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Prieto-Díaz MA, Pallares-Carratala V, Manuel Micó-Pérez R, Escobar-Cervantes C, Martín-Sanchez V, Coca A, Barquilla-García A, Velilla-Zancada SM, Polo-García J, Segura-Fragoso A, Ginel-Mendoza L, Hermida-Ameijerias Á, Cinza-Sanjurjo S. Clinical characteristics, treatment, and blood pressure control in patients with hypertension seen by primary care physicians in Spain: the IBERICAN study. Front Cardiovasc Med 2023; 10:1295174. [PMID: 38173815 PMCID: PMC10763308 DOI: 10.3389/fcvm.2023.1295174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/29/2023] [Indexed: 01/05/2024] Open
Abstract
Objectives To determine the clinical profile, according to the history of hypertension, the risk of developing hypertension, current antihypertensive treatment and BP control rates in patients with hypertension from the IBERICAN cohort. Methods IBERICAN is an ongoing prospective cohort study, whose primary objective is to determine the frequency, incidence, and distribution of CVRF in the adult Spanish population seen in primary care settings. This analysis shows the baseline clinical characteristics of patients with hypertension. Adequate BP control was defined as BP <140/90 mmHg according to 2013 ESH/ESC guidelines. Results A total of 8,066 patients were consecutively included, of whom 3,860 (48.0%) had hypertension. These patients were older (65.8 ± 10.9 vs. 51.6 ± 14.7 years; p < 0.001), had more cardiovascular risk factors, target organ damage and cardiovascular disease (CVD) in comparison with those without hypertension. The risk of hypertension increased with the presence of associated CV risk factors and comorbidities, particularly diabetes, obesity and the metabolic syndrome, and decreased with the intensity of physical activity. Regarding antihypertensive treatments, 6.1% of patients did not take any medication, 38.8% were taking one antihypertensive drug, 35.5% two drugs, and 19.6% three or more antihypertensive drugs. Overall, 58.3% achieved BP goals <140/90 mmHg. A greater probability of BP control was observed with increasing age of patients and the greater number of antihypertensive drugs. Blood pressure control was lower in hypertensive patients with diabetes, obesity, the metabolic syndrome, increased urinary albumin excretion, higher pulse pressure, and lack of antihypertensive treatment. Conclusions About half of patients attended in primary care settings have hypertension in Spain. Patients with hypertension have a worse CV clinical profile than non-hypertensive patients, with greater association of CVRF and CVD. Around four out of ten patients do not achieve the recommended BP goals, and higher use of combination therapies is associated with a better BP control.
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Affiliation(s)
- Miguel A. Prieto-Díaz
- Vallobín-La Florida Health Center, Principality of Asturias Health Service, Oviedo, Spain
- Faculty of Medicine, University of Santiago de Compostela, A Coruña, Spain
| | - Vicente Pallares-Carratala
- Health Surveillance Unit, Mutual Insurance Union, Castellon, Spain
- Department of Medicine, Jaume I University, Castellon, Spain
| | | | | | - Vicente Martín-Sanchez
- Institute of Biomedicine (IBIOMED), Epidemiology and Public Health Networking Biomedical Research Centre (CIBERESP), University of León, León, Spain
| | - Antonio Coca
- Hypertension and Vascular Risk Unit, Department of Internal Medicine, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | | | | | - José Polo-García
- Casar de Cáceres Health Center, Extremadura Health Service, Cáceres, Spain
| | | | | | | | - Sergio Cinza-Sanjurjo
- Milladoiro Health Centre, Health Area of Santiago de Compostela, Health Research Institute of Santiago de Compostela (IDIS), A Coruña, Spain
- Networking Biomedical Research, Centre-Cardiovascular Diseases (CIBERCV), Santiago de Compostela, Spain
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Sung KC, Hong SJ, Rhee MY, Jeong MH, Kim DH, Lim SW, Park K, Lee JB, Kim SY, Cho JM, Cho GY, Heo JH, Kim SH, Lee HY, Kim W, Cho DK, Park S, Shin J, Pyun WB, Kwon K, Rha SW, Jung JA. Comparison of efficacy and safety between third-dose triple and third-dose dual antihypertensive combination therapies in patients with hypertension. J Clin Hypertens (Greenwich) 2023; 25:429-439. [PMID: 37095689 PMCID: PMC10184484 DOI: 10.1111/jch.14656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 02/20/2023] [Accepted: 02/28/2023] [Indexed: 04/26/2023]
Abstract
