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The rapid increase in population aging and associated age-related cognitive decline requires identifying innovative and effective methods to prevent it. To manage this socio-economic challenge, physical, cognitive, and combined stimulations are proposed. The superiority of simultaneous training compared to passive control and physical training alone seems to be an efficient method, but very few studies assess the acute effect on executive function. This study aimed to investigate the acute effect of simultaneous physical and cognitive exercise on executive functions in healthy older adults, in comparison with either training alone. Seventeen healthy older adults performed three experimental conditions in randomized order: physical exercise, cognitive exercise, and simultaneous physical and cognitive exercise. The protocol involved a 30 min exercise duration at 60% of theoretical maximal heart rate or 30 min of cognitive exercise or both. Executive functions measured by the Stroop task and pre-frontal cortex oxygenation were assessed before and after the intervention. We found a main effect of time on executive function and all experimental condition seems to improve inhibition and flexibility scores (

Summary Aims Cardiovascular events occurring during physical activity are becoming a public health problem. Besides medical exams screening for cardiac abnormalities, better prevention could make such accidents less frequent. This study assessed the lack of awareness of cardiovascular risk factors and behaviors in the general sporting population. Methods A survey was conducted by questionnaire in 3590 regular sports practitioners in 6 sport medicine centers. Results Among the 3590 practitioners, mean age was 30.7 ± 16 years, 71% were men, 9.5% were smokers, 5.5% had hypercholesterolemia, 4.4% had high blood pressure and 0.9% were diabetics. In subjects 40 years old, only 54% had undergone a pre-participation exercise test. Among the entire sample, 17% were not aware of the danger of smoking before and just after exercising, and 67%, 47% and 32% did not know the risks of training with fever, exercising in low or high temperature, respectively. The risks of doping, lack of warm-up or proper hydration were unknown to 22%, 2% and 3%, respectively. Finally, the need to report palpitation, dizziness and chest pain related to exercise was unknown to 18%, 7% and 11%, respectively. Recreational athletes had a higher correct response rate than competitive ones, especially those training Conclusion The lack of awareness about cardiovascular events remains significant among sports practitioners. Better education about such risks seems necessary to reduce the rate of accidents in the future.

Today by the e-health and the telemedicine, many people are more and more interested by the improvement of disease knowledge on cardiovascular diseases and associated risk factors, personalized self management support follow-up and e-Health monitoring. MGEN is a not-for-profit complementary health insurance gave itself the ways to use the new digital tools in health. MGEN developed an original and personalized program VIVOPTIM for the primary prevention of the cardiovascular risks for their members. The VIVOPTIM Pilot program is based upon digital services and was experimented by November 2015 to December, 2017 with 8000 members of the MGEN, from 30 to 70 years old and resident in two French areas (Occitanie and Bourgogne Franche-Comte). The assessment of the experiment VIVOPTIM e -health program was positive for the personalized cardiovascular support and for their health. Therefore, the MGEN generalized the VIVOPTIM program of cardiovascular prevention, to the whole France on July 11th, 2018.

International audience; Background: Cardiovascular diseases are a leading cause of mortality, but a substantial proportion are preventable.Aims: The Mutuelle générale de l'éducation nationale (MGEN), a provider of private health insurance in France, has developed the VIVOPTIM programme, a novel digital approach to healthcare based on individualized, multiprofessional, ranked management of cardiovascular risk factors.Methods: Between November 2015 and June 2016, eligible individuals (age 30-70 years) from two regions of France were invited to participate. Volunteers completed a questionnaire based on the Framingham Heart Study Risk Score and were assigned to one of three cardiovascular risk levels. VIVOPTIM comprises four components: cardiovascular risk assessment, instruction on cardiovascular diseases and associated risk factors, personalized coaching (telephone sessions with a specially trained healthcare professional to provide information on risk factors and disease management, set individual health targets, monitor progress and motivate participants), and e-Health monitoring.Results: Data from 2240 participants were analysed. Significant benefits were observed on mean systolic blood pressure (-3.4mmHg), weight (-1.5kg), smoking (-2.2 cigarettes/day) and daily steps (+1726 steps/day (all P

Aims/hypothesis: Tenascin-C (TN-C) is an extracellular matrix glycoprotein highly expressed in inflammatory and cardiovascular (CV) diseases. Serum TN-C has not yet been specifically studied in individuals with type 2 diabetes, a condition associated with chronic low-grade inflammation and increased CV disease risk. In this study, we hypothesised that elevated serum TN-C at enrolment in participants with type 2 diabetes would be associated with increased risk of death and major adverse CV events (MACE) during follow-up.Methods: We used a prospective, monocentric cohort of consecutive type 2 diabetes participants (the SURDIAGENE [SUivi Rénal, DIAbète de type 2 et GENEtique] cohort) with all-cause death as a primary endpoint and MACE (CV death, non-fatal myocardial infarction or stroke) as a secondary endpoint. We used a proportional hazard model after adjustment for traditional risk factors and the relative integrated discrimination improvement (rIDI) to assess the incremental predictive value of TN-C for these risk factors.Results: We monitored 1321 individuals (58% men, mean age 64 ± 11 years) for a median of 89 months. During follow-up, 442 individuals died and 497 had MACE. Multivariate Cox analysis showed that serum TN-C concentrations were associated with an increased risk of death (HR per 1 SD: 1.27 [95% CI 1.17, 1.38]; p < 0.0001) and MACE (HR per 1 SD: 1.23 [95% CI 1.13, 1.34]; p < 0.0001). Using TN-C concentrations on top of traditional risk factors, prediction of the risk of all-cause death (rIDI: 8.2%; p = 0.0006) and MACE (rIDI: 6.7%; p = 0.0014) improved significantly, but modestly.Conclusions/interpretation: In individuals with type 2 diabetes, increased serum TN-C concentrations were independently associated with death and MACE. Therefore, including TN-C as a prognostic biomarker could improve risk stratification in these individuals.

