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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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Luque del Moral R, Gastelurrutia MA, Martinez-Martinez F, Jacomé JA, Dago A, Suarez B, Fikri-Benbrahim N, Martí M, Nuñez C, Sierra-Alarcón S, Fernandez-Gomez FJ. Effect of Pharmaceutical Intervention in Pharmacologically Treated Hypertensive Patients-A Cluster-Randomized Clinical Trial: AFPRES-CLM Study. J Pers Med 2023; 13:1484. [PMID: 37888095 PMCID: PMC10608270 DOI: 10.3390/jpm13101484] [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: 09/14/2023] [Revised: 10/05/2023] [Accepted: 10/07/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Evaluate the effect of a community pharmaceutical intervention on the control of blood pressure in hypertensive patients treated pharmacologically. METHODS A cluster-randomized clinical trial of 6 months was carried out. It was conducted in the Autonomous Community of Castilla-La Mancha (Spain). Sixty-three community pharmacies and 347 patients completed the study. Intervention patients received the community pharmaceutical intervention based on a protocol that addresses the individual needs of each patient related to the control of their blood pressure, which included Health Education, Pharmacotherapy Follow-up and 24 h Ambulatory Blood Pressure Measurement. Control patients received usual care in the community pharmacy. RESULTS The pharmaceutical intervention resulted in better control of blood pressure (85.8% vs. 66.3% p < 0.001), lower use of emergencies (p = 0.002) and improvement trends in the physical components of quality of life, measured by SF-36 questionnaire, after 6 months of pharmaceutical intervention. No significant changes were observed for any of these variables in the control group. There were also detected 354 negative medication-related outcomes that were satisfactorily resolved in a 74.9% of the cases and 330 healthcare education interventions and 29 Ambulatory Blood Pressure Monitorings were performed in order to increase adherence to pharmacological treatment and minimize Negative Outcomes associated with Medication and prevent medication-related problems. CONCLUSIONS Community pharmaceutical intervention can increase hypertensive patients with controlled blood pressure, after 6 months, compared with usual care.
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Affiliation(s)
- Raúl Luque del Moral
- Pharmaceutical Care Research Group, University of Granada, 18011 Granada, Spain; (M.A.G.); (F.M.-M.); (B.S.); (N.F.-B.)
- Council of Official Associations of Pharmaceutics of Castilla-La Mancha, 45005 Toledo, Spain
- Group of Cellular and Molecular Pharmacology, Department of Pharmacology, CEIR Campus Mare Nostrum, University of Murcia, Campus de Ciencias de la Salud, 30120 Murcia, Spain; (C.N.); (F.-J.F.-G.)
| | - Miguel A. Gastelurrutia
- Pharmaceutical Care Research Group, University of Granada, 18011 Granada, Spain; (M.A.G.); (F.M.-M.); (B.S.); (N.F.-B.)
| | - Fernando Martinez-Martinez
- Pharmaceutical Care Research Group, University of Granada, 18011 Granada, Spain; (M.A.G.); (F.M.-M.); (B.S.); (N.F.-B.)
| | - Julio A. Jacomé
- Pharmaceutical Care Foundation, 08017 Barcelona, Spain; (J.A.J.); (A.D.); (M.M.)
| | - Ana Dago
- Pharmaceutical Care Foundation, 08017 Barcelona, Spain; (J.A.J.); (A.D.); (M.M.)
| | - Blanca Suarez
- Pharmaceutical Care Research Group, University of Granada, 18011 Granada, Spain; (M.A.G.); (F.M.-M.); (B.S.); (N.F.-B.)
- Council of Official Associations of Pharmaceutics of Castilla-La Mancha, 45005 Toledo, Spain
| | - Narjis Fikri-Benbrahim
- Pharmaceutical Care Research Group, University of Granada, 18011 Granada, Spain; (M.A.G.); (F.M.-M.); (B.S.); (N.F.-B.)
| | - Mercé Martí
- Pharmaceutical Care Foundation, 08017 Barcelona, Spain; (J.A.J.); (A.D.); (M.M.)
| | - Cristina Nuñez
- Group of Cellular and Molecular Pharmacology, Department of Pharmacology, CEIR Campus Mare Nostrum, University of Murcia, Campus de Ciencias de la Salud, 30120 Murcia, Spain; (C.N.); (F.-J.F.-G.)
- Murcia Research Institute of Health Sciences (IMIB), 30120 Murcia, Spain
| | - Sandra Sierra-Alarcón
- Group of Cellular and Molecular Pharmacology, Department of Pharmacology, CEIR Campus Mare Nostrum, University of Murcia, Campus de Ciencias de la Salud, 30120 Murcia, Spain; (C.N.); (F.-J.F.-G.)
- Murcia Research Institute of Health Sciences (IMIB), 30120 Murcia, Spain
| | - Francisco-José Fernandez-Gomez
- Group of Cellular and Molecular Pharmacology, Department of Pharmacology, CEIR Campus Mare Nostrum, University of Murcia, Campus de Ciencias de la Salud, 30120 Murcia, Spain; (C.N.); (F.-J.F.-G.)
- Murcia Research Institute of Health Sciences (IMIB), 30120 Murcia, Spain
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Hypertension: The most common chronic health problem in Spain. A call to action. HIPERTENSION Y RIESGO VASCULAR 2022; 39:121-127. [DOI: 10.1016/j.hipert.2022.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 03/22/2022] [Indexed: 11/23/2022]
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4
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Estrada D, Sierra C, Soriano RM, Jordán AI, Plaza N, Fernández C. Grado de conocimiento de la hipertensión en pacientes hipertensos. ENFERMERIA CLINICA 2020; 30:99-107. [DOI: 10.1016/j.enfcli.2018.11.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 11/28/2018] [Indexed: 01/07/2023]
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Hermida RC, Ayala DE, Mojón A, Smolensky MH, Fernández JR. Diagnosis and management of hypertension: around-the-clock ambulatory blood pressure monitoring is substantially more effective and less costly than daytime office blood pressure measurements. Chronobiol Int 2019; 36:1515-1527. [PMID: 31446805 DOI: 10.1080/07420528.2019.1658201] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The cost-effectiveness of ambulatory blood pressure (BP) monitoring (ABPM) versus traditional office BP measurement (OBPM) for the diagnosis and management of hypertension has been evaluated only by few studies and based solely on the reduction of medical care expenses through avoiding treatment of isolated-office hypertension. Data from the 21963 participants in the Hygia Project, a multicenter outcomes study that incorporates into routine primary care periodic, at least yearly, 48 h ABPM evaluation, were utilized to assess the cost-effectiveness - relative to vascular pathology expenditures countrywide in Spain - of ABPM versus OBPM. The actual reported Spanish healthcare expenditure for vascular pathology in 2015 - aggregate costs of medical examinations, outpatient and inpatient care, therapeutic interventions, plus non-healthcare services (productivity losses due to morbidity/mortality and informal family/friends-provided care) - was used to compare yearly costs when diagnostic and treatment decisions for hypertension are based on the OBPM versus the ABPM-model. Our economic analysis is based on the more realistic and feasible approach of restricting ABPM solely to high-risk individuals of age ≥60 years and/or with diabetes, chronic kidney disease, and/or previous cardiovascular event, who in the Hygia Project accounted for >90% of all documented events. The projected net benefit countrywide in favor of the proposed ABPM-model is ~5294M€/year, i.e., 360.33€/year (95%CI [347.52-374.85]) per ABPM-evaluated person. This highly conservative economic analysis indicates ABPM is a much more cost-effective strategy than repeated OBPM not only for accurate diagnosis and management of true hypertension but marked reduction of expenditures on elevated BP-associated vascular pathology.
