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Coll-Brito V, Calero F, Arias P, Ayasreh N, Ochoa J, Ramos A, Guirado L, Fernández-Llama P. [Improved office blood pressure control by automatic delayed-reading oscillometric device]. HIPERTENSION Y RIESGO VASCULAR 2021; 38:119-124. [PMID: 33893057 DOI: 10.1016/j.hipert.2021.03.002] [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: 01/12/2021] [Revised: 03/16/2021] [Accepted: 03/19/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Office blood pressure (BP) measurement is a recommended procedure, although the out-of-office BP measurements are increasingly used. OBJECTIVE To know the degree of BP control by clinical measurement. MATERIAL AND METHODS During November 2019 demographic and clinical data, office attended systolic BP (SBP) and diastolic BP (DBP) measured with an automatic device with delayed reading and, if performed, data from ambulatory BP monitoring (ABPM) were collected. RESULTS 102 patients (67 men) were included, with a mean age of 64.9 years, 30% diabetic and 34% with cardiovascular complications. 70% had a controlled hypertesion (<140/90 mmHg) by office BP, the mean SBP was 131 ± 16.5 mmHg and the DBP was 73 ± 9.5 mmHg. Old age and diabetes were associated with uncontrolled hypertension. Thirty three patients had ABPM data, which allowed them to be classified according to the 24-hour BP into: 30% true normotension, 9% white-coat hypertension, 15% sustained hypertension, and 45% masked hypertension. CONCLUSION The use of automatic devices reduces the white-coat phenomenon, improving the % of patients with office BP controlled. However, this is not confirmed outside the clinic, showing the importance of ABPM in the evaluation of hypertension control. Office BP measurement is useful in patients initial assessment and also provides educational aspects, although the methodology must be optimized to define its clinical role.
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Affiliation(s)
- V Coll-Brito
- Servicio de Nefrología, Fundació Puigvert, Barcelona, España; Universitat Autònoma de Barcelona, Barcelona, España; REDinREN (Instituto de Investigación Carlos III); Instituto de Investigaciones Biomédicas Sant Pau (IIB Sant Pau), Barcelona, España
| | - F Calero
- Unidad de HTA y Prevención de Daño Renal, Barcelona, España; Servicio de Nefrología, Fundació Puigvert, Barcelona, España; Universitat Autònoma de Barcelona, Barcelona, España; REDinREN (Instituto de Investigación Carlos III); Instituto de Investigaciones Biomédicas Sant Pau (IIB Sant Pau), Barcelona, España
| | - P Arias
- Unidad de HTA y Prevención de Daño Renal, Barcelona, España; Servicio de Nefrología, Fundació Puigvert, Barcelona, España; Universitat Autònoma de Barcelona, Barcelona, España
| | - N Ayasreh
- Unidad de HTA y Prevención de Daño Renal, Barcelona, España; Servicio de Nefrología, Fundació Puigvert, Barcelona, España; Universitat Autònoma de Barcelona, Barcelona, España; REDinREN (Instituto de Investigación Carlos III); Instituto de Investigaciones Biomédicas Sant Pau (IIB Sant Pau), Barcelona, España
| | - J Ochoa
- Servicio de Nefrología, Fundació Puigvert, Barcelona, España; Universitat Autònoma de Barcelona, Barcelona, España; REDinREN (Instituto de Investigación Carlos III); Instituto de Investigaciones Biomédicas Sant Pau (IIB Sant Pau), Barcelona, España
| | - A Ramos
- Unidad de HTA y Prevención de Daño Renal, Barcelona, España; Servicio de Nefrología, Fundació Puigvert, Barcelona, España; Universitat Autònoma de Barcelona, Barcelona, España; REDinREN (Instituto de Investigación Carlos III); Instituto de Investigaciones Biomédicas Sant Pau (IIB Sant Pau), Barcelona, España
| | - Ll Guirado
- Servicio de Nefrología, Fundació Puigvert, Barcelona, España; Universitat Autònoma de Barcelona, Barcelona, España; REDinREN (Instituto de Investigación Carlos III); Instituto de Investigaciones Biomédicas Sant Pau (IIB Sant Pau), Barcelona, España
| | - P Fernández-Llama
- Unidad de HTA y Prevención de Daño Renal, Barcelona, España; Servicio de Nefrología, Fundació Puigvert, Barcelona, España; Universitat Autònoma de Barcelona, Barcelona, España; REDinREN (Instituto de Investigación Carlos III); Instituto de Investigaciones Biomédicas Sant Pau (IIB Sant Pau), Barcelona, España.
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Gómez García MC, Millaruelo Trillo JM, Avila Lachica L, Cos-Claramunt FX, Franch-Nadal J, Cortés Gil X. [ESCRYTO study. Diabetes without cardiovascular disease and level of control]. Semergen 2020; 46:261-269. [PMID: 31874786 DOI: 10.1016/j.semerg.2019.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 11/17/2019] [Accepted: 11/20/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND OBJECTIVES Diabetes is a significant risk factor for the development of cardiovascular disease, which is the main cause of death. The purpose of this study was to determine the level of glycaemic control in patients with type 2 diabetes without cardiovascular disease in Spain. The data used includes the most recent determination of glycosylated haemoglobin, as well as the pattern of antidiabetic treatment, the incidence of episodes of severe hypoglycaemia in the last 6 months, and the level of control of cardiovascular risk factors, and gender. PATIENTS AND METHODS A national, multicentre, and cross-sectional epidemiological study in which 800 doctors associated with the GDPS network participated. RESULTS Of the total of 1,059 patients, 57% male, with a mean age of 62.7 years in men vs. 65.2 in women (P<.001). The mean onset of diabetes was 9.4±7.5 years. The mean HbA1C was 7.0% in men vs. 7.1% in women (P=.039), with the control objective of <7% being observed in 47.2%. There were 65% patients on treatment with metformin, and 62.4% on DPP-4 inhibitors, and basal insulin: 14.2%. Incidence of severe hypoglycemias in the last 6 months was 1.9%. The women had worse glycaemic control, total cholesterol, LDL cholesterol, abdominal obesity, and glomerular filtration levels. CONCLUSIONS The glycaemic control is worse in women even if adjusted for age and time of onset of diabetes (P=.043), and for the number of hypoglycaemic agents (P=.015). The level of control is also worse in women for dyslipidaemia, abdominal obesity, and glomerular filtration. A preventive strategy promoted from Primary care on healthy lifestyles and controlling all vascular risk factors is essential.
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Affiliation(s)
| | | | - L Avila Lachica
- Consultorio Almachar, Unidad de Gestión Clínica Vélez-Norte, Almachar, Málaga, España
| | - F X Cos-Claramunt
- CAP Sant Martí, Atenció Primària, Institut Catalá de la Salut, Barcelona, España
| | - J Franch-Nadal
- Centro de Salud de Raval Sud, Barcelona, España; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, España
| | - X Cortés Gil
- Departamento Médico, Almirall S.A., Barcelona, España
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Divisón-Garrote JA, Prieto-Díaz MÁ, Alonso-Moreno FJ, Velilla-Zancada SM, Escobar-Cervantes C, Llisterri-Caro JL, Cinza-Sanjurjo S, Rodríguez-Roca GC, Polo-García J, Pallarés-Carratalá V. Prevalence of hypotension in hypertensive treated patients within the Primary Care setting. The PRESCAP 2010 study. Semergen 2019; 46:107-114. [PMID: 31395479 DOI: 10.1016/j.semerg.2019.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 06/23/2019] [Accepted: 07/05/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine the prevalence of hypotension and associated factors in hypertensive patients treated in the Primary Care setting. MATERIALS AND METHODS A cross-sectional, descriptive, and multicentre study was conducted with a total of 2635 general practitioners consecutively including 12,961 hypertensive patients treated in a Primary Care setting in Spain. An analysis was performed on the variables of age, gender, weight, height, body mass index, waist circumference, cardiovascular risk factors (diabetes, dyslipidaemia, smoking, obesity, sedentary lifestyle), fasting plasma glucose, complete lipid profile, as well as the presence of target organ damage (left ventricular hypertrophy, microalbuminuria, carotid atherosclerosis) and associated clinical conditions. Hypotension was defined as a systolic blood pressure less than 110mmHg or a diastolic blood pressure less than 70mmHg. A multivariate analysis was performed to determine the variables associated with the presence of hypotension. RESULTS The mean age was 66.2 years, and 51.7% of patients were women. The mean time of onset of hypertension was 9.1 years. A total of 13.1% of patients (95% confidence interval 12.4-13.6%) had hypotension, 95% of whom had low diastolic blood pressure. The prevalence of hypotension was higher in elderly patients (25.7%) and in those individuals with coronary heart disease (22.6%). The variables associated with the presence of hypotension included a history of cardiovascular disease, being treated with at least 3 antihypertensive drugs, diabetes, and age. CONCLUSIONS One out of 4-5 elderly patients, or those with cardiovascular disease, had hypotension. General practitioners should identify these patients in order to determine the causes and adjust treatment to avoid complications.