N-terminal pro-B-type natriuretic peptide (NT-proBNP) is the gold standard prognostic biomarker for diagnosis and occurrence of heart failure. Here, we compared its prognostic value for the occurrence of congestive heart failure with that of plasma mid-region pro-adrenomedullin (MR-proADM), a surrogate for adrenomedullin, a vasoactive peptide with vasodilator and natriuretic properties, in people with type 2 diabetes. Plasma MR-proADM concentration was measured in baseline samples of a hospital-based cohort of consecutively recruited participants with type 2 diabetes. Our primary endpoint was heart failure requiring hospitalisation. We included 1438 participants (age 65 ± 11 years; 604 women and 834 men). Hospitalisation for heart failure occurred during follow-up (median 64 months) in 206 participants; the incidence rate of heart failure was 2.5 (95% CI 2.2, 2.9) per 100 person-years. Plasma concentrations of MR-proADM and NT-proBNP were significantly associated with heart failure in a Cox multivariable analysis model when adjusted for age, diabetes duration, history of coronary heart disease, proteinuria and baseline eGFR (adjHR [95%CI] 1.83 [1.51, 2.21] and 2.20 [1.86, 2.61], respectively, per 1 SD log10 increment, both p

RESUME Dans sa strategie nationale de sante pour les maladies hypertensives, la Societe francaise d’HTA ( www.sfhta.eu ) propose des recommandations de prevention globale avec une correction des inegalites sociales et geographiques en integrant les specificites des DOM-ROM (recommandations 5 a 9). Il s’agit d’integrer la prevention de l’HTA dans les actions generales de sante publique a enseigner des la petite enfance, en accord avec les preconisations de la Federation Francaise de Cardiologie ( www.fedecardio.org ) : la lutte contre la sedentarite, la pratique d’une activite physique reguliere, une alimentation equilibree, l’absence de la premiere cigarette, la prevention du stress chronique en particulier au travail et de la depression. Il est recommande de prevoir un plan de lutte specifique contre l’obesite en Outre-Mer et d’amener tous les professionnels de sante a renforcer le depistage du surpoids et de l’obesite a tous âges. Il est necessaire d’informer le patient hypertendu que l’hygiene de vie permet de renforcer l’efficacite du traitement voire de l’alleger. Il convient de favoriser le depistage de l’HTA surtout en presence d’un contexte familial d’HTA ou de mauvaises conditions socio-economiques, notamment en Outre-mer. Le medecin traitant, le pharmacien et l’infirmier y ont leur place ainsi que les centres de sante au travail et les centres d’examens de sante de la Caisse Primaire d’Assurance Maladie.

International audience; Since 2016, the French Society of Hypertension has warned about the decline in the management of high blood pressure in France: stagnation, or even decreased number of people who know their blood pressure level, take a treatment and are controlled. These results are lower than those observed in many other countries. Blood pressure is measured with an old method in the doctor's office. Accepted, simple and cost-effective, this method is currently unavoidable for reasons of feasibility and social habit. It has been used in observational and intervention studies that are the basis of the medical reasoning for screening, treatment and drug control of hypertension. In practice, it is too often poorly applied and unpredictable. It is now necessary to measure blood pressure in mmHg using a validated oscillometric automatic device coupled to a specific upper arm cuff adapted to the arm circumferences for the diagnosis and monitoring of high blood pressure in the doctor's office and at home. The auscultatoric measurement is only recommended if any doubt about the reliability of the electronic measurement. Blood pressure measurement is basically performed on both arms to detect asymmetry and then on the arm with the highest blood pressure. It is performed in sitting or lying position after a few minutes of rest without speaking and without having smoked and then in standing position to diagnose orthostatic hypotension, especially in elderly, diabetic and multi-medicated subjects. The blood pressure measurement during the consultation must be repeated and include at least 3 consecutive measurements at one minute intervals. The average of the last 2 measurements determines the blood pressure level. It is recommended to perform BP measurements outside the medical environment for the diagnosis and monitoring of hypertension; Home BP measurement is preferred to ambulatory blood pressure measurement for practical reasons unless otherwise specified. The home blood pressure measurement should include three measurements in the morning at breakfast and three measurements in the evening before bedtime at one minute intervals for at least three days. Prior training must be provided. In treated hypertensive patients, a masked hypertension should be considered as an uncontrolled hypertension and antihypertensive therapy adapted accordingly. The measurement of central BP pressure (aorta) should be limited to clinical research.

