[Hypertension: novelties 2021]. / Hypertension artérielle.

The past year has been particularly rich in the field of arterial hypertension. Our annual review covers the latest epidemiological studies which show that more than 1.2 billion people have high blood pressure, half of them are unaware of it and that only a quarter of treated patients reach the recommended targets. The impact of poor adherence in young hypertensive patients on cardiovascular events and the effects of intensive treatment in patients over 60 years of age will be discussed. Finally, the adjustment of anti hypertensive treatment in pregnant women with a history of pre-eclampsia according to hemodynamic parameters measured during pregnancy and the effects of potassium supplementation in table salt on cardiovascular events will be presented.

L'année écoulée a été particulièrement riche dans le domaine de l'hypertension artérielle (HTA). Notre revue annuelle couvre les dernières études épidémiologiques qui montrent que plus de 1,2 milliard de personnes sont atteintes d'HTA, que la moitié d'entre elles l'ignore et finalement qu'un quart des patient·e·s atteignent les cibles recommandées. L'impact d'une mauvaise adhésion chez des jeunes patients hypertendus sur les événements cardiovasculaires ainsi que les effets d'un traitement intensif chez des patients de plus de 60 ans seront abordés. Finalement, l'ajustement d'un traitement antihypertenseur chez des femmes enceintes avec antécédents de prééclampsie en fonction des paramètres hémodynamiques mesurés en cours de grossesse et les effets d'une supplémentation de potassium dans le sel de table sur les événements cardiovasculaires seront présentés.

Relationship between renal function and blood pressure dipping status in renal transplant recipients: a longitudinal study.

BACKGROUND: Hypertension (HT) is associated with adverse outcomes in kidney transplant (KTX) recipients. Blunting of physiological decrease in nighttime compared to daytime blood pressure (non-dipping status) is frequent in this setting. However, weather non-dipping is independently associated with renal function decline in KTX patients is unknown. METHODS: We retrospectively screened KTX outpatients attending for a routine ambulatory blood pressure monitoring (ABPM) (T1) at a single tertiary hospital. Patients had two successive follow-up visits, 1 (T2) and 2 (T3) years later respectively. Routine clinical and laboratory data were collected at each visit. Mixed linear regression models were used with estimated glomerular filtration rate (eGFR) as the dependent variable. RESULTS: A total of 123 patients were included with a mean follow-up of 2.12 ± 0.45 years after ABPM. Mean age and eGFR at T1 were 56.0 ± 15.1 and 54.9 ± 20.0 mL/min/1.73m2 respectively. 61 patients (50.4%) had sustained HT and 81 (65.8%) were non-dippers. In multivariate analysis, systolic dipping status was positively associated with eGFR (p = 0.009) and compared to non-dippers, dippers had a 10.4 mL/min/1.73m2 higher eGFR. HT was negatively associated with eGFR (p = 0.003). CONCLUSIONS: We confirm a high prevalence of non-dippers in KTX recipients. We suggest that preserved systolic dipping is associated with improved renal function in this setting independently of potential confounders, including HT and proteinuria. Whether modification of dipping status by chronotherapy would preserve renal function remains to be tested in clinical trials.

[Benefits of meditation on the hypertensive adult]. / Bénéfices de la meditation chez l'adulte hypertendu.

The prevalence of high blood pressure is increasing and expanding preventive and treatment measures may be useful. Some data in the literature suggest that meditation can play a role not only in stress management but also in blood pressure control and cardiovascular disease prevention. Mechanisms involved may be based on the regulation of emotional and biological responses to stress, by regulation of the autonomous nervous system. This approach is available to everyone interested, has no adverse effects and is not related to any particular religious beliefs.

La prévalence de l'hypertension artérielle est en augmentation et élargir le spectre des mesures à disposition pour sa prévention et son traitement peut être utile. Certaines données de la littérature suggèrent que la méditation pourrait jouer un rôle non seulement dans la gestion du stress, mais aussi dans le contrôle tensionnel et la prévention des maladies cardiovasculaires. Les mécanismes impliqués reposeraient sur la modulation de la réaction émotionnelle et la réponse biologique au stress, via la régulation du système nerveux autonome. Il s'agit d'une méthode accessible à toute personne intéressée, dénuée d'effets secondaires et ne reposant pas sur un système de croyance particulier.

Inactive Matrix Gla-Protein Is Associated With Arterial Stiffness in an Adult Population-Based Study.

Increased pulse wave velocity (PWV) is a marker of aortic stiffness and an independent predictor of mortality. Matrix Gla-protein (MGP) is a vascular calcification inhibitor that needs vitamin K to be activated. Inactive MGP, known as desphospho-uncarboxylated MGP (dp-ucMGP), can be measured in plasma and has been associated with various cardiovascular markers, cardiovascular outcomes, and mortality. In this study, we hypothesized that high levels of dp-ucMGP are associated with increased PWV. We recruited participants via a multicenter family-based cross-sectional study in Switzerland. Dp-ucMGP was quantified in plasma by sandwich ELISA. Aortic PWV was determined by applanation tonometry using carotid and femoral pulse waveforms. Multiple regression analysis was performed to estimate associations between PWV and dp-ucMGP adjusting for age, renal function, and other cardiovascular risk factors. We included 1001 participants in our analyses (475 men and 526 women). Mean values were 7.87±2.10 m/s for PWV and 0.43±0.20 nmol/L for dp-ucMGP. PWV was positively associated with dp-ucMGP both before and after adjustment for sex, age, body mass index, height, systolic and diastolic blood pressure (BP), heart rate, renal function, low- and high-density lipoprotein, glucose, smoking status, diabetes mellitus, BP and cholesterol lowering drugs, and history of cardiovascular disease (P≤0.01). In conclusion, high levels of dp-ucMGP are independently and positively associated with arterial stiffness after adjustment for common cardiovascular risk factors, renal function, and age. Experimental studies are needed to determine whether vitamin K supplementation slows arterial stiffening by increasing MGP carboxylation.