We compared the efficacy and safety of third-standard-dose triple and third-standard-dose dual antihypertensive combination therapies in patients with mild to moderate hypertension. This was a phase II multicenter, randomized, double-blind, parallel-group trial. After a 4-week placebo run-in period, 245 participants were randomized to the third-dose triple combination (ALC group; amlodipine 1.67 mg + losartan potassium 16.67 mg + chlorthalidone 4.17 mg) or third-dose dual combination (AL group; amlodipine 1.67 mg + losartan potassium 16.67 mg, LC group; losartan potassium 16.67 mg + chlorthalidone 4.17 mg, AC group; amlodipine 1.67 mg + chlorthalidone 4.17 mg) therapy groups and followed up for 8 weeks. The mean systolic blood pressure (BP) reduction was -18.3 ± 13.2, -13.0 ± 13.3, -16.3 ± 12.4, and -13.8 ± 13.2 mmHg in the ALC, AL, LC, and AC groups, respectively. The ALC group showed significant systolic BP reduction compared to the AL and AC groups at weeks 4 (P = .010 and P = .018, respectively) and 8 (P = .017 and P = .036, respectively). At week 4, the proportion of systolic BP responders was significantly higher in the ALC group (42.6%) than in the AL (22.0%), LC (23.3%), and AC (27.1%) groups (P = .013, P = .021, and P = .045, respectively). At week 8, the proportion of systolic and diastolic BP responders was significantly higher in the ALC group (59.7%) than in the AL (39.3%) and AC (42.4%) groups (P = .022 and P = .049, respectively) at week 8. Third-standard-dose triple antihypertensive combination therapy demonstrated early effective BP control compared to third-standard-dose dual combination therapies, without increasing adverse drug reactions in patients with mild-to-moderate hypertension.
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Affiliation(s)
- Ki-Chul Sung
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University College of Medicine, Seoul, Republic of Korea
| | - Soon Jun Hong
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Moo-Yong Rhee
- Cardiovascular Center, Dongguk University Ilsan Hospital, Goyang-si, Gyeonggi, Republic of Korea
| | - Myung-Ho Jeong
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Dae-Hee Kim
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang-Wook Lim
- Cardiology Division, Cardiac center, CHA Bundang medical center, CHA University, Seongnam, Republic of Korea
| | - Kyungil Park
- Dong-A University Hospital, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Jin Bae Lee
- Department of Cardiology, Daegu Catholic University Medical Center, Daegu, Republic of Korea
| | - Seok-Yeon Kim
- Department of Cardiology, Seoul Medical Center, Seoul, Republic of Korea
| | - Jin-Man Cho
- Cardiovascular Center, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Goo-Yeong Cho
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jung-Ho Heo
- Division of Cardiology, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Republic of Korea
| | - Sang-Hyun Kim
- Boramae Hospital, Seoul University College of Medicine, Seoul, Republic of Korea
| | - Hae-Young Lee
- Department of internal medicine, Division of Cardiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Weon Kim
- Department of Internal Medicine, Kyung Hee University Medical Center, Kyung Hee University, Seoul, Republic of Korea
| | - Deok-Kyu Cho
- Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin, Republic of Korea
| | - Sungha Park
- Department of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jinho Shin
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Wook-Bum Pyun
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Seoul, Republic of Korea
| | - Kihwan Kwon
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea
| | - Seung-Woon Rha
- Department of Internal Medicine, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Jin-A Jung
- Hanmi Pharm.Co.,Ltd., Songpa-gu, Seoul, Republic of Korea
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Barrios V, Escobar C, Suarez C, Garcia-Moll X, Lozano F. Clinical Profile and Management of Patient Patients with Ischemic Heart Disease and/or Peripheral Artery Disease in Clinical Practice: The APALUSA Study. J Clin Med 2022; 11:jcm11123554. [PMID: 35743622 PMCID: PMC9224728 DOI: 10.3390/jcm11123554] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 06/13/2022] [Accepted: 06/17/2022] [Indexed: 02/01/2023] Open
Abstract
This study was aimed to ascertain the clinical profile and management of patients with ischemic heart disease (IHD) and/or peripheral artery disease (PAD). In this observational and cross-sectional study developed in 80 hospitals throughout Spain, consecutive adults with stable IHD and/or PAD were included. A total of 1089 patients were analyzed, of whom 65.3% had only IHD, 17.8% PAD and 16.9% both. A total of 80.6% were taking only one antiplatelet agent, and 18.2% were on dual antiplatelet therapy (mainly aspirin/clopidogrel). Almost all patients were taking ≥1 lipid lowering drug, mainly moderate-to-high intensity statins. IHD patients took ezetimibe more commonly than PAD (43.9% vs. 12.9%; p < 0.001). There were more patients with IHD that achieved blood pressure targets compared to PAD (<140/90 mmHg: 67.9% vs. 43.0%; p < 0.001; <130/80 mmHg: 34.1% vs. 15.7%; p < 0.001), LDL-cholesterol (<70 mg/dL: 53.1% vs. 41.5%; p = 0.033; <55 mg/dL: 26.5% vs. 16.0%; p = 0.025), and diabetes (HbA1c < 7%, with SGLT2i/GLP1-RA: 21.7% vs. 8.8%; p = 0.032). Modifications of antihypertensive agents and lipid-lowering therapy were performed in 69.0% and 82.3% of patients, respectively, without significant differences between groups. The use of SGLT2i/GLP1-RA was low. In conclusion, cardiovascular risk factors control remains poor among patients with IHD, PAD, or both. A higher use of combined therapy is warranted.
