Association of serum copeptin and urinary uromodulin with kidney function, blood pressure and albuminuria at 6 weeks post-partum in pre-eclampsia.

Background: Preeclampsia (PE) is associated with subsequent higher risk of cardiovascular and kidney disease. Serum copeptin, as a proxy for vasopressin, and urinary uromodulin, were associated with PE physiopathology and kidney functional mass respectively. We describe concentrations of these proteins in the post-partum period and characterize their association with persistent hypertension (HTN) or albuminuria. Methods: Patients with PE and healthy controls with uncomplicated pregnancy were prospectively included at two teaching hospitals in Switzerland. Clinical parameters along with serum copeptin and urinary uromodulin were measured at 6 weeks post-partum. PE patients were further characterized based on presence of HTN (defined as either systolic BP (SBP) ≥140 mmHg or diastolic (BP) ≥90 mmHg) or albuminuria [defined as urinary albumin to creatinine ratio (ACR) ≥3 mg/mmol]. Results: We included 226 patients with 35 controls, 120 (62.8%) PE with persistent HTN/albuminuria and 71 (37.1%) PE without persistent HTN/albuminuria. Median serum copeptin concentration was 4.27 (2.9-6.2) pmol/L without differences between study groups (p > 0.05). Higher copeptin levels were associated with higher SBP in controls (p = 0.039), but not in PE (p > 0.05). Median urinary uromodulin concentration was 17.5 (7.8-28.7) mg/g with lower levels in PE patients as compared to healthy controls (p < 0.001), but comparable levels between PE patients with or without HTN/albuminuria (p > 0.05). Higher uromodulin levels were associated with lower albuminuria in PE as well as control patients (p = 0.040). Conclusion: Serum copeptin levels at 6 weeks post-partum are similar between PE patients and healthy controls and cannot distinguish between PE with or without residual kidney damage. This would argue against a significant pathophysiological role of the vasopressin pathway in mediating organ damage in the post-partum period. On the opposite, post-partum urinary uromodulin levels are markedly lower in PE patients as compared to healthy controls, potentially reflecting an increased susceptibility to vascular and kidney damage that could associate with adverse long-term cardiovascular and kidney outcomes.

[Hypertension: what's new in 2023]. / Hypertension artérielle : ce qui a changé en 2023.

Highlights for 2023 include the confirmation of hypertension as a cardiovascular risk factor and the standard procedure for measuring blood pressure. Transdermal oestrogens do not appear to be associated with an increased risk of hypertension unlike oestrogen given orally. The usefulness of blood pressure measured in hospital in elderly patients and the risks of intensive treatment are reviewed. A new study suggests that we are not all equal when it comes to recommended treatments. Finally, RNA interference technology has enabled the synthesis of a new antihypertensive treatment administered every 6 months that inhibits the production of hepatic angiotensinogen with a good effect on blood pressure.

Le survol de l'année 2023 met l'accent sur l'hypertension artérielle (HTA) comme facteur de risque cardiovasculaire et sur les conditions de mesure de la pression artérielle. Du côté hormonal, les œstrogènes en application transdermique ne semblent pas être associés à un risque augmenté d'HTA, contrairement à ceux administrés par voie orale. L'utilité de la pression artérielle mesurée en milieu hospitalier chez des patients âgés et les risques de son traitement intensif sont également discutés. Une nouvelle étude suggère que nous ne sommes pas tous égaux face aux traitements recommandés. Enfin, la technologie des ARN interférents a permis la synthèse d'un nouveau traitement antihypertenseur administré aux 6 mois inhibant la production d'angiotensinogène hépatique avec un bon effet sur la pression artérielle.

[Antihypertensive treatment: the winning combination]. / Traitement antihypertenseur : la combinaison gagnante.

Detecting, treating and controlling hypertension remains a primary goal in health policy. New recommendations in the management of hypertension were published in 2023 to withhold its global pandemic. The first step is to initiate dual antihypertensive therapy in most of the cases by combining 2 molecules from different classes in a single tablet. Subsequent steps involve ensuring blood pressure control and, if indicated, combining other drug classes, again as a single pill combination (SPC). These polypills make it possible to reduce blood pressure more effectively, to offer earlier cardioprotection and to increase patient's compliance while simplifying their treatment and eliminating adverse effects. In this article, we will focus on the combination of antihypertensive classes as a revolutionary paradigm.

