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Supplemental Digital Content is available in the text., The SPARTE study (Strategy for Preventing cardiovascular and renal events based on ARTErial stiffness; URL: https://www.clinicaltrials.gov; Unique identifier: NCT02617238) is a multicenter open-label randomized controlled trial with blinded end point evaluation, undertaken at 25 French research centers in university hospitals. Patients with primary hypertension were randomly assigned (1:1) to a therapeutic strategy targeting the normalization of carotid-femoral pulse wave velocity (PWV) measured every 6 months (PWV group, n=264) versus a classical therapeutic strategy only implementing the European Guidelines for Hypertension Treatment (conventional group, n=272). In the PWV group, the therapeutic strategy used preferably a combination of ACE (angiotensin-converting enzyme) inhibitor or angiotensin receptor blocker and calcium channel blockers, as well as maximal recommended doses of ACE inhibitors and angiotensin receptor blockers. The primary outcome was a combined end point including particularly stroke and coronary events. Secondary outcomes included the time-course changes in brachial office blood pressure (BP), ambulatory BP, PWV, and treatments. After a median follow-up of 48.3 months, there was no significant between-group difference in primary outcome (hazard ratio, 0.74 [95% CI, 0.40–1.38], P=0.35). In the PWV group, combinations of renin-angiotensin-system blockers and calcium channel blockers were prescribed at higher dosage (P=0.028), office and ambulatory systolic blood pressure and diastolic blood pressure decreased more (P

Pulse wave velocity is an established marker of early vascular aging but may also help identifying individuals with supernormal vascular aging. We tested the hypothesis that individuals with the largest difference (Δ-age) between chronological and vascular age show the lowest rate of cardiovascular events and may thus be defined as supernormal vascular aging. Vascular age was defined as the predicted age in the best fitting multivariable regression model including classical risk factors and treatment and pulse wave velocity, in a subset of the Reference Values for Arterial Stiffness Collaboration Database (n=3347). Δ-age was then calculated as chronological age minus vascular age, and the 10th and 90th percentiles were used to define early (Δ-age6.8 years). The risk for fatal and nonfatal cardiovascular events associated with vascular aging categories was investigated in the Malmö Diet and Cancer Study cohort (n=2642). In the Malmö Diet and Cancer Study Cohort (6.6-year follow-up, 286 events), Δ-age was significantly ( P

Objective: Impaired baroreflex function is an early indicator of cardiovascular autonomic imbalance. Patients with type 2 diabetes mellitus (T2D) have decreased baroreflex sensitivity (BRS), however, whether the neural and/or mechanical component of the BRS (nBRS and mBRS, respectively) is altered in those with high metabolic risk (HMR, impaired fasting glucose and/or metabolic syndrome) or with overt T2D, is unknown. We examined this in a community-based observational study, the Paris Prospective Study III (PPS3). Approach and Results: In 7626 adults aged 50 to 75 years, resting nBRS (estimated by low-frequency gain, from carotid distension rate and RR intervals [time intervals between successive R waves]) and mBRS were measured by high-precision carotid echotracking. The associations between overt T2D or HMR as compared with subjects with normal glucose metabolism (NGM) and nBRS or mBRS were quantified using multivariable linear regression analysis. There were 319 subjects with T2D (61±6 years, 77% male), 1450 subjects with HMR (60±6 years, 72% male), and 5857 subjects with NGM (59±6 years, 57% male). Compared with NGM subjects, nBRS was significantly lower in HMR subjects (β=−0.07 [95% CI, −0.12 to −0.01]; P =0.029) and in subjects with T2D (β=−0.18 [95% CI, −0.29 to −0.07]; P =0.002) after adjustment for confounding and mediating factors. Subgroup analysis suggests significant and independent alteration in mBRS only among HMR patients who had both impaired fasting glucose and metabolic syndrome. Conclusions: In this community-based study of individuals aged 50 to 75, a graded decrease in nBRS was observed in HMR subjects and patients with overt T2D as compared with NGM subjects.