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Affiliation(s)
- Ramón C Hermida
- Bioengineering & Chronobiology Laboratories; Atlantic Research Center for Information and Communication Technologies (AtlantTIC), University of Vigo , Vigo , Spain
| | - Diana E Ayala
- Bioengineering & Chronobiology Laboratories; Atlantic Research Center for Information and Communication Technologies (AtlantTIC), University of Vigo , Vigo , Spain
| | - Artemio Mojón
- Bioengineering & Chronobiology Laboratories; Atlantic Research Center for Information and Communication Technologies (AtlantTIC), University of Vigo , Vigo , Spain
| | - Michael H Smolensky
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin , Austin , Texas , USA
| | - José R Fernández
- Bioengineering & Chronobiology Laboratories; Atlantic Research Center for Information and Communication Technologies (AtlantTIC), University of Vigo , Vigo , Spain
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Rehm J, Anderson P, Prieto JAA, Armstrong I, Aubin HJ, Bachmann M, Bastus NB, Brotons C, Burton R, Cardoso M, Colom J, Duprez D, Gmel G, Gual A, Kraus L, Kreutz R, Liira H, Manthey J, Møller L, Okruhlica Ľ, Roerecke M, Scafato E, Schulte B, Segura-Garcia L, Shield KD, Sierra C, Vyshinskiy K, Wojnar M, Zarco J. Towards new recommendations to reduce the burden of alcohol-induced hypertension in the European Union. BMC Med 2017; 15:173. [PMID: 28954635 PMCID: PMC5618725 DOI: 10.1186/s12916-017-0934-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 08/22/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Hazardous and harmful alcohol use and high blood pressure are central risk factors related to premature non-communicable disease (NCD) mortality worldwide. A reduction in the prevalence of both risk factors has been suggested as a route to reach the global NCD targets. This study aims to highlight that screening and interventions for hypertension and hazardous and harmful alcohol use in primary healthcare can contribute substantially to achieving the NCD targets. METHODS A consensus conference based on systematic reviews, meta-analyses, clinical guidelines, experimental studies, and statistical modelling which had been presented and discussed in five preparatory meetings, was undertaken. Specifically, we modelled changes in blood pressure distributions and potential lives saved for the five largest European countries if screening and appropriate intervention rates in primary healthcare settings were increased. Recommendations to handle alcohol-induced hypertension in primary healthcare settings were derived at the conference, and their degree of evidence was graded. RESULTS Screening and appropriate interventions for hazardous alcohol use and use disorders could lower blood pressure levels, but there is a lack in implementing these measures in European primary healthcare. Recommendations included (1) an increase in screening for hypertension (evidence grade: high), (2) an increase in screening and brief advice on hazardous and harmful drinking for people with newly detected hypertension by physicians, nurses, and other healthcare professionals (evidence grade: high), (3) the conduct of clinical management of less severe alcohol use disorders for incident people with hypertension in primary healthcare (evidence grade: moderate), and (4) screening for alcohol use in hypertension that is not well controlled (evidence grade: moderate). The first three measures were estimated to result in a decreased hypertension prevalence and hundreds of saved lives annually in the examined countries. CONCLUSIONS The implementation of the outlined recommendations could contribute to reducing the burden associated with hypertension and hazardous and harmful alcohol use and thus to achievement of the NCD targets. Implementation should be conducted in controlled settings with evaluation, including, but not limited to, economic evaluation.
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Affiliation(s)
- Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
- Addiction Policy, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Institute of Medical Science, University of Toronto, Faculty of Medicine, Medical Sciences Building, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Peter Anderson
- Substance Use, Policy and Practice, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
- Alcohol and Health, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | | | - Iain Armstrong
- Health and Wellbeing Directorate, Public Health England, London, UK
| | - Henri-Jean Aubin
- CESP, University Paris-Sud, UVSQ, INSERM, Université Paris-Saclay, APHP, Hôpitaux Universitaires Paris-Sud, Villejuif, France
| | | | | | - Carlos Brotons
- Sardenya Primary Health Care Center, Biomedical Research Institute Sant Pau, Barcelona, Spain
| | - Robyn Burton
- Health and Wellbeing Directorate, Public Health England, London, UK
| | - Manuel Cardoso
- General Directorate for Intervention on Addictive Behaviours and Dependencies (SICAD), Lisbon, Portugal
| | - Joan Colom
- Program on Substance Abuse, Public Health Agency of Catalonia, Department of Health, Government of Catalonia, Barcelona, Spain
| | - Daniel Duprez
- Cardiovascular Division, School of Medicine, University of Minnesota, Minneapolis, USA
| | - Gerrit Gmel
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
- Implant Systems Group, National ICT Australia, Eveleigh, Australia
- Faculty of Engineering, University of New South Wales, Sydney, Australia
| | - Antoni Gual
- Addictions Unit, Psychiatry Department, Neurosciences Institute, Hospital Clinic, IDIBAPS, Barcelona, Spain
| | - Ludwig Kraus
- IFT Institut für Therapieforschung, Munich, Germany
- Centre for Social Research on Alcohol and Drugs (SoRAD), Stockholm University, Stockholm, Sweden
| | - Reinhold Kreutz
- Institute of Clinical Pharmacology and Toxicology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Helena Liira
- General Practice, School of Primary, Aboriginal and Rural Health Care, University of Western Australia, Perth, Australia
- University of Helsinki, Department of General Practice, and Helsinki University Central Hospital, Unit of Primary Health Care, Helsinki, Finland
| | - Jakob Manthey
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.