Dépister, traiter et contrôler l'HTA reste un objectif primordial de politique de santé. De nouvelles recommandations ont été publiées en 2023 afin d'endiguer cette pandémie mondiale. La première étape, pour la majorité des cas, consiste à instaurer une bithérapie en combinant 2 molécules de différentes classes en un seul comprimé (single pill combination (SPC)). Il faut ensuite s'assurer du bon contrôle tensionnel et, si indiqué, associer d'autres classes médicamenteuses, toujours sous forme de SPC. Ces polypill permettent d'être plus efficace pour réduire la TA, offrent une cardioprotection précoce et augmentent l'adhésion thérapeutique des patients tout en simplifiant leur traitement et en limitant les effets indésirables. Dans cet article, l'accent est mis sur l'association des classes d'antihypertenseurs, comme paradigme révolutionnaire.

[Immuno-inflammatory mechanisms of hypertension : contribution to the clinic]. / Mécanismes immuno-inflammatoires de l'HTA : apport à la clinique.

In both industrialized and developing countries, the prevalence of hypertension is increasing. The classical pathophysiology of this major cardiovascular risk factor has recently been enriched by new concepts involving the inflammation and the immune system as potential players. Indeed in certain immune-mediated inflammatory diseases such as psoriatic arthritis, rheumatoid polyarthritis or lupus erythematosus, but also degenerative arthritis, periodontitis, arterial hypertension is found more frequently than in the general population, often underdiagnosed and poorly controlled, and the cardiovascular (CV) risk is more important. The aim of this article is to review the state of knowledge on this subject, and to draw out any implications for clinical practice.

La prévalence de l'hypertension artérielle est en constante augmentation tant dans les pays industrialisés que dans ceux à bas revenus. La physiopathologie classique de ce facteur de risque cardiovasculaire (CV) majeur s'est récemment enrichie de nouveaux concepts mettant en jeu l'inflammation et le système immunitaire comme acteurs potentiels. En effet, dans certaines maladies auto-immunes ou inflammatoires à médiation immunitaire, comme le psoriasis, la polyarthrite rhumatoïde ou le lupus érythémateux disséminé, mais aussi les arthropathies dégénératives, la parodontite, on retrouve plus fréquemment une hypertension artérielle qu'au sein de la population générale, souvent sous-diagnostiquée et mal contrôlée, et le risque CV y est plus important. Le but de cet article est de faire le point sur l'état des connaissances à ce sujet, et d'en tirer d'éventuelles implications pour la clinique.

Variability of 24-Hour Sodium Urinary Excretion in Young Healthy Males Based on Consecutive Urine Collections: Impact on Categorization of Salt Intake.

OBJECTIVE: Several nonconsecutive 24-h urinary collections are considered the gold standard for estimating dietary salt intake. As those samples are logistically demanding, we aimed to describe the variability of 24-h sodium urinary excretion over consecutive days and report its adequacy with sodium intake. METHODS: We enrolled 16 healthy male volunteers in a prospective controlled study. All participants randomly received a low salt diet (LSD) (3 g/day of NaCl), a normal salt diet (NSD) (6 g/day of NaCl), and a high salt diet (HSD) (15 g/day of NaCl) for 7 days in a crossover design without wash-out period. RESULTS: On day 6, median sodium urinary excretion was 258 (216-338), 10 (8-18), and 87 (69-121) mmol/day for HSD, LSD, and NSD, respectively (P < .001). When considering days 4-6, sodium urinary excretion was in steady state as models with and without interaction term "diet type X sample day" were not significantly different (P = .163). On day 6, area under the curve (AUC) of receiver operating characteristic for urinary sodium excretion to detect HSD was 1.0 (1.0-1.0) and a cut-point of 175 mmol/day was 100% sensitive and specific to detect HSD. On day 6, receiver operating characteristic AUC to detect LSD was 0.993 (0.978-1.0) and a cut-point of 53 mmol/day was 96.4% sensitive and 100% specific to detect LSD. CONCLUSION: A steady state of sodium balance, where sodium intake is proportional to its excretion, is reached within a few days under a constant diet in the real-life setting. Categorization of salt consumption into low (3 g/day), normal (6 g/day), or high (15 g/day) based on a single 24-h urine collection is nearly perfect. Based on these results, repeated nonconsecutive urine collection might prove unnecessary to estimate sodium intake in daily clinical practice provided that diet is rather constant over time.

