From guidelines to current practices: Suboptimal hypertension management in France.

In France, the prevalence of hypertension is higher than 30%. Although treatment guidelines have been well established over the last twenty years, the national blood pressure control rate is below the average of high-income countries. This observational study aimed to describe the antihypertensive prescription behaviours of primary care physicians (PCPs) in France and to assess their compliance with current French guidelines, focusing on three specific prescription issues and their potential repercussions on blood pressure control: treatment initiation, treatment renewal or change and type of triple therapy. Prescription data were retrieved using the IQVIA longitudinal patient database (LPD), which delivers real-world data insights from French primary care electronic medical records (EMR). The average number of prescribed therapeutic agents was 1.9 per patient, with 39.3% monotherapy prescriptions. Treatment initiation represented 7.2% of all antihypertensive prescriptions. At treatment initiation, 22.5% of patients were prescribed dual therapy. The proportion of treatment renewal in the same therapeutic class was 74.3% while the proportion of treatment change was 18.5%. Of these, only 6.3% of patients received an additional therapy. Lastly, 35.7% of triple therapies were consistent with the recommended combinations. In conclusion, this study provides evidence of therapeutic gaps in hypertension management in France. The low blood control rate may be attributed to PCPs' therapeutic inertia and lack of knowledge of treatment guidelines. All stakeholders should commit to rapid corrective action in order to provide patients with the best care.

Peripheral arterial disease and isolated systolic hypertension: the ATTEST study.

Hypertension is a risk factor for cardiovascular (CV) diseases, either coronary artery disease (CAD), peripheral artery disease (PAD) or cerebrovascular disease (CVD). The relationships between those different localizations of CV disease and the haemodynamic features of hypertension have been poorly evaluated in the past. In the ATTEST study, a geographically representative panel of 3020 general practitioners recruited 8316 consecutive patients with CV diseases (PAD, CAD or CVD, alone or in association). Blood pressure, which was not an inclusion criterion, was then measured and related to the different forms of CV diseases. Blood pressure classification involved 20% normotensive subjects, 24% subjects with controlled hypertension, 42% subjects with isolated systolic hypertension and 14% subjects with systolic-diastolic hypertension, all hypertensives with or without antihypertensive therapy. From multiple regression analysis, it appeared that subjects with systolic hypertension were characterized by the presence of PAD, with little or no presence of CAD and/or CVD. Subjects with systolic-diastolic hypertension were characterized by the presence of CAD and/or CVD, but without PAD. Although the former was only influenced by age, dyslipidaemia and diabetes mellitus influenced the latter. This study confirms the high prevalence of hypertension (80%) in a large population of patients with CV diseases selected in primary care. Analysis of different features of hypertension revealed that isolated systolic hypertension was the most prevalent form of hypertension in this treated population. Finally, one of the predominant goals of secondary prevention in subjects with PAD should be the treatment of isolated systolic hypertension.

[A muscular calcium pyrophosphate deposition pseudo-abscess: An atypical localization of chondrocalcinosis]. / Pseudo-abcès musculaire d'origine microcristalline : une localisation exceptionnelle de chondrocalcinose.

INTRODUCTION: Chondrocalcinosis results from calcium pyrophosphate crystals deposition in the joints. We report an exceptional case of aseptic psoas abscess with a deposition of calcium pyrophosphate crystals. CASE REPORT: A 92-year-old man presented to our department for an acute onset of inflammatory pain in the left hip. Computed tomography detected a coxofemoral arthritis and multiple intramuscular collections located in the iliopsoas muscle and the gluteus minimus. A sample of the fluid was obtained with a guided aspiration, and its analysis revealed an inflammatory liquid with no bacteria but numerous calcium pyrophosphate crystals. The final diagnosis was thus a muscular calcium pyrophosphate deposition pseudo-abscess, associated with a hip arthritis. CONCLUSION: Hip chondrocalcinosis is unusual, and the association with intramuscular deposition of calcium pyrophosphate crystals seems extremely rare as we found only four other published cases. A microcrystalline arthritis could have spread from the coxofemoral joint through the iliopsoas bursa and into the muscle. However, the imaging aspect with an abscess and a predominant muscular injury might suggest a mechanism of crystal formation originating directly within the muscle. The outcome was always favourable even if some patients required surgery.

