[Perception of physicians on factors that influence the choice of a dicoumarin or a new oral anticoagulant in patients with non-valvular atrial fibrillation]. / Percepción de los médicos sobre los factores que influyen en la elección de un dicumarínico o de un nuevo anticoagulante oral en pacientes con fibrilación auricular no valvular.

AIMS: Recent studies have demonstrated the efficacy and safety of new oral anticoagulant drugs for the prevention of thromboembolic events in patients with non-valvular atrial fibrillation. Our aim was to evaluate the factors that can influence physicians in their choice between a classic and a new anticoagulant in these patients. DESIGN: Several variables of interest were discussed and analysed using a WorkmatTM methodology. SITES: Six regional meetings were held in Spain (East, Catalonia, Andalusia-Extremadura, Madrid, North-east, and North of Spain). PARTICIPANTS: Meetings were attended by 39 specialists (cardiologists, neurologists, haematologists, internists, and emergency and Primary Care physicians). MEASUREMENTS: Each participant graded their level of agreement, with a score from 1 to 10, on every analysed variable. RESULTS: A new anticoagulant drug was preferred in patients with previous failure of dicoumarin therapy (9.7±0.5), high haemorrhagic risk (8.7±1), prior bleeding (7.8±1.5), and high thrombotic risk (7.7±1.2). Dicoumarins were preferred in cases of severe (1.2±0.4) or moderate (4.2±2.5) kidney failure, good control with dicoumarins (2.3±1.5), cognitive impairment (3.2±3), and low haemorrhagic risk (4.3±3). Age, sex, weight, cost of drug, polymedication, and low thrombotic risk achieved intermediate scores. There were no differences between the different specialists or Spanish regions. CONCLUSIONS: The presence of a high thrombotic or haemorrhagic risk and the failure of previous dicoumarin therapy lead to choosing a new oral anticoagulant in patients with non-valvular atrial fibrillation, while kidney failure, cognitive impairment, good control with dicoumarins, and a low bleeding risk predispose to selecting a classic dicoumarin anticoagulant.

Concordance between automated oscillometric measurement of ankle-brachial index and traditional measurement by eco-Doppler in patients without peripheral artery disease.

AIM: To evaluate the concordance between automated oscillometric measurement (WatchBP® Office ABI) of the ankle- brachial index (ABI) and the traditional measurement by eco-Doppler in a Spanish population without peripheral artery disease attended in primary care. METHODS: The ABI was determined by both methods in a general population aged ≥ 18 years, from the RICARTO study. The intraclass correlation coefficient was calculated to assess the concordance between both techniques and the Bland-Altman plot was determined to analyze the agreement between them. RESULTS: A total of 322 subjects (mean age 47.7 ± 16.0 years; 54.3% women) were included in the study. With regard to cardiovascular risk factors, 70.5% of subjects had dyslipidemia, 26.7% hypertension, 24.8% obesity, 8.4% diabetes and 25.5% were smokers. Mean ABI measured by eco-Doppler and the automated method were 1.17 ± 0.1 and 1.2 ± 0.1, respectively (mean differences - 0.03 ± 0.09; p < 0.001). The Pearson correlation coefficient and the intraclass correlation coefficient were in both cases 0.70. CONCLUSIONS: The automated oscillometric measurement of ABI is a reliable and useful alternative to conventional eco-Doppler determination in the general population without peripheral artery disease attended in primary care.

[Vascular age in a sample of general population of the sanitary area of Toledo (Spain). RICARTO study]. / Edad vascular de una muestra de población general del área sanitaria de Toledo (España). Estudio RICARTO.

