Objective To identify childhood and parental factors associated with initiation of statin therapy in children with heterozygous familial hypercholesterolemia (HeFH), including underlying genetic diagnosis or parental premature atherosclerotic cardiovascular disease (ASCVD). Study design This multicenter cohort study included 245 HeFH child- parent pairs from the REFERCHOL national register (2014-2020). Demographic and clinical characteristics at the last visit were collected. Vascular disease in parents was defined as a history of ASCVD, and/or a coronary artery calcium score >100, and/or stenosis of >50% in at least carotid artery. Statistical analyses included descriptive analysis, logistic regression for univariate and multivariate effects of statins, and a sensitivity analysis combining the characteristics of children and parents. Results Among the 245 children in the study cohort, 135 (58%), with a mean age of 14 +/- 3 years, were treated with a statin. In multivariable analysis, the predictive childhood factors associated with statin treatment were genetic diagnosis (OR, 2.5; 95% CI, 1.3 to 4.9; P = .01), older age (OR, 4.4; 95% CI, 1.8-10.6; P = .01), more than 2 visits (OR, 2.36; 95% CI, 1.18-4.73; P = .015), and longer duration of follow-up (OR, 1.3; 95% CI, 1.1-1.6; P < .001). The predictive parental factor associated with childhood treatment was the presence of vascular disease (OR, 2.4; 95% CI, 1.0-5.7; P = .04). Conclusions HeFH confirmed by DNA testing during childhood and a history of vascular disease in parents were independently associated with statin treatment in children with HeFH. Genetic diagnosis may be useful for cardiovascular prevention in children. (J Pediatr 2023;253:18-24).

Identification of patients with monogenic familial hypercholesterolemia (FH) is demonstrated to be crucial for adapting cardiovascular (CV) risk prevention. Screening strategies for FH have long been based on clinical-biological criteria such as Dutch Lipid Clinic Network Criteria (DLCNC). With the advent of new sequencing technologies (NGS), molecular diagnosis is routinely performed and may be combined with methods aimed to identify polygenic forms that are suggested to have a lower CV risk. In addition, according to DLCNC, untreated LDL-C (uLDL-c) levels above 190 mg/dL are said to be suspicious of FH but overlap also with polygenic forms. Gathering several years of molecular analysis (monogenic and polygenic), we propose a readjustment of criteria for screening and diagnosis of FH in France notably based on a combined biochemical and molecular score. Since 2015, 3736 index cases with “possible FH” (DLCNC) were analysed by NGS (LDLR, PCSK9, ApoB and ApoE genes) as well as for 12 SNPs combined in a polygenic score (GS12). We further selected 2743 subjects over 18 years old with uLDL-c above 190 mg/dL in order to analyse the prevalence of monogenic FH by deciles of uLDL-C as well as GS12 distribution. In our study group of 2743 subjects, 1222 cases (so-called “mutated”) had a mutation (null or missense), 158 had a variant of unknown significance and 1363 (so-called “non-mutated”) had no molecular defect. In this cohort of severe hypercholesterolemia, mutated patients represented only 17% of subjects within the lower uLDL-c decile (LDLc < 206 mg/dL), whereas they accounted for 88% of the upper decile (LDLc > 365 mg/dL). The uLDL-c cut-off associated with a significantly higher prevalence of monogenic FH was 293 mg/dL, corresponding to the 8th uLDL-c decile (71% of mutated subjects). When we analysed GS12 distribution, we observed a higher prevalence of non-mutated (polygenic) subjects starting from 52% in the 6th GS12-decile and increasing progressively up to the 68% in the higher GS12-decile. Combining uLDL-c and GS12 in a single biochemical and molecular score leads to a higher discrimination power (AUC 0.812) compared to the separate uLDL-c and GS12 scores. A high likelikood of monogenic FH is observed starting from uLDL-c of 290 mg/dL. These findings highlight the importance of family history of hypercholesterolemia (rather than ASCVD) in the screening of FH. The improvement of FH diagnosis by this combined score should allow to better define the CV risk and therapeutic management, once validated in replication cohorts.