| | - Lars Møller
- Division of Noncommunicable Diseases through the Life Course, WHO Regional Office for Europe, Copenhagen, Denmark
| | | | - Michael Roerecke
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
- Addiction Policy, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Emanuele Scafato
- National Observatory on Alcohol, National Centre on Addiction and Doping, Istituto Superiore di Sanità, Rome, Italy
- Società Italiana di Alcologia (SIA), Italian Society of Alcohology, Bologna, Italy
| | - Bernd Schulte
- Centre for Interdisciplinary Addiction Research, Hamburg University, Universitätsklinik Hamburg-Eppendorf, Hamburg, Germany
| | - Lidia Segura-Garcia
- Program on Substance Abuse, Public Health Agency of Catalonia, Department of Health, Government of Catalonia, Barcelona, Spain
| | - Kevin David Shield
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
| | - Cristina Sierra
- Hypertension and Vascular Risk Unit, Internal Medicine Department, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Konstantin Vyshinskiy
- Research Institute on Addictions, Federal Medical Research Centre for Psychiatry and Narcology n.a. V. Serbsky, Moscow, Russia
| | - Marcin Wojnar
- Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland
| | - José Zarco
- Drugs Intervention Group, semFYC, Ibiza Primary Health Care Center, Madrid, Spain
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Abstract
Objectives: The study aimed to assess the current epidemiology of hypertension, including its prevalence, the awareness of the condition and its treatment and control, in Turkey to evaluate changes in these factors over the last 10 years by comparing the results with the prevalence, awareness, treatment, and control of hypertension in Turkey (PatenT) study data (2003), as well as to assess parameters affecting awareness and the control of hypertension. Methods: The PatenT 2 study was conducted on a representative sample of the Turkish adult population (n = 5437) in 2012. Specifically trained staff performed the data collection. Hypertension was defined as mean SBP or DBP at least 140/90 mmHg, previously diagnosed disease or the use of antihypertensive medication. Awareness and treatment were assessed by self-reporting, and control was defined as SBP/DBP less than 140/90 mmHg. Results: Although the prevalence of hypertension in the PatenT and PatenT 2 surveys was stable at approximately 30%, hypertension awareness, treatment, and control rates have improved in Turkey. Overall, 54.7% of hypertensive patients were aware of their diagnosis in 2012 compared with 40.7% in 2003. The hypertension treatment rate increased from 31.1% in 2003 to 47.4% in 2012, and the control rate in hypertensives increased from 8.1% in 2003 to 28.7% in 2012. The rate of hypertension control in treated patients improved between 2003 (20.7%) and 2012 (53.9%). Awareness of hypertension was positively associated with older age, being a woman, residing in an urban area, a history of parental hypertension, being a nonsmoker, admittance by a physician, presence of diabetes mellitus, and being obese or overweight; it was inversely associated with a higher amount of daily bread consumption. Factors associated with better control of hypertension were younger age, female sex, residing in an urban area, and higher education level in Turkey. Conclusion: Although some progress has been made in recognizing hypertension from 2003 to 2012, there is still a large population of untreated or inadequately treated hypertensives in Turkey. Strengthening of population-based efforts to improve the prevention, early detection, and treatment of hypertension is needed.
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Práctica clínica en el manejo de la hipertensión y la diabetes en Atención Primaria: estudio ATENCION. Semergen 2017; 43:196-206. [DOI: 10.1016/j.semerg.2016.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 02/09/2016] [Accepted: 04/20/2016] [Indexed: 11/22/2022]
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Banegas J, Gijón-Conde T. Epidemiología de la hipertensión arterial. HIPERTENSION Y RIESGO VASCULAR 2017; 34 Suppl 2:2-4. [DOI: 10.1016/s1889-1837(18)30066-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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10
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Gorostidi M, Prieto-Díaz MA. [Combination for initial therapy in hypertension, is it useful?]. HIPERTENSION Y RIESGO VASCULAR 2017; 34 Suppl 1:19-24. [PMID: 29703398 DOI: 10.1016/s1889-1837(18)30059-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Hypertension represents the first cause of mortality worldwide because a leading role in development of cardiovascular and renal diseases. Evidence about the benefits of controlling hypertension is overwhelming, but adequate control of blood pressure is still poor even in high-income countries. At least one of 2 hypertensive patients suffers from uncontrolled blood pressure. Nearly 75% of hypertensive patients do not achieve adequate control with monotherapy. Strategies to improve control include avoiding inertia in initiating pharmacological treatment, prompt shift to combined therapy from monotherapy, initial treatment with a 2-drug combination, and use of fixed-dose combinations in a single pill. This review focuses in benefits of initiating treatment combining antihypertensive drugs.
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Affiliation(s)
- M Gorostidi
- Servicio de Nefrología, Hospital Universitario Central de Asturias, RedinRen, Oviedo, España.
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Hipertensión al día en 6 preguntas. Curso precongreso SEH-LELHA Valencia 2016. Presentación. HIPERTENSION Y RIESGO VASCULAR 2017; 34 Suppl 1:1-3. [DOI: 10.1016/s1889-1837(18)30055-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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12
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Saiz-Satjes M, Martinez-Martin FJ, Roca-Cusachs A. Factors associated with the reduction of albumin excretion in diabetic hypertensive patients: differential effect of manidipine versus amlodipine. Future Cardiol 2016; 13:143-151. [PMID: 27885840 DOI: 10.2217/fca-2016-0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIMS In AMANDHA trial, the addition of manidipine, but not amlodipine, in diabetic patients with uncontrolled hypertension, microalbuminuria and preserved renal function resulted in a large decrease of urinary albumin excretion (UAE) despite similar blood pressure (BP) reductions. Factors associated with the reduction of UAE were analyzed. METHODS For this purpose, a multivariable analysis was performed. RESULTS Although after 6 months of treatment, manidipine and amlodipine decreased BP to a similar extent, reductions of UAE were higher with manidipine. The assigned treatment, changes in mean BP, sympathetic tone and glycemic control were associated with changes in UAE. CONCLUSION The assigned treatment, changes in mean BP, sympathetic tone and glycemic control were independently associated with changes in UAE. Compared with amlodipine, manidipine reduced UAE to a higher extent, independently of BP reduction.
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Affiliation(s)
| | | | - Alex Roca-Cusachs
- Internal Medicine Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
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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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Piotrowicz K, Prejbisz A, Klocek M, Topór-Mądry R, Szczepaniak P, Kawecka-Jaszcz K, Narkiewicz K, Grodzicki T, Januszewicz A, Gąsowski J. Subclinical Mood and Cognition Impairments and Blood Pressure Control in a Large Cohort of Elderly Hypertensives. J Am Med Dir Assoc 2016; 17:864.e17-22. [PMID: 27502451 DOI: 10.1016/j.jamda.2016.06.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 06/22/2016] [Accepted: 06/22/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Blood pressure (BP) control in the elderly is often limited by poor compliance with prescribed regimen. Both can be influenced by clinical cognitive or mood impairments; however, the impact of subclinical alterations of cognition or mood remains unknown. OBJECTIVES To assess the relation between cognition, mood, and BP control in treated older hypertensive patients. DESIGN Cross-sectional association study. SETTING Predefined substudy to the POLFOKUS nationwide survey investigating the correlates of poor BP control in patients randomly drawn from primary and specialist practices across Poland. PARTICIPANTS 1988 outpatients ≥65 years of age treated for hypertension for at least 1 year. MEASUREMENTS BP was mean of at least 2 office measurements. We assessed adherence to antihypertensive medications using a questionnaire and performed screening tests for cognitive deficits [Abbreviated Mental Test Score (AMTS)] and mood disorders [Geriatric Depression Scale (GDS)]. In all patients, we used a unified (BP <140/90 mm Hg) and in ≥80 years old a unified or age-specific (<150 mm Hg systolic BP) definition of BP control. We fitted logistic regression models to assess the probability of poor BP control in association with cognitive and mood disturbances. RESULTS The mean [standard deviation (SD)] age of 1988 (65.6% women) patients was 73.9 (6.0) years (19.3% ≥80 years old). Cognitive and mood impairments were observed in 8.0% and 37.2%, respectively. Mean systolic and diastolic BP were 141.8 (16.4) and 83.6 (9.5) mm Hg, respectively. According to age-stratified and unified definition of proper BP control, goal BP was achieved in 65.4% and 38.5% patients ≥80 years of age, respectively. In younger patients, the control reached 46%. Globally, 66% patients adhered to antihypertensive medications. Poor compliance was related to cognitive and mood impairments. When unified goal was applied, there was a 15.0% higher risk of finding poor BP control per 1 score lost in AMTS and an 8.0% increase per 1 score gained in GDS (all P < .001). CONCLUSION Poorer BP control is related to subclinical worsening of cognition and mood, which supports widespread use of the Comprehensive Geriatric Assessment even in apparently self-dependent older patients with hypertension.