Summary Background Hypertension guidelines recommend moderate-intensity continuous training (MICT) for the primary or secondary prevention of hypertension. However, alternative modalities, such as high-intensity interval training (HIIT) on dry land or in water, have been studied less widely. Aim To assess chronic blood pressure (BP) response to a 2-week training programme involving six sessions of either MICT or HIIT performed on dry land or HIIT performed in an immersed condition, in participants with baseline office systolic/diastolic BP (SBP/DBP) ≥ 130/85 mmHg. Methods We randomly assigned 42 individuals (mean age 65 ± 7 years; 52% men) with baseline office SBP/DBP ≥ 130/85 mmHg to perform six 24-minute sessions on an ergocycle (three times a week for 2 weeks) of either MICT on dry land, HIIT on dry land or HIIT in a swimming pool, and assessed BP responses using 24-hour ambulatory BP monitoring. Results While 2-week MICT and HIIT on dry land modified none of the 24-hour average haemodynamic variables significantly, immersed HIIT induced a significant decrease in 24-hour BP (SBP −5.1 ± 7.3 [P = 0.02]; DBP −2.9 ± 4.1 mmHg [P = 0.02]) and daytime BP (SBP −6.2 ± 8.3 [P = 0.015]; DBP −3.4 ± 4.0 mmHg [P = 0.008]), and slightly improved 24-hour and daytime pulse wave velocity (PWV) (24-hour PWV −0.17 ± 0.23 m/s [P = 0.015]; daytime PWV −0.18 ± 0.24 m/s [P = 0.02]). Conclusion HIIT on an immersed stationary ergocycle is an innovative method that should be considered as an efficient non-pharmacological treatment of hypertension. As such, it should now be implemented in a larger cohort to study its long-term effects on the cardiovascular system.

BackgroundSimulations in healthcare reproduce clinical situations in stressful conditions. Repeated stress exposure might influence the learning process in simulation as well as real-life.Objectives1) To record heart rate and heart rate variability evolution during one-day simulation over one year; 2) To analyze the effect of repetitive high-fidelity simulations on the risk of post-traumatic stress disorder.Study designSingle-center, investigator-initiated RCT. 48 participants were randomized in 12 multidisciplinary teams of French Emergency Medical Services to manage infant shock in high-fidelity simulations. In the experimental group, 6 multidisciplinary teams were exposed to 9 different simulation sessions over 1 year. In the control group, 6 multidisciplinary teams participated in only 3 simulation sessions, in common with those of the experimental group (initial, intermediate after 6 months, and finally after 1 year). Heart rate (HR) and heart rate variability (HRV) were analyzed on a 24-hour Holter from the day prior to simulation until the end of simulation. Questionnaires of Impact of Event Scale-Revised at 7 days and Post-traumatic Check-List Scale at 1 month were used to detect possible post-traumatic stress disorder in participants. pResultsStress increased during each simulation in the two groups. After analysis on the 24-hour period, there was no significant difference between the two groups during the initial simulation session in terms of heart rate and heart rate variability. In the 24-hour period of the intermediate and final simulation sessions, the level of stress was higher in the control group during the diurnal (p = 0.04) and nocturnal periods (p = 0.01). No participant developed post-traumatic stress disorder after the 72 simulation sessions.ConclusionsDespite the stress generated by simulation, the more the sessions were repeated, the less were their repercussions on the daily lives of participants, reflected by a lower sympathetic activity. Moreover, repetition of simulations did not lead to post-traumatic stress disorder.Trial registrationClinicalTrials.gov NCT02424890.

OBJECTIVE The pattern of renal function decline prior to cardiovascular (CV) events in type 2 diabetes is not well known. Our aim was to describe the association between renal function trajectories and the occurrence of a CV event. RESEARCH DESIGN AND METHODS We considered patients with type 2 diabetes from the SURDIAGENE (Survie, Diabete de type 2 et Genetique) study (discovery cohort) and the DIABHYCAR (Non-Insulin-Dependent Diabetes, Hypertension, Microalbuminuria or Proteinuria, Cardiovascular Events, and Ramipril) study (replication cohort). Global patterns of estimated glomerular filtration rate (eGFR) (Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI]) and serum creatinine (SCr) prior to a major CV event (MACE) or last update were determined using a linear mixed-effects model and annual individual slopes computed by simple linear regression. RESULTS In the 1,040 participants of the discovery cohort, establishment of global patterns including 22,227 SCr over 6.3 years of follow-up showed an annual eGFR decline and an annual SCr increase that were significantly greater in patients with MACE compared with patients without (−3.0 and −1.7 mL/min/1.73 m2/year and +10.7 and +4.0 μmol/L/year, respectively; P < 0.0001 for both). Median annual individual slopes were also significantly steeper in patients with MACE, and adjusted risk of MACE was 4.11 times higher (3.09–5.45) in patients with rapid decline in eGFR (change less than −5 mL/min/1.73 m2/year). Consideration of renal function trajectories provided significant additive information helping to explain the occurrence of MACE for both SCr and eGFR (PIDI < 0.0001 and P = 0.0005, respectively). These results were confirmed in the replication cohort. CONCLUSIONS Renal function decline was associated with a higher risk of MACE. The pattern of renal function decline, beyond baseline kidney function, is an independent factor of CV risk.

