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Redondo-Rodríguez C, Villafaina S, Ramos-Fuentes MI, Fuentes-García JP. The psychological well-being index and quality of life after a cardiac rehabilitation program based on aerobic training and psychosocial support. Physiol Behav 2024; 280:114560. [PMID: 38631544 DOI: 10.1016/j.physbeh.2024.114560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 04/12/2024] [Accepted: 04/15/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND This study aimed to investigate the physical and psychological benefits of an alternative cardiac rehabilitation program based on therapeutic groups during physical exercise sessions and to compare the results with those of a conventional cardiac rehabilitation program. METHOD The sample included 112 patients from the cardiac rehabilitation unit of a medical center, 91.1 % of whom were male. The control group consisted of 47 subjects, with a mean age of 57.89 ± 12.30 and the experimental group consisted of 65 subjects, with a mean age of M = 58.38 ± 9.86. Quality of life, psychological well-being, health-related quality of life, body mass index, blood pressure, abdominal circumference and resting heart rate were measured before starting and at the end of the cardiac rehabilitation program. RESULTS The experimental group improved significantly more than the control group in body mass index, systolic and diastolic blood pressure, abdominal circumference, and resting heart rate (p value < 0.005). In addition, the experimental group had significantly greater improvements in quality of life, psychological well-being, and health-related quality of life than the control group (p-value < 0.001). CONCLUSIONS A cardiac rehabilitation program based on simultaneous aerobic training and psychosocial support improved the physical function, health-related quality of life and well-being.
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Affiliation(s)
| | - Santos Villafaina
- Faculty of Sport Science, University of Extremadura, Cáceres 10003, Spain
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2
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Brotons C, Camafort M, Castellanos MDM, Clarà A, Cortés O, Diaz Rodríguez Á, Elosua R, Gorostidi M, Hernández AM, Herranz M, Justo S, Lahoz C, Niño P, Pallarés-Carratalá V, Pedro-Botet J, Pérez Pérez A, Royo-Bordonada MÁ, Santamaría R, Tresserras R, Zamora A, Zuza I, Armario P. Statement of the Spanish Interdisciplinary Vascular Prevention Committee on the updated European Guidelines on Cardiovascular Disease Prevention. Nefrologia 2023; 43:360-369. [PMID: 37635013 DOI: 10.1016/j.nefroe.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 05/17/2022] [Indexed: 08/29/2023] Open
Abstract
We present the Spanish adaptation of the 2021 European Guidelines on Cardiovascular Disease (CVD) prevention in clinical practice. The current guidelines besides the individual approach greatly emphasize on the importance of population level approaches to the prevention of cardiovascular diseases. Systematic global CVD risk assessment is recommended in individuals with any major vascular risk factor. Regarding LDL-Cholesterol, blood pressure, and glycemic control in patients with diabetes mellitus, goals and targets remain as recommended in previous guidelines. However, it is proposed a new, stepwise approach (Step 1 and 2) to treatment intensification as a tool to help physicians and patients pursue these targets in a way that fits patient profile. After Step 1, considering proceeding to the intensified goals of Step 2 is mandatory, and this intensification will be based on 10-year CVD risk, lifetime CVD risk and treatment benefit, comorbidities and patient preferences. The updated SCORE algorithm-SCORE2, SCORE-OP- is recommended in these guidelines, which estimates an individual's 10-year risk of fatal and non-fatal CVD events (myocardial infarction, stroke) in healthy men and women aged 40-89 years. Another new and important recommendation is the use of different categories of risk according different age groups (< 50, 50-69, ≥70 years). Different flow charts of CVD risk and risk factor treatment in apparently healthy persons, in patients with established atherosclerotic CVD, and in diabetic patients are recommended. Patients with chronic kidney disease are considered high risk or very high-risk patients according to the levels of glomerular filtration rate and albumin-to-creatinine ratio. New lifestyle recommendations adapted to the ones published by the Spanish Ministry of Health as well as recommendations focused on the management of lipids, blood pressure, diabetes and chronic renal failure are included.
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Affiliation(s)
- Carlos Brotons
- Sociedad Española de Medicina de Familia y Comunitaria (semFYC), Barcelona, Spain.