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Affiliation(s)
- Karolina Piotrowicz
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Kraków, Poland
| | | | - Marek Klocek
- 1st Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Roman Topór-Mądry
- Faculty of Health Sciences, Jagiellonian University Medical College, Kraków, Poland
| | | | - Kalina Kawecka-Jaszcz
- 1st Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Krzysztof Narkiewicz
- Department of Hypertension and Diabetology, Medical University of Gdansk, Gdańsk, Poland
| | - Tomasz Grodzicki
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Kraków, Poland
| | | | - Jerzy Gąsowski
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Kraków, Poland.
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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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[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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Alba-Leonel A, Carvajal A, Fierro I, Castillo-Nájera F, Campos-Ramos O, Villa-Romero A, Molina-Guarneros J. Prescription patterns of antihypertensives in a community health centre in Mexico City: a drug utilization study. Fundam Clin Pharmacol 2016; 30:276-81. [PMID: 26787266 DOI: 10.1111/fcp.12179] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 11/10/2015] [Accepted: 01/13/2016] [Indexed: 12/24/2022]
Abstract
Hypertension is highly prevalent; in Mexico, the 2012 National Health and Nutrition Survey reported a prevalence of hypertension of 31.5% in the adult population. Pharmacological treatment is the commonest intervention and has been shown to reduce cardiovascular mortality and morbidity, and total mortality. Accordingly, the type and number of antihypertensives used and the outcome - in terms of blood pressure (BP) control - are important. Therefore, our purpose is to learn the pattern of antihypertensive drug prescription and explore the determinants of BP control in an urban population in Mexico. A retrospective cross-sectional drug utilization study was conducted. Medical records from a community health centre were searched to identify those corresponding to patients diagnosed with hypertension; information upon antihypertensives used and control of the disease was carefully retrieved. A logistic regression model was built to know the main determinants of BP control. A sample of 345 clinical records of interest was identified. Most patients received antihypertensives (86.4%); the leading medications used were angiotensin-converting enzyme inhibitors, 63.8%; beta-blockers (26.5%), diuretics (19.8%), angiotensin-receptor blockers (15.8%) and calcium-channel blockers (6.4%). Only the age (≥55 years) and BMI (>30) of the patients, and the age of the doctors (≥55 years), had an important influence on BP control. Obesity is a particular and important determinant of uncontrolled hypertension; it is worth to act on body weight, on an individual basis. As lack of control has been also tied to elderly doctors, an education programme could be envisaged.
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Affiliation(s)
- Adela Alba-Leonel
- Nursing Obstetric National School and Department of Public Health, Autonomous National University of Mexico UNAM, Mexico, Mexico
| | - Alfonso Carvajal
- Centro de Estudios sobre la Seguridad de los Medicamentos (CESME), Universidad de Valladolid, Valladolid, Spain
| | - Immaculada Fierro
- Centro de Estudios sobre la Seguridad de los Medicamentos (CESME), Universidad de Valladolid, Valladolid, Spain
| | | | - Oscar Campos-Ramos
- Sanitary District Benito Juarez, Public Health Services of the Federal District, Mexico, Mexico
| | - Antonio Villa-Romero
- Department of Public Health, Faculty of Medicine, Autonomous National University of Mexico (UNAM), Mexico, Mexico
| | - Juan Molina-Guarneros
- Department of Pharmacology, Faculty of Medicine, Autonomous National University of Mexico (UNAM), Mexico, Mexico
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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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Banegas JR, Navarro-Vidal B, Ruilope LM, de la Cruz JJ, López-García E, Rodríguez-Artalejo F, Graciani A. Trends in hypertension control among the older population of Spain from 2000 to 2001 to 2008 to 2010: role of frequency and intensity of drug treatment. Circ Cardiovasc Qual Outcomes 2015; 8:67-76. [PMID: 25604557 DOI: 10.1161/circoutcomes.114.001191] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND The use of antihypertensive medication and hypertension control has significantly increased during recent decades in some developed countries, but the impact of improved drug treatment on blood pressure (BP) control in the population is unknown. METHODS AND RESULTS Data were taken from 2 surveys representative of the population aged ≥ 60 years in Spain conducted with the same methodology in 2000 to 2001 and in 2008 to 2010. BP was measured 6×. The first BP reading was discarded, and the average of the remaining 3 to 5 BP readings was taken for analysis. Hypertension prevalence was 68.7% in 2000 to 2001 and 66.0% in 2008 to 2010. Between both time periods there was an improvement in hypertension awareness (63.6%-67.7%), drug treatment among those aware (84.5%-87.5%), and BP control among treated hypertensives (30.3%-42.9%). Overall, BP control among all hypertensives increased from 16.3% to 25.4%. After adjustment for age, sex, education, hypertension duration, smoking, alcohol consumption, body mass index, sedentary behavior, diabetes mellitus, cardiovascular disease, and visits to the physician through logistic regression, ≈ 7% of the improvement in BP control among all hypertensives was explained by higher hypertension awareness, and 36.2% was explained by a higher treatment rate. Among the treated hypertensives, 22.6% of the progress in BP control was because of the increase in the number of BP medications used in each patient. CONCLUSIONS BP control among the older hypertensive population in Spain has improved from 2000 to 2001 to 2008 to 2010 because of a higher treatment rate and more intense antihypertensive drug treatment.
