[Cardiovascular prevention in primary healthcare]

Educational intervention on cardiovascular parameters in perimenopausal women with a cardiovascular risk factor. Randomised clinical trial

BACKGROUND AND OBJECTIVE

Randomised clinical trial performed in two urban health centres in Spain. To evaluate if educational intervention in women of perimenopausal age with hypertension, diabetes mellitus and/or dyslipidaemia could achieve significant changes in the reduction of biochemical and haemodynamic risk parameters.

PATIENTS AND METHODS

The study included 320 women aged between 45 and 60 years old who were diagnosed with hypertension, diabetes mellitus and/or dyslipidaemia. They were randomly assigned to the experimental group (n=160) and the control group (n=160). The intervention group received three educational sessions and the control group received an informative leaflet sent by mail. Haemodynamic and biochemical variables were evaluated at baseline and one year later in both groups.

RESULTS

Women in the intervention group showed a decrease in low density lipoprotein (P=.034), (-5.89±29.8; 95% CI: -13.1/0.27) and an increase in high density lipoprotein (P=.013), (2.71±10.6; 95% CI: -1.36/6.20), as well as improvements in systolic blood pressure (P=.016), (-2.16±11.8; 95% CI: -4.4/0.01) and frequency (P=.003), (-1.46±10.3; 95% CI: -3.34/0.42) compared to women in the control group. Women in the control group significantly increased glucose (P=.04), (4.84±15.5; 95% CI: -0.75/31.3) and gamma-glutamyltranspeptidase (P=.031), (3.61±14.7; 95% CI: 0.87/6.36) levels more than those in the experimental group.

CONCLUSIONS

An educational intervention can be an effective method of reducing the parameters associated with an increased likelihood of cardiovascular disease in women at perimenopausal age with hypertension, diabetes mellitus and/or dyslipidaemia.

Estratificación y grado de control del riesgo cardiovascular en la población hipertensa española. Resultados del estudio DICOPRESS

BACKGROUND AND OBJECTIVE

Hypertension, together with other contributing risk factors, is a major risk for cardiovascular disease. The aim of this study was to assess the cardiovascular risk in the Spanish hypertensive population according to the 2003 European Society of Hypertension-European Society of Cardiology (ESH/ESC) guidelines criteria and to determine the control rate of the main cardiovascular risk factors (CVRF).

PATIENTS AND METHOD

Observational and transversal study including 22,639 patients with essential hypertension, who have been admitted to primary care units and hypertension units in Spain.

RESULTS

Dyslipemia (52.1%), diabetes (36.6%) and smoking (22.3%) were the most prevalent CVRF. Cardiovascular risk stratification according to the ESH/ESC guidelines showed that more than 70% patients were considered at high added risk (36.9%) or at very high added risk (35.8%), whereas only 7.6% were classified in the low-risk stratum. Blood pressure was the worst controlled risk factor among hypertensive patients (80.6%). Total cholesterol was also poorly controlled in a high percentage of the analyzed population (66.4%). Diabetes was the best predictor of uncontrolled blood pressure with an odds ratio of 5.25 (99% confidence interval, 4.57-6.06).

CONCLUSIONS

Coexistence of several cardiovascular risk factors, as well as the presence of target organ damage and associated cardiovascular conditions in the Spanish hypertensive population, increase the vascular risk, complicate the control in the hypertensive population and show the convenience of using ESH/ESC 2003 guidelines to estimate the cardiovascular risk.