OBJECTIVE: To know the vascular age (VA) of a sample of general population included in the RICARTO study. PATIENTS AND METHOD: Epidemiological study of the general population aged ≥18 from the Health Area of Toledo, based on the health card database. VA was calculated from the absolute cardiovascular risk (CVR) estimated with the Framingham and SCORE equations (type2 diabetes increased CVR in SCORE 2-fold in men and 4-fold in women). Patients with cardiovascular or renal disease were excluded. An ANCOVA analysis was conducted to adjust and compare the mean of VA by age and sex. RESULTS: 1,496 subjects (53.54% women) were analyzed. Mean (SD) age was 48.77 (14.89) years old and. Mean VA was 51.37 (19.13) with Framingham equation and 57.09 (17.63) years old with SCORE equation. VA was significantly higher in men, low education level, arterial hypertension, dyslipidemia, hypertriglyceridemia, diabetes mellitus, abdominal obesity, general obesity, smoking and in individuals with 5CVR factors vs none (P<.001 in all). Higher differences (Cohen's D >0.5) were found in non-diabetic vs diabetic people (1.58 Framingham; 2.44 SCORE), normotensive vs hypertensive subjects (1.64 Framingham; 1.19 SCORE), and non-dyslipidemia vs presence of dyslipidemia (0.95 Framingham; 0.66 SCORE). CONCLUSIONS: VA of our sample is two and a half years older than chronological one with Framingham equation and more than eight years with SCORE equation. Control of CVR factors is the key to get a VA closer to real and to obtain a better cardiovascular health in the population.

Cardiovascular risk and blood pressure control in a Spanish hypertensive population attended in a Primary Care setting. Data from the PRESCAP 2006 study.

AIMS: To analyse the cardiovascular risk of a broad sample of hypertensive patients and to examine whether there are differences in blood pressure control and associated factors according to the different cardiovascular risk categories. MAJOR FINDINGS: A total of 10,520 patients > or = 18 years old were included (mean age 64.6+/-11.3 years; 53.7% women). In this cohort, 3.3% were average risk, 22.6% low added risk, 22.2% moderate added risk, 33.5% high added risk and 18.4% very high added risk. Blood pressure was controlled in 41.4% (95% CI 40.5-42.4) of the total population, in 91.7% of patients with low added risk, in 19.4% with moderate added risk, in 27.4% with high added risk and in 6.8% with very high added risk. Diabetes was the factor most strongly associated with poor blood pressure control in patients with high to very high added risk (OR=7.2; p<0.0001). PRINCIPAL CONCLUSION: More than half of the hypertensive patients treated in primary health care have a high or very high added cardiovascular risk. In these patients, blood pressure control is inadequate and diabetes is associated with a sevenfold increase in the likelihood of poor blood pressure control.

[Prevalence of undetected chronic kidney disease in dyslipidemic population treated in primary care. LIPICAP study]. / Prevalencia de la enfermedad renal crónica oculta en la población dislipémica asistida en atención primaria. Estudio LIPICAP.

BACKGROUND AND OBJECTIVE: Information about the prevalence of chronic kidney disease (CKD) in population treated in primary care (PC) is scarce. The aim of this study was to determine undetected CKD prevalence in dyslipidemic population measuring creatinine clearance according to the Cockcroft-Gault equation corrected for surface area. PATIENTS AND METHOD: Cross-sectional study including patients with diagnosis of dyslipidemia selected by consecutive sampling in PC. CKD was diagnosed when the glomerular filtration rate (GFR) was < 60 ml/min/1.73 m2. We assessed sociodemographic and clinical data, cardiovascular risk factors, coronary disease risk categories, dyslipidemia characteristics, functional CKD stage, and pharmacological treatments. RESULTS: The sample included 5,990 patients (50.2% women). The mean (standard deviation) age was 60.9 (11.1) years. The main reason for iclusion was hypercholesterolemia (65%), followed by mixed hyperlipidemia (26.4%), low high density lipoproteins (HDL)-cholesterol (4.9%) and hypertrigliceridemia (3.7%). According to the Cockcroft-Gault equation, CKD prevalence was 16.2% (95% confidence interval, 15.3-17.1) and it was significantly higher in women (22.7%) than in men (9.8%) (p < 0.0001). Patients with CKD were older compared with patients with normal GFR, and had higher systolic blood pressure, glucose and HDL-cholesterol (p < 0.001), as well as lower levels of total cholesterol, low density lipoproteins-cholesterol, and triglycerides (p < 0.01). The probability of presenting CKD was related to female gender, age, and lower body mass index. CONCLUSIONS: The LIPICAP study results indicate that almost 20% of PC dyslipidemic patients in Spain present undetected CKD when the GFR is measured according to the Cockcroft-Gault equation corrected for surface area.

