Niveau d’activité physique et contrôle ambulatoire de l’hypertension artérielle. Résultats de l’étude pilote « Acti-HTA »

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 < 10/30). Subjects with normal HBPM value (< 135/85 mm Hg) (55% of them) compared to those with high HBPM were older, had a non-significant trend towards higher weekly caloric expenditure (4959 ± 5045 kcal/week vs. 4048 ± 4199 kcal/week, P = 0.3755) and score of Dijon (19.44 ± 5.81 vs. 18.00 ± 4.32, P = 0.2094) with a higher proportion of “active” subjects (48.9% vs. 34.2%, P = 0.1773). In conclusion, our results demonstrate a “tendency” to a higher level of reported PA for subjects whose hypertension was controlled. This encourages us to continue with a study that would include more subjects, which would assess PA level using an objective method such as wearing an accelerometer sensor.     

Gestion des toxicités induites par les inhibiteurs de checkpoint immunologique : données de la réunion de concertation pluridisciplinaire « ToxImmun » en Occitanie Est

Immune checkpoint inhibitors (ICIs) can cause numerous and complex immune-related adverse events whose management need a multidisciplinary approach. Herein, we investigated 114 requests, mostly concerning patients suffering from lung cancer, that were submitted to the « ToxImmun » multidisciplinary meeting in Eastern Occitania between December the 17th 2018 and January the 20th 2020. The leading reasons for the request concerned the putative causal link between immunotherapy and immune-toxicity and its management, followed by possible retreatment after temporary withdrawn because of adverse event, and finally the possibility to initiate ICIs in patients with pre-existing autoimmunity. Colitis, hepatitis and myocarditis were the most frequent immune-related adverse events (IRAEs), both all grade and grade 3–4. Sicca syndrome (with or without Sjogren criteria) was also frequent (26% of cases) and seems to be associated with severe toxicity and multi-toxicity. The mean time to first IRAE was 3.8 months, a time shortened with the use of anti-PD-L1 agents or ICI combination. A majority of requests came from initial evaluation by the internist confirming the early and main role of this specialty in the management of immunotoxicity. Expansion of this regional multidisciplinary meeting, coordinated by internists and medical oncologists, could improve management of immune-related adverse events for the patients’ benefits.     

Dissociation des réponses cardiorespiratoires et neuromusculaires à l’exercice à la suite de 4 semaines de réentraînement à l’effort chez des patients cardiaques

Previous studies showed that changes in peak of oxygen uptake value (VO_2peak) with training were poorly related to changes in Maximal Tolerated Power output (MTP) among patients with cardiovascular disease. This result could be due to a difference between cardiopulmonary adaptation to training and the skeletal muscle conditioning.ObjectiveThe aim of the study was to compare the responses to exercise training of electromyographic activities of vastus lateralis (rms-EMG) and respiratory parameters.MethodsNine cardiac patients (64.0 ± 3.1 y, 172.9 ± 4.8 cm, 83.4 ± 16.3 kg, BMI: 27.8 ± 4.5) performed an incremental cycling exercise test to determine MTP, VO_2peak and peak values of heart rate, before and after an aerobic training. Ventilatory thresholds were respectively determined as the breakpoint in the curve of carbon dioxide output against oxygen uptake plot (VT₁) and the point at which the ratio of minute ventilation to carbon dioxide output starts to increase (VT₂). EMG_th1 and EMG_th2 were defined as the first and the second breakpoints in the rms-EMG – power output relationship.ResultsShort-term exercise training (23.7 ± 8.8 days) induced a significant increase in VO_2peak (P = 0.004), MTP (P = 0.015), VT₁ (P = 0.001) and VT₂ (P = 0.001). Changes in VO_2peak only attained the survival criteria (3.5 ± 2.9 mL min⁻¹ kg⁻¹). No significant differences (P > 0.05) existed between mean power values of VT₁ and EMG_th1 (60.5 ± 4.1 vs. 59.2 ± 9.6% of MTP, respectively), or between VT₂ and EMG_th2 (78.3 ± 5.7 vs. 80.2 ± 5.2% of MTP). After training, EMG_th1 occurred significantly before VT₁ (60.5 ± 6.2 vs. 64.8 ± 4.8% of MTP, P = 0.049).ConclusionThis might be taken into account for prescribing exercise rehabilitation according initial clinical limitations of patients.