| | | | | | - Albert Clarà
- Sociedad Española de Angiología y Cirugía Vascular, Madrid, Spain
| | - Olga Cortés
- Asociación Española de Pediatría de Atención Primaria, Madrid, Spain
| | | | | | | | | | - María Herranz
- Federación de Asociaciones de Enfermería Comunitaria y Atención Primaria (FAECAP), Madrid, Spain
| | | | - Carlos Lahoz
- Sociedad Española de Medicina Interna, Madrid, Spain
| | - Pilar Niño
- Sociedad Española de Medicina y Seguridad del Trabajo, Madrid, Spain
| | | | | | | | | | | | - Ricard Tresserras
- Sociedad Española de Salud Pública y Administración Sanitaria (SESPAS), Barcelona, Spain
| | | | - Inés Zuza
- Ministerio de Sanidad, Madrid, Spain
| | - Pedro Armario
- Sociedad Española de Hipertensión-Liga Española para la Lucha contra la Hipertensión Arterial, Madrid, Spain
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3
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Jiménez Rodríguez A, Palomo Cobos L, Rodríguez Martín A, Fernández Del Valle P, Novalbos-Ruiz JP. [Correlations between dietary salt intake and 24-h urine sodium excretion in a sample of the urban population of Cáceres]. Aten Primaria 2023; 55:102513. [PMID: 36401891 PMCID: PMC9676135 DOI: 10.1016/j.aprim.2022.102513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 10/12/2022] [Accepted: 10/21/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Excessive salt intake is associated with higher levels of AHT and prevalence of cardiovascular diseases. WHO recommends consuming less than 5 g/day of salt (equivalent to 2 g Na+/day). Identifying foods and behaviours with greater contribution to excess intake would facilitate preventive dietary advice. DESIGN Observational study. SITE: Urban Health Center in Cáceres. MAIN MEASUREMENTS We estimated salt consumption using two food consumption frequency (FFQ) questionnaires, one generic and one with high Na+ content, and a 24 h follow-up survey. We use the Evalfinut program for nutritional evaluation of the diet. We analyzed correlations between estimated salt intake and 24-h urine sodium elimination (gold standard). RESULTS 92% of the population had consumption higher than the recommendations with intakes equivalent to 9.5 g/day of salt (3.7 g/d of Na+). When sodium intake is determined by the Na+/K+ ratio, 79.54% have high intakes. Sodium elimination follows a slightly increasing trend with BMI. The perception of salt consumption is low, 56.3% consider it "adequate". 32.4% add salt to food once served. FFQ underestimate Na+ intake and targeted surveys provide higher values. The correlation between FFQ and Na+ urinary elimination is weak. CONCLUSION We must reduce salt intake by increasing the perception of consumption, improving knowledge about the salt content in food and identifying target patients of the health council.
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Affiliation(s)
| | | | - Amelia Rodríguez Martín
- Departamento de Biomedicina, Biotecnología y Salud Pública, Universidad de Cádiz, Cádiz, España
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4
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Lear-Claveras A, Oliván-Blázquez B, Clavería A, Couso-Viana S, Puente-Comesaña J, Magallón Botaya R. Sex Differences in Clinical Parameters, Pharmacological and Health-Resource Utilization in a Population With Hypertension Without a Diagnosis of COVID-19. Int J Public Health 2022; 67:1604913. [PMID: 36090835 PMCID: PMC9453807 DOI: 10.3389/ijph.2022.1604913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 07/20/2022] [Indexed: 11/27/2022] Open
Abstract
Objectives: Determine the changes in clinical, pharmacological and healthcare resource use parameters, between the 6 months prior to the lockdown and the 6 months following its end, in a population with hypertension who did not have a diagnosis of COVID-19. Methods: Real world data observational study of 245,979 persons aged >16 years with hypertension in Aragon (Spain). Clinical (systolic-diastolic blood pressure, estimated glomerular filtration rate (eGFR), blood creatinine, cholesterol, triglycerides and anthropometric measures); pharmacological (diuretics, calcium channel antagonists, and ACE inhibitors); and utilization of healthcare resources were considered. We performed the Student's T-test for matched samples (quantitative) and the Chi-squared test (qualitative) to analyze differences between periods. Results: SBP, DBP, parameters of renal function and triglycerides displayed a significant, albeit clinically irrelevant, worsening in women. In men only DBP and eGFR showed a worsening, although to a lesser extent than in women. Certain antihypertensive drugs and health-resource utilization remained below pre-pandemic levels across the 6 months post-lockdown. Conclusion: Changes in lifestyles, along with difficulties in access to routine care has not substantially compromised the health and quality of life of patients with hypertension.
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Affiliation(s)
- Ana Lear-Claveras
- Aragonese Research Group in Primary Care (Grupo Aragonés de Investigación en Atención Primaria/GAIAP), Aragón Health Research Institute, Zaragoza, Spain
| | - Bárbara Oliván-Blázquez
- Aragonese Research Group in Primary Care (Grupo Aragonés de Investigación en Atención Primaria/GAIAP), Aragón Health Research Institute, Zaragoza, Spain
- Department of Psychology and Sociology, Faculty of Social Sciences, University of Zaragoza, Zaragoza, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain
| | - Ana Clavería
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain
- I-Saúde Group, Galicia South Health Research Institute, Vigo, Spain
- Vigo Health Area, SERGAS, Vigo, Spain
| | - Sabela Couso-Viana
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain
- Vigo Health Area, SERGAS, Vigo, Spain
| | - Jesús Puente-Comesaña
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain
- Vigo Health Area, SERGAS, Vigo, Spain
| | - Rosa Magallón Botaya
- Aragonese Research Group in Primary Care (Grupo Aragonés de Investigación en Atención Primaria/GAIAP), Aragón Health Research Institute, Zaragoza, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain
- Department of Medicine, Psychiatry and Dermatology, University of Zaragoza, Zaragoza, Spain
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5
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Brotons C, Camafort M, Castellanos MDM, Clarà A, Cortés O, Diaz Rodriguez A, Elosua R, Gorostidi M, Hernández AM, Herranz M, Justo S, Lahoz C, Niño P, Pallarés-Carratalá V, Pedro-Botet J, Pérez Pérez A, Royo-Bordonada MA, Santamaria R, Tresserras R, Zamora A, Zuza I, Armario P. Statement of the Spanish Interdisciplinary Vascular Prevention Committee on the updated European Guidelines on Cardiovascular Disease Prevention. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ARTERIOSCLEROSIS 2022; 34:219-228. [PMID: 35906022 DOI: 10.1016/j.arteri.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 03/28/2022] [Indexed: 06/15/2023]
Abstract
We present the Spanish adaptation of the 2021 European Guidelines on Cardiovascular Disease Prevention in Clinical Practice. The current guidelines besides the individual approach greatly emphasize on the importance of population level approaches to the prevention of cardiovascular diseases. Systematic global cardiovascular disease risk assessment is recommended in individuals with any major vascular risk factor. Regarding LDL-cholesterol, blood pressure, and glycemic control in patients with diabetes mellitus, goals and targets remain as recommended in previous guidelines. However, it is proposed a new, stepwise approach (steps 1 and 2) to treatment intensification as a tool to help physicians and patients pursue these targets in a way that fits patient profile. After step 1, considering proceeding to the intensified goals of step 2 is mandatory, and this intensification will be based on 10-year cardiovascular disease risk, lifetime cardiovascular disease risk and treatment benefit, comorbidities and patient preferences. The updated SCORE algorithm ?SCORE2, SCORE2-OP? is recommended in these guidelines, which estimates an individual's 10-year risk of fatal and non-fatal cardiovascular disease events (myocardial infarction, stroke) in healthy men and women aged 40-89 years. Another new and important recommendation is the use of different categories of risk according to different age groups (<50, 50-69, ≥70 years). Different flow charts of cardiovascular disease risk and risk factor treatment in apparently healthy persons, in patients with established atherosclerotic cardiovascular disease, and in diabetic patients are recommended. Patients with chronic kidney disease are considered high risk or very high-risk patients according to the levels of glomerular filtration rate and albumin-to-creatinine ratio. New lifestyle recommendations adapted to the ones published by the Spanish Ministry of Health as well as recommendations focused on the management of lipids, blood pressure, diabetes and chronic renal failure are included.