[Hypertension: what's new in 2022]. / Hypertension artérielle : ce qui a changé en 2022.

Our article summarizing the most important studies of the past year emphasizes the difficulty of controlling blood pressure (BP) in hypertensive patients. In addition, it discusses factors such as temperature and sodium that may influence BP, proposes new targets in pregnant hypertensive patients, and challenges the usefulness of taking an antihypertensive drug nightly. Finally, a strategy targeting endothelin blockade in resistant hypertension is presented.

Notre article résumant les études marquantes de l'année écoulée met l'accent sur la difficulté à contrôler la pression artérielle (PA) chez les hypertendus. De plus, il aborde certains facteurs comme la température et le sodium pouvant influencer la PA, les cibles chez les patientes hypertendues enceintes et l'utilité d'une prise vespérale d'un antihypertenseur. Finalement, une stratégie visant le blocage de l'endothéline est présentée dans l'hypertension résistante.

Cardiovascular therapy use, modification, and in-hospital death in patients with COVID-19: A cohort study.

AIMS: To assess the associations of exposure and modifications in exposure (i.e., discontinuation on admission, initiation during hospitalization) to eight common cardiovascular therapies with the risk of in-hospital death among inpatients with coronavirus disease 2019 (COVID-19). METHODS: In this observational study including 838 hospitalized unvaccinated adult patients with confirmed COVID-19, the use of cardiovascular therapies was assessed using logistic regression models adjusted for potential confounders. RESULTS: No cardiovascular therapy used before hospitalization was associated with an increased risk of in-hospital death. During hospitalization, the use of diuretics (aOR 2.59 [1.68-3.98]) was associated with an increase, and the use of agents acting on the renin-angiotensin system (aOR 0.39 [0.23-0.64]) and lipid-lowering agents (aOR 0.41 [0.24-0.68]) was associated with a reduction in the odds of in-hospital death. Exposure modifications associated with decreased survival were the discontinuation of an agent acting on the renin-angiotensin system (aOR 4.42 [2.08-9.37]), a ß-blocker (aOR 5.44 [1.16-25.46]), a lipid-modifying agent (aOR 3.26 [1.42-7.50]) or an anticoagulant (aOR 5.85 [1.25-27.27]), as well as the initiation of a diuretic (aOR 5.19 [2.98-9.03]) or an antiarrhythmic (aOR 6.62 [2.07-21.15]). Exposure modification associated with improved survival was the initiation of an agent acting on the renin-angiotensin system (aOR 0.17 [0.03-0.82]). CONCLUSION: In hospitalized and unvaccinated patients with COVID-19, there was no detrimental association of the prehospital use of any regular cardiovascular medication with in-hospital death, and these therapies should be continued as recommended.

[Does arterial hypertension have a gender?] / L'hypertension artérielle a-t-elle un genre?

Women are less frequently affected by arterial hypertension than men during their reproductive life, but their risk catches up and exceeds men's after the menopause. There is a knowledge gap about the specificity of arterial hypertension in women, due to an under inclusion of women in clinical trials. Hypertensive disorders of pregnancy are a recognized ulterior cardiovascular risk factor, and obstetrical history must be part of the evaluation of hypertensive women. In certain cases, we propose to lower the doses of antihypertensive medications in women, due to increased efficiency and increased risk of secondary effects, most notably for thiazide diuretics and calcium channel blockers.

Les femmes sont moins touchées par l'hypertension artérielle (HTA) que les hommes durant leur vie reproductive, mais leur tension artérielle et leur risque cardiovasculaire s'élèvent et dépassent ceux des hommes après la ménopause. Il existe un déficit de connaissances sur les spécificités de l'HTA féminine en raison d'une sous-inclusion des femmes dans les études cliniques. Les pathologies hypertensives de la grossesse sont un facteur de risque cardiovasculaire ultérieur reconnu et l'anamnèse obstétricale doit faire partie de l'évaluation des femmes hypertendues. Dans certains cas, une diminution de la posologie des traitements antihypertenseurs chez les femmes est à considérer en raison d'une efficacité augmentée et d'un risque accru d'effets secondaires chez elles, notamment pour les diurétiques thiazidiques et les anticalciques.