Blood pressure rise following angiogenesis inhibition by bevacizumab. A crucial role for microcirculation.

Arterial hypertension (HT) has been reported in all studies involving bevacizumab, an antiangiogenic agent designed to target vascular endothelial growth factor (VEGF). The mechanism underlying bevacizumab-related HT is not yet clearly understood. As far as endothelial dysfunction and microvascular rarefaction are hallmarks in all forms of HT, we tested the hypothesis that anti-VEGF therapy could alter the microcirculation in nontumor tissues and, thus, result in an increase in blood pressure (BP). We used intravital video microscopy to measure dermal capillary densities in the dorsum of the fingers. Microvascular endothelial function was assessed by laser Doppler flowmetry combined with iontophoresis of pilocarpine (acetylcholine analogue). All measurements were carried out in 18 patients before and after a 6-month treatment with bevacizumab (mean cumulative dose: 3.16 +/- 0.90 g). Mean BP was increased after 6 months of therapy compared with baseline, from 129 +/- 13/75 +/- 7 mmHg to 145 +/- 17/82 +/- 7 mmHg for systolic BP and diastolic BP, respectively (P < 0.0001). Compared with the baseline, mean dermal capillary density at 6 months was significantly lower (75 +/- 12 versus 83 +/- 13/mm(2); P < 0.0001), as well as pilocarpine-induced vasodilation (P < 0.05). Thus, bevacizumab treatment resulted in endothelial dysfunction and capillary rarefaction; both changes are closely associated and could be responsible for the rise in BP observed in most patients.

[Metabolic syndrome: epidemiology and its risks]. / Le syndrome métabolique : son épidémiologie et ses risques.

The prevalence of the metabolic syndrome is rising, particularly in developed countries, and this is largely driven by increasing obesity and sedentarity rates. Regardless of the definition, the prevalence found in France was lower than in North America and in other European countries; it varied from 11.7 p. cent in men and 7.5 p. cent in women according to the National Cholesterol Education Program (NCEP) definition to 26 p. cent in men and 18.4 p. cent in women according to the International Diabetes Federation (IDF) definition. The presence of the metabolic syndrome promotes the occurrence of type 2 diabetes and clinical atherosclerosis. Relative risk of cardiovascular morbidity and mortality is close to 2 in subjects with metabolic syndrome. The informative value of identifying metabolic syndrome has been demonstrated in the general population as well as in hypertensive subjects. However, it could provide only limited clinical value for cardiovascular disease risk stratification in type 2 diabetes mellitus.

[Vitamine K antagonists overdose: Physician adherence to the French guidelines]. / Surdosages en antivitamines K : audit de la prise en charge hospitalière.

INTRODUCTION: Vitamin K antagonists (VKA) are drugs with a major risk of side effect. Guidelines have been published in 2008 by the Haute Autorité de santé (HAS) concerning the management of an excessively elevated INR ratio. Our research aimed to assess physicians' adherence to those guidelines. METHODS: We realized a retrospective, multicentric study. One hundred and ten cases of excessively elevated INR ratio were identified and analyzed. RESULTS: Overall physicians adherence was 58%. However, patients with the most elevated INR, i.e., INR>6, were treated according to guidelines in only 33% of the cases. The use of vitamin K was the major source of mistakes. The rate of mortality was 20%. CONCLUSION: Adherence to HAS guidelines seems finally limited. It is necessary to put in place procedures to secure the behavior of physicians.

[Number and use of home blood pressure devices in France in 2004 and 2006 (FLAHS 2006)]. / Possession et usage des appareils d'automesure en France en 2004 et 2006. Enquête FLAHS 2006.