International audience; Objectives: Pulse wave velocity (PWV) of the aortic arch is usually estimated by using 2D phase contrast in MRI. Thanks to 4D flow MRI, segmental PWV of the ascending and descending aorta, as well as PWV of the entire thoracic aorta can now be estimated within the same examination. Our objective is to compare PWVs obtained by 2D and 4D PC, through their relationships with carotid-femoral PWV (cf-PWV), age and left ventricular remodelling.Basic methods: MRI examinations were performed at 3 Tesla, including 2D PC acquisitions with through-plane velocity encoding and sagittal 4D phase contrast acquisitions covering the thoracic aorta volume. PWVs were calculated after estimating aortic lengths and flow transit times between the ascending aorta and descending aorta in 2D and between valve, isthmus and diaphragm in 4D resulting in 2D-PWV, 4D-TA-PWV; 4D-AA-PWV, 4D-DA-PWV.Main results: Fifty-seven healthy volunteers (25 men, age 51 years ± 17) were studied. All MRI-PWVs were correlated with cf-PWV (r = 0.67; r = 0.63: r = 0.47; r = 0.61 for 2D-PWV, 4D-TA-PWV; 4D-AA-PWV, 4D-DA-PWV, respectively, P < 0.001). 2D-PWV and 4D-TA-PWV were strongly related with age (r = 0.76 and r = 0.77, respectively). The highest correlation, between left ventricular thickness or LV mass/end diastolic volume (EDV) ratio and segmental PWVs of the thoracic aorta was found with 4D-AA-PWV (r = 0.43, P < 0.01 and r = 0.48, P < 0.01).Principal conclusions: Global and segmental PWV analysis of the thoracic aorta can be accurately assessed using 4D flow MRI. 4D-PWVs were highly correlated with ageing and cf-PWV. The strong association between the ascending aorta stiffness and the left ventricular remodelling in healthy volunteers is encouraging to better estimate left ventricular afterload.

OBJECTIVE Increased carotid stiffness and remodelling is reported in patients with moderate and advanced chronic kidney disease (CKD) and is associated with cardiovascular events. Here, we tested the hypothesis that carotid artery alterations start earlier, during mild CKD. METHODS Within the Paris Prospective Study 3, a large prospective observational survey of nonreferred people aged 50-75 who received an extensive health check-up, there were 294 participants with glomerular filtration rate (GFR) of at least 45 and less than 60 ml/min per 1.73 m (Stage 3A CKD), 840 participants with GFR 60-89 ml/min per 1.73 m with proteinuria (Stage 2 CKD), 4666 participants with GFR 60-89 ml/min per 1.73 m without proteinuria and 3317 individuals with GFR at least 90 ml/min per 1.73 m at study recruitment. Carotid artery measurements were performed using a high-resolution echotracking device. RESULTS Compared with patients with GFR at least 90 ml/min per 1.73 m, the carotid distensibility and strain progressively decreased (P for trend

Vascular aging is a major contributor to cardiovascular disease and can be quantified by higher carotid stiffness, intima-media thickness and diameter, and hypertension. Weight gain across the lifetime may be an important, modifiable determinant of vascular aging. We therefore aimed to assess lifetime body silhouette trajectories (a marker of weight change across the lifespan) in relation to vascular aging in late adulthood. We used cross-sectional data from a community-based cohort study (n=8243; age, 59.4; 38.7% women). A linear mixed model was used to assess trajectories of recalled body silhouettes from age 8 to 45 years. We assessed carotid artery properties (ultrasonography), resting hypertension (blood pressure ≥140/90 mm Hg or use of antihypertensives), and exaggerated exercise blood pressure, a marker of masked hypertension (systolic blood pressure ≥150 mm Hg during submaximal exercise) at study recruitment when the participants were 50 to 75 years of age. We identified 5 distinct body silhouette trajectories: lean stable (32.0%), lean increase (11.1%), moderate stable (32.5%), lean-marked increase (16.3%), and heavy stable (8.1%). Compared with individuals in the lean-stable trajectory, those in the moderate-stable, lean-marked increase, and heavy-stable trajectories had higher carotid stiffness, intima-media thickness and diameter (odds ratios between 1.23 and 2.10 for highest quartile versus lowest quartile of manifestations of vascular aging; P P