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Affiliation(s)
- José R Banegas
- From the Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPAZ-CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain (J.R.B., B.N.-V., L.M.R., J.J.d.l.C.; E.L.-G., F.R.-A., A.G.); and Hypertension Unit, Research Institute, Hospital 12 de Octubre, Madrid, Spain (L.M.R.).
| | - Beatriz Navarro-Vidal
- From the Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPAZ-CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain (J.R.B., B.N.-V., L.M.R., J.J.d.l.C.; E.L.-G., F.R.-A., A.G.); and Hypertension Unit, Research Institute, Hospital 12 de Octubre, Madrid, Spain (L.M.R.)
| | - Luis M Ruilope
- From the Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPAZ-CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain (J.R.B., B.N.-V., L.M.R., J.J.d.l.C.; E.L.-G., F.R.-A., A.G.); and Hypertension Unit, Research Institute, Hospital 12 de Octubre, Madrid, Spain (L.M.R.)
| | - Juan J de la Cruz
- From the Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPAZ-CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain (J.R.B., B.N.-V., L.M.R., J.J.d.l.C.; E.L.-G., F.R.-A., A.G.); and Hypertension Unit, Research Institute, Hospital 12 de Octubre, Madrid, Spain (L.M.R.)
| | - Esther López-García
- From the Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPAZ-CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain (J.R.B., B.N.-V., L.M.R., J.J.d.l.C.; E.L.-G., F.R.-A., A.G.); and Hypertension Unit, Research Institute, Hospital 12 de Octubre, Madrid, Spain (L.M.R.)
| | - Fernando Rodríguez-Artalejo
- From the Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPAZ-CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain (J.R.B., B.N.-V., L.M.R., J.J.d.l.C.; E.L.-G., F.R.-A., A.G.); and Hypertension Unit, Research Institute, Hospital 12 de Octubre, Madrid, Spain (L.M.R.)
| | - Auxiliadora Graciani
- From the Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPAZ-CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain (J.R.B., B.N.-V., L.M.R., J.J.d.l.C.; E.L.-G., F.R.-A., A.G.); and Hypertension Unit, Research Institute, Hospital 12 de Octubre, Madrid, Spain (L.M.R.)
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The Concept and the Epidemiology of Diabetic Nephropathy Have Changed in Recent Years. J Clin Med 2015; 4:1207-16. [PMID: 26239554 PMCID: PMC4484995 DOI: 10.3390/jcm4061207] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 04/27/2015] [Accepted: 05/11/2015] [Indexed: 11/22/2022] Open
Abstract
Diabetes Mellitus (DM) is a growing worldwide epidemic. It was estimated that more than 366 million people would be affected. DM has spread its presence over the world due to lifestyle changes, increasing obesity and ethnicities, among others. Diabetic nephropathy (DN) is one of the most important DM complications. A changing concept has been introduced from the classical DN to diabetic chronic kidney disease (DCKD), taking into account that histological kidney lesions may vary from the nodular or diffuse glomerulosclerosis to tubulointerstitial and/or vascular lesions. Recent data showed how primary and secondary prevention were the key to reduce cardiovascular episodes and improve life expectancy in diabetic patients. A stabilization in the rate of end stage kidney disease has been observed in some countries, probably due to the increased awareness by primary care physicians about the prognostic importance of chronic kidney disease (CKD), better control of blood pressure and glycaemia and the implementation of protocols and clinical practice recommendations about the detection, prevention and treatment of CKD in a coordinated and multidisciplinary management of the DM patient. Early detection of DM and DCKD is crucial to reduce morbidity, mortality and the social and economic impact of DM burden in this population.
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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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Solé-Auró A, Alcañiz M. Are we living longer but less healthy? Trends in mortality and morbidity in Catalonia (Spain), 1994-2011. Eur J Ageing 2015; 12:61-70. [PMID: 28804346 PMCID: PMC5549217 DOI: 10.1007/s10433-014-0317-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Evidence on trends in prevalence of disease and disability can clarify whether countries are experiencing a compression or expansion of morbidity. An expansion of morbidity, as indicated by disease, has appeared in Europe and other developed regions. It is likely that better treatment, preventive measures, and increases in education levels have contributed to the declines in mortality and increments in life expectancy. This paper examines whether there has been an expansion of morbidity in Catalonia (Spain). It uses trends in mortality and morbidity and links these with survival to provide estimates of life expectancy with and without diseases and mobility limitations. We use a repeated cross-sectional health survey carried out in 1994 and 2011 for measures of morbidity, and information from the Spanish National Statistics Institute for mortality. Our findings show that at age 65 the percentage of life with disease increased from 52 to 70 % for men, and from 56 to 72 % for women; the expectation of life with mobility limitations increased from 24 to 30 % for men and from 40 to 47 % for women between 1994 and 2011. These changes were attributable to increases in the prevalence of diseases and moderate mobility limitation. Overall, we find an expansion of morbidity along the period. Increasing survival among people with diseases can lead to a higher prevalence of diseases in the older population. Higher prevalence of health problems can lead to greater pressure on the health care system and a growing burden of disease for individuals.
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Affiliation(s)
- Aïda Solé-Auró
- Mortality, Health and Epidiemology Unit, Institut National d’Études Démographiques INED, 133 Boulevard Davout, 75020 Paris, France
- Riskcenter, Department of Econometrics, Statistics and Spanish Economy, University of Barcelona, Av. Diagonal 690, 08034 Barcelona, Spain
| | - Manuela Alcañiz
- Riskcenter, Department of Econometrics, Statistics and Spanish Economy, University of Barcelona, Av. Diagonal 690, 08034 Barcelona, 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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Cayuela A, Cayuela L, Escudero-Martínez I, Rodríguez-Domínguez S, González A, Moniche F, Jiménez MD, Montaner J. Analysis of cerebrovascular mortality trends in Spain from 1980 to 2011. Neurologia 2014; 31:370-8. [PMID: 25524042 DOI: 10.1016/j.nrl.2014.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 05/21/2014] [Accepted: 09/06/2014] [Indexed: 10/24/2022] Open
Abstract
INTRODUCTION In recent decades, mortality rates for cerebrovascular diseases (CVD) have declined significantly in many countries. This study analyses changes in CVD mortality rates in Spain (1980-2011) to determine if previously observed trends remain. PATIENTS AND METHODS Data on CVD mortality rates and the population data needed for the analysis were provided by Spain's National Statistics Institute. We calculated age-specific mortality rate, age-standardised overall mortality, and age-truncated mortality (35-64 years) using the direct method and standard European population structure. Joinpoint analysis was used to estimate the percentage of annual change in rates and identify significant changes in trends. RESULTS CVD mortality rate decreased considerably and continuously over the last 32 years in all age groups and in both sexes in Spain. For both sexes, joinpoint analysis identifies a final period with more marked decline: 2005-2011 in women (-6.3%) and 2007-2011 in men (-7.2%). CONCLUSIONS CVD mortality rates displayed a marked and continuous decline in Spain between 1980 and 2011. Due to the ageing of the population, doctors expect an increase in CVD prevalence and therefore its magnitude in terms of disability and healthcare costs, which poses a challenge to our health system.