The authors aimed to study the impact of a combined 9‐month lifestyle program (Mediterranean diet nutritional counselling, and high‐intensity interval training twice a week) on blood pressure (BP) in individuals with abdominal obesity, taking into account the regression‐to‐the‐mean phenomena. A total of 115 participants (53±9 years; 84 women; waist circumference [WC]: 111±13 cm; systolic/diastolic BP [SBP/DBP]: 133±13/82±8 mm Hg; 13% diabetics; 12% smokers; and 30% taking antihypertensive therapy) were retrospectively analyzed before and after the program. After 9 months, we observed an improvement in weight (−5.2±5.6 kg) and WC (−6.3±6.0 cm), and an average SBP/DBP net decrease of −5.1±13.7/−2.8±8.7 mm Hg. These changes were not uniform: 67 participants (58%) decreased their SBP by 2 mm Hg or more. The characteristics of responders included a higher baseline BP than nonresponders (SBP/DBP: 137.2±13.7/83.1±7.3 mm Hg vs 127.0±10.3/80.0±7.3 mm Hg, P

Background Tenascin-C (TNC) is an extracellular matrix glycoprotein highly expressed in inflammatory and cardiovascular (CV) pathologies. In heart failure or after myocardial infarction, elevated TNC is associated with adverse outcomes. Serum TNC has not yet been studied specifically in patients with type II diabetes, a condition associated with chronic low-grade inflammation and increased CV risk. We hypothesized that high serum TNC measured at enrolment in a large cohort of type II diabetic patients is associated with major adverse CV events (MACE) and death during follow-up. Methods A prospective, monocentric cohort of consecutive type 2 diabetes patients (the SURDIAGENE cohort; total of 1338 patients; 58% men, mean ± SD age 64 ± 11 years) was followed for a median of 89 months for death as primary endpoint and MACE (i.e. CV death, myocardial infarction or stroke) as a secondary endpoint. Patients with stage ≥ 4 renal disease were excluded. Results During follow-up, 448 patients (representing 4.4% of the total person-years) died and 506 patients (representing 5.2% of the total person-years) presented with MACE. Cox multivariate analysis showed that increased serum TNC concentrations were significantly associated with death (HR per 10 ng/mL: 1.03 (1.01–1.05) P = 0.0095) and MACE (HR per 10 ng/mL: 1.02 (1.00–1.04) P = 0.0162), after adjustment for sex, age, established modifiable CV risk factors (active smoking, hypertension, hypercholesterolemia) and NT-proBNP levels. Conclusions In patients with type 2 diabetes, we show for the first time that increased serum TNC concentrations are independently associated with MACE and death. These findings suggest that elevated TNC expression might be implicated in the increased CV risk associated with diabetes, and might be useful for CV risk stratification in this context.

OBJECTIVE Aortic stiffness may provide information to classical risk factors information regarding cardiovascular risk. Aortic pulse wave velocity (PWV) can be measured by applanation tonometry but also theoretical PWV was calculated according to age, blood pressure, heart rate and sex. We aim to highlight biological and hemodynamic determinants of the aortic PWV index, that is the individually calculated [(measured PWV - theoretical PWV)/theoretical PWV] difference, in hypertensive diabetic patients. METHODS A cross-sectional study was conducted in 514 patients, involving normotensive and hypertensive patients and people with and without diabetes. Biological parameters were measured during day-hospital for cardiovascular screening. Hemodynamic parameters were determined by applanation tonometry. Multivariate regression analyses evaluated the PWV index determinants. RESULTS Hypertensive and/or diabetic population presents higher PWV index in correlation with the presence of proteinuria (P = 0.0428) and previous cardiovascular events (P = 0.0227). Hypertensive diabetic patients present a higher PWV index than the other patients (P

International audience; Stress might impair clinical performance in real life and in simulation-based education (SBE). Subjective or objective measures can be used to assess stress during SBE. This monocentric study aimed to evaluate the effects of simulation of life-threatening events on measurements of various stress parameters (psychological, biological, and electrophysiological parameters) in multidisciplinary teams (MDTs) during SBE. The effect of gender and status of participants on stress response was also investigated. Twelve emergency MDTs of 4 individuals were recruited for an immersive simulation session. Stress was assessed by: (1) self-reported stress; (2) Holter analysis, including heart rate and heart rate variability in the temporal and spectral domain (autonomic nervous system); (3) salivary cortisol (hypothalamic pituitary adrenal axis). Forty-eight participants (54.2% men

Diabetes & Metabolism - In Press.Proof corrected by the author Available online since lundi 12 mars 2018

Background: Most of patients suffering from resistant hypertension (RH) have obstructive sleep apnea (OSA). However, little is known about the metabolic profile of these patients as well as the efficacy of continuous positive airway pressure (CPAP) in RH. Methods: We performed a multicentre, comparative (presence or not of OSA), randomized, simple blind study in 62 patients (60 ± 10 years; 77% of men, body mass index, 29.6 ± 3.9 kg/m2) with essential RH (24-hour daytime systolic BP (SBP) / diastolic BP (DBP): 145 ± 13 / 85 ± 10 mmHg, 3.7 antihypertensive drugs). OSA patients (AHI: 37.6 [25.4 ; 51.8] /h, n=37) were randomized to receive either sham CPAP (3-months, n=18) followed by active CPAP (6 months) or only 6 months of active CPAP (n=19). The primary endpoint was the influence of OSA on blood leptin level in patients with RH. The influence of OSA on BP and the impact of CPAP treatment were also studied. Results: The 37 OSA patients with RH (60% of the 62 included patients) were predominantly men, with metabolic syndrome (84 vs 60%, p=0.036). Their blood leptin level was significantly lower than in non-OSA patients (9 [6 ; 15] vs 17 [6 ; 29] ng/mL, p=0.041). In intention to treat analysis, 3 months of CPAP decreased significantly nighttime SBP by 6.4 mmHg (p=0.033) and HR by 6.0 mmHg (p=0.010), compared to sham CPAP effect. Six months under effective CPAP also decreased nighttime BP and improved dipper profile. Conclusion: It is important to investigate OSA in RH and to stat CPAP treatement since besides its interest on sleepiness, CPAP is efficient to decrease nighttime BP in apneic patients suffering from RH. NCT00746902.