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Affiliation(s)
- J A Divisón-Garrote
- Centro de Salud Casas Ibañez, Albacete, Spain; Director Cátedra de Medicina de Familia SEMERGEN, Universidad Católica San Antonio de Murcia, Spain
| | - M Á Prieto-Díaz
- Centro de Salud Vallobín-La Florida, Oviedo, Spain; Doctorando en Facultad de Medicina, Cátedra Universidad Santiago de Compostela - SEMERGEN, Spain.
| | | | | | | | | | - S Cinza-Sanjurjo
- Centro de Salud Porto do Son, A Coruña, Spain; Cátedra SEMERGEN Universidad de Santiago de Compostela, Spain
| | | | - J Polo-García
- Centro de Salud Centro de Salud Casar de Cáceres, Cáceres, Spain
| | - V Pallarés-Carratalá
- Unidad de Vigilancia de la Salud, Unión de Mutuas, Castellón, Spain; Departamento de Medicina, Universitat Jaume I, Castellón, Spain
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Prevalencia de obesidad y comorbilidad cardiovascular asociada en los pacientes incluidos en el estudio IBERICAN (Identificación de la poBlación Española de RIesgo CArdiovascular y reNal). Semergen 2019; 45:311-322. [DOI: 10.1016/j.semerg.2018.11.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 11/05/2018] [Accepted: 11/09/2018] [Indexed: 01/24/2023]
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Márquez-Contreras E, López García-Ramos LD, Martell-Claros N, Gil-Guillen VF, Márquez-Rivero S, Pérez-López E, Garrido-Lopez MA, Farauste C, López-Pineda A, Casado-Martinez JJ, Orozco-Beltran D, Quesada JA, Carratalá-Munuera C. Validation of the electronic prescription as a method for measuring treatment adherence in hypertension. PATIENT EDUCATION AND COUNSELING 2018; 101:1654-1660. [PMID: 29731180 DOI: 10.1016/j.pec.2018.04.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 04/18/2018] [Accepted: 04/21/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To validate electronic prescriptions (e-prescriptions) as a method for measuring treatment adherence in patients with hypertension. METHODS This prospective study initially included 120 patients treated for hypertension in primary care centers. Adherence was measured using the gold standard, the medication event monitoring system (MEMS), versus the index test, the e-prescription program, at baseline and at 6, 12, 18 and 24 months. We calculated the adherence rate using the MEMS and the medication possession ratio (MPR) for the e-prescriptions. We considered patients adherent if they had an adherence rate of 80% to 100%. To validate the e-prescription, we obtained measures of diagnostic accuracy, the Kappa concordance index, and the area under the ROC curve (AUC). RESULTS We included 102 patients. Overall adherence was 77.4% by MEMS (95%CI: 66.8-88) and 80.4% (95%CI: 70.3-90.5) by MPR. At 24 months, sensitivity was 87% and specificity, 93.7%. The AUC was 0.903 (95%CI: 0.817-0.989). CONCLUSION Measures of treatment adherence were not significantly different between e-prescription and gold standard at most visits, and the e-prescription showed good discriminatory diagnostic capacity. PRACTICE IMPLICATIONS If patients are included in an e-prescription program for at least 2 years, e-prescription is an inexpensive method to measure adherence in hypertension.
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Affiliation(s)
| | | | | | - Vicente F Gil-Guillen
- Cátedra de Medicina de Familia. Clinical Medicine Department, Miguel Hernandez University, San Juan de Alicante, Spain
| | | | | | | | | | - Adriana López-Pineda
- Cátedra de Medicina de Familia. Clinical Medicine Department, Miguel Hernandez University, San Juan de Alicante, Spain.
| | | | - Domingo Orozco-Beltran
- Cátedra de Medicina de Familia. Clinical Medicine Department, Miguel Hernandez University, San Juan de Alicante, Spain
| | - Jose A Quesada
- Cátedra de Medicina de Familia. Clinical Medicine Department, Miguel Hernandez University, San Juan de Alicante, Spain
| | - Concepción Carratalá-Munuera
- Cátedra de Medicina de Familia. Clinical Medicine Department, Miguel Hernandez University, San Juan de Alicante, Spain
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Shalnova SA, Konradi AО, Balanova YA, Deev AD, Imaeva AE, Muromtseva GA, Evstifeeva SE, Kapustina AV, Shlyakhto EV, Boytsov SA, Drapkina ОМ. What factors do influence arterial hypertension control in Russia. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2018. [DOI: 10.15829/1728-8800-2018-4-53-60] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- S. A. Shalnova
- National Medical Research Centre of Prevention Medicine of the Ministry of Health
| | - A. О. Konradi
- Almazov National Medical Research Centre of the Ministry of Health
| | - Yu. A. Balanova
- National Medical Research Centre of Prevention Medicine of the Ministry of Health
| | - A. D. Deev
- National Medical Research Centre of Prevention Medicine of the Ministry of Health
| | - A. E. Imaeva
- National Medical Research Centre of Prevention Medicine of the Ministry of Health
| | - G. A. Muromtseva
- National Medical Research Centre of Prevention Medicine of the Ministry of Health
| | - S. E. Evstifeeva
- National Medical Research Centre of Prevention Medicine of the Ministry of Health
| | - A. V. Kapustina
- National Medical Research Centre of Prevention Medicine of the Ministry of Health
| | - E. V. Shlyakhto
- Almazov National Medical Research Centre of the Ministry of Health
| | - S. A. Boytsov
- National Medical Research Centre of Cardiology of the Ministry of Health
| | - О. М. Drapkina
- National Medical Research Centre of Prevention Medicine of the Ministry of Health
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Martínez MA, Garcia-Puig J, Loeches MP, Mateo MC, Utiel I, Torres R. Home blood pressure vs. clinic blood pressure measurement-based follow up in type ii diabetics: Effect on 24-h ambulatory BP and albuminuria. Randomised trial. Med Clin (Barc) 2018; 150:413-420. [PMID: 28867335 DOI: 10.1016/j.medcli.2017.06.023] [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: 05/25/2017] [Revised: 06/12/2017] [Accepted: 06/15/2017] [Indexed: 11/18/2022]
Abstract
BAKGROUND AND OBJECTIVE To compare the efficacy of two strategies of blood pressure (BP) measurement-based follow-up in hypertension and albuminuria control. PATIENTS AND METHODS Multicentre, prospective, randomised, open trial with a parallel-group design. Nineteen primary care centres and a hospital clinic participated. Adult type 2 diabetics with systolic BP ≥140mmHg without relevant renal disease were randomised to one of two follow-up strategies: 1) standard follow up, with a clinic BP target <140/90mmHg and 2) self-monitoring home BP (SMHBP)-based follow up, with a BP target <135/85mmHg. Biochemical standard blood variables, albuminuria, and 24-h ambulatory BP monitoring were performed at entry, 12 and 24 months. The main outcome measurement was 24-h ambulatory systolic BP variation. Albuminuria change was analysed as a secondary outcome. RESULTS 116 patients were analysed (mean age: 66.8 years). Mean systolic ambulatory 24- h BP change in two years was 3.9mmHg (95% CI 1.8-6.1). We did not find significant differences between both groups (p=0.706). Similarly, no differences were found when we compared other ambulatory BP values. Initial albuminuria was similar in both groups and did not significantly changed throughout the follow-up period. CONCLUSION In type 2 diabetics without relevant nephropathy a SMHBP- based follow up was equivalent to a standard clinic-based BP follow up in BP and albuminuria control.
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Affiliation(s)
- María A Martínez
- Unidad de Riesgo Vascular, Servicio de Medicina Interna, Hospital Infanta Sofía, S. S. de los Reyes, Universidad Europea, Madrid, España.
| | - Juan Garcia-Puig
- Unidad Metabólico-Vascular, Servicio de Medicina Interna, Hospital Universitario La Paz, Madrid, España
| | | | | | - Isaías Utiel
- Centro de Salud General Ricardos, Madrid, España
| | - Rosa Torres
- Unidad Metabólico-Vascular, Servicio de Medicina Interna, Hospital Universitario La Paz, Madrid, España
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Miquel L, López-Pelayo H, Nuño L, Arbesú JÁ, Zarco J, Manthey J, Rehm J, Gual A. Barriers to implement screening for alcohol consumption in Spanish hypertensive patients. Fam Pract 2018; 35:295-301. [PMID: 29106526 DOI: 10.1093/fampra/cmx107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Alcohol intake and hypertension (HT) are interrelated public health problems with cost-effective interventions at the primary care level that, to date, are poorly implemented. OBJECTIVE This study aims to explore the barriers to implementing alcohol interventions for people with HT in primary care. METHODS As part of the project BASIS (Baseline Alcohol Screening and Intervention Survey), an internet survey from five European countries was developed to determine the role of alcohol in the management of HT in primary care practice. The survey contained 28 core items and 7 country-specific items. We present answers from Spanish general practitioners (GPs), who were reached through the main professional and scientific societies via e-mail and asked to take the online survey. RESULTS In total, 867 GPs answered the survey (65.1% women, 70.4% > 30 years old). As indicated by the Alcohol Use Disorders Identification Test-C scores, 12.4% of GPs who responded were risky drinkers (21.3% of men versus 7.1% of women). GPs reported considering alcohol relatively unimportant in HT treatment, as well as a difficult condition to deal with. The three main barriers to implement screening for alcohol consumption in HT patients were the lack of time (50.0%), considering alcohol unimportant for HT (28.4%) and stigma (16.5%). CONCLUSIONS GPs did not consider alcohol consumption a relevant factor for HT and, additionally, found it difficult to deal with alcohol problems. Some of the barriers for alcohol screening could be overcome through structural changes in the health system, such as empowering GPs to treat alcohol use disorders (rather than a single focus on implementing preventive strategies) by enhancing training in alcohol diagnosis and treatment.
