[Evaluation of an "Emergency Thrombosis" care system in a university-hospital department of general emergencies]. / Évaluation de la mise en place d'une filière de soins « Urgence Thrombose ¼ dans un service hospitalo-universitaire d'Urgences générales.

GOAL: Describe the use of diagnostic, prognostic and therapeutic algorithms for venous thromboembolism (VTE), derived from the 2014 European guidelines, in a teaching hospital's emergencies department and compare two groups: the 2015 group "without a care path" and the 2017 group "with a care path". METHOD: Comparative and retrospective study of the characteristics of emergencies department patients admitted for VTE from January to June 2015 for the 2015 group and from January to June 2017 for the 2017 group. RESULTS: Seventy-nine patients were included in the 2015 group and 62 patients in the 2017 group. In 24% of cases a clinical probability rule was calculated in the 2017 group (vs. no score in 2015, P<0.05). In the 2015 group, 10% of patients did not have a D-Dimer measurement in case of low clinical probability (vs. 0% in 2017, P<0.05). For both groups, the severity score sPESI was not noted in the medical record. All patients with pulmonary embolism were hospitalized in both groups. A total of 36% of patients with deep vein thrombosis (DVT) were hospitalized in the 2015 group (vs. none in 2017, P<0.05). A total of 52.5% of patients were treated with direct oral anticoagulants (DOAS) in the 2017 group vs. 32.5% in the 2015 group (P<0.05). In 18% of cases DOAS were prescribed by emergency physicians in the 2017 group vs. 2.5% in the 2015 group (P<0.05). Mean hospital stay was 7.4 days in the 2017 group and 9.4 days in the 2015 group (P<0.05). CONCLUSION: We observed a change in clinical practices and prescriptions after the establishment of an "Emergency Thrombosis" care system. Indeed, improvement in the calculation of the clinical probability score, increase in the outpatient management of DVT, increase in prescribing DOAS and reducing the length of hospital stay were the main revisions. The implementation of standardized digitally calculated clinical and prognostic probability scores would optimize this care path, as well as allow a better distribution of the post-emergency consultations created for outpatients.

[PASTIS study: Evaluation of an automated office blood pressure measurement]. / Étude PASTIS : pression artérielle sans intervention de soignant. Évaluation d'une mesure de la pression artérielle automatisée en cabinet.

OBJECTIVE: The evaluation of automated office blood pressure (AOBP) measurement compared to 24-hour ambulatory BP monitoring (ABPM), Home BP measurement and manual BP. PATIENTS AND METHODOLOGY: A 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 24hours), Home BP (18 measurement during 3 days), AOBP using the SPRINT methodology: lying patient, isolated with an automatic measurement (Dinamap) every minutes during 8minutes (average of the last 3 measurement). Twenty-two out of 123 patients (26%) did not complete the Home BP measurement. RESULTS: The average of AOBP measurement using SPRINT is 132±12/69±9mmHg, of ABPM 134±13/79±9, of Home BP: 135±13/70±13 and of manual BP: 138±13/72±11mmHg 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. CONCLUSION: The 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.

The repercussion of stopping reimbursement of olmésartan on antihypertensive drugs prescription and blood pressure control of treated hypertensive patients in France.

OBJECTIVE: Since January 2017, olmesartan-based treatments are no longer reimbursed by French health insurance. Health authorities have recommended switch to one of the "many effective, better tolerated and reimbursed alternatives". The objective of this study was to evaluate the consequences on the prescription of antihypertensive drugs in France and to evaluate the blood pressure control of treated hypertensive patients after the switch from olmesartan to another Angiotensin receptor blocker (ARB). METHODS: To evaluate antihypertensive prescriptions, the French League Against Hypertension Survey (FLAHS) was conducted in 2007, 2012 and 2017 by self-questionnaire sent by mail to a representative panel of the population living in metropolitan France aged 35 years and over. Antihypertensive treatments were grouped by pharmacological class. To evaluate blood pressure control in hypertensive patients treated with olmesartan alone or in combination, 3 home blood pressure monitoring (HBPM) were performed. The first and the second were performed without modification of the dose of olmesartan. The third was performed 1 month after the switch to another ARB. RESULTS: Antihypertensive prescriptions changed between 2007 and 2017. Beta-blockers decreased between 2007 and 2012 and then increased slightly. Between 2012 and 2017, ARB and diuretics decreased and ACE inhibitors (ACE-I) and calcium antagonist (CA) drugs increased. Blood pressure control was assessed in 82 hypertensive patients aged 63±11 years treated with olmesartan. The difference in SBP/DBP between the first 2 self-measurements was -0.96/-0.83mmHg. After therapy switch, the 3rd self-measurement showed an increase in SBP/DBP of 3.4/1.2mmHg. In the subgroup of olmesartan-treated controlled hypertensive patients, the switch to another ARB lead to uncontrolled hypertension for 20% of patients with a 12.1mmHg increase in SBP. CONCLUSION: With the halt of reimbursement of olmesartan, there was a decrease in the prescription of ARB in France. When olmersartan was replaced by another ARB, a worse blood pressure control was observed in treated hypertensive patients. The cessation of the reimbursement of olmesartan has had consequences on the treatment of hypertension in France.