[Control of blood pressure in Spanish hypertensive population attended in primary health-care. PRESCAP 2006 Study]. / Control de la presión arterial en la población hipertensa española atendida en atención primaria. Estudio PRESCAP 2006.

BACKGROUND AND OBJECTIVES: More information is needed on hypertension control and its evolution in clinical practice. This study aimed to determine the degree of blood pressure (BP) control in Spanish hypertensive patients attended in primary care (PC) and to determine the factors associated with poor BP control. PATIENTS AND METHOD: Cross-sectional, multicenter study, carried out in PC settings throughout Spain. Hypertensive patients >or= 18 years, with antihypertensive treatment (>or= 3 months) were consecutively recruited. BP measurement was performed in surgery hours (morning and evening) following standardized methods and averaging 2 consecutive readings. BP control was regarded as optimum when BP values were < 140/90 mmHg in general population and <130/80 mmHg in patients with diabetes, chronic renal disease or cardiovascular disease. RESULTS: 10,520 hypertensive patients were included (53.7% women), mean age (SD) 64.6 (11.3) years. 41.4% (95% confidence interval [CI], 40.5-42.4) presented good systolic BP (SBP) and diastolic BP (DBP) control, 46.5% (95% CI, 45.5-47.4) only SBP control and 67.1% (95% CI, 66.2-68.0) only DBP control. 55.6% of patients were treated with combination therapy (41.2% 2 drugs, 11.7% 3 and 2.8% more than 3). BP control was significantly (p<0.001) higher in the evening measurement (48.9%) than in the morning measurement (40.5%), and if patients had taken the treatment before measurement (42.0%) compared with those who had not taken it (38.8%). Factors such as diabetes, cardiovascular disease, sedentary lifestyle, alcohol consumption and surgery hour were associated with poor BP control (p<0.001). CONCLUSIONS: The results of the PRESCAP 2006 study indicate that 4 out of 10 hypertensive patients treated in PC in Spain have an optimal BP control. The degree of control of arterial hypertension has improved remarkably with respect to the PRESCAP 2002 study.

[Arterial hypertension in immigrant patients in Spanish primary health care]. / Prevalencia de la hipertensión arterial en la población inmigrante asistida en atención primaria en España.

BACKGROUND AND OBJECTIVE: To evaluate the arterial hypertension (AHT) prevalence in a wide sample of immigrant patients. PATIENTS AND METHOD: A transversal and multicentric study that has included immigrant patients aged 18 years or more, consecutive sampling recruitment in primary healthcare consultations. The patient was defined with AHT hypertension when the average of 6 measurements in 3 visits (2 measurements per visit) was > or = 140 mmHg for the systolic blood pressure and/or 90 mmHg for diastolic blood pressure or if the patient had been previously diagnosed. RESULTS: 1,424 immigrants were followed-up (53.1% women) with average age (standard deviation) of 42.8 (13.1) years and mean stay in our country of 5.6 (5.7) years. Most of the patients' origin was Central and South America (40.2%) and Eastern Europe (21.9%). The prevalence of AHT was 31.4% (95% confidence interval [CI], 30.1-32.7%), of which the 62.1% where known patients. Patients coming from Asia showed a significant higher prevalence of AHT (40.0%; 95% CI, 38.7-41.3). CONCLUSIONS: Three of each 10 immigrant patients have AHT. There are significant differences according to the gender, the origin and period of residence of these patients.

[Control of hypertension in elderly patients receiving primary care in Spain]. / Control de la hipertensión arterial en la población española > or = 65 años asistida en atención primaria.

