Prevalence of masked and nocturnal hypertension in patients with obstructive sleep apnea syndrome

IntroductionObstructive sleep apnea (OSA) is considered as a risk factor for the development and worsening of compensation of arterial hypertension and other cardiovascular diseases. Prevalence of masked and nocturnal hypertension can have a significant negative impact on these patients and these prevalences are not well known.AimTo evaluate the prevalence of masked and nocturnal hypertension in patients with OSA.Materials and methodsIn this study, 97 (88 men) patients were enrolled, average age 53.9 ± 9.7 years. OSA was diagnosed with polysomnography and the continuous positive airway pressure therapy has been indicated according to current guidelines. Then were evaluated parameters of OSA (apnea-hypopnea index (AHI), oxygen desaturation index (ODI), % of sleep time <90% SpO₂, average night SpO₂). Patients also underwent physical examination including office blood pressure measurement, 24 h blood pressure monitoring (ABPM) and measurement of anthropometric parameters.ResultsFollowing average values were present in OSA patients (mean value and standard deviation): AHI 54.6 ± 22.7, ODI 58.3 ± 24, % of sleep time < 90% SpO₂ 35.4 ± 25.1, average night SpO₂ 88.8 ± 5. Masked hypertension was present in 55 (56.7%) patients, nocturnal hypertension in 79 (81.4%) patients. Arterial hypertension was appropriately compensated in only 15 (15.5%) patients. Results have not shown any statistically significant correlation between prevalence of nocturnal hypertension and AHI (p = 0.059), % of sleep time <90% SpO₂ (p = 0.516), average night SpO₂ (p = 0.167). ODI was significantly higher in patients with nocturnal hypertension (p = 0.002). No correlation between prevalence of masked hypertension and AHI (p = 0.841), ODI (p = 0.137), average night SpO₂ (p = 0.991) and % of sleep time <90% SpO₂ (p = 0.896) has been present.ConclusionThis study has demonstrated high prevalence of masked and nocturnal hypertension in patients with OSA, which can considerably increase risks of cardiovascular diseases in these patients.     

Hypertension artérielle au moment du diagnostic du diabète de type 2 de l’adulte

Aim of studyOur aim was to determine the prevalence of arterial hypertension and evaluate its association with vascular chronic complications in newly diagnosed type 2 diabetes patients, in an observational, prospective study.Material and methodsWe have recruited 327 newly diagnosed type 2 diabetics aged from 40 to 70 years, in general practice units. Arterial blood pressure has been measured according to WHO guidelines. All data on clinical examination, diabetes's chronic complications were collected during 6 months and statistically analyzed with Epi-Info 6.04 database program.ResultsAmong the patients, 66.7% had arterial hypertension at diagnosis of diabetes, 28% were known as hypertensive. They were 54.3 ± 8.4 years old and have metabolic syndrome in 88.4%. Men have more frequently a higher cardiovascular risk, higher glycaemia and albuminuria; women were more likely to have a metabolic syndrome and a higher BMI. Blood pressure increases with cardiovascular risk and metabolic syndrome components. Microangiopathy is present in 65.7%, atherosclerosis in 59.4 and 71.2% of hypertensive patients who have atherosclerosis have also microvascular complications.ConclusionThe prevalence of arterial hypertension in newly diagnosed type 2 diabetes is high. This association is linked with an alarming level of vascular morbidity. Early detection and treatment of these two diseases need a better implication and motivation of patients and health care providers. Clinicaltrials.gov ID: NCT02002091.     

L’hypertension artérielle masquée chez les obèses : facteurs associés et atteinte myocardique infraclinique

