Bernard Vaisse

Predictive factors for masked hypertension within a population of controlled hypertensives.

Context Prevalence of masked hypertension (MH) is far from negligible reaching 40% in some studies. The SHEAF study (Self measurement of blood pressure at Home in the Elderly: Assessment and Follow-Up) and others clearly showed that masked hypertension (MH) as detected by home blood pressure measurement (HBPM) is associated with poor cardiovascular prognosis. Objective Systematic HBPM to detect MH is not yet routine. The aim of this work is to better define the clinical profile of masked hypertensives within a population with controlled office blood pressure (BP) and the factors associated with a higher prevalence of MH. Materials and methods BP was measured at the clinic by the doctor and at home by the patient himself. Risk factors for MH were analysed in a cohort of 1150 treated hypertensive patients over the age of 60 (mean age 70 ± 6.5, 48.9% men) with controlled office BP. (SBP <140 mmHg and DBP <90 mmHg). Results 463 patients (40%) were masked hypertensives (SBP≥135 mmHg or DBP≥85 mmHg at home). Three parameters were associated with MH (odds ratio OR): office SBP (OR = 1.110), male gender (OR = 2.214) and age (OR = 1.031). Decision trees showed a 130 mmHg SBP was an efficient threshold to propose HBPM with a higher probability to detect MH. Subsequent variables were male gender and age over 70 in males. Conclusion To detect masked hypertension, it would be logical to first of all select patients whose office SBP is between 130 and 140 mmHg.

Comparison of angiotensin-converting enzyme inhibitors and calcium antagonists in the treatment of mild to moderate systemic hypertension, according to baseline ambulatory blood pressure level

This study was aimed at determining whether baseline ambulatory blood pressure (BP) levels influence the efficacy of angiotensin-converting enzyme inhibitors and calcium antagonists in the same manner. Accordingly, the ambulatory BP recordings of 236 mild to moderate hypertensive patients who had previously entered a clinical trial and had received either a calcium antagonist (n = 121) or an angiotensin-converting enzyme inhibitor (n = 115) were reviewed. The inclusion criterion was a clinic diastolic BP between 95 and 115 mm Hg at the end of the placebo period. Patients were classified according to the difference between their observed and predicted ambulatory BP (the latter assessed by regressing the observed ambulatory BP on the clinic BP). Reduction in ambulatory systolic and diastolic BP seemed to be greater (p less than 0.0001, p = 0.01) in patients receiving an angiotensin-converting enzyme inhibitor than in those who were given a calcium antagonist. However, analysis of variance showed (1) there was a significant interaction (F = 6.37 p = 0.01) between the pharmacologic class and the baseline systolic ambulatory BP; and (2) the difference in diastolic ambulatory BP reduction between both classes was no longer significant when adjusted for baseline diastolic ambulatory BP. In patients with higher than predicted ambulatory BP levels, angiotensin-converting enzyme inhibitors and calcium antagonists had roughly a similar effect (reduction in systolic BP, 9 +/- 8% vs 7 +/- 6%, p = not significant; reduction in diastolic BP, 11 +/- 8% vs 8 +/- 6%, p = not significant).(ABSTRACT TRUNCATED AT 250 WORDS)

A specific training on hypertension guidelines improves blood pressure control by more than 10% in hypertensive patients: the VALNORM study.