OBJECTIVES: To estimate the number and the using modalities of devices for home blood pressure (HBP) measurements in the French population in 2006 and to evaluate the trend of these data over the past two Years. METHODS: The French League Against Hypertension Surveys have been performed both in 2004 and 2006 (FLAHS-2006) by an independent company (TNS-SOFRES) within a representative sample of French population older than 35 and living in metropolitan France. The surveys involved 3707 and 3389 subjects, respectively. A questionnaire evaluating ownership, kind and using modalities of HBP device was given. Subjects who declared taking an antihypertensive medication were classified as treated hypertensive patients. The data from the INSEE census performed in1999 allowed for an estimate of the total number of HBP devices owned by French people. RESULTS: In 2006, 19% of the French population above the age of 35 years owned a HBP device, a rate reaching 36% in treated hypertensives versus 11% in the rest of the population (p<0.001). In 2004, the ownership rates were 24% and 7%, respectively. It could be estimated that about 6 million HBP devices were owned by French people in 2006, meaning an increase of 2 million devices, as compared with 2004 survey. 53% of BP devices were equipped with an arm cuff in 2006, versus 33% only, in 2004. Device purchase has been made in 2006 either in a pharmacy (39%), or in a hypermarket (7%), or through the web (3%); they were given as a gift in 39%. Device use was indicated as regular by 30% of hypertensive patients and 23% of the rest of the people. Giving up was observed in 7% and 15%, respectively. CONCLUSION: In 2006, about 6 million HBP devices are owned by French people; the rate of treated hypertensives owning a HBP device is 1/3. The huge increase in the number of HBP devices from 2004 to 2006 suggests that the recommendations of the French "Haute Autorité de Santé" as well as the national programs about HBP measurement have had a real impact on the use of this technique in France.

[Treatment of hypertension in Guadeloupe (FWI) in 2005: Pretrahguad study]. / Traitements médicamenteux et non médicamenteux chez l'hypertendu en Guadeloupe en 2005 : enquête PRETRAHGUAD.

OBJECTIVES: To estimate life style and drug therapy for treatment of hypertension in Guadeloupe (FWI) in 2005, and to compare the data with those obtained in a similar study realised in France metropolitan population in 2004. METHODS: A cross-sectional study of a sample of 509 subjects selected as being representative of the Guadeloupe population for age (35 years and above), gender, socioeconomic status, and place of living. Subjects who declare to take an antihypertensive medication were classified as treated hypertensive patients. A questionnaire evaluating changes in life style during the last year (physical activities, quality of food consumption, smoking, and alcohol habits) was administered by phone. RESULTS: In 2005, 32% of the population above the age of 35 years was treated for hypertension, corresponding to an estimate of 51,230 subjects. Hypertensive subjects experienced: a weight loss of more than 3 kg in 29 vs 25% in the general population, an increased in fruits and vegetables consumption in 29 vs 46%, a decreased in cheese (11 vs 8%), pork-butchery (23 vs 16%) and alcohol consumption (10 vs 6%). The percentage of subjects who increased their physical activities was not different in the two groups (24 vs 25%). We observed a larger use of diuretics and ACE-I/ARBs prescribed as combined drugs. The most frequent drug prescribed as single drug is calcium antagonist. When the patients are receiving at least two medications or more (41%), combined treatment is found with high frequency (75%). CONCLUSION: Changes in life style were more often applied by the subjects treated for hypertension that by the general population. The dominating place that occupies today fixed-dose combination drugs indicates a change of the therapeutic practices. When comparing with FLAHS study concerning the French metropolitan population, diuretics and calcium antagonist are more often prescribed in Guadeloupe, in witch 90% of the population is Afro-Caribbean.

[Usefulness of different techniques of blood pressure measurements in 2016]. / Place des différentes techniques de mesure de la pression artérielle en 2016.

The management of hypertensive patients is greatly influenced by blood pressure levels and accurate measurement of blood pressure is crucial in this context. Mercury sphygmomanometer has been progressively replaced by more precise oscillometric devices that can be widely used in the clinic and ambulatory setting. The purpose of this review was to detail the different methods for evaluating blood pressure, and to refine their indications and clinical benefit. Office blood pressure measurement has a great variability and should follow a strict protocol to give consistent results. National and international guidelines focus on blood pressure measurement in the ambulatory setting. When used by trained patients, home blood pressure monitoring is reproducible and can provide substantial prognostic information, even if ambulatory blood pressure monitoring remains the gold standard. The role of central blood pressure and pulse wave velocity monitoring in the therapeutic strategy of hypertension needs further assessment.