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Affiliation(s)
- Vivencio Barrios
- Cardiology Department, University Hospital Ramon y Cajal, 28034 Madrid, Spain
- Correspondence:
| | - Carlos Escobar
- Cardiology Department, University Hospital La Paz, 28046 Madrid, Spain;
| | - Carmen Suarez
- Internal Medicine Department, University Hospital la Princesa, 28006 Madrid, Spain;
| | - Xavier Garcia-Moll
- Cardiology Department, University Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain;
| | - Francisco Lozano
- Vascular Surgery Department, University Hospital Clínico, 37007 Salamanca, Spain;
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Escobar C, Barrios V. Revisiting Hypertension in Rural Areas: A New Approach Is Required. Am J Hypertens 2021; 34:910-911. [PMID: 34021301 DOI: 10.1093/ajh/hpab078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 05/18/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Carlos Escobar
- Department of Cardiology, University Hospital La Paz, Madrid, Spain
| | - Vivencio Barrios
- Department of Cardiology, University Hospital Ramon y Cajal, Madrid, Spain
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Castro-Dominguez Y, Trejo Paredes MC, Mones P, Spatz ES, Lombo B, Sepulveda P, Reyes-Uribe O, Otero J, Ramirez G, Urena P, Lopez E, Dominguez B, McNamara RL. Patient Awareness and Clinical Inertia: Obstacles to Hypertension Control in Rural Communities in the Dominican Republic. Am J Hypertens 2021; 34:939-947. [PMID: 33822861 DOI: 10.1093/ajh/hpab054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 02/07/2021] [Accepted: 04/02/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Many obstacles exist for adequate hypertension control, including low individual awareness and clinical inertia (CI). In this study, we aimed to determine hypertension prevalence, awareness, treatment, and control among community residents of rural areas of Peravia in Dominican Republic (DR), followed by an assessment of CI in their primary care clinics (PCCs). METHODS We interviewed 827 adults from 8 rural communities of Peravia. Demographics, medical history, health care information, and blood pressure (BP) were obtained. We reviewed the community PCC visits of patients with known hypertension or a BP ≥140/90, abstracting medical history and the physician's action toward uncontrolled BP. RESULTS Of those interviewed, 57% (95% CI: 53%-60%) had hypertension, with 63% (95% CI: 59%-68%) of those aware of their diagnosis. Among individuals with hypertension, 60% (95% CI: 56%-65%) were receiving pharmacological treatment, and only 35% (95% CI: 31%-40%) were controlled. Characteristics associated with awareness were female sex, age >55 years, diabetes, private insurance, and having at least 1 health care visit within the past year. Of the 507 PCC patients reviewed, 340 (67%) had uncontrolled BP. Of these, 220 had no clinical action to address the uncontrolled BP, corresponding to a CI rate of 65%. CONCLUSIONS Among rural communities in the DR, undiagnosed hypertension remains common, especially in individuals who are younger, uninsured, or with limited access to health care. For those seen in PCCs, therapeutic intensification to achieve controlled BP is infrequently done. Strategies to address population awareness and CI are needed to improve hypertension control.
