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Resume Le renimome (ou tumeur de l’appareil juxta-glomerulaire) est une cause rare mais curable d’hypertension arterielle secondaire. Nous rapportons l’observation d’une femme de 18 ans hospitalisee pour un complement d’exploration devant une hypertension arterielle persistante avec hypokaliemie et hyperaldosteronisme secondaire. Une exploration tomodensitometrique et echographique avait ete realisee il y a 2 ans mais n’avait trouve aucune explication a la symptomatologie. Au cours de l’hospitalisation, une IRM et un catheterisme de veines renale avec prelevement in situ ont mis en evidence une lesion nodulaire du pole inferieur du rein droit et des valeurs elevees de renine au niveau de la branche inferieure de la veine renale droite. Apres resection chirurgicale, l’analyse anatomopathologique confirma le diagnostic de reninome et la tension arterielle de la patiente se normalisa.

Clinic-ambulatory blood pressure (BP) difference is influenced by patients- and device-related factors and inadequate clinic-BP measurement. We investigated whether nonadherence to antihypertensive medications may also influence this difference in a post hoc analysis of the DENERHTN trial (Renal Denervation for Hypertension). We pooled the data of 77 out of 106 evaluable patients with apparent resistant hypertension who received a standardized antihypertensive treatment and had both ambulatory BP and drug-screening results available at baseline after 1 month of standardized triple therapy and at 6 months on a median of 5 antihypertensive drugs. After drug assay samplings on study visits, patients took their antihypertensive treatment under supervision immediately after the start of the ambulatory BP recording, and supine clinic BP was measured 24 hours post-dosing; both allowed to calculate the clinic minus daytime ambulatory systolic BP (SBP) difference (clinic-SBP–day-SBP). A total of 29 (37.7%) were found nonadherent to medications at baseline and 38 (49.4%) at 6 months. At baseline, the mean clinic-SBP–day-SBP difference in the nonadherent group was 12.7 mm Hg (95% CI, 7.8–17.7 mm Hg, P P =0.947). Similar observations were made at 6 months. Using receiver operating characteristics curves, we found that a 6 mm Hg cutoff of clinic-SBP–day-SBP difference had 67% sensitivity and 69% specificity to predict nonadherence to the triple therapy at baseline. In conclusion, a large clinic-SBP–day-SBP difference may help discriminating between adherence and nonadherence to treatment in patients with resistant hypertension. Clinical Trial Registration— URL: https://www.clinicaltrials.gov . Unique identifier: NCT01570777.

International audience; BACKGROUND: Diet strongly influences cardiovascular risk. Dietary evaluation is a major issue in cardiovascular prevention, but few simple tools are available. Our team previously validated a short food frequency questionnaire; a new version of this questionnaire (Cardiovascular Dietary Questionnaire 2 [CDQ-2]) is easier to complete and more reliable. AIMS: To validate CDQ-2 in comparison with the original version, and to test its reproducibility. METHODS: CDQ-2 has 17 closed-ended questions; it provides a global dietary score that is a combination of specific scores for saturated, monounsaturated and omega-3 fatty acids, and fruit and vegetables. CDQ-2 was validated against the original version in two groups, who completed both questionnaires: 99 patients with cardiovascular risk factors and 50 healthy subjects. Reproducibility was assessed with 27 health professionals who completed the questionnaire twice, with a 1-month interval. RESULTS: The correlation coefficients of the scores between the two questionnaires ranged from 0.65 (monounsaturated fatty acids) to 0.93 (fruit and vegetables) (all P

