Mortality and major postoperative complications within 1 year after vascular surgery: a prospective cohort study.

INTRODUCTION: Patients undergoing vascular procedures are prone to developing postoperative complications affecting their short­term mortality. Prospective reports describing the incidence of long­term complications after vascular surgery are lacking. OBJECTIVES: We aimed to describe the incidence of complications 1 year after vascular surgery and to evaluate an association between myocardial injury after noncardiac surgery (MINS) and 1­year mortality. PATIENTS AND METHODS: This is a substudy of a large prospective cohort study Vascular Events in Noncardiac Surgery Patients Cohort Evaluation (VISION). Recruitment took place in 28 centers across 14 countries from August 2007 to November 2013. We enrolled patients aged 45 years or older undergoing vascular surgery, receiving general or regional anesthesia, and hospitalized for at least 1 night postoperatively. Plasma cardiac troponin T concentration was measured before the surgery and on the first, second, and third postoperative day. The patients or their relatives were contacted 1 year after the procedure to assess the incidence of major postoperative complications. RESULTS: We enrolled 2641 patients who underwent vascular surgery, 2534 (95.9%) of whom completed 1­year follow­up. Their mean (SD) age was 68.2 (9.8) years, and the cohort was predominantly male (77.5%). The most frequent 1­year complications were myocardial infarction (224/2534, 8.8%), amputation (187/2534, 7.4%), and congestive heart failure (67/2534, 2.6%). The 1­year mortality rate was 8.8% (223/2534). MINS occurred in 633 patients (24%) and was associated with an increased 1­year mortality (hazard ratio, 2.82; 95% CI, 2.14-3.72; P <0.001). CONCLUSIONS: The incidence of major postoperative complications after vascular surgery is high. The occurrence of MINS is associated with a nearly 3­fold increase in 1­year mortality.

One-year Outcomes after Discharge from Noncardiac Surgery and Association between Predischarge Complications and Death after Discharge: Analysis of the VISION Prospective Cohort Study.

BACKGROUND: In previous analyses, myocardial injury after noncardiac surgery, major bleeding, and sepsis were independently associated with most deaths in the 30 days after noncardiac surgery, but most of these deaths occurred during the index hospitalization for surgery. The authors set out to describe outcomes after discharge from hospital up to 1 yr after inpatient noncardiac surgery and associations between predischarge complications and postdischarge death up to 1 yr after surgery. METHODS: This study was an analysis of patients discharged after inpatient noncardiac surgery in a large international prospective cohort study across 28 centers from 2007 to 2013 of patients aged 45 yr or older followed to 1 yr after surgery. The study estimated (1) the cumulative postdischarge incidence of death and other outcomes up to a year after surgery and (2) the adjusted time-varying associations between postdischarge death and predischarge complications including myocardial injury after noncardiac surgery, major bleeding, sepsis, infection without sepsis, stroke, congestive heart failure, clinically important atrial fibrillation or flutter, amputation, venous thromboembolism, and acute kidney injury managed with dialysis. RESULTS: Among 38,898 patients discharged after surgery, the cumulative 1-yr incidence was 5.8% (95% CI, 5.5 to 6.0%) for all-cause death and 24.7% (95% CI, 24.2 to 25.1%) for all-cause hospital readmission. Predischarge complications were associated with 33.7% (95% CI, 27.2 to 40.2%) of deaths up to 30 days after discharge and 15.0% (95% CI, 12.0 to 17.9%) up to 1 yr. Most of the association with death was due to myocardial injury after noncardiac surgery (15.6% [95% CI, 9.3 to 21.9%] of deaths within 30 days, 6.4% [95% CI, 4.1 to 8.7%] within 1 yr), major bleeding (15.0% [95% CI, 8.3 to 21.7%] within 30 days, 4.7% [95% CI, 2.2 to 7.2%] within 1 yr), and sepsis (5.4% [95% CI, 2.2 to 8.6%] within 30 days, 2.1% [95% CI, 1.0 to 3.1%] within 1 yr). CONCLUSIONS: One in 18 patients 45 yr old or older discharged after inpatient noncardiac surgery died within 1 yr, and one quarter were readmitted to the hospital. The risk of death associated with predischarge perioperative complications persists for weeks to months after discharge.

Statement of the Spanish Interdisciplinary Vascular Prevention Committee on the updated European Guidelines on Cardiovascular Disease Prevention.

We present the Spanish adaptation of the 2021 European Guidelines on Cardiovascular Disease (CVD) prevention in clinical practice. The current guidelines besides the individual approach greatly emphasize on the importance of population level approaches to the prevention of cardiovascular diseases. Systematic global CVD risk assessment is recommended in individuals with any major vascular risk factor. Regarding LDL-Cholesterol, blood pressure, and glycemic control in patients with diabetes mellitus, goals and targets remain as recommended in previous guidelines. However, it is proposed a new, stepwise approach (Step 1 and 2) to treatment intensification as a tool to help physicians and patients pursue these targets in a way that fits patient profile. After Step 1, considering proceeding to the intensified goals of Step 2 is mandatory, and this intensification will be based on 10-year CVD risk, lifetime CVD risk and treatment benefit, comorbidities and patient preferences. The updated SCORE algorithm-SCORE2, SCORE-OP- is recommended in these guidelines, which estimates an individual's 10-year risk of fatal and non-fatal CVD events (myocardial infarction, stroke) in healthy men and women aged 40-89 years. Another new and important recommendation is the use of different categories of risk according different age groups (< 50, 50-69, ≥70 years). Different flow charts of CVD risk and risk factor treatment in apparently healthy persons, in patients with established atherosclerotic CVD, and in diabetic patients are recommended. Patients with chronic kidney disease are considered high risk or very high-risk patients according to the levels of glomerular filtration rate and albumin-to-creatinine ratio. New lifestyle recommendations adapted to the ones published by the Spanish Ministry of Health as well as recommendations focused on the management of lipids, blood pressure, diabetes and chronic renal failure are included.

Statement of the Spanish Interdisciplinary Vascular Prevention Committee on the updated European Guidelines on Cardiovascular Disease Prevention. / Comentario del CEIPV a las nuevas Guías Europeas de Prevención Cardiovascular 2021.