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Affiliation(s)
- A Cayuela
- Unidad de Gestión Clínica de Salud Pública, Prevención y Promoción de la Salud, Hospital de Valme, Área de Gestión Sanitaria Sur de Sevilla, Sevilla, España
| | - L Cayuela
- Facultad de Medicina, Universidad de Sevilla, Sevilla, España
| | - I Escudero-Martínez
- Unidad de Ictus, Unidad de Gestión Clínica de Neurociencias, Hospital Universitario Virgen del Rocío, Sevilla, España.
| | | | - A González
- Servicio de Neurorradiología Intervencionista, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - F Moniche
- Unidad de Ictus, Unidad de Gestión Clínica de Neurociencias, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - M D Jiménez
- Unidad de Ictus, Unidad de Gestión Clínica de Neurociencias, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - J Montaner
- Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Barcelona, España; Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío, Sevilla, España
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Have we attained the right control of hypertension? Consequences of the 2013 European Society of Hypertension/European Society of Cardiology and Eighth Joint National Committee recommendations. J Hypertens 2014; 32:1906-7. [DOI: 10.1097/hjh.0000000000000276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Boytsov SA, Balanova YA, Shalnova SA, Deev AD, Artamonova GV, Gatagonova TM, Duplyakov DV, Efanov AY, Zhernakova YV, Konradi AO, Libis RA, Minakov AV, Nedogoda SV, Oshchepkova EV, Romanchuk SA, Rotar OP, Trubacheva IA, Chazova IE, Shlyakhto EV, Muromtseva GA, Evstifeeva SE, Kapustina AV, Konstantinov VV, Oganov RG, Mamedov MN, Baranova EI, Nazarova OA, Shutemova OA, Furmenko GI, Babenko NI, Azarin OG, Bondartsov LV, Khvostikova AE, Ledyaeva AA, Chumachek EV, Isaeva EN, Basyrova IR, Kondratenko VY, Lopina EA, Safonova DV, Skripchenko AE, Indukaeva EV, Cherkass NV, Maksimov SA, Danilchenko YV, Mulerova TA, Shalaev SV, Medvedeva IV, Shava VG, Storozhok MA, Tolparov GV, Astakhova ZT, Toguzova ZA, Kaveshnikov VS, Karpov RS, Serebryakova VN. ARTERIAL HYPERTENSION AMONG INDIVIDUALS OF 25–64 YEARS OLD: PREVALENCE, AWARENESS, TREATMENT AND CONTROL. BY THE DATA FROM ECCD. ACTA ACUST UNITED AC 2014. [DOI: 10.15829/1728-8800-2014-4-4-14] [Citation(s) in RCA: 132] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Aim. To study prevalence of arterial hypertension (AH), mean values of systolic and diastolic blood pressure (SBP, DBP), awareness of patients about their disease, medication consumption (MC) and efficacy of treatment in several regions of Russia.Material and methods. Representative selections were made in 9 regions of Russia: men (n=5563), women (n=9737) of 25–64 y.o., studied in 2012–2013 with the response 80%. Systematic stratified multilevel random selection was formed with localilty criteria (Kisch method). The Questionnaire on the presence of AH included: awareness of the patient about his disease, drug intake. BP measurement was performed on the right arm by automatic tonometer Omron in sitting position after 5 minutes resting. The mean value of two measurements was used. BP defined as SBP ≥140 mmHg, DBP ≥90 mmHg, or if the patient had taken antihypertensive therapy. Efficacy of treatment — the part of patients (in %) who reached target BP. Control group — part of patients (in %) with BP <140/90 mmHg. Statistic data calculation was done with computer-based statistic software — SAS with standardising by age stratification of Europe.Results. Mean SBP and DBP were 130,7±0,1 mmHg and 81,6±0,1 mmHg respectively. Prevalence of AH — 44%, higher in men (p<0,001). Prevalence of AH was higher in rural area citizens in men — 51,8% vs 47,5% (р<0,02) and in women — 42,9% vs 40,2% (р<0,05). Awareness was 67,5% in men, 78,9% in women. Medications were taken by 60,9% of women and 39,5% of men. Effectively treated were 53,5% of women and 41,4% of men. With the age the part of effectively treated decreases (p<0,0005). BP is under control only in 1/3 of women and 14,4% of men.Conclusion. The role of AH as one of the main modifiable risk factors of cardiovascular diseases is proved, however it is depressing that the percent of controlled AH is low. BP control is the main task of outpatient surveillance at every local outpatient department, where now less than a half of those affected are being observed.
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Affiliation(s)
- S. A. Boytsov
- FSBI State Scientific-Research Centre for Preventive Medicine of the Ministry of Health, Moscow
| | - Yu. A. Balanova
- FSBI State Scientific-Research Centre for Preventive Medicine of the Ministry of Health, Moscow
| | - S. A. Shalnova
- FSBI State Scientific-Research Centre for Preventive Medicine of the Ministry of Health, Moscow
| | - A. D. Deev
- FSBI State Scientific-Research Centre for Preventive Medicine of the Ministry of Health, Moscow
| | - G. V. Artamonova
- FSBI Scientific-Research Institute for Complex Cardiovascular Problems of SD RAMS, Kemerovo
| | | | - D. V. Duplyakov
- SBHI Samara Region Clinical Cardiological Dispensary, Samara
| | | | - Yu. V. Zhernakova
- FSBI Russian Cardiologic Scientific-Production Complex of the Ministry of Helath, Moscow
| | - A. O. Konradi
- FSBI The Almazov Medical Research Centre, Saint-Petersburg
| | - R. A. Libis
- SBEI HPE Orenburg State Medical Academy, Orenburg
| | | | | | - E. V. Oshchepkova
- FSBI Russian Cardiologic Scientific-Production Complex of the Ministry of Helath, Moscow
| | | | - O. P. Rotar
- FSBI The Almazov Medical Research Centre, Saint-Petersburg
| | | | - I. E. Chazova
- FSBI Russian Cardiologic Scientific-Production Complex of the Ministry of Helath, Moscow
| | | | - G. A. Muromtseva
- FSBI State Scientific-Research Centre for Preventive Medicine of the Ministry of Health
| | - S. E. Evstifeeva
- FSBI State Scientific-Research Centre for Preventive Medicine of the Ministry of Health
| | - A. V. Kapustina
- FSBI State Scientific-Research Centre for Preventive Medicine of the Ministry of Health
| | - V. V. Konstantinov
- FSBI State Scientific-Research Centre for Preventive Medicine of the Ministry of Health
| | - R. G. Oganov
- FSBI State Scientific-Research Centre for Preventive Medicine of the Ministry of Health
| | - M. N. Mamedov
- FSBI State Scientific-Research Centre for Preventive Medicine of the Ministry of Health
| | - E. I. Baranova
- Первый Санкт-Петербургский государственный медицинский университет им. акад. И.П. Павлова
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - A. E. Skripchenko
- FSBI Scientific-Research Institute for Complex Cardiovascular Problems of SD RAMS
| | - E. V. Indukaeva
- FSBI Scientific-Research Institute for Complex Cardiovascular Problems of SD RAMS
| | - N. V. Cherkass