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Affiliation(s)
- Carlos Brotons
- Sociedad Española de Medicina de Familia y Comunitaria (semFYC), Barcelona, España.
| | | | | | - Albert Clarà
- Sociedad Española de Angiología y Cirugía Vascular, Madrid, España
| | - Olga Cortés
- Asociación Española de Pediatría de Atención Primaria, Madrid, España
| | | | | | | | | | - María Herranz
- Federación de Asociaciones de Enfermería Comunitaria y Atención Primaria (FAECAP), Madrid, España
| | | | - Carlos Lahoz
- Sociedad Española de Medicina Interna, Madrid, España
| | - Pilar Niño
- Sociedad Española de Medicina y Seguridad del Trabajo, Madrid, España
| | | | | | | | | | | | - Ricard Tresserras
- Sociedad Española de Salud Pública y Administración Sanitaria (SESPAS), Barcelona, España
| | - Alberto Zamora
- Sociedad Española de Arteriosclerosis, Barcelona, España
| | - Inés Zuza
- Ministerio de Sanidad, Madrid, España
| | - Pedro Armario
- Sociedad Española de Hipertensión-Liga Española para la Lucha contra la Hipertensión Arterial, Madrid, España
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Brotons C, Camafort M, Castellanos MDM, Clarà A, Cortés O, Díaz Rodríguez Á, Elosua R, Gorostidi M, Hernández AM, Herranz M, Justo S, Lahoz C, Niño P, Pallarés-Carratalá V, Pedro-Botet J, Pérez A, Royo-Bordonda MÁ, Santamaría R, Tresserras R, Zamora A, Zuza I, Armario P. Comentario del CEPIV a las nuevas guías europeas de prevención cardiovascular 2021. REVISTA CLÍNICA DE MEDICINA DE FAMILIA 2022. [DOI: 10.55783/rcmf.150207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Se presenta la adaptación española de las Guías Europeas de Prevención Cardiovascular 2021. En esta actualización, además del abordaje individual, se pone mucho más énfasis en las políticas sanitarias como estrategia de prevención poblacional. Se recomienda el cálculo del riesgo vascular de manera sistemática a todas las personas adultas con algún factor de riesgo vascular. Los objetivos terapéuticos para el colesterol LDL, la presión arterial y la glucemia no han cambiado respecto a las anteriores guías, pero se recomienda alcanzar estos objetivos de forma escalonada (etapas 1 y 2). Se recomienda llegar siempre hasta la etapa 2, y la intensificación del tratamiento dependerá del riesgo a los 10 años y de por vida, del beneficio del tratamiento, de las comorbilidades, de la fragilidad y de las preferencias de los pacientes. Las guías presentan por primera vez un nuevo modelo para calcular el riesgo —SCORE2 y SCORE2-OP— de morbimortalidad vascular en los próximos 10 años (infarto de miocardio, ictus y mortalidad vascular) en hombres y mujeres entre 40 y 89 años. Otra de las novedades sustanciales es el establecimiento de diferentes umbrales de riesgo dependiendo de la edad (< 50, 50-69, ≥ 70 años).
Se presentan diferentes algoritmos de cálculo del riesgo vascular y tratamiento de los factores de riesgo vascular para personas aparentemente sanas, pacientes con diabetes y aquellos con enfermedad vascular aterosclerótica. Los pacientes con enfermedad renal crónica se considerarán de riesgo alto o muy alto, según la tasa del filtrado glomerular y el cociente albúmina/creatinina. Se incluyen innovaciones en las recomendaciones sobre los estilos de vida, adaptadas a las recomendaciones del Ministerio de Sanidad, así como aspectos novedosos relacionados con el control de los lípidos, la presión arterial, la diabetes y la insuficiencia renal crónica.
Palabras clave: prevención y control, enfermedades vasculares, guías de práctica clínica, dieta saludable, hipertensión arterial, diabetes, control de lípidos, tabaco, riesgo cardiovascular.