International audience; Objective: Several guidelines call for blood pressure (BP) measurement on a bare arm, which is not always easy. This systematic review aims to synthesize existing evidence concerning the effect of a sleeve on BP measurement.Methods: Pubmed and Embase were searched for cross-sectional studies comparing BP values measured on a bare arm, over a sleeve or below a rolled-up sleeve. A meta-analysis was conducted on available data.Results: Thirteen articles were selected from 720 references. All studies reported office BP values, 12 compared measurements on a bare arm and on a sleeve, and four also performed measurements below a rolled-up sleeve, with heterogeneous sleeve types and thicknesses. Most studies had a high risk of bias. Three studies showed a small overestimation of BP measured over a sleeve, but the remaining 10 studies did not find statistically significant differences between measurements. Meta-analysis showed a nonsignificant 0.59 mmHg [95% confidence interval (CI) -0.11 to +1.30; P = 0.10] overestimation of SBP measured over a sleeve when the thinnest sleeve was considered for studies that investigated various thicknesses, a nonsignificant 1.10 mmHg (95% CI -0.21 to +2.40; P = 0.10) overestimation of SBP when the thickest sleeve was considered, and a nonsignificant 2.76 mmHg (95% CI -0.96 to +6.47; P = 0.15) overestimation of SBP measured below a rolled-up sleeve.Conclusion: Measuring BP over a thick sleeve in the office may result in a small overestimation of recorded values but measuring over a thin sleeve does not appear to have a significant impact and, in any case, should be preferred to rolling it up.

Objectifs La surrenalectomie est le traitement de reference en cas de diagnostic de pheochromocytome. Toutefois cette chirurgie est a risque, notamment de poussee d’hypertension arterielle (HTA) peroperatoire. L’objectif de cette etude etait de rapporter les complications de la surrenalectomie pour pheochromocytome et de rechercher les facteurs predictifs de poussee d’HTA peroperatoire. Methodes Tous les patients ayant eu une surrenalectomie pour pheochromocytome dans un centre entre 2006 et 2019 ont ete inclus dans une etude retrospective. Le protocole de preparation preoperatoire incluait de l’Eupressyl IVSE. Le critere de jugement principal etait la survenue de fluctuations hemodynamiques (FLUCTHEM) definies comme pression arterielle (PA) systolique > 160 mmHg ou diastolique Resultats Soixante-quinze patients ont ete inclus. Cinquante-huit patients ont presente des FLUCTHEM (77,3 %) avec une mediane de 2 episodes par patients d’une duree moyenne totale de 23 minutes. Trois patients ont presente un DYSRYTHM peroperatoire. Il y a eu 14 complications postoperatoires (18,7 %), mais uniquement cinq Clavien 3 (6,7 %). Il y a eu cinq complications cardiovasculaires postoperatoires : une embolie pulmonaire (1,3 %), deux syndromes coronariens aigus (2,7 %) et deux œdemes aigues du poumons (2,7 %). Ces patients avaient un nombre median d’episodes de FLUCTHEM plus important (3 vs 2 ; p = 0,11). Les seuls facteurs associes a la survenue de FLUCTHEM en analyse univariee etait la taille de la lesion (OR = 1,03 ; p = 0,03), le taux de normetanephrines urinaires (OR = 1,01 ; p = 0,03) et l’existence d’une HTA anterieure (OR = 4,41 ; p = 0,04) ( Tableau 1 ). Conclusion La survenue de FLUCTHEM durant la surrenalectomie pour pheochromocytome est frequente mais ne s’accompagne que de rares complications en particulier cardiovasculaires. Toutefois, il pourrait exister un lien entre FLUCTHEM et complications cardiovasculaires postoperatoires et les mesures permettant de limiter les FLUCTHEM paraissent donc d’interet.

The DENERHTN trial (Renal Denervation for Hypertension) confirmed the blood pressure (BP) lowering efficacy of renal denervation added to a standardized stepped-care antihypertensive treatment for resistant hypertension at 6 months. We report here the effect of denervation on 24-hour BP and its variability and look for parameters that predicted the BP response. Patients with resistant hypertension were randomly assigned to denervation plus stepped-care treatment or treatment alone (control). Average and standard deviation of 24-hour, daytime, and nighttime BP and the smoothness index were calculated on recordings performed at randomization and 6 months. Responders were defined as a 6-month 24-hour systolic BP reduction ≥20 mm Hg. Analyses were performed on the per-protocol population. The significantly greater BP reduction in the denervation group was associated with a higher smoothness index ( P =0.02). Variability of 24-hour, daytime, and nighttime BP did not change significantly from baseline to 6 months in both groups. The number of responders was greater in the denervation (20/44, 44.5%) than in the control group (11/53, 20.8%; P =0.01). In the discriminant analysis, baseline average nighttime systolic BP and standard deviation were significant predictors of the systolic BP response in the denervation group only, allowing adequate responder classification of 70% of the patients. Our results show that denervation lowers ambulatory BP homogeneously over 24 hours in patients with resistant hypertension and suggest that nighttime systolic BP and variability are predictors of the BP response to denervation. Clinical Trial Registration— URL: https://www.clinicaltrials.gov . Unique identifier: NCT01570777.