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Affiliation(s)
- Laia Miquel
- Grup de Recerca en Addiccions Clínic, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Red de Trastornos adictivos (RETICS), Barcelona, Spain
| | - Hugo López-Pelayo
- Grup de Recerca en Addiccions Clínic, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Red de Trastornos adictivos (RETICS), Barcelona, Spain
| | - Laura Nuño
- Grup de Recerca en Addiccions Clínic, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Red de Trastornos adictivos (RETICS), Barcelona, Spain
| | - José Ángel Arbesú
- Área de Neurociencias de Semergen, Primary Health Care Center Eria, Oviedo, Spain
| | - José Zarco
- Primary Health Care Center Ibiza, Servicio Madrileño de Salud, Madrid, Spain.,Sociedad Española de Medicina Familiar y Comunitaria (semFYC), Madrid, Spain.,Departamento Medicina Interna, Universidad Complutense de Madrid, Madrid, Spain
| | - Jakob Manthey
- Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität, Dresden, Germany
| | - Jürgen Rehm
- Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität, Dresden, Germany.,Institute for Mental Health Policy Research (IMHPR), Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, CAMH, Toronto, ON, Canada
| | - Antoni Gual
- Grup de Recerca en Addiccions Clínic, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Red de Trastornos adictivos (RETICS), Barcelona, Spain
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Brotons Cuixart C, Alemán Sánchez JJ, Banegas Banegas JR, Fondón León C, Lobos-Bejarano JM, Martín Rioboó E, Navarro Pérez J, Orozco-Beltrán D, Villar Álvarez F. Recomendaciones preventivas cardiovasculares. Actualización PAPPS 2018. Aten Primaria 2018; 50 Suppl 1:4-28. [PMID: 29866357 PMCID: PMC6836998 DOI: 10.1016/s0212-6567(18)30360-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Carlos Brotons Cuixart
- Especialista en Medicina Familiar y Comunitaria, Equipo de Atención Primaria Sardenya, Barcelona
| | - José Juan Alemán Sánchez
- Especialista en Medicina Familiar y Comunitaria, Dirección General de Salud Pública, Servicio Canario de la Salud
| | - José Ramón Banegas Banegas
- Especialista en Medicina Preventiva y Salud Pública, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid
| | - Carlos Fondón León
- Especialista en Medicina Familiar y Comunitaria, Centro de Salud Colmenar de Oreja, Madrid
| | | | | | - Jorge Navarro Pérez
- Especialista en Medicina Familiar y Comunitaria, Hospital Clínico Universitario, Valencia
| | - Domingo Orozco-Beltrán
- Especialista en Medicina Familiar y Comunitaria, Unidad de Investigación CS Cabo Huertas, Departamento San Juan de Alicante, Alicante
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10
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Banegas JR, Ruilope LM, de la Sierra A, Vinyoles E, Gorostidi M, de la Cruz JJ, Ruiz-Hurtado G, Segura J, Rodríguez-Artalejo F, Williams B. Relationship between Clinic and Ambulatory Blood-Pressure Measurements and Mortality. N Engl J Med 2018; 378:1509-1520. [PMID: 29669232 DOI: 10.1056/nejmoa1712231] [Citation(s) in RCA: 335] [Impact Index Per Article: 55.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Evidence for the influence of ambulatory blood pressure on prognosis derives mainly from population-based studies and a few relatively small clinical investigations. This study examined the associations of blood pressure measured in the clinic (clinic blood pressure) and 24-hour ambulatory blood pressure with all-cause and cardiovascular mortality in a large cohort of patients in primary care. METHODS We analyzed data from a registry-based, multicenter, national cohort that included 63,910 adults recruited from 2004 through 2014 in Spain. Clinic and 24-hour ambulatory blood-pressure data were examined in the following categories: sustained hypertension (elevated clinic and elevated 24-hour ambulatory blood pressure), "white-coat" hypertension (elevated clinic and normal 24-hour ambulatory blood pressure), masked hypertension (normal clinic and elevated 24-hour ambulatory blood pressure), and normotension (normal clinic and normal 24-hour ambulatory blood pressure). Analyses were conducted with Cox regression models, adjusted for clinic and 24-hour ambulatory blood pressures and for confounders. RESULTS During a median follow-up of 4.7 years, 3808 patients died from any cause, and 1295 of these patients died from cardiovascular causes. In a model that included both 24-hour and clinic measurements, 24-hour systolic pressure was more strongly associated with all-cause mortality (hazard ratio, 1.58 per 1-SD increase in pressure; 95% confidence interval [CI], 1.56 to 1.60, after adjustment for clinic blood pressure) than the clinic systolic pressure (hazard ratio, 1.02; 95% CI, 1.00 to 1.04, after adjustment for 24-hour blood pressure). Corresponding hazard ratios per 1-SD increase in pressure were 1.55 (95% CI, 1.53 to 1.57, after adjustment for clinic and daytime blood pressures) for nighttime ambulatory systolic pressure and 1.54 (95% CI, 1.52 to 1.56, after adjustment for clinic and nighttime blood pressures) for daytime ambulatory systolic pressure. These relationships were consistent across subgroups of age, sex, and status with respect to obesity, diabetes, cardiovascular disease, and antihypertensive treatment. Masked hypertension was more strongly associated with all-cause mortality (hazard ratio, 2.83; 95% CI, 2.12 to 3.79) than sustained hypertension (hazard ratio, 1.80; 95% CI, 1.41 to 2.31) or white-coat hypertension (hazard ratio, 1.79; 95% CI, 1.38 to 2.32). Results for cardiovascular mortality were similar to those for all-cause mortality. CONCLUSIONS Ambulatory blood-pressure measurements were a stronger predictor of all-cause and cardiovascular mortality than clinic blood-pressure measurements. White-coat hypertension was not benign, and masked hypertension was associated with a greater risk of death than sustained hypertension. (Funded by the Spanish Society of Hypertension and others.).
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Affiliation(s)
- José R Banegas
- From the Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/Instituto de Investigación Hospital Universitario La Paz (IdiPAZ) and Centro de Investigación Biomédica en Red (CIBER) of Epidemiology and Public Health (J.R.B., L.M.R., J.J.C., F.R.-A.), the Hypertension Unit, Department of Nephrology, and Cardiorenal Translational Research Laboratory, Institute of Research, Hospital Universitario 12 de Octubre and CIBER of Cardiovascular Disease (L.M.R., G.R.-H., J.S.), the School of Doctoral Studies and Research, Universidad Europea de Madrid (L.M.R.), and Madrid Institute for Advanced Studies Food Institute, Campus de Excelencia Internacional de la Universidad Autónoma de Madrid y Consejo Superior de Investigaciones Científicas (F.R.-A.), Madrid, the Department of Internal Medicine, Hospital Mutua Terrassa (A.S.), and La Mina Primary Care Center (E.V.), University of Barcelona, Barcelona, and the Nephrology Service, Hospital Universitario Central de Asturias, Red de Investigación Renal, Oviedo (M.G.) - all in Spain; and University College London (UCL) Institute of Cardiovascular Science and the National Institute for Health Research UCL Hospitals Biomedical Research Centre, London (B.W.)
| | - Luis M Ruilope
- From the Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/Instituto de Investigación Hospital Universitario La Paz (IdiPAZ) and Centro de Investigación Biomédica en Red (CIBER) of Epidemiology and Public Health (J.R.B., L.M.R., J.J.C., F.R.-A.), the Hypertension Unit, Department of Nephrology, and Cardiorenal Translational Research Laboratory, Institute of Research, Hospital Universitario 12 de Octubre and CIBER of Cardiovascular Disease (L.M.R., G.R.-H., J.S.), the School of Doctoral Studies and Research, Universidad Europea de Madrid (L.M.R.), and Madrid Institute for Advanced Studies Food Institute, Campus de Excelencia Internacional de la Universidad Autónoma de Madrid y Consejo Superior de Investigaciones Científicas (F.R.-A.), Madrid, the Department of Internal Medicine, Hospital Mutua Terrassa (A.S.), and La Mina Primary Care Center (E.V.), University of Barcelona, Barcelona, and the Nephrology Service, Hospital Universitario Central de Asturias, Red de Investigación Renal, Oviedo (M.G.) - all in Spain; and University College London (UCL) Institute of Cardiovascular Science and the National Institute for Health Research UCL Hospitals Biomedical Research Centre, London (B.W.)
| | - Alejandro de la Sierra
- From the Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/Instituto de Investigación Hospital Universitario La Paz (IdiPAZ) and Centro de Investigación Biomédica en Red (CIBER) of Epidemiology and Public Health (J.R.B., L.M.R., J.J.C., F.R.-A.), the Hypertension Unit, Department of Nephrology, and Cardiorenal Translational Research Laboratory, Institute of Research, Hospital Universitario 12 de Octubre and CIBER of Cardiovascular Disease (L.M.R., G.R.-H., J.S.), the School of Doctoral Studies and Research, Universidad Europea de Madrid (L.M.R.), and Madrid Institute for Advanced Studies Food Institute, Campus de Excelencia Internacional de la Universidad Autónoma de Madrid y Consejo Superior de Investigaciones Científicas (F.R.-A.), Madrid, the Department of Internal Medicine, Hospital Mutua Terrassa (A.S.), and La Mina Primary Care Center (E.V.), University of Barcelona, Barcelona, and the Nephrology Service, Hospital Universitario Central de Asturias, Red de Investigación Renal, Oviedo (M.G.) - all in Spain; and University College London (UCL) Institute of Cardiovascular Science and the National Institute for Health Research UCL Hospitals Biomedical Research Centre, London (B.W.)