- FSBI Scientific-Research Institute for Complex Cardiovascular Problems of SD RAMS
| | - S. A. Maksimov
- FSBI Scientific-Research Institute for Complex Cardiovascular Problems of SD RAMS
| | - Ya. V. Danilchenko
- FSBI Scientific-Research Institute for Complex Cardiovascular Problems of SD RAMS
| | - T. A. Mulerova
- FSBI Scientific-Research Institute for Complex Cardiovascular Problems of SD RAMS
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Abstract
Combined therapy is required in the majority of patients with hypertension to achieve blood pressure (BP) targets. Although different antihypertensive drugs can be combined, not all combinations are equally effective and safe. In this context, the combination of a renin angiotensin system inhibitor with a diuretic, usually a thiazide, particularly hydrochlorothiazide (HCTZ) or thiazide-like diuretics, such as chlorthalidone or indapamide, is recommended. However, not all diuretics are equal. Although HCTZ, chlorthalidone, and indapamide as add-on therapy effectively reduce BP levels, the majority of studies have obtained greater BP reductions with chlorthalidone or indapamide than with HCTZ. Moreover, there are data showing benefits with chlorthalidone or indapamide beyond BP. Thus, chlorthalidone seems to have pleiotropic effects beyond BP reduction. Moreover, compared with placebo, chlorthalidone has small effects on fasting glucose and total cholesterol, and compared with HCTZ, chlorthalidone achieves significantly lower total cholesterol and low-density lipoprotein cholesterol levels. Similarly, indapamide has demonstrated no negative impact on glucose or lipid metabolism. More importantly, although head-to-head clinical trials comparing the effects of indapamide or chlorthalidone with HCTZ are not available, indirect comparisons and post hoc analyses suggest that the use of chlorthalidone or indapamide is associated with a reduction in cardiovascular events. Despite this, the most frequent diuretic used in clinical practice as add-on therapy for hypertension is HCTZ. The purpose of this review is to update the published data on the efficacy and safety of HCTZ, chlorthalidone, and indapamide as add-on therapy in patients with hypertension.
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Affiliation(s)
| | - Carlos Escobar
- Department of Cardiology, Hospital La Paz, Madrid, Spain
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Ringoir L, Widdershoven JW, Pedersen SS, Keyzer JM, Pop VJ. Symptoms associated with an abnormal echocardiogram in elderly primary care hypertension patients. Neth Heart J 2014; 22:234-9. [PMID: 24700349 PMCID: PMC4016336 DOI: 10.1007/s12471-014-0543-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background The prevalence and diagnostic value of heart failure symptoms in elderly primary care patients with hypertension is unknown. Aim To assess the prevalence, sensitivity, specificity, positive and negative predictive value of symptoms in association with an abnormal echocardiogram. Design and setting Cross-sectional screening study in five general practices in the south-east of the Netherlands. Method Between June 2010 and January 2013, 591 primary care hypertension patients aged between 60 and 85 years were included, without known heart failure and not treated by a cardiologist. All patients underwent an echocardiogram and a structured interview including assessment of heart failure symptoms: shortness of breath, fatigue, oedema, cold extremities, and restless sleep. Results and conclusion Restless sleep was reported by 25 %, cold extremities by 23 %, fatigue by 19 %, shortness of breath by 17 %, and oedema by 13 %. Oedema was the only symptom significantly associated with an abnormal echocardiogram (positive predictive value was 45 %, sensitivity 20 %, and specificity 90 %, OR 2.12; 95 % CI = 1.23–3.64), apart from higher age (OR 1.06; 95 % CI = 1.03–1.09), previous myocardial infarction (OR 3.00; 95 % CI = 1.28–7.03), and a systolic blood pressure of >160 mmHg (OR 1.62; 95 % CI = 1.08–2.41). Screening with echocardiography might be considered in patients with oedema.
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Affiliation(s)
- L Ringoir
- Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic Diseases (CoRPS), Tilburg University, PO Box: 90153, 5000 LE, Tilburg, the Netherlands
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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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Galve E, Alegría E, Cordero A, Fácila L, Fernández de Bobadilla J, Lluís-Ganella C, Mazón P, de Pablo Zarzosa C, González-Juanatey JR. Temas de actualidad en cardiología: riesgo vascular y rehabilitación cardiaca. Rev Esp Cardiol 2014. [DOI: 10.1016/j.recesp.2013.09.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Galve E, Alegría E, Cordero A, Fácila L, Fernández de Bobadilla J, Lluís-Ganella C, Mazón P, de Pablo Zarzosa C, González-Juanatey JR. Update in cardiology: vascular risk and cardiac rehabilitation. ACTA ACUST UNITED AC 2014; 67:203-10. [PMID: 24774395 DOI: 10.1016/j.rec.2013.09.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Accepted: 09/26/2013] [Indexed: 12/11/2022]
Abstract
Cardiovascular disease develops in a slow and subclinical manner over decades, only to manifest suddenly and unexpectedly. The role of prevention is crucial, both before and after clinical appearance, and there is ample evidence of the effectiveness and usefulness of the early detection of at-risk individuals and lifestyle modifications or pharmacological approaches. However, these approaches require time, perseverance, and continuous development. The present article reviews the developments in 2013 in epidemiological aspects related to prevention, includes relevant contributions in areas such as diet, weight control methods (obesity is now considered a disease), and physical activity recommendations (with warnings about the risk of strenuous exercise), deals with habit-related psychosocial factors such as smoking, provides an update on emerging issues such as genetics, addresses the links between cardiovascular disease and other pathologies such as kidney disease, summarizes the contributions of new, updated guidelines (3 of which have recently been released on topics of considerable clinical importance: hypertension, diabetes mellitus, and chronic kidney disease), analyzes the pharmacological advances (largely mediocre except for promising lipid-related results), and finishes by outlining developments in the oft-neglected field of cardiac rehabilitation. This article provides a briefing on controversial issues, presents interesting and somewhat surprising developments, updates established knowledge with undoubted application in clinical practice, and sheds light on potential future contributions.