Background and Aims : Children with heterozygous familial hypercholesterolemia (HeFH) are undertreated despite international guidelines advocating for early statin initiation during childhood; dramatically increasing their risk of premature atherosclerotic cardiovascular disease (ASCVD).The objective of the study was to identify childhood and parental factors associated with statin early initiation in HeFH children to promote early treatment.Methods: Design, Setting and Participants: National register-based (REFERCHOL) multicenter, retrospective and prospective cohort study. We selected HeFH children aged 8-18 years and their FH parents, followed between 2014 and 2020. Demographic and clinical characteristics at last visit to the lipid clinic were collected. Vascular damage in parents was defined as a history of ASCVD, and/or a coronary artery calcium score above 100, and/or at least one carotid stenosis (>50%). Main outcome: Statin initiation in HeFH children.Results: We included 245 child-parent pairs. The children age was 14±3 years, and only 135 (58%) were under statin treatment. In multivariate analysis, the predictive childhood factors associated with being treated by a statin were: genetic diagnosis (OR=2.5, 95%CI [1.3; 4.9], p=0.01), older age (OR=4.4, 95%CI [1.8; 10.6], p=0.01), and longer follow-up duration (OR=1.3, 95%CI [1.1; 1.6], p<0.001); whereas the predictive parental factor associated with child treatment was the presence of vascular damage (OR=2.4, 95%CI [1.0; 5.7], p=0.04).Conclusions: A positive genetic diagnosis during childhood and vascular damage in parents were independently associated with statin treatment in HeFH children. Genetic diagnosis seems an important tool for cardiovascular prevention in these future adults. Background and Aims : Children with heterozygous familial hypercholesterolemia (HeFH) are undertreated despite international guidelines advocating for early statin initiation during childhood; dramatically increasing their risk of premature atherosclerotic cardiovascular disease (ASCVD).The objective of the study was to identify childhood and parental factors associated with statin early initiation in HeFH children to promote early treatment. Methods: Design, Setting and Participants: National register-based (REFERCHOL) multicenter, retrospective and prospective cohort study. We selected HeFH children aged 8-18 years and their FH parents, followed between 2014 and 2020. Demographic and clinical characteristics at last visit to the lipid clinic were collected. Vascular damage in parents was defined as a history of ASCVD, and/or a coronary artery calcium score above 100, and/or at least one carotid stenosis (>50%). Main outcome: Statin initiation in HeFH children. Results: We included 245 child-parent pairs. The children age was 14±3 years, and only 135 (58%) were under statin treatment. In multivariate analysis, the predictive childhood factors associated with being treated by a statin were: genetic diagnosis (OR=2.5, 95%CI [1.3; 4.9], p=0.01), older age (OR=4.4, 95%CI [1.8; 10.6], p=0.01), and longer follow-up duration (OR=1.3, 95%CI [1.1; 1.6], p<0.001); whereas the predictive parental factor associated with child treatment was the presence of vascular damage (OR=2.4, 95%CI [1.0; 5.7], p=0.04). Conclusions: A positive genetic diagnosis during childhood and vascular damage in parents were independently associated with statin treatment in HeFH children. Genetic diagnosis seems an important tool for cardiovascular prevention in these future adults.

Objective: Euroaspire surveys highlighted the insufficiency of control of cardiovascular risk factor (CVRF) in coronary patient in secondary prevention. Patient profiles have changed, making it difficult to analyse these data over time. Our aim was to establish the state of CVRF control in two cohorts of French hypertensive patients in different clinical situations of primary and secondary prevention by following the variables assessed in Euroaspire. Design and method: Of each of the 22 participating hypertension specialist consultations, the first 20 patients (followed for at least one year) were included. Theoretical objectives were notified for each patient according to clinical profile. Two cohorts were formed, Cohort 1 (C1) in 2009 (n = 185) and Cohort 2 (C2) in 2019 (n = 260). Patients were classified according to their prevention (P) profile: primary (P1) and secondary (P2). Results: Baseline data are summarized in Table 1. The main statistically significant results between C2 vs C1 respectively are: younger people (58.8 vs 63.9 y) and more women in P1 (50% vs 32%); higher systolic blood pressure (BP) in P2 (143.7 vs 134.7 mm Hg), whereas higher diastolic BP in P1 (81.7 vs 76.6 mm Hg); fewer diabetic patients in P1 (19% vs 41%); poorly BP targets met in P1 (43% vs 63%); lower number of antihypertensive drugs in both groups (P1: 2.17 vs 2.66; P2: 2.62 vs 3.16); prescription of statins felt by half in P1 (30% vs 43%) within 10y. Conclusions: The high prevalence of unhealthy lifestyles, modifiable CVRF and inadequate use of drug therapies to achieve BP and lipid goals, are documented findings of the Euroaspire surveys in coronary patient, which we confirm in our hypertensive patients. Indeed, the P1 patient is less well managed than 10 years. In P2, there is no difference between the two cohorts, no improvement in BP control, possibly related with a reduction in the number of antihypertensive drugs. Ambition targets allocated for global prevention by combating the clinical inertia in titrating treatments must be a medical priority in clinical practice. Thanks to patients and Club des Jeunes Hypertensiologues.

