[Pneumo-Quest: A standardised self-questionnaire to be completed at home before a first appointment at a respiratory clinic]

The Pneumo-Quest self-questionnaire was developed to standardize the practice of recollection when welcoming a new patient. It consists of 82 main questions and 34 subsidiary questions to be completed at home by the patients before their first visit to a pulmonologist. This evaluation was carried out on the basis of 137 returned questionnaires. The feasibility (main criterion) was good with 93±5% of the questions answered and an average completion time of 15.1±9.8minutes (mean±SD). The reliability of the responses (secondary criterion) was good with the agreement between the patient's response and the doctor's opinion being excellent or good for the majority of medical histories and treatments, as evidenced by the high values of the kappa coefficient (>0.90; <0.90; <0.75). Patient and physician perception of the questionnaire was good with 99% and 90% positive ratings, respectively. The use of the questionnaire was unhelpful in the course of the consultation in only 2% of cases. Doctors found the tool useful for obtaining a comprehensive history in 87% of cases and patients declared that it helped them "forgot nothing" in 93% of the cases. The questionnaire helped the doctor to identify the patient's problems rapidly in 71% of cases and saved time in 64%. These positive results encourage a wide dissemination of the questionnaire (www.pneumo-quest.com).

[Assessment of antihypertensive monotherapies effectiveness by home blood pressure self-measurement in hypertensive patients]

OBJECTIVE

To evaluate the blood pressure (BP) control and the efficacy of antihypertensive monotherapy using home BP self-measurement in a French population of treated hypertensive subjects in 2007 2009 and 2010.

METHODS

The French League Against Hypertension Surveys (FLAHS) are conducted among a representative sample of individuals aged 35 years and older living in France. For the 2007, 2009 and 2010 surveys, a sample of 1467 subjects who owned a BP self-measurement device and performed three consecutive morning BP measurements were included. Among the 60% of subjects who reported taking at least one antihypertensive drug, we analyzed subjects treated with one of the following antihypertensive monotherapy, i.e., beta-blocker (BB), ACE inhibitors, calcium channel blocker (CCB) and angiotensin receptor blockers (ARB).

RESULTS

Among treated hypertensive subjects (n=886), 66% (n=586) had home BP below the 140/90mmHg threshold and 50% (n=449) below 135/85mmHg. Three hundred two subjects were treated with a single antihypertensive drug, 33% had ARB, 25% BB, 19% CCB and 13% ACE inhibitors. Age (years) for each treatment group is different (P<0.01) CCB (72.1±9.3), BB (65.6±9.8), ARB (68.6±8.9) and ACEI (67.3±10.2). The mean systolic/diastolic BP (mmHg) is not comparable between monotherapy 130.7/76.1 (ARB), 130.7/78.7 (BB), 134.0/75.2 (CCB) and 139.1/80.3 (ACEI) for ARB, BB, CCB and ACE inhibitors respectively. Compared to ACE inhibitors, BP was significantly lower with ARB (P<0.01). The proportion of subjects with a BP below 140/90mmHg was 73% for ARB, 52% for BB, 68% for CCB and 47% for ACE with a statistical significance (P=0.03) for ARB vs. ACEI and CCB vs. ACEI.

CONCLUSION

Among subjects treated for hypertension who owned a BP self-measurement device, 50 to 66% had a controlled BP (depending on the threshold used). It is observed differences between antihypertensive efficacy of monotherapy with a larger number of patients controlled with ARB or CCB.

[Use of antihypertensive drugs in France and relationship with cardiovascular disease. FLAHS 2009-2010 surveys]

OBJECTIVE

Describe how antihypertensive drugs are prescribed in France in 2009 and 2010 and assess the effect of the presence of cardiovascular disease on the characteristics of the treatment.

METHODS

The French League Against Hypertension Surveys (FLAHS) are conducted among a representative sample of individuals aged 35 years and older living in France. For the 2009 and 2010 surveys, a sample of 2292 subjects who declared to take one or more antihypertensive drug has been studied. In addition to the details of antihypertensive medications taken the day of the survey, the personal history for cardiovascular diseases was compiled.