We present the Spanish adaptation of the 2021 European Guidelines on Cardiovascular Disease Prevention in Clinical Practice. The current guidelines besides the individual approach greatly emphasize on the importance of population level approaches to the prevention of cardiovascular diseases. Systematic global cardiovascular disease risk assessment is recommended in individuals with any major vascular risk factor. Regarding LDL-cholesterol, blood pressure, and glycemic control in patients with diabetes mellitus, goals and targets remain as recommended in previous guidelines. However, it is proposed a new, stepwise approach (steps 1 and 2) to treatment intensification as a tool to help physicians and patients pursue these targets in a way that fits patient profile. After step 1, considering proceeding to the intensified goals of step 2 is mandatory, and this intensification will be based on 10-year cardiovascular disease risk, lifetime cardiovascular disease risk and treatment benefit, comorbidities and patient preferences. The updated SCORE algorithm ?SCORE2, SCORE2-OP? is recommended in these guidelines, which estimates an individual's 10-year risk of fatal and non-fatal cardiovascular disease events (myocardial infarction, stroke) in healthy men and women aged 40-89 years. Another new and important recommendation is the use of different categories of risk according to different age groups (<50, 50-69, ≥70 years). Different flow charts of cardiovascular disease risk and risk factor treatment in apparently healthy persons, in patients with established atherosclerotic cardiovascular disease, and in diabetic patients are recommended. Patients with chronic kidney disease are considered high risk or very high-risk patients according to the levels of glomerular filtration rate and albumin-to-creatinine ratio. New lifestyle recommendations adapted to the ones published by the Spanish Ministry of Health as well as recommendations focused on the management of lipids, blood pressure, diabetes and chronic renal failure are included.

Participación ciudadana en la política pública de deporte en Medellín / Citizen Participation in the Public Policy of Sport in Medellin

Resumen ¿Cuál es la incidencia de la participación ciudadana en la formulación de políticas públicas locales? Este artículo de reflexión responde, exploratoriamente, esta pregunta desde el caso de la política pública del deporte, la recreación y la actividad física en Medellín. Teniendo en cuenta el mismo método, instrumentos e información recolectada durante el proceso original de reformulación, se contrasta esta información con la incorporada en los documentos oficiales que recogen la actualización de la política pública. Aunque se invoca la metodología de co-creación, se mantienen los mismos canales y limitaciones a la participación ciudadana; entonces, se participa, pero no se co-crea.

Abstract What is the incidence of citizen participation in the formulation of local public policies? This reflective article answers, in an exploratory way, this question from the case of the public policy of sport, recreation, and physical activity in Medellin. By taking into account the same method, instruments, and information collected during the original reformulation process, this information is contrasted with that incorporated in the official documents that reflect the updating of the public policy. Although the methodology of co-creation is invoked, the same channels and limitations to citizen participation are maintained. Thus, there is participation, but there is no co-creation.

[Statement of the Spanish Interdisciplinary Vascular Prevention Committee on the updated European Guidelines on Cardiovascular Disease Prevention.] / Comentario del CEIPV a las nuevas Guías Europeas de Prevención Cardiovascular 2021.

We present the Spanish adaptation of the 2021 European Guidelines on Cardiovascular Disease (CVD) prevention in clinical practice. The current guidelines besides the individual approach greatly emphasize on the importance of population level approaches to the prevention of cardiovascular diseases. Systematic global CVD risk assessment is recommended in individuals with any major vascular risk factor. Regarding LDL-Cholesterol, blood pressure, and glycemic control in patients with diabetes mellitus, goals and targets remain as recommended in previous guidelines. However, it is proposed a new, stepwise approach (Step 1 and 2) to treatment intensification as a tool to help physicians and patients pursue these targets in a way that fits patient profile. After Step 1, considering proceeding to the intensified goals of Step 2 is mandatory, and this intensification will be based on 10-year CVD risk, lifetime CVD risk and treatment benefit, comorbidities and patient preferences. The updated SCORE algorithm (SCORE2, SCORE-OP) is recommended in these guidelines, which estimates an individual's 10-year risk of fatal and non-fatal CVD events (myocardial infarction, stroke) in healthy men and women aged 40-89 years. Another new and important recommendation is the use of different categories of risk according different age groups (<50, 50-69, >70 years). Different flow charts of CVD risk and risk factor treatment in apparently healthy persons, in patients with established atherosclerotic CVD, and in diabetic patients are recommended. Patients with chronic kidney disease are considered high risk or very high-risk patients according to the levels of glomerular filtration rate and albumin-to-creatinine ratio. New lifestyle recommendations adapted to the ones published by the Spanish Ministry of Health as well as recommendations focused on the management of lipids, blood pressure, diabetes and chronic renal failure are included.

Presentamos la adaptación española de las Guías Europeas de Prevención Cardiovascular 2021. En esta actualización además del abordaje individual, se pone mucho más énfasis en las políticas sanitarias como estrategia de prevención poblacional. Se recomienda el cálculo del riesgo vascular de manera sistemática a todas las personas adultas con algún factor de riesgo vascular. Los objetivos terapéuticos para el colesterol LDL, la presión arterial y la glucemia no han cambiado respecto a las anteriores guías, pero se recomienda alcanzar estos objetivos de forma escalonada (etapas 1 y 2). Se recomienda llegar siempre hasta la etapa 2, y la intensificación del tratamiento dependerá del riesgo a los 10 años y de por vida, del beneficio del tratamiento, de las comorbilidades, de la fragilidad y de las preferencias de los pacientes. Las guías presentan por primera vez un nuevo modelo para calcular el riesgo (SCORE2 y SCORE2 OP) de morbimortalidad vascular en los próximos 10 años (infarto de miocardio, ictus y mortalidad vascular) en hombres y mujeres entre 40 y 89 años. Otra de las novedades sustanciales es el establecimiento de diferentes umbrales de riesgo dependiendo de la edad (<50, 50-69, >70 años). Se presentan diferentes algoritmos de cálculo del riesgo vascular y tratamiento de los factores de riesgo vascular para personas aparentemente sanas, pacientes con diabetes y pacientes con enfermedad vascular aterosclerótica. Los pacientes con enfermedad renal crónica se considerarán de riesgo alto o muy alto según la tasa del filtrado glomerular y el cociente albúmina/creatinina. Se incluyen innovaciones en las recomendaciones sobre los estilos de vida, adaptadas a las recomendaciones del Ministerio de Sanidad, así como aspectos novedosos relacionados con el control de los lípidos, la presión arterial, la diabetes y la insuficiencia renal crónica.