BACKGROUND:Diet strongly influences cardiovascular risk. Dietary evaluation is a major issue in cardiovascular prevention, but few simple tools are available. Our team previously validated a short food frequency questionnaire; a new version of this questionnaire (Cardiovascular Dietary Questionnaire 2 [CDQ-2]) is easier to complete and more reliable. AIMS:To validate CDQ-2 in comparison with the original version, and to test its reproducibility. METHODS:CDQ-2 has 17 closed-ended questions; it provides a global dietary score that is a combination of specific scores for saturated, monounsaturated and omega-3 fatty acids, and fruit and vegetables. CDQ-2 was validated against the original version in two groups, who completed both questionnaires: 99 patients with cardiovascular risk factors and 50 healthy subjects. Reproducibility was assessed with 27 health professionals who completed the questionnaire twice, with a 1-month interval. RESULTS:The correlation coefficients of the scores between the two questionnaires ranged from 0.65 (monounsaturated fatty acids) to 0.93 (fruit and vegetables) (all P<0.001). The percentage of subjects classified in the same quartile by both questionnaires ranged from 56% (omega-3 fatty acids) to 78% (fruit and vegetables). The percentage of subjects classified in the same or adjacent quartile ranged from 91% to 99%. The intraclass correlation coefficients, which assessed reproducibility, ranged from 0.61 (fruit and vegetables) to 0.88 (saturated fatty acids) (P<0.001). CONCLUSIONS:This new version of the short dietary questionnaire shows good reproducibility and correlations with the original version; use and reliability are improved, which makes CDQ-2 a valuable tool for cardiovascular prevention.

Background Surgery is the treatment of choice for pheochromocytoma. However, this surgery carries a risk of hemodynamic instability (HDI). The aim of this study was to report complications associated with this procedure, to identify risk factors for HDI during surgery, and its impact on postoperative outcomes. Methods The charts of all patients who underwent adrenalectomy for pheochromocytoma in two academic centers between 2006 and 2020 were retrospectively reviewed. The primary outcome was HDI defined by a systolic blood pressure >160 mmHg or a mean blood pressure <60 mmHg intraoperatively. The secondary outcomes of interest were the total duration of HDI, the occurrence of intraoperative arrhythmia, perioperative cardiovascular events, and postoperative complications. Results 205 patients were included. HDI occurred intraoperatively in 155 patients (75.6%) but only 6 (3.2%) experienced arrhythmia. Thirty-eight postoperative complications were reported (18.6%) but only nine were >= 3 according to Clavien-Dindo (4.4%). There were 10 postoperative cardiovascular events (5.7%). Patients with intraoperative HDI had higher rates of postoperative complications (21.3% vs 10%; P = .07), major postoperative complications (5.8% vs 0%; P = .12) and cardiovascular events (6.5% vs 0%; P = .12). Factors associated with intraoperative HDI in univariate analysis were age (OR = 8.14; P = .006), high blood pressure preoperatively (OR = 2.16; P = .04), tumor size (OR = 15.83; P = .0001), and urinary normetanephrine level (OR = 9.33; P = .04). Discussion In multidisciplinary centers, the overall morbidity of adrenalectomy for pheochromocytoma is low. HDI during adrenalectomy for pheochromocytoma is highly prevalent but rarely associated with major cardiovascular events. There might be a link between HDI and postoperative cardiovascular events.