[Hypertension and SCUBA diving]. / Hypertension artérielle et plongée sous-marine.

Hypertension is a major cardiovascular risk factor in our population. This condition is widely recognized as an exacerbating factor for several physiopathological mechanisms, especially under an intense physical effort. In this article we focus on the link between high blood pressure and risk factors in scuba diving. In particular, we illustrate how a hypertensive diver is exposed to an increased risk of acute immersion pulmonary edema, as well as cardiac death.

L'hypertension artérielle est un facteur de risque cardiovasculaire prépondérant dans notre population. Elle est reconnue comme pouvant exacerber de nombreux mécanismes physiopathologiques lors de conditions d'efforts. Dans cet article, nous nous focalisons sur le lien entre l'hypertension artérielle et le risque qu'elle pourrait représenter lors de la pratique de la plongée sous-marine. En particulier, nous illustrerons comment un plongeur hypertendu peut être exposé à un risque augmenté d'œdème pulmonaire aigu d'immersion, ainsi qu'à la mort subite d'origine cardiaque.

Increased glucocorticoid metabolism in diabetic kidney disease.

AIMS: Glomerular damage indicated by proteinuria is a main symptom in diabetic nephropathy. Mineralocorticoid receptor (MR) antagonists (MRAs) are beneficial irrespective of aldosterone availability. Thus, we hypothesized an alternatively activated MR to promote glomerular damage in proteinuric diabetic nephropathy. Specifically, we aimed first to demonstrate the presence of steroid hormones serving as alternative MR targets in type II diabetic patients with proteinuric kidney disease, second whether MR selectivity was modified, third to characterize MR and glucocorticoid receptor (GR) expression and activity in glomerular cell types exposed to eu- and hyperglycemic conditions, fourth to characterize the pro-fibrotic potential of primary human renal mesangial cells (HRMC) upon stimulation with aldosterone and cortisol, and fifth to specify the involvement of the MR and/or GR in pro-fibrotic signaling. MATERIALS AND METHODS: Urinary steroid hormone profiles of patients with diabetic kidney disease were analyzed by gas chromatography-mass spectrometry and compared to an age and gender matched healthy control group taken out of a population study. In both cohorts, the activity of the MR pre-receptor enzyme 11ß-hydroxysteroid dehydrogenase type 2 (HSD11B2), which inactivates cortisol to prevent it from binding to the MR, was assessed to define a change in MR selectivity. Expression of HSD11B2, MR and GR was quantified in HRMC and primary human renal glomerular endothelial cells (HRGEC). Activity of MR and GR was explored in HRMC by measuring the MR/GR down-stream signal SGK1 and the pro-fibrotic genes TGFB1, FN1 and COL1A1 in normal and high glucose conditions with the MR/GR agonists aldosterone/cortisol and the MR/GR antagonists spironolactone/RU486. RESULTS: Patients with diabetic kidney disease excreted more tetrahydroaldosterone than the control group reaching significance in men. The excretion of MR-agonistic steroid hormones was only increased for 18-hydroxytetrahydrocorticosterone in diabetic women. The excretion of most glucocorticoids was higher in the diabetic cohort. Higher apparent systemic HSD11B2 activity suggested less activation of the MR by cortisol in diabetic patients. Both cell types, HRMC and HRGEC, lacked expression of HSD11B2. Hyperglycemic conditions did not change MR and GR expression and activity. Stimulation with both aldosterone and cortisol promoted upregulation of pro-fibrotic genes in HRMC. This effect of MR and/or GR activation was more pronounced in high glucose conditions and partially inhibited by MRAs and GR antagonists. CONCLUSIONS: In patients with diabetic kidney disease alternative MR activation is conceivable as cortisol and cortisone metabolites are increased. Systemic availability of active metabolites is counteracted via an increased HSD11B2 activity. As this cortisol deactivation is absent in HRMC and HRGEC, cortisol binding to the MR is enabled. Both, cortisol and aldosterone stimulation led to an increased expression of pro-fibrotic genes in HRMC. This mechanism was related to the MR as well as the GR and more marked in high glucose conditions linking the benefit of MRAs in diabetic kidney disease to these findings.