Characteristics, treatment, and nursing care of patients infected by Sars-CoV-2 hospitalized in intensive care units: multicenter study of colombian hospitals / Características, tratamiento y cuidados de enfermería de pacientes infectados por SARS-CoV-2 hospitalizados en unidades de cuidados intensivos: estudio multicéntrico de hospitales colombianos / Características, tratamento e cuidados de enfermagem de pacientes infectados por SARS-CoV-2 hospitalizados em unidades de tratamento intensivos: estudo multicêntrico de hospitais colombianos

Objective. To describe the clinical characteristics, treatment, evolution, and nursing care of adult patients with severe acute respiratory distress syndrome who were positive for SARS-CoV-2 and hospitalized in intensive care units (ICUs) during the first peak of the pandemic in Colombia, 2020. Methods. Multicenter descriptive study of four high-complexity hospitals in Colombia, which included 473 consecutive adult patients admitted to intensive care units with a confirmed diagnosis of SARS CoV-2. Sociodemographic and clinical information - comorbidities, treatment and evolution - and nursing care provided were included. Results. Of the patients included, 43.7% died, 88.8% had pneumonia, and 60.2% developed respiratory distress syndrome. Most of those who died were men. Those who died had a median age of 68.4 years and a higher frequency of comorbidities (hypertension, cardiovascular disease, chronic obstructive pulmonary disease, and higher body mass index). They were admitted to the ICU with higher rate of dyspnea, lower oxygen saturation, and higher score of multiorgan failure. They also more often required mechanical ventilation and pronation therapy and were given more vasopressors and renal replacement therapy. Conclusion. People with severe acute respiratory distress syndrome due to COVID-19 who were hospitalized in the ICU had a high risk of death, especially older patients; males; those with cardiovascular, respiratory, and hypertension comorbidities; those who needed mechanical ventilation; and those with an elevated SOFA score. The nursing care of these critically ill patients focused on respiratory care and the prevention of associated complications.

Objetivo. Describir las características clínicas, tratamiento, evolución y cuidados de enfermería de los pacientes adultos con síndrome de dificultad respiratoria aguda grave, positivos para SARS-CoV-2, hospitalizados en Unidades de Cuidados Intensivos (UCI) durante el primer pico de pandemia en Colombia en 2020. Métodos. Estudio descriptivo multicéntrico con la participación de cuatro hospitales de alto nivel de complejidad en Colombia, que incluyó 473 pacientes adultos, admitidos de forma consecutiva en unidades de cuidados intensivos -UCI-, con diagnóstico confirmado para SARS CoV-2. Se incluyó información sociodemográfica, clínica, comorbilidades, tratamiento y evolución, además de los cuidados de enfermería brindados. Resultados. Del total de pacientes incluidos fallecieron el 43.7%, presentaron neumonía el 88.8% y un 60.2% desarrollaron síndrome de dificultad respiratoria. Las personas que fallecieron en su mayoría fueron hombres, con una mediana de edad de 68.4 años, con mayor frecuencia de comorbilidades (hipertensión, enfermedad cardiovascular, enfermedad pulmonar obstructiva crónica y mayor índice de masa corporal); además ingresaron a UCI con mayor presencia de disnea, menor saturación de oxígeno, y con puntaje mayor de falla multiorgánica. Así mismo, requirieron con más frecuencia de ventilación mecánica, terapia de pronación, uso de vasopresores y terapia de reemplazo renal. Los cuidados de enfermería de estos pacientes en estado crítico se enfocaron al cuidado respiratorio y la prevención de complicaciones asociadas. Conclusión. Las personas con síndrome de dificultad respiratoria aguda grave por COVID-19 que se hospitalizaron en UCI tuvieron un riesgo elevado de fallecer, especialmente los pacientes de mayor edad, sexo masculino y con comorbilidades cardiovasculares, respiratorias e hipertensión arterial, uso de ventilación mecánica y un puntaje puntaje de SOFA elevado. Los cuidados de enfermería de estos pacientes en estado crítico se enfocaron al cuidado respiratorio y la prevención de complicaciones asociadas.

Objetivo. Descrever as características clínicas, tratamento, evolução e cuidados de enfermagem dos pacientes adultos com síndrome de dificuldade respiratória aguda grave, positivos para SARS-CoV-2, hospitalizados nas Unidades de tratamentos Intensivos (UTI) durante o primeiro pico de pandemia na Colômbia em 2020. Métodos. Estudo descritivo multicêntrico com a participação de quatro hospitais de alto nível de complexidade na Colômbia, que incluiu 473 pacientes adultos, admitidos de forma consecutiva nas unidades de tratamentos intensivos -UTI-, com diagnóstico confirmado para SARS CoV-2. Se incluiu informação sociodemográfica, clínica, comorbilidades, tratamento e evolução, além dos cuidados de enfermagens brindados. Resultados. Do total de pacientes incluídos faleceram 43.7%, apresentaram pneumonia 88.8% e um 60.2% desenvolveram síndrome de dificuldade respiratória. As pessoas que faleceram em sua maioria foram homens, com uma média de idade de 68.4 anos, com maior frequência de comorbilidades (hipertensão, doença cardiovascular, doença pulmonar obstrutiva crónica e maior índice de massa corporal); ademais ingressaram a UTI com maior presença de dispneia, menor saturação de oxigeno, e com pontuação maior de falha multiorgânica. Assim mesmo, requereram com mais frequência de ventilação mecânica, terapia de pronação, uso de vasopressores e terapia de substituição renal. Os cuidados de enfermagem destes pacientes em estado crítico se enfocaram ao cuidado respiratório e a prevenção de complicações associadas. Conclusão. As pessoas com síndrome de dificuldade respiratória aguda grave por COVID-19 que se hospitalizaram em UTI tinham um elevado risco de morte, especialmente os pacientes mais velhos; os homens; aqueles com comorbilidades cardiovasculares, respiratórias e hipertensão; aqueles que precisavam de ventilação mecânica; e aqueles com um escore SOFA elevado. Os cuidados de enfermagem destes pacientes criticamente doentes concentraram-se nos cuidados respiratórios e na prevenção de complicações associadas.

