In comparison with radiological procedures, TEE had limited accuracy for detecting pulmonary embolism with acute cor pulmonale. When the pulmonary embolism was located in the main or right pulmonary artery, TEE could clarify the diagnosis within a few minutes without further invasive diagnostic procedures. However, a negative TEE did not exclude left proximal or lobar pulmonary embolism.

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Objective:Blood pressure control in France leaves room for improvement. Analysis of the data from the 2015 ESTEBAN study found treatment to be insufficient, with disproportionate use of monotherapies. The 2016 French National Authority for Health (HAS) guidelines emphasise the importance of logical treatment titration giving preference in primary prevention to a triple therapy combining a renin-angiotensin system blocker, a thiazide diuretic and a dihydropyridine. The impact of these guidelines on the prescription of triple therapies has not been studied in France.Design and method:Data from the IQVIA Longitudinal Patient Database (LPD) France were used. LPD France is a permanent observatory to which a nationally representative panel of physicians – including general practitioners (GPs) (n = 1200) and community cardiologists (n = 100) – contribute anonymised electronic medical records (EMR). The analysis included all antihypertensive treatment prescriptions from July 2020 to June 2021, which were then extrapolated to the entire population of mainland France.Results:In 2021, a total of 2 455 065 patients had received a triple therapy. A figure that accounted for 17.4% of the patients seen by a GP (n = 2 016 689) and 19.0% of the hypertensive patients followed by a cardiologist (n = 438 376). The most common (>5%) triple therapy combinations are given in the table. The ‘standard’ triple therapy recommended by the guidelines accounted for only 24.7% of the prescriptions in general practice. The prescriptions made in the cardiology and general practice settings have more similarities than differences.Conclusions:These findings confirm not just the insufficient use of triple therapies, but also their misuse, with the overrepresentation of the beta-blockers class not always justified by preferential indications. These observations should call into question both the quality of the guidelines’ dissemination and the continuing education of the primary care practitioners for this disease.