An article recently published in the Lancet (1) concerned a meta-analysis of two therapeutic trials ONTARGET (2) and TRANSCEND (3). They were both designed to compare angiotensin receptor blocker (ARB) to angiotensin-converting enzyme (ACE) inhibitors (or their combination) or placebo respectively, to reduce the rate of a composite of cardiovascular death, myocardial infarction (MI), stroke and hospital admission for heart failure, among patients at high risk for cardiovascular events.

International audience; The effectiveness of regular exercise in decreasing both systolic and diastolic blood pressure (BP) is well-established. Our purpose was to assess the impact of both subject and physical activity program characteristics on ambulatory BP through a meta-analysis of the existing literature. Three databases (PubMed, Embase, Web of Science) were searched using relevant terms and strategies. From 637 identified records, 37 studies met inclusion criteria: details about training intervention and participant characteristics, pre- and post-training ambulatory BP measurements, at home (HBPM) or during 24-h (ABPM). The weighted mean difference was for 24-h systolic/diastolic ABPM (n = 847 participants): -4.06/-2.77 mmHg (95%CI: -5.19 to -2.93/-3.58 to -1.97; P < 0.001), for daytime (ABPM or HBPM, n = 983): -3.78/-2.73 mmHg (95%CI: -5.09 to -2.47/-3.57 to -1.89; P < 0.001) and nighttime ABPM periods (n = 796): -2.35/-1.70 mmHg (95%CI: -3.26 to -1.44/-2.45 to -0.95; P < 0.001). Characteristics significantly influencing BP improvement were: an initial office BP ≥130/85 mmHg and diet-induced weight-loss. We found no differences according to sex, age, or training characteristics (intensity, number of sessions, training duration). Antihypertensive effects of aerobic training assessed by ambulatory BP measurements appear significant and clinically relevant for both daytime and nighttime periods, in particular for participants with an office BP ≥130/85 mmHg.

High blood pressure is a frequent pathology with many cardiovascular complications. As highlighted in guidelines, the therapeutic management of hypertension relies on non-pharmacological measures, which are diet and regular physical activity, but both patients and physicians are reluctant to physical activity prescription. To acquire the conviction that physical activity is beneficial, necessary and possible, we can take into account some fundamental and clinical studies, as well as the feedback of our clinical practice. Physical inactivity is a major risk factor for cardiovascular morbidity and mortality, and hypertension contributes to increase this risk. Conversely, regular practice of physical activity decreases very significantly the risk by up to 60%. The acute blood pressure changes during exercise and post-exercise hypotension differs according to the dynamic component (endurance or aerobic and/or strength exercises), but the repetition of the sessions leads to the chronic hypotensive benefit of physical activity. Moreover, physical activity prescription must take into account the assessment of global cardiovascular risk, the control of the hypertension, and the opportunities and desires of the patient in order to promote good adherence and beneficial lifestyle change.

Objective: To evaluate a patient questionnaire(HY-QUEST) to be completed at home before consulting ina hypertension clinic for the first time.Methods: HY-QUEST is a questionnaire translated intopatient language of the items from a standardizedcomputerized medical record used since 1975 andregularly updated. This questionnaire contains 97 closedand seven free-text questions designed to evaluatecardiovascular risk and possible secondary hypertension,and to guide therapeutic strategy. One hundred and thirty-three new patients were asked to complete it at home andto bring it with them to their first visit in the hypertensionclinic. The primary end-point was completeness of theanswers. Other end-points were legibility and correctnessof the answers.Results: Questionnaires were available for 128 out of133 patients (96%). More than 80% of the 97 closedquestions were answered in 121 out of 128 questionnaires[94.6%; 95% confidence interval (CI) 90.7–98.5] and noquestion had a response rate less than 85%. The answerswere legible in 85% of the closed questions and theconcordance rate with the physician’s assessment was94%. Among the 101 treated patients, 72 (71.3%; 95%CI 62.5–80.1) were able to provide the correct names,doses and schedule of their antihypertensive treatments.Conclusion: The HY-QUEST questionnaire can becompleted by most patients with few missing or incorrectanswers. It is well accepted by patients and provides usefulinformation to orient the first consultation in ahypertension clinic. Whether the same approach is feasibleand useful in primary care remains to be investigated.Keywords: hypertension, medical history, medical records,patient questionnaire, preinterviewAbbreviations: BP, blood pressure; ESH, European Societyfor Hypertension; SFHTA, French Society for Hypertension

a CHU de Poitiers, Cardiologie, 86021 Poitiers, France b Universite de Poitiers, Laboratoire MOVE (EA 6314), 86000 Poitiers, France c Mon Stade, Complexe medico-sportif, 75013 Paris, France d Inserm U872, Universite Pierre & Marie Curie Paris 6, 75006 Paris, France e CHU de Poitiers, Endocrinologie, 86021 Poitiers, France f Universite de Poitiers, CIC1402, 86021 Poitiers, France g CHU de Poitiers, Centre d'investigation clinique, 86021 Poitiers, France h Inserm, CIC1402, 86021 Poitiers, France i Universite de Poitiers, Faculte de Medecine et de Pharmacie, 86000 Poitiers, France