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Affiliation(s)
- Carlos Brotons
- Sociedad Española de Medicina de Familia y Comunitaria-semFYC. Barcelona (España)
| | | | | | - Albert Clarà
- Sociedad Española de Angiología y Cirugía Vascular. Madrid (España)
| | - Olga Cortés
- Asociación Española de Pediatría de Atención Primaria. Madrid (España)
| | | | | | | | | | - María Herranz
- Federación de Asociaciones de Enfermería Comunitaria y Atención Primaria-FAECAP. Madrid (España)
| | | | - Carlos Lahoz
- Sociedad Española de Medicina Interna. Madrid (España)
| | - Pilar Niño
- Sociedad Española de Medicina y Seguridad del Trabajo. Madrid (España)
| | | | | | | | | | | | - Ricard Tresserras
- Sociedad Española de Salud Pública y Administración Sanitaria-SESPAS. Barcelona (España)
| | - Alberto Zamora
- Sociedad Española de Arteriosclerosis. Barcelona (España)
| | - Inés Zuza
- Ministerio de Sanidad. Madrid (España)
| | - Pedro Armario
- Sociedad Española de Hipertensión-Liga Española para la Lucha contra la Hipertensión Arterial. Madrid (España)
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Comentario del CEIPV a las nuevas Guías Europeas de Prevención Cardiovascular 2021. Nefrologia 2022. [DOI: 10.1016/j.nefro.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Sánchez Peinador C, Torras Borrell J, Castillo Moraga MJ, Egocheaga Cabello MI, Rodríguez Villalón X, Turégano Yedro M, Gamarra Ortiz J, Domínguez Sardiña M, Pallarés Carratalá V. [Optimizing blood pressure control through telemedicine in Primary Care in Spain (Iniciativa Óptima): Results from a Delphi study]. Aten Primaria 2022; 54:102353. [PMID: 35588550 PMCID: PMC9119825 DOI: 10.1016/j.aprim.2022.102353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/28/2022] [Accepted: 03/14/2022] [Indexed: 11/24/2022] Open
Abstract
Objetivo Representantes de los grupos de trabajo de hipertensión o enfermedad cardiovascular de las Sociedades Españolas de Médicos de Atención Primaria (MAP) [SEMERGEN], de Medicina Familiar y Comunitaria [semFYC] y de Médicos Generales y de Familia [SEMG] realizaron un estudio Delphi para validar con un panel de MAP expertos en hipertensión una propuesta de recomendaciones para optimizar la teleconsulta en pacientes hipertensos. Materiales y métodos Estudio Delphi basado en un cuestionario online con 59 recomendaciones, elaborado en base a la bibliografía relacionada disponible y a la experiencia clínica aportada por los autores. Resultados Un total de 118 MAP participaron en dos rondas del cuestionario (98,3% de los invitados), alcanzándose el consenso en 53/62 sentencias (85%). El equipo de Atención Primaria debe seleccionar a los pacientes hipertensos candidatos a realizar la consulta telemática proactivamente, informando de la cita con antelación. Al iniciar la consulta telemática, se recomienda explicar el motivo y los objetivos de la misma, y realizar la anamnesis preguntando por signos y síntomas de empeoramiento de la enfermedad, tratamientos actuales y adherencia a los mismos. En pacientes con una automedida de la presión arterial (AMPA) ≤ 135/85 mmHg se recomienda pautar una nueva cita telemática en 3-6 meses. Por el contrario, en pacientes asintomáticos que reporten una AMPA ≥ 135/85 mmHg se recomienda la monitorización ambulatoria de la presión arterial, modificar el tratamiento, o derivar al paciente a visita presencial o al hospital en caso de signos o síntomas de alarma. Conclusiones La teleconsulta puede complementar la consulta presencial, constituyendo un elemento más a tener en cuenta para el adecuado control de los pacientes hipertensos.
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Affiliation(s)
- Carmen Sánchez Peinador
- Centro de Salud Cantalejo, Cantalejo, Segovia, España; Grupo de Trabajo de ECV de SEMG, España
| | - Joan Torras Borrell
- CAP Sant Llàtzer, Terrassa, Barcelona, España; Coordinador del grupo de HTA de la Societat Catalana de Medicina Familiar i Comunitària, CAMFIC, España; Grupo de Trabajo de HTA de SEMFYC, España.
