Relation between clinical and therapeutic variables and quality of life in hypertension.

OBJECTIVE: Study the relation between quality of life (QoL) and various clinical, therapeutic and sociodemographic variables in treated hypertensive patients. MATERIAL AND METHODS: A prospective study was carried out in 92 primary care centres in Spain. A total of 269 hypertensive patients were selected and 106 healthy normotensive individuals were included as controls. At the time of inclusion a wide range of clinical variables was documented. QoL was assessed at baseline and 1 month after the intensification of antihypertensive therapy, using a self-administered, specific hypertension, 56-item questionnaire in addition to the generic EuroQoL-5D. RESULTS: QoL was poorer among the hypertensive subjects than among the normotensive individuals, even adjusting for the differences observed between the groups (age, sex, education and working status). The same was found with the EuroQol-5D. In the hypertensive subjects, after applying a multiple regression equation, only four variables significantly retained their negative impact on QoL: sex (female), greater organ damage and higher heart rate and weight. After the intensification of antihypertensive therapy with irbesartan, QoL improved significantly. Neither the presence of side-effects during the month of follow-up, nor the degree of BP reduction showed a significant impact on QoL, although the latter came close to statistical significance. CONCLUSIONS: Hypertensive patients have significantly poorer QoL than normotensive subjects, even with adjustment for differences. In hypertensives, QoL is affected by some clinical variables that might help us to identify those with worse QoL. Intensification of antihypertensive therapy produced a positive impact on QoL.

[Cardiovascular morbidity and its relationship to left ventricular hypertrophy in a cohort of hypertensive patients: the Gòtic study]. / Morbilidad cardiovascular y su relación con la hipertrofia ventricular izquierda de una cohorte de pacientes hipertensos: estudio Gòtic.

BACKGROUND: To describe cardiovascular morbidity of a hypertensive patients cohort and relate it to the presence of left ventricular hypertrophy (LVH), LVH geometric patterns, other cardiovascular risk factors (CRF), previous pathology (PP) and a range of variables. DESIGN: Prospective study of the cohort visited in a from 1993 to 1998. Place. Downtown primary care center. PATIENTS: A random sample of 267 hypertensive patients under 80 years old was used. Method and procedures. The presence of universals of CRF, PP and a range of variables such as age, sex, systolic and diastolic blood pressure (SBP and DBP), heart rate, body mass index (BMI), left ventricular mass index (LVMI) and Cornell and Sokolov-Lyon electrocardiographic criteria were registered. Also cardiovascular events (CE) were recorded: heart failure (HF), coronary heart disease (CHD), stroke, arrythmia and peripheral vascular disease (PVD). Then the association between these variaables and CE appearance was studied. MEASURES AND RESULTS: The total amount of CE was 60, with an accumulated incidence of 22.5% (confidence interval 95% from 19.4 to 25.7%).HF was more frequent among patients with a higher BMI (p = 0.05). The patients with HF showed a stronger smoking habit as CRF and a higher PAS (p = 0.05). The PVD was more common among hypertensive patients with smoking habit as CRF (p = 0.05).EC was highly observed in those patients either with LVH or CRF, especially in those cases such as HF (90% had LVH), stroke (87.5%) and arrythmias (83.3%). However, it was less observed in those ones with PVD (66.7%) and HF (60%). No relation was found between the patterns of LVH and EC. CONCLUSIONS: The HF was more frequent among the hypertensive patients with a higher LVMI, the HF among the smokers and a higher PAS and PVD among the smokers. The LVH is strongly related to the HF, stroke and arrythmias. The differences among the populations with cardiovascular epidemiology as well as the short span of follow-up may have contributed to obtaining such results.

[Control of blood pressure in a population of patients with hypertension and in a subgroup with hypertension and diabetes: relationship with characteristics of the health care center and the community]. / Control de la presión arterial en la población hipertensa y en el subgrupo de hipertensos y diabéticos: relación con las características del centro y de la comunidad.