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Affiliation(s)
- Yulanka Castro-Dominguez
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Maria Camila Trejo Paredes
- Department of Internal Medicine, School of Medicine, University of Connecticut, Farmington, Connecticut, USA
| | - Patricia Mones
- School of Medicine, Instituto Tecnologico de Santo Domingo, Santo Domingo, Dominican Republic
| | - Erica S Spatz
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Bernardo Lombo
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Priscilla Sepulveda
- School of Medicine, Instituto Tecnologico de Santo Domingo, Santo Domingo, Dominican Republic
| | - Olmar Reyes-Uribe
- School of Medicine, Instituto Tecnologico de Santo Domingo, Santo Domingo, Dominican Republic
| | - Jorge Otero
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Gisselle Ramirez
- School of Medicine, Instituto Tecnologico de Santo Domingo, Santo Domingo, Dominican Republic
- Medicina Cardiovascular Asociada, Santo Domingo, Dominican Republic
| | - Pedro Urena
- Medicina Cardiovascular Asociada, Santo Domingo, Dominican Republic
| | - Emilton Lopez
- School of Medicine, Instituto Tecnologico de Santo Domingo, Santo Domingo, Dominican Republic
| | - Boanerges Dominguez
- School of Medicine, Instituto Tecnologico de Santo Domingo, Santo Domingo, Dominican Republic
| | - Robert L McNamara
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
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Ali DH, Kiliç B, Hart HE, Bots ML, Biermans MCJ, Spiering W, Rutten FH, Hollander M. Therapeutic inertia in the management of hypertension in primary care. J Hypertens 2021; 39:1238-1245. [PMID: 33560056 DOI: 10.1097/hjh.0000000000002783] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Therapeutic inertia is considered to be an obstacle to effective blood pressure (BP) control. AIMS To identify patient characteristics associated with therapeutic inertia in patients with hypertension managed in primary care and to assess reasons not to intensify therapy. METHODS A Dutch cohort study was conducted using electronic health record data of patients registered in the Julius General Practitioners' Network (n = 530 564). Patients with a diagnosis of hypertension, SBP at least 140 and/or DBP at least 90 mmHg, and one or two BP-lowering drug(s) were included. Therapeutic inertia was defined as not undertaking therapeutic action in follow-up despite uncontrolled BP. Multivariable logistic regression was used to identify characteristics associated with inertia. Furthermore, an exploratory survey was performed in which general practitioners of 114 patients were asked for reasons not to intensify treatment. RESULTS We identified 6400 (10% of all patients with hypertension) uncontrolled patients on one or two BP-lowering drugs. Therapeutic inertia was 87%, similar in men and women. Older age, lower systolic, diastolic and near-target SBP, and diabetes were positively associated, while renal insufficiency and heart failure were inversely related to inertia. General practitioners did not intensify therapy because they first, considered office BP measurements as nonrepresentative (27%); second, waited for next BP readings (21%); third, wanted to optimize lifestyle first (19%). Eleven percent of patients explicitly did not want to change treatment. CONCLUSION Therapeutic inertia is common in primary care patients with uncontrolled hypertension. Older age, and closer to target BP, but also concurrent diabetes were associated with inertia.
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Affiliation(s)
- Dalia H Ali
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University
| | - Birsen Kiliç
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University
| | - Huberta E Hart
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University
- Leidsche Rijn Julius Health Center
| | - Michiel L Bots
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht
| | - Marion C J Biermans
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen
| | - Wilko Spiering
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Frans H Rutten
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University
| | - Monika Hollander
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University
- Leidsche Rijn Julius Health Center
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Pallarés-Carratalá V, Bonig-Trigueros I, Palazón-Bru A, Esteban-Giner MJ, Gil-Guillén VF, Giner-Galvañ V. Clinical inertia in hypertension: a new holistic and practical concept within the cardiovascular continuum and clinical care process. Blood Press 2019; 28:217-228. [PMID: 31023106 DOI: 10.1080/08037051.2019.1608134] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Purpose: Recognition of clinical inertia is essential to improve the control of chronic diseases. Although it is very intuitive, a better interpretation of the concept of clinical inertia is lacking, likely due to its high complexity. Materials and Methods: After a review of the published articles, we propose a practical vision of inertia, contextualized within the clinical process of hypertension care. Results: This new vision enables the integration of previous terms and definitions of clinical inertia, as well as proposing specific strategies for its reduction. Conclusion: Although some concepts should be considered as 'justified inertia' or 'investigator inertia', the idea that inertia may be present throughout the continuum of care gives physicians a holistic view of the problem that is easily applicable to their clinical practice. Measures to overcome inertia are complicated because of the intrinsic complexity of the concept.
