspectée chez 36,4 % des patients. Chez les sujets éligibles pour réaliser le recueil urinaire, seuls 63 % des patients ont réalisé l'examen. Chez 104 sujets, un recueil sur 24 heures a été obtenu, et une CES a été observée chez 15 % alors que X-SALT ® était positif chez 50,9%. Dans cette population, si le seuil de 5 pour la positivité du test X-SALT ® est retenu il est noté une VPP de 0,19 et une VPN de 0,90. Conclusion Le dépistage d'une consommation excessive de sel en consultation de médecine générale a été bien accepté par la réalisation du test X-SALT ® en salle d'attente, alors que la demande de réalisation d'un recueil urinaire des 24 heures n'a été effectuée que par 63% des patients. Chez les patients suivis en médecine générale, une négativité au test X-SALT ® permet d'éviter de demander la réalisation d'un dosage urinaire du sodium car la probabilité sera très faible de mettre en évidence une CES. [ABSTRACT FROM AUTHOR]

Résumé: Pour améliorer la prise en charge de l’HTA dans la population des sujets vivant en France, la Société française d’HTA propose une mise à jour en 2013 des recommandations pour la prise en charge de l’HTA de l’adulte. Ce texte a été conçu pour être utile à la pratique dans une forme synthétique afin de permettre sa bonne lisibilité. Son objectif est d’obtenir une large diffusion auprès des professionnels de santé et de la population des sujets traités. Une évaluation sur son impact auprès des professionnels de santé et sur les objectifs de santé publique sera mise en œuvre. Ces recommandations comportent 15 conseils à appliquer au cours de 3 périodes observées dans le suivi d’un hypertendu. Avant de débuter le traitement: (1) Confirmer le diagnostic, avec mesures tensionnelles en dehors du cabinet médical. (2) Mettre en place les mesures hygiénodiététiques. (3) Réaliser un bilan initial. (4) Organiser une consultation d’information et d’annonce de l’HTA. Plan de soin initial (6 premiers mois): (5) Objectif principal : contrôle de la pression artérielle dans les six premiers mois (PAS : 130–139 et DBP<90mmHg). (6) Privilégier cinq classes d’antihypertenseurs qui ont démontré une prévention des complications cardiovasculaires chez les hypertendus. (7) Choix individualisé du premier traitement antihypertenseur, tenant compte notamment de la persistance. (8) Privilégier les bithérapies (fixes) en cas d’échec de la monothérapie, puis une trithérapie si nécessaire. (9) S’assurer de la bonne tolérance. Plan de soin à long terme: (10) HTA non contrôlée à six mois sous trithérapie : avis spécialisé après avoir vérifié la bonne observance et l’HTA en dehors du cabinet médical. (11) En cas d’HTA contrôlée, visite tous les trois à six mois. (12) Dépister la mauvaise observance des traitements antihypertenseurs. (13) Favoriser la pratique de l’automesure tensionnelle. (14) Après 80ans, objectif PAS inférieure à 150mmHg modulé sans dépasser trois antihypertenseurs. (15) Après complication cardiovasculaire, ajustement des traitements et maintien de l’objectif tensionnel. Avec la diffusion de ces recommandations et leur mise en application, il est souhaité que 70 % des sujets hypertendus traités soient contrôlés pour leur pression artérielle en 2015 en France. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To evaluate in hypertensive patients followed in a specialized hypertension unit, the prevalence of subjects uncontrolled despite triple therapy including a diuretic. The aim is to estimate the percentage of hypertensive patients with an indication to renal denervation. Method: From a database of computerized medical records of a unit specialized in hypertension, it was extracted 144 consecutive cases of subjects treated and followed for at least 1year and having had a home pressure monitoring (HPM) on treatment, and if necessary a work-up for a secondary hypertension. The blood pressure (BP) was evaluated in office by automated method (after 2 and 8minutes) and with HPM (average of three measurements in the morning and evening for three consecutive days). Results: The population has the following characteristics: age 62 with 26% over 70years, treated dyslipidemia (39%), treated diabetes (11%), adrenal hypertension treated medically (14%), severe renal failure (3%). The means of treatment are: a monotherapy (33%), bitherapy (35%), triple therapy (17%), quadritherapy (7%), pentatherapy or more (1%), spironolactone (45%), thiazide diuretics (49%). The uncontrolled hypertension was observed in 26% if the BP is evaluated with HPM, in 52% if the BP is evaluated at the office after 2minutes of rest and 7% if the BP is evaluated after 8minutes of rest (P <0.01). In patients treated with at least a tritherapy in association with a diuretic, an uncontrolled hypertension was observed in 5% if the BP is evaluated with HPM. Failure to control for the SBP is the cause of 80% of resistant hypertension. Conclusion: The frequency of resistant hypertension is 5% of hypertensive patients followed in a specialized hypertension unit when guidelines are applied in the case of uncontrolled hypertension. These results indicate that the indication for renal denervation affects only a small percentage of patients treated for hypertension. [Copyright &y& Elsevier]