The changes experienced by the arterial system due to the aging process have been extensively studied but are incompletely understood. Within-subject patterns of changes in regards to input impedance and wave reflection parameters have not been assessed. The Asklepios study is a longitudinal population study including healthy (at onset) middle-aged subjects, with 974 males and 1052 females undergoing two rounds of measurements of applanation tonometry and ultrasound, 10.15 ± 1.40 years apart. Carotid-femoral pulse wave velocity (PWV), aortic input impedance, and wave reflection parameters were assessed, and linear mixed-effects models were used to evaluate their longitudinal trajectories and determinants. Overall, the effective 10-year increase in PWV was less than expected from first round cross-sectional data, and PWV was found to accelerate more in women than in men. Interestingly, the increase in PWV was not paralleled by a decrease in arterial volume compliance, particularly in younger males. Aortic root characteristic impedance decreased with age in younger subjects while it increased for the older subjects in the study. These changes suggest that aortic dilation and elongation may play an important role determining the longitudinal age-related changes in impedance parameters in middle-age. Wave reflection decreased with aging, whereas resistance increased in women and decreased in men. We conclude that the effective impact of aging on arterial system properties, in a middle-aged population, is not well reflected by cross-sectional studies. Future studies should assess the interaction between geometric remodeling and wall stiffening as determinants of pulsatile hemodynamics.

Due to limited space and resources, it can be difficult to train students on audiological procedures adequately. In the present study, we compared audiology training outcomes between a traditional approach and a recently developed immersive virtual reality (VR) approach in audiology students. Twenty-nine first-year audiology students participated in the study; 14 received traditional training (“TT group”), and 15 received the VR training (“VRT group”). Pre- and post-training evaluation included a 20-item test developed by an audiology educator. Post-training satisfaction and self-confidence were evaluated using Likert scales. Mean post-training test scores improved by 6.9±9.8 percentage points in the TT group and by 21.1±7.8 points in the VRT group; the improvement in scores was significant for both groups. After completing the traditional training, the TT group was subsequently trained with the VR system, after which mean scores further improved by 7.5 points; there was no significant difference in post-VR training scores between the TT and VRT groups. After training, the TT and VRT groups completed satisfaction and self-confidence questionnaires. Satisfaction and self-confidence ratings were significantly higher for the VR training group, compared to the traditional training group. Satisfaction ratings were “good” (4 on Likert scale) for 74% of the TT group and 100% of the VRT group. Self-confidence ratings were “good” for 71% of the TT group and 92% of the VRT group. These results suggest that a VR training approach may be an effective alternative or supplement to traditional training for audiology students.