Evaluation of Indicators of a Vascular Access Device Program led by Nursing Professionals in a High-complexity University Hospital in Colombia / Evaluación de indicadores de un Programa de Dispositivos de Acceso Vascular liderado por profesionales de enfermería en un hospital universitario de alta complejidad en Colombia / Avaliação de indicadores de um Programa de Dispositivos de Acesso Vascular liderado por profissionais de enfermagem num hospital universitário de alta complexidade na Colômbia

Objective. This work sought to evaluate result indicators of the specialized vascular access program led by nursing during the period between 01 January 2018 and 31 December 2019 at Fundación Cardioinfantil -Instituto de Cardiología (Colombia). Methods. This was a retrospective descriptive study based on medical records of 1,210 patients who received insertion of vascular access devices by the specialized group of nurses. Result indicators are described. Results. Of all the patients who received insertion of a vascular access catheter, 53.1% were women, with mean age of 34.2 years, admitted to critical care services with cardiovascular problems and sepsis (90.2%). Placement of the peripherally inserted central catheter, midline and arterial was echo-guided between 91% and 100%, with a success rate on the first puncture of 66%. The average duration time of the peripherally inserted central catheter was 25.3 days, that of the midline catheter was 8 days, with a reach of 57% until the end of the treatment. The rate observed per catheter-days of overall phlebitis was 2.03, for positive blood culture of the central peripheral insertion device was 1.9 and thrombosis of 0.50; and arterial line thrombosis was 11.7. Conclusion. The Vascular Access Device Program led by nursing reported rational use of these elements with structured therapeutic purposes according with the complexity of the patients admitted to hospitalization. Improvement plans must be implemented to increase efficacy in post-admission insertion times, reduce infection rate and thrombosis through effective follow-up and control mechanisms.

Objetivo. Evaluar los indicadores de resultado del programa especializado de accesos vasculares liderado por enfermería durante el periodo comprendido entre enero 1ro de 2018 -diciembre 31 de 2019 en la Fundación Cardioinfantil -Instituto de Cardiología en Colombia. Métodos. Estudio descriptivo retrospectivo, con base en historias clínicas de 1210 pacientes que recibieron la inserción de dispositivos de acceso vascular por el grupo especializado de enfermeras. Se describen indicadores de resultado. Resultados. Del total de pacientes que recibieron la inserción de un catéter vía acceso vascular, el 53.1% fueron mujeres, con edad promedio de 34.2 años, admitidos en servicios de cuidado crítico con problemas cardiovasculares y sepsis (90.2%). La colocación del catéter central de inserción periférica, de línea media y arterial fue eco-guiada entre el 91-100%, con una tasa de éxito a la primera punción del 66%. El tiempo promedio de duración del catéter central de inserción periférica fue de 25.3 días, la del catéter de línea media fue de 8 días, con un alcance del 57% hasta el final del tratamiento. La tasa observada por días-catéter de flebitis global fue de 2.03, para hemocultivo positivo del dispositivo central de inserción periférica fue de 1.9 y trombosis de 0.50; y trombosis de la línea arterial fue de 11.7. Conclusión. El programa de dispositivos de acceso vascular liderado por enfermería reportó un uso racional de estos elementos con fines terapéuticos estructurados de acuerdo con la complejidad de los pacientes admitidos a hospitalización. Planes de mejora deben ser implementados con el fin de incrementar la eficacia en los tiempos de inserción pos-admisión, reducción de tasa de infección y trombosis mediante mecanismos efectivos de seguimiento y control.

Objetivo. Avaliar os indicadores de resultado do programa especializado de acessos vasculares liderado por enfermagem durante o período compreendido entre o dia 1° de janeiro de 2018 -dezembro 31 de 2019 na Fundação Cardio-infantil -Instituto de Cardiologia em Colômbia. Métodos. Estudo descritivo retrospectivo, com base nas histórias clínicas de 1210 pacientes que receberam a inserção de dispositivos de acesso vascular pelo grupo especializado de enfermeiras. Se descrevem indicadores de resultado. Resultados. Do total de pacientes que receberam a inserção de um cateter via acesso vascular, 53.1% foram mulheres, com idade média de 34.2 anos, admitidos em serviços de cuidado crítico com problemas cardiovasculares e sepses (90.2%). A colocação do cateter central de inserção periférica, de linha média e arterial foi ecoguiada entre 91-100%, com uma taxa de sucesso à primeira punção de 66%. O tempo médio de duração do cateter central de inserção periférica foi de 25.3 dias, a do cateter de linha média foi de 8 dias, com um alcance de 57% até o final do tratamento. A taxa observada por dias-cateter de flebites global foi de 2.03, para hemocultura positivo do dispositivo central de inserção periférica foi de 1.9 e trombose de 0.50; e trombose da linha arterial foi de 11.7. Conclusão. O programa de dispositivos de acesso vascular liderado por enfermagem reportou um uso racional destes elementos com fins terapêuticos estruturados de acordo com a complexidade dos pacientes admitidos a hospitalização. Planos de melhora devem ser implementados com o fim de incrementar a eficácia nos tempos de inserção pós-admissão, redução de taxa de infecção e trombose mediante mecanismos efetivos de seguimento e controle.

Relationship between molar incisor hypomineralization, intrapartium medication and illnesses in the first year of life.

Molar incisor hypomineralization (MIH) affects the first permanent molars and permanent incisors whose formative embryological process develops around birth and the first year of life. This study's main objective is to assess the relationship between MIH, on the one hand, with the administration during childbirth of epidural bupivacaine, intramuscular meperidine with haloperidol, synthetic intravenous oxytocin, and prostaglandins such as dinoprostone vaginally, and on the other hand, with suffered pathologies during the first year of life. Cross-sectional retrospective study was carried out on 111 children who attended dental check-ups. Oral examination was carried out to determine MIH involvement. Data on the administration of medications during delivery and the illnesses suffered by the children in the first year of life were taken from the hospital records. Significant relationship with Pearson's chi-square was found between the presence of MIH and the administration of meperidine with haloperidol intramuscularly and the vaginal administration of dinoprostone during labour. Also in children who have suffered serious infections and those who have received antibiotics in early childhood. In recent years there has been a growing trend in many countries to medicalize childbirth even above what the World Health Organization recommends. Some of the drugs used in these protocols could be involved in the appearance of dental mineralization alterations of the MIH type and this would help to explain the increase in its prevalence.

Preoperative walking recommendation for non-cardiac surgery patients to reduce the length of hospital stay: a randomized control trial.