| | - Ernest Vinyoles
- From the Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/Instituto de Investigación Hospital Universitario La Paz (IdiPAZ) and Centro de Investigación Biomédica en Red (CIBER) of Epidemiology and Public Health (J.R.B., L.M.R., J.J.C., F.R.-A.), the Hypertension Unit, Department of Nephrology, and Cardiorenal Translational Research Laboratory, Institute of Research, Hospital Universitario 12 de Octubre and CIBER of Cardiovascular Disease (L.M.R., G.R.-H., J.S.), the School of Doctoral Studies and Research, Universidad Europea de Madrid (L.M.R.), and Madrid Institute for Advanced Studies Food Institute, Campus de Excelencia Internacional de la Universidad Autónoma de Madrid y Consejo Superior de Investigaciones Científicas (F.R.-A.), Madrid, the Department of Internal Medicine, Hospital Mutua Terrassa (A.S.), and La Mina Primary Care Center (E.V.), University of Barcelona, Barcelona, and the Nephrology Service, Hospital Universitario Central de Asturias, Red de Investigación Renal, Oviedo (M.G.) - all in Spain; and University College London (UCL) Institute of Cardiovascular Science and the National Institute for Health Research UCL Hospitals Biomedical Research Centre, London (B.W.)
| | - Manuel Gorostidi
- From the Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/Instituto de Investigación Hospital Universitario La Paz (IdiPAZ) and Centro de Investigación Biomédica en Red (CIBER) of Epidemiology and Public Health (J.R.B., L.M.R., J.J.C., F.R.-A.), the Hypertension Unit, Department of Nephrology, and Cardiorenal Translational Research Laboratory, Institute of Research, Hospital Universitario 12 de Octubre and CIBER of Cardiovascular Disease (L.M.R., G.R.-H., J.S.), the School of Doctoral Studies and Research, Universidad Europea de Madrid (L.M.R.), and Madrid Institute for Advanced Studies Food Institute, Campus de Excelencia Internacional de la Universidad Autónoma de Madrid y Consejo Superior de Investigaciones Científicas (F.R.-A.), Madrid, the Department of Internal Medicine, Hospital Mutua Terrassa (A.S.), and La Mina Primary Care Center (E.V.), University of Barcelona, Barcelona, and the Nephrology Service, Hospital Universitario Central de Asturias, Red de Investigación Renal, Oviedo (M.G.) - all in Spain; and University College London (UCL) Institute of Cardiovascular Science and the National Institute for Health Research UCL Hospitals Biomedical Research Centre, London (B.W.)
| | - Juan J de la Cruz
- From the Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/Instituto de Investigación Hospital Universitario La Paz (IdiPAZ) and Centro de Investigación Biomédica en Red (CIBER) of Epidemiology and Public Health (J.R.B., L.M.R., J.J.C., F.R.-A.), the Hypertension Unit, Department of Nephrology, and Cardiorenal Translational Research Laboratory, Institute of Research, Hospital Universitario 12 de Octubre and CIBER of Cardiovascular Disease (L.M.R., G.R.-H., J.S.), the School of Doctoral Studies and Research, Universidad Europea de Madrid (L.M.R.), and Madrid Institute for Advanced Studies Food Institute, Campus de Excelencia Internacional de la Universidad Autónoma de Madrid y Consejo Superior de Investigaciones Científicas (F.R.-A.), Madrid, the Department of Internal Medicine, Hospital Mutua Terrassa (A.S.), and La Mina Primary Care Center (E.V.), University of Barcelona, Barcelona, and the Nephrology Service, Hospital Universitario Central de Asturias, Red de Investigación Renal, Oviedo (M.G.) - all in Spain; and University College London (UCL) Institute of Cardiovascular Science and the National Institute for Health Research UCL Hospitals Biomedical Research Centre, London (B.W.)
| | - Gema Ruiz-Hurtado
- From the Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/Instituto de Investigación Hospital Universitario La Paz (IdiPAZ) and Centro de Investigación Biomédica en Red (CIBER) of Epidemiology and Public Health (J.R.B., L.M.R., J.J.C., F.R.-A.), the Hypertension Unit, Department of Nephrology, and Cardiorenal Translational Research Laboratory, Institute of Research, Hospital Universitario 12 de Octubre and CIBER of Cardiovascular Disease (L.M.R., G.R.-H., J.S.), the School of Doctoral Studies and Research, Universidad Europea de Madrid (L.M.R.), and Madrid Institute for Advanced Studies Food Institute, Campus de Excelencia Internacional de la Universidad Autónoma de Madrid y Consejo Superior de Investigaciones Científicas (F.R.-A.), Madrid, the Department of Internal Medicine, Hospital Mutua Terrassa (A.S.), and La Mina Primary Care Center (E.V.), University of Barcelona, Barcelona, and the Nephrology Service, Hospital Universitario Central de Asturias, Red de Investigación Renal, Oviedo (M.G.) - all in Spain; and University College London (UCL) Institute of Cardiovascular Science and the National Institute for Health Research UCL Hospitals Biomedical Research Centre, London (B.W.)
| | - Julián Segura
- From the Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/Instituto de Investigación Hospital Universitario La Paz (IdiPAZ) and Centro de Investigación Biomédica en Red (CIBER) of Epidemiology and Public Health (J.R.B., L.M.R., J.J.C., F.R.-A.), the Hypertension Unit, Department of Nephrology, and Cardiorenal Translational Research Laboratory, Institute of Research, Hospital Universitario 12 de Octubre and CIBER of Cardiovascular Disease (L.M.R., G.R.-H., J.S.), the School of Doctoral Studies and Research, Universidad Europea de Madrid (L.M.R.), and Madrid Institute for Advanced Studies Food Institute, Campus de Excelencia Internacional de la Universidad Autónoma de Madrid y Consejo Superior de Investigaciones Científicas (F.R.-A.), Madrid, the Department of Internal Medicine, Hospital Mutua Terrassa (A.S.), and La Mina Primary Care Center (E.V.), University of Barcelona, Barcelona, and the Nephrology Service, Hospital Universitario Central de Asturias, Red de Investigación Renal, Oviedo (M.G.) - all in Spain; and University College London (UCL) Institute of Cardiovascular Science and the National Institute for Health Research UCL Hospitals Biomedical Research Centre, London (B.W.)
| | - Fernando Rodríguez-Artalejo
- From the Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/Instituto de Investigación Hospital Universitario La Paz (IdiPAZ) and Centro de Investigación Biomédica en Red (CIBER) of Epidemiology and Public Health (J.R.B., L.M.R., J.J.C., F.R.-A.), the Hypertension Unit, Department of Nephrology, and Cardiorenal Translational Research Laboratory, Institute of Research, Hospital Universitario 12 de Octubre and CIBER of Cardiovascular Disease (L.M.R., G.R.-H., J.S.), the School of Doctoral Studies and Research, Universidad Europea de Madrid (L.M.R.), and Madrid Institute for Advanced Studies Food Institute, Campus de Excelencia Internacional de la Universidad Autónoma de Madrid y Consejo Superior de Investigaciones Científicas (F.R.-A.), Madrid, the Department of Internal Medicine, Hospital Mutua Terrassa (A.S.), and La Mina Primary Care Center (E.V.), University of Barcelona, Barcelona, and the Nephrology Service, Hospital Universitario Central de Asturias, Red de Investigación Renal, Oviedo (M.G.) - all in Spain; and University College London (UCL) Institute of Cardiovascular Science and the National Institute for Health Research UCL Hospitals Biomedical Research Centre, London (B.W.)
| | - Bryan Williams
- From the Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/Instituto de Investigación Hospital Universitario La Paz (IdiPAZ) and Centro de Investigación Biomédica en Red (CIBER) of Epidemiology and Public Health (J.R.B., L.M.R., J.J.C., F.R.-A.), the Hypertension Unit, Department of Nephrology, and Cardiorenal Translational Research Laboratory, Institute of Research, Hospital Universitario 12 de Octubre and CIBER of Cardiovascular Disease (L.M.R., G.R.-H., J.S.), the School of Doctoral Studies and Research, Universidad Europea de Madrid (L.M.R.), and Madrid Institute for Advanced Studies Food Institute, Campus de Excelencia Internacional de la Universidad Autónoma de Madrid y Consejo Superior de Investigaciones Científicas (F.R.-A.), Madrid, the Department of Internal Medicine, Hospital Mutua Terrassa (A.S.), and La Mina Primary Care Center (E.V.), University of Barcelona, Barcelona, and the Nephrology Service, Hospital Universitario Central de Asturias, Red de Investigación Renal, Oviedo (M.G.) - all in Spain; and University College London (UCL) Institute of Cardiovascular Science and the National Institute for Health Research UCL Hospitals Biomedical Research Centre, London (B.W.)
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Torija Archilla A, Pérez González J, Sarmiento Ramírez Á, Fernández Sánchez E, González Ruiz JR, Guisado Barrilao R. [Effects of a recreational general physical activity program with short term and moderate intensity of blood pressure and other cardiovascular risk factors in hypertensive patients over 50 years old]. Aten Primaria 2017; 49:473-483. [PMID: 28185666 PMCID: PMC6876056 DOI: 10.1016/j.aprim.2016.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Revised: 11/06/2016] [Accepted: 11/07/2016] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES To evaluate the effects of a recreational general physical activity program with moderate intensity and short duration on blood pressure and other cardiovascular risk factors (BMI, cholesterol, Rest Heart Rate, HDL, LDL, Triglycerides) in hypertensive patients older than 50years. DESIGN Non-randomised pre-post design, quasi-experimental study. LOCATION Íllora, Granada, Spain. PARTICIPANTS A total of 60 subjects aged 50-75years taking part in the Health Hypertensive Program in the Medical Centre were selected. INTERVENTION A recreational general physical activity program, mainly aerobic capacity, of 4weeks duration, 3days/week, and an intensity of 45-55% HR Reserve. MAIN MEASUREMENTS SBP, DBP, HR, BMI, total cholesterol, HDL, LDL, TG, and Glucose. RESULTS AND CONCLUSIONS Statistically significant decreases (P<.05) were observed in BMI (-0.51%; 95%CI: 30.26 to 31.93units), HR (-5.57beats/min; 95%CI: 68.76 to 71.73beats/min), SBP (-14.82mmHg; 95%CI: 131.57 to 137.52mmHg), DBP (-5.33mmHg; 95%CI: 78.94 to 83.68mmHg), Glucose (-7.63mg/dL; 95%CI: 125.06 to 153.73mg/dL) and REGICOR risk (-20.46%; 95%CI: 5.45 to 6.90%). Statistically significant increases were observed in HDL (+2.82mg/dl; 95%CI: 46.78 to 52.11mmHg), and TG (+8.27mg/dl; 95%CI: 133.89 to 152.60mg/dL). Men had a wider variation in HR and DBP, and women in SBP (P<.05). Subjects with baseline SBP≥160mmHg experienced greater declines in HR, SBP, DBP, Glucose and TG (-10.67beats/min, -31mmHg, -8.27mmHg, -10.86mg/dL, and 34.66mg/dL, respectively) than those with an initial SBP<160mmHg, where there was an increase in HDL and a decrease in LDL. After this program, improvements in BP and other cardiovascular risk factors were obtained in hypertensive subjects over 50years.