Abstract: Objectives: To evaluate the influence of hospitalization on drug prescription in chronic conditions. Methods: Admission and discharge prescriptions from 92 patients consecutively admitted in a specialized department of the Assistance Publique–Hôpitaux de Paris hospital were recorded in a prospective two-month study. A Qualitative Therapeutical Score (QTS) was calculated as an estimation of qualitative modifications in the prescription. Results: Patients admitted for an hospital stay of over 24h have more lines of prescription than patients admitted for an hospitalization shorter than 24h (5.7±4.2/d vs 2.9±2.5/d, P <0.01). For all the patients enrolled, the hospital stay is not associated with any change in the global number of treatments. However, in patients treated with antihyperstensive drug, the number of drug intakes decreases (2.6±1.5/d vs 1.9±1.4/d, P <0.05) as a consequence of an increase in the prescription of fixed-dose combinations. In patients with cardiovascular diseases, the QTS is higher and qualitative modifications are more often found in patients admitted for an hospital stay of over 24h than for those admitted for a an hospitalization shorter than 24h (0.57 vs 0.11; P <0.01 and 31% vs 11%; P <0.05 respectively). Antihypertensive drugs are the most represented drugs within these qualitative modifications. Conclusion: In patients with drug treatments for arterial hypertension or chronic conditions, hospitalization is not associated with quantitative but with qualitative modifications, especially for an over 24h hospital stay. [Copyright &y& Elsevier]

Abstract: Objective: To evaluate the blood pressure (BP) control and the efficacy of antihypertensive monotherapy using home BP self-measurement in a French population of treated hypertensive subjects in 2007 2009 and 2010. 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 2007, 2009 and 2010 surveys, a sample of 1467 subjects who owned a BP self-measurement device and performed three consecutive morning BP measurements were included. Among the 60% of subjects who reported taking at least one antihypertensive drug, we analyzed subjects treated with one of the following antihypertensive monotherapy, i.e., beta-blocker (BB), ACE inhibitors, calcium channel blocker (CCB) and angiotensin receptor blockers (ARB). Results: Among treated hypertensive subjects (n =886), 66% (n =586) had home BP below the 140/90mmHg threshold and 50% (n =449) below 135/85mmHg. Three hundred two subjects were treated with a single antihypertensive drug, 33% had ARB, 25% BB, 19% CCB and 13% ACE inhibitors. Age (years) for each treatment group is different (P <0.01) CCB (72.1±9.3), BB (65.6±9.8), ARB (68.6±8.9) and ACEI (67.3±10.2). The mean systolic/diastolic BP (mmHg) is not comparable between monotherapy 130.7/76.1 (ARB), 130.7/78.7 (BB), 134.0/75.2 (CCB) and 139.1/80.3 (ACEI) for ARB, BB, CCB and ACE inhibitors respectively. Compared to ACE inhibitors, BP was significantly lower with ARB (P <0.01). The proportion of subjects with a BP below 140/90mmHg was 73% for ARB, 52% for BB, 68% for CCB and 47% for ACE with a statistical significance (P =0.03) for ARB vs. ACEI and CCB vs. ACEI. Conclusion: Among subjects treated for hypertension who owned a BP self-measurement device, 50 to 66% had a controlled BP (depending on the threshold used). It is observed differences between antihypertensive efficacy of monotherapy with a larger number of patients controlled with ARB or CCB. [Copyright &y& Elsevier]