Le rénimome (ou tumeur de l’appareil juxta-glomérulaire) est une cause rare mais curable d’hypertension artérielle secondaire. Nous rapportons l’observation d’une femme de 18 ans hospitalisée pour un complément d’exploration devant une hypertension artérielle persistante avec hypokaliémie et hyperaldostéronisme secondaire. Une exploration tomodensitométrique et échographique avait été réalisée il y a 2 ans mais n’avait trouvé aucune explication à la symptomatologie. Au cours de l’hospitalisation, une IRM et un cathétérisme de veines rénale avec prélèvement in situ ont mis en évidence une lésion nodulaire du pôle inférieur du rein droit et des valeurs élevées de rénine au niveau de la branche inférieure de la veine rénale droite. Après résection chirurgicale, l’analyse anatomopathologique confirma le diagnostic de réninome et la tension artérielle de la patiente se normalisa.

La surrénalectomie est le traitement de référence en cas de diagnostic de phéochromocytome. Toutefois cette chirurgie est à risque, notamment de poussée d’hypertension artérielle (HTA) peropératoire. L’objectif de cette étude était de rapporter les complications de la surrénalectomie pour phéochromocytome et de rechercher les facteurs prédictifs de poussée d’HTA peropératoire. Tous les patients ayant eu une surrénalectomie pour phéochromocytome dans un centre entre 2006 et 2019 ont été inclus dans une étude rétrospective. Le protocole de préparation préopératoire incluait de l’Eupressyl IVSE. Le critère de jugement principal était la survenue de fluctuations hémodynamiques (FLUCTHEM) définies comme pression artérielle (PA) systolique > 160 mmHg ou diastolique < 60 mmHg pendant l’intervention. Les critères de jugement secondaires étaient la durée de FLUCTHEM durant l’intervention, la survenue d’un trouble du rythme peropératoire (DYSRYTHM), la survenue d’une complication cardiovasculaire périopératoire et les complications postopératoires classées selon Clavien. Soixante-quinze patients ont été inclus. Cinquante-huit patients ont présenté des FLUCTHEM (77,3 %) avec une médiane de 2 épisodes par patients d’une durée moyenne totale de 23 minutes. Trois patients ont présenté un DYSRYTHM peropératoire. Il y a eu 14 complications postopératoires (18,7 %), mais uniquement cinq Clavien 3 (6,7 %). Il y a eu cinq complications cardiovasculaires postopératoires : une embolie pulmonaire (1,3 %), deux syndromes coronariens aigus (2,7 %) et deux œdèmes aiguës du poumons (2,7 %). Ces patients avaient un nombre médian d’épisodes de FLUCTHEM plus important (3 vs 2 ; p = 0,11). Les seuls facteurs associés à la survenue de FLUCTHEM en analyse univariée était la taille de la lésion (OR = 1,03 ; p = 0,03), le taux de normétanéphrines urinaires (OR = 1,01 ; p = 0,03) et l’existence d’une HTA antérieure (OR = 4,41 ; p = 0,04) (Tableau 1). La survenue de FLUCTHEM durant la surrénalectomie pour phéochromocytome est fréquente mais ne s’accompagne que de rares complications en particulier cardiovasculaires. Toutefois, il pourrait exister un lien entre FLUCTHEM et complications cardiovasculaires postopératoires et les mesures permettant de limiter les FLUCTHEM paraissent donc d’intérêt.

Clinic-ambulatory blood pressure (BP) difference is influenced by patients- and device-related factors and inadequate clinic-BP measurement. We investigated whether nonadherence to antihypertensive medications may also influence this difference in a post hoc analysis of the DENERHTN trial (Renal Denervation for Hypertension). We pooled the data of 77 out of 106 evaluable patients with apparent resistant hypertension who received a standardized antihypertensive treatment and had both ambulatory BP and drug-screening results available at baseline after 1 month of standardized triple therapy and at 6 months on a median of 5 antihypertensive drugs. After drug assay samplings on study visits, patients took their antihypertensive treatment under supervision immediately after the start of the ambulatory BP recording, and supine clinic BP was measured 24 hours post-dosing; both allowed to calculate the clinic minus daytime ambulatory systolic BP (SBP) difference (clinic-SBP-day-SBP). A total of 29 (37.7%) were found nonadherent to medications at baseline and 38 (49.4%) at 6 months. At baseline, the mean clinic-SBP-day-SBP difference in the nonadherent group was 12.7 mmHg (95% CI, 7.8-17.7 mmHg, P<0.001). In contrast, clinic SBP was almost identical to day-SBP in the adherent group (clinic-SBP-day-SBP difference, 0.1 mmHg; 95% CI, -3.3 to 3.5 mmHg; P=0.947). Similar observations were made at 6 months. Using receiver operating characteristics curves, we found that a 6 mmHg cutoff of clinic-SBP-day-SBP difference had 67% sensitivity and 69% specificity to predict nonadherence to the triple therapy at baseline. In conclusion, a large clinic-SBP-day-SBP difference may help discriminating between adherence and nonadherence to treatment in patients with resistant hypertension. Clinical Trial Registration- URL: https://www.clinicaltrials.gov. Unique identifier: NCT01570777.

