["Heart, arteries and women" an innovative care pathway for women at high risk: First evaluation at one year]. / Le circuit « cœur, artères et femmes ¼ chez la femme à haut risque cardiovasculaire : première évaluation à un an.

INTRODUCTION: Cardiovascular diseases remain the first cause of death in women. To improve women's health cardiologists and gynaecologists should work together on women's specific cardiovascular risk factor. METHOD: Our study evaluated a care pathway named "heart, arteries and women". One hundred and ninety-one women were included for vascular (n=55) or hypertensive (n=136) explorations from January the first to December the 31st of 2013. We studied their clinical presentation and medical management. RESULTS: All women were at high cardiovascular risk (38% of them at very high risk). The average age was 52 years old. A woman on three had experienced high blood pressure or diabetes during pregnancy. One on two was postmenopausal woman. We stopped twelve estrogen-progesterone contraceptions; 60% didn't have gynaecological follow-up; 146 had high blood pressures (73% at night, 50% had no dipping blood pressure profile and 15 were newly diagnosed for hypertension). Sleep apnoea syndrome was suspected in half women. Medical therapies were optimized especially for women with atheroma in which 30 to 46% were properly treated (P=0.0005). Only 18% of the gynecologists received conclusive reports. CONCLUSION: At one year, our care pathway "heart, arteries and women" allowed to optimize medical therapy and clinical management. Everyone should be aware of this program.

[Systematic screening of masked hypertension in patients with peripheral arterial disease: a pilot study]. / Dépistage systématique de l'hypertension artérielle masquée chez les patients ayant une artériopathie des membres inférieurs: une étude pilote.

AIM: Masked hypertension (MH) is defined by a normal office blood pressure (BP) and a high ambulatory BP. MH is characterized by high prevalence and poor cardiovascular prognosis. The aim of this study was to evaluate the usefulness of routine MH screening, using 24-h blood pressure monitoring (BPM), among patients with peripheral arterial disease (PAD). METHODS: Between 2011 and 2013, 54 patients with PAD were included in the Hypertension and Vascular Medicine Unit of the Lille Hospital. They had normal office BP (< 140/90mmHg). A 24 h-BPM device was set on each patient. MH diagnosis was established if the BP average over 24 hours was ≥ 130/80 mmHg and/or the daytime average ≥ 135/85 mmHg and/or the nighttime average ≥ 120/70 mmHg. RESULTS: MH prevalence was about 42.6% (23 patients). It was significantly more frequent in diabetic patients (odds ratio: 3.8 [1.1-12.8]), in patients with known hypertension (odds ratio: 5 [1.5-16.9]) or with high normal office BP (<140/90 mmHg but ≥ 130/85 mmHg) (odds ratio: 5.6 [1.7-18.2]). By multivariate analysis, only known hypertension and high normal office BP were associated with masked hypertension. CONCLUSION: The high prevalence of MH in patients with PAD shows us the importance of a careful screening of MH in this population, especially in diabetic patients, in patients with known hypertension or with a high normal office BP.

[Heart, arteries and women, a care pathway for women at high cardiovascular risk]. / Cœur, artères et femmes, un circuit de soins dédié aux femmes à risque cardiovasculaire.

Cardiovascular (CV) diseases are the primary cause of death of women. Since they kill 10 times more than breast cancer, preventive measures should be implemented. According to U.S. recommendations, a woman is either at "CV risk" or at "optimal health status" if she has no risk factors and a perfectly healthy lifestyle. Some risk factors are more deleterious to women (smoking, diabetes, stress, depression, atrial fibrillation); or specific to women (preeclampsia, gestational diabetes, contraception, menopause, headaches). The lifestyle plays a key role for them. The blood pressure measurement is the most frequent opportunity to detect women at risk. CV tests should be performed to all symptomatic women and for those over the age of 45 who want to start practicing sport. The cardiologist can play a key role to improve women's CV health by integrating their hormonal risks. Women themselves can also make a powerful contribution to prevention by adopting a healthy lifestyle. From those recommendations concerning women's CV health, there is a great opportunity to initiate a health path for women at high cardiovascular risk. The objectives of the specific path "heart, arteries and women" of University hospital of Lille will be to improve professional practice, awareness of women, educate public authorities and within a few years reduce the epidemic of CVD of French women.

[A specific questionnaire to evaluate therapeutic inertia in hypertensive patients: a pilot study]. / Évaluation de l'inertie thérapeutique chez des patients hypertendus à l'aide d'un questionnaire ciblé : étude pilote.

BACKGROUND: Therapeutic inertia (TI) is a recent concept still unknown by many physicians. In chronic diseases such as hypertension, it is defined as the tendency of physicians not to increase or change antihypertensive medications when the target blood pressure is not reached. Acting on TI could improve blood pressure control in France. METHOD: This was a single-center prospective pilot study conducted by hypertension specialist physicians at the University Cardio-Vascular Center in Lille (France). It was conducted between March and June 2011. Data was collected from 161 hypertensive patients (mean age: 61.64±11.18 years; 98 (60.9%) male; 75 secondary prevention patients). Each physician completed a questionnaire on therapeutic inertia. TI was defined as a consultation in which treatment change was indicated (systolic blood pressure [BP]≥140 and/or diastolic BP≥90mmHg in all patients), but did not occur, with absence of an adapted justification of this choice. We considered as an adapted justification: a white coat effect demonstrated by ambulatory blood pressure monitoring (ABPM) or home blood pressure monitoring; scheduled reassessment of the BP by ABPM; recent change in antihypertensive treatment (less than 4 weeks); hospitalization needed for complete evaluation of secondary causes of hypertension and a more detailed assessment of potential target organ damage in patients with grade 1 or 2 hypertension. Our study aimed to evaluate rates of TI, to identify factors associated with TI, and to test the TI questionnaire. RESULTS: Therapeutic inertia as defined in this study occurred in 11 consultations (8.3%) of the 133 hypertensive patients having uncontrolled BP above or equal to 140 and/or 90mmHg. Significant factors associated with TI were older age (Z=2.35, P<0.05) and sleep apnea syndrome (χ(2)=8.33, P<0.05). The absence of ambulatory blood pressure monitoring before the consultation (χ(2)=4.28, 0.1>P>0.05) and the number of consultations (Z=1.92, 0.1>P>0.05) exhibited a significant trend to be associated with TI. CONCLUSIONS: Although the rate of TI was low in our study conducted in a specialized center, a well-accepted definition of therapeutic inertia would be useful for further study. The feasibility of using the questionnaire tested with this study shows that this measurement tool could help physicians become more aware of TI, both in the hospital and primary care setting. Further multicenter studies are needed for validation.