BACKGROUND: Even though the importance of preparing patients for a surgical event is recognized, there are still gaps about the benefit of improving functional capacity by walking during the waiting time among patients scheduled for non-cardiac surgery. The aim of this study was to evaluate the impact of pre-surgical walking in-hospital length of stay, early ambulation, and the appearance of complications after surgery among patients scheduled for non-cardiac surgery. METHODS: A two-arm, single- blinded randomized controlled trial was developed from May 2016 to August 2017. Eligible outpatients scheduled for non-cardiac surgery, capable of walking, were randomized (2:1 ratio) to receive a prescription of walking 150 min/week during the whole pre-surgical waiting time (n = 249) or conventional care (n = 119). The primary outcome was the difference in hospital length of stay, and secondary results were time to first ambulation during hospitalization, description of ischemic events during hospitalization and after six months of hospital discharge, and the walking continuation. We performed an intention to treat analysis and compared length of stay between both groups by Kaplan-Meier estimator (log-rank test). RESULTS: There were no significant differences in the length of hospital stay between both groups (log-rank test p = 0.367) and no differences in the first ambulation time during hospitalization (log-rank test p = 0.299). Similar rates of postoperative complications were observed in both groups, but patients in the intervention group continued to practice walking six months after discharge (p < 0.001). CONCLUSION: Our study is the first clinical trial evaluating the impact of walking before non-cardiac surgery in the length of stay, early ambulation, and complications after surgery. Prescription of walking for patients before non-cardiac surgery had no significant effect in reducing the length of stay, and early ambulation. The results become a crucial element for further investigation. TRIAL REGISTRATION: PAMP-Phase2 was registered in ClinicalTrials.gov NCT03213496 on July 11, 2017.

Statement of the Spanish Interdisciplinary Vascular Prevention Committee on the updated European Cardiovascular Prevention Guidelines. / Comentario del CEIPV a la actualización de las Guías Europeas de Prevención Vascular en la Práctica Clínica.

We present the adaptation for Spain of the updated European Cardiovascular Prevention Guidelines. In this update, greater stress is laid on the population approach, and especially on the promotion of physical activity and healthy diet through dietary, leisure and active transport policies in Spain. To estimate vascular risk, note should be made of the importance of recalibrating the tables used, by adapting them to population shifts in the prevalence of risk factors and incidence of vascular diseases, with particular attention to the role of chronic kidney disease. At an individual level, the key element is personalised support for changes in behaviour, adherence to medication in high-risk individuals and patients with vascular disease, the fostering of physical activity, and cessation of smoking habit. Furthermore, recent clinical trials with PCSK9 inhibitors are reviewed, along with the need to simplify pharmacological treatment of arterial hypertension to improve control and adherence to treatment. In the case of patients with type 2 diabetes mellitus and vascular disease or high vascular disease risk, when lifestyle changes and metformin are inadequate, the use of drugs with proven vascular benefit should be prioritised. Lastly, guidelines on peripheral arterial disease and other specific diseases are included, as is a recommendation against prescribing antiaggregants in primary prevention.

[Statement of the Spanish Interdisciplinary Vascular Prevention Committee on the updated European Cardiovascular Prevention Guidelines]. / Comentario del CEIPV a la actualización de las Guías Europeas de Prevención Vascular en la Práctica Clínica.

We present the adaptation for Spain of the updated European Cardiovascular Prevention Guidelines. In this update, greater stress is laid on the population approach, and especially on the promotion of physical activity and healthy diet through dietary, leisure and active transport policies in Spain. To estimate vascular risk, note should be made of the importance of recalibrating the tables used, by adapting them to population shifts in the prevalence of risk factors and incidence of vascular diseases, with particular attention to the role of chronic kidney disease. At an individual level, the key element is personalised support for changes in behaviour, adherence to medication in high-risk individuals and patients with vascular disease, the fostering of physical activity, and cessation of smoking habit. Furthermore, recent clinical trials with PCSK9 inhibitors are reviewed, along with the need to simplify pharmacological treatment of arterial hypertension to improve control and adherence to treatment. In the case of patients with type 2 diabetes mellitus and vascular disease or high vascular disease risk, when lifestyle changes and metformin are inadequate, the use of drugs with proven vascular benefit should be prioritised. Lastly, guidelines on peripheral arterial disease and other specific diseases are included, as is a recommendation against prescribing antiaggregants in primary prevention.

[Statement of the Spanish Interdisciplinary Vascular Prevention Committee on the updated European Cardiovascular Prevention Guidelines.] / Comentario del CEIPV a la actualización de las Guías Europeas de Prevención Vascular en la Práctica Clínica.

We present the adaptation for Spain of the updated European Cardiovascular Prevention Guidelines. In this update, greater stress is laid on the population approach, and especially on the promotion of physical activity and healthy diet through dietary, leisure and active transport policies in Spain. To estimate vascular risk, note should be made of the importance of recalibrating the tables used, by adapting them to population shifts in the prevalence of risk factors and incidence of vascular diseases, with particular attention to the role of chronic kidney disease. At an individual level, the key element is personalised support for changes in behaviour, adherence to medication in high-risk individuals and patients with vascular disease, the fostering of physical activity, and cessation of smoking habit. Furthermore, recent clinical trials with PCSK9 inhibitors are reviewed, along with the need to simplify pharmacological treatment of arterial hypertension to improve control and adherence to treatment. In the case of patients with type 2 diabetes mellitus and vascular disease or high vascular disease risk, when lifestyle changes and metformin are inadequate, the use of drugs with proven vascular benefit should be prioritised. Lastly, guidelines on peripheral arterial disease and other specific diseases are included, as is a recommendation against prescribing antiaggregants in primary prevention.

Presentamos la adaptación para España de la actualización de las Guías Europeas de Prevención Vascular. En esta actualización se hace mayor énfasis en el abordaje poblacional, especialmente en la promoción de la actividad física y de una dieta saludable mediante políticas alimentarias y de ocio y transporte activo en España. Para estimar el riesgo vascular, se destaca la importancia de recalibrar las tablas que se utilicen, adaptándolas a los cambios poblaciones en la prevalencia de los factores de riesgo y en la incidencia de enfermedades vasculares, con particular atención al papel de la enfermedad renal crónica. A nivel individual resulta clave el apoyo personalizado para el cambio de conducta, la adherencia a la medicación en los individuos de alto riesgo y pacientes con enfermedad vascular, la promoción de la actividad física y el abandono del hábito tabáquico. Además, se revisan los ensayos clínicos recientes con inhibidores de PCKS9, la necesidad de simplificar el tratamiento farmacológico de la hipertensión arterial para mejorar su control y la adherencia al tratamiento. En los pacientes con diabetes mellitus 2 y enfermedad vascular o riesgo vascular alto, cuando los cambios de estilo de vida y la metformina resultan insuficientes, deben priorizarse los fármacos con demostrado beneficio vascular. Por último, se incluyen pautas sobre enfermedad arterial periférica y otras enfermedades específicas, y se recomienda no prescribir antiagregantes en prevención primaria.