Abstract: Objective: To evaluate the variability in blood pressure observed during office visit in treated hypertensive patients and its consequences on the diagnosis of controlled hypertension. Method: The medical records of 144 subjects seen consecutively in a hypertension excellence center were extracted from a computerized medical database including hypertension subjects treated and followed-up for at least one year. BP measured with an automatic device (four consecutives measurements at 2min intervals) where compared to BP values of home BP performed in the previous week''s visit. Thresholds were 140/90mmHg for office BP and 135/85mmHg for HBP. Results: The population has the following characteristics: age 62 years with 26% over 70 years, treated with a monotherapy (33%), bitherapy (35%), triple therapy (17%), quadri-therapy or more (8%). A white coat effect SBP above 20mmHg was noted in 32% of patients when BP at 2min is taken and in 2% when BP at 8min is taken (P <0.01). After 8min, a masked effect is noted in 16% for SBP above 20mmHg and in 44% for DBP above 10mmHg. White coat hypertension or masked hypertension was noted in 40% or 16% respectively (BP 2min) and in 5% or 29% (BP 8min) in treated hypertensive. Conclusion: In treated hypertensive, office BP measured by an automatic device shows significant variability. When the BP is taken with an automatic device, measures taken after 8minutes of rest avoid the misleading effects of white coat effect, but the masked hypertension is present in nearly one third of the subjects. The use of AMT for monitoring hypertensive patients is the best way to monitor treatment efficacy. [Copyright &y& Elsevier]

Abstract: The prevalence of hypertension resistant to treatment to indicate for renal denervation. Objective: To evaluate the efficiency for imaging the adrenal glands with an abdominal CT scan in first-line in subjects with resistant hypertension suspected to have an adrenal cause. Methods: On 75 hypertensive patients uncontrolled by at least a combination therapy, but suspected to have secondary hypertension due to adrenal cause, an abdominal CT scan was performed in first intention. In all subjects, an exploration of the renin-aldosteron axis in standardized conditions, a 24-hour urinary cortisol and a WHO recommended biological analysis were also performed. Results: An abnormal morphology of adrenal was found by abdominal CT in 64% of patients. The abnormalities observed were: bilateral hyperplasia (27%), unilateral adenoma (15%), unilateral hyperplasia (15%), bilateral adenoma (7%). Abnormal biological and/or hormonal tests for adrenal disease were found in 29% of patients, with a primary aldosteronism (A/R corrected>23) in 11% or K less than 3.5mmol/L in 20%. According to the assessment conducted in first-line, indication to spironolactone is selected in 48% of patients investigated with CT as first-line and in 17% of patients investigated with biological tests (P <0.01) while the indication to adrenal surgery would be held in 15% and 11% of patients respectively. Conclusion: In a population of subjects with uncontrolled hypertension in which an adrenal cause is suspected, achieving a first-line abdominal CT leads to adrenal abnormality observed in 64% of patients while a specific biological abnormality is noted in 29% of subjects. This study shows that assessment that starts with an abdominal CT scan allows to indicate treatment with spironolactone more frequently than when the first assessment is limited to a biological investigation. [Copyright &y& Elsevier]

Abstract: Objectives: To estimate life style and drug therapy for treatment of hypertension in Guadeloupe (FWI) in 2005, and to compare the data with those obtained in a similar study realised in France metropolitan population in 2004. Methods: A cross-sectional study of a sample of 509 subjects selected as being representative of the Guadeloupe population for age (35 years and above), gender, socioeconomic status, and place of living. Subjects who declare to take an antihypertensive medication were classified as treated hypertensive patients. A questionnaire evaluating changes in life style during the last year (physical activities, quality of food consumption, smoking, and alcohol habits) was administered by phone. Results: In 2005, 32% of the population above the age of 35 years was treated for hypertension, corresponding to an estimate of 51,230 subjects. Hypertensive subjects experienced: a weight loss of more than 3 kg in 29 vs 25% in the general population, an increased in fruits and vegetables consumption in 29 vs 46%, a decreased in cheese (11 vs 8%), pork-butchery (23 vs 16%) and alcohol consumption (10 vs 6%). The percentage of subjects who increased their physical activities was not different in the two groups (24 vs 25%). We observed a larger use of diuretics and ACE-I/ARBs prescribed as combined drugs. The most frequent drug prescribed as single drug is calcium antagonist. When the patients are receiving at least two medications or more (41%), combined treatment is found with high frequency (75%). Conclusion: Changes in life style were more often applied by the subjects treated for hypertension that by the general population. The dominating place that occupies today fixed-dose combination drugs indicates a change of the therapeutic practices. When comparing with FLAHS study concerning the French metropolitan population, diuretics and calcium antagonist are more often prescribed in Guadeloupe, in witch 90% of the population is Afro-Caribbean. [Copyright &y& Elsevier]