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Affiliation(s)
- Vicente Pallarés-Carratalá
- a Health Surveillance Unit , Castellón Mutual Insurance Union , Castellón de la Plana , Spain.,b Department of Medicine , Jaume I University , Castellón de la Plana , Spain
| | - Irene Bonig-Trigueros
- c Department of Internal Medicine (Cardiovascular Prevention Unit) , La Plana Hospital , Vila-Real , Spain
| | - Antonio Palazón-Bru
- d Department of Clinical Medicine , Miguel Hernández University , San Juan de Alicante , Spain
| | - María José Esteban-Giner
- e Department of Internal Medicine (Hypertension and Cardiometabolic Risk Unit) , Mare de Déu dels Lliris Hospital , Alcoy , Spain
| | - Vicente Francisco Gil-Guillén
- d Department of Clinical Medicine , Miguel Hernández University , San Juan de Alicante , Spain.,f Research Unit General University Hospital of Elda , Elda , Spain
| | - Vicente Giner-Galvañ
- e Department of Internal Medicine (Hypertension and Cardiometabolic Risk Unit) , Mare de Déu dels Lliris Hospital , Alcoy , Spain
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Ali WE, Bakris GL. Initial single-pill combinations for antihypertensive treatment: greater cardiovascular mortality reduction yet still not used. Eur Heart J 2018; 39:3662-3663. [DOI: 10.1093/eurheartj/ehy500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Waleed E Ali
- Department of Medicine, Comprehensive Hypertension Center, University of Chicago Medicine, Chicago, IL, USA
| | - George L Bakris
- Department of Medicine, Comprehensive Hypertension Center, University of Chicago Medicine, Chicago, IL, USA
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Cosin-Sales J, Orozco Beltrán D, Ledesma Rodríguez R, Barbon Ortiz Casado A, Fernández G. [Perception of Primary Care physicians on the integration with cardiology through continuity of healthcare programs in secondary prevention]. Semergen 2018; 44:400-408. [PMID: 29463442 DOI: 10.1016/j.semerg.2018.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 12/18/2017] [Accepted: 01/04/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the perception of Primary Care (PC) physicians on the integration with cardiology (CA) through continuity of healthcare programs. MATERIAL AND METHODS A cross-sectional and multicentre study was conducted, in which a total of 200 PC physicians from all over Spain completed a qualitative survey that evaluated the level of integration with CA in secondary prevention. Physicians were grouped according to the level of PC-CA integration. RESULTS The integration between CA and PC was good, but it was better in those centres with a higher integration (74.0% vs. 60.0%; p=.02) and in general, physicians considered that integration had improved (92.0% vs. 73.0%; p<.001). Almost all PC physicians received the hospital discharge report. The majority of the hospital discharge reports included recommendations about the CA and PC follow-up, control of risk factors, as well as the duration of secondary prevention treatment, with not significant differences according to the level of integration. In 55.8%, 63.6%, and 51.3% of hospital discharge reports, indications were given on when to perform the follow-up blood analysis, as well as information about returning to working life and sexual activity, respectively. The most common communication method was the paper-based report (75 vs. 84%; p=NS). The communication between healthcare levels was greater in those Primary Care centres with a higher level of integration, as well as periodicity of the communication and the satisfaction of physicians (80.0% vs. 63.0%; p=.005). CONCLUSIONS The level of integration between PC and CA is, in general, satisfactory, but those centres with a higher level of integration benefit more from a greater communication and satisfaction.
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Affiliation(s)
- J Cosin-Sales
- Servicio de Cardiología, Hospital Arnau de Vilanova, Valencia, España.