PRESCRIPTION OF FIXED DOSE COMBINATIONS OF ANTIHYPERTENSIVE DRUGS. Many fixed-dose antihypertensive combinations are available for treating hypertension. Compared to free associations, fixed-dose combinations have major advantages including a well-defined dose-ratio and a better adherence. The later leads to higher antihypertensive efficacy and faster blood pressure lowering effect, particularly interesting in patients at high cardiovascular risk, and to a lower cost of global medical care. However, fixed-dose combinations have some theorical limitations that need to be evaluated in clinical practice: a reduced detection of the possible inefficacy of one of the medications, a reduced possibility of combining different dosages, an increased risk of misuse, and a higher risk of complications in case of non-adherence. Fixed-dose combination therapies are insufficiently prescribed for first-line antihypertensive treatment despite an increasing level of evidence and their recommendations by learned societies. Triple fixed-dose combinations, prescribed as second-line antihypertensive treatment, are not yet reimbursed by health care systems. Drug companies should be encouraged to perform large randomized controlled clinical trials, in order to demonstrate that fixeddose combination therapies, prescribed first-line, increase short and long-term adherence compared to free associations, and thus lower blood pressure to a higher extent, ultimately leading to a lower incidence of cardiovascular complications.PRESCRIPTION DES ASSOCIATIONS FIXES D’ANTIHYPERTENSEURS. Pour le traitement de l’hypertension artérielle, le médecin dispose d’un grand nombre d’associations thérapeutiques fixes. Celles-ci présentent des atouts importants par rapport aux associations libres : un rapport de posologie rigoureusement étudié et une meilleure observance. La meilleure observance est source d’efficacité antihypertensive supplémentaire et d’une plus grande rapidité d’action particulièrement intéressante chez les patients à haut risque cardiovasculaire, à un moindre coût de la prise en charge médicale globale. Les limites des associations fixes par rapport aux associations libres sont théoriques et nécessitent d’être évaluées en pratique : moindre détection d’une possible inefficacité d’un des deux médicaments, restriction des possibilités de combinaison de posologies, plus fréquent mésusage, et dangerosité en cas d’inobservance. En première intention, les bithérapies fixes restent insuffisamment prescrites malgré un niveau de preuve croissant alors que leur utilisation est maintenant recommandée par les sociétés savantes européennes. Les combinaisons fixes triples d’antihypertenseurs, prescrites en deuxième intention, ne font pas encore l’objet d’un remboursement. Les industriels du médicament devraient être encouragés à mettre en place des essais thérapeutiques randomisés qui prendraient en compte l’amélioration de l’observance à court et à long terme, la baisse de la pression artérielle et la réduction des complications cardiovasculaires.

Background: Large artery stiffness is an index of vascular ageing associated with cardiovascular mortality. While traditional risk factors for arterial stiffness are known, the contribution of socioeconomic factors are less reported. We sought to determine the relationship between arterial stiffness and socioeconomic deprivation (at the individual and neighborhood levels) in healthy males and females. Methods: In 7803 adults, carotid stiffness was determined by high-precision carotid echotracking. Individual deprivation data included education, living alone, occupation and Evaluation of the Deprivation and Inequalities of Health in Healthcare Centers (EPICES) score. Neighborhood deprivation was determined from commune level data (smallest administrative sub-division) available from French National Institute of statistics and Economic Studies (2011) using principal component analysis. The separate and combined associations between individual and neighborhood deprivation (main exposures) and carotid stiffness (outcome) were quantified using linear and multilevel model adjusted for traditional risk factors including age, mean blood pressure, body mass index, fasting glucose, high density lipoprotein, triglycerides, heart rate, history of cardiovascular disease, smoking, alcohol, and physical activity. Analyses were conducted separately in males and females. Results: Individual deprivation (lower education and occupation in males, and living alone and higher EPICES in both populations) was adversely related to carotid stiffness, independently of potential confounders (p < 0.05). Neighborhood deprivation was adversely related to carotid stiffness in males (p < 0.05) but not in females. Conclusion: Socioeconomic deprivation, both at the individual and, to a lesser extent, neighborhood level are associated with carotid stiffness in males. Only individual deprivation is associated with carotid stiffness in females.

