[Associated factors and sub-clinical myocardial dysfunction in obese patients with masked hypertension]. / L'hypertension artérielle masquée chez les obèses : facteurs associés et atteinte myocardique infraclinique.

INTRODUCTION: Obesity is a worldwide health problem. Masked hypertension is a relatively recent reported entity with a diagnostic problem. The aim of this study was to determine the clinical and paraclinical characteristics and to identify the predictive factors of masked hypertension in obese patients. METHODS: It is a prospective study including obese patients with normal arterial pressure at office. All of these patients were given ambulatory blood pressure measurement (ABPM) to screen for masked hypertension, laboratory tests and a complete echocardiography study. RESULTS: A total of 50 patients were included. The mean age was 46.52±10.4 years. The mean systolic blood pressure (BP) at office was 120.8±8.8mmHg and the mean diastolic BP was 75±7.3mmHg. The prevalence of masked hypertension in obese adults was 36% with a predominantly non-dipper profile (38%). The study of echocardiographic parameters found dilated left atrium (LA) in 16 patients (32%). The left ventricle (LV) was hypertrophied in 32 patients (64%). The overall LV global longitudinal strain (GLS) was on average -18.85±0.9% and the LA GLS was on average 37.35±4.5%. In our study, metabolic syndrome, low HDL cholesterol, elevated fasting blood glucose, hyperuricemia, LA dilatation, LV hypertrophy, diastolic LV dysfunction and altered myocardial deformities were factors associated with masked hypertension in obese adults. CONCLUSION: It is important to screen for hypertension by ambulatory measurement in at-risk obese patients who present associated cardiovascular risk factors to reduce morbidity and mortality. Echocardiography and speckle tracking analysis could be helpful in detection sub-clinical myocardial deterioration in obese patients with masked hypertension.

Subclinical left ventricle impairment following breast cancer radiotherapy: Is there an association between segmental doses and segmental strain dysfunction?

BACKGROUND: Cardiotoxicity following breast cancer radiotherapy (RT) represents one of the most redoubtable toxicities. The Global longitudinal strain measurement (GLS) based on 2D speckle tracking imaging (STI) allows detection of left ventricular (LV) dysfunction at a subclinical stage. The aim of this prospective study was to detect patients at risk of cardiotoxicity using echocardiographic parameters and to determine the association between segmental RT doses and early cardiac toxicity. MATERIAL AND METHODS: The STI was performed prior to RT and at 3, 6 and 12 months after. The association between subclinical LV dysfunction, defined as a reduction of GLS more than 10% from the initial value, radiation doses to different LV segments and non-radiation factors were performed based on multivariate analyses. RESULTS: From June 2017 to August 2018, a total of 103 female patients were included. Sixty patients had left sided RT. Seven patients (7.8%) developed a GSL impairment. The segmental alterations predominated in the anteroseptal and apical LV segments. The mean Dmean in altered segments was significantly higher than in non-altered segments (6.7 ± 8.8Gy-7.8 ± 8.9Gy vs 4.9 ± 7.9-5.4 ± 8.2Gy; p < 0.05). Age > 55 years and obesity were important confounding factors that should be considered during radiotherapy planning. CONCLUSION: The results of our study show that radiation dose is correlated with the subclinical LV segments' alteration. Global heart delineation seems to be insufficient during the breast radiotherapy planning. Segmental delineation of the LV may be an interesting alternative to limit segmental doses and to reduce the risk of subclinical alterations. A mean dose of 5Gy could be proposed in exposed heart segment.

[Impact of socioeconomic factors on blood pressure control: Observational study about 2887 hypertensive patients]. / Impact des facteurs socioéconomiques sur l'équilibre de la pression artérielle : étude observationnelle à propos de 2887 hypertendus.

INTRODUCTION: Despite therapeutic progress, less than half of hypertensive patients are controlled. The objective of this study was to examine the links between blood pressure control and socioeconomic factors. METHODS: We used data collected in the cardiology department of Sfax University Hospital as part of the Tunisian national hypertension registry. We studied the associations between the socio-economic variables (educational level, profession, medical insurance) and optimal blood pressure control (SBP<140mmHg and DBP<90mmHg) using logistic regression models. RESULTS: The average age of our population was 65 and the sex ratio was 0.95. We found, as expected, the clinical and behavioral factors associated with a good blood pressure control, namely: female sex, low-sodium diet, therapeutic compliance, and regular physical activity. However, obesity and an increased number of antihypertensive drugs have been associated with poor blood pressure control. The study of the effect of socio-economic variables on BP control finds a significant gradient against the most disadvantaged social categories for our three social variables in the univariate analysis. The inclusion of clinical and behavioral factors in the multivariate analysis attenuated these associations but did not fully explain them. CONCLUSION: Our study shows that there are social inequalities in the control of blood pressure. Social justice and improving living conditions are probably the real solutions to the problem of these social inequalities in health.