[Self monitoring of blood pressure in Guadeloupe in 2005 results of the PRETRAHGUAD enquiry]. / Utilisation des appareils d'automesure tensionnelle en Guadeloupe en 2005: enquête PRETRAHGUAD.

The object of this enquiry was to estimate the number of self monitoring devices for blood pressure measurement in Guadeloupe in 2005 and to determine how they were used. The enquiry included 509 patients aged over 35 years and living in Guadeloupe meeting the inclusion criteria of PRETRAHGUAD: PREvalence et TRAitement de Hypertension en GUADeloupe. The enquiry was made by Qualistat, a survey institute. Designed as a survey, it was based on the two degree quota method. It was carried out by telephone by CATI (Computer Assisted Telephone Inquiry) networked computer programming by ten operators trained by experts of the HTA-GWAD organisation. In addition to questions on socio-demographic background and biometric parameters, the operators also asked about observance of antihypertensive treatment, the ownership of a self monitoring blood pressure device and its usage. A subject who said he took a treatment validated as antihypertensive was considered to be a "treated hypertensive". The results indicate that in 2005, in Guadeloupe, 32% of the population over 35 years of age were treated hypertensives, making a total of 51,230 individuals. Forty three percent of treated hypertensives and 19% of other subjects admitted to having used a self monitoring blood pressure device. Twenty six percent of the study population owned a device. Of the estimated total of 43,220 devices in circulation, nearly half of them were wrist devices. Regular usage (at least once per month) was declared by 73% of hypertensive and 46% of other subjects. Out of the total population, the medical practitioner had spoken of self monitoring of blood pressure to his patients and had incited only 18% to carry it out. The authors conclude that, in 2005, one third of adults over 35 years of age were treated for hypertension and 43% of treated hypertensives owned a self monitoring blood pressure device. The incitation by medical practitioners to use this method of self monitoring remained modest. This technique would seem to be little used by medical practitioners although the patients have started to equip themselves with the device.

[Determinants of controlled hypertension in patients treated with antihypertensive drugs in France: The French League Against Hypertension Survey (FLAHS 2015)]. / Déterminants de l'hypertension artérielle contrôlée chez les sujets traités par antihypertenseurs en France : enquête FLAHS 2015.

OBJECTIVE: The FLASH 2015 survey sought the determinants of hypertension control in subjects treated with antihypertensive drugs in France. METHOD: Sending self-administered questionnaire by mail to a representative sample of the population living in metropolitan France (MetaScope basis, TNS Sofres, France). Patients who declare taking antihypertensive drugs are considered treated hypertensives. A home blood pressure monitoring during 3 days was asked in subjects owing a blood pressure monitor and the average of 18 measurements was calculated. RESULTS: A total of 6379 subjects aged 55 and older were included with 2814 (44.1%) treated with antihypertensive drugs. Home blood pressure was obtained from 1455 subjects including 882 (60.6%) treated. SBP/DBP are 129.3±13.5/75.5±9.0mmHg and are higher in treated subjects in each age category. BP<135/85 was observed in 55.4% and BP<140/90 in 71.7%. Determinants of BP control (<135/85) are the number of measurement for averaging (18 measures over 3 days vs 3 measurements on a morning; 55.4%/44.3%), age (55-64 years vs 80 years old; 57.6%/49.1%), gender (women vs men; 60.3%/50.1%), BMI (<25 vs >30; 63.1%/46.1%). In the 80 and older, a SBP<145 was observed in 74.7% of subjects. The control was 61% when considering an SBP/DBP<135/85 in 55-79 years and SBP<145 among 80 and older. CONCLUSION: The control of hypertension evaluated by home blood pressure on a representative population living in metropolitan France is estimated at between 44.3% and 74.7% and several determinants influence the control of blood pressure like age, gender and BMI.

[Evaluation of the prevalence and management of normocholesterolaemic and non coronary hypertensives in France]. / Evaluation de la prévalence et de la prise en charge des hypertendus normo-cholestérolémiques et non coronariens en France.

