S. Le Jeune

[PP.08.06] IS THE DEVELOPMENT OF TELEMEDICINE IN HYPERTENSION A DIGITAL IMMIGRANT ISSUE ?

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 (36u200a±u200a9 y, 50.8% men), mostly hospital practitioners (84.5%) and 322 hypertensive outpatients (61u200a±u200a14.6 y, 60.4% men, SBP/DBP average 143u200a±u200a19/82u200a±u200a13u200ammHg, 31.8% with diabetes) completed a self-administered questionnaire. Results: The prevalence of technical equipment in both groups is summarized in Table 1. Figure. No caption available. 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.

[PP.09.02] ACCESSORY RENAL ARTERIES IN RESISTANT HYPERTENSION

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 50u200a±u200a15 years, 62% males, BP 145u200a±u200a23u200a/ 87u200a±u200a13 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%, pu200a=u200a0,62), but there were significantly more ARA per patient in NRHT (2u200a±u200a0,9) vs RHT (1,3u200a±u200a0,5, pu200a=u200a0,03). ARA were similar in diameter or length between the 2 groups. Patients with ARA had a significative increase in renin plasma levels at baseline (51,6u200a±u200a49,3u200amUI/l) versus patients without ARA (20,3u200a±u200a25,1u200amUI/l, pu200a=u200a9x10-3), 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.

EVALUATION OF VASCULAR AGE AND ITS CONTRIBUTORS IN THE GENERAL POPULATION: PP.19.238

Background: A sex-specific multivariable risk factor algorithm has been recently proposed to assess general CVD risk and risk of individual CVD events in primary care (Dagostino et al. Circulation. 2008;117:743).To facilitate easier understanding of the concept of risk, the authors also constructed “vascular age” sheets. An individuals vascular age is calculated as the age of a person with the same predicted risk but with all other risk factor levels in normal ranges. The aim of this study was to calculate the vascular age of a large sample of consecutive subjects attending a free health check-up. Patients and Methods: Between january 2008 and june 2009, 11351 subjects (5823 males) aged 30 to 75 years were investigated at the health center of the social security of Bobigny, France. All clinical and biological parameters were evaluated on the same day of the examination by trained investigators. Results: Active smoking was present in 28% of men and in 13% of women. Mean vascular age is presented by comparison with real age, by sex in the following table. In this cohort, a difference ranging from 7 to 10 years was demonstrated between vascular age and real age for males>40 yo and for women>50 yo. Before the age of 50 yo, active smoking is the main contributor to the excess in vascular age, whereas high blood pressure becomes the major contributor in vascular aging after 50 yo. Conclusion: Vascular age calculation is easily feasible in a primary care setting. It provides an understandable parameter of CV risk for the general population. Identifying the respective weight of each risk factor for different age/sex groups could provide a useful tool to target in specific populations the most efficient public health actions in terms of cardiovascular prevention. Figure 1. No caption available.