IntroductionObesity is a worldwide health problem. Masked hypertension is a relatively recent reported entity with a diagnostic problem. The aim of this study was to determine the clinical and paraclinical characteristics and to identify the predictive factors of masked hypertension in obese patients.MethodsIt is a prospective study including obese patients with normal arterial pressure at office. All of these patients were given ambulatory blood pressure measurement (ABPM) to screen for masked hypertension, laboratory tests and a complete echocardiography study.ResultsA total of 50 patients were included. The mean age was 46.52 ± 10.4 years. The mean systolic blood pressure (BP) at office was 120.8 ± 8.8 mmHg and the mean diastolic BP was 75 ± 7.3 mmHg. The prevalence of masked hypertension in obese adults was 36% with a predominantly non-dipper profile (38%). The study of echocardiographic parameters found dilated left atrium (LA) in 16 patients (32%). The left ventricle (LV) was hypertrophied in 32 patients (64%). The overall LV global longitudinal strain (GLS) was on average ?18.85 ± 0.9% and the LA GLS was on average 37.35 ± 4.5%. In our study, metabolic syndrome, low HDL cholesterol, elevated fasting blood glucose, hyperuricemia, LA dilatation, LV hypertrophy, diastolic LV dysfunction and altered myocardial deformities were factors associated with masked hypertension in obese adults.ConclusionIt is important to screen for hypertension by ambulatory measurement in at-risk obese patients who present associated cardiovascular risk factors to reduce morbidity and mortality. Echocardiography and speckle tracking analysis could be helpful in detection sub-clinical myocardial deterioration in obese patients with masked hypertension.     

Orthostatic hypertension in normotensive type 2 diabetics: What characteristics?

Aim of the studyWe aimed to determine the prevalence of orthostatic hypertension (OHT) in normotensive, newly diagnosed type 2 diabetics, to assess clinical, biological characteristics of those patients and evaluate the evolution of their blood pressure, after one year of follow-up.Materials and methodsIt is an observational, prospective, cohort study, on 108 normotensive, newly diagnosed diabetics, 40 men and 68 women aged from 40 to 70 ans. OHT was defined as an increase of systolic blood pressure (SBP) ≥ 20 mmHg and/or diastolic blood pressure (DBP) ≥ 10 mmHg, after 1 and 2 min of standing from supine position. Arterial hypertension and metabolic syndrome were respectively defined according to WHO and AHA 2009 guidelines. Clinical and biological data were collected for all patients. They had a screening for diabetic complications and a follow-up during one year. Statistical analysis was performed with Epi-Info 6.04.ResultsWe found OHT in 22 patients (20.4%). Patients with OHT had a higher SBP at lying position (P = 0.029), a higher waist circumference (P = 0.022) and LDL (P = 0.041). They had more frequently obesity (P = 0.036) left ventricular hypertrophy (P = 0.024), metabolic syndrome (P = 0.042) and cerebrovascular events (P = 0.050) when compared with those with normal blood pressure response to orthostasis. One year after follow-up, the prevalence of permanent hypertension was significantly higher in the OHT group (P = 0.0008).ConclusionOur study suggests that OHT is associated with insulin resistance syndrome and onset of sustained arterial hypertension in normotensive, newly diagnosed diabetics.     

Comparison of demographic,clinical, laboratory parameters between patients with sustained normotension,white coat hypertension,masked hypertension,and sustained hypertension

BackgroundAfter measurement of office blood pressure (BP) and ambulatory BP monitoring (ABPM), 4 groups of patients were identified namely: (i) sustained normotensive patients (BPs are normal both clinically and by ABPM); (ii) white coat hypertensive patients (clinical BP were above limits, but ABPM were normal); (iii) masked hypertensive patients (clinical BP were normal, but ABPM were high); (iv) sustained hypertensive patients (both office and ABPM were high). The exact pathophysiologic mechanisms of these conditions are not exactly known. Besides in the literature there are only few studies that compare the 4 groups of patients together. Thus the study was carried out to compare patients with sustained normotension (SNT), white coat hypertension (WCHT), masked hypertension (MHT), and sustained hypertension (SHT).MethodsAll patients underwent history taking, physical examination, laboratory analysis, and ABPM. They were referred to the cardiology department for echocardiographic evaluation.ResultsIn total 85 patients with SNT, 112 patients with WCHT, 31 patients with MHT, and 81 patients with SHT were included. Going from SNT to SHT, body mass index (p < 0.0001), waist circumference (p < 0.0001), fasting blood glucose (p = 0.002), and uric acid (p = 0.029) rose progressively. Presence of metabolic syndrome was also highest in SHT and lowest in SNT (p < 0.0001).ConclusionMost of the metabolic risk factors were higher in patients with MHT and SHT when compared to SNT and WCHT. Studies are needed to determine whether metabolic risk factors play a causative role for the development of MHT and SHT.     