INTRODUCTION AND OBJECTIVES: Little information is available about the control of arterial hypertension in the elderly population. The aim of this study was to investigate hypertension control, factors associated with poor control, and general practitioners' responses to poor control in a large sample of hypertensive patients aged 65 years or older receiving primary care in Spain. PATIENTS AND METHOD: A cross-sectional study of elderly hypertensive patients taking antihypertensives was carried out. Blood pressure was measured in the standard manner. Blood pressure control was regarded as optimum if pressure averaged less than 140/90 mm Hg or, in diabetics, less than 130/85 mm Hg. RESULTS: The study included 5970 patients (mean age, 72.4 years; 62.8% women). Both systolic and diastolic blood pressures were well controlled in 33.5% of patients, systolic blood pressure alone in 35.5%, and diastolic blood pressure alone in 76.2%. Blood pressure control was found to be good more frequently when it was assessed in the evening (39.8%; P<.001), and when patients had taken treatment on the day of assessment (35.1%; P <.001). Some 12.9% of diabetics had pressures less than 130/85 mmHg and 9.7% had pressures less than 130/80 mmHg. General practitioners modified their therapeutic approach with only 17.2% of poorly controlled patients. CONCLUSIONS: Arterial blood pressure control was optimum in only three out of 10 Spanish hypertensive patients aged 65 years or older. Blood pressure control assessment was significantly influenced by surgery hours and by the timing of antihypertensive intake. General practitioners' therapeutic responses to poor control were too conservative.

[Blood pressure control in Spanish hypertensive patients in Primary Health Care Centres. PRESCAP 2002 Study]. / Control de la presión arterial en la población hipertensa española atendida en atención primaria. Estudio PRESCAP 2002.

BACKGROUND AND OBJECTIVE: More information is needed on hypertension control in clinical practice, which includes taking at least two blood pressure (BP) readings and taking into account surgery times and previous antihypertensive drug intake. Our study aimed to assess the optimum degree of BP control in a broad sample of Spanish hypertensive patients in primary care and to determine factors associated with a poor control. PATIENTS AND METHOD: Cross-sectional, multicenter study of hypertensive patients aged over 18 years and treated with drugs during the preceeding three months, who were recruited by general practitioners through consecutive sampling in primary care settings throughout Spain over 3 consecutive days. BP measurements were performed in surgery hours (morning and evening) following standardized methods and averaging two consecutive readings. An average BP lower than 140/90 mm Hg (values lower than 130/85 mm Hg in diabetics) was regarded as optimum BP control. RESULTS: 12 754 patients were included, mean age 63.3 years (10.8), 57.2% women. 36.1% (95% CI, 35.2-36.9) had good systolic blood pressure (SBP) and diastolic blood pressure (DBP) controls, 39.1% (95% CI, 38.3-40.0) had good SBP control only, and 73.1% (95% CI, 72.3-73.9) had good DBP control only. BP control was significantly (*2, p < 0.001) better during evening than during morning measurements (43.6% vs 37.1%) and in patients who had taken antihypertensive treatment before measurement (37.2%) vs. those who had not taken it (21.0%). Factors such as alcohol consumption, sedentary lifestyle, obesity and age were all associated with poor BP control (Wald's (chi 2, p < 0.001). CONCLUSIONS: The results of the PRESCAP 2002 study indicate that approximately 4 out of 10 hypertensive patients treated pharmacologically by primary health care centers in Spain have optimal BP control. Significant differences were found in the degree of control depending on surgery hours and the previous intake of antihypertensive medication.

Blood pressure control and management of very elderly patients with hypertension in primary care settings in Spain.

This study aimed to determine the clinical profile, blood pressure (BP) control rates, therapeutic management and physicians' therapeutic behavior regarding very elderly hypertensive patients. A total of 1540 hypertensive patients 80 years old on antihypertensive therapy and receiving care in primary care settings in Spain were included in this cross-sectional study. The