Objective: Several guidelines call for blood pressure (BP) measurement on a bare arm, which is not always easy. This systematic review aims to synthesize existing evidence concerning the effect of a sleeve on BP measurement. Methods: Pubmed and Embase were searched for cross-sectional studies comparing BP values measured on a bare arm, over a sleeve or below a rolled-up sleeve. A meta-analysis was conducted on available data. Results: Thirteen articles were selected from 720 references. All studies reported office BP values, 12 compared measurements on a bare arm and on a sleeve, and four also performed measurements below a rolled-up sleeve, with heterogeneous sleeve types and thicknesses. Most studies had a high risk of bias. Three studies showed a small overestimation of BP measured over a sleeve, but the remaining 10 studies did not find statistically significant differences between measurements. Meta-analysis showed a nonsignificant 0.59 mmHg [95% confidence interval (CI) −0.11 to +1.30; P = 0.10] overestimation of SBP measured over a sleeve when the thinnest sleeve was considered for studies that investigated various thicknesses, a nonsignificant 1.10 mmHg (95% CI −0.21 to +2.40; P = 0.10) overestimation of SBP when the thickest sleeve was considered, and a nonsignificant 2.76 mmHg (95% CI −0.96 to +6.47; P = 0.15) overestimation of SBP measured below a rolled-up sleeve. Conclusion: Measuring BP over a thick sleeve in the office may result in a small overestimation of recorded values but measuring over a thin sleeve does not appear to have a significant impact and, in any case, should be preferred to rolling it up.

Objective: Attended clinic SBP (cSBP) is usually higher than daytime ambulatory SBP in patients with resistant hypertension (RHTN), and the cSBP-dASBP difference is influenced by various factors. We investigated whether this difference was influenced by non-adherence to antihypertensive treatments (AHT) in a post-hoc analysis of the French Renal Denervation for Resistant Hypertension (DENERHTN) trial. Design and method: 86/106 patients with RHTN to 4 weeks of indapamide 1.5 mg/d, ramipril 10 mg/d (or irbesartan 300 mg/d), and amlodipine 10 mg/d confirmed by ABPM were included in this post-hoc study. Non-adherence was defined as the absence of at least one AHT by drug screening (LCMSMS and AcSDKP) in urine/plasma samples collected before ingestion of any AHT, ABP or cBP measurements. After the start of ABPM, patients were given their AHT and were asked to return to the study center the next morning without having taken their treatment to undergo cBP measurements. Results: 32/86 patients (37.2 %) were non-adherent to the triple therapy after 4 weeks. cSBP (171 ± 26 mmHg) was significantly greater than dASBP (158 ± 20 mmHg) in the non-adherent group (p < 0.0001) with a median cSBP-dASBP difference of 8.7 mmHg (IQR:3.5;22.3). In contrast, cSBP (150 ± 16 mmHg) did not significantly differ with dASBP (149 ± 13 mmHg) in the adherent group, with a median cSBP-dASBP difference of 1.5 mmHg (IQR:−7.0;9.0). The Bland–Altman plots showed a significant bias between cSBP and dASBP in the non-adherent group only. In univariate analysis, greater age, non-adherence to AHT and African origin were significant determinants of the cSBP-dASBP difference whereas BMI, gender, plasma creatinine were not. In the multivariate analysis, only age and non-adherence to AHT remained significantly related to the cSBP-dASBP difference. Conclusions : Non-adherence to AHT impacts greatly the cSBP-dASBP difference in patients with RHTN.