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Affiliation(s)
- Ana Torija Archilla
- Ciencias de la Actividad Física y el Deporte, Enfermería, Universidad de Granada, Granada, España.
| | | | | | | | | | - Rafael Guisado Barrilao
- Departamento de Enfermería, Facultad de Ciencias de la Salud, Universidad de Granada, Granada, España
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Sánchez-Prieto J, Sabatel F, Villarrubia Mendez G, Divisón JA, Garcia-Donaire JA, Rodríguez-Padial L. [Control of blood pressure by using an intelligent telephone application with feedback and competitiveness strategy. HTApp Control project]. Semergen 2017; 44:30-36. [PMID: 28882734 DOI: 10.1016/j.semerg.2017.07.006] [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: 03/02/2017] [Revised: 06/26/2017] [Accepted: 07/11/2017] [Indexed: 11/18/2022]
Abstract
INTRODUCTION AND OBJECTIVE Arterial hypertension is a highly important cardiovascular risk factor, with low control percentages. New technologies can help to obtain a better control of this disease. The intention is to know if a mobile application can help achieve this goal. METHOD A mobile phone application is used to give feedback to physicians with the aim of generate competitiveness in achieving objectives. The application could, at any time, determine the rate of controlled patients (<140/90mmHg) by each physician, and compare them with the mean number of the patients controlled by the group. The possible changes in the therapeutic attitude of physicians are also analysed and the differences in achieving objectives are compared based on specific characteristics of patients. RESULTS The study included 220 patients aged 18-80 years, with mean blood pressure>140/90mmHg, despite medical treatment, tracked for 4 visits. At the end of the follow-up, 69.03% achieved good control, compared to 12.8% in the baseline study (P<.001), with no differences between gender (control of 68.6 and 69.29% of women and men, respectively), nor among the different levels of cardiovascular risk. CONCLUSIONS The use of interactive tools that allow the dynamic process of feedback on the results fosters the motivation and improves the therapeutic inertia in the control of blood pressure.
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Affiliation(s)
- J Sánchez-Prieto
- Servicio de Cardiología, Complejo Hospitalario Universitario de Toledo, Toledo, España.
| | - F Sabatel
- Servicio de Cardiología, Complejo Hospitalario Universitario de Toledo, Toledo, España
| | | | - J A Divisón
- Centro de Salud Casas Ibáñez, Casas Ibáñez, Albacete, España
| | - J A Garcia-Donaire
- Unidad de Hipertensión Arterial, Hospital Clínico San Carlos, Madrid, España
| | - L Rodríguez-Padial
- Servicio de Cardiología, Complejo Hospitalario Universitario de Toledo, Toledo, España
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Most advisable strategy in search of asymptomatic target organ damage in hypertensive patients. HIPERTENSION Y RIESGO VASCULAR 2017; 34:149-156. [PMID: 28522299 DOI: 10.1016/j.hipert.2017.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 04/03/2017] [Accepted: 04/09/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the diagnostic potential of seven examinations in order to define the most suitable strategy for target organ damage (TOD) search in hypertensive patients. METHODS This is a descriptive, cross-sectional study. 153 consecutive treated and essential hypertensive patients were enrolled. Patients with established cardiovascular or chronic renal disease (stage ≥4) were excluded. TOD search was assessed by: glomerular filtration rate (GFR), albumin/creatinine ratio (ACR), electrocardiogram (ECG), echocardiogram (ECO), ankle-brachial index (ABI), pulse wave velocity (PWV), and carotid ultrasound (intima media thickness and presence of plaques). The rationale of our strategy ought to determine the performance of applying a set of the most widely available tests (GFR, ACR, ABI, ECG) and advise about the optimal sequence of the remaining tests. RESULTS The sample was 64.4±7.9 years old, 45.8% males. 82.6% of the sample had any TOD at all. The resulting algorithm found a 37% TOD in relation to GFR, ACR, ABI and ECG values. Adding carotid ultrasound added up to 70% of the studied population and properly classified (TOD+/TOD-) 89% of the cohort. When performing PWV, 78% of the patients had been identified as TOD+ and 96% of the population was correctly identified. Contribution of ECO was minor. CONCLUSION After running the more widely available explorations (GFR, ACR, ABI, ECG), a step-by-step strategy that included carotid ultrasound, PWV and ECO could be the best sequence for TOD search in asymptomatic hypertensive patients.
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Mazón P, Galve E, Gómez J, Gorostidi M, Górriz JL, Mediavilla JD. [Medical expert consensus in AH on the clinical use of triple fixed-dose antihypertensive therapy in Spain]. HIPERTENSION Y RIESGO VASCULAR 2016; 33:133-144. [PMID: 27129628 DOI: 10.1016/j.hipert.2016.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 02/29/2016] [Accepted: 03/08/2016] [Indexed: 01/13/2023]
Abstract
INTRODUCTION The opinion of experts (different specialties) on the triple fixed-dose antihypertensive therapy in clinical practice may differ. MATERIALS AND METHODS Online questionnaire with controversial aspects of the triple therapy answered by panel of experts in hypertension (HT) using two-round modified Delphi method. RESULTS The questionnaire was completed by 158 experts: Internal Medicine (49), Nephrology (26), Cardiology (83). Consensus was reached (agreement) on 27/45 items (60%); 7 items showed differences statistically significant. Consensus was reached regarding: Predictive factors in the need for combination therapy and its efficacy vs. increasing the dose of a pretreatment, and advantage of triple therapy (prescription/adherence/cost/pressure control) vs. free combination. CONCLUSIONS This consensus provides an overview of the clinical use of triple therapy in moderate-severe and resistant/difficult to control HT.
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Affiliation(s)
- P Mazón
- Servicio de Cardiología, Hospital Clínico Universitario, Santiago de Compostela, España.
| | - E Galve
- Servicio de Cardiología, Hospital Vall d'Hebrón, Barcelona, España
| | - J Gómez
- Servicio de Medicina Interna, Hospital Infanta Sofía, Madrid, España
| | - M Gorostidi
- Servicio de Nefrología, Hospital Universitario Central de Asturias, Oviedo, España
| | - J L Górriz
- Servicio de Nefrología, Hospital Universitario Dr. Peset, Valencia, España
| | - J D Mediavilla
- Unidad de Hipertensión, Hospital Virgen de las Nieves, Granada, España
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Estudio PATHWAY-2. La visión del médico de familia en el abordaje de la hipertensión arterial resistente. HIPERTENSION Y RIESGO VASCULAR 2016; 33:145-149. [DOI: 10.1016/j.hipert.2016.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 06/02/2016] [Accepted: 06/06/2016] [Indexed: 11/23/2022]
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[Baseline characteristics and clinical management of the first 3,000 patients enrolled in the IBERICAN study (Identification of the Spanish population at cardiovascular and renal risk)]. Semergen 2016; 43:493-500. [PMID: 27567214 DOI: 10.1016/j.semerg.2016.07.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 07/04/2016] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To determine the prevalence and incidence of cardiovascular risk factors in Spain, as well as cardiovascular events, in Spanish adult population attended in primary care. METHODOLOGY IBERICAN is a longitudinal, observational, multicenter study in which patients aged 18 to 85years attended in primary care health center in Spain are being included. The obtained cohort will be followed annually for at least 5years. The estimated final sample is 7,000 patients. The baseline characteristics of the second cut (n=3,042) are presented. RESULTS The mean age of the subjects included is 57.9±14.6 years, and 55.5% are women. 54.9% live in urban habitat, and 57.3% have primary education. 50.3% had dyslipidemia, 47.4% hypertension, 29.7% physical inactivity, 28.2% abdominal obesity and 19% diabetes mellitus. The degree of control of hypertension, dyslipidemia and type2 diabetes was 58.5%, 25.8% and 75.9%. 28.2% have criteria for metabolic syndrome. 15.6% of patients had previous cardiovascular disease. 7.8% have a history of coronary heart disease, a glomerular filtration rate <60ml/min (CKD-EPI) 8.4%, microalbuminuria 9.6%, atrial fibrillation 5.5%, stroke 4.6%, and heart failure 2.9%. CONCLUSIONS Although the population treated in primary care is relatively young, the high prevalence of risk factors, their poor control and the existence of previous cardiovascular disease will determine the impact on the prognosis of the cohort.