Hypertension artérielle et risque cardiovasculaire associés au syndrome d’apnées obstructives du sommeil chez l’adulte en Guadeloupe

Background and purposeIn Guadeloupe, data on the relationships between arterial hypertension and obstructive sleep apnea are unavailable. The aim of this study was: to assess the frequency of hypertension and non-dipper pattern evaluated by 48-hour ambulatory blood pressure monitoring in an adult population identified obstructive sleep apnea/non-obstructive sleep apnea during overnight polygraphy ; to determine the cardio-metabolic factors associated with obstructive sleep apnea.Design and methodA cross-sectional study was realized at Pointe-à-Pitre Hospital. Patients were referred for suspected sleep apnea to sleep specialist and performed a nocturnal polygraphy. Diagnosis was confirmed if the apnea-hypopnea index was ≥ 5. We obtained two groups: sleep apnea/non-sleep apnea. All patients underwent 48-hour ambulatory blood pressure monitoring. The cardio-metabolic factors were identified and assessed (fasten level of hs-CRP and Homa-IR index).ResultsA total of 204 patients were included. Mean age at diagnosis was 54 ± 10 years, 63% were women. OSA was present in 69.6% with a higher frequency in men than in women. Difference was not significant between the two groups for hypertension frequency (84.5% vs 77%; P = 0.22), non-dipper pattern (77.5% vs 76%; P = 0.79) and hs-CRP. Differences for age, snoring, body max index, mean waist circumference, Homa-IR index, obesity, dyslipidemia, and type 2 diabetes were significant.ConclusionsOur data highlight raised frequency of cardiovascular metabolic factors in patients with obstructive sleep apnea and confirm their high cardiovascular risk.     

Impaired systolic blood dipping and nocturnal hypertension: an independent predictor of carotid intima–media thickness in type 1 diabetic patients

ObjectiveType 1 diabetes in children predicts a broad range of later health problems including an increased risk of cardiovascular morbidity and mortality. This study aimed to evaluate whether nocturnal hypertension and impaired nocturnal dipping affect atherosclerosis in children and adolescents with type 1 diabetes and to investigate the relationship between atherogenic risk factors and carotid intima–media thickness (CIMT).MethodsOne hundred fifty-nine type 1 diabetic patients and 100 healthy controls were included in the study. We investigated metabolic and anthropometric parameters such as body mass index (BMI), waist circumference, fasting glucose and insulin, serum lipids, 24 h ambulatory blood pressure monitoring (ABPM), and CIMT and compared these with those in control subjects (CS).ResultsNo difference was found between type 1 diabetic patients and CS in age, weight, waist/hip ratio, triglyceride, HDL-cholesterol level. However in children with type 1 diabetes, total cholesterol (p = 0.016),and LDL-cholesterol (p = 0.002) levels and CIMT (P < 0.001) were greater than those of controls. It was determined that 10% of type 1 diabetic patients had dyslipidemia.In 23.2% of type 1 diabetic patients, ABPM showed arterial hypertension. CIMT was significantly higher in the hypertensive group than in the nonhypertensive group (P = 0.003).Twenty-three (14.4%) diabetic patients had nocturnal hypertension. CIMT was significantly greater in the nocturnal hypertensive group (p = 0.023).Mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) dipping was significantly different in diabetic patients (P < 0.001).CIMT was correlated positively with Hba1c (r = 0.220, p = 0.037), and negatively with SBP dipping (r = − 0.362, p = 0.020) in the diabetic patients.In stepwise regression analysis, Hba1c and SBP dipping emerged as a significant predictor of CIMT (β = 0.300, p = 0.044, β = 0.398 p = 0.009) contributing to 15.58% of its variability.ConclusionThese results provide additional evidence for the presence of subclinical cardiovascular disease (CVD) and its relation to hypertension in type 1 diabetic patients. They also indicate a significant relation between nocturnal hypertension, SBP dipping and increased arterial stiffness. It is also important to note that our findings reveal significant relationships between HBA1c cardiovascular changes and underline the importance of glucose control to predict CVD.     