International audience; BACKGROUND:Conflicting blood pressure-lowering effects of catheter-based renal artery denervation have been reported in patients with resistant hypertension. We compared the ambulatory blood pressure-lowering efficacy and safety of radiofrequency-based renal denervation added to a standardised stepped-care antihypertensive treatment (SSAHT) with the same SSAHT alone in patients with resistant hypertension.METHODS:The Renal Denervation for Hypertension (DENERHTN) trial was a prospective, open-label randomised controlled trial with blinded endpoint evaluation in patients with resistant hypertension, done in 15 French tertiary care centres specialised in hypertension management. Eligible patients aged 18-75 years received indapamide 1·5 mg, ramipril 10 mg (or irbesartan 300 mg), and amlodipine 10 mg daily for 4 weeks to confirm treatment resistance by ambulatory blood pressure monitoring before randomisation. Patients were then randomly assigned (1:1) to receive either renal denervation plus an SSAHT regimen (renal denervation group) or the same SSAHT alone (control group). The randomisation sequence was generated by computer, and stratified by centres. For SSAHT, after randomisation, spironolactone 25 mg per day, bisoprolol 10 mg per day, prazosin 5 mg per day, and rilmenidine 1 mg per day were sequentially added from months two to five in both groups if home blood pressure was more than or equal to 135/85 mm Hg. The primary endpoint was the mean change in daytime systolic blood pressure from baseline to 6 months as assessed by ambulatory blood pressure monitoring. The primary endpoint was analysed blindly. The safety outcomes were the incidence of acute adverse events of the renal denervation procedure and the change in estimated glomerular filtration rate from baseline to 6 months. This trial is registered with ClinicalTrials.gov, number NCT01570777.FINDINGS:Between May 22, 2012, and Oct 14, 2013, 1416 patients were screened for eligibility, 106 of those were randomly assigned to treatment (53 patients in each group, intention-to-treat population) and 101 analysed because of patients with missing endpoints (48 in the renal denervation group, 53 in the control group, modified intention-to-treat population). The mean change in daytime ambulatory systolic blood pressure at 6 months was -15·8 mm Hg (95% CI -19·7 to -11·9) in the renal denervation group and -9·9 mm Hg (-13·6 to -6·2) in the group receiving SSAHT alone, a baseline-adjusted difference of -5·9 mm Hg (-11·3 to -0·5; p=0·0329). The number of antihypertensive drugs and drug-adherence at 6 months were similar between the two groups. Three minor renal denervation-related adverse events were noted (lumbar pain in two patients and mild groin haematoma in one patient). A mild and similar decrease in estimated glomerular filtration rate from baseline to 6 months was observed in both groups.INTERPRETATION:In patients with well defined resistant hypertension, renal denervation plus an SSAHT decreases ambulatory blood pressure more than the same SSAHT alone at 6 months. This additional blood pressure lowering effect may contribute to a reduction in cardiovascular morbidity if maintained in the long term after renal denervation.FUNDING:French Ministry of Health.