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Levi M, Pasqua A, Cricelli I, Cricelli C, Piccinni C, Parretti D, Lapi F. Patient Adherence to Olmesartan/Amlodipine Combinations: Fixed Versus Extemporaneous Combinations. J Manag Care Spec Pharm 2016; 22:255-62. [PMID: 27003555 PMCID: PMC10398216 DOI: 10.18553/jmcp.2016.22.3.255] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Lack of adherence to prescribed therapies is often a cause of suboptimal blood pressure control in patients with hypertension. To enhance patients' adherence to treatment, fixed-dose combinations of active substances with complementary mechanisms of action have been developed. An angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker (ARB) is often combined with a calcium channel blocker. Olmesartan is the most used ARB in combination therapy. In Italy, in September 2011, a fixed-dose combination of olmesartan/amlodipine (olmesartan/amlodipine 20/5 mg, 40/5 mg, or 40/10 mg) was introduced to treat patients with hypertension for whom control of blood pressure is not reached with either olmesartan or amlodipine alone. Prior research on adherence to olmesartan/amlodipine combinations was carried out in local contexts (e.g., claims databases of Italian regions or local health authorities), and/or it was limited by the fact that adherence was assessed against monotherapies already known for their low compliance profile, such as diuretics. OBJECTIVE To compare adherence with olmesartan/amlodipine fixed-dose combination (FDC) and extemporaneous combination in primary care in Italy. METHODS A nationwide, population-based study was conducted by using the Health Search IMS Health Longitudinal Patient Database. Patients aged > 17 years, affected by hypertension and treated with the FDC or extemporaneous combination of olmesartan/amlodipine, were identified. Adherence to these 2 therapeutic regimens was estimated by calculating the proportion of days covered (PDC). Patients were classified into 3 levels of adherence: high (PDC ≥ 80%), intermediate (PDC = 40%-79%), or low (PDC < 40%). RESULTS In the 6-month follow-up, FDC showed higher adherence compared with an extemporaneous combination (55.1% vs. 15.9%, P < 0.001). This difference was confirmed in a multivariable logistic regression model clustered on patient identifier (odds ratio = 6.65; 95% CI = 3.10-14.26; P < 0.001). The proportion of patients adherent to FDC varied from 60.4% for the 40/5 mg formulation to 47.5% for the 40/10 mg formulation. CONCLUSIONS These findings suggest that higher adherence may be achieved with FDCs than with extemporaneous combinations. To improve the degree of adherence, general practitioners may consider prescribing fixed combinations of antihypertensive agents as soon as monotherapies fail to achieve the expected therapeutic objective.
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Affiliation(s)
- Miriam Levi
- Research Fellow, Department of Health Sciences, University of Florence, Florence, Italy
| | - Alessandro Pasqua
- Chief Statistician, Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Iacopo Cricelli
- General Director, Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Claudio Cricelli
- President, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Carlo Piccinni
- Postdoctoral Researcher, Department of Medical and Surgical Sciences−Pharmacology Unit, University of Bologna, Bologna, Italy
| | - Damiano Parretti
- General Practitioner, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Francesco Lapi
- Research Director, Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
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Gual A, Zarco J, Colom Farran J, Rehm J. [Early screening and brief intervention in alcohol misuse to improve the treatment of hypertension in primary care]. Med Clin (Barc) 2015; 146:81-5. [PMID: 26520609 DOI: 10.1016/j.medcli.2015.07.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 07/15/2015] [Accepted: 07/16/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Antoni Gual
- Unidad de Alcohología, Servicio de Psiquiatría, Instituto de Neurociencias, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España.
| | - José Zarco
- Centro de Salud Ibiza, Servicio Madrileño de Salud, Madrid, España
| | - Joan Colom Farran
- Subdirección General de Drogodependencias, Agencia de Salud Pública de Cataluña, Departamento de Salud, Generalitat de Cataluña, Barcelona, España
| | - Jürgen Rehm
- Unidad de Investigación Epidemiológica, Psicología Clínica y Psicoterapia, Universidad Tecnológica de Dresde, Dresde, Alemania; Centre for Addiction and Mental Health, Toronto, Canadá
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Evolution of clinical profile, treatment and blood pressure control in treated hypertensive patients according to the sex from 2002 to 2010 in Spain. J Hypertens 2015; 33:1098-107. [DOI: 10.1097/hjh.0000000000000502] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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García Iglesias A, Lozano Alonso J, Álamo Sanz R, Vega Alonso T. Factores asociados al control de la presión arterial en la cohorte del estudio del Riesgo de Enfermedad Cardiovascular en Castilla y León (RECCyL). HIPERTENSION Y RIESGO VASCULAR 2015; 32:48-55. [DOI: 10.1016/j.hipert.2014.10.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 10/06/2014] [Accepted: 10/17/2014] [Indexed: 11/27/2022]
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Monteserín-Matesanz M, Esparza-Gómez GC, García-Chías B, Gasco-García C, Cerero-Lapiedra R. Descriptive study of the patients treated at the clinic "integrated dentistry for patients with special needs" at Complutense University of Madrid (2003-2012). Med Oral Patol Oral Cir Bucal 2015; 20:e211-7. [PMID: 25662539 PMCID: PMC4393985 DOI: 10.4317/medoral.20030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Indexed: 11/23/2022] Open
Abstract
Objectives: To study clinical and epidemiological characteristics of the patients treated at the clinic “Integrated Dentistry for Patients with Special Needs (Special Care Dentistry)” at Complutense University of Madrid (UCM), as well as to know the dental treatments performed in these patients and the modifications from the usual treatment protocol. The information obtained from the results could also be applied in order to assess the needs of dental students education about this type of patients.
Study Design: Medical records review of all the patients referred to the clinic of “Integrated Dentistry for Patients with Special Needs”, performing a retrospective cross-sectional study analyzing their main pathology, ASA risk score (Classification system used by the American Society of Anesthesiologists to estimate the risk posed by the anesthesia for various patient conditions), pharmacological treatment, what kind of dental treatment was necessary, whether the patient was treated or not, and if it was required to change any procedure due to the patient health status (sedation or antibiotic prophylaxis).
Results: The number of patients referred to the clinic was 447, of whom 426 were included in this study. Out of them, 52,35 % were men and 47,89 were women, with a mean age of 49,20 years. More frequent pathologies were cardiovascular or cerebrovascular diseases (24,29 %), infectious diseases (12,41%), endocrine diseases (11,66%) and intellectual disability (8,85%). 70’18% of the patients were treated, with sedation being necessary in 9,03% of the cases and antibiotic prophylaxis in 11,70%.
Conclusions: Given the high number of patients with some kind of pathology and the amount of medicines that they use, it seems necessary for dentistry students to have a specific training regarding how to handle and treat these patients, so they will be able to provide them the best possible care.
Key words:Patients with special needs, medically compromised patients, dental treatment, special care dentistry.
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Affiliation(s)
- Marta Monteserín-Matesanz
- Department of Medicine and Buccofacial Surgery, Faculty of Dentistry, UCM, Plaza Ramón y Cajal s/n, Ciudad Universitaria, 28040 Madrid, Spain,
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de la Sierra A, Oliveras A, Armario P, Lucas S. Control de la presión arterial en pacientes en tratamiento con terapia combinada. Med Clin (Barc) 2015; 144:145-50. [DOI: 10.1016/j.medcli.2013.09.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Revised: 09/19/2013] [Accepted: 09/26/2013] [Indexed: 11/17/2022]
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Barrios V, Escobar C, Llisterri J, Rodríguez Roca G, Badimón J, Vergara J, Prieto M, Serrano A, Cinza S, Murillo C. Características clínicas basales y manejo de los pacientes incluidos en el estudio IBERICAN. Semergen 2015; 41:3-12. [DOI: 10.1016/j.semerg.2014.09.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Accepted: 09/29/2014] [Indexed: 12/18/2022]
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Benítez Camps M, Egocheaga Cabello MI, Dalfó Baqué A, Bajo García J, Vara González L, Sanchis Doménech C, Martín Rioboo E, Ureña Fernández T, Domínguez Sardiña M, Bonet Pla A. Estudio Conocimiento: grado de conocimiento sobre hipertensión arterial de nuestros pacientes. Relación con el nivel de control de la misma. HIPERTENSION Y RIESGO VASCULAR 2015; 32:12-20. [DOI: 10.1016/j.hipert.2014.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 06/22/2014] [Accepted: 06/26/2014] [Indexed: 11/28/2022]
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[Validation of the telephone call as a method for measuring compliance to arterial hypertension treatment in Extremadura]. Semergen 2014; 40:366-73. [PMID: 24838054 DOI: 10.1016/j.semerg.2014.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 01/15/2014] [Accepted: 02/04/2014] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Pharmacological non-compliance is a significant problem that can affect patient health. The main aim of this investigation is to validate the telephone call to the patient' home as a self-report method of counting the amount of tablets taken by the patient, as an alternative method to a simple tablet count in the clinic (gold standard). PATIENTS AND METHODS An observational, multicentre, prospective, and longitudinal study was conducted by 25 researchers in different health centres in Extremadura, and which included 125 consecutively enrolled patients with uncontrolled arterial hypertension, 121 ended the study. Three visits were made, including enrollment visit, follow-up visit at 4 weeks, and final visit at 8 weeks. A telephone call was made prior to the enrollment and final visit to remind the patients of the next visit, and to ask at the same time about the number of tablets remaining. RESULTS A total of 121 patients completed the study. In the final visit, the phone-call method of compliance showed: 100% sensitivity, 86% specificity, 86.8% of overall accuracy, 30.4% PPV, 100% NPV, CP+ 7.13, CP- 0.0, and a kappa index of 0.415 (P<.0001). The area under the ROC curve was 0.995 (95% CI, 0.985-1). CONCLUSIONS It was concluded that the telephone phone call, as a therapeutic compliance method, can be a good alternative due to being almost universal, easy to use, its reduced cost, and without the need of patients to go to the medical centres.