Study of serum insulin levels in patients of euglycemic essential hypertension: A cross sectional study in North Indian population

ObjectiveEssential hypertension is associated with multiple metabolic abnormalities, among them one of the most important is hyperinsulinemia. Hyperinsulinemia has been suggested as being responsible for the increased arterial pressure in patients with essential hypertension. But this is contradicted by the finding that all patients of essential hypertension are not hyperinsulinemic.The present study was conducted to explore the hypothesis that hyperinsulinemia plays a pathogenic role in hypertension in euglycemic North Indian population.Methods and materials120 subjects were studied (60 hypertensive and 60 normotensive). Blood pressure, fasting insulin levels, lipid profile and BMI were calculated for both the groups. Statistical analysis was done using online statistical software freely at www.openepi.com.ResultsHypertensive subjects were characterized by increased fasting insulin levels (16.77 ± 7.62 vs. 8.84 ± 2.04 μIU/ml, p < 0.01), increased BMI (p < 0.01) and dyslipidemia, i.e. increased total cholesterol, high serum triglycerides, high LDL-C and low HDL-C with p < 0.01. There was a positive correlation of fasting insulin levels with BMI, total cholesterol and LDL-C (p < 0.01) and a negative correlation with HDL-C (p < 0.05). However, serum insulin levels showed a non significant correlation with mean systolic and mean diastolic blood pressure (p > 0.05).ConclusionsOur study showed a significant increase in serum insulin levels in hypertensive patients thereby supporting a possible pathogenic role of insulin resistance in onset of hypertension even when the fasting blood sugar is within normal limits.     

Facteurs associés à un mauvais contrôle tensionnel chez 253 hypertendus traités

IntroductionHypertension is a major public health problem throughout the world. The blood pressure control and the decrease of global cardiovascular risk are two main goals of the treatment of hypertension. The purpose of this study was to determine the proportion and associated factors of uncontrolled hypertension in hypertensive patients followed by private cardiologists in Oran.Materials and methodsThis study included 253 hypertensive patients followed by 7 private cardiologists in Oran. Was regarded as uncontrolled high blood pressure, a systolic blood pressure (SBP) superior or equal to 140 mmHg and/, or a diastolic blood pressure (DBP) superior or equal to 90 mmHg. A logistic regression analysis was performed to determine the associated factors with poor blood pressure control.ResultsThe proportion of uncontrolled hypertension was 69.6 % (75.8 % of men and 65.8 % of women). Using multivariate analysis, poor blood pressure control was found to be associated with salt consumption (OR_a = 2.71; CI 95 % = [1.42–5.18]).ConclusionNutritional actions are required for better blood pressure control.     

The incremental role of obstructive sleep apnoea on markers of atherosclerosis in patients with metabolic syndrome

ObjectiveMetabolic syndrome (MS) is associated with subclinical atherosclerosis, but the relative role of obstructive sleep apnoea (OSA) is largely unknown. The main objective of this study is to determine the impact of OSA on markers of atherosclerosis in patients with MS.MethodsEighty-one consecutive patients with MS according to the Adult Treatment Panel III underwent a clinical evaluation, polysomnography, laboratory and vascular measurements of carotid intima media thickness (IMT), carotid-femoral pulse wave velocity (PWV) and carotid diameter (CD) in a blind fashion. OSA was defined as an apnoea-hypopnoea index (AHI) ≥15 events/hour. Multiple linear regression was performed to determine the variables that were independently associated with the vascular parameters.ResultsFifty-one patients (63%) had OSA. No significant differences existed in age, sex, MS criteria, and cholesterol levels between patients with (MS+OSA) and without OSA (MS?OSA). Compared with MS?OSA patients, MS+OSA patients had higher levels of IMT (661 ± 117 vs. 767 ± 140 μm), PWV (9.6 ± 1.0 vs. 10.6 ± 1.6 m/s), and CD (6705 ± 744 vs. 7811 ± 862 μm) (P < 0.001 for each comparison). Among patients with MS+OSA, all vascular parameters were similar in patients with and without daytime sleepiness. The independent parameters associated with IMT, PWV, and CD were AHI, abdominal circumference, and systolic blood pressure (R² = 0.42); AHI and systolic blood pressure (R² = 0.38); and AHI, age, abdominal circumference and systolic blood pressure (R² = 0.45), respectively. The R² of AHI for IMT, PWV and CD was 0.12, 0.10 and 0.20, respectively.ConclusionsOSA is very common and has an incremental role in atherosclerotic burden in consecutive patients with MS.     