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Affiliation(s)
- Enrique Galve
- Servicio de Cardiología, Hospital Vall d'Hebron, Barcelona, Spain.
| | - Eduardo Alegría
- Servicio de Cardiología, Policlínica Gipuzkoa, San Sebastián, Guipúzcoa, Spain
| | - Alberto Cordero
- Departamento de Cardiología, Hospital Universitario de San Juan, Sant Joan d'Alacant, Alicante, Spain
| | - Lorenzo Fácila
- Servicio de Cardiología, Consorcio Hospital General de Valencia, Valencia, Spain
| | | | - Carla Lluís-Ganella
- Grupo de Epidemiología y Genética Cardiovascular, IMIM (Institut Hospital del Mar d'Investigacións Mèdiques), Barcelona, Spain
| | - Pilar Mazón
- Servicio de Cardiología, Hospital Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | | | - José Ramón González-Juanatey
- Servicio de Cardiología, Hospital Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
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Segura J, Banegas JR, Ruilope LM. Usefulness of ambulatory blood pressure monitoring (ABPM) in daily clinical practice: Data from the Spanish ABPM registry. Clin Exp Pharmacol Physiol 2013; 41:30-6. [DOI: 10.1111/1440-1681.12126] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 05/19/2013] [Accepted: 05/22/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Julian Segura
- Hypertension Unit; Department of Nephrology; Hospital 12 de Octubre Madrid Spain
| | - Jose R Banegas
- Department of Preventive Medicine and Public Health; Universidad Autónoma de Madrid; Madrid Spain
| | - Luis M Ruilope
- Hypertension Unit; Department of Nephrology; Hospital 12 de Octubre Madrid Spain
- Department of Preventive Medicine and Public Health; Universidad Autónoma de Madrid; Madrid Spain
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Barrios V, Escobar C. Letter from Barrios and Escobar regarding article, "trends in antihypertensive medication use and blood pressure control among United States adults with hypertension: the national health and nutrition examination survey, 2001 to 2010". Circulation 2013; 127:e859. [PMID: 23775199 DOI: 10.1161/circulationaha.112.153338] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Sengul S, Erdem Y, Batuman V, Erturk S. Hypertension and chronic kidney disease in Turkey. Kidney Int Suppl (2011) 2013; 3:308-311. [PMID: 25019009 PMCID: PMC4089601 DOI: 10.1038/kisup.2013.64] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Worldwide, both hypertension and chronic kidney disease are major public health problems, due to their epidemic proportions and their association with high cardiovascular mortality. In 2003, the first Prevalence, awareness, treatment, and control of hypertension in Turkey (the PatenT) study was conducted in a nationally representative population (n=4910) by the Turkish Society of Hypertension and Renal Diseases, and showed that overall age- and sex-adjusted prevalence of hypertension in Turkey was 31.8%. The PatenT study also reported that overall awareness (40.7%), treatment (31.1%), and control rates (8.1%) of hypertension were strikingly low. Only 20.7% of the patients who were aware of their hypertension and receiving treatment had their blood pressure controlled to <140/90 mm Hg. In the Chronic Renal Disease in Turkey (CREDIT) study (n=10,748), the overall prevalence of chronic kidney (including all stages) disease was 15.7% and increased with advancing age. In the same population, the prevalence of hypertension, diabetes mellitus, dyslipidemia, obesity, and metabolic syndrome were reported as 32.7%, 12.7%, 76.3%, 20.1%, and 31.3%, respectively. The prevalence and awareness of hypertension in CREDIT population was 32.7% and 48.6%, respectively. According to the data obtained from national surveys, the prevalence of hypertension and chronic kidney disease in Turkey is alarmingly high. To improve prevention, early diagnosis, and treatment of these major public health problems, appropriate health strategies should be implemented by the government, together with medical societies, non-governmental organizations, industry, health-care providers, and academia.
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Affiliation(s)
- Sule Sengul
- Department of Nephrology, Ankara University School of Medicine, Ankara, Turkey
| | - Yunus Erdem
- Department of Nephrology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Vecihi Batuman
- Division of Nephrology, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Sehsuvar Erturk
- Department of Nephrology, Ankara University School of Medicine, Ankara, Turkey
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43
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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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Barrios V, Escobar C. Azilsartan medoxomil in the treatment of hypertension: the definitive angiotensin receptor blocker? Expert Opin Pharmacother 2013; 14:2249-61. [PMID: 24070321 DOI: 10.1517/14656566.2013.834887] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Azilsartan medoxomil is the newest angiotensin receptor blocker marketed for the treatment of arterial hypertension. The aim of this article was to review the available evidence about this drug alone or combined with other antihypertensive agents in the treatment of hypertensive population. AREAS COVERED For this purpose, a search on MEDLINE and EMBASE databases was performed. The MEDLINE and EMBASE search included both medical subject headings (MeSHs) and keywords including azilsartan or azilsartan medoxomil or angiotensin receptor blockers or renin angiotensin system or chlorthalidone and hypertension. References of the retrieved articles were also screened for additional studies. There were no language restrictions. EXPERT OPINION Azilsartan medoxomil has a potent and persistent ability to inhibit binding of angiotensin II to AT1 receptors, which may play a role in its superior blood pressure (BP) -lowering efficacy compared with other drugs, including ramipril, candesartan, valsartan or olmesartan, without an increase of side effects. Chlortalidone is a diuretic which significantly differs from other classic thiazides and has largely demonstrated clinical benefits in outcome trials. The fixed-dose combination of azilsartan and chlorthalidone has been shown to be more effective than other potent combinations of angiotensin receptor blockers plus hydrochlorothiazide, with a good tolerability profile.
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Affiliation(s)
- Vivencio Barrios
- Hospital Ramon y Cajal, Department of Cardiology , Madrid 28034 , Spain +34 91 336 8665 ;
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47
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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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Escobar C, Barrios V. An evaluation of the latest evidence relating to renin-angiotensin system inhibitors. Expert Opin Drug Metab Toxicol 2013; 9:847-58. [PMID: 23560616 DOI: 10.1517/17425255.2013.788149] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
INTRODUCTION In the last few years, a number of important clinical trials have been completed that have investigated the inhibition of the renin-angiotensin system. New drugs, focusing on this system, have now emerged as a result. AREAS COVERED The authors review the most relevant information available, reported from the last 5 years, pertaining to the most important clinical trials on renin-angiotensin system blockers (ARBs). The authors' data review includes the trials of aliskiren, telmisartan, olmesartan and azilsartan. The authors also review the possible risk of cancer with ARBs. EXPERT OPINION The results of ASPIRE and ALTITUDE trials strongly suggested that dual inhibition of aliskiren with either ARBS or angiotensin converting enzyme inhibitors (ACEi) should be avoided. Olmesartan is an effective and safe antihypertensive agent, but special attention should be paid to high-risk patients, such as those with coronary disease, to avoid an excessive reduction in blood pressure. The authors also note that while azilsartan is probably the most potent ARB, there is still a lack of data regarding potential organ damage and the incidence of cardiovascular events. Lastly, recent evidence has shown a lack of a relationship between ARB therapy and the occurrence of cancer.
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Affiliation(s)
- Carlos Escobar
- Hospital La Paz, Department of Cardiology, Madrid, Spain
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Reply to F. Catalá-López et al. J Hypertens 2013; 31:631-2. [DOI: 10.1097/hjh.0b013e32835c6d3d] [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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Aspectos prácticos de la combinación de 3 fármacos antihipertensivos a dosis fijas. HIPERTENSION Y RIESGO VASCULAR 2013. [DOI: 10.1016/s1889-1837(13)70016-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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