Background The DENERHTN (Renal Denervation for Hypertension) trial confirmed the efficacy of renal denervation (RDN) in lowering daytime ambulatory systolic blood pressure when added to standardized stepped‐care antihypertensive treatment (SSAHT) for resistant hypertension at 6 months. Methods and Results This post hoc exploratory analysis assessed the impact of abdominal aortic calcifications (AAC) on the hemodynamic and renal response to RDN at 6 months. In total, 106 patients with resistant hypertension were randomly assigned to RDN plus SSAHT or to the same SSAHT alone (control group). Total AAC volume was measured, with semiautomatic software and blind to randomization, from the aortic hiatus to the iliac bifurcation using the prerandomization noncontrast abdominal computed tomography scans of 90 patients. Measurements were expressed as tertiles. The baseline‐adjusted difference in the change in daytime ambulatory systolic blood pressure from baseline to 6 months between the RDN and control groups was −10.1 mm Hg ( P =0.0462) in the lowest tertile and −2.5 mm Hg ( P =0.4987) in the 2 highest tertiles of AAC volume. Estimated glomerular filtration rate remained stable at 6 months for the patients in the lowest tertile of AAC volume who underwent RDN (+2.5 mL/min per 1.73 m 2 ) but decreased in the control group (−8.0 mL/min per 1.73 m 2 , P =0.0148). In the 2 highest tertiles of AAC volume, estimated glomerular filtration rate decreased similarly in the RDN and control groups ( P =0.2640). Conclusions RDN plus SSAHT resulted in a larger decrease in daytime ambulatory systolic blood pressure than SSAHT alone in patients with a lower AAC burden than in those with a higher AAC burden. This larger decrease in daytime ambulatory systolic blood pressure was not associated with a decrease in estimated glomerular filtration rate. Clinical Trial Registration URL: http://www.clinicaltrials.gov . Unique identifier: NCT01570777.

The DENERHTN trial (Renal Denervation for Hypertension) confirmed the blood pressure (BP) lowering efficacy of renal denervation added to a standardized stepped-care antihypertensive treatment for resistant hypertension at 6 months. We report here the effect of denervation on 24-hour BP and its variability and look for parameters that predicted the BP response. Patients with resistant hypertension were randomly assigned to denervation plus stepped-care treatment or treatment alone (control). Average and standard deviation of 24-hour, daytime, and nighttime BP and the smoothness index were calculated on recordings performed at randomization and 6 months. Responders were defined as a 6-month 24-hour systolic BP reduction ≥20 mm Hg. Analyses were performed on the per-protocol population. The significantly greater BP reduction in the denervation group was associated with a higher smoothness index (P=0.02). Variability of 24-hour, daytime, and nighttime BP did not change significantly from baseline to 6 months in both groups. The number of responders was greater in the denervation (20/44, 44.5%) than in the control group (11/53, 20.8%; P=0.01). In the discriminant analysis, baseline average nighttime systolic BP and standard deviation were significant predictors of the systolic BP response in the denervation group only, allowing adequate responder classification of 70% of the patients. Our results show that denervation lowers ambulatory BP homogeneously over 24 hours in patients with resistant hypertension and suggest that nighttime systolic BP and variability are predictors of the BP response to denervation.CLINICAL TRIAL REGISTRATION:URL: https://www.clinicaltrials.gov. Unique identifier: NCT01570777.

Blood pressure (BP) measurement is a central element in clinical practice. According to international recommendations 3 to 5 minutes of resting is needed before blood pressure measurement. Surprisingly, no study has modelled the time course of BP decrease and the minimum resting-time before BP measurement. A cross-sectional bicentric observational study was performed including outpatients addressed for vascular examination. Using two automatic BP monitors we recorded the blood pressure every minute during 11 consecutive minutes. The data was analyzed by non-linear mixed effect regression. Systolic (SBP) and diastolic BPs were studied and we tested the effect of covariates on its evolution through log-likelihood ratio tests. We included 199 patients (66+/−13years old). SBP was found to decrease exponentially. Simulations based on the final model show that only half the population reaches a stabilized SBP (defined as SBP + 5 mmHg) after 5 min of resting-time while it takes 25 min to ensure 90% of the population has a stabilized SBP. In conclusion, our results and simulations suggest that 5 minutes are not enough to achieve a stabilized SBP in most patients and at least 25 minutes are required. This questions whether the diagnosis of hypertension can be reliably made during routine visits in general practitioners’ offices.