Accurate Location of Catheter Tip With the Free-to-Total Metanephrine Ratio During Adrenal Vein Sampling.

Background: The selectivity index (SI) of cortisol is used to document correct catheter placement during adrenal vein sampling (AVS) in patients with primary aldosteronism (PA). We aimed to determine the cutoff values of the SIs based on cortisol, free metanephrine, and the free-to-total metanephrine ratio (FTMR) using an adapted AVS protocol in combination with CT. Methods: Adults with PA and referred for AVS were recruited in two hypertension centers. The cortisol and free metanephrine-derived SIs were calculated as the concentration of the analyte in adrenal veins divided by the concentration of the analyte in the distal vena cava. The FTMR-derived SI was calculated as the concentration of free metanephrine in the adrenal vein divided by that of total metanephrine in the ipsilateral adrenal vein. The AVS was classified as an unequivocal radiological success (uAVS) if the tip of the catheter was seen in the adrenal vein. The SI cutoffs of each index marker were established using receiver operating characteristic curve analysis. Results: Out of 125 enrolled patients, 65 patients had an uAVS. The SI cutoffs were 2.6 for cortisol, 10.0 for free metanephrine, 0.31 for the FTMR on the left side, and 2.5, 9.9, and 0.25 on the right side. Compared to free metanephrine and the FTMR, cortisol misclassified AVS as unsuccessful in 36.6% and 39.0% of the cases, respectively. Conclusion: This study is the first to calculate the SIs of cortisol, free metanephrine, and the FTMR indices for the AVS procedure. It confirms that free metanephrine-based SIs are better than those based on cortisol.

[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.

Dietary sodium intake does not alter renal potassium handling and blood pressure in healthy young males.

BACKGROUND: The effects of sodium (Na+) intakes on renal handling of potassium (K+) are insufficiently studied. METHODS: We assessed the effect of Na+ on renal K+ handling in 16 healthy males assigned to three 7-day periods on low salt diet [LSD, 3 g sodium chloride (NaCl)/day], normal salt diet (NSD, 6 g NaCl/day) and high salt diet (HSD, 15 g NaCl/day), with constant K+ intake. Contributions of distal NaCl co-transporter and epithelial Na+ channel in the collecting system on K+ and Na+ handling were assessed at steady state by acute response to 100 mg oral hydrochlorothiazide and with addition of 10 mg of amiloride to hydrochlorothiazide, respectively. RESULTS: Diurnal blood pressure slightly increased from 119.30 ± 7.95 mmHg under LSD to 123.00 ± 7.50 mmHg (P = 0.02) under HSD, while estimated glomerular filtration rate increased from 133.20 ± 34.68 mL/min under LSD to 187.00 ± 49.10 under HSD (P = 0.005). The 24-h K+ excretion remained stable on all Na+ intakes (66.28 ± 19.12 mmol/24 h under LSD; 55.91 ± 21.17 mmol/24 h under NSD; and 66.81 ± 20.72 under HSD, P = 0.9). The hydrochlorothiazide-induced natriuresis was the highest under HSD (30.22 ± 12.53 mmol/h) and the lowest under LSD (15.38 ± 8.94 mmol/h, P = 0.02). Hydrochlorothiazide increased kaliuresis and amiloride decreased kaliuresis similarly on all three diets. CONCLUSIONS: Neither spontaneous nor diuretic-induced K+ excretion was influenced by Na+ intake in healthy male subjects. However, the respective contribution of the distal convoluted tubule and the collecting duct to renal Na+ handling was dependent on dietary Na+ intake.

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.

[Hyponatremia and thiazides]. / Hyponatrémie et diurétiques thiazidiques.

Thiazide diuretics (hydrochlorothiazide) and « thiazide-like ¼ (chlorthalidone, indapamide) are widely prescribed due to their effectiveness in the treatment of arterial hypertension. The use of thiazides may be complicated by hyponatremia that is associated with increased morbidity and mortality. The pathophysiology of thiazide-induced hyponatremia is not yet clear. It is currently difficult to predict who will develop thiazide-induced hyponatremia. Genetic predisposition is considered, and several studies are attempting to clarify it in order to identify patients at risk of developing hyponatremia after taking a thiazide. Their reintroduction to a patient who already presented hyponatremia upon thiazide should be avoided.

