Étude PASTIS : pression artérielle sans intervention de soignant. Évaluation d’une mesure de la pression artérielle automatisée en cabinet

ObjectiveThe evaluation of automated office blood pressure (AOBP) measurement compared to 24-hour ambulatory BP monitoring (ABPM), Home BP measurement and manual BP.Patients and methodologyA total of 123 hypertensive patients were included. Overall, 68 completed the 4 measurement: Manual BP in the office (Omron 705 CP 3 measurements), ABPM (Spacelab of 96 measurement/per 24 hours), Home BP (18 measurement during 3 days), AOBP using the SPRINT methodology: lying patient, isolated with an automatic measurement (Dinamap) every minutes during 8 minutes (average of the last 3 measurement). Twenty-two out of 123 patients (26%) did not complete the Home BP measurement.ResultsThe average of AOBP measurement using SPRINT is 132 ± 12/69 ± 9 mmHg, of ABPM 134 ± 13/79 ± 9, of Home BP: 135 ± 13/70 ± 13 and of manual BP: 138 ± 13/72 ± 11 mmHg The Bland & Altman method highlight that the AOBP, the ABPM and home BP measurement are 3 substitutable methods. The confidence interval is smaller between the ABPM and the AOBP than with the home BP.ConclusionThe automated office blood pressure, as the Home BP measurement, can be considered a reliable substitute for the ABPM, when the later is not accessible, and when a repeated therapeutic evaluation is needed, or when the home BP measurement is not done. These results encourage us to use it more frequently as the Canadian Hypertension Education Program recommend it.     

Impact de la maladie parodontale sur la pression artérielle des souris diabétiques

Diabetes-driven cardiovascular diseases represent a high challenge for developed countries. Periodontal disease is strictly linked to the aforementioned diseases, due to its Gram negative–driven inflammation. Thus, we investigated the effects of periodontal disease on arterial pressure during the development of diabetes in mice. To this aim, C57BL/6 female mice were colonized with pathogens of periodontal tissue (Porphyromonas gingivalis, Prevotella intermedia and Fusobacterium nucleatum) for 1 month, whereas another group of mice did not undergo the colonization. Subsequently, all mice were fed a high-fat carbohydrate-free diet for 3 months. Then, arterial pressure was measured in vivo and a tomodensitometric analysis of mandibles was realized as well. Our results show increased mandibular bone-loss induced by colonization with periopathogens. In addition, periodontal infection augmented glucose-intolerance and systolic and diastolic arterial pressure, parameters already known to be affected by a fat-diet. In conclusion, we show here that periodontal disease amplifies metabolic troubles and deregulates arterial pressure, emerging as a new axis of metabolic investigation.     

Différences induites par la définition des périodes diurnes et nocturnes sur la pression artérielle et le dipping lors d’une mesure ambulatoire de la pression artérielle

Ambulatory blood pressure monitoring (ABPM) has become indispensable for the diagnosis and control of hypertension. However, no consensus exists on how daytime and nighttime periods should be defined.ObjectiveTo compare daytime and nighttime blood pressure (BP) defined by an actigraph and by body position with BP resulting from arbitrary daytime and nighttime periods.Patients and methodABPM, sleeping periods and body position were recorded simultaneously using an actigraph (SenseWear Armband^®) in patients referred for ABPM. BP results obtained with the actigraph (sleep and position) were compared to the results obtained with fixed daytime (7 a.m.–10 p.m.) and nighttime (10 p.m.–7 a.m.) periods.ResultsData from 103 participants were available. More than half of them were taking antihypertensive drugs. Nocturnal BP was lower (systolic BP: 2.08 ± 4.50 mmHg; diastolic BP: 1.84 ± 2.99 mmHg, P < 0.05) and dipping was more marked (systolic BP: 1.54 ± 3.76%; diastolic BP: 2.27 ± 3.48%, P < 0.05) when nighttime was defined with the actigraph. Standing BP was higher (systolic BP 1.07 ± 2.81 mmHg; diastolic BP: 1.34 ± 2.50 mmHg) than daytime BP defined by a fixed period.ConclusionDiurnal BP, nocturnal BP and dipping are influenced by the definition of daytime and nighttime periods. Studies evaluating the prognostic value of each method are needed to clarify which definition should be used.     

Influence de la variabilité de la pression artérielle en consultation sur le diagnostic du contrôle tensionnel chez des hypertendus traités

ObjectiveTo evaluate the variability in blood pressure observed during office visit in treated hypertensive patients and its consequences on the diagnosis of controlled hypertension.MethodThe medical records of 144 subjects seen consecutively in a hypertension excellence center were extracted from a computerized medical database including hypertension subjects treated and followed-up for at least one year. BP measured with an automatic device (four consecutives measurements at 2 min intervals) where compared to BP values of home BP performed in the previous week's visit. Thresholds were 140/90 mmHg for office BP and 135/85 mmHg for HBP.ResultsThe population has the following characteristics: age 62 years with 26% over 70 years, treated with a monotherapy (33%), bitherapy (35%), triple therapy (17%), quadri-therapy or more (8%). A white coat effect SBP above 20 mmHg was noted in 32% of patients when BP at 2 min is taken and in 2% when BP at 8 min is taken (P < 0.01). After 8 min, a masked effect is noted in 16% for SBP above 20 mmHg and in 44% for DBP above 10 mmHg. White coat hypertension or masked hypertension was noted in 40% or 16% respectively (BP 2 min) and in 5% or 29% (BP 8 min) in treated hypertensive.ConclusionIn treated hypertensive, office BP measured by an automatic device shows significant variability. When the BP is taken with an automatic device, measures taken after 8 minutes of rest avoid the misleading effects of white coat effect, but the masked hypertension is present in nearly one third of the subjects. The use of AMT for monitoring hypertensive patients is the best way to monitor treatment efficacy.     

