Prognostic value of the extent of left ventricular hypertrophy and its evolution in the hypertensive patient.

Objective: Left ventricular hypertrophy (LVH) is a marker of cardiovascular risk. However, the progression of the risk as a function of the course of the LVH has only been the subject of few studies.

Methods: We report the consequences of the evolution of the left ventricular mass (LVM) in a cohort of hypertensive patients whose LVM was measured before any antihypertensive treatment.

Determination of central blood pressure by a noninvasive method (brachial BP and QKD interval).

Background: The measurement of central blood pressure (BPc) has become a matter of importance. Several therapeutic trials have noted a different protective effect against cardiovascular complications with different antihypertensive strategies, but an identical decrease in brachial BP (BPb). A possible explanation lies in the different effects of the treatments on BPc.

ECG detection of left ventricular hypertrophy: the simpler, the better?

Objective: ECG is commonly employed to identify left ventricular hypertrophy (LVH) and a high risk of cardiovascular events (CVE) in hypertensive patients. However, the multiplicity of the existing criteria does not simplify interpretation of the data. We compared a number of common criteria in hypertensive patients by taking as references left ventricular mass (LVM) measured by echocardiography and prediction of incident CVE.

Atrioventricular conduction in the hypertensive patient: influence of aging, pulse pressure, and arterial stiffness.

Atrioventricular (AV) conduction time (PR interval) lengthens with age. Hypertension is often presented as an accelerated aging of the heart and arteries. The principal marker of arterial aging is an increase in arterial stiffness and pulse pressure.

Impact of malignant arterial hypertension on the heart.

Objectives: To assess the consequences of malignant hypertension and its evolution with antihypertensive treatment.

Background: Malignant hypertension can be considered as a model of the effects of very high blood pressure and renin-angiotensin levels on target organs. However, the consequences on the heart have been little studied.

Ambulatory or home measurement of blood pressure?

Ambulatory blood pressure monitoring (ABPM) and home blood pressure (HBPM) monitoring have been shown to be superior to conventional measurement of blood pressure in terms of reproducibility, relationship to the impact of high blood pressure on target organs, and the prediction of cardiovascular events. Nevertheless, these 2 techniques have yet to find their place in the diagnosis of hypertension and during evaluation of the efficacy of antihypertensive treatment. Although these 2 methods do not give identical results in approximately 20% of cases, their diagnostic performance and prognostic value are quite comparable.

Long-term decline in renal function is linked to initial pulse pressure in the essential hypertensive.

Objectives: In the absence of malignant hypertension, the mechanisms for the decline in renal function in hypertensive patients are not well known. Several recent studies, essentially cross-sectional, point to a role for an increase in arterial stiffness and its corollary, the increased pulse pressure (PP), in barotrauma of the renal glomerulus.

Methods: We examined relations between the PP measured on consultation or by 24-h ambulatory blood pressure monitoring and the long-term decline in renal function in a population of essential hypertensive patients initially untreated, with normal renal function and without proteinuria.

Long-term influence of antihypertensive treatment on arterial stiffness assessed by ambulatory measurement of the QKD interval.

An increase in arterial stiffness is an important risk factor for cardiovascular events. However, there are few data on the long-term evolution of arterial stiffness in treated hypertensives. We evaluated the progression of arterial stiffness in 120 initially untreated hypertensive patients whose arterial stiffness was assessed by the ambulatory monitoring of the QKD interval measured at baseline and then more than 1 year later.

Can ambulatory blood-pressure monitoring provide reliable indices of arterial stiffness?

Background: The use of ambulatory recordings of blood pressure (BP) was proposed to estimate arterial stiffness (AS). We compared the relative value of the ambulatory AS index (AASI), and of the slope of pulse pressure (PP) according to mean BP (MBP) obtained from 24-h ambulatory BP monitoring, to the monitoring of the arrival time of Korotkoff sounds (QKD interval) in the prediction of cardiovascular (CV) events.

Methods: Twenty-four-hour ambulatory BP and QKD monitoring were recorded at baseline, before antihypertensive treatment of hypertensive patients in our Bordeaux cohort.

Acoustic videodensitometric parameters correlate with abnormalities of left ventricular filling in hypertensive patients assessed via Doppler Tissue Imaging.

Purpose: Using a videodensitometric technique developed in our center we investigated whether the amplitude of variation of gray levels in the interventricular septum was related to functional parameters, especially ventricular filling as studied by doppler tissue imaging (DTI) in hypertensive patients.

Methods And Results: We included 35 hypertensive patients from whom we recorded a two dimensional sequence of the left ventricle from the short axis parasternal view and a doppler tissue scan of the mitral ring. Two-dimensional sections were then analyzed with Iodp software to measure variations in levels of gray in the septum.