While physical activity (PA) is recommended for high blood pressure management, the level of PA practice of hypertensive patients remains unclear. We aimed to assess the association between the level of both PA and blood pressure of individuals consulting in 9 hypertension specialist centres. Eighty-five hypertensive patients were included (59 ± 14 years, 61% men, 12% smokers, 29% with diabetes). Following their consultation, they performed home blood pressure measurement (HBPM) over 7 days (2 in the morning+2 in the evening), they wrote in a dedicated form their daily activities to estimate the additional caloric expenditure using Acti-MET device (built from International physical Activity Questionnaire [IPAQ]). Thus, patients completed a self-administered questionnaire "score of Dijon" (distinguishing active subjects with a score>20/30, from sedentary, Alors que la pratique régulière d’une activité physique (AP) est recommandée en cas d’hypertension artérielle (HTA), le niveau d’AP des sujets hypertendus reste mal connu. Notre objectif était d’étudier l’association entre le niveau d’AP et le caractère contrôlé ou non de l’HTA de sujets vus en consultation dans 9 centres spécialisés en HTA. Quatre-vingt-cinq sujets hypertendus ont été inclus (59 ± 14 ans, 61 % d’hommes, 12 % fumeurs, 29 % diabétiques). Au décours de leur consultation, une automesure tensionnelle (AMT) sur 7 jours (2 mesures le matin + 2 le soir) était réalisée, ainsi qu’un compte rendu de leurs activités quotidiennes permettant d’estimer la dépense calorique additionnelle à l’aide d’une réglette Acti-MET extrapolée du questionnaire international d’activités physiques (IPAQ). Les sujets complétaient ensuite un auto-questionnaire « score de Dijon » sur 30 points (distinguant les sujets actifs, score > 20/30, des sédentaires < 10/30). Les hypertendus contrôlés en AMT (< 135/85 mm Hg) (55 % des sujets), en comparaison aux non contrôlés, étaient plus âgés, avaient une tendance non significative à une dépense calorique déclarée plus élevée (4959 ± 5045 kcal/semaine vs 4048 ± 4199 kcal/semaine, p = 0,3755) et leur score de Dijon (19,44 ± 5,81 vs 18,00 ± 4,32, p = 0,2094) montrait une proportion de sujets « actifs » plus importante (48,9 % vs 34,2 %, p = 0,1773). En conclusion, nos résultats ont objectivé une « tendance » à une AP déclarée plus importante pour les sujets dont l’HTA est contrôlée. Ceci nous encourage à poursuivre par une étude qui inclurait davantage de sujets et dont l’AP serait évaluée par le port pendant 7 jours d’un capteur de type accéléromètre (méthode objective).

L’HTA refractaire (HTAR) constitue un veritable enjeu de sante publique du fait de sa frequence elevee et du sur-risque cardiovasculaire associe. Les protocoles de denervation renale ont recemment suggere une forte prevalence des arteres renales accessoires (ARA) depistees par angio-TDM chez les sujets presentant une HTAR, mais aucune etude a ce jour n’a compare la frequence des ARA dans une population de patients HTAR et non refractaires (HTANR). Soixante-sept patients hypertendus essentiels ayant beneficie d’un angio-TDM ou d’une angio-IRM des arteres renales dans le bilan initial de leur HTA ont ete inclus dans 4 centres specialises en HTA. Au terme d’un suivi retrospectif minimum de 6 mois, ils ont ete classes en HTANR ou HTAR, celle-ci etant definie comme une HTA non controlee sous tritherapie anti-hypertensive a dose maximale toleree dont un diuretique ou controlee sous ≥ 4 medicaments anti-hypertenseurs (Calhoun, 2012). Une lecture centralisee des imageries arterielles renales etait realisee en aveugle a la recherche d’ARA ou d’autres variantes anatomiques des arteres renales. Les principales caracteristiques a la derniere consultation de suivi etaient (moy ± ET) : âge 50,6 ± 13,9 ans, 41 hommes (64 %), IMC 29,2 ± 5,9 kg/m2, PA clinique 148 ± 24/88 ± 12 mmHg, nombre de traitements anti-hypertenseurs : 2,3 ± 1,7. Quarante et un patients (61 %) presentaient une HTAR, et 23 patients (34 %) au moins une ARA. Il n’y avait pas d’association significative entre HTAR et la presence d’au moins une ARA (HTAR : 37 % ; HTANR : 31 %, p = 0,62), mais il y avait significativement plus d’ARA par patient dans le groupe HTANR (2 ± 0,9) par rapport au groupe HTAR (1,4 ± 0,5) (p = 0,05). Il n’etait pas note de difference de longueur ou de diametre des ARA entre les 2 groupes. Les patients HTA presentant au moins une ARA avaient un controle tensionnel similaire a celui des patients sans ARA, mais presentaient une frequence plus faible de proteinurie (9 % vs 41 %, p = 0,05). Les ARA etaient plus frequemment situees sur le rein gauche (83 % vs 52 % des patients avec ARA, p = 0,02). Cette premiere serie decrivant les variantes anatomiques des arteres renales dans une population ciblee de patients HTA ne montre pas d’association significative entre le caractere refractaire de l’HTA et la presence d’au moins une ARA. Des arguments indirects pourraient a l’inverse suggerer une meilleure perfusion renale chez les patients porteurs d’ARA.