Digital, The Lancet Commission on Hypertension identified that a key action to address the worldwide burden of high blood pressure (BP) was to improve the quality of BP measurements by using BP devices that have been validated for accuracy. Currently, there are over 3 000 commercially available BP devices, but many do not have published data on accuracy testing according to established scientific standards. This problem is enabled through weak or absent regulations that allow clearance of devices for commercial use without formal validation. In addition, new BP technologies have emerged (e.g. cuffless sensors) for which there is no scientific consensus regarding BP measurement accuracy standards. Altogether, these issues contribute to the widespread availability of clinic and home BP devices with limited or uncertain accuracy, leading to inappropriate hypertension diagnosis, management and drug treatment on a global scale. The most significant problems relating to the accuracy of BP devices can be resolved by the regulatory requirement for mandatory independent validation of BP devices according to the universally-accepted International Organization for Standardization Standard. This is a primary recommendation for which there is an urgent international need. Other key recommendations are development of validation standards specifically for new BP technologies and online lists of accurate devices that are accessible to consumers and health professionals. Recommendations are aligned with WHO policies on medical devices and universal healthcare. Adherence to recommendations would increase the global availability of accurate BP devices and result in better diagnosis and treatment of hypertension, thus decreasing the worldwide burden from high BP., La Comisión Lancet de Hipertensión determinó que una medida clave para responder a la carga mundial que representa la hipertensión arterial era mejorar la calidad de las mediciones de la presión arterial, mediante la utilización de dispositivos cuya exactitud haya sido validada. En la actualidad existen 3000 dispositivos comercializados, pero muchos no tienen datos publicados sobre pruebas de exactitud conformes a las normas científicas establecidas. La falta de regulación o su ineficiencia, que permiten la autorización de dispositivos para uso comercial sin una validación oficial, posibilitan este problema. Además, han surgido tecnologías nuevas de medición de la presión arterial (por ejemplo, los sensores sin brazalete) sobre las cuales no existe unanimidad en la comunidad científica con respecto a las normas de exactitud de la medición. En conjunto, estos aspectos contribuyen a la disponibilidad generalizada de tensiómetros de consultorio o domiciliarios que ofrecen una exactitud limitada o incierta, que llevan a diagnósticos, manejo y farmacoterapia inapropiados de la hipertensión a escala mundial. Los problemas más importantes relacionados con la exactitud de los dispositivos de medición de la presión arterial se pueden resolver mediante el requisito regulatorio de una validación independiente obligatoria de los dispositivos, en consonancia con la norma ISO universalmente aceptada. Esta es una recomendación básica y constituye una necesidad internacional acuciante. Otras recomendaciones clave son la elaboración de normas de validación específicas para las tecnologías nuevas de medición de la presión arterial y la publicación en línea de listas de los dispositivos nuevos exactos que están a la disposición de los usuarios y los profesionales de salud. Las recomendaciones están en consonancia con las políticas de la Organización Mundial de la Salud sobre los dispositivos médicos y la atención universal de la salud. El cumplimiento de las recomendaciones aumentará la disponibilidad mundial de dispositivos de medición de la presión arterial que sean exactos y tendrá como efecto un mejor diagnóstico y tratamiento, reduciendo así la carga mundial de la hipertensión., A Comissão Lancet sobre Hipertensão Arterial identificou que uma iniciativa central para enfrentar a carga mundial da hipertensão arterial seria a melhoria na qualidade da mensuração da pressão arterial pelo uso aparelhos de pressão arterial validados quanto à acurácia. Atualmente, existem mais de 3 000 aparelhos de pressão arterial disponíveis comercialmente; entretanto, muitos não têm dados publicados sobre testes de acurácia realizados de acordo com padrões científicos estabelecidos. Este problema resulta de regulamentação fraca ou inexistente, o que permite a aprovação para uso comercial de dispositivos sem validação formal. Além disso, surgiram novas tecnologias de mensuração da pressão arterial (por exemplo, sensores sem algemas) sem consenso científico quanto aos padrões de acurácia. No conjunto, essas questões contribuem para a oferta generalizada de dispositivos de pressão arterial clínica e domiciliar com acurácia limitada ou incerta, levando a diagnóstico, gerenciamento e tratamento inadequados da hipertensão em escala global. Os problemas mais significativos relacionados com a acurácia dos dispositivos de pressão arterial podem ser resolvidos por regulamentação que imponha a obrigatoriedade de validação independente dos aparelhos de pressão arterial, de acordo com a norma universalmente aceita pela Organização Internacional de Normalização. Esta é uma recomendação fundamental para a qual existe uma necessidade internacional urgente. Outras recomendações essenciais incluem o desenvolvimento de padrões de validação especificamente para novas tecnologias de mensuração da pressão arterial e listas on-line de aparelhos com acurácia adequada que sejam acessíveis aos consumidores e profissionais de saúde. As recomendações estão alinhadas com as políticas da Organização Mundial da Saúde (OMS) sobre dispositivos médicos e atenção universal à saúde. A adesão às recomendações aumentaria a oferta global de dispositivos de pressão arterial com acurácia adequada e resultaria em melhor diagnóstico e tratamento da hipertensão arterial, diminuindo assim a carga mundial dessa doença., Traducción oficial al español del artículo original en inglés efectuada por la Organización Panamericana de la Salud. En caso de discrepancia, prevalecerá la versión original en inglés. Wolters Kluwer Health, Inc. y sus sociedades no se hacen responsables de la exactitud de la traducción del original inglés ni de los eventuales errores que esta pueda contener. Cita del artículo original: Sharman JE, O'Brien E, Alpert B, Schutte AE, Delles C, Hecht Olsen M et al. Lancet commission on hypertension group position statement on the global improvement of accuracy standards for devices that measure blood pressure. J Hypertens. 2020:38:21-29.doi: https://doi. org/10.1097/HJH.0000000000002246, Ciencias Médicas y de la Salud