[Use of the EvalObs® adherence scale in an unselected French population of treated subjects with antihypertensive, hypolipemiants or oral antidiabetics medications: The FLAHS 2017 adherence survey]. / Utilisation de l'échelle d'observance EvalObs® dans une population de sujets traités pour une hypertension, une dyslipidémie ou un diabète : enquête FLAHS observance 2017.

OBJECTIVE: A Visual Analog Scale (VAS) is useful for diagnosing medication nonadherence and its validity has been evaluated using electronic pillbox as the gold standard. We have developed the EvaLobs® scale for use on paper or on smartphone and the aim of the study was to administrate the scale among FLAHS 2017 participants treated for an hypertension, a dyslipidemia or diabetes. In subjects treated with antihypertensive medications, participants completed the 6-item Girerd Scale and EvaLobs®. METHODS: The French League Against Hypertension Survey (FLAHS) are carried out by self-questionnaire sent by mail to individuals from the French Kantar Health sampling frame (representative panel of the population living in metropolitan France). In 2017, FLAHS was conducted in 4783 subjects aged 35 and over. The EvaLobs® has a scale from 0 to 15 and the use instruction is "how many days have you taken the drug in the past 15 days". A score>12 indicates a "good compliance". The 6-item Girerd scale was also completed. "Good adherence" was determined for a score of 0 to 2 and "nonadherence" for a score of 3 or more. The agreement between EvaLobs® and the 6-item Girerd scale was evaluated in treated hypertensives. RESULTS: The survey included 4783 subjects with 1308 treated hypertensives, 942 subjects treated with lipid-lowering drugs and 405 subjects treated with anti-diabetics. EVALOBS® indicates "Good adherence" in 96% of subjects and the 6 questions questionnaire indicates "good adherence" in 95% of subjects. An excellent agreement is noted in 93.8%. An EvaLobs® score indicating nonadherence or an absence of response to EvaLobs® is observed in 3.6% [CI 95, 2.5-4.7] of hypertensives, in 6.0% [CI 95, 3.9-8.1] of diabetics and in 8.2% [CI 95, 6.5-9.9] of dyslipidemic patients. CONCLUSION: In the population living in France and in unselected patients treated for metabolic disease or hypertension, non-adherence is lowest for antihypertensive medications and highest for statins. EvaLobs®, which shows good agreement with an adherence questionnaire, is a quick and simple tool for assessing adherence. The smartphone app EvaLobs® is available for free on Google play and the Apple store.

[Development of a risk calculator for drug compliance in treated hypertensives: The FLAHS Compliance Calculator]. / Mise au point d'un calculateur du risque d'inobservance aux traitements antihypertenseurs chez des hypertendus traités : le calculateur FLAHS Observance.

OBJECTIVE: To investigate the determinants of non-compliance with antihypertensive treatments among participants in the FLAHS 2015 survey and to develop a risk calculator for drug compliance in a hypertensive population. METHODS: The FLAHS surveys are carried out by self-questionnaire sent by mail to individuals from the TNS SOFRES (representative panel of the population living in metropolitan France) sampling frame. In 2015, FLAHS was performed in subjects aged 55years and older. Using the Girerd questionnaire, the "perfect observance" was determined for a score of 0 and "nonobservance" for a score of 1 or higher. A Poisson regression was conducted in univariate and multivariate to estimate risk ratios for each determinant. A non-compliance risk calculator is constructed from multivariate analysis. A Poisson regression was performed in univariate and multivariate to estimate risk ratios. For each sex, a probability table is produced from the equation of the multivariate analysis and then the calculation of a nonobservance probability ratio (PR) using the profile with the best probability as a reference. Each subject is then classified into one of the three classes of risk of non-compliance: low (PR <1.5), high (PR>=2) and intermediate (PR>=1.5 and <2). RESULTS: The survey included 6379 subjects and analysis based on 2370 treated hypertensives. The onset of treatment was less than 2years in 7% of subjects and the median follow-up duration of treatment was 10years. Perfect compliance was observed in 64% of subjects. Independent determinants of non-compliance are: male sex, young age, number of antihypertensive tablet, treatment for a metabolic disease (diabetes, dyslipidemia), presence of other chronic illness, secondary prevention of cardiovascular disease. To get the risk class of nonobservance a web page is available at http://www.comitehta.org/flahs-observance-hta/. CONCLUSION: The development of the FLAHS Compliance Test is a tool whose use is possible during an office visit. Its free availability for French doctor will be one of the actions undertaken as part of the "call for action for adherence in hypertension" proposed by the French League Against Hypertension in 2017.