Summary Background Biological diagnostic criteria for diagnosing aldosterone-producing adenoma (APA) are not well-established. Aim The aim of the study was to establish the best biological predictors of APA. Methods A prospective register was implemented in 17 secondary or tertiary hypertension centres. The inclusion criterion was one of the following: onset of hypertension before 40 years of age; history of hypokalaemia; drug-resistant hypertension (resistant to three drugs); or spironolactone efficiency on BP. Results Among the 338 collected cases, 192 patients had two aldosterone-to-renin ratio (ARR) determinations (after 1 hour supine and at least 1 hour upright) on the same occasion. Twenty-five patients (8.2%) had biological hyperaldosteronism and an adrenal adenoma identified by computed tomography. APA was histologically confirmed in all 12 patients who underwent surgery. Histologically proven APAs were used as the ‘gold standard’ in receiver operating characteristic (ROC) curve analysis. ARRs were computed with a minimum renin value set at 5 ng/L to avoid misclassification of so-called ‘low-renin hypertension’. To predict an APA, the ARR area under the ROC curve was 0.93. A supine ARR cut-off value of 32 ng/ng provided the highest sum of sensitivity (92%) plus specificity (92%). On the basis of an ARR ≥ 32 ng/ng in the supine and/or upright position, sensitivity reached 100%. Conclusion The proposed cut-off value of 32 ng/ng for ARR (minimum renin value set at 5 ng/L) in one of two determinations had 100% sensitivity and 72% specificity with 20% positive and 100% negative predictive values for diagnosing APA.

Aging is a natural and complex physiological process influenced by many factors, some of which are modifiable. As the number of older individuals continues to increase, it is important to develop interventions that can be easily implemented and contribute to "successful aging". In addition to a healthy diet and psychosocial well-being, the benefits of regular exercise on mortality, and the prevention and control of chronic disease affecting both life expectancy and quality of life are well established. We summarize the benefits of regular exercise on longevity, present the current knowledge regarding potential mechanisms, and outline the main recommendations. Exercise can partially reverse the effects of the aging process on physiological functions and preserve functional reserve in the elderly. Numerous studies have shown that maintaining a minimum quantity and quality of exercise decreases the risk of death, prevents the development of certain cancers, lowers the risk of osteoporosis and increases longevity. Training programs should include exercises aimed at improving cardiorespiratory fitness and muscle function, as well as flexibility and balance. Though the benefits of physical activity appear to be directly linked to the notion of training volume and intensity, further research is required in the elderly, in order to develop more precise recommendations, bearing in mind that the main aim is to foster long-term adherence to physical activity in this growing population.

International audience; We aimed to compare blood pressure (BP) responses following moderate-intensity continuous exercise (MICE), high intensity interval exercise (HIIE) in dry land or HIM in immersed condition, using 24-hour ambulatory BP monitoring. Forty-two individuals (65 +/- 7 years, 52% men) with a baseline BP >= 130/85 mm Hg (systolic/diastolic blood pressures [SBP/DBP]) were randomly assigned to perform one of the three following exercises on a stationary cycle: MICE (24 minutes at 50% peak power output) or HIIE in dry land (two sets of 10 minutes with phases of 15 seconds 100% peak power output interspersed by 15 seconds of passive recovery) or HIIE in up-to-the-chest immersed condition. While MICE modified none of the 24-hour average hemodynamic variables, dryland HIIE induced a 24-hour BP decrease (SBP: -3.6 +/- 5.7/DBP: -2.8 +/- 3.0 mm Hg, P < .05) and, to a much greater extent, immersed HIIE (SBP: -6.8 +/- 9.5/DBP: -3.0 +/- 4.5 mm Hg, P < .05). The one condition that modified 24-hour pulse-wave velocity was immersed HIIE (-0.21 +/- 0.30 m/s, P < .05).

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Background Greater renal function decline (RFD) in type 2 diabetes (T2DM) has been suggested in men compared with women, and imbalances in estrogen/androgen levels have been associated with cardiovascular disease mortality in elderly men, but it remains unclear whether sex hormone disequilibrium is related to diabetic nephropathy (DN) in men with T2DM. Objective This study examined the relationship between sex steroid concentrations and renal outcomes in male T2DM patients. Population and methods Total testosterone (T), total estradiol (E2), sex hormone-binding globulin (SHBG), and total and calculated free (cf) E2/T ratios were compared in 735 male T2DM patients with ( n =513) and without ( n =222) DN, using a cross-sectional approach. Also, in a pilot complementary prospective nested case-control cohort, total E2/total T and cfE2/cfT were evaluated according to a hard renal outcome (HRO): end-stage renal disease/doubling of baseline serum creatinine (36 HRO cases, 72 HRO controls) and rate of eGFR decline (68 rapid vs 68 slow RFD). Result With the cross-sectional approach, E2 and cfE2 were higher in DN cases vs DN controls (95.5 vs 86.8pmol/L [ P =0.0246] and 2.59 vs 2.36pmol/L [ P =0.005], respectively). The difference in E2 persisted on multivariate analysis. In the prospective approach, E2 and T concentrations, and total E2/total T and cfE2/cfT2 ratios did not differ in HRO cases vs controls or in patients with rapid vs slow RFD. Conclusion Although positively related to DN in the cross-sectional analysis, progression of renal disease in male patients with T2DM was not related to either sex hormone levels or aromatase index as reflected by E2/T ratio.