Objective: Refractory hypertension (RHT) is a major health care concern affecting 20 to 30% of hypertensive patients and increasing cardiovascular risk. Recent renal denervation trials suggest a high prevalence of accessory renal arteries (ARA) in RHT. Previous publications report a putative role of ARA in triggering hypertension through renin secretion in underperfused renal segments. Our objective was to compare the prevalence of ARA in RHT vs non-refractory hypertension (NRHT). Design and method: 86 essential hypertensive patients who benefited from an abdominal CT-scan or MRI during their initial work-up were retrospectively recruited in 6 french hypertension centers. At the end of a minimal 6 months of follow up, patients were classified between RHT or NRHT. RHT was defined as blood pressure that remains above goal in spite of 3 antihypertensive agents at optimal dose including a diuretic, or controlled by more than 3 medications (Calhoun, 2008). Other patients were classified as NRHT. Blinded independant central review of all radiologic renal artery charts was performed. Results: Baseline characteristics were: age 50 ± 15 years, 62% males, BP 145 ± 23 / 87 ± 13 mmHg. 53 (62%) patients had RHT and 25 (29%) had at least one ARA. Prevalence of ARA was comparable between RHT (25%) and NRHT patients (33%, p = 0,62), but there were significantly more ARA per patient in NRHT (2 ± 0,9) vs RHT (1,3 ± 0,5, p = 0,03). ARA were similar in diameter or length between the 2 groups. Patients with ARA had a significative increase in renin plasma levels at baseline (51,6 ± 49,3 mUI/l) versus patients without ARA (20,3 ± 25,1 mUI/l, p = 9x10-3), but this did not translate into a worse blood pressure control or a raise in medication number, especially in renin angiotensin system inhibitors at the end of follow up. Conclusions: In this retrospective series of 86 essential hypertensive patients, we found no difference in the prevalence of ARA in RHT and NRHT, but NRHT patients had significantly more ARA per patients than RHT patients. This study confirms elevated renin plasma levels at baseline in hypertensive patients with ARA, but limits its clinical relevance in terms of blood pressure control.

Objective: Telemedicine refers to the use of medical information exchanged from one site to another via electronic communication and the role in the management arterial hypertension should strive against uncontrolled patients. Nowadays, patients easily e-transfer their results of home blood pressure measurement (HBPM) and practitioners receive and assess these HBPM results. Young generations, grown with the Internet, have been labelled “digital natives” (born after 1985) in comparison with older generations, labelled “digital immigrants”, who need to learn e-technology. Thus, we aimed to collect data on technical equipment of physicians and patients, on their expectations of use about this way of relationship. Design and method: 116 physicians, hypertension specialists (36 ± 9 y, 50.8% men), mostly hospital practitioners (84.5%) and 322 hypertensive outpatients (61 ± 14.6 y, 60.4% men, SBP/DBP average 143 ± 19/82 ± 13 mmHg, 31.8% with diabetes) completed a self-administered questionnaire. Results: The prevalence of technical equipment in both groups is summarized in Table 1.68.2% of patients had an HBPM device (51.6% upper arm). From the 69/98 diabetic’ patients used a blood glucose meter. 41% of patients vs 66% of physicians believed that telemedicine could improve the control of hypertension; 25% of patients vs 22% physicians thought that consultations’ frequency could be lightened. 18% of physicians thought that HBPM would fight inertia. 75% of patients vs 84% of physicians would agree for HBPM data being transferred to a non- medical staff. Whilst 89.5% of physicians were supporting the development of telemedicine in their daily practice, 99% of them found many “limits” to this method: budget (49%), difficulties in accessing informatics tools (38%), medical reluctance (35%), lack of legal frame (34%), confidentiality (33%), absence of direct benefit (21%). Conclusions: Although our population has no daily access to the telemedicine, today technical equipment is no longer an obstacle. The majority of patients and medical practitioners agree with e-transfer of HBPM data. However physicians highlight various obstacles to its expansion: financial limits, medical reluctance and lack of legal frame. Telemedicine might take off when the natives will outnumber immigrants. Meanwhile, physicians have a key-role to lead the patients in their e-education.