Obstructive sleep apnoea syndrome and the metabolic syndrome in an internal medicine setting

BackgroundObstructive sleep apnoea syndrome (OSAS) is widely accepted as a cardiovascular risk factor. Lately it has been considered in turn as both a component and one of the causes of the metabolic syndrome (MS).MethodsWe studied 281 heavy snorers of both sexes consecutively attending a metabolic clinic. Aim was to evaluate the association of OSAS and MS in a large series of patients within an internal medicine setting. Patients underwent a clinical and biochemical work up and performed unattended polysomnography.ResultsOf 226 non-diabetic snorers, 48 had primary snoring; 54 mild, 51 moderate, and 73 severe OSAS. A positive association was found between OSAS severity, central obesity indices and the mean metabolic score (p = 0.016). Prevalence of hypertension increased with OSA severity (p = 0.010). Polysomnographic indices were correlated with the metabolic score, insulin levels and central obesity indices.At regression analysis, male sex (t = 3.92; p = 0.000) and waist circumference (t = 3.93; p = 0.000) were independently associated with AHI (apnoea/hypopnoea index), while ODI (oxygen desaturation index) and waist circumference were the independent predictors (t = 2.16; p = 0.033 and t = 3.74; p = 0.000 respectively) of the metabolic score.Prevalence of OSA was 83% in 55 patients with diabetes and 34% had severe OSA. Almost all diabetics with OSA had MS. The metabolic score was higher in diabetic OSA as compared to non-diabetic OSAS (p = 0.000).ConclusionsOur findings show a high prevalence of OSAS among patients referred to a metabolic outpatient clinic because of suspected metabolic disorders and heavy snoring and suggest a strong bidirectional association between OSAS and MS.     

Effect of pulmonary hypertension on outcome of pulmonary tuberculosis

BackgroundThis study performed at the National Research Institute of Tuberculosis and Lung Disease, Tehran, Iran, aimed to evaluate the effect of concomitant pulmonary hypertension on the outcome of pulmonary tuberculosis.MethodsNew cases of pulmonary tuberculosis were recruited for the study. Pulmonary hypertension was defined as systolic pulmonary arterial pressure ≥35 mm Hg estimated by transthoracic Doppler echocardiography. We assessed the relationship between pulmonary hypertension and mortality during the six-month treatment of tuberculosis.ResultsOf 777 new cases of pulmonary tuberculosis, 74 (9.5%) had systolic pulmonary arterial pressure ≥35 mm Hg. Ten of them (13.5%) died during treatment compared to 5% of cases with pulmonary arterial pressure less than 35 mm Hg (p = 0.007). Logistic regression analysis showed that pulmonary hypertension and drug abuse remained independently associated with mortality (OR = 3.1; 95% CI: 1.44–6.75 and OR = 4.4; 95% CI: 2.35–8.17, respectively).ConclusionA significant association was found between mortality and presence of pulmonary hypertension and drug abuse among new cases of pulmonary tuberculosis.     

Catheter-based radiofrequency renal sympathetic denervation for resistant hypertension; initial Egyptian experience

ObjectivesTo evaluate the feasibility, efficacy, and safety of catheter-based radiofrequency renal sympathetic denervation for treatment of resistant hypertension.BackgroundIn a subpopulation of patients with essential hypertension, therapeutic targets are not met, despite the use of multiple types of medication. In this paper we describe our first experience with a novel percutaneous treatment modality using renal artery radiofrequency (RF) ablation.MethodsThirty patients with essential hypertension unresponsive to at least three types of antihypertensive medical therapy (baseline office systolic blood pressure ⩾160 mmHg) were selected between March and September 2012 and received percutaneous RF ablation. Patients were followed up for 6 months after treatment. The primary effectiveness endpoint was change in seated office-based measurement of systolic blood pressure at 6 months. Another thirty patients were taken as control.ResultsA reduction of mean office blood pressure was seen from 170/102 ± 9/5 mmHg at baseline to 151/91 ± 8/6 mmHg at 6 months follow-up (p = 0.001). Also, we noted a significant decrease in plasma renin activity (3.66 ± 0.64 versus 3.37 ± 0.47 ng/mL/h; p = 0.003). No periprocedural complications, adverse events or change in renal function were noted during follow-up.ConclusionCatheter-based renal denervation seems an attractive minimally invasive treatment option in patients with resistant hypertension, with a low risk of serious adverse events.     