OBJECTIVE Epidemiological studies and randomized clinical trials have demonstrated in various populations that resting heart rate (RHR) was an independent predictor of cardiovascular (CV) risk and all-cause mortality. However, few data specifically evaluated the relationship between RHR and long-term CV and renal complications in a large population of type 2 diabetic (T2D) patients. RESEARCH DESIGN AND METHODS We performed a single-center, prospective analysis in 1,088 T2D patients. RHR was determined at baseline by electrocardiogram. The primary outcome was a composite criterion of CV and renal morbi-mortality (CV death, nonfatal myocardial infarction and/or stroke, hospitalization for heart failure, renal replacement therapy), which was adjusted for death from non-CV cause as a competing event. The secondary outcome was a renal composite criterion (renal replacement therapy or doubling of baseline serum creatinine) adjusted for all-cause death as a competing event. RESULTS During median follow-up of 4.2 years, 253 patients (23%) and 62 patients (6%) experienced the primary and secondary outcomes, respectively. In the subgroup of patients with CV disease history at baseline (n = 336), RHR was found to be associated with the incidence of primary outcome (P = 0.0002) but also with renal risk alone, adjusted for all-cause death as a competing event (secondary outcome; P < 0.0001). In patients without history of CV disease, no relation was found between RHR and the incidence of CV and/or renal events. CONCLUSIONS In the real-life setting, RHR constitutes an easy and less time-consuming factor that would permit identification of CV disease diabetic patients with an increased risk for long-term CV and renal complications.

The effects of sauna alone vs exercise and sauna on ambulatory blood pressure monitoring and central hemodynamic variables were measured in 16 patients with untreated hypertension assigned to a control period, sauna, or exercise and sauna. Exercise and sauna had positive effects on 24-hour systolic and mean blood pressure in patients with untreated hypertension. Exercise and sauna and sauna alone reduce total vascular resistance, with positive effects lasting up to 120 minutes after heat exposure.

The use of "snus" (smokeless tobacco) can be detrimental to health. Snus delivers rapidly high doses of nicotine which can lead to addiction. The use of snus increases the risk of myocardial infarction and stroke. Nicotine substitution therapy as well as bupropion and varenicline reduce withdrawal symptoms and tobacco craving during snus cessation. However, they have been shown not to assist in long-term abstinence. Information concerning potential cardiovascular hazards of snus must be incorporated into health educational programs in order to discourage its use. Snus is not a recommended product to help stop smoking.

criteria on various cardiovascular endpoints in type 2 diabetic patients☆ Philippe Sosner ⁎, Severin Cabasson , Charlotte Hulin-Delmotte , Pierre-Jean Saulnier , Elise Gand , Florence Torremocha , Xavier Piguel , Aurelie Miot , Richard Marechaud , Daniel Herpin , Stephanie Ragot , Samy Hadjadj , for the SURDIAGENE Study Group a CHU de Poitiers, Cardiologie, Poitiers, France b Universite de Poitiers, Laboratoire MOVE (EA 6314), Poitiers, France c CHU de Poitiers, Reanimation Medicale, Poitiers, France d CHU de Poitiers, Physiologie, France e Universite de Poitiers, Faculte de Medecine et de Pharmacie, Poitiers, France f Universite de Poitiers, CIC1402, Poitiers, France g CHU de Poitiers, Centre d'Investigation Clinique, Poitiers, France h Inserm, CIC1402, Poitiers, France i CHU de Poitiers, Endocrinologie, Poitiers, France

Points essentiels L’urgence hypertensive doit etre distinguee des elevations tensionnelles sans souffrance viscerale immediate . Les signes de souffrance viscerale sont cliniques [douleur thoracique, dyspnee, troubles neurologiques, anomalies a l’electrocardiogramme (ECG), au fond d’œil], et paracliniques (biologie sang et urine, imagerie cerebrale en cas de troubles neurologiques). La prise en charge est urgente, hospitaliere, par des traitements antihypertenseurs intraveineux, sous controle d’un monitorage tensionnel . Les objectifs tensionnels sont adaptes a la maladie aigue associee [infarctus du myocarde, œdeme pulmonaire, dissection aortique, eclampsie en cours de grossesse, encephalopathie hypertensive, retinopathie, hemorragie cerebro-meningee, hemorragie intracerebrale, accident vasculaire cerebral (AVC) ischemique fibrinolyse ou non].

Objectifs En complement des parametres chiffres de condition physique que nous obtenons de facon systematique par l’evaluation a l’effort, nous avons mis en place une quantification de l’etat emotionnel du patient par un questionnaire de qualite de vie. Les resultats ont ete compares entre le debut et la fin du programme de readaptation cardiaque pour chaque patient. Methodes Le questionnaire est remis au patient en salle d’attente du test d’effort avec pour instruction « remplissez sans trop reflechir… » Le patient evalue ses sentiments a l’aide d’une echelle de 0 a 4, sur laquelle 65 sentiments sont regroupes en 7 emotions presentees sous forme d’une courbe. Resultats Quatre cent questionnaires ont etes remplis, saisis et compares. 164 hommes et 36 femmes, 59,7 ± 11,9 ans, 106 coronariens et 94 non coronariens, 83 patients operes et 117 non operes. Duree de sejour 24,4 ± 10,8 jours Ont ete diminuees et de facon significative : l’anxiete de 9,3 ± 5,1 a 6,6 ± 4,2 (p Conclusions Le POMS est un outil valide, simple d’utilisation, rapide et pratique. Il permet d’avoir des elements chiffres et de constater l’amelioration franche et significative des etats emotionnels et de la qualite de vie des patients apres le sejour en readaptation cardiaque ( Fig. 1 ).