VALNORM was designed to assess the impact on blood pressure (BP) control of a specific training in new European Society of Hypertension-International Society of Hypertension (ESH-ISH) guidelines for hypertension management. It was an 8-week prospective, randomized, open, blinded end points design study. General practitioners (GPs) located in France were randomized in two groups: group 1 (G1) without training to the guidelines and free attitude for the prescription whereas group 2 (G2) received a specific training in ESH guidelines. The primary efficacy criteria was strict BP control at week 8 (systolic BP/diastolic BP [SBP/DBP] <140/90 mm Hg and/or SBP/DBP <130/80 mm Hg if diabetes or renal insufficiency). All physicians used the same treatment (valsartan 80 or 160 mg once daily alone or in fixed combination with hydrochlorothiazide 12.5 or 25 mg once daily). BP was measured in the GPs office with an electronic device. The groups GPs included 4,436 patients with essential uncontrolled hypertension (G1: 595 physicians, 2,308 patients; G2: 502 physicians, 2,128 patients). Patients main characteristics were: age = 61 +/- 13 years, 52% female, BP = 160 +/- 13/92 +/- 9 mm Hg. No difference was observed between the two groups. The primary efficacy criteria showed in G2: 47.8% of BP control vs. G1: 44.7%, P = .005. Subgroup analysis according to age, body mass index (BMI), previous diabetes, and antihypertensive treatment showed that higher efficacy in G2 was more significant in these high-risk subgroups: age >60 years (G1: n = 1,150, G2: n = 1,035), BMI >/=25 kg/m(2) (G1: n = 1540, G2: n = 1430), diabetes (G1: n = 267, G2: n = 290), no previous antihypertensive treatment (G1: n = 1,111, G2: n = 1,005). The percentage of patients with controlled BP in each subgroup was: diabetes: G1 11.2% vs. G2 17.9% (P = .001), age >60 years: G1 40.3% vs. G2 43.7% (P = .022), BMI >/=25 kg/m(2): G1 43.2% vs. G2 45% (P = .165), untreated: G1 48.2% vs. G2 52.4% (P = .005). Specific training on the guidelines showed a positive impact on BP control, highly significant in patients at high cardiovascular risk such as diabetic hypertensive patients.

USE OF THE EVALOBS® ADHERENCE SCALE IN AN UNSELECTED FRENCH POPULATION OF TREATED SUBJECTS WITH ANTIHYPERTENSIVE, STATINS OR ORAL ANTIDIABETICS MEDICATIONS: THE FLAHS 2017 STUDY

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®. Design and method: 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 scoreu200a>u200a12 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. EVALOB® 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. Conclusions: 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.

[OP.2B.02] DEVELOPMENT OF A RISK CALCULATOR FOR DRUG COMPLIANCE IN TREATED HYPERTENSIVES: THE FLAHS COMPLIANCE TEST

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. Design and method: 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 55 years 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 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 2 years in 7% of subjects and the median follow-up duration of treatment was 10 years. 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/ Conclusions: 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 Society of Hypertension in 2017.

[OP.7A.09] A NATIONWIDE EVALUATION OF BLOOD PRESSURE CONTROL IN FRANCE USING HOME BLOOD PRESSURE MONITORING: THE FRENCH LEAGUE AGAINST HYPERTENSION SURVEY (FLAHS 2015)

Objective: In 2010, FLAHS survey indicated a 50% control in treated hypertensive patients in France. In 2015, the goal was to make a new estimate of control of hypertension in subjects aged 55 and over living in metropolitan France. Design and method: FLAHS 2015 was performed cross-sectionally on 882 subjects, part of a sample of 6 379 subjects selected as being representative of the French metropolitan population for age (55 years and above), gender, socioeconomic status, and place of living. 2 814 subjects declared taking an antihypertensive medication and detailed the name of his treatment. 1724 subjects declared taking their blood pressure at home with an electronic monitor. 882 subjects treated with antihypertensive medication monitored their BP at home (3 measures in the morning and in the evening on 3 consecutives days). The average of 12 readings over 3 days led to classify each subject as controlled by the thresholds of SBP/DBPu200a<u200a135/85 or SBPu200a<u200a145 in elderly over 80 years. Results: In treated hypertension, 55.4% are controlled with an averageu200a<u200a135/85 and 71.7% with an averageu200a<u200a140/90. Age, gender and weight are determinants of the performance of the BP control. Control is better among women (60.3%) than in men (50.1%), in subjects aged 55–64 (57.6%) than those aged 80 and over (49.1 %), in subjects with BMIu200a<u200a25 (63%) than those with BMIu200a>u200a30 (54%). When the threshold control is adapted in patients aged 80 and over to a SBPu200a<u200a145 the proportion of controlled subjects came to this age group to 74.7% and control of hypertension for the entire population of elderly hypertensive patients treated and 55 years living in France is 61%. Conclusions: Control of hypertension evaluated by home blood pressure monitoring on a representative population of subjects aged 55 and over, living in France, is estimated between 50.1% and 74.7% in relation to age, gender and weight of subjects. These data indicate a mild improvement in blood pressure control in treated hypertensive patients since the FLAHS 2010 survey.