[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.

[Prevalence and severity of hypertensive emergencies and outbreaks in the hospital emergency department of CHU Timone at Marseille: Follow-up in three months of hospitalized patients]. / Prévalence et gravité des urgences et des poussées hypertensives dans le service d'urgence hospitalière du CHU La Timone de Marseille : suivi à trois mois des patients hospitalisés.

GOAL: Evaluation of the prevalence and severity of hypertensive emergencies and crisis in an Emergency Service of Timone hospital in Marseille and follow-up of 3 months of hospitalized emergencies. METHODS: This study was conducted in the Emergency Department between April 1 and June 30, 2015. All patients with BP>180 and/or 110mmHg was recorded and classified in true emergencies (presence of visceral pain) and hypertensive isolated crisis. A phone follow-up patients was organized. RESULTS: During this period, 170 patients were identified: 95 (56%) hypertensive crisis and 75 (44%) hypertensive emergencies: 25 OAP (33%), 18 ischemic stroke (24%), 15 hemorrhagic stroke (20%), 9 angina (12%) and 8 different. The clinical characteristics of hypertensive emergencies are preferentially dyspnea (27%) motor deficit (36%), and chest pain (16%). The BP of hypertensive emergencies at their admission (3 measurements, oscillometric automatic device) is close to the hypertensive crisis (198.17±19.3 to 96.4±21.2mmHg versus 191±31.6 to 96.12±21). The BP controlled after 15minutes of rest is lower for crisis compared to real emergencies (152±47 to 79±28 vs. 174±31 to 86±26). Age emergency is larger (77±14 vs. 67±17), the number of slightly larger drug (1.79 versus 1.67±1±1). Telephone follow-up was performed after an average period of three months. Ninety-nine patients were contacted by telephone: 46 patients who were admitted for hypertensive emergency patients and 53 for a push. Eighteen deaths have been recorded, including 15 among hypertensive emergencies (9 in hemorrhagic stroke, 5 for ischemic stroke, and 1 for OAP) with 5-hospital deaths within 48hours after admission and 10 within 3 months in patients hospitalized with hypertensive emergency or 33%. Seventy-seven patients out of 99 had been reviewed by their attending physicians. A questionnaire was sent by mail to patients who have not answered the phone contacts, and responses are pending. CONCLUSION: Hypertensive emergencies hospitalized in Timone Hospital represent 44% of patients hospitalized for emergency HTA. Their gravity is 1/3 since most patients die within three months warranting closer management of these fragile patients by creating a specialized consulting postemergency.

Management of resistant hypertension: expert consensus statement from the French Society of Hypertension, an affiliate of the French Society of Cardiology.

To improve the management of resistant hypertension, the French Society of Hypertension, an affiliate of the French Society of Cardiology, has published a set of eleven recommendations. The primary objective is to provide the most up-to-date information based on the strongest scientific rationale and that is easily applicable to daily clinical practice. Resistant hypertension is defined as uncontrolled blood pressure on office measurements and confirmed by out-of-office measurements despite a therapeutic strategy comprising appropriate lifestyle and dietary measures and the concurrent use of three antihypertensive agents including a thiazide diuretic, a renin-angiotensin system blocker (ARB or ACEI) and a calcium channel blocker, for at least 4 weeks, at optimal doses. Treatment compliance must be closely monitored, as must factors that are likely to affect treatment resistance (excessive dietary salt intake, alcohol, depression, drug interactions and vasopressor drugs). If the diagnosis of resistant hypertension is confirmed, the patient should be referred to a hypertension specialist to screen for potential target organ damage and secondary causes of hypertension. The recommended treatment regimen is a combination therapy comprising four treatment classes, including spironolactone (12.5-25 mg per day). In the event of a contraindication or a non-response to spironolactone, or if adverse effects occur, a ß-blocker, an α-blocker, or a centrally acting antihypertensive drug should be prescribed. Because renal denervation is still undergoing assessment for the treatment of hypertension, this technique should only be prescribed by a specialist hypertension clinic.