We performed a study amongst hypertensive patients who consulted French general practitioners in the Sentinelles network. Firstly, the significance of this population in mainland France was quantified by keeping a register of all hypertensive patients aged over 40 years seen in a general practice consultation, and secondly the distribution of risk factors and management of normocholesterolaemic (total cholesterol < or = 2.5 g/l) without lipid lowering treatment and non coronary patients was described more precisely. Analysis of the population of 7864 hypertensives from this register showed that on average one doctor saw 3 hypertensive patients a day and that about half of them (54%) were normocholesterolaemic, non coronary patients. Analysis of this sub-population of 2519 patients showed that 19.9% of them had at least 3 of the other cardiovascular risk factors described in the ASCOT study (Anglo-Scandinavian Cardiac Outcomes Trial) and that 39.5% had controlled hypertension according to the New York Heart Association classification. The extrapolated number of hypertensive, non coronary patients who were normocholesterolaemic without lipid lowering treatment was estimated as 4.6 million (4.1:5.1) for the whole of France.

[Use of home blood pressure devices in France in 2004]. / Utilisation des appareils d'automesure tensionnelle en France en 2004. Enquête FLAHS 2004.

OBJECTIVE: To estimate the number of devices for home blood pressure measurements in the French population in 2004 and to evaluate the use of these apparatus. METHODS: The French League Against Hypertension Survey 2004 (FLAHS-2004) was performed cross-sectionally on 3707 subjects, part of a sample of 5476 subjects selected as being representative of the French metropolitan population for age (35 years and above), gender, socioeconomic status, and place of living. Subjects who declare to take an antihypertensive medication were classified as treated hypertensive patients. A questionnaire evaluating the condition of use of HBP device was given. RESULTS: In 2004, 24% of the French population above the age of 35 years was treated for hypertension, corresponding to an estimate of 7.5 million of subjects. 25% of treated hypertensives and 12% of untreated subjects had a tensiometer. A total of 4 millions of BP devices are owned in the general population with 43% by treated hypertensive patients. 67% of BP devices are wrist cuff. Medical doctors recommended home blood pressure monitoring in only 12% of subjects. CONCLUSION: In 2004, the number of subjects treated for hypertension is 1/4 of the general population over the age of 35 years in France. In this group of subjects, 1/4 possessed a tensiometer but in only 10% medical doctor recommended the use of home blood pressure monitoring.

[Changes in life style and drug therapy for treatment of hypertension in France between 2002 and 2004]. / Evolution dans l'utilisation des traitements non médicamenteux et médicamenteux pour le traitement de l'hypertension artérielle en France. Enquête FLAHS 2004.

OBJECTIVES: To estimate changes in life style and drug therapy for treatment of hypertension in France between 2002 and 2004. METHODS: The French League Against Hypertension Survey 2004 (FLAHS-2004) was performed cross-sectionally on 3 707 subjects, part of a sample of 5476 subjects selected as being representative of the French metropolitan population for age (35 years and above), gender, socioeconomic status, and place of living. Subjects who declare to take an antihypertensive medication were classified as treated hypertensive patients. A questionnaire evaluating changes in life style during the last year (physical activities, quality of food consumption, smoking, and alcohol habits) was auto-administered. RESULTS: In 2004, 24% of the French population above the age of 35 years was treated for hypertension, corresponding to an estimate of 7.5 million of subjects. The two most frequent prescribed drugs are: fixed-dose combination drugs and beta-blockers in patients aged less than 75 years, and calcium antagonist and fixed-dose combination drugs in patients aged more than 75 years. Hypertensive subjects experienced: a weight loss of more than 3 kg in 11% vs 9%* in the general population, an increased in fruits and vegetables consumption in 41% vs 34%*, a decreased in cheese (21 vs 17%*), pork-butchery (46 vs 34%*) and alcohol consumption (23 vs 18%*) [*p < 0.01]. On the other hand, the percentage of subjects who increased their physical activities was low and not different in the two groups (7 vs 9%). CONCLUSION: Changes in life style were more often applied by the subjects treated for hypertension that by the general population. The dominating place that occupies today fixed-dose combination drugs indicates a change of the therapeutic practices.