Relationships of insulin-like growth factor-1, its binding proteins,and cardiometabolic risk in hypertensive perimenopausal women

PurposeDuring the transition from premenopause to postmenopause, many women experience weight gain and central fat deposition; therefore, we hypothesized that circulating growth factors can play a role in the pathogenesis of hypertension, metabolic syndrome, and subclinical organ damage in perimenopausal women.Basic ProceduresThe study included 192 women aged 40 to 60 years; 152 had newly diagnosed essential hypertension that had never been treated, and 40 were normotensive age-matched controls. For all subjects, 24-h ambulatory blood pressure monitoring (ABPM), echocardiographic examination with assessment of left ventricular mass (LVM) and systolic and diastolic functions (GE Vivid 7.0, General Electric Vingmed Ultrasound, Horten, Norway), carotid ultrasound with measurement of intima-media thickness, and carotid-femoral pulse wave velocity (PWV) measurement (SphygmoCor, AtCor Medical, Sydney, Australia) were performed. Serum levels of insulin-like growth factor 1 (IGF-1), insulin-like growth factor-binding protein 2 (IGFBP-2), and insulin-like growth factor-binding protein 3 (IGFBP-3) were measured using an immunochemical assay.Main FindingsHypertensive women had significantly lower IGFBP-2 levels than did normotensive controls (162.9 ± 83.7 vs. 273.1 ± 103.0 μg/L, p < 0.001); the groups did not differ regarding IGF and IGFBP-3 concentrations. After adjusting the covariates, multivariate analysis showed that IGFBP2 was significantly negatively correlated with 24-h systolic blood pressure (β = − 0.31, p = 0.02). The adjusted odds ratio for hypertension per standard deviation decrease in IGFBP-2 was 3.43 (95% confidence interval [CI] 1.65–7.13). IGFBP-2 showed a negative correlation with the number of metabolic syndrome components. Independent of body composition, IGFBP-2 was significantly related to left ventricular relative wall thickness and the ratio of mitral inflow velocities as parameter of diastolic function.Principal ConclusionsIn perimenopausal women, decreased IGFBP-2 levels may play a role in blood pressure regulation and the development of subclinical left ventricular diastolic dysfunction. Whether IGFBP-2 is a marker or a mediator of cardiovascular disease in this population merits further investigation.     

Effects of transjugular intrahepatic portosystemic shunt (TIPS) on blood volume distribution in patients with cirrhosis

BackgroundCirrhosis is accompanied by portal hypertension with splanchnic and systemic arterial vasodilation, and central hypovolaemia.A transjugular intrahepatic portosystemic shunt (TIPS) alleviates portal hypertension, but also causes major haemodynamic changes.AimsTo investigate effects of TIPS on regional blood volume distribution, and systemic haemodynamics.MethodsThirteen cirrhotic patients had their regional blood volume distribution determined with gamma-camera technique before and after TIPS. Additionally, we measured systemic haemodynamics during liver vein and right heart catheterization. Central and arterial blood volume (CBV) and cardiac output (CO) were determined with indicator dilution technique.ResultsAfter TIPS, the thoracic blood volume increased (+10.4% of total blood volume (TBV), p < 0.01), whereas the splanchnic blood volume decreased (−11.9% of TBV, p < 0.001). CO increased (+22%, p < 0.0001), and systemic vascular resistance decreased (−26%, p < 0.001), whereas CBV did not change. Finally, right atrial pressure and mean pulmonary artery pressure increased after TIPS (+50%, p < 0.005; +40%, p < 0.05, respectively).ConclusionsTIPS restores central hypovolaemia by an increase in thoracic blood volume and alleviates splanchnic vascular congestion. In contrast, CBV seems unaltered. The improvement in central hypovolaemia is therefore based on an increase in thoracic blood volume that includes both the central venous and arterial blood volume. This is supported by an increase in preload, combined with a decrease in afterload.     