[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.

[Flash Survey 2012: the use of self-measurement in France and its evolution since 2010]. / Enquête FLAHS 2012: la pratique de l'automesure tensionnelle en France et son évolution depuis 2010.

UNLABELLED: The objective of this investigation is to describe the characteristics of subjects with a self-measurement device, representative of the French population. METHODS: Auto four-page questionnaire administered by mail to 4500 individuals aged 35 years and over. RESULTS: Three thousand four hundred and sixty-two subjects aged 56 years responded to the questionnaire: 1054 subjects were treated hypertensives with a mean age 65.9 years and 2388 were untreated. Among treated subjects, 41% have one self-measurement blood pressure device (36% in 2010), 15% use one humeral device and 26% wrist device. Only 2% of treated hypertensive patients measure their blood pressure before a medical consultation, one times occasionally 49%, 11% several times a week, and 4% every day! Among 569 subjects owners of self-measure, 61% are treated hypertensive, 26% normotensive and 13% untreated hypertensive patients. Treated hypertensives are controlled with self-measurement in 50% of cases (BP<135 and 85 mmHg) (49% in 2010) CONCLUSIONS: In 2012, seven million of self-measurement devices are used in France, four million in treated hypertensives. Only 2% of hypertensive patients with self-measurement device use it correctly. Better education for hypertensive subjects is required. Control in hypertensive stagnated at 50%, incite to improve our therapeutic strategy, favoring pluritherapies.

[Trends in the use of antihypertensive drugs in France from 2002 to 2012: FLAHS surveys]. / Évolution dans l'usage des traitements antihypertenseurs en France entre 2002 et 2012: enquêtes FLAHS.

OBJECTIVE: To evaluate from studies conducted between 2002 and 2012, trends in the use of antihypertensive drugs in France. METHOD: French League Against Hypertension Survey (FLAHS) were conducted in a representative sample of subjects aged 35 and over living in France. A list including the names for all antihypertensive drugs marketed at the time of each survey made it possible to detail drug therapies employed. Data analysis has taken the patient as a unity. The data obtained in 2002, 2007 and 2012 are subject to this analysis. RESULTS: In 2012, 30% of the French population aged 35 and older was treated with antihypertensive drugs (11.4 million), while 24% were treated in 2002 (8.2 million). On average, prescription of antihypertensive included 1.4 ± 0.7 pills in 2002, 1.5 ± 0.8 in 2007 and 1.8 ± 0.9 in 2012, which corresponds to a pharmacological monotherapy prescribed in 47% of subjects in 2012, a different percentage than in 2007 (46%) and 2002 (56%). Over the period, the percentage of prescriptions of diuretics (41% to 42%) and ACE inhibitors (24% to 23%) and beta-blockers (35% to 36%) is stable, but they are increasing with ARBs (23% to 47%) and calcium antagonists (24% to 34%). The prescriptions of fixed-dose combinations were also increased (19% to 30%). In 2012, fixed-dose combinations included a diuretic (79%), an ARB (65%), an ACEI (23%) and a calcium antagonist (20%). Blood pressure control estimated with home blood pressure monitoring increases from 38% in 2002 to 50% in 2007 and 2012. CONCLUSION: Changes in the use of antihypertensive drugs in France between 2002 and 2012 led to the prescription of antihypertensive treatment with associations in the majority. ARBs or ACEI are present on 70% of prescriptions with diuretics combined in 80%. Extensive use of fixed-dose combinations with diuretics and ARA2 characterizes this period in which it was observed an increase in blood pressure control in France.

[Assessment of antihypertensive monotherapies effectiveness by home blood pressure self-measurement in hypertensive patients]. / Évaluation par l'automesure au domicile de l'efficacité de monothérapies antihypertensives chez des hypertendus traités en France.