Les diurétiques thiazidiques (hydrochlorothiazide) et thiazidiques apparentés (chlortalidone, indapamide) sont largement prescrits du fait de leur efficacité dans le traitement de l'hypertension artérielle. La prise de thiazidiques peut se compliquer d'une hyponatrémie associée à une morbidité et une mortalité augmentées. La physiopathologie de cette hyponatrémie n'est pas encore totalement élucidée. Il est à l'heure actuelle difficile de prédire qui va présenter une hyponatrémie induite par les thiazidiques. Une susceptibilité génétique a été envisagée et plusieurs études tentent de la préciser dans le but d'identifier les patients à risque de développer une hyponatrémie après la mise sous thiazidiques. Chez un patient qui a présenté une hyponatrémie sur thiazidiques, leur réintroduction devrait être évitée.

[Effect of seasons on blood pressure]. / Effet des saisons sur la pression artérielle.

Blood pressure (BP) variability appears to be a cardiovascular risk factor in its own right. Seasonal and temperature changes contribute to BP variations in the medium term with increased BP values in winter and lowered values in summer, and in the short term by influencing the circadian rhythm of BP. International societies have not issued specific recommendations on the detection of patients at risk of significant seasonal variations in BP, nor on the possible adaptation of antihypertensive treatments. This is a topical issue in the context of global warming, which will make these seasonal differences more significant in the future. Measuring BP outside the medical setting can be of great help in screening and monitoring these patients.

La variabilité de la pression artérielle (PA) semble être un facteur de risque cardiovasculaire à part entière. Les changements de saison et de température participent aux variations de la PA à moyen terme avec des valeurs tensionnelles augmentées en hiver et abaissées en été et à court terme en influençant le rythme circadien de la PA. Les sociétés internationales n'ont pas émis de recommandations spécifiques sur la détection des patients à risque de présenter des variations saisonnières importantes de la PA, ni sur l'adaptation éventuelle des traitements antihypertenseurs. Le sujet est d'actualité à l'heure du réchauffement climatique qui pourrait rendre ces différences saisonnières plus importantes à l'avenir. La mesure de la PA hors du milieu médical peut être d'une grande aide au dépistage et au suivi de ces patients.

Assessment of a strategy combining ambulatory blood pressure, adherence monitoring and a standardised triple therapy in resistant hypertension.

PURPOSE: Poor adherence to drug therapy and inadequate drug regimens are two frequent factors responsible for the poor blood pressure (BP) control observed in patients with apparent resistant hypertension. We evaluated the efficacy of an antihypertensive management strategy combining a standardised therapy with three long acting drugs and electronic monitoring of drug adherence in patients with apparent resistant hypertension. MATERIALS AND METHODS: In this multicentric observational study, adult patients with residual hypertension on 24 h ambulatory BP monitoring (ABMP) despite the use of three or more antihypertensive drugs could be included. Olmesartan/amlodipine (40/10 mg, single pill fixed-dose combination) and chlorthalidone (25 mg) were prescribed for 3 months in two separated electronic pills boxes (EPB). The primary outcome was 24 h ambulatory systolic BP (SBP) control at 3 months, defined as mean SBP <130 mmHg. RESULTS: We enrolled 48 patients (36.0% women) of whom 35 had complete EPB data. After 3 months, 52.1% of patients had 24 h SBP <130 mmHg. 24 h SBP decreased by respectively -9.1 ± 15.5 mmHg, -22.8 ± 30.6 mmHg and -27.7 ± 16.6 mmHg from the tertile with the lowest adherence to the tertile with the highest adherence to the single pill combination (p = 0.024). A similar trend was observed with tertiles of adherence to chlorthalidone. Adherence superior to 90% was associated with 24 h systolic and diastolic blood pressure control in multiple logistic regression analysis (odds ratio = 14.1 (95% confidence interval 1.1-173.3, p = 0.039). CONCLUSIONS: A simplified standardised antihypertensive therapy combined with electronic monitoring of adherence normalises SBP in about half of patients with apparent resistant hypertension. Such combined management strategy enables identifying patients who need complementary investigations and those who rather need a long-term support of their adherence.