Retinal arteriolar remodeling evaluated with adaptive optics camera: Relationship with blood pressure levels

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

Prévalence de l’hypertension artérielle résistante chez des hypertendus non contrôlés adressés dans un centre de soins tertiaires

ObjectivesEstimate the prevalence of resistant hypertension (rHTN) in uncontrolled hypertensive treated patients referred to a tertiary care center specialized for hypertension management.MethodsThe study was prospective observational. Between January 2013 and April 2015, we recruited hypertensive treated patients, 18 years age or older, under antihypertensive drugs since at least 12 months, and referred to the hypertension unit of Tizi-ouzou university hospital for uncontrolled hypertension. rHTn was defined as an office blood pressure ≥ 140 mmHg despite a triple therapy including renin angiotensin system blockers, calcium antagonists and diuretics at optimal doses, since at least 4 weeks.ResultsWe screened 2367 patients with a mean age of 61.1 ± 11.2 years and 64.2% of men. Eight hundred forty-three (35.6%) patients had suboptimal treatment, 364 (15.4%) a poor adherence to treatment and 202 (8.5%) a white-coat effect. An excessive salt intake and a drug-related hypertension were identified in 281 (11.9%) and 36 (1.5%) patients, respectively. A secondary cause of hypertension was diagnosed in 468 (19.8%) subjects. Finally, only 173 patients showed a true rHTN requiring four drugs or more and its prevalence was 7.3% (CI 95%: 6.3–8.3).ConclusionLess than one patient from ten referred in our center for uncontrolled hypertension had a true rHTN, and more than fifty percent of patients had pseudo-resistance. Most of patients with seemingly rHTN can reach blood pressure target provided they undergo thorough work up and care by a specialized team.     

Causes of secondary hypertension in the young population: A monocentric study

ObjectiveTo study the prevalence of different causes of hypertension in young adults referred to a hypertension center in the south west of France.MethodsWe conducted a retrospective overview of patients younger than 40 years old hospitalized consecutively in the Hypertension department of Toulouse University Hospital between 2012 and 2014. Clinical data about gender, age, anthropomorphic parameters and blood pressure measurement by 24 h Ambulatory Blood Pressure Monitoring (ABPM) were recorded. Biological data concerned dosages of kalemia, renin and aldosterone in the supine or after 15 min of seating. Recorded radiological examinations were renal artery ultrasound and abdominal CT scan.ResultsOne hundred and forty-eight detailed medical records were analyzed, 69 women and 79 men. Among the 69 women, the causes of secondary hypertension were primary aldosteronism (n = 7), fibromuscular dysplasia (n = 5) and renal disease (n = 4). Oral contraceptives were involved in 13 women. In addition, essential hypertension concerned 40 women (58%). Among the 79 men, the causes of secondary hypertension were primary aldosteronism (n = 10), fibromuscular dysplasia (n = 3), left main renal artery entrapment by a diaphragmatic crura (n = 2), renal disease (n = 1), pheochromocytoma (n = 3) and coarctation of the aorta (n = 2). In addition, essential hypertension concerned 58 men (73%).ConclusionsIn our population, the prevalence of secondary hypertension is close to 33% (42% of females and 27% of males), with the following main causes: primary aldosteronism for 11.5%; fibromuscular dysplasia for 5.4%. Oral contraceptives were involved in the hypertension of 19% of the females.     

Acute effects of autoadjusting and fixed continuous positive airway pressure treatments on cardiorespiratory coupling in obese patients with obstructive sleep apnea

BackgroundTreatment with positive airway pressure devices improved signs and symptoms of obstructive sleep apnea syndrome (OSA); however, auto-adjusting positive pressure (APAP) device was not as effective as continuous positive airway pressure (CPAP) in reducing arterial blood pressure and insulin resistance. The role played by autonomic cardiac regulation remains to be clarified.We aimed to test the effects of CPAP and APAP on autonomic regulation and cardiorespiratory coupling during sleep.MethodsWe retrospectively analyzed full-night polysomnographic studies. 19 patients newly diagnosed with severe OSA (AHI > 30) and 7 obese subjects without OSA (CON) were enrolled. Each OSA subject was assigned to CPAP or APAP treatment and underwent a sleep study after 1 week of treatment. Spectral and cross-spectral analyses of heart rate variability (HRV) and respiration were performed to assess autonomic profile and coherence (K²) between respiration and HF oscillation during sleep in CPAP, APAP and CON groups.ResultsIn CPAP and CON, LFnu and LF/HF, markers of sympathetic modulation, decreased from N2 to N3 and increased during REM sleep (p < 0.001), while in APAP group, sympathetic modulation was significantly higher compared with those of CPAP and CON during all sleep stages. K² values were lower in APAP compared with those in CPAP and CON.ConclusionAPAP treatment was characterized by a greater sympathetic activation and it was associated with a lower cardio-respiratory coupling compared with CPAP. This might account for the different effects on cardiovascular risk factors induced by the two treatments.