OBJECTIVE: To evaluate the blood pressure (BP) control and the efficacy of antihypertensive monotherapy using home BP self-measurement in a French population of treated hypertensive subjects in 2007 2009 and 2010. METHODS: The French League Against Hypertension Surveys (FLAHS) are conducted among a representative sample of individuals aged 35 years and older living in France. For the 2007, 2009 and 2010 surveys, a sample of 1467 subjects who owned a BP self-measurement device and performed three consecutive morning BP measurements were included. Among the 60% of subjects who reported taking at least one antihypertensive drug, we analyzed subjects treated with one of the following antihypertensive monotherapy, i.e., beta-blocker (BB), ACE inhibitors, calcium channel blocker (CCB) and angiotensin receptor blockers (ARB). RESULTS: Among treated hypertensive subjects (n=886), 66% (n=586) had home BP below the 140/90mmHg threshold and 50% (n=449) below 135/85mmHg. Three hundred two subjects were treated with a single antihypertensive drug, 33% had ARB, 25% BB, 19% CCB and 13% ACE inhibitors. Age (years) for each treatment group is different (P<0.01) CCB (72.1±9.3), BB (65.6±9.8), ARB (68.6±8.9) and ACEI (67.3±10.2). The mean systolic/diastolic BP (mmHg) is not comparable between monotherapy 130.7/76.1 (ARB), 130.7/78.7 (BB), 134.0/75.2 (CCB) and 139.1/80.3 (ACEI) for ARB, BB, CCB and ACE inhibitors respectively. Compared to ACE inhibitors, BP was significantly lower with ARB (P<0.01). The proportion of subjects with a BP below 140/90mmHg was 73% for ARB, 52% for BB, 68% for CCB and 47% for ACE with a statistical significance (P=0.03) for ARB vs. ACEI and CCB vs. ACEI. CONCLUSION: Among subjects treated for hypertension who owned a BP self-measurement device, 50 to 66% had a controlled BP (depending on the threshold used). It is observed differences between antihypertensive efficacy of monotherapy with a larger number of patients controlled with ARB or CCB.

[Renal artery stenosis after abdominal radiotherapy]. / La sténose radique de l'artère rénale : une complication inhabituelle de la radiothérapie.

INTRODUCTION: Renal artery stenosis represented 1 to 5% of all arterial hypertensions and is the leading cause of secondary hypertension. Renovascular hypertension is more common among women less than 30 years old (fibrodysplasia, 33%) and men older than 50 years old (66% atherosclerosis). Other causes are rare, especially radiation-induced renal artery stenosis. MATERIALS AND METHODS: We report the case of Mr. D., 49 years old, with severe high blood pressure (230/125 mmHg) seven years after abdominal radiotherapy for Hodgkin's disease. Echo-Doppler was performed and found a subocclusive right ostial renal artery stenosis probably radiation-induced taking into account the history of the patient. Renal angiography confirmed this diagnosis and percutaneous transluminal renal artery angioplasty was performed with a final acceptable result (residual stenosis<50%). DISCUSSION: Radiation-induced renal artery stenosis is rare (0.5/1000 to 1%). Most of the cases are proximal and the median time from radiation to referral is nine years. Radiation-induced nephritis disease was often referred to occurrence high blood pressure after abdominal radiotherapy but various data shows that radiation can also cause damage to larger vessels sizes (such as renal arteries) induced by atherosclerosis radiation. Patients should be successful treated by percutaneous intervention, as demonstrated by Fakhouri et al. [Am J Kidney Dis 38 (2001) 302-309] in a study of 11 patients. CONCLUSION: This case shows that radiation-induced renal artery stenosis may occur many years after initial treatment, and patients developing severe arterial hypertension after abdominal radiation should be investigated for renal artery stenosis.

[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.

[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.

[Blood pressure control in hypertensive patients with stable coronary heart disease]. / Contrôle de la pression artérielle chez l'hypertendu coronarien stable.