| | - D Orozco Beltrán
- Centro de Atención Primaria Cabo Huertas, San Juan de Alicante, Alicante, España
| | | | | | - G Fernández
- Departamento Médico, Merck Sharp & Dohme Spain, Madrid, España
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Rodilla Sala E, Adell Alegre M, Giner Galvañ V, Perseguer Torregrosa Z, Pascual Izuel JM, Climent Catalá MT, Adell Alegre M, Alcázar Franco S, Alonso Garre C, Aparicio Cercós C, Baixauli Fernández V, Bellver Monzó O, Cano Congost M, Climent Catalá MAT, Colomer Molina V, Córcoles Ferrándiz MAE, Cortés Botella MAJ, Delgado Correa F, Dols Alonso D, Ferrer Estrela F, García Zaragozá MAE, Granell Vidal L, Hernández Marrero MR, Herrero Mascarós A, Hueso Fibla E, Jordá Requena R, Jordá Requena A, Llopis Miró T, González Martínez C, Mud Castelló F, Navarro Clérigues A, Perseguer Torregrosa Z, Prats Mas RM, Rodrigo Soriano MJ, Ruiz Gonzalez D, Salar Ibáñez L, Sanchis Boronat MJ, Urcullu Donatg B. Rigidez arterial en sujetos normotensos e hipertensos: frecuencia en farmacias comunitarias. Med Clin (Barc) 2017; 149:469-476. [DOI: 10.1016/j.medcli.2017.04.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 04/19/2017] [Accepted: 04/20/2017] [Indexed: 10/19/2022]
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Affiliation(s)
- Omar Al Dhabyi
- Department of Medicine, ASH Comprehensive Hypertension Center, University of Chicago Medicine, Chicago, IL
| | - George L Bakris
- Department of Medicine, ASH Comprehensive Hypertension Center, University of Chicago Medicine, Chicago, IL
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Feldman RD, Liu L, Wu Z, Zhang Y, Yu X, Zhang X. Hypertension Attitude PersPEctives and Needs (HAPPEN): A Real-World Survey of Physicians and Patients With Hypertension in China. J Clin Hypertens (Greenwich) 2017; 19:256-264. [PMID: 27781379 PMCID: PMC5347891 DOI: 10.1111/jch.12912] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 07/26/2016] [Accepted: 08/02/2016] [Indexed: 12/12/2022]
Abstract
The Hypertension Attitude PersPEctives and Needs (HAPPEN) survey was a real-world survey of cardiologists, nephrologists, and patients with treated hypertension at level 3 hospitals in China. It aimed to characterize the attitudes and behavior of physicians and patients and to identify possible causes of poor blood pressure (BP) control. Randomly selected participants (100 cardiologists, 30 nephrologists, 400 patients) completed face-to-face interviews investigating BP control rates, consulting behavior, prescribing patterns, and attitudes toward hypertension management. Perceived levels of BP control were high; 70% of physicians and 85% of patients believed that BP targets were achieved, despite only 31% of patients achieving targets. Physician satisfaction with control rates and patient satisfaction with treatment were high. Differences in perceived and actual levels of BP control may be driving therapeutic inertia. In combination with inadequate patient evaluation and support services, therapeutic inertia may contribute to poor BP control among patients with treated hypertension in China.
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Affiliation(s)
- Ross D. Feldman
- Discipline of MedicineMemorial University of NewfoundlandSt. John'sCanada
| | - Lisheng Liu
- Beijing Hypertension League InstituteBeijingChina
- Department of CardiologyFuwai Cardiology HospitalBeijingChina
| | - Zhaosu Wu
- Department of EpidemiologyBeijing Anzhen HospitalBeijingChina
| | - Yuqing Zhang
- Department of CardiologyFuwai Cardiology HospitalBeijingChina
| | - Xueqing Yu
- Department of NephrologySun Yat‐sen UniversityGuangzhouChina
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Sarganas G, Neuhauser HK. Untreated, Uncontrolled, and Apparent Resistant Hypertension: Results of the German Health Examination Survey 2008-2011. J Clin Hypertens (Greenwich) 2016; 18:1146-1154. [PMID: 27481706 DOI: 10.1111/jch.12886] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 04/20/2016] [Accepted: 04/29/2016] [Indexed: 11/30/2022]
Abstract
The prevalence and associated factors of untreated, uncontrolled, and apparent-resistant hypertension (RH) in Germany are unknown. Based on European Society of Hypertension criteria, apparent RH was defined as blood pressure (BP) ≥140/90 mm Hg (≥140/85 mm Hg in diabetics) under treatment with three different classes of antihypertensive agents including a diuretic. Data from the German Health Examination Survey (2008-2011; n=7115, age 18-79 years) including standardized BP measurements and Anatomical Therapeutic Chemical-coded taken medications were analyzed. Among patients aware of their hypertensive status (n=2205), 37.9% were uncontrolled and, among those, 33.4% were untreated. Being aware and having untreated and uncontrolled BP was associated with male sex, young age, not having cardiovascular disease, not performing BP self-measurement, not being obese, and not smoking. Apparent RH occurred in 6.8% of treated aware hypertensive patients and was positively associated with having diabetes. The proportion of uncontrolled BP is still high. Not having "obvious risk factors" has become a risk itself for having untreated and uncontrolled hypertension.