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).

Le patient hypertendu diabetique a le plus souvent un risque cardiovasculaire eleve, mais le veritable niveau de risque doit en fait etre specifiquement evalue pour un patient donne. L'objectif tensionnel a atteindre est une pression arterielle (PA) < 130/80 mmHg. Une bitherapie, ou meme une tritherapie est souvent necessaire pour atteindre cet objectif relativement ambitieux. Les inhibiteurs du systeme renine angiotensine doivent etre utilises preferentiellement en cas de souffrance renale. La proteinurie doit etre ramenee en dessous de 0,5 g/24 heures. Les facteurs de risque associes doivent etre pris en charge avec la meme efficacite: en particulier, le LDL-cholesterol doit etre amene en dessous de 1 g/L quand le niveau de risque se revele particulierement eleve. L'aspirine doit etre systematiquement prescrite (a la dose de 75 mg/j) des que la pression arterielle est bien controlee.

The objectives of the study were to appraise the knowledge which the patients have about their hypertension, and to assess the knowledge and involvement of pharmacists in the management of the hypertensive patient. All the pharmacies in the Poitou-Charentes area were invited both to participate in a training session about arterial hypertension and asked to fill in a pharmacist's questionnaire. Furthermore, each participant was required to submit a patient's questionnaire to 20 consecutive hypertensives. A total of 104 pharmacies and 1015 hypertensive patients participated in the survey. In all, 88% of the patients (n = 893) were aware of their blood pressure (BP) figures, but 68% (349/515) considered themselves wrongly, to be normalized; 39% (n = 350) only had BP figures140/90 mmHg. They said they had been poorly informed about recommended lifestyle changes. In all, 18% (n = 185) were equipped with an automatic device. A total of 77% (n = 779) were able to give the names of their drugs without the help of the pharmacist. Treatment-related unwanted effects were reported by 8% of the patients (n = 79). Only 18% (n = 29) of the pharmacists were able to provide a correct definition of hypertension. Most of them thought hypertension was well controlled in the general population and considered that both tolerance of and compliance with antihypertensive treatment were satisfactory. They could most often (80%, n = 135) supply a SBPM device, but 58 (36%) only were able to provide relevant advice regarding the recommended procedures. In conclusion, The BP goals and the lifestyle modifications are poorly known by the hypertensives. Pharmacists' knowledge is frequently wrong and should be improved by appropriate training programmes.

OBJECTIVE: Stress hyperglycaemia increases the risk of mortality after acute myocardial infarction in diabetic and in non-diabetic patients. We aimed to determine the contribution of admission plasma glucose and HbA(1c) on post-acute myocardial infarction prognosis. PATIENTS AND METHODS: Admission plasma glucose and HbA(1c) were simultaneously measured in all patients consecutively hospitalized for acute myocardial infarction. Patient survival was measured on 5 and 28 days after admission. Patients were defined as having 'previously diagnosed diabetes' (personal history of diabetes defined using ADA 1997 criteria), 'no diabetes', those without previously diagnosed diabetes and HbA(1c) below 6.5%, or 'possible diabetes', i.e. those without previously diagnosed diabetes and HbA(1c) above 6.5%. RESULTS: Of the 146 patients included, four had died by day 5 and 14 by day 28. Admission plasma glucose was higher in patients who had died by day 28 (11.7 +/- 5.8 vs. 8.0 +/- 3.3 mmol/l, P = 0.002), whereas HbA(1c) was not (6.4 +/- 1.9 vs. 6.1 +/- 0.8%, NS). Admission plasma glucose was significantly higher in those who had died by day 28 after adjustment on HbA(1c). A multivariate analysis, including sex, age and heart failure prior to acute myocardial infarction, showed that admission plasma glucose concentration was an independent predictor of survival after acute myocardial infarction. Twenty-seven of the patients had previously diagnosed diabetes and 119 had no history of diabetes. Eleven were found to have possible diabetes. Admission plasma glucose was significantly higher in previously diagnosed diabetes (11.1 +/- 5.6) than in the other groups: 7.7 +/- 2.9 in non-diabetes, 8.2 +/- 2.1 in possible diabetes (P < 0.0001). The relationship between HbA(1c)-adjusted admission plasma glucose and mortality after acute myocardial infarction was also found in the non-diabetes group. CONCLUSIONS: Admission plasma glucose, even after adjustment on HbA(1c), is a prognostic factor associated with mortality after acute myocardial infarction. Acute rather than the chronic pre-existing glycometabolic state accounts for the prognosis after acute myocardial infarction.

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.

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Correspondance : Jacques Blacher Unite hypertension arterielle, prevention et therapeutique cardiovasculaire Centre de diagnostic et de therapeutique Hotel-Dieu, AP-HP 1, place du Parvis Notre-Dame 75181 Paris cedex 4 jacques.blacher@htd.aphp.fr Membres du groupe de travail : Jacques Amar, Athanase Benetos, Jacques Blacher (redacteur), Guillaume Bobrie, Bernard Chamontin, Xavier Girerd, Jean-Michel Halimi, Daniel Herpin, Claire Mounier-Vehier, Jean-Jacques Mourad, Jean Ribstein, Bruno Schnebert, Bernard Vaisse.