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Evolution of therapy inertia in primary care setting in Spain during 2002–2010. J Hypertens 2014; 32:1138-45; discussion 1145. [DOI: 10.1097/hjh.0000000000000118] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Barrios V, Escobar C, Calderón A, Moreno FJA, Pallarés V, Galgo A. Clinical profile and blood pressure control in patients managed in primary care in Spain: are there any differences between the young and the old? REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2014; 66:824-5. [PMID: 24773867 DOI: 10.1016/j.rec.2013.04.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 04/18/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Vivencio Barrios
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain.
| | - Carlos Escobar
- Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain
| | - Alberto Calderón
- Centro de Salud Rosa de Luxemburgo, San Sebastián de los Reyes, Madrid, Spain
| | | | - Vicente Pallarés
- Unidad de Vigilancia de la Salud, Unión de Mutuas, Castellón, Spain
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Cinza-Sanjurjo S, Alonso-Moreno FJ, Prieto-Díaz MÁ, Divisón-Garrote JA, Rodríguez-Roca GC, Llisterri-Caro JL. [Resistant arterial hypertension in Primary Care patients in Spain. PRESCAP Study 2010]. Semergen 2014; 41:123-30. [PMID: 24768029 DOI: 10.1016/j.semerg.2014.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Revised: 02/15/2014] [Accepted: 02/17/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To determine the prevalence and clinical and epidemiological characteristics of Primary Care patients with resistant hypertension (RHT) in Spain. PATIENTS AND METHODS A cross-sectional multicenter study was conducted on hypertensive patients aged 18 or over and seen in a Primary Care clinic. RHT was considered as the presence of uncontrolled blood pressure in patients treated with at least 3 drugs, one of which is a diuretic. RESULTS Of the 12,961 hypertensive patients in the PRESCAP 2010 study, 962 (7.4%) fulfilled criteria for RHT, of whom 51% were women, and with a mean age (SD) 68.8 [11.4] years. Patients with RHT were older (68.80 [10.69] years vs. 66.06 [11.44] years, P<.001), had a higher prevalence of obesity (55.2 vs. 38.6%, P<.001), a higher waist circumference (103.90 [13.89] vs. 99.32 [13.69] cm, P<.001), and a higher prevalence of DM (48.3 vs. 29.5%, P<.001). The prevalence of target organ damage (73.0 vs. 61.4%, P<.001) and cardiovascular disease (46.7 vs. 26.8%, P<.001) were higher in patients with resistant hypertension. The multivariate analysis showed that the variables associated with resistant hypertension were the presence of cardiovascular disease, diabetes mellitus, sedentary life style, microalbuminuria, body mass index, duration of AHT, and triglycerides. CONCLUSIONS The prevalence of RHT in Primary Care patients is related to inappropriate lifestyles, the presence of target organ damage, and cardiovascular disease.
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Affiliation(s)
- S Cinza-Sanjurjo
- Centro de Salud de Porto do Son, Porto do Son, A Coruña, España.
| | | | | | | | - G C Rodríguez-Roca
- Centro de Salud Puebla de Montalbán, La Puebla de Montalbán, Toledo, España
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Barquilla García A, Llisterri Caro JL, Prieto Díaz MA, Alonso Moreno FJ, García Matarín L, Galgo Nafría A, Mediavilla Bravo JJ. [Blood pressure control in a population of hypertensive diabetic patients treated in primary care: PRESCAP-Diabetes Study 2010]. Semergen 2014; 41:13-23. [PMID: 24703582 DOI: 10.1016/j.semerg.2014.02.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 02/12/2014] [Accepted: 02/12/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To determine the level of blood pressure (BP) control in hypertensive diabetic patients treated in primary care and to determine the factors associated with poor control. MATERIAL AND METHODS A cross-sectional, multicentre study that enrolled hypertensive diabetics recruited by consecutive sampling by family doctors in Spain in June 2010. A mean BP of less than 140/90mmHg was considered as good control of arterial hypertension. The percentages of patients with<130/80mmHg PA, 140/80mmHg, and 140/85mmHg, respectively, were also determined. Sociodemographic, clinical, cardiovascular risk factors, and pharmacological treatments were recorded. RESULTS A total of 3,993 patients were enrolled (50.1% female) with a mean age (standard deviation) of 68.2 (10.2) years, of whom 73.9% received combination therapy. The figures showed good control of both blood pressure values (<140/90mmHg) in 56.4% (95% CI: 54.3 to 58.4) of the cases, with 58.5% (95% CI: 57.0-60.0) only in systolic BP, and 84.6% (95% CI, 83.2 to 85.8) only in diastolic BP. The variables with strongest association with poor control were the presence of albuminuria, elevated total cholesterol, physical inactivity, and not taking the medication on the day of the interview. CONCLUSIONS The PRESCAP-Diabetes 2010 study results indicate that 43.6% of diabetics with hypertension seen in primary care have a poorly controlled BP, in particular, systolic BP.
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Affiliation(s)
- A Barquilla García
- Medicina de Familia y Comunitaria, Centro de Salud de Trujillo, Cáceres, España.
| | - J L Llisterri Caro
- Medicina de Familia y Comunitaria, Centro de Salud Ingeniero Joaquín Benlloch, Valencia, España
| | - M A Prieto Díaz
- Medicina de Familia y Comunitaria, Centro de Salud de Vallobín-La Florida, Oviedo, España
| | - F J Alonso Moreno
- Medicina de Familia y Comunitaria, Centro de Salud Sillería, Toledo, España
| | - L García Matarín
- Medicina de Familia y Comunitaria, Unidad de Gestión Clínica de Vicar, Almería, España
| | - A Galgo Nafría
- Medicina de Familia y Comunitaria, Centro de Salud Espronceda, Madrid, España
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Royo-Bordonada MÁ, Lobos JM, Brotons C, Villar F, de Pablo C, Armario P, Cortés O, Gil Nuñez A, Lizcano Á, de Santiago A, Sans S. El estado de la prevención cardiovascular en España. Med Clin (Barc) 2014; 142:7-14. [DOI: 10.1016/j.medcli.2012.09.046] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Revised: 09/24/2012] [Accepted: 09/27/2012] [Indexed: 11/26/2022]
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Dominguez-Rodriguez A, Rodríguez S, Abreu-Gonzalez P, Avanzas P. Impacto de la contaminación atmosférica sobre la inflamación, el estrés oxidativo y el pronóstico a un año en pacientes ingresados por síndrome isquémico coronario agudo: diseño del estudio AIRACOS. Med Clin (Barc) 2013; 141:529-32. [DOI: 10.1016/j.medcli.2013.05.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 05/08/2013] [Accepted: 05/16/2013] [Indexed: 11/16/2022]
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Gómez-Huelgas R, Martínez-Castelao A, Artola S, Górriz JL, Menéndez E. [Treatment of type 2 diabetes mellitus in patients with chronic kidney disease. Grupo de Trabajo para el Documento de Consenso sobre el tratamiento de la diabetes tipo 2 en el paciente con enfermedad renal crónica]. Med Clin (Barc) 2013; 142:85.e1-10. [PMID: 24268912 DOI: 10.1016/j.medcli.2013.10.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 10/21/2013] [Accepted: 10/24/2013] [Indexed: 02/06/2023]
Abstract
Chronic kidney disease (CKD) and type 2 diabetes mellitus (T2DM) are highly prevalent chronic diseases, which represent an important public health problem and require a multidisciplinary management. T2DM is the main cause of CKD and it also causes a significant comorbidity with regard to non-diabetic nephropathy. Patients with diabetes and kidney disease represent a special risk group as they have higher morbi-mortality as well as higher risk of hypoglycemia than diabetic individuals with a normal kidney function. Treatment of T2DM in patients with CKD is controversial because of the scarcity of available evidence. The current consensus report aims to ease the appropriate selection and dosage of antidiabetic treatments as well as the establishment of safety objectives of glycemic control in patients with CKD.
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Affiliation(s)
| | - Alberto Martínez-Castelao
- Sociedad Española de Nefrología (SEN), Grupo Español de Estudio de la Nefropatía Diabética (GEENDIAB), España
| | - Sara Artola
- Red de Grupos de Estudio de la Diabetes en Atención Primaria (redGDPS), España
| | - José Luis Górriz
- Sociedad Española de Nefrología (SEN), Grupo Español de Estudio de la Nefropatía Diabética (GEENDIAB), España
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Blood pressure control and management of very elderly patients with hypertension in primary care settings in Spain. Hypertens Res 2013; 37:166-71. [DOI: 10.1038/hr.2013.130] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 04/27/2013] [Accepted: 07/03/2013] [Indexed: 11/08/2022]
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Perfil clínico y grado de control de la presión arterial de la población hipertensa asistida en atención primaria en España: ¿hay diferencias entre la población joven y la más mayor? Rev Esp Cardiol 2013. [DOI: 10.1016/j.recesp.2013.04.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Ruíz-Arzalluz MV, Fernández MCG, Burgos-Alonso N, Vinyoles E, Blanco RSV, Grandes G. Protocol for assessing the hypotensive effect of evening administration of acetylsalicylic acid: study protocol for a randomized, cross-over controlled trial. Trials 2013; 14:236. [PMID: 23890047 PMCID: PMC3750457 DOI: 10.1186/1745-6215-14-236] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 07/12/2013] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The objective of this study is to evaluate the antihypertensive effect of bedtime administration of low doses of aspirin in patients with treated hypertension and high cardiovascular risk on low-dose aspirin for secondary prevention, in order to optimize their usual treatment and reduce their cardiovascular risk. METHODS/DESIGN This is a prospective phase IV multicentre, randomised, triple-blind, placebo-controlled, cross-over clinical trial. We will include 258 individuals with hypertension treated with low-dose aspirin for secondary prevention. These patients will be randomly recruited, by approximately 40 primary care physicians collaborating in the study, mainly in the Guipúzcoa West, Bilbao and Barcelona areas. The 258 patients will be randomly allocated to treatments to create two comparable groups. In the first period, the intervention group will take aspirin at night and placebo in the morning, while the control group will take their aspirin in the morning and placebo in the evening for 2 months. After a washout period of 15 to 30 days, there will be a second 2-month period for which groups will swap treatments. Participants will undergo ambulatory blood pressure monitoring at baseline, at the end of first period and then again at the beginning and end of the second period. The main outcome measure is the change in mean blood pressure over 24 h, and as secondary outcomes we will also assess changes in systolic and diastolic blood pressure, during the day and night, and the relationship between them. Lastly, we will explore whether non-dipper patients convert into dippers with the intervention. DISCUSSION The goal of this research is to provide the scientific basis for indicating a change in the time of aspirin administration from morning to evening, by primary health practitioners, to improve the patient control of blood pressure and more effectively reduce their cardiovascular risk, by combining this hypotensive effect with the well-known anti-platelet effect of low-dose aspirin. TRIAL REGISTRATION ClinicalTrials.gov NCT01741922.