[Hypertension in the elderly in France: Characteristics of treatments and frequency of cognitive complaint according to the 2014 French League against Hypertension Survey]. / Hypertension artérielle du sujet âgé en France : caractéristiques du traitement et fréquence de la plainte cognitive selon l'enquête FLAHS 2014.

OBJECTIVE: Describe hypertensive patients treated in 2014 in France by age and estimate the degree of cognitive complaint among subjects aged 55 and over. METHOD: French League against Hypertension Survey (FLAHS) was conducted by mail in a representative sample of subjects aged 35 and over living in metropolitan France. Antihypertensive treatment data were obtained by self-administered questionnaire. Among the owners of a self-measurement device, blood pressure was considered to be controlled if the average of three measurements in the morning was below 135/85 mmHg. Cognitive complaint was detected by the cognitive complaint questionnaire (QPC) and analyzed by age and medical history of each subject. RESULTS: In 2014, 30% of the population aged 35 and over (11.6 million) was treated with antihypertensive drugs. The number of treated hypertensive was: 3.45 million in the 75 and older, 2.96 million in 65-74 years, 3.24 million in 55-64 years, 1.58 million in the 45-54 years and 0.441 million in 35-44. The mono/bi/tri/quad-therapy is used in 46%/35%/14%/5% of patients. This distribution varies with age with monotherapy used in 63% of subjects under 55 years but in 40% of subjects 75 years and over. A positive QPC was noted in 11% of 55-64 years, in 21% of 75 years and older (P<0.001), in 20% of uncontrolled hypertensive patients, and in 34% of subjects with a personal history of stroke. CONCLUSION: In France, hypertension is a disease that affects mainly the elderly. The modalities of treatment are different depending on age. Cognitive complaints are more common in uncontrolled hypertensive patients and in patients with a history of stroke.

Opposite effects of remodeling and hypertrophy on arterial compliance in hypertension.

Sustained hypertension is associated with a reduction in large artery compliance. However, we previously showed that, at the site of the radial artery, a distal muscular artery, the compliance of hypertensive patients was not significantly different from those of normotensive controls when the two groups were studied at their respective mean arterial pressures, despite increased wall thickness in hypertensives. To determine whether this paradoxical finding could be related to a specific pattern of geometrical changes, we studied arterial compliance in never-treated hypertensive patients characterized either by radial artery hypertrophy or remodeling, and compared them to normotensive controls. By analogy with Devereux's classification for left ventricular hypertrophy, we defined remodeling as an increased thickness to radius ratio (h/r) and a normal vascular mass (VM), and arterial hypertrophy as an increased VM irrespective of the values of h/r. Internal diameter and wall thickness were measured at the site of the radial artery using a high resolution echo-tracking system. The lumen cross-section-pressure curve was determined from the two simultaneous and continuous recordings of arterial diameter and blood pressure. Then, the cross-sectional compliance (CC)-pressure curve was calculated. Isobaric compliance was calculated at 100 mm Hg. Thresholds for h/r and VM were determined according to gender as the 95th percentile of a group of 100 normotensive subjects. The group of hypertensive patients included 58 patients with hypertrophy (h/r: 0.25+/-0.04; VM: 31+/-6 mg/cm; mean+/-SD) and 25 patients with remodeling (h/r: 0.29+/-0.06; VM: 20+/-4 mg/cm) and was compared to a group of 50 age- and gender-matched normotensives (h/r: 0.16+/-0.02; VM: 17+/-4 mg/cm). Compared to normotensives, isobaric compliance of the radial artery was increased in hypertensive patients with hypertrophy (HH) whereas it was not different in hypertensive patients with remodeling (RH). These results indicate that compliance is dependent on hypertrophy or remodeling pattern and suggest that in the face of hypertension, only arterial hypertrophy is an adaptive process leading to normal operating compliance through an increased isobaric compliance.

Increased stiffness of radial artery wall material in end-stage renal disease.

