Michel Burnier

Physiologic Control of the Circadian Variability in Blood Pressure

Blood pressure (BP) is a physiological parameter with high short term variability, but also a well-recognized circadian rhythm with a period length of about 24 h. The variability of BP is caused by many internal and external factors. In this review, we discuss the pathophysiology of the circadian variability of BP with a special emphasis on clock genes, on sleep disturbances and neuro-hormonal factors. We also emphasize the role of sodium and the importance of maintaining a sodium balance over 24h as a factor influencing the circadian rhythm of BP. The variability of BP is recognized today as a risk factor for the development of cardiovascular complications and maintaining a physiological circadian of BP, particularly during the night has become a target of hypertension management.

Qualitative Assessments of Adherence

The diagnosis of non-adherence to prescribed medications is a real challenge in clinical medicine. Besides objective methods such as measurements of drug concentrations in plasma or urine and electronic monitoring of adherence, several qualitative approaches are available, which are based on self-report medication adherence scales or specific questionnaires. In a recent systematic review, more than 43 adherence scales have been reported that have been used essentially in chronic diseases including essential hypertension. Although self-reports and questionnaires are considered to have a low reliability to detect a poor medication-taking process, they do provide additional information, which cannot be obtained with objective measures. Thus, adequately validated questionnaires can identify relevant barriers and beliefs to a good medication-taking behavior. Therefore, these approaches should be considered as complementary to the objective measures of adherence and should perhaps not be totally disregarded as they often are.

Determinants and Barriers to Adherence in Hypertension

Hypertension is a chronic disease which needs a lifelong treatment in mostly asympatomatic patients. During the life of a patient treated for essential hypertension, many obstacles may occur which impair his/her ability to stay on therapy. In this chapter, we will review the determinants and barriers to adherence in hypertension utilizing the WHO Multidimensional Adherence Model classification, showing in which phase of the adherence process they intervene. We will review how these barriers may complicate the therapeutic history of a hypertensive patient based on a clinical case.

Salz und kardiovaskuläres Risiko: Evidenz aus epidemiologische Studien

Die drei hauptsachlichen Moglichkeiten, den Salzkonsum in der Allgemeinbevolkerung abzuschatzen, sind Diatfragebogen, Untersuchung des Verhaltnisses Natrium/Kreatinin in einer Urinprobe sowie Sammeln von 24-Stunden-Urin.

Behandlung der therapierefraktären arteriellen Hypertonie durch renale Denervation

Bei der renalen Denervation handelt es sich um ein neues invasives therapeutisches Verfahren bei therapierefraktarer Hypertonie. Dieser Eingriff darf Patienten erst nach Ausschluss aller anderen, ublichen Ursachen fur Therapieresistenz angeboten werden.

Sel et risque cardiovasculaire: évidence des études épidémiologiques

Les trois facons principales d’estimer la consommation de sel dans la population generale sont le questionnaire alimentaire, le sport urinaire (rapport sodium/creatinine) ainsi que la recolte d’urine de 24 heures.