RESULTS

Of the 2292 prescriptions with at least one antihypertensive prescription frequencies are: ARB (43%), diuretics (43%), beta-blockers (34%), CCB (26%), ACEI (26%), spironolactone (8%), central and alpha (7%), DRI (1%). The prescription is performed as monotherapy (42%), bitherapy (37%), triple therapy (16%) and quadruple or more (5%). When triple therapy is prescribed, there is an association ACEI or ARB or DRI+Diu+BB in 46%, and an association ACEI or ARB or DRI+Diu+AC in 30%. Cardiovascular disease is present or past reported by 24% of hypertensive patients: coronary artery disease (13%), heart failure (6%), arrhythmias (5%), stroke (4%), PAD (4%). The use of BB is more common in hypertensive patients who have coronary artery disease, heart failure and arrhythmia. ACE inhibitors are more common in hypertensive patients with coronary artery disease, heart failure or stroke. CCB are more frequent in cases of coronary artery disease or PAD. The ARB are less frequent in patients with coronary artery disease.

CONCLUSION

The ARB, diuretics and beta-blockers are the most prescribed antihypertensives in France in 2009 to 2010. Cardiovascular diseases declared in 24% of hypertensives led to a preferential prescription of an ACE inhibitor or BB.

[Number and use of home blood pressure devices in France in 2004 and 2006 (FLAHS 2006)]

OBJECTIVES

To estimate the number and the using modalities of devices for home blood pressure (HBP) measurements in the French population in 2006 and to evaluate the trend of these data over the past two Years.

METHODS

The French League Against Hypertension Surveys have been performed both in 2004 and 2006 (FLAHS-2006) by an independent company (TNS-SOFRES) within a representative sample of French population older than 35 and living in metropolitan France. The surveys involved 3707 and 3389 subjects, respectively. A questionnaire evaluating ownership, kind and using modalities of HBP device was given. Subjects who declared taking an antihypertensive medication were classified as treated hypertensive patients. The data from the INSEE census performed in1999 allowed for an estimate of the total number of HBP devices owned by French people.

RESULTS

In 2006, 19% of the French population above the age of 35 years owned a HBP device, a rate reaching 36% in treated hypertensives versus 11% in the rest of the population (p<0.001). In 2004, the ownership rates were 24% and 7%, respectively. It could be estimated that about 6 million HBP devices were owned by French people in 2006, meaning an increase of 2 million devices, as compared with 2004 survey. 53% of BP devices were equipped with an arm cuff in 2006, versus 33% only, in 2004. Device purchase has been made in 2006 either in a pharmacy (39%), or in a hypermarket (7%), or through the web (3%); they were given as a gift in 39%. Device use was indicated as regular by 30% of hypertensive patients and 23% of the rest of the people. Giving up was observed in 7% and 15%, respectively.

CONCLUSION

In 2006, about 6 million HBP devices are owned by French people; the rate of treated hypertensives owning a HBP device is 1/3. The huge increase in the number of HBP devices from 2004 to 2006 suggests that the recommendations of the French "Haute Autorité de Santé" as well as the national programs about HBP measurement have had a real impact on the use of this technique in France.

[Prevalence and mechanism of masked hypertension: the ol'mesures survey]

RATIONALE

Masked hypertension (MH) and uncontrolled hypertension (UCH) have both bad prognosis. The influence of measurement circumstances on MH prevalence and reproducibility are little known.

OBJECTIVE

To evaluate the prevalence and reproducibility of MH after excluding confusing factors [method and time of blood pressure (BP) measurement, antihypertensive treatment] by a standardization procedure.

METHODS

2189 hypertensive patients (61+/- 12 years, men 57%) having been treated in monotherapy by an angiotensin II receptor inhibitor for at least 8 weeks Were evaluated in a French multicenter prospective observational survey. Three BP successive office measurements were performed by the GPs during 2 visits (V) at similar times 13 +/- 9 days apart (BP: V1 149 +/- 19 / 85 +/- 11 mmHg, V2 145 +/- 19/83 +/- 11 mmHg) and home BP self-measurements (HBPM) were performed morning and evening for 3 consecutive days (HBPM morning + evening : n=18 +/- 1; 142 +/- 16/81 +/- 9 mmHg) and at the time of the visit (daytime HBPM: n=9 +/- 1; 140 +/- 16/80 +/- 10 mmHg) by the patients (Omron-705CP).

RESULTS

[table: see text].

CONCLUSION

the observed MH prevalence is similar to previous published studies and is independent of: treatment, BP measurement methods, measurements frequency and HBPM time but it depends on office BP values. Consequently, its reproducibility is directly dependent of the quality of office BP measurements.

[Use of home blood pressure devices in France in 2004]

OBJECTIVE

To estimate the number of devices for home blood pressure measurements in the French population in 2004 and to evaluate the use of these apparatus.

METHODS

The French League Against Hypertension Survey 2004 (FLAHS-2004) was performed cross-sectionally on 3707 subjects, part of a sample of 5476 subjects selected as being representative of the French metropolitan population for age (35 years and above), gender, socioeconomic status, and place of living. Subjects who declare to take an antihypertensive medication were classified as treated hypertensive patients. A questionnaire evaluating the condition of use of HBP device was given.