| | - María José Castillo Moraga
- Centro de Salud Sanlúcar Barrio Bajo, Sanlúcar de Barrameda, Cádiz, España; Grupo de Trabajo de HTA y ECV de SEMERGEN, España
| | | | | | - Miguel Turégano Yedro
- Grupo de Trabajo de HTA y ECV de SEMERGEN, España; Centro de Salud Aldea Moret, Cáceres, España
| | - Javier Gamarra Ortiz
- Grupo de Trabajo de ECV de SEMG, España; CS Medina Rural, Medina del Campo, Valladolid, España
| | | | - Vicente Pallarés Carratalá
- Grupo de Trabajo de HTA y ECV de SEMERGEN, España; Unidad de Vigilancia de la Salud, Unión de Mutuas, Castellón, España; Departamento de Medicina, Universitat Jaume I, Castellón, España
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9
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Brotons C, Camafort M, Del Mar Castellanos M, Clarà A, Cortés O, Diaz Rodriguez A, Elosua R, Gorostidi M, Hernández AM, Herranz M, Justo S, Lahoz C, Niño P, Pallarés-Carratalá V, Pedro-Botet J, Pérez Pérez A, Royo-Bordonada MA, Santamaria R, Tresserras R, Zamora A, Zuza I, Armario P. [Statement of the Spanish Interdisciplinary Vascular Prevention Committee on the updated European Guidelines on Cardiovascular Disease Prevention]. HIPERTENSION Y RIESGO VASCULAR 2022; 39:69-78. [PMID: 35331672 DOI: 10.1016/j.hipert.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 02/21/2022] [Indexed: 10/18/2022]
Abstract
Statement of the Spanish Interdisciplinary Vascular Prevention Committee on the updated European Guidelines on Cardiovascular Disease Prevention. We present the Spanish adaptation of the 2021 European Guidelines on Cardiovascular Disease (CVD) prevention in clinical practice. The current guidelines besides the individual approach greatly emphasize on the importance of population level approaches to the prevention of cardiovascular diseases. Systematic global CVD risk assessment is recommended in individuals with any major vascular risk factor. Regarding LDL-Cholesterol, blood pressure, and glycemic control in patients with diabetes mellitus, goals and targets remain as recommended in previous guidelines. However, it is proposed a new, stepwise approach (Step 1 and 2) to treatment intensification as a tool to help physicians and patients pursue these targets in a way that fits patient profile. After Step 1, considering proceeding to the intensified goals of Step 2 is mandatory, and this intensification will be based on 10-year CVD risk, lifetime CVD risk and treatment benefit, comorbidities and patient preferences. The updated SCORE algorithm-SCORE2, SCORE-OP- is recommended in these guidelines, which estimates an individual's 10-year risk of fatal and non-fatal CVD events (myocardial infarction, stroke) in healthy men and women aged 40-89 years. Another new and important recommendation is the use of different categories of risk according different age groups (< 50, 50-69 ≥ 70 years). Different flow charts of CVD risk and risk factor treatment in apparently healthy persons, in patients with established atherosclerotic CVD, and in diabetic patients are recommended. Patients with chronic kidney disease are considered high risk or very high-risk patients according to the levels of glomerular filtration rate and albumin-to-creatinine ratio. New lifestyle recommendations adapted to the ones published by the Spanish Ministry of Health as well as recommendations focused on the management of lipids, blood pressure, diabetes and chronic renal failure are included.
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Affiliation(s)
- C Brotons
- Sociedad Española de Medicina de Familia y Comunitaria-semFYC, Barcelona, España.
| | - M Camafort
- Sociedad Española de Medicina Interna, Barcelona, España
| | | | - A Clarà
- Sociedad Española de Angiología y Cirugía Vascular, Madrid, España
| | - O Cortés
- Asociación Española Pediatría de Atención Primaria, Madrid, España
| | - A Diaz Rodriguez
- Sociedad Española de Médicos de Atención Primaria-SEMERGEN, Madrid, España
| | - R Elosua
- Sociedad Española de Epidemiología, Barcelona, España
| | - M Gorostidi
- Sociedad Española de Nefrología, Santander, España
| | | | - M Herranz
- Federación de Asociaciones de Enfermería Comunitaria y Atención Primaria-FAECAP, Madrid, España
| | - S Justo
- Ministerio de Sanidad, Madrid, España
| | - C Lahoz
- Sociedad Española de Medicina Interna, Barcelona, España
| | - P Niño
- Sociedad Española de Medicina y Seguridad del Trabajo, España
| | | | - J Pedro-Botet
- Sociedad Española de Arteriosclerosis, Barcelona, España
| | | | | | - R Santamaria
- Sociedad Española de Nefrología, Santander, España
| | - R Tresserras
- Sociedad Española de Salud Pública y Administración Sanitaria-SESPAS, Barcelona, España
| | - A Zamora
- Sociedad Española de Arteriosclerosis, Barcelona, España
| | - I Zuza
- Ministerio de Sanidad, Madrid, España
| | - P Armario
- Sociedad Española-Liga Española para la Lucha contra la Hipertensión Arterial, Madrid, España
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Barrios-Fernandez S, Sosa-Sánchez EM, Carlos-Vivas J, Muñoz-Bermejo L, Morenas-Martín J, Apolo-Arenas MD, Adsuar JC, Domínguez-Muñoz FJ. Intrasession Reliability Analysis for Oscillometric Blood Pressure Method Using a Digital Blood Pressure Monitor in Peruvian Population. Healthcare (Basel) 2022; 10:209. [PMID: 35206824 PMCID: PMC8871912 DOI: 10.3390/healthcare10020209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/30/2021] [Accepted: 01/20/2022] [Indexed: 11/30/2022] Open
Abstract
Blood Pressure (BP) is one of the most used measured clinical parameters in health promotion and intervention. BP measures can vary due to different parameters, so we aim to study the intrasession test-retest reliability for an oscillometric method using a digital tensiometer in the Peruvian population aged over 15 with and without a diagnosis of hypertension (HT). Data were taken from the Demographic and Family Health Survey conducted in Peru in 2019. Technicians had to follow a standardized protocol on the conditions to carry out a valid and reliable measurement. Relative reliability was excellent in most cases (intraclass correlation coefficient > 0.9); absolute reliability was excellent (standard error of measurement < 5%) and smallest real difference < 10% in most cases. The Bland-Altman plot showed a systematic error of 2.36 for systolic BP in men and 2.16 in women, and 0.823 for diastolic BP in men and 0.71 for diastolic BP in women. Results suggest that the oscillometric method with a digital blood pressure monitor was reliable in absolute and relative terms in this population, so it could be used as a reliable control test to measure changes after an intervention.