Évolution de la pression artérielle après introduction d’un antidépresseur en établissement public de santé mentale

IntroductionPrimary prescribing of antidepressants is common in general practice. The relationship between antidepressant introduction and blood pressure (BP) changes is not well established in the literature. The purpose of our study was to examine the short-term course of AHR with and without the introduction of an antidepressant into a public institution of mental health (EPSM).Materials and methodsAn exposed/non-exposed single-centre analytical epidemiological study on a retrospective cohort, with a collection of data on stays between 2013 and 2015 at the EPSM in Armentières. The stays were divided into two groups: antidepressant treatment (introduced during the stay) and control (without antidepressant). BP measurements were taken over a 30-day period per stay. To assess the evolution of AHR across groups, we used a nested mixed linear regression model with multivariate adjustment.ResultsOut of 1241 stays analysed, 124 were in the treated group and 1117 in the control group. The average age was 44.6 ± 14.7 years. The two groups were comparable on most of the variables analyzed. The change in systolic BP was associated with systolic BP values at baseline, history of hypertension, presence of an antihypertensive drug and BMI; the change in diastolic BP was associated with diastolic BP values at baseline, presence of an antihypertensive drug, BMI and history of bipolar disorder. We find no significant difference in the evolution of BP over time between the treated group and the control group over the 30 days of measurement per stay, after adjustment (evolution coefficient of +0.12 mmHg systolic BP and −0.1 mmHg diastolic BP, P = 0.45 and 0.38 respectively).ConclusionThese results are reassuring on the early development of BP after the introduction of antidepressants. They should not overlook the frequent effects of depression and antidepressants on cardiovascular risk (decreased physical activity, dyslipidemia, weight gain, etc.).     

Prise en charge de l’hypertension artérielle de l’adulte. Recommandations 2013 de la Société française d’hypertension artérielle

To improve the management of hypertension in the French population, the French Society of Hypertension has decided to update the national guidelines with the following characteristics: usefulness for practice, synthetic form, good readability, comprehensive writing for non-doctors, emphasizing the role of patient education in the management of hypertension, wide dissemination to health professionals and the population of hypertensive subjects, impact assessment among health professionals and the public health goals. These guidelines include the following 15 recommendations, divided in three chapters, according to the timing of the medical management.Before starting treatment1. Confirm the diagnosis, with blood pressure measurements outside the doctor's office. 2. Implement lifestyle measures. 3. Conduct an initial assessment. 4. Arrange a dedicated information and hypertension announcement consultation.Initial treatment plan (first 6 months)5. Main objective: control of blood pressure in the first 6 months (SBP: 130–139 and DBP < 90 mmHg). 6. Favour the five classes of antihypertensive agents that have demonstrated prevention of cardiovascular complications in hypertensive patients. 7. Individualized choice of the first antihypertensive treatment, taking into account persistence. 8. Promote the use of (fixed) combination therapy in case of failure of monotherapy. 9. Monitor safety.Long-term care plan10. Uncontrolled hypertension at 6 months despite appropriate triple-drug treatment should require specialist's opinion after assessment of compliance and confirmation of ambulatory hypertension. 11. In case of controlled hypertension, visits every 3 to 6 months. 12. Track poor adherence to antihypertensive therapy. 13. Promote and teach how to practice home blood pressure measurement. 14. After 80 years, change goal BP (SBP < 150 mmHg) without exceeding three antihypertensive drugs. 15. After cardiovascular complication, treatment adjustment with maintenance of same blood pressure goal. We hope that a vast dissemination of these simple guidelines will help to improve hypertension control in the French population from 50 to 70 %, an objective expected to be achieved in 2015 in France.     

Effet de la supplémentation des polysaccharides de l’algue verte Ulva lactuca sur la pression artérielle et sur les facteurs du risque athérogène,chez des rats consommant un régime riche en lipides

Aim of the studyTo highlight the benefits of green alga Ulva lactuca polysaccharides supplementation on blood pressure and atherogenic risk factors in rats fed a high fat diet.MethodsWistar male rats were fed a high fat diet (30% sheep fat) for 3 months. At an average body weight (BW) of 360 g, the rats (n = 18) were divided into 3 groups and consumed, for 28 days, either a high fat diet (HFD) or a high fat diet enriched with 1% of whole green algae (WGA) powder or with 1% of its polysaccharides (PLS).ResultsIn HFD, WGA and PLS supplementation reduced BW and food intake. WGA and PLS compared to HFD reduced systolic (PAS) (−17% and −19%) and diastolic (PAD) blood pressure (−38% and −39%), serum glucose (−37% and −30%, respectively), insulinemia (−55% and −74%, respectively), serum and hepatic total lipids, triglycerides, total cholesterol levels, as well as the total cholesterol concentration of low and very low density lipoproteins. The same, atherogenicity ratios and membrane fluidity decreased in the WGA and PLS vs HFD while lecithin: cholesterol acyltransferase (LCAT) activity increased (51 and 41% respectively).ConclusionUlva lactuca and its polysaccharides, one of the bioactive compounds of this macroalga, seem to have hypotensive, hypoglycemic, hypolipaemic and antiatherogenic properties that can correct or prevent certain cardiovascular complications linked to a high fat diet.