In subjects with essential hypertension, increased cardiac and radial artery mass are positively associated. The mechanical factor that contributes in the larger extent to their enhancement is pulse pressure, not mean arterial pressure. [ABSTRACT FROM AUTHOR]

Background Microvascular vessels and microvascular remodeling play a major role in blood pressure (BP) regulation and peripheral tissue oxygen delivery. The adaptive optics camera (AOC), a novel technique of fundus image analysis enables the noninvasive characterization of microvascular remodeling in the retina on a large scale. Our objective was to assess the role of Blood Pressure (BP), ageing, diabetes and other risk factors on retinal arteriolar remodeling using AOC. Methods In 1.000 consecutive subjects in primary prevention with risk factors, we used the new RTX1 ® AOC (Imagine-Eyes, Orsay, France) and a semi-automated segmentation software to measure Wall Thickness (WT), Internal Diameter (ID) and to calculate Wall-to-Lumen Ratio (WLR) and Wall Cross Sectional Area (WCSA) on retinal arteriolar microvasculature. BP was assessed on standard conditions using oscillometric device during the AOC assessment. Hypertension was defined as the presence of Systolic BP>140mmHg and/or Diastolic BP>90mmHg. Standardized clinical and biological examinations were performed to assess for the presence of diabetes, dyslipidemia, obesity and current smoking which were defined according to guidelines. Results Overall, ageing was associated with an increase in WLR due to sole WT increase. Subjects with office hypertension (n = 313) had inward eutrophic remodeling with increased WLR (0.325±0.049 vs 0.292±0.056) due to higher WT, lower ID and overall stable WCSA. Diabetics (n = 180) presented with hypertrophic remodeling indicated by higher WLR due to a significant increase in WT and WCSA concomitant to a normal BP. There was no significant remodeling associated with other cardiovascular risk factors. In multivariate analysis, BP and age remained independent positive correlates of WLR and WT whereas age had no influence on ID and only BP negatively correlated to ID Abstract CO-01 – Table N Retinal Arteriolar Microvasculature Blood Pressure WLR ID.-μm WT.-μm WCSA.-μm 2 Systolic BP.-MmHg Diastolic BP.-MmHg Gender Female 489 0.301 ± .0.50 79.0 ± 10.9 23.5 ± 3.6 3386 ± 817 * 129.5 ± 21.2 72.2 ± 13.7 Male 511 0.300 ± .0.57 77.3 ± 11.1 22.89 ± 4.2 3234 ± 886 132.2 ± 19.4 71.5 ± 13.8 Hypertension Yes 313 0.325 ± .0.49 ‡ 75.6 ± 10.9 † 24.2 ± 4.0 ‡ 3392 ± 832 153.1 ± 16.1 ‡ 82.1 ± 14.8 ‡ No 687 0.292 ± .0.56 78.6 ± 10.8 22.7 ± 3.6 3249 ± 873 120.8 ± 12.4 67.1 ± 10.3 Diabetes Yes 180 0.308 ± .0.52 79.5 ± 11.2 24.2 ± 3.8 ‡ 3523 ± 861 † 134.4 ± 19.6 70.8 ± 13.6 No 820 0.299 ± .0.55 77.8 ± 11.2 23.0 ± 3.9 3256 ± 844 130.2 ± 20.5 72.1 ± 13.9 Dyslipidemia Yes 436 0.301 ± .0.57 77.6 ± 11.1 23.3 ± 4.1 3333 ± 828 130.4 ± 20.0 69.4 ± 12.2 ‡ No 564 0.301 ± .0.53 78.6 ± 11.1 23.2 ± 3.7 3281 ± 886 131.3 ± 20.6 73.7 ± 14.6 Obesity Yes 164 0.303 ± .0.55 77.0 ± 11.4 23.2 ± 3.9 3255 ± 838 136.1 ± 20.3 ‡ 76.3 ± 13.2 ‡ No 836 0.300 ± .0.55 78.2 ± 10.8 23.1 ± 3.9 3307 ± 838 129.3 ± 20.3 70.5 ± 13.7 WLR is Wall-to-Lumen Ratio, ID is internal Diameter, WT is Wall Thickness, WCSA is Wall Cross Sectionnal Area, BP is blood pressure * p<.01 † p<001 ‡ p<.0001 between groups Conclusions Hypertension, age and diabetes are associated with increase in WLR and WT. Assessment OF WT and ID are mandatory to perform a correct interpretation of WLR increase. OAC could represent a promising tool for interventional studies on treatment-induced remodeling regression. [ABSTRACT FROM AUTHOR]