OBJECTIVE: To evaluate systolic blood pressure (SBP) control in hypertensive patients with a stable coronary heart disease (CHD) in general practice in France. METHODS: A survey was conducted in a sample of 206 general practitionners (GP) representative of the French medical population, in 2003 [LHYCORNE survey]. Each GP had to include 3 hypertensive patients, >18 years old, BP > or = 140/90 mmHg and/or treated for hypertension, and with evidence of CHD documented by myocardial infarction (MI) or angina pectoris (AP) [diagnosis previously established by a cardiologist]. Three office BP measurements were performed, the last two recorded. BP levels were considered as controlled by treatement if they were < 140/90 mmHg. RESULTS: 595 patients were included, 75% men mean age 66 years, 25% women mean age 73 years. All patients had a CHD: MI 46%, AP 54%; 533 (90%) had more than 2 cardiovascular risk factors: hyperlipidemia (411; 69%), smokers (375; 63%), diabetes (158; 27%). Mean BP was 140.7 +/- 14/80.8 +/- 9.7 mmHg; 553 (93%) of these hypertensive patients were treated, and 239 (40%) were considered as having a controlled SBP at the treshold of 140 mmHg: 47% in patients with previous MI and 38% with AP (p < 0.001). Diastolic BP (DBP) was <90 mmHg in 480 (81%) and pulse pressure was >65 mmHg in 202 (34%); 313 (53%) patients received a combination of three drugs or more; 354 (60%) had a beta-blocker, 260 (44%) a calcium channel blocker, 237 (40%) an ACE inhibitor, 287 (48%) other antihypertensive drugs (246 diuretics, 41%); 502 (84%) received antiplatelet therapy, 403 (68%) statins. CONCLUSION: This survey shows that systolic BP is not at goal in 6/10 hypertensive patients with stable CHD suggesting there is a place for a more effective combination therapy according to evidence-based medicine.

[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.

Detection of masked hypertension by home blood pressure measurement: is the number of measurements an important issue?

BACKGROUND: Office blood pressure (OBP) and home blood pressure (HBP) enable the identification of patients with masked hypertension. Masked hypertension is defined by normal OBP and high HBP and is known as a pejorative cardiovascular risk factor. OBJECTIVE: The objective was to evaluate in the SHEAF study the influence of the number of office or home blood pressure measurements on the classification of patients as masked hypertensives. METHODS: Patients with OBP <140/90 mmHg (mean of six values: three measurements at two separate visits, V1 and V2) and HBP >135/85 mmHg (mean of all valid measurements performed over a 4-day period) were the masked hypertensive reference group. The consistency of the classification was evaluated by using five definitions of HBP values (mean of the 3, 6, 9, 12 and 15 first measurements) and two definitions of OBP values (mean of three measurements at V1 and mean of three measurements at V2). RESULTS: Among the 4939 treated hypertensives included in the SHEAF study, 463 (9.4%) were classified as masked hypertensives (reference group). By decreasing the number of office or home measurements, the prevalence of masked hypertension ranged from 8.9-12.1%. The sensitivity of the classification ranged from 94-69% therefore 6-31% of the masked hypertensives were not detected. The specificity ranged from 98-94% therefore 1-6% of patients were wrongly classified as masked hypertensives. CONCLUSION: A limited number of home and office BP measurements allowed the detection of masked hypertension with a high specificity and a low sensitivity. A sufficient number of measurements (three measurements at two visits for OBP and three measurements in the morning and in the evening over 2 days for HBP) are required to diagnose masked hypertension.

[Estimation of the number of patients treated for hypertension, diabetes or hyperlipidemia in France: FLAHS study 2002]. / Estimation du nombre des sujets traités pour une hypertension, un diabète ou une hyperlipidémie en France: étude FLAHS 2002.

The study used a cross-sectional survey of the general population living in metropolitan France in April 2002. A national sample of 5,000 adults, representative of the French population, 15 years of age or older, received at their home a questionnaire mailed by SOFRES medical. The sample was designed to provide estimates of the prevalence of hypertension in the general population and in persons older than 60 years of age, a subgroup on which prevalence of treated cardiovascular risk factors is unknown in France. The questionnaire included questions related to diagnosis of hypertension, awareness of their usual BP, current SBP/DBP values, prescribed medicine for hypertension dyslipidemia and diabetes. In FLAHS 2002, a number of 3,499 (70%) questionnaires were suitable for analysis. Estimates of prevalence were standardized by the direct method to the age distribution of the French population given by the 1999 national French census (INSEE 2000). Analysis on 2,363 subjects older than 35 years and indicates that 35% are currently treated for one or more risk factor. Overall, 8,036,000 received antihypertensive medication, 1,877,000 were treated for diabetes and 6,074,000 for dyslipidemia. Prevalence of treated hypertension increased with age from from 4.2% (35-44 years) to 51.8% (> 75 years) and 70% of treated hypertensives were older than 60 years. Subjects treated for two risk factors were 3,201,000 and those treated for three risk factors were 640,000. The FLAHS 2002 represents the best available data to estimate the prevalence of treated patients for a cardiovascular risk factor in the general French population. Thirty-five percent of the population 35 years of age or older representing around 11 millions persons were taking medications for the treatment of hypertension, diabetes or dyslipidemia in France.