Association between complications and death within 30 days after noncardiac surgery.

BACKGROUND: Among adults undergoing contemporary noncardiac surgery, little is known about the frequency and timing of death and the associations between perioperative complications and mortality. We aimed to establish the frequency and timing of death and its association with perioperative complications. METHODS: We conducted a prospective cohort study of patients aged 45 years and older who underwent inpatient noncardiac surgery at 28 centres in 14 countries. We monitored patients for complications until 30 days after surgery and determined the relation between these complications and 30-day mortality using a Cox proportional hazards model. RESULTS: We included 40 004 patients. Of those, 715 patients (1.8%) died within 30 days of surgery. Five deaths (0.7%) occurred in the operating room, 500 deaths (69.9%) occurred after surgery during the index admission to hospital and 210 deaths (29.4%) occurred after discharge from the hospital. Eight complications were independently associated with 30-day mortality. The 3 complications with the largest attributable fractions (AF; i.e., potential proportion of deaths attributable to these complications) were major bleeding (6238 patients, 15.6%; adjusted hazard ratio [HR] 2.6, 95% confidence interval [CI] 2.2-3.1; AF 17.0%); myocardial injury after noncardiac surgery [MINS] (5191 patients, 13.0%; adjusted HR 2.2, 95% CI 1.9-2.6; AF 15.9%); and sepsis (1783 patients, 4.5%; adjusted HR 5.6, 95% CI 4.6-6.8; AF 12.0%). INTERPRETATION: Among adults undergoing noncardiac surgery, 99.3% of deaths occurred after the procedure and 44.9% of deaths were associated with 3 complications: major bleeding, MINS and sepsis. Given these findings, focusing on the prevention, early identification and management of these 3 complications holds promise for reducing perioperative mortality. Study registration: ClinicalTrials.gov, no. NCT00512109.

Fotografía digital: Una herramienta para Enfermería en la evaluación de las Lesiones Por Presión (LPP) / Fotografia digital: Uma ferramenta para Enfermagem na avaliação das lesões por pressão / Digital Photography: a Tool for Nursing on the Assessment of Pressure Lesions

Objective. This work sought to assess the inter-observer agreement among expert nurses by using digital photographs and between these experts and the nursing registries in the electronic clinical record in the identification and degree of PL. Methods. This was an observational study, including 225 photographic records (184 patients, 97 with pressure lesion and 128 registries without lesion) randomly selected from the total of photographs registered in the PENFUP clinical trial (without lesion). Three expert evaluators assessed said photographs in masked manner. The notes from nursing of patients included related with the description of PL were evaluated. The Kappa index was calculated along with the composite agreement ratio for each evaluation. Results. Good agreement was observed among expert evaluators of photographic records on the presence of PL and between good-moderate for the degree of PL (I-II). Likewise, upon evaluating the agreement between the nursing registries of PL and the photographic assessment of the three expert evaluators of the same areas, good agreement was observed to determine the presence of PL and moderate agreement for the degrees of PL. Conclusion. Photographic records are a tool that permits recognizing the types of wounds, as well as the visualization of the different layers of skin injured. The study highlights the importance of assessment and validation by experts, given that it permits identifying existing problems that can lead to the underestimation or overestimation of PL when conducted by a single caregiver.(AU)

Objetivo. Evaluar la concordancia interobservador en la identificación y grado de las Lesiones Por Presión ­LPP- entre: i) enfermeros expertos utilizando fotografías digitales y, ii) entre estos expertos y los registros de enfermería en la historia clínica electrónica. Métodos. Estudio observacional, que incluyó 225 registros fotográficos (184 pacientes, 97 con lesión por presión y 128 registros sin lesión) seleccionados al azar del total de fotografías registradas en el ensayo clínico PENFUP. Tres evaluadores expertos valoraron las mismas fotografías de forma encubierta. Se evaluaron las notas de enfermería de los pacientes incluidos relacionadas con la descripción de LPP. Se calculó el índice Kappa y la proporción de acuerdo con el compuesto para cada evaluación. Resultados. Se observó una concordancia buena entre los evaluadores expertos de registros fotográficos sobre la presencia de LPP y entre buena y moderada para el grado de LPP (I-II). Así mismo, al evaluar la concordancia entre los registros de enfermería de LPP y la valoración fotográfica de los tres evaluadores expertos de las mismas áreas, se observó una concordancia buena para determinar la presencia de LPP moderada para la concordancia de los grados de LPP. Conclusión. Los registros fotográficos son una herramienta que permite el reconocimiento de los tipos de heridas al igual que la visualización de las diferentes capas de piel lesionadas. Se resalta la importancia de la evaluación y validación por expertos ya que nos permite identificar problemas existentes que pueden llevar a la subvaloración o sobrevaloración de las LPP cuando los realiza un solo cuidador. (AU)

Objetivo. Avaliar a concordância inter-observador na identificação e grau das Lesões Por Pressão ­LPP- entre: i) enfermeiros especialistas utilizando fotografias digitais e, ii) entre estes especialistas e os registros de enfermagem na história clínica eletrônica. Métodos. Estudo observacional, que incluiu 225 registros fotográficos (184 pacientes, 97 com lesão por pressão e 128 registros sem lesão) selecionados por azar do total de fotografias registradas no ensaio clínico PENFUP. Três avaliadores especialistas avaliaram as mesmas fotografias de forma encoberta. Se avaliaram as notas de enfermagem dos pacientes incluídos relacionadas com a descrição da LPP. Se calculou o índice Kappa e a proporção de acordo composto para cada avaliação. Resultados. Se observou uma boa concordância entre os avaliadores especialistas de registros fotográficos sobre a presença de LPP e entre boa e moderada para o grau de LPP (I-II). Assim mesmo, ao avaliar a concordância entre os registros de enfermagem de LPP e a valorização fotográfica dos três avaliadores especialistas das mesmas áreas, se observou uma boa concordância para determinar a presença de LPP e moderada para a concordância dos graus de LPP. Conclusão. Os registros fotográficos são uma ferramenta que permite o reconhecimento dos tipos de feridas ao igual que a visualização das diferentes capas de pele lesionadas. Se recalca a importância da avaliação e validação por especialistas já que nos permite identificar problemas existentes que podem levar à subvalorização ou sobrevalorização das LPP quando os realiza um único cuidador.(AU)

Inactivity and Its Associated Factors in Adults Scheduled for Noncardiac Surgery: The PAMP Phase I Study.