Objective: The DENERHTN trial confirmed the BP lowering efficacy of renal denervation (RDN) added to a standardised stepped-care antihypertensive treatment (SSAHT) for resistant hypertension (RH) at 6 months. There was large between-patient variability in the BP response to RDN and SSAHT. The presence of aortic abdominal calcification (AAC), which has been related to arterial stiffness, may impact BP response to both RDN and SSAHT. Design and method: Patients with confirmed RH to 4-week treatment with indapamide 1.5 mg/day, ramipril 10 mg/day (or irbesartan 300 mg/day), and amlodipine 10 mg/day on daytime ABPM (> = 135/85 mmHg) were randomly assigned to RDN+SSAHT, or the same SSAHT alone (control group). After randomisation, spironolactone 25 mg/day, bisoprolol 10 mg/day, prazosin 5 mg/day, and rilmenidine 1 mg/day were sequentially added from months 2 to 5, in both groups if home BP was > = 135/85 mmHg. AAC were delineated blind to the randomization with a semiautomatic segmentation software from the aortic hiatus to the iliac bifurcation on each pre-randomization abdominal CT angiogram. Results: Of the 106 randomised patients, 42/53 in the RDN group and 48/53 in the control group were analyzed because of missing endpoints (age: 54.6+/-10.6 years, males: 61.1%, type 2 diabetes: 22.2%, daytime ambulatory BP: 154/93 mmHg). 78.9% of patients had AAC. Median (IQR) AAC volume was 451 (34–2225) mm3 in all patients. Increasing tertiles of AAC were significantly associated with increasing age, male sex, Caucasian ethnicity, smoking, diabetes, hypercholesterolemia, prior cardiovascular events and obstructive sleep apnea (Table). Higher AAC was associated higher levels of ambulatory and central pulse pressure and pulse wave velocity at baseline. However, at 6-month follow-up, the change in daytime ambulatory SBP/DBP and number of controlled patients did not significantly differ according to tertiles of AAC. Figure. No caption available. Conclusions: In these highly selected patients with RH, AAC were associated with arterial stiffness and cardiovascular risk factors. The presence AAC on CT-angiogram did not impact the BP response in patients treated with RDN+SSAHT or SSAHT alone.

L’HTA réfractaire (HTAR) constitue un véritable enjeu de santé publique du fait de sa fréquence élevée et du sur-risque cardiovasculaire associé. Les protocoles de dénervation rénale ont récemment suggéré une forte prévalence des artères rénales accessoires (ARA) dépistées par angio-TDM chez les sujets présentant une HTAR, mais aucune étude à ce jour n’a comparé la fréquence des ARA dans une population de patients HTAR et non réfractaires (HTANR). Soixante-sept patients hypertendus essentiels ayant bénéficié d’un angio-TDM ou d’une angio-IRM des artères rénales dans le bilan initial de leur HTA ont été inclus dans 4 centres spécialisés en HTA. Au terme d’un suivi rétrospectif minimum de 6 mois, ils ont été classés en HTANR ou HTAR, celle-ci étant définie comme une HTA non contrôlée sous trithérapie anti-hypertensive à dose maximale tolérée dont un diurétique ou contrôlée sous ≥ 4 médicaments anti-hypertenseurs (Calhoun, 2012). Une lecture centralisée des imageries artérielles rénales était réalisée en aveugle à la recherche d’ARA ou d’autres variantes anatomiques des artères rénales. Les principales caractéristiques à la dernière consultation de suivi étaient (moy ± ET) : âge 50,6 ± 13,9 ans, 41 hommes (64 %), IMC 29,2 ± 5,9 kg/m2, PA clinique 148 ± 24/88 ± 12 mmHg, nombre de traitements anti-hypertenseurs : 2,3 ± 1,7. Quarante et un patients (61 %) présentaient une HTAR, et 23 patients (34 %) au moins une ARA. Il n’y avait pas d’association significative entre HTAR et la présence d’au moins une ARA (HTAR : 37 % ; HTANR : 31 %, p = 0,62), mais il y avait significativement plus d’ARA par patient dans le groupe HTANR (2 ± 0,9) par rapport au groupe HTAR (1,4 ± 0,5) (p = 0,05). Il n’était pas noté de différence de longueur ou de diamètre des ARA entre les 2 groupes. Les patients HTA présentant au moins une ARA avaient un contrôle tensionnel similaire à celui des patients sans ARA, mais présentaient une fréquence plus faible de protéinurie (9 % vs 41 %, p = 0,05). Les ARA étaient plus fréquemment situées sur le rein gauche (83 % vs 52 % des patients avec ARA, p = 0,02). Cette première série décrivant les variantes anatomiques des artères rénales dans une population ciblée de patients HTA ne montre pas d’association significative entre le caractère réfractaire de l’HTA et la présence d’au moins une ARA. Des arguments indirects pourraient à l’inverse suggérer une meilleure perfusion rénale chez les patients porteurs d’ARA.