BACKGROUND Masked hypertension has been associated with obesity. However, because most studies do not mention the specific cuff size used for home measurements, masked hypertension prevalence may have been overestimated in obese patients because of undersized cuffs. In this prospective, observational study, the effect of miscuffing on hypertension status was evaluated in patients with large arms. METHODS Fifty-three patients with an upper-arm circumference >33cm, undergoing treatment for mild-to-moderate hypertension, took 2 sets of home blood pressure (BP) measurements (standard vs. large cuff) using the validated Microlife BP A100 Plus automated device. RESULTS Mean BP was 143/85mm Hg at the office using a large cuff, 141/84mm Hg at home using a standard cuff, and 134/80mm Hg at home using a large cuff. Standard vs. large cuff home BP mean differences were 6.9mm Hg (95% confidence interval (CI) = 4.7-9.2; P < 0.0001) for systolic BP and 4.0mm Hg (95% CI = 2.4-5.5; P < 0.0001) for diastolic BP. Hypertension status differed significantly between standard vs. large cuffs: sustained hypertension (56.6% vs. 41.5%, respectively; P = 0.002), controlled hypertension (20.8% vs. 28.3%, respectively; P = 0.04), white coat hypertension (7.5% vs. 22.6%, respectively; P = 0.002), masked hypertension (15.1% vs. 7.5%, respectively; P = 0.04). CONCLUSIONS In patients with large arms, use of an appropriately sized large cuff for home BP measurements led to a 2-fold reduction in masked hypertension. Regarding clinical and epidemiological implications, future studies investigating masked hypertension should specify cuff size for home BP measurements. The low market availability and increased cost of large cuffs should also be addressed.

Objectifs L'HTA refractaire (HTAR) constitue un veritable enjeu de sante publique du fait de sa frequence elevee et du sur-risque cardiovasculaire associe. Les protocoles de denervation renale ont recemment suggere une forte prevalence des arteres renales accessoires (ARA) depistees par angio-TDM chez les sujets presentant une HTAR, mais aucune etude a ce jour n'a compare la frequence des ARA dans une population de patients HTAR et nonrefractaires (HTANR). Methodes 67 patients hypertendus essentiels ayant beneficie d'un angio-TDM ou d'une angio-IRM des arteres renales dans le bilan initial de leur HTA ont ete inclus dans 4 centres specialises en HTA. Au terme d'un suivi retrospectif minimum de 6 mois, ils ont ete classes en HTANR ou HTAR, celle-ci etant definie comme une HTA non controlee sous tritherapie anti-hypertensive a dose maximale toleree dont un diuretique ou controlee sous 4 ou plus medicaments anti-hypertenseurs (Calhoun 2012). Une lecture centralisee des imageries arterielles renales etait realisee en aveugle a la recherche d'ARA ou d'autres variantes anatomiques des arteres renales. Resultats Les principales caracteristiques a la derniere consultation de suivi etaient (moy ± ET) : âge 50,6 ± 13,9 ans, 41 hommes (64 %), IMC 29,2 ± 5,9 kg/m 2 , PA clinique 148 ± 24/88 ± 12 mmHg, nombre de traitements anti-hypertenseurs: 2,3 ± 1,7. 41 patients (61 %) presentaient une HTAR, et 23 patients (34 %) au moins une ARA. Il n'y avait pas d'association significative entre HTAR et la presence d'au moins une ARA (HTAR : 37 % ; HTANR: 31 %, p = 0,62), mais il y avait significativement plus d'ARA par patient dans le groupe HTANR (2 ± 0,9) par rapport au groupe HTAR (1,4 ± 0,5) (p = 0,05). Il n'etait pas note de difference de longueur ou de diametre des ARA entre les 2 groupes. Les patients HTA presentant au moins une ARA avaient un controle tensionnel similaire a celui des patients sans ARA, mais presentaient une frequence plus faible de proteinurie (9 % vs 41 %, p = 0,05). Les ARA etaient plus frequemment situees sur le rein gauche (83 % vs 52 % des patients avec ARA, p = 0,02). Conclusion Cette premiere serie decrivant les variantes anatomiques des arteres renales dans une population ciblee de patients HTA ne montre pas d'association significative entre le caractere refractaire de l'HTA et la presence d'au moins une ARA. Des arguments indirects (association d'un nombre eleve d'ARA avec un meilleur controle tensionnel, moindre frequence de la proteinurie chez les patients HTA avec ARA) pourraient a l'inverse suggerer une meilleure perfusion renale chez les patients porteurs d'ARA.