PURPOSE: The aim of this study was to determine the prevalence of physical inactivity and its associated factors in adult patients admitted to hospital for noncardiac surgery. DESIGN: Cross-sectional study. METHODS: Five hundred able-bodied patients (age ≥45 years) admitted to hospital, also participants in the VISION study, were recruited before noncardiac surgery. The physical activity level (PAL) was assessed with the International Physical of Activity Questionnaire. Logistic regression analysis was conducted to determine the associations between a number of predetermined factors and physical inactivity. FINDINGS: Overall, 59.8% were inactive. Factors associated with inactivity included age, assistance with activities of daily living, and insulin-dependent diabetes. CONCLUSION: A substantial number of patients scheduled for noncardiac surgery are inactive. Elderly patients, those needing assistance, and those with long-lasting diabetes may benefit from PAL assessment before surgery. CLINICAL RELEVANCE: Healthcare providers should identify PALs and monitor for known risk factors to prepare patients for surgical procedures.

Uso de apósitos hidrocoloides en la prevención de úlceras por presión en pacientes de alto riesgo: una cohorte retrospectiva / Uso de curativos hidrocoloides na prevenção de úlceras por pressão em pacientes de alto risco: uma coorte retrospectiva / Use of Hydrocolloid Dressings in Preventing Pressure Ulcers in High-risk Patients: a Retrospective Cohort

Objective. This work sought to evaluate the association between using preventive hydrocolloid dressings and the onset of pressure ulcers in hospitalized patients. Methods. Retrospective cohort study that included adult patients with high risk of pressure ulcers (PU) evaluated according to the Braden scale and who had been admitted with preventive purposes to a skin care program. The preventive care prescribed by the nursing staff included using hydrocolloid dressing plus conventional care (HD+CC) or only conventional care (CC), in a tier IV hospital in Bogotá, Colombia. Information was obtained from the clinical records of the demographic variables, health, and complications during hospitalization. Results. One-hundred seventy subjects were included in the study (23 in HD+CC and 147 in CC). In all, 30.4% of the patients in the HD+CC group and 17% in the CC group had PU during follow up (p=0.15). The ratio between the type of preventive treatment received and the development of PU obtained a raw Hazzard ratio (HR) of 1.35 (CI95%: 0.58-3.14; p=0.48) and HR adjusted for confounding variables of 1.06 (CI95%: 0.29-3.84 p=0.92). Conclusion. Our results showed no superiority of HD+CC against CC in preventing PU in adult patients with high risk according to the Braden scale. The cohort study did not reveal significant differences between both interventions. It is necessary to promote and develop clinical trials to evaluate the effectiveness of using dressings and other conventional care in high-risk patients for this type of event. (AU)

Objetivo. Evaluar la asociación entre el uso de apósitos hidrocoloides preventivos y la aparición de úlceras por presión en pacientes hospitalizados. Métodos. Estudio de cohorte retrospectivo que incluyó pacientes adultos con alto riesgo de úlceras por presión (UPP) evaluados según escala Braden y que habían sido admitidos con fines preventivos en un programa de cuidado de la piel, en un hospital de cuarto nivel de atención, en Bogotá, Colombia. Los cuidados preventivos prescritos por el personal de enfermería incluyeron el uso de apósito hidrocoloide más cuidado convencional (AH+CC) o solo cuidado convencional (CC). Se obtuvo información de las historias clínicas de las variables demográficas, de salud y complicaciones durante hospitalización. Resultados. Se incluyeron en el estudio un total de 170 pacientes (23 de AH+CC y 147de CC). El 30.4% en el grupo AH+CC y el 17% de CC presentó UPP durante el seguimiento (p=0.15). La relación entre el tipo de tratamiento preventivo recibido y el desarrollo de UPP obtuvo un HR crudo de 1.35 (IC95%: 0.58-3.14; p=0.48) y un HR ajustado por factores de confusión de 1.06 (IC95%: 0.29-3.84 p=0.92). Conclusión. Nuestros resultados mostraron no superioridad de AH+CC frente al CC enfermero en la prevención de UPP en pacientes adultos con alto riesgo según Braden. El estudio de la cohorte no reveló diferencias significativas entre las dos intervenciones. Se hace necesario la promoción y desarrollo de ensayos clínicos que evalúen la efectividad del uso de los apósitos y otros cuidados convencionales en pacientes de alto riesgo para este tipo de evento (AU)

Objetivo. Avaliar a associação entre o uso de curativos hidrocoloides preventivos e a aparição de úlceras por pressão em pacientes hospitalizados. Métodos. Estudo de coorte retrospectivo que incluiu pacientes adultos com alto risco de úlceras por pressão (UPP) avaliados segundo escala Braden e que haviam sido admitidos com fins preventivos num programa de cuidado da pele, num hospital de quarto nível de atenção, em Bogotá, Colômbia. Os cuidados preventivos prescritos pelo pessoal de enfermagem incluíram o uso de curativo hidrocoloide mais cuidado convencional (AH+CC) ou só cuidado convencional (CC). Se obteve informação das histórias clínicas das variáveis demográficas, de saúde e complicações durante hospitalização. Resultados. Um total de 170 pacientes foram incluídos no estudo (23 de AH+CC e 147de CC). 30.4% no grupo AH+CC e 17% de CC apresentaram UPP durante o seguimento (p=0.15). A relação entre o tipo de tratamento preventivo recebido e o desenvolvimento de UPP obteve um HR cru de 1.35 (IC95%: 0.58-3.14; p=0.48) e um HR ajustado por fatores de confusão de 1.06 (IC95%: 0.29-3.84 p=0.92). Conclusão. Nossos resultados mostraram não superioridade de AH+CC frente a CC enfermeiro na prevenção de UPP em pacientes adultos com alto risco segundo Braden. O estudo da coorte não revelou diferencias significativas entre as duas intervenções. Se faz necessário a promoção e desenvolvimento de ensaios clínicos que avaliem a efetividade do uso dos curativos e outros cuidados convencionais em pacientes de alto risco para este tipo de evento.(AU)

Myocardial Injury After Noncardiac Surgery (MINS) in Vascular Surgical Patients: A Prospective Observational Cohort Study.