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Affiliation(s)
- Giselle Sarganas
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany. .,DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.
| | - Hannelore K Neuhauser
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
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16
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O'Flynn AM, Curtin RJ, Perry IJ, Kearney PM. Hypertension Prevalence, Awareness, Treatment, and Control: Should 24-Hour Ambulatory Blood Pressure Monitoring be the Tool of Choice? J Clin Hypertens (Greenwich) 2016; 18:697-702. [PMID: 26611695 PMCID: PMC8032046 DOI: 10.1111/jch.12737] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 09/16/2015] [Accepted: 09/22/2015] [Indexed: 12/01/2022]
Abstract
We aimed to examine hypertension prevalence, awareness, treatment and control in a community sample and investigate the impact of using 24 hour ABPM. Office blood pressure (BP) was taken from the electronic health record. Study BP was measured by standardised methods. Participants were invited to undergo ABPM. Hypertension was defined by accepted thresholds or anti-hypertensive use. Standardised questions assessed awareness and treatment. Control was defined as anti-hypertensive use with BP below normal threshold. There were 931 (45%) participants with office BP, study BP and ABPM. By study BP, hypertension prevalence was 60%, awareness 59%, 60% were treated and 46% controlled. By daytime ABPM threshold, prevalence was 61%, awareness 59%, 59% were treated and 54% controlled. ABPM reclassified 13.5% from normotensive to hypertensive and 14.5% from hypertensive to normotensive. ABPM may not hugely impact population hypertension prevalence but at an individual level it reduces misclassification and facilitates more appropriate management.
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Affiliation(s)
- Anne Marie O'Flynn
- Department of Epidemiology & Public HealthUniversity College CorkCorkIreland
| | | | - Ivan J. Perry
- Department of Epidemiology & Public HealthUniversity College CorkCorkIreland
| | - Patricia M. Kearney
- Department of Epidemiology & Public HealthUniversity College CorkCorkIreland
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Escobar C, Barrios V, Prieto L. Therapeutic behavior of primary care physicians in patients with atrial fibrillation taking vitamin K antagonists not adequately controlled. Eur J Intern Med 2016; 30:e17-e18. [PMID: 26827100 DOI: 10.1016/j.ejim.2016.01.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 01/20/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Carlos Escobar
- Cardiology Department, University Hospital La Paz, Madrid, Spain.
| | - Vivencio Barrios
- Cardiology Department, University Hospital Ramon y Cajal, Madrid, Spain
| | - Luis Prieto
- Medical Biostatistics, Universidad Católica San Antonio de Murcia, Murcia, Spain
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18
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Barrios V, Escobar C. Improving cardiovascular protection: focus on a cardiovascular polypill. Future Cardiol 2016; 12:181-96. [DOI: 10.2217/fca.15.80] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Lack of adherence may explain, at least in part, the poor cardiovascular risk factors control observed in patients with ischemic heart disease, increasing the risk of developing new events. Polypill improves medication adherence, which may actually reduce blood pressure and LDL cholesterol compared with the drugs given separately. The fixed combination of acetylsalicylic acid 100 mg + ramipril 2.5, 5, or 10 mg + either simvastatin 40 mg or atorvastatin 20 mg is the unique cardiovascular polypill that has been registered in 22 countries worldwide. The polypill-containing simvastatin has been specifically tested in a clinical trial including only patients with ischemic heart disease. The FOCUS study showed that patients treated with the polypill showed a higher adherence compared with those receiving separate medications.
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Affiliation(s)
- Vivencio Barrios
- Department of Cardiology, University Hospital Ramon y Cajal, School of Medicine. University of Alcalá, Madrid, Spain
| | - Carlos Escobar
- Cardiology Department, University Hospital La Paz, Madrid, Spain
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[Changes in therapeutic targets and level of control of arterial hypertension: New evidence]. HIPERTENSION Y RIESGO VASCULAR 2016; 33:63-8. [PMID: 26857088 DOI: 10.1016/j.hipert.2016.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 01/20/2016] [Indexed: 11/21/2022]
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Escobar C, Barrios V. Antihypertensive Medication: On the Right Path? REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2015; 68:1191. [PMID: 26507540 DOI: 10.1016/j.rec.2015.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 08/24/2015] [Indexed: 06/05/2023]
Affiliation(s)
- Carlos Escobar
- Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain
| | - Vivencio Barrios
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Universidad de Alcalá de Henares, Madrid, Spain.