RESULTS

In 2004, 24% of the French population above the age of 35 years was treated for hypertension, corresponding to an estimate of 7.5 million of subjects. 25% of treated hypertensives and 12% of untreated subjects had a tensiometer. A total of 4 millions of BP devices are owned in the general population with 43% by treated hypertensive patients. 67% of BP devices are wrist cuff. Medical doctors recommended home blood pressure monitoring in only 12% of subjects.

CONCLUSION

In 2004, the number of subjects treated for hypertension is 1/4 of the general population over the age of 35 years in France. In this group of subjects, 1/4 possessed a tensiometer but in only 10% medical doctor recommended the use of home blood pressure monitoring.

[Changes in life style and drug therapy for treatment of hypertension in France between 2002 and 2004]

OBJECTIVES

To estimate changes in life style and drug therapy for treatment of hypertension in France between 2002 and 2004.

METHODS

The French League Against Hypertension Survey 2004 (FLAHS-2004) was performed cross-sectionally on 3 707 subjects, part of a sample of 5476 subjects selected as being representative of the French metropolitan population for age (35 years and above), gender, socioeconomic status, and place of living. Subjects who declare to take an antihypertensive medication were classified as treated hypertensive patients. A questionnaire evaluating changes in life style during the last year (physical activities, quality of food consumption, smoking, and alcohol habits) was auto-administered.

RESULTS

In 2004, 24% of the French population above the age of 35 years was treated for hypertension, corresponding to an estimate of 7.5 million of subjects. The two most frequent prescribed drugs are: fixed-dose combination drugs and beta-blockers in patients aged less than 75 years, and calcium antagonist and fixed-dose combination drugs in patients aged more than 75 years. Hypertensive subjects experienced: a weight loss of more than 3 kg in 11% vs 9%* in the general population, an increased in fruits and vegetables consumption in 41% vs 34%*, a decreased in cheese (21 vs 17%*), pork-butchery (46 vs 34%*) and alcohol consumption (23 vs 18%*) [*p < 0.01]. On the other hand, the percentage of subjects who increased their physical activities was low and not different in the two groups (7 vs 9%).

CONCLUSION

Changes in life style were more often applied by the subjects treated for hypertension that by the general population. The dominating place that occupies today fixed-dose combination drugs indicates a change of the therapeutic practices.

[The AIRE Study: data analysis of 753 European children with asthma]

PROBLEM

To analyse the paediatric data from the AIRE study (Asthma insights and reality in Europe) describing the standard of asthma control in Europe.

MATERIAL AND METHODS

Among the 73,880 households contacted by telephone in 7 countries 753 children under the age of 16 were identified. An interview was conducted with a close relative to determine the frequency and severity of symptoms during the recent month, visits to casualty and hospital admissions during the past year, the medications used, the effects on the lives of the children, the opinions of the parents on the level of control of asthma and the monitoring methods used.

RESULTS

38.2% of children reported diurnal symptoms and 28% disturbance of sleep at least once a week. The consequences were important: limitation of sporting activities (29.5%) and absence from school (42.7% in the past year). Treatment was inadequate: 26% of children used inhaled steroids yet 45.9% had persistent asthma. The level of control was overestimated: 61% of parents of children with severe persistent asthma considered the asthma to be well controlled.

CONCLUSION

European asthmatic children are poorly controlled, under-treated and rarely followed up. The consequences, particularly absence from school, should stimulate an improvement in their therapeutic and educational management.

[History of hypertension and of vascular risk: at the origins of change of contemporary medicine]

One hundred years ago arterial hypertension was not even mentioned in medical textbooks. In 1930 it was referred to as "a disease of civilisation". Today we know that it is largely responsible for cardiovascular deaths, the major cause of mortality in industrialized countries. Arterial hypertension is a singular disease entity. It is defined arbitrarily, it is closely linked to sociocultural factors and it has an enormous economic impact. Hypertension was recognized as a risk factor between the two World Wars. The driving force behind this recognition was financial rather than medical. The evolution of the understanding and management of hypertension reflects the profound changes that have affected twentieth century medicine. A Century of Arterial Hypertension reflects on the evolving concepts of hypertension over the past hunderd years and reveals an essential yet little-known facet of modern medicine. The originality, wealth of historical documents and bibliography will make this subject of interest not only to cardiologists and physicians in general, but to anyone who aspires to understand how modern medicine has achieved what it has.