TRENDS IN ANTIHYPERTENSIVE PRESCRIBING IN THE FRENCH LEAGUE AGAINST HYPERTENSION SURVEY (FLAHS 2002 TO 2009): PP.20.312

Objective: To evaluate the use of antihypertensive treatments in France in 2009 and study trends in antihypertensive prescribing since 2002. Methods: French League Against Hypertension Survey 2009 (FLAHS) study was performed cross-sectionally on 3838 subjects, part of a sample of 4 500 subjects selected as being representative of the French metropolitan population for age (35 years and above), gender, socioeconomic status, and place of living. 1 025 subjects declared taking an antihypertensive medication and detailed the name of this treatment. The same methodology was used in 2002 and a comparison in prevalence was performed. Results: In 2009, 30% of the population (10.82 millions) was treated with at least one antihypertensive drug as compared to 24% in 2002 (8.19 millions). Table gives percentages for each pharmacological family and for fixed dose combination (FDC). Figure 1. No caption available. Hypertensives were treated with 1.4 ± 0.7 pills in 2002 and with 1.6 ± 0.9 in 2009. Only one pill was prescribed in 65%, 2 pills in 26% and 3 or more in 9%, however pharmacological monotherapy was prescribed in 47% in 2009 (55% in 2002). If a diuretic was given, it was given under FDC formulation in 58%. If an ARB was given, it was given under FDC in 50%. Conclusion: Changes in the use of antihypertensive medications were observed in France between 2002 and 2009. Recent trends indicated an increase in the prescription of Fixed Dose Combinations containing a diuretic and an ARB.

UPDATED PREVALENCE OF ARTERIAL HYPERTENSION AND VASCULAR RISK FACTORS IN FRANCE: RESULTS OF THE FLAHS 2009 SURVEY: PP.19.224

Objective: To evaluate the prevalence and distribution of cardiovascular risk factors (CRF) in France in 2009. Method: The French League Against Hypertension Survey (FLAHS 2009) was conducted by mail among a representative sample of 3838 individuals aged over 35, living in metropolitan France. Taking a drug treatment for a considered risk factor (arterial hypertension, diabetes, dyslipidemia) qualified the subject as having the disease. Waist circumference was measured and BMI was calculated. The base INSEE national census (late 2008) was used to calculate the number of patients from the observed frequencies by age and gender in the sample. Results: Within this population, 40% of subjects reported being treated for at least one of 3 CRF. 30.2% were treated for hypertension, 22% for dyslipidemia and 7% for diabetes. 12% of treated hypertensives were active smokers. Waist circumference (cm) (98.8 ± 15.3 vs. 90.7 ± 14.2) and BMI (kg / m2) (28.2 ± 5.3 vs. 25.2 ± 4.4) of hypertensive patients were significantly higher than the rest of the population and 30% of hypertensive were obese. 36% reported owning a self-measurement device. The percentage of hypertension was 5.6% for 35–44 years, 18.8% for 45–54 years, 40.7% for 55–64 years, 49.5% for 65–74 years and 57.5% for individuals over 75 years. When reported to the latest national census data, those percentages let us estimate the number of hypertensive patients treated in France for nearly 10 820 000 (10 819 444) (+320 000 vs 2007). Conclusion: These updated data emphasize the potential impact in terms of public health of hypertension and its management. If the percentage of patients with hypertension by age group remained stable compared to 2007, the aging population explains the increase in total number of treated hypertensive in France. Within this representative sample of French subjects older than 35 years, active smoking remained stable compared to 2007, despite the change in legislation that occurred in 2008.