OBJECTIVE: To determine the prognostic relevance, clinical characteristics, and 30-day outcomes associated with myocardial injury after noncardiac surgery (MINS) in vascular surgical patients. BACKGROUND: MINS has been independently associated with 30-day mortality after noncardiac surgery. The characteristics and prognostic importance of MINS in vascular surgery patients are poorly described. METHODS: This was an international prospective cohort study of 15,102 noncardiac surgery patients 45 years or older, of whom 502 patients underwent vascular surgery. All patients had fourth-generation plasma troponin T (TnT) concentrations measured during the first 3 postoperative days. MINS was defined as a TnT of 0.03 ng/mL of higher secondary to ischemia. The objectives of the present study were to determine (i) if MINS is prognostically important in vascular surgical patients, (ii) the clinical characteristics of vascular surgery patients with and without MINS, (iii) the 30-day outcomes for vascular surgery patients with and without MINS, and (iv) the proportion of MINS that probably would have gone undetected without routine troponin monitoring. RESULTS: The incidence of MINS in the vascular surgery patients was 19.1% (95% confidence interval (CI), 15.7%-22.6%). 30-day all-cause mortality in the vascular cohort was 12.5% (95% CI 7.3%-20.6%) in patients with MINS compared with 1.5% (95% CI 0.7%-3.2%) in patients without MINS (P < 0.001). MINS was independently associated with 30-day mortality in vascular patients (odds ratio, 9.48; 95% CI, 3.46-25.96). The 30-day mortality was similar in MINS patients with (15.0%; 95% CI, 7.1-29.1) and without an ischemic feature (12.2%; 95% CI, 5.3-25.5, P = 0.76). The proportion of vascular surgery patients who suffered MINS without overt evidence of myocardial ischemia was 74.1% (95% CI, 63.6-82.4). CONCLUSIONS: Approximately 1 in 5 patients experienced MINS after vascular surgery. MINS was independently associated with 30-day mortality. The majority of patients with MINS were asymptomatic and would have gone undetected without routine postoperative troponin measurement.

Impacto de la Entrevista Motivacional en la Adherencia de Pacientes Diabéticos Inactivos a la Actividad Física: Estudio Piloto de un Ensayo Clínico EMQAGTIF - DM / The Motivational Interview's Impact on Inactive Diabetic Patients' Adherence to Physical Activity: A Pilot Study of a Clinical Trial / Impacto da Entrevista Motivacional na Adesão de Pacientes Diabéticos Inativos à Atividade Física: Estudo-piloto de um Ensaio Clínico EMÜACTIF-DM

Resumen Este artículo investiga la factibilidad y aceptabilidad de un ensayo clínico para evaluar el impacto de la entrevista moti vacional (EM) en la adherencia a la actividad física (AF) de pacientes inactivos con diabetes mellitus. En este ensayo se incluyeron treinta participantes; dieciséis recibieron EM con refuerzo telefónico durante 4 semanas, los restantes reci bieron cuidado convencional. Se evaluó AF, índice de masa corporal, nivel de glucosa en la sangre y autoeficacia hacia la AF. El grupo de intervención mostró mejoría significativa en la AF (p<.05) y el nivel de glucosa en la sangre (p<.05). Al tener en cuenta el cambio en IMC para un estudio a gran escala, el cálculo de la muestra oscila entre 710 y 950 pacientes. Para estudios de menor escala, si se tiene en cuenta el cambio en METS, glucemia y autoeficacia, el cálculo de la muestra oscila entre 34 y 272 pacientes.

Summary This article studies the feasibility and acceptability in a clinical trial of the impact of the motivational interview (MI) on inactive diabetic (diabetes mellitus) patients' adherence to physical activity (PA). This trial included thirty participants; sixteen received MI with telephone reinforcement for four weeks, the remaining received conventional care. PA, body mass index (BMI), blood glucose level and self-efficacy in PA were measured. The intervention group showed significant improvement in the PA (p<.05) and blood glucose level (p<.05). Taking into account the change in BMI for a large scale study, the calculation of the sample varies between 710 and 950 patients. For smaller-scale studies, taking into account the change in Metabolic Equivalent of Task (MET), blood glucose, and self-efficacy, the sample calculation ranges be tween 34 and 272 patients.

Resumo Este artigo investiga a factibilidade e a aceitabilidade de um ensaio clínico para avaliar o impacto da entrevista motivacional (EM) na adesão à atividade física (AF) de pacientes inativos com diabetes mellitus. Neste ensaio, foram incluídos 30 participantes; 16 receberam EM com reforço telefônico durante quatro semanas; o restante recebeu cuidado conven cional. Avaliaram-se AF, índice de massa corporal (IMC), nível de glucose no sangue e autoeficácia para a AF. O grupo de intervenção mostrou melhoria significativa na AF (p<.05) e no nível de glucose no sangue (p<.05). Ao considerar a mudança no IMC para um estudo de grande escala, o cálculo da amostra varia entre 710 e 950 pacientes. Para estudos de menor escala, se for considerada a mudança no Equivalente Metabólico da Tarefa (METS), glicemia e autoeficácia, o cálculo da amostra oscila entre 34 e 272 pacientes.

[Spanish adaptation of the 2016 European Guidelines on cardiovascular disease prevention in clinical practice]. / Adaptación española de las guías europeas de 2016 sobre prevención de la enfermedad cardiovascular en la práctica clínica.

The VI European Guidelines for Cardiovascular Prevention recommend combining population and high-risk strategies with lifestyle changes as a cornerstone of prevention, and propose the SCORE function to quantify cardiovascular risk. The guidelines highlight disease specific interventions, and conditions as women, young people and ethnic minorities. Screening for subclinical atherosclerosis with noninvasive imaging techniques is not recommended. The guidelines distinguish four risk levels (very high, high, moderate and low) with therapeutic objectives for lipid control according to risk. Diabetes mellitus confers a high risk, except for subjects with type 2 diabetes with less than <10 years of evolution, without other risk factors or complications, or type 1 diabetes of short evolution without complications. The decision to start pharmacological treatment of arterial hypertension will depend on the blood pressure level and the cardiovascular risk, taking into account the lesion of target organs. The guidelines don't recommend antiplatelet drugs in primary prevention because of the increased bleeding risk. The low adherence to the medication requires simplified therapeutic regimes and to identify and combat its causes. The guidelines highlight the responsibility of health professionals to take an active role in advocating evidence-based interventions at the population level, and propose effective interventions, at individual and population level, to promote a healthy diet, the practice of physical activity, the cessation of smoking and the protection against alcohol abuse.