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Affiliation(s)
- Sabina Barrios-Fernandez
- Social Impact and Innovation in Health (InHEALTH) Research Group, Faculty of Sport Sciences, University of Extremadura, 10003 Caceres, Spain;
| | - Eduardo Manuel Sosa-Sánchez
- Promoting a Healthy Society Research Group (PHeSO), Faculty of Sport Sciences, University of Extremadura, 10003 Caceres, Spain; (E.M.S.-S.); (J.C.A.)
| | - Jorge Carlos-Vivas
- Promoting a Healthy Society Research Group (PHeSO), Faculty of Sport Sciences, University of Extremadura, 10003 Caceres, Spain; (E.M.S.-S.); (J.C.A.)
| | - Laura Muñoz-Bermejo
- Social Impact and Innovation in Health (InHEALTH) Research Group, Faculty of Sport Sciences, University of Extremadura, 10003 Caceres, Spain;
| | - Jesús Morenas-Martín
- Motor Control Research Group, Faculty of Sport Sciences, University of Extremadura, 10003 Caceres, Spain;
| | - María Dolores Apolo-Arenas
- Department of Medical and Surgical Therapeutics, Medicine and Health Sciences College, University of Extremadura, 06006 Badajoz, Spain;
| | - Jose Carmelo Adsuar
- Promoting a Healthy Society Research Group (PHeSO), Faculty of Sport Sciences, University of Extremadura, 10003 Caceres, Spain; (E.M.S.-S.); (J.C.A.)
| | - Francisco Javier Domínguez-Muñoz
- Physical Activity and Quality of Life Research Group (AFYCAV), Faculty of Sport Science, University of Extremadura, 10003 Caceres, Spain;
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Statement of the Spanish Interdisciplinary Vascular Prevention Committee on the updated European Guidelines on Cardiovascular Disease Prevention. ANGIOLOGIA 2022. [DOI: 10.20960/angiologia.00411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Gijón-Conde T, Rubio E, Gorostidi M, Vinyoles E, Armario P, Rodilla E, Segura J, Divisón-Garrote JA, García-Donaire JA, Molinero A, Ruilope LM. 2021 Spanish Society of Hypertension position statement about telemedicine. HIPERTENSION Y RIESGO VASCULAR 2021; 38:186-196. [PMID: 33888438 PMCID: PMC8054212 DOI: 10.1016/j.hipert.2021.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 03/29/2021] [Indexed: 12/01/2022]
Abstract
The pandemic caused by coronavirus SARS-CoV-2 (COVID-19) has forced, in many cases, to replace face-to-face consultation with the telematic consultation, in order to reduce the risk of contagion associated with the presence of patients in health centres. This change may represent an opportunity for a different and more effective communication between professionals and patients, allowing better accessibility to medical care and more systematic and comprehensive approach to patients with hypertension and cardiovascular risk. However, organisational tools are needed to facilitate communication between patients and professionals, specifically with the exchange of clinical data by remote monitoring of variables associated with hypertension and cardiovascular risk (blood pressure, weight, height, blood tests…), and allow monitoring of adherence to treatments, lifestyles and risk factors. It would be desirable for this to be carried out by multidisciplinary teams, both from primary care, hospital and community pharmacy, with an adequate coordination of care. This document of the Spanish Society of Hypertension (SEH-LELHA) tries to give the keys to improve the quality of care of telematic consultations of patients with hypertension and cardiovascular risk, provide basic criteria of telematic or face to face attention and systematise their content. Likewise, the follow-up criteria are proposed by the different professionals.
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Affiliation(s)
- T Gijón-Conde
- Centro de Salud Cerro del Aire, Departamento de Medicina, Universidad Autónoma Madrid/IdiPAZ y CIBERESP, Majadahonda, Madrid, Spain.
| | - E Rubio
- Servicio de Nefrología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
| | - M Gorostidi
- Servicio de Nefrología, Hospital Universitario Central de Asturias, RedinRen, Universidad de Oviedo, Oviedo, Spain
| | - E Vinyoles
- Centre d'Atenció Primària La Mina, Departamento de Medicina, Universidad de Barcelona, Barcelona, Spain
| | - P Armario
- Área Atención Integrada de Riesgo Vascular, Departamento de Medicina Interna, Hospital Moisès Broggi Sant Joan Despi, Universidad de Barcelona, Sant Joan Despí, Barcelona, Spain
| | - E Rodilla
- Servicio de Medicina Interna, Hospital Universitario de Sagunto, Universidad Cardenal Herrera-CEU, Sagunto, Valencia, Spain
| | - J Segura
- Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, Spain; Unidad de Hipertensión, Servicio de Nefrología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - J A Divisón-Garrote
- Centro de Salud de Casas Ibáñez, Universidad Católica San Antonio, Casas Ibáñez, Albacete, Spain
| | | | - A Molinero
- Sociedad Española de Farmacia Comunitaria (SEFAC), Spain
| | - L M Ruilope
- Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, Spain; Unidad de Hipertensión, Servicio de Nefrología, Hospital Universitario 12 de Octubre, Madrid, Spain; Escuela de Estudios de Doctorado e Investigación, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
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Effect of a repeated educational intervention versus an initial intervention on blood pressure control in hypertensive patients. Med Clin (Barc) 2021; 158:406-412. [PMID: 34373072 DOI: 10.1016/j.medcli.2021.04.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 04/18/2021] [Accepted: 04/20/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION AND OBJECTIVES Hypertension is one of the main cardiovascular risk factors. An educational intervention, aimed at increasing or reinforcing the patient's knowledge, can contribute to better control of their blood pressure. Our goal was to evaluate the efficacy of a continuing therapeutic education versus an initial intervention in hypertensive patients. METHODS Experimental study of multicenter community intervention, through the application of a therapeutic education program in hypertension. RESULTS 980 patients on antihypertensive treatment were included, 490 in each group, with a mean age of 65 years, and 50% women, baseline mean SBP in both groups was136 mmHg. Regarding knowledge about hypertension, although a similar initial improvement was observed in both groups, at the end of the study, in the continuous intervention group (CIG) an average of 23.06 correct answers was observed, while in the Initial intervention group (IIG) the mean was 20.91, being the difference statistically significant (p < 0.001). At the end of the study, the mean SBP was 127.5 mmHg in the CIG and 136.57 mmHg in the IIG group. Likewise, a lower percentage of patients with a BMI ≥25 was observed in the CIG (78.2%) than in the IIG 82.6%, this difference being statistically significant (p < 0.001). This same effect was observed on the abdominal perimeter, observing an increased abdominal perimeter in 46.3% of the CIG compared to 68.8% in the IIG (p < 0.001). CONCLUSIóN: A continuous educational intervention increases the degree of knowledge about hypertension compared to an initial intervention. Likewise, this intervention is associated with an improvement in blood pressure, weight, body mass index and abdominal girth figures.
