[Blood pressure measurement campaign (May Measurement Month) from community pharmacies in 2018: analysis of screening in Spain]. / Campaña de medida de la presión arterial (May Measurement Month) desde las farmacias comunitarias en el 2018: análisis del cribado en España.

INTRODUCTION: Within the international project May Measurement Month, in Spain, the community pharmacy is where the greatest number of measurements are carried out and where the population can be made aware of the importance of regular blood pressure measurement. OBJECTIV: To ascertain the situation of the Spanish population's blood pressure and dissemination of the importance of its regular measurement through the community pharmacies. METHODS: Cross-sectional descriptive study carried out in Spanish community pharmacies during the month of May 2018, among pharmacy users of legal age. Systolic blood pressure, diastolic blood pressure and heart rate were measured as main variables. RESULTS: Five thousand, seven hundred and eighty-five readings were made by 891 pharmacists. One thousand, seven hundred and fifty-five (34.8%) people had not had their blood pressure measured in the last year. Of the participants, 31.2% had high blood pressure readings. Mean systolic blood pressure was 127.1±20.1 and mean diastolic blood pressure 77.5±12.5, higher in men (p<.001). There were normal blood pressure values in 3,981 (68.8%) patients; one high reading in 1,226 (21.2%); and two in 578 (10%). There were 912 (15.76%) patients with SBP≥140 and 314 (5.4%) with DBP≥90. Four (0.07%) hypertensive emergencies were detected. CONCLUSIONS: Three out of ten participants had a high blood pressure reading. Therefore, protocolized blood pressure readings carried out in a health care facility such as the community pharmacy, allowed the identification of a significant number of subjects with high and untreated blood pressure.

Antihypertensive activity of verapamil: impact of dietary sodium. The VERSAL Study Group.

OBJECTIVE: To define the influence of dietary salt intake on the antihypertensive effect of slow-release verapamil 240 mg once a day in a population with mild-to-moderate essential hypertension. DESIGN: Parallel, randomized, multicentre study. METHODS: Patients were advised to follow a moderately low salt diet (Low-salt group). After a 2-week run-in period, those patients with 24-h urinary sodium excretion (UNa) < or = 120 mmol/day and a diastolic blood pressure (DBP) between 90 and 114 mmHg were randomly assigned to verapamil + Low-salt or verapamil + unrestricted-salt diet (High-salt group) for 28 days. Compliance with diets was defined as Low-salt UNa < or = 120 mmol/day and High-salt UNa > 120 mmol/day with UNa increased by > or = 60 mmol/day over the level attained at the end of the run-in period. RESULTS: Significant reductions in mean systolic blood pressure (SBP) and DBP were found in both the Low-salt (n = 235) and High-salt (n = 183) groups. The therapeutic goal (DBP < 90 mmHg) was achieved in 38.3% of patients in the Low-salt and 44.8% of patients in the High-salt group. Office blood pressure results were confirmed by ambulatory 24-h blood pressure monitoring in a subsample of patients. Verapamil reduced mean blood pressure throughout the nycthemeral cycle without any significant difference between the two groups. CONCLUSION: The restriction in sodium intake does not have an additive effect on the antihypertensive effect of the slow-channel calcium antagonist verapamil.

[Treatment of essential arterial hypertension with hypercholesterolemia. Effects of an alpha-adrenergic blocker and an inhibitor of the angiotensin converting enzyme]. / Tratamiento de la hipertensión arterial esencial con hipercolesterolemia. Efectos de un bloqueador alfaadrenérgico y un inhibidor de la enzima conversiva de la angiotensina.

BACKGROUND: Hypertension and hypercholesterolemia are frequently associated with this leading to considerable cardiovascular risk. METHODS: An open parallel randomized study was performed in which the effects of doxazosin, an alpha-adrenergic blocker and enalapril, an inhibitor of the angiotensin converting enzyme were compared in 70 patients with essential high blood pressure and plasma cholesterol levels greater than 240 mg/dl. Following 2-4 weeks of placebo administration the patients were randomly treated with one of the two drugs. When required doses were increased and hydrochlorothiazide added until blood pressure lower than 160/95 mmHg was achieved. After this period the patients were observed for a minimum of 8 weeks. The mean length of the study was of 22 weeks. RESULTS: Both drugs significantly reduced blood pressure without modifying cardiac frequency. Doxazosin tended to favorably modify the lipid profile of the plasma while enalapril significantly reduced the levels of cholesterol, lipids and high density lipoproteins (HDL). Upon termination of the study the total HDL/cholesterol index increased 8.6% in those treated with doxazosin and decreased 5.5% in those receiving enalapril (p < 0.05). CONCLUSIONS: Although doxazosin and enalapril are potent antihypertensive drugs, the effects on plasma lipid obtained with doxazosin indicate that a reduction in cardiovascular risk was achieved with this drug in the patients included in this study.