Objectives To compare home blood pressure (BP) values obtained with two validated OMRON (wrist or arm) monitors used in the same individual sequentially, but with two different hand positions. Methods In 200 hypertensive individuals referred to hypertension specialists, a self-measurement of BP was performed sequentially with an OMRON M4-I (arm cuff, A/A, British Hypertention Society validation) and an OMRON RX-I (wrist cuff, B/B, BHS validation). Each patient recorded home BP during two periods of 4 days with three measures in the morning and three in the evening. Order for use of each monitor was randomized. For the first 100 patients, the hand was positioned on the opposite shoulder whereas for the next 100 patients, the hand was positioned on the opposite elbow. BP values were reported on a standardized document. Results In this population, aged 60+/-10 years, with 54% of men, BP values were 136+/-/80+/- mmHg with the wrist monitor (WM) when the hand is positioned on the opposite shoulder as compared with 144+/-16/81+/-9 mmHg obtained with the arm monitor taken as the gold standard. On the contrary, BP values were 142+/-/82+/- mmHg with the WM when the hand is positioned on the opposite elbow as compared with 144+/-16/81+/-9 mmHg obtained with the arm monitor. The lower value of systolic blood pressure observed with WM positioned on the shoulder is independent of age, initial BP level and order of use (multivariate analysis). Conclusion When advising home BP monitoring with a WM, the instruction to be given to patients is to position the hand on the opposite elbow.

La dissection aortique est une affection peu frequente mais grave. C’est une dechirure de la paroi aortique au sein de la media a partir d’un orifice que l’on nomme porte d’entree, faisant communiquer la lumiere aortique (vrai chenal) et un nouveau chenal cree au sein des tuniques arterielles: le faux chenal. La dissection aortique dans sa forme aigue est observee dans les 14 jours suivant le debut des symptomes (la dissection aortique chronique est observee ulterieurement). La classification de Stanford et Daily, la plus simple, distingue deux types de dissection: le type A interessant l’aorte ascendante et/ou la crosse aortique et le type B interessant seulement l’aorte descendante.

Background— Prospective cohort studies have revealed that plasma γ-glutamyltransferase (GGT) activity exhibits a positive association with coronary artery disease. GGT which is equally elevated in metabolic syndrome (MS), is the major regulator of circulating concentrations of thiol compounds derived from glutathione (GSH) cleavage, ie, cysteine and cysteinyl glycine. We compared the circulating thiol profile in a cohort of patients displaying atherogenic dyslipidemia with and without MS. Methods and Results— This cross-sectional study involved 1131 dyslipidemic patients in primary prevention of whom 26% presented with MS. GGT activity and plasma cysteinyl-glycine and cysteine concentrations were higher in MS patients; by contrast, levels of GSH were significantly lower ( P P for trend −6 ). Conclusion— Dyslipidemic patients exhibiting MS are characterized by elevated GGT activity which is associated with perturbed metabolism of thiol compounds.

Abdominal obesity and high blood pressure (HBP) are known to be associated with sleep apnea syndrome (SAS). Resistant hypertension commonly leads physicians to prescribe a sleep record because the prevalence of SAS is high in patients with resistant hypertension. Data on the prevalence of SAS in patients with treated and controlled hypertension are lacking. Moreover, while the metabolic syndrome (MS) and insulin resistance frequently occur in association with SAS, few studies have evaluated the prevalence of SAS in patients with MS. Epworth sleepiness scale (ESS) is often proposed to identify patients at high risk for sleep disorders and for which a sleep record should be prescribed. The reliability of this test to identify SAS has not been studied in patients with MS.(i) To assess the prevalence of SAS in men with MS, (ii) to study the relationship between controlled hypertension and SAS in patients with MS, (iii) to assess the reliability of the ESS to diagnose SAS in patients with MS.Among 135 men hospitalized for MS, the 125 who had no history of SAS were systematically evaluated by a nocturnal polygraphy was systematically performed in the 125 men without known SAS at the admission. An excessive daytime sleepiness was assessed by the ESS. Results of analyses in patients with controlled HBP (130/85 mmHg with antihypertensive drug(s), n=41) were compared with those in patients with normotension (130/85 mmHg without treatment, n=32).The prevalence of SAS (apnea-hypopnea index (AHI)or=15/h) in men with MS was 44% in the whole population, 28.1% in the subgroup of patients with normotension and 61.0% in patients with treated and controlled HBP. A severe SAS (AHIor=30/h) was respectively present in 6.3% and 34.1% of patients with normotension and controlled HTA (p0.01). Compared with patients without SAS, those with SAS displayed higher blood pressure and BMI. Logistic regression analysis showed that controlled HTA was a determinant of SAS which persisted after adjustment for BMI. As suggested by the ROC curve, the ESS is not a good tool to identify patients with SAS. With a threshold of 11/24 the positive and negative values of this scale were of 0.20 and 0.47.The prevalence of SAS is high in men with MS. The ESS does not identify patients who should undergo a nocturnal record. Because a severe SAS is found in nearly one third of patients with MS and controlled HBP, we suggest that a nocturnal record should be systematically proposed to these patients irrespective of the degree of daytime sleepiness assessed by questionnaires.

Hypertension and type-2 diabetes are frequently observed concomitantly in a same patient. There are possibilities to delay the onset of type-2 diabetes, especially in patients already managed for hypertension. Trials on renin-angiotensin blockers show that compared to other drug therapies, there is a lower incidence of diabetes in patients treated by an ACE-inhibitor or an Angiotensin 11 antagonist and the benefit can be estimated at 22% (relative risk at 0.78 with a confidence interval from 0.74 to 0.83). A higher risk of occurrence of type-2 diabetes is particularly noted in those under beta-blocking therapy combined to diuretics. In ALLHAT, the comparison of a thiazide diuretic, an ACE-inhibitor and a calcium antagonist showed that the incidence of new cases of diabetes was the highest in the diuretic group and the lowest in the ACE-inhibitor group. Hypertensive patients under calcium antagonists presented an incidence in between the two other groups. According to a recent hypothesis, the insulin-resistance decrease as a consequence of renin-angiotensin system blocking is related to the recruitment of pre-adipocytes. The NAVIGATOR and ONTARGET trials will probably confirm the preliminary results obtained in this topic. Their results are expected within the 2 next years.

In patients with uncontrolled systolic hypertension, to estimate the value of home blood pressure monitoring in addition to office blood pressure for inclusion in a trial.80 patients with systolic hypertension, defined as SBPor =140 mmHg and pulse pressureor =60 mmHg, were treated for 4 weeks with a thiazide diuretic at usual dose (25 mg HCTZ or 1.5 mg indapamide or methyclothiazide 5 mg). Blood pressure was measured using an automatic monitor (Omron M6) at office and at home in the 3 days prior the visit. Subjects with an uncontrolled hypertension were included in the second part of the trial only if there fulfilled inclusion criteria: office SBPor =140 mmHg and home SBPor =135 mmHg (mean of 18 measurements obtained on 3 consecutive days) and office pulse pressureor =60 mmHg.After 4 weeks with diuretic treatment, 62% of patients fulfilled 3 criteria and were included in the second part of the trial. It was observed 76% of patients with office SBPor =140 mmHg, 72% with office pulse pressureor =60 mmHg and 70% with both office SBP and PP criteria. However, only 67% of patients had home SBPor =135 mmHg. Discrepancy between office and home SBP was observed and subjects with a white coat hypertension was noticed in 14% and masked hypertension in 5%.If patients with systolic hypertension have to be included into a drug trial because there are uncontrolled, home blood pressure monitoring in addition to office blood pressure is a very useful criteria for inclusion because misclassifications due to white coat or masked hypertension is frequent in these patients.

To compare two periods of three days of home blood pressure monitoring (HBPM) using two different monitors with one including MAM (microlife average mode) technology.In 152 hypertensive subjects referred to hypertension specialists, a self-measurement of blood pressure was performed sequentially with an Omron M6 (arm cuff, A/A, BHS validation) or Microlife BP-3AC1 with the MAM technology. Each patient recorded home blood pressure during two periods of 3 days with 3 measures in the morning and 3 in the evening. Order for use of each monitor was randomised. BP values were reported on a standardized document.In this population, aged 60 +/- 14 years, with 57% of men and a mean blood pressure of 150 +/- 21/84 +/- 21 mmHg, the home blood pressure values were 141.5 +/- 18.7/79.9 +/- 9.6 mmHg with the OMRON monitor and 138.2 +/- 17.1/79.9 +/- 10.1 mmHg with the Microlife monitor. Values between the two monitors differed about 5 mmHg for the mean SBP and about 2.8 mmHg for the mean DBP. The mean HBPM values does not differ between the two methods for more than 2.5 mmHg, 5 mmHg, 10 mmHg and 15 mmHg in 29%, 49%, 80% and 90% for SBP and in 42%, 76%, 94% and 98% for DBP respectively.For most of patients, mean SBP/DBP obtained with home blood pressure Measurement during three days are comparable when using monitor operated with MAM technology or not.

To compare home blood pressure values obtained with two validated OMRON (wrist or arm) monitors used sequentially in the same subject.In 265 hypertensive subjects referred to hypertension specialists, a self measurement of blood pressure was performed sequentially with an OMRON M4-I (arm cuff, A/A, BHS validation) or OMRON RX-I (wrist cuff, B/B, BHS validation). Each patient recorded home blood pressure during two periods of 4 days with 3 measures in the morning and 3 in the evening. Order for use of each monitor was randomised. With wrist devices, subjects were advised to keep the arm at heart level during measurements. BP values were reported on a standardized document. Patients were asked by a questionnaire about the tolerance and feasibility of the 2 methods.In this population, aged 59 +/- 14 years, with 60% of men and a mean blood pressure of 152 +/- 21 / 86 +/- 14 mmHg, the home blood pressure values were 143 +/- 20/81 +/- 11 mmHg with the arm monitor and 135 +/- 10 / 80 +/- 11 mmHg with the wrist monitor. Mean SBP adjusted on age, initial blood pressure level and period order was significantly lower when home blood pressure monitoring has been recorded with a wrist monitor as compared to an arm monitor (p0.001). Self measurement of blood pressure was felt as easy in 92% with the arm monitor and in 96% with the wrist monitor (p0.05). Self measurement of blood pressure was felt as constraining in 14% with the arm monitor and in 7% with the wrist monitor (p0.01). The feasibility between the two devices was good with none of the value missing in 86% with the arm monitor and in 85% with the wrist monitor. The missing values were in 56% the fourth day.Despite the use of two validated monitors, mean SBP is significantly lower when home blood pressure monitoring is recorded with a wrist monitor as compared to an arm monitor. Uncertainty in the arm position with the use of wrist device could explain these results. When advising home blood pressure monitoring, care should be taken to recommend only the use of validated devices and to prefer the use of arm devices in order to avoid the uncertainty of an inadequate utilisation.

This clinical trial of fenspiride (injectable and sustained-release 80 mg tablet) was carried out on patients selected because their bronchopathy was of a hypersecretory type. Interesting results were observed in 20 out of 37 cases, but they were often delayed. This group of patients included a high proportion of patients with major hypersecretion; the efficacy of fenspiride is often evident, (in 8 out of 11 cases) but it is unpredictable individually. It can be concluded from this trial that a long term treatment with fenspiride, well tolerated, can usefully be tried in patients with predominant signs of bronchial hyperexudation.