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Insurance-Related Delay in Access to Bariatric Surgery, Is It Helpful as Is Thought? Obes Surg 2020; 30:4198-4205. [PMID: 32621054 DOI: 10.1007/s11695-020-04794-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND In Argentina, health insurances demand a 24-month duration preoperative weight loss program (POWLP) before bariatric surgery. It is unknown whether it enhances weight loss before or after surgery, or even if it is related to comorbidity remission. The main objective of this study was to determine its effectiveness and reliability. METHODS An observational, longitudinal, retrospective study was carried out from June 2009 to December 2016, enrolling patients who underwent bariatric surgery in Sanatorio Allende Hospital of Cordoba, Argentina. Patients were divided into three groups according time-to-surgery from preoperative assessment initiation (A = before the 6th month, B = from 6th to 24th month, and C = over 24th month; all related to the first visit as previously mentioned). BMI, %EWL, comorbidity remission BMI, %EWL, comorbidity remission, and complications rate were assessed after surgery at 1, 3, 6, 12 months, and then annually until the 5th postoperative year. Revisional surgeries were excluded. RESULTS Three hundred seventy-six patients were recruited. There were no significant differences in the preoperative and postoperative weight loss, neither co-morbidities resolution between groups. CONCLUSIONS Insurance-related delay in access to bariatric surgery is not associated to any benefit in comorbidity remission, as well as any improvement in weight loss in all groups studied.
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Casas-Tapia C, Araujo-Castillo RV, Saavedra-Tafur L, Bert-Dulanto A, Piscoya A, Casas-Lucich A. Higher HOMA-IR index is associated with increased excess weight loss in patients with BMI≥35kg/m 2 after vertical gastrectomy. Cir Esp 2020; 98:328-335. [PMID: 32000981 DOI: 10.1016/j.ciresp.2019.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 11/22/2019] [Accepted: 12/01/2019] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Bariatric surgery is considered the most effective treatment for severe obesity. However, it is not clear if patients with diabetes mellitus or insulin resistance have the same response than patients without those conditions. Our objective was to evaluate association between pre-surgical HOMA-IR index and percentage of excess weight loss (EWL%) one year after bariatric surgery using sleeve gastrectomy. METHODS Retrospective cohort including patients ≥18 years old with BMI≥35kg/m2, who underwent primary sleeve gastrectomy between 2014-2017 at the Avendaño Medical Center, Peru. Only patients with Type 2 Diabetes, Hypertension, or Dyslipidemia were included. EWL% ≥60% one year after surgery was considered satisfactory. Crude and adjusted Lineal and Poisson regression with robustness was used to assess statistical associations with EWL%. RESULTS Ninety-one patients were included with a median of 34 years, and 57.1% were women. 85.7% had insulin resistance as per HOMA-IR. One year after surgery, 76.9% had a satisfactory EWL%. The lineal model showed .29% less EWL% per each extra year of life (P=.019), and .93% more EWL% per each extra HOMA-IR point (P=.004). The adjusted Poisson model showed 2% lower risk of having a satisfactory EWL% per each additional year of life (P=.050), and 2% more chance of success per each additional HOMA-IR point (P=.038). CONCLUSIONS There was association between a higher pre-surgical HOMA-IR index and increased EWL% one year after surgery. It is possible that insulin resistance does not affect negatively sleeve gastrectomy outcomes.
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Affiliation(s)
| | | | - Lil Saavedra-Tafur
- Cirugía General, Endoscópica y Bariátrica, Clínica de Día Avendaño, Lima, Perú
| | - Aimeé Bert-Dulanto
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Perú
| | - Alejandro Piscoya
- Dirección de Investigación, Universidad San Ignacio de Loyola, Lima, Perú; Servicio de Gastroenterología, Hospital Guillermo Kaelin de la Fuente, Lima, Perú
| | - Alberto Casas-Lucich
- Facultad de Ciencias de la Salud, Universidad Privada San Juan Bautista, Lima, Perú
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Pérez-Manchón D, Plaza-Rivera S. [Screening of hypertension. Variability between clinical practice and current recommendations]. HIPERTENSION Y RIESGO VASCULAR 2020; 37:45-47. [PMID: 31727494 DOI: 10.1016/j.hipert.2019.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 05/22/2019] [Accepted: 09/03/2019] [Indexed: 11/18/2022]
Affiliation(s)
- D Pérez-Manchón
- Facultad de Educación y Salud, Universidad Camilo José Cela, Madrid, España.