The incremental elastic modulus (Einc), which is the slope of the relationship between stress and strain of arteries, is a marker of vascular wall material stiffness. Isobaric Einc is reduced at the site of the radial artery in patients with essential hypertension and increased at the site of the common carotid artery in subjects with end-stage renal disease (ESRD). Whether the changes in Einc are influenced by the topography of the vessels, the composition of the arterial wall, and/or by the presence of ESRD is largely ignored. Radial artery Einc was measured in 19 patients with ESRD and compared with the Einc of 89 subjects with essential hypertension and 20 normotensive control subjects. Transcutaneous measurements of radial artery internal diameter and wall thickness (echo-tracking device) and digital pulse pressure (Finapres) were allowed to calculate Einc under operational (ie, at the mean arterial pressure of each group) and isobaric (100 mm Hg) conditions, as well as for a given wall stress. Internal diameter and pulsatile changes in diameter were identical in the three groups. Wall thickness and mean blood pressure were significantly elevated in subjects with hypertension but not in ESRD patients. Circumferential wall stress was identical in the three groups. For the same operational wall stress, and therefore at the operational mean arterial pressure of each group, Einc (kPa x 10[3]) was increased in patients with ESRD (5.53+/-4.0 versus 3.3+/-2.4 in control subjects; P<.05) and normal in subjects with essential hypertension (3.87+/-4.0). Under isobaric conditions, Einc was also significantly lower in subjects with hypertension and elevated in patients with ESRD. Thus, at the site of a medium-sized muscular artery constantly devoid of atherosclerosis, the stiffness of wall material is increased in patients with ESRD. The demonstrated alterations of the arterial wall are independent of the level of blood pressure and tensile stress and should be related to the status ESRD.

Remodeling of the radial artery in response to a chronic increase in shear stress.

Chronic changes in large artery blood flow rates induce corresponding adjustments in arterial diameter, but little is known about structural adaptations of the vessel wall in humans. We used a high-resolution echo-tracking system to measure radial artery internal diameter, wall thickness, and mean blood flow on both arms of 11 patients with end-stage renal disease. Measurements were performed on the wrist side of the arteriovenous fistula. The contralateral radial artery was investigated as control. Wall cross-sectional area, circumferential wall stress, and mean wall shear stress were calculated. Results indicate a sixfold increase in blood flow on the side of the arteriovenous fistula compared with the control side, with a 1.4-fold increase in internal diameter. The diameter enlargement was sufficient to normalize wall shear stress. Changes in diameter were not associated with arterial wall hypertrophy because wall cross-sectional area was not increased and rather suggest a "remodeling" of the arterial wall. For the same level of blood pressure, circumferential wall stress was increased on the side of the arteriovenous fistula. These results suggest that the structural adaptations of the arterial wall to a chronic increase in blood flow normalize wall shear stress and overcome stretch-induced changes in the particular circumstance of arteriovenous fistula.

Lack of association between renin-angiotensin system, gene polymorphisms, and wall thickness of the radial and carotid arteries.

To investigate the relationship between polymorphisms of the angiotensin-converting enzyme (ACE) and the angiotensin II type 1 receptor (AT1R) genes and structural phenotypes of arteries, we studied a cohort of 340 subjects (aged 49+/-12 years) without evidence of cardiovascular disease and who had never been treated previously with any cardiovascular treatments. Structural phenotypes (wall thickness and internal diameter) were evaluated for the common carotid and the radial arteries using high-resolution echo-tracking devices (NIUS-02 and Wall Track System). The influence of ACE insertion/deletion (I/D) and AT1R A/C1166 polymorphism genotypes on structural parameters was tested by ANOVA and logistic regression analysis. For the radial artery, mean wall thickness among subjects according to the ACE I/D or AT1R A/C1166 genotypes was not different. This lack of association persisted in a logistic regression analysis or when the comparison was restricted to a subgroup of subjects potentially at high genetic risk (DD and CC or AC) compared with subjects at low genetic risk (AA and II or ID). Also, no association was observed between the carotid artery intima-media thickness and the 2 polymorphisms. In conclusion, the ACE I/D and the AT1R A/C1166 gene polymorphisms are not markers of vascular hypertrophy in subjects with no evidence of cardiovascular disease. These results suggest that these gene polymorphisms have an undetectable role in the geometry of the radial and carotid arteries compared with usual determinants such as blood pressure and age.