[Thiazide diuretics and calcium metabolism: role in renal lithiasis and osteoporosis]. / Diuréticos tiazídicos y metabolismo cálcico: papel en la litiasis renal y en la osteoporosis.

Thiazidic diuretics are first line drugs for treatment of hypertension, due to their proven capacity to reduce cardiovascular morbidity and mortality in hypertensive subjects, including the elderly. In addition, they are very useful in the treatment of heart failure and volumen overload in liver and renal diseases. On the other hand, diuretics are efficacious to prevent calcium-related renal stone formation with or without accompanying hypercalciuria. Finally, related to their capacity to reduce urinary calcium excretion they prevent postmenopausal and senile bone mass loose, and reduce the incidence of hip fracture with relevant socioeconomic consequences.

Campaña de medida de la presión arterial (May Measurement Month) desde las farmacias comunitarias en el 2018: análisis del cribado en España / Blood pressure measurement campaign (May Measurement Month) from community pharmacies in 2018: analysis of screening in Spain

Introducción: Dentro del proyecto internacional May Measurement Month (MMM) en España, la farmacia comunitaria es el establecimiento sanitario en el que se llevan a cabo el mayor número de mediciones y donde se puede sensibilizar a la población sobre la importancia de la medida periódica de la presión arterial (PA). Objetivo: Conocer la situación de la PA de la población española y la difusión de la importancia de su medida periódica, a través de las farmacias comunitarias. Material y métodos: Estudio descriptivo transversal realizado en las farmacias comunitarias españolas durante el mes de mayo de 2018, entre los usuarios de las mismas, mayores de edad. Como variables principales se midieron la presión arterial sistólica (PAS), presión arterial diastólica (PAD) y frecuencia cardíaca. Resultados: Se llevaron a cabo 5.785 determinaciones por 891 farmacéuticos. 1.755 (34,8%) personas no se habían medido la PA en el último año. El 31,2% de los participantes tenía cifras elevadas de PA. PAS media (PASm) fue de 127,1 ± 20,1 y PAD media (PADm) de 77,5 ± 12,5, mayor en hombres (p < 0,001). Los pacientes con valores de PA de normalidad fueron 3.981 (68,8%); elevadas una 1.226 (21,2%) y dos 578 (10%). Los pacientes con PAS ≥ 140 fueron 912 (15,76%) y con PAD ≥ 90 fueron 314 (5,4%). Se detectaron cuatro (0,07%) emergencias hipertensivas. Conclusiones: Tres de cada diez personas participantes tenían algún valor alto de PA. Por lo que, las determinaciones de PA protocolizadas realizadas en un establecimiento sanitario como la farmacia comunitaria, ha permitido identificar un número significativo de sujetos con PA elevada y no tratada. (AU)

Introduction: Within the international project May Measurement Month, in Spain, the community pharmacy is where the greatest number of measurements are carried out and where the population can be made aware of the importance of regular blood pressure measurement. Objectiv: To ascertain the situation of the Spanish population's blood pressure and dissemination of the importance of its regular measurement through the community pharmacies. Methods: Cross-sectional descriptive study carried out in Spanish community pharmacies during the month of May 2018, among pharmacy users of legal age. Systolic blood pressure, diastolic blood pressure and heart rate were measured as main variables. Results: Five thousand, seven hundred and eighty-five readings were made by 891 pharmacists. One thousand, seven hundred and fifty-five (34.8%) people had not had their blood pressure measured in the last year. Of the participants, 31.2% had high blood pressure readings. Mean systolic blood pressure was 127.1±20.1 and mean diastolic blood pressure 77.5±12.5, higher in men (p<.001). There were normal blood pressure values in 3,981 (68.8%) patients; one high reading in 1,226 (21.2%); and two in 578 (10%). There were 912 (15.76%) patients with SBP≥140 and 314 (5.4%) with DBP≥90. Four (0.07%) hypertensive emergencies were detected. Conclusions: Three out of ten participants had a high blood pressure reading. Therefore, protocolized blood pressure readings carried out in a health care facility such as the community pharmacy, allowed the identification of a significant number of subjects with high and untreated blood pressure. (AU)

[Control of arterial pressure: experience at a hospital monographic unit arterial hypertension]. / Control de la presión arterial: experiencia de una Unidad monográfica de Hipertensión Arterial hospitalaria.