AIMS: To evaluate how well blood pressure (BP) is controlled in the population of persons with hypertension alone and with diabetes, and to evaluate the influence of characteristics of the health care center on the degree of control of BP. Design. Descriptive, cross-sectional, multicenter, retrospective study. SETTING: 31 health centers in Catalonia (Northeastern Spain). Participants. Random sample of 2240 clinical records of patients with hypertension who were seen at 31 different primary care centers in Catalonia between January and December 1996. MAIN OUTCOME MEASURES: Audit of clinical records. We recorded the two most recent BP measurements, and annotations regarding screening for and diagnosis of other cardiovascular risk factors. We also recorded health center and physician characteristics. RESULTS: 495 patients (22.1%) had diabetes in addition to hypertension. 61.2% were women. Mean age was 64.9 years (95% CI, 64.4-65.4 years). In 25.7% of the patients, BP was below 140/90 mmHg (95% CI, 23.9-27.5%), but among patients with diabetes only 6.7% had BP below 130/85 mmHg (95% CI, 4.5-8.9%). Mean systolic and diastolic BP at the end of the study period were higher at teaching centers. Diastolic BP was significantly higher at urban centers and in patients younger than 65 years. Diastolic BP was also higher in patients with at least one associated cardiovascular risk factor, and at centers less than 6 years old, although these differences were not statistically significant. We found no differences according to physician characteristics. CONCLUSIONS: Blood pressure was adequately controlled in few patients with hypertension and diabetes in Catalonia. Associated cardiovascular risk factors, age less than 65 years, and being a patient at a teaching center or an urban center, were associated with a worse degree of BP control.

[Self perception of health and complete evaluation of the elderly patient at a primary care center]. / Autopercepción de salud y evaluación integral del paciente anciano en un centro de atención primaria.

OBJECTIVES: 1) To make an integrated evaluation of the cognitive status, functional capacity, chronic disorders and social situation of the over-75 age group. 2) To find this group's self-perception of their health. DESIGN: A descriptive crossover study. SETTING: The Gòtic Health District in Barcelona. PARTICIPANTS: 316 people were included in the study. They were chosen by simple randomised sampling from the over-75s seen at the centre (n = 1,625). MEASUREMENTS AND MAIN RESULTS: To assess cognitive status, the Pfeiffer Short Portable Mental Status Questionnaire was used; for functional capacity, the Katz Index; and for chronic disorders, the medical records were reviewed. A questionnaire was used to find patients' social situation and assessed social relationships, social resources used and architectonic barriers. Self-perception of health status was evaluated using the Nottingham Health Profile. Prevalence of cognitive deterioration was 29.7%. 39.4% of patients were dependent in one or more basic activities of their daily life. 90.8% had a chronic disorder, the most frequent being AHT, arthrosis, obesity and dyslipemias. 28.3% lived alone and 26.7% used social services. CONCLUSIONS: We think this kind of assessment is useful in primary care. It would provide an integrated diagnosis (clinical, functional, medical and social) of elderly patients.

[Left ventricular hypertrophy in a general hypertensive population in Barcelona]. / Hipertrofia ventricular izquierda en una población hipertensa general de Barcelona.

BACKGROUND: Left ventricular hypertrophy (LVH) is a well known cardiac risk factor. There are no data available as to the epidemiology of this disease in the general hypertensive population in Spain. METHODS: A randomized sample (n = 267) of a general hypertensive population under the age of 80 years was followed in a Basic Health Care Area located in the center of Barcelona, Spain. A Doppler-echocardiographic study of the patients was carried out. The patients were considered to have LVH when they demonstrated an index > 134 g/m2 of left ventricular mass in males and > 110 g/m2 in females. The odds ratio (OR) was estimated on presentation of LVH associated with exposure to different factors. RESULTS: A prevalence of LVH diagnosed by echocardiogram was observed in 64% (confidence interval 95% from 58.3 to 69.8%). The independent risk factors associated with the presence of LVH were female sex, age and systolic blood pressure. CONCLUSIONS: Left ventricular hypertrophy is a frequent cardiovascular risk factor in the general hypertensive population in Spain. A systematic search by echocardiography cannot be recommended in primary health care until cost-effectiveness studies have been performed.

[Reflex sympathetic dystrophy]. / Distrofia simpática refleja.

OBJECTIVE: The description of three cases of reflex sympathetic dystrophy. DESIGN: Retrospective clinical observations. SETTING: Gòtic basic Health Area, Barcelona. PATIENTS AND OTHER PARTICIPANTS: Two women and a man (aged 75, 65 and 56) with mechanical pain and inflammation in the extremities. Two of the cases had a case history of trauma. Radiological signs of mottled osteoporosis were observed in the affected extremities of all the patients. In one there was gammagraphic pick-up. They were diagnosed as suffering reflex sympathetic dystrophy. INTERVENTIONS: Rehabilitation, non-steroid anti-inflammatories and treatment with Calcitonin. MEASUREMENTS AND MAIN RESULTS: Clinical and complementary diagnostic trials. CONCLUSIONS: Describing the clinical presentation and the necessary complementary trials to be able to reach an early diagnosis of this illness, which provides a better prognosis.