International audience; Arterial stiffness is a major independent risk factor for cardiovascular complications causing isolated systolic hypertension and increased pulse pressure in the microvasculature of target organs. Stiffening of the arterial wall is determined by common mechanisms including reduced elastin/collagen ratio, production of elastin cross-linking, reactive oxygen species–induced inflammation, calcification, vascular smooth muscle cell stiffness, and endothelial dysfunction. This brief review will discuss current biological mechanisms by which other cardiovascular risk factors (eg, aging, hypertension, diabetes mellitus, and chronic kidney disease) cause arterial stiffness, with a particular focus on recent advances regarding nuclear mechanotransduction, mitochondrial oxidative stress, metabolism and dyslipidemia, genome mutations, and epigenetics. Targeting these different molecular pathways at different time of cardiovascular risk factor exposure may be a novel approach for discovering drugs to reduce arterial stiffening without affecting artery strength and normal remodeling.

We propose an integrated pathophysiological approach that we named “large/small artery cross-talk” in order to better explain how large and small artery changes interact in pressure wave transmission; increase central pressure pulsatility; exaggerate cardiac, brain, and kidney damage; and lead to cardiovascular and renal complications. The cross-talk between the micro- and the macrocirculation promotes a vicious circle, which can begin either from large vessels or at the site of small arteries. Sequentially, increased resistance in small arteries increases mean BP and then increases arterial stiffness in the large elastic arteries, which concomitantly with more pressure wave reflections increases central systolic blood pressure, ultimately leading to target organ damage. The increased central BP pulsatility is in turn a factor of small resistance artery damage. Lastly, the increase in the media-to-lumen ratio of small resistance arteries and the concomitant reduction in lumen diameter represent the most important part of the structural aspects of increased total peripheral resistance, leading to a rise in mean BP and thus prolonging the vicious circle.

Background Orthostatic hypotension, blood pressure (BP) variability, and arterial stiffness are three markers of cardiovascular risk beyond the average BP. However, the relationships between these three parameters are not well known. Aim To examine the relationships between orthostatic hypotension, BP variability, and arterial stiffness. Methods and results In the Three-City study, a sample of 1151 elderly participants (mean age = 80 ± 3 years) was screened for orthostatic hypotension, undertook home BP and pulse wave velocity (PWV) measurements. We performed logistic regression analyses to look at the associations between orthostatic hypotension and both day-to-day (D-to-D) BP variability quartiles and PWV quartiles. Orthostatic hypotension was detected in 210 participants who were more likely to be hypertensive, exhibit higher BP variability and have increased arterial stiffness. In the multivariate logistic regression analysis, the frequency of orthostatic hypotension increased by 20% with every quartile of D-to-D SBP variability and by 20% with every quartile of PWV. PWV and D-to-D BP variability were not associated. In stratified analysis, the use of beta-blocker changes these relationships: orthostatic hypotension was not associated to PWV anymore but its association with D-to-D SBP variability was apparently stronger. Conclusion In this large sample of elderly individuals, orthostatic hypotension was independently associated with both BP variability and PWV. BP variability being more indicative of a baroreflex dysfunction and PWV being a marker of vascular ageing, these two components would participate to the orthostatic hypotension mechanisms.