OBJECTIVE: To analyse the evolution of blood pressure control in patients referred to our centre for study, proportion of controlled hypertensive patients, changes in the characteristics of hypertensive patients and in therapeutic guidelines in the last twenty years. MATERIAL AND METHODS: A total of 4,103 patients were referred to study of hypertension. The analysed variables year by year included sex, age, weight, systolic blood pressure (SBP) and diastolic blood pressure (DBP). Cross sections at five-year intervals were performed to collect basal SBP and DBP and the evolution of BP in the following five years. RESULTS: From 1977 to 1997 the following changes were observed: basal mean age changed from 67 +/- 9 down to 56 +/- 10 years among males and from 68 +/- 8 down to 52 +/- 9 years among females; basal mean weight changed from 71 +/- 7 up to 81 +/- 8 kg among males and from 69 +/- 12 up to 73 +/- 13 years among females. Males showed a decrease in basal mean values of SBP/DBP from 176 +/- 25/112 +/- 20 mmHg down to 154 +/- 21/94 +/- 12 mmHg. In women, the corresponding values changed from 182 +/- 36/105 +/- 19 mmHg down to and 154 +/- 23/93 +/- 12 mmHg. In the early 1980's, 62% of patients received one or no antihypertensive drug. In the last few years such percentage has been 36% and 64% have been treated with two or more drugs. CONCLUSIONS: A decrease in age and an increase in weight of hypertensive patients referred to study have been observed in the last twenty years. Such patients show a less severe hypertension compared with referred patients in the early years. The use of new hypertensive drugs and their combined use are measures that contribute to improve the percentage of controlled hypertensive patients.

Ventajas potenciales de aliskiren, el primer inhibidor de la renina / Potential advantages of aliskiren, the first renin inhibitor

A la hora de plantear el tratamiento más efi caz del paciente hipertensoresulta imprescindible lograr la inhibición óptima del sistema renina-angiotensina-aldosterona (SRAA), por ser una pieza clave como objetivofarmacológico en la prevención de la enfermedad vascular. El tratamientocon los inhibidores de la enzima conversora de la angiotensina (IECA)y los antagonistas de los receptores AT1 de la angiotensina II ha demostradoposeer un efecto antihipertensivo moderadamente efi caz, que setraduce en benefi cio en la morbilidad y mortalidad. Sin embargo, un grannúmero de pacientes hipertensos en todas las fases del continuum cardiovascularno logran alcanzar la prevención del desarrollo de lesiónorgánica y su posterior regresión para evitar la aparición de episodioscardiovasculares. En esta fase es especialmente importante el bloqueodel sistema renina-angiotensina para retrasar el desarrollo de un nuevoepisodio. La aparición de una nueva familia de antihipertensivos, los inhibidoresdirectos de la renina (IDR), cuyo representante es aliskiren, hagenerado una gran expectación, ya que cuentan con un creciente númerode evidencias que avalan su efi cacia antihipertensiva, tanto enmonoterapia como en combinación farmacológica, y ofrecen resultadosde buena tolerabilidad y perfi l de seguridad, además de datos benefi ciosos sobre protección orgánica(AU)

Optimal and most efficient antihipertensive therapy must achieve abest possible renin-angiotensin-aldosterone system inhibition. Thisstrategy is a key point as a therapeutic target in order to preventcardiovascular disease. Treatment with angiotensin converting enzymeinhibitors and angiotensin receptor blockers has shown to offeran appropriate blood pressure lowering effect, which translates incardiovascular mortality reduction. Nevertheless, a high population ofhypertensives included in each and every stage of the cardiovascularcontinuum does not attain prevention of the development of targetorgan damage and its latter regression in order to avoid cardiovascularevents. Appearance of a new family of antihipertensive drugs,direct renin inhibitors, as aliskiren, has aroused great interest due toits increasing number of evidences that endorses its antihipertensiveeffectiveness and organ protection, both in monotherapy and as apharmacological combination with a good tolerability and securityprofile(AU)