Background A recently developed non-invasive opto-electronic technology (Adaptive Optics Camera, AOC) provides a morphologic analysis of the retinal arteriolar tree. Coupled with a validated semi-automated segmentation software it allows reproducible and reliable measurements of wall thickness (WT), internal diameter (ID), wall cross sectional area (WCSA) and calculation of wall-to-lumen ratio (WLR). Our aim was to assess the determinants of WLR along the temporal retinal artery and in case of acute Blood Pressure (BP) rise or drug-induced short term BP drop. Methods We studied 3 groups of patients : 1/ We consecutively enrolled 48 patients and calculated WLR before the first bifurcation (parental vessel) and on its large and small post-bifurcation branches on the right eye temporal superior artery. 2/ In a subgroup of 10 patients WLR was measured at rest and right after exercise dynamic test. 3/ In 55 hypertensive subjects AOC assessment was repeated after a median of 49 days in 27 subjects with stable BP and 38 days in 28 subjects with a drop in BP secondary to antihypertensive drug adaptation. WT and ID were directly measured using non-invasive rtx1 ® AOC (ImagineEyes-Orsay, France) and a dedicated software analysis system was used to calculate WLR and WCSA. BP was measured at the time of AOC examination in standard conditions. Hypertension was defined as the presence of Systolic Blood Pressure (SBP)>140 mmHg and/or Diastolic blood pressure (DBP)>90 mmHg. Results 1/ In the first group, in both normo- and hypertensive patients, a significant decrease in ID, WT and WCSA was observed on post-bifurcation branches whereas WLR remained constant (table 1, next page). 2/ In the second group, while SBP acutely increased of 47±8 mmHg, ANOVA analysis did not show any significant changes in WLR. 3/ At 6 weeks, in the follow-up group with a short-term SBP drop (–19.3±7.7%), a decrease of WLR (–7.0±8.0 mmHg) due to ID increase (+5.6±5.9%) without significant changes in WT and WSCA were observed. No changes were observed in the group with a stable BP (see table next page). Conclusions WLR, the index of remodeling in retinal small arteries, is constant along the arterial tree despite changes in WT and ID. While WLR did not change during acute exercise-induced BP surge, it decreased due to a ID increase after a short-term drug-induced BP drop. Those results confirm the homogeneity of remodeling along the retinal arteriolar tree and that mechanisms of BP changes have different effects on remodeling. P4-33 – Tableau : Retinal arteriolar microvascular indices in parental vesse, large and small branches Parental Vessel Large Branch Small Branch p Wall to lumen ratio 0.295±0.051 0.296 ± 0.064 0.317±0.071 NS Internal diameter - μm 79.8012±9.23 71.0716±10.78 ¥ 54.498±8.05 * † <0.001 Wall Thickness - μm 23.4015±4.12 20.7199±4.13 § 17.1838±4.31 * † <0.001 Wall Cross Sectionnal Area - μm 3376.34±849.73 2680.75±775.56 ¥ 1891.40±1110.74 * † <0.001 Small branch vs parental vessel: * p<0.001. Small branch vs large branch: † p<0.001. Large branch vs parental vessel: § p<0.05; ¥ p<0.01 [ABSTRACT FROM AUTHOR]