The 2008 European Society of Cardiology/European Society of Hypertension guidelines recommend the first-line prescription of two antihypertensive drugs in single-pill combinations (SPCs), also known as fixed-dose combinations, for the treatment of most patients with hypertension. This recommendation is based on a large amount of data, which shows that first-line treatment with SPCs supports reaching blood pressure targets rapidly and reducing cardiovascular outcome risk while keeping the therapeutic strategies as simple as possible and fostering adherence and persistence. As this approach constitutes a big shift from the stepped-care approaches that have been dominant for many years, practicing physicians have expressed concerns about using SPCs as first-line agents. In this review, we will discuss the barriers to the uptake of this recommendation. We will also offer suggestions to reduce the impact of these barriers and address specific concerns that have been raised.

RESUME Il existe un paradoxe entre d’un cote le grand nombre de molecules disponibles et bon marche et la quasi-gratuite des medicaments et d’autre part leur sous-utilisation par inertie therapeutique et inobservance. Nous souhaitons souligner ici certaines imperfections concernant les traitements antihypertenseurs en France et suggerer quelques moyens de les corriger. Cela concerne en premier lieu l’utilisation des generiques. Nous proposons la generalisation de la prescription DCI (Denomination Commune Internationale) et l’utilisation par le patient d’un generique de la meme marque tout au long de son traitement pour eviter toute erreur de prise et favoriser l’observance medicamenteuse. Le deuxieme probleme concerne les bitherapies fixes d’antihypertenseurs de premiere intention, insuffisamment prescrites malgre un niveau de preuve croissant alors que leur utilisation est maintenant recommandee par les societes savantes europeennes. Il est necessaire de sensibiliser les medecins et les patients, ainsi que les industriels du medicament a l’interet de controler rapidement l’hypertension. La troisieme imperfection concerne l’absence de remboursement des combinaisons fixes triples d’antihypertenseurs, prescrites en deuxieme intention. Les industriels du medicament devraient etre encourages a mettre en place des essais therapeutiques randomises qui prendraient en compte l’amelioration de l’observance a court et a long terme, la baisse de la pression arterielle et la reduction des complications cardiovasculaires, de maniere a convaincre les membres de la Commission de la Transparence de la Haute Autorite de Sante (HAS) et obtenir ainsi un remboursement. Enfin, de maniere plus specifique, la prescription d’eplerenone devrait etre autorisee et remboursee en cas d’HTA resistante sans hyperaldosteronisme primaire chez les patients intolerants a la spironolactone.

Physical activity (PA) is a preventative behavior for noncommunicable disease. However, little consideration is given as to whether different domains of PA have differing associations with health outcomes. We sought to determine the association between occupational, sport, leisure, and total PA with baroreflex sensitivity (BRS), distinguishing between neural (nBRS) and mechanical (mBRS) BRS. In a cross-sectional analysis of 8649 adults aged 50 to 75 years, resting nBRS (estimated by low-frequency gain, from carotid distension rate and heart rate) and mBRS (carotid stiffness) were measured by high-precision carotid echo-tracking. PA was self-reported using the validated Baecke questionnaire. The associations between PA and nBRS and mBRS were quantified using multivariate linear regression analysis, separately in the working and nonworking population. In working adults (n=5039), occupational PA was associated with worse nBRS (unstandardized β=−0.02; [95% CI, −0.04 to −0.003]; P =0.022) whereas sport PA was associated with better nBRS (β=0.04; [95% CI, 0.02–0.07]; P =0.003) and mBRS (β=−0.05; [95% CI, −0.09 to −0.00001]; P =0.049). Neither leisure PA nor total PA was associated with nBRS or mBRS. In nonworking adults (n=3610), sport PA and total PA were associated with better mBRS (β=−0.08; [95% CI, −0.15 to 0.02]; P =0.012 and β=−0.05; [95% CI, −0.10 to 0.009]; P =0.018) but not nBRS. These findings suggest differential associations between domains of PA and BRS and may provide insights into the mechanisms underlying the association between occupational PA and cardiovascular disease.

Summary In recent years great emphasis has been placed on the role of arterial stiffness in the development of cardiovascular diseases. The present article is an abridged version of an expert consensus document reporting the proceedings of several meetings of the European Network for Non Invasive Investigation of Large Arteries, and providing an updated and practical overview of the most relevant methodological aspects and clinical applications in this area. It provides recommendations for the determination of regional, local and systemic of arterial stiffness, and for the noninvasive determination of wave reflections. Clinical applications of arterial stiffness are also discussed.

The aim of this study, enrolling 118 patients, was to clinically evaluate the accuracy of carotid pulse waveform acquisition with a new non-invasive optical fiber probe using invasive and non-invasive pressure readings as references. Pulse waves were acquired simultaneously in the ascending aorta and right common carotid; for the non-invasive study, the pulses were sequentially acquired using the optical fiber device and the Complior Analyse® (Alam Medical, France) device in the right carotid artery. For all subjects, the pulse waveforms assessed using the optical fiber sensor and the references were superimposed to analyze the deviation and point-by-point correlation. Augmentation index and central pressure were compared using intraclass correlation and Bland-Altman analyses with a confidence interval of 95%. For the invasive study, the acquired waves presented a mean deviation of 11 ± 3% and a mean intraclass correlation of 0.97 ± 0.02. Concerning the augmentation index and central systolic pressure, correlations of 0.79 (p

International audience; Background: Left ventricular (LV) remodeling and aortic stiffness have independent predictive value for all causes and cardiovascular mortality. Because elastic properties of the arterial wall vary along the aortic pathway, we hypothesized that local and regional aortic stiffness could differently impact on LV remodeling.Methods and results: Regional aortic stiffness was determined from carotid-femoral pulse wave velocity (cfPWV) measured by aplanation tonometry. Aortic arch pulse wave velocity was measured by phase contrast cardiovascular magnetic resonance (CMR). Local stiffness was calculated in the ascending aorta pulse wave velocity (aaPWV) and descending aorta pulse wave velocity using central pulse pressure measurement, cine CMR acquisition, and surface change estimation. CMR LV remodeling was expressed as LV mass to end-diastolic volume ratio.We evaluated 146 study participants (41 ± 15 years) free of overt cardiovascular disease. In stepwise multivariate regression analysis, cfPWV and aaPWV were significantly and independently correlated to mass to end-diastolic volume ratio (partial R = 0.07 and R = 0.10, respectively, all P < 0.005) after adjustment for age, sex, BMI, brachial mean blood pressure, and central pulse pressure. Descending aorta pulse wave velocity was correlated with mass to end-diastolic volume ratio to a lower extent (R = 0.04, P = 0.0115) and aortic arch pulse wave velocity was not independently associated with mass to end-diastolic volume ratio. CfPWV and aaPWV were both independently associated with mass to end-diastolic volume ratio, explaining 5 and 8% of mass to end-diastolic volume ratio variance, respectively.Conclusion: In study participants free of overt cardiovascular disease, stiffness of the ascending aorta representing the local proximal aortic function face to the LV and of the downstream aortic pathway assessed by cfPWV reflecting more advanced alterations of material properties involving the entire aorta, are independent determinants of LV remodeling after adjustment to age, BMI, mean blood pressure, and sex.

The Palais de la Lumiere or Pavillon de l’Electricite (Electricity Pavilion), built by Robert Mallet-Stevens with interior design by Georges-Henri Pingusson and housing the mural La Fee Electricite...