J. J. Mourad

Effect of a fixed combination of Perindopril and Amlodipine on blood pressure control in 6256 patients with not-at-goal hypertension: the AVANT'AGE study.

In clinical practice, general practitioners are likely to face hypertensives with uncontrolled blood pressure (BP), whose antihypertensive treatment need to be modified. In the present study, 710 general practitioners have each included the first 10 patients with not-at-goal hypertension, for whom they decided to modify their antihypertensive treatment with addition of a fixed combination of Perindopril and Amlodipine at either of its four dosages: 5/5, 5/10, 10/5, or 10/10 mg. In total, 6256 patients were included, with BP measured both at baseline and after 3 months. At the end of follow-up, a mean reduction of 20.3 ± 12.4 mm Hg in systolic BP and 11.3 ± 9.6 mm Hg in diastolic BP were observed, and 62.3% achieved successful BP control. Body mass index and waist circumference were significant determinants of both systolic and diastolic BP reductions (P ≤ .04). Moreover, in addition to baseline BP level, body mass index was the only significant determinant of BP control of systolic, diastolic BP, and of both (P ≤ .04). Addition of a fixed combination of Perindopril and Amlodipine to BP regimen was efficient, in terms of BP control, for 62.3% of those patients with not-at-goal hypertension. Furthermore, baseline BP level and obesity were important influential factors of BP control.

[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/DBP < 135/85 or SBP < 145 in elderly over 80 years. Results: In treated hypertension, 55.4% are controlled with an average < 135/85 and 71.7% with an average < 140/90. 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 BMI < 25 (63%) than those with BMI > 30 (54%). When the threshold control is adapted in patients aged 80 and over to a SBP < 145 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.

16 Reduction of radial artery mass after pharmacological treatment in older essential hypertensives

Objective To study the effect of antihypertensive treatment on arterial wall hypertrophy, at the site of a muscular artery, the radial artery. Design and methods: Eighty hypertensive patients (± 60 years of age) were randomized in a double-blind parallel study to receive either perindopril (2–8 mg) or hydrochlorothiazide (12.5–50 mg) for 9 months. The mass of a 1 cm-long radial artery segment (RAM) was calculated from internal diameter and wall thickness, measured non-invasively with a high-resolution echotracking device (Nius-2): RAM =r(pRe2-pRi2), where r is the arterial wall density (1.06g/cm3), and Re and Ri the values of internal and external radii, respectively. In a previous study, RAM was validated in vitro by comparing the weight of arterial segments to ultrasonic measurement: the repeatability coefficient (RC2=SDi2/n) was 1.3 mg. In vivo, intra-observer repeatability coefficients were 80 and 20 μm for arterial diameter and wall thickness measurements, respectively. An intermediate analysis was performed after 5 months on 25 patients (70±6 years). Results: Systolic/diastolic blood pressure decreased from 169±15/84±8 to 151±18/78±8mmHg (P<0.001); internal diameter did not change significantly from 2408±444 to 2418±352 μm; wall thickness decreased from 289±59 to 276±60 μm (P< 0.001); RAM decreased from 27±9 to 25±8mg (P< 0.001); circumferential stress did not change (63±15 to 62±12 kPa). Conclusion: These results indicate that the decrease in blood pressure in older hypertensive patients is accompanied by a reduction in the mass of a muscular medium-sized artery wall.