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Collazos-Huaman L, Guerreros-Espino C. Comentario al artículo publicado «El valor de la MAPA y de los parámetros de lesión subclínica de órgano diana en el diagnóstico de hipertensión refractaria» por Poveda García MI, et al., revista de Nefrología, 13 de marzo del 2018. Nefrologia 2019; 39:554-555. [DOI: 10.1016/j.nefro.2018.12.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 12/21/2018] [Indexed: 11/24/2022] Open
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Pallarés-Carratalá V, Divisón Garrote JA, Prieto Díaz MA, García Matarín L, Seoane Vicente MC, Molina Escribano F, Velilla Zancada S, Rey Aldana D, Cinza Sanjurjo S, Santos Altozano C, Górriz JL, Alonso Moreno FJ, Polo García J, Barquilla García A, Beato Fernández P, Escobar Cervantes C. [Positioning for the management of arterial hypertension in Primary Care from the critical analysis of the American (2017) and European (2018) guidelines. Spanish Society of Primary Care Physicians (SEMERGEN)]. Semergen 2019; 45:251-272. [PMID: 31005506 DOI: 10.1016/j.semerg.2019.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 02/04/2019] [Indexed: 11/30/2022]
Abstract
The Scientific Societies of Primary Care, being the area in which there is a considerable prevalence of Arterial Hypertension (AHT), need to periodically evaluate the international guidelines for its management. This is particularly relevant when disparate guidelines make it difficult to make decisions in daily clinical practice. The present document has as its aim to analyse the changes and new developments proposed in the guidelines of the American College of Cardiology and the American Heart Association (ACC/AHA 2017), as well as in the guidelines of the European Society of Cardiology and European Society of Hypertension (ESC/ESH 2018). An analysis will be made of any differences, limitations, and their applicability to Primary Care in Spain. Finally, the most relevant available and appropriate information is extracted and integrated in order to homogenise the care of the hypertensive patient, from a critical, but also a reasoned, perspective. The discrepancies between the recommendations in such essential aspects as the management of the disease, require the compiling and critical analysis of the information that enables us as scientific society, interested in providing all PC physicians with the most relevant, and at the same time, sensible, recommendations of all the guidelines.
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Affiliation(s)
- V Pallarés-Carratalá
- Unidad de Vigilancia de la Salud, Unión de Mutuas, Castellón, España; Departamento de Medicina, Universitat Jaume I, Castellón, España.
| | - J A Divisón Garrote
- Centro de Salud Casas Ibañez, Casas Ibáñez, Albacete, España; Cátedra de Medicina de Familia SEMERGEN, Universidad Católica San Antonio de Murcia, Murcia, España.
| | | | | | | | - F Molina Escribano
- Centro de Salud Casas Ibañez, Consultorio Balsa de Ves, Balsa de Ves, Albacete, España
| | | | - D Rey Aldana
- Centro de Salud A Estrada, A Estrada, Pontevedra, España
| | - S Cinza Sanjurjo
- Cátedra SEMERGEN, Universidad de Santiago de Compostela, Santiago de Compostela, A Coruña, España; Centro de Salud Porto do Son, Porto de Son, A Coruña, España
| | | | - J L Górriz
- Servicio de Nefrología, Hospital Clínico de Valencia, Valencia, España; Departamento de Medicina, Facultad de Medicina, Universidad de Valencia, Valencia, España
| | | | - J Polo García
- Centro de Salud Casar de Cáceres, Casar de Cáceres, Cáceres, España
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Fernandes M, Olde Rikkert MGM. The new US and European guidelines in hypertension: A multi-dimensional analysis. Contemp Clin Trials 2019; 81:44-54. [PMID: 31002956 DOI: 10.1016/j.cct.2019.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 03/30/2019] [Accepted: 04/11/2019] [Indexed: 11/29/2022]
Abstract
The Systolic Blood Pressure Intervention Trial (SPRINT) compared the clinical outcomes between target systolic blood pressure (SBP) levels between 140 and 120 mmHg or lower. Both,the 2017 ACC/AHA and the 2018 ESC/ESH guidelines in hypertension are derived from the SPRINT trial and advise initiation and/or intensification of treatment at lower blood pressure thresholds. The ACC/AHA guidance supersedes the 2014 Eight Joint National Committee guideline (JNC-8) which advised initiation of treatment when the BP was 140/90 mmHg or higher; in adults 60 years or over, the target was 150/90 mmHg. Compared to JNC-8, the new guidelines lower the SBP target by 10 mmHg in patients under age of 60 years, and by 20 mmHg in the elderly. We performed a qualitative multi-dimensional analysis in order to answer two key questions: will the new guidelines deliver the stated benefits? and, will translation to the clinic be simple, risk-free, and affordable? A major investment by national healthcare administrations will be necessary for the initiation and support of this program but this decision can only be justified by a valid expectation of clinical benefit. At this time, a definitive answer is not available and a "wait and see" attitude appears appropriate and reasonable. In the interim, efforts are best directed to the immediate problem of untreated hypertension worldwide.
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En relación con «Documento de la Sociedad Española de Hipertensión-Liga Española para la Lucha contra la Hipertensión Arterial (SEH-LELHA) sobre las guías ACC/AHA 2017 de hipertensión arterial». HIPERTENSION Y RIESGO VASCULAR 2019; 36:53-54. [DOI: 10.1016/j.hipert.2018.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 09/16/2018] [Indexed: 11/21/2022]
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