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Escobar C, Barrios V. Prescripción de fármacos antihipertensivos: ¿en el buen camino? Rev Esp Cardiol (Engl Ed) 2015. [DOI: 10.1016/j.recesp.2015.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Barrios V, Escobar C, Prieto L, Osorio G, Polo J, Lobos JM, Vargas D, García N. Control de la anticoagulación en pacientes con fibrilación auricular no valvular asistidos en atención primaria en España. Estudio PAULA. Rev Esp Cardiol 2015. [DOI: 10.1016/j.recesp.2015.04.017] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Machado-Duque ME, Ramírez-Valencia DM, Medina-Morales DA, Machado-Alba JE. Effectiveness and clinical inertia in the management of hypertension in patients in Colombia. ACTA ACUST UNITED AC 2015; 9:878-84. [PMID: 26454799 DOI: 10.1016/j.jash.2015.08.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 08/20/2015] [Accepted: 08/21/2015] [Indexed: 11/18/2022]
Abstract
Determine the effectiveness of treatment and the frequency of clinical inertia in the management of hypertension in Colombian patients. A retrospective study with prospective follow-up of individuals on antihypertensive medication who were treated on medical consultation for 1 year was conducted in 20 Colombian cities. Clinical inertia was considered when no modification of therapy occurred despite not achieving control goals. A total of 355 hypertensive patients were included. From a total of 1142 consultations, therapy was effective in 81.7% of cases. In 18.3% of the cases, the control goal was not achieved, and of these, 81.8% were considered clinical inertia. A logistic regression showed that the use of antidiabetics (odds ratio: 2.31; 95% confidence interval: 1.290-4.167; P = .008) was statistically associated with an increased risk of clinical inertia. With a determination of the frequency of inertia and the high effectiveness of antihypertensive treatment, valuable information can be provided to understand the predictors of clinical inertia.
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Affiliation(s)
- Manuel Enrique Machado-Duque
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A, Pereira, Colombia
| | - Diana Marcela Ramírez-Valencia
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A, Pereira, Colombia
| | - Diego Alejandro Medina-Morales
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A, Pereira, Colombia
| | - Jorge Enrique Machado-Alba
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A, Pereira, Colombia.
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Barrios V, Escobar C, Prieto L, Osorio G, Polo J, Lobos JM, Vargas D, García N. Anticoagulation Control in Patients With Nonvalvular Atrial Fibrillation Attended at Primary Care Centers in Spain: The PAULA Study. ACTA ACUST UNITED AC 2015; 68:769-76. [PMID: 26169326 DOI: 10.1016/j.rec.2015.04.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Accepted: 04/28/2015] [Indexed: 01/30/2023]
Abstract
INTRODUCTION AND OBJECTIVES To determine the current status of anticoagulation control in patients with nonvalvular atrial fibrillation treated with vitamin K antagonists in the primary care setting in Spain. METHODS The PAULA study was a multicenter cross-sectional/retrospective observational study conducted throughout Spain. The study included patients with nonvalvular atrial fibrillation who had been receiving vitamin K antagonist therapy during the past year and were attended at primary care centers. International normalized ratio (INR) values over the past 12 months were recorded. The degree of anticoagulation control was defined as the time the patient had remained within the therapeutic range and was determined by both the direct method (poor control < 60%) and by the Rosendaal method (poor control < 65%). RESULTS The study assessed 1524 patients (mean age, 77.4 ± 8.7 years; 48.6% women; 64.2% in permanent atrial fibrillation; CHADS2 mean, 2.3 ± 1.2; CHA2DS2-VASc, 3.9 ± 1.5, and HAS-BLED, 1.6 ± 0.9). The mean number of INR readings recorded per patient was 14.4 ± 3.8. A total of 56.9% of patients had adequate INR control according to the direct method and 60.6% according to the Rosendaal method. The multivariate analysis identified the following predictors for poor INR control: female sex, dietary habits potentially affecting anticoagulation with vitamin K antagonists, multidrug therapy, and a history of labile INR. CONCLUSIONS Approximately 40% of patients (43.1% by the direct method and 39.4% by the Rosendaal method) with nonvalvular atrial fibrillation who were receiving anticoagulation therapy with vitamin K antagonists in primary care in Spain had poor anticoagulation control during the previous 12 months.
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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
| | - Luis Prieto
- Bioestadística Médica, Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain
| | | | - José Polo
- Centro de Salud Casar de Cáceres, Casar de Cáceres, Cáceres, Spain
| | - José María Lobos
- Centro de Salud Jazmín, Área 4 de Atención Primaria, Madrid, Spain
| | - Diego Vargas
- Unidad de Hospitalización Polivalente, Hospital de Alta Resolución El Toyo, Hospital de Poniente El Ejido, Almería, Spain
| | - Nicolás García
- Departamento Médico, Bayer Hispania S.L., Barcelona, Spain
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25
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Affiliation(s)
- Denis L. Clement
- From the Department of the Dean, Ghent University Hospital, Ghent, Belgium
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26
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Reducing therapeutic inertia to improve blood pressure control. J Hypertens 2014; 32:988-9. [DOI: 10.1097/hjh.0000000000000144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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