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Affiliation(s)
- Mª Victoria Ruíz-Arzalluz
- Primary Care Research Unit – Bizkaia, Basque Health Service (Osakidetza), Bilbao, Spain
- Primary Care Center of Andoain, Basque Health Service (Osakidetza), Gipuzkoa, Spain
| | | | - Natalia Burgos-Alonso
- Primary Care Research Unit – Bizkaia, Basque Health Service (Osakidetza), Bilbao, Spain
| | - Ernest Vinyoles
- Primary Care Universitary Research Institut, Jordi Gol Foundation, (IDIAP Jordi Gol), Barcelona, Spain
| | - Ricardo San Vicente Blanco
- Primary Care Research Unit – Bizkaia, Basque Health Service (Osakidetza), Bilbao, Spain
- Primary Care Center of Zumarraga, Basque Health Service (Osakidetza), Gipuzkoa, Spain
| | - Gonzalo Grandes
- Primary Care Research Unit – Bizkaia, Basque Health Service (Osakidetza), Bilbao, Spain
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de la Sierra A, Barrios V, González-Segura D. [Blood pressure control in hospital units in Spain]. Med Clin (Barc) 2013; 141:47-52. [PMID: 22766063 DOI: 10.1016/j.medcli.2012.04.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Revised: 04/13/2012] [Accepted: 04/19/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE Blood pressure (BP) control has been extensively studied in patients attended in primary care but reports in the hospital setting, which includes referral units, are scarce. The aim was to evaluate the degree of BP control in hypertensive patients attended in referral units. PATIENTS AND METHODS We studied 1,550 hypertensive subjects (41.5% women) with a mean age of 64 (12) years, who were receiving antihypertensive drugs. The degree of BP control was estimated in a single visit by the proportion of patients with BP below 140/90 mm Hg. RESULTS BP was controlled in 653 patients (42%). In comparison, those whose BP was not controlled were more frequently women (odds ratio [OR] 1.57; 95% confidence interval [95%CI]: 1.23-1.99), obese (OR 1.28; 95%CI 1.00-1.63), smokers (OR 1.78; 95%CI 1.36-2.34), had left ventricular hypertrophy (OR 1.86; 95%CI 1.46-2.36) and elevated values of total serum cholesterol (OR 1.50; 95%CI 1.19-1.90) and triglycerides (OR 1.63; 95%CI 1.29-2.07). Therapeutical inertia was observed in 39% of uncontrolled patients. In a subgroup of patients who underwent ambulatory BP monitoring, discordance between measurements was only present in 23% (9.8 with isolated clinic hypertension and 13.1% with masked hypertension). CONCLUSION The degree of BP control in patients attended in referral units is estimated in 42% and has not been modified in the last decade. Although therapeutical effort and inertia have improved, this only compensates the increased risk and comorbidities of attended patients, making more difficult the control of BP values.
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Affiliation(s)
- Alejandro de la Sierra
- Servicio de Medicina Interna, Hospital Mutua Terrassa, Universidad de Barcelona, Terrassa, Barcelona, España.
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Sierra C, Ruilope LM. [Effectiveness of antihypertensive treatment and control of blood pressure: is it improvable?]. Med Clin (Barc) 2013; 141:343-5. [PMID: 23831401 DOI: 10.1016/j.medcli.2013.04.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 04/12/2013] [Accepted: 04/18/2013] [Indexed: 02/01/2023]
Affiliation(s)
- Cristina Sierra
- Unidad de Hipertensión y Riesgo Vascular, Servicio de Medicina Interna, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universidad de Barcelona, Barcelona, España
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Guitard Sein-Echaluce ML, Torres Puig-gros J, Farreny Justribó D, Gutiérrez Vilaplana JM, Martínez Orduna M, Artigues Barberá EM. [Adherence to physical activity recommendations in a hypertensive primary care population]. GACETA SANITARIA 2013; 27:365-8. [PMID: 23287102 DOI: 10.1016/j.gaceta.2012.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 11/13/2012] [Accepted: 11/13/2012] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine the prevalence of adherence to physical activity recommendations in the hypertensive population of Lerida (Spain) attended in primary care and to identify related factors. METHODS A cross sectional study was carried out in hypertensive adults. The dependent variable was adherence to physical activity recommendations measured with the Minnesota Questionnaire. The independent variables were sociodemographic factors, the information received, and attitudes to physical activity. RESULTS A total of 786 hypertensive patients participated in this study; 53.9% were women and the mean age was 66.0±10.2 years. Adherence to recommendations was found in 64.3% (95% CI: 60.9-67.6); this percentage was 65.2% in men (95% CI: 60.2-70.0) and 63.4% in women (95% CI: 58.8-67.9). Greater adherence was associated with age in men and with residence in a rural area in women. In both genders, greater adherence was associated with unpaid work and with having a favorable attitude to physical activity. No association was observed with the number of recommendations received in the last 6 months. CONCLUSIONS More than half the hypertensive population adhered to physical activity recommendations. To improve physical activity levels, recommendations can be tailored to the attitudes of individual patients.
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[Medical conduct in primary care as regards blood pressure control. PRESCAP 2010 study]. Semergen 2012; 39:3-11. [PMID: 23517891 DOI: 10.1016/j.semerg.2012.05.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Accepted: 05/15/2012] [Indexed: 11/22/2022]
Abstract
INTRODUCTION There is a need for more information on therapeutic inertia in blood pressure (BP) treatment. The purpose of this study was to determine the therapeutic behaviour and associated factors of Primary Care (PC) physicians on uncontrolled hypertensive patients. PATIENTS AND METHODS Cross-sectional multicentre study of patients with hypertension attending Spanish PC centres. Data was collected from patients (social-demographics, clinical status and treatment), as well as data from physicians (medical practice, background and therapeutic behaviour) were collected. Uncontrolled BP was considered when average BP values where ≥140/90mmHg. RESULTS A total of 12,961 patients (52.0% women) were included. The mean age was 66.3 (SD 11.4) years, and mean number of years from diagnosis of hypertension was 9.1 (6.7) years. Almost two-thirds (62.4%) of the patients were taking a combined blood pressure treatment, (44.2% with two drugs and 18.2% with three drugs, or more). An uncontrolled BP was observed in 38.9% (95% CI: 38.1-39.7) of patients. Treatment was changed by physicians in 41.8% (95% CI: 40.4-43.2) out of 5,036 uncontrolled patients. Adding another drug was the most frequent behaviour (55.6%). The physician's perception of good BP control in uncontrolled patients, together with the presence of combined blood pressure treatment, were the two variables most strongly associated with therapeutic inertia. CONCLUSIONS The Spanish PC Physician modified antihypertensive treatment in only 4 out of 10 uncontrolled patients. The physician's perception of good BP control was the variable most strongly associated with therapeutic inertia.
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Doménech CS, Caro JLL, Sanz VP, Moreno FJA, Rodríguez IL, Loro AN, Zamorano MÁ, García NG, Conesa MDA, Lázaro Y de Mercado P. [Objective KONTROL study: therapeutic inertia in hypertensive patients attended in primary care of Spain]. Aten Primaria 2011; 43:638-47. [PMID: 21414690 PMCID: PMC7025126 DOI: 10.1016/j.aprim.2010.09.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2010] [Revised: 08/20/2010] [Accepted: 09/09/2010] [Indexed: 10/14/2022] Open
Abstract
OBJECTIVES To determine the level of therapeutic inertia (TI), and the factors associated to the patient, doctor and the health organisation, in hypertensive patients treated in Primary Care (PC). DESIGN Cross-sectional, multicentre study. SETTING A sample of PC Teams from all over Spain. PARTICIPANTS The study was conducted among PC doctors using a questionnaire and clinical records of 4 patients. MAIN MEASUREMENTS The TI was calculated for each patient (TIp) as the proportion of visits in which there was no change in medication when this was indicated. RESULTS A total of 543 PC doctors provided data on 2,032 patients, who fulfilled the indication of a change in requirement. There was TI In 77.8% of cases. The TIp observed was non-existent or low for 17.1% of the patients, intermediate for 42% and high for 40.8%. For the patients, the factors most associated with TIp were, age (P<.001), diabetes (P<.001), stroke (P<.01), obesity (P<.01) and a low education level (P<.001). To be female, be less than 40 years or more than 55 years, to be a family doctor with a training program other than MIR and to work in the public sector increased the probability of TIp (P<.001 for all the assumptions). CONCLUSIONS The results of the study indicate that there is TI in 7 out every 10 visits made by hypertensive patients in Primary care. There are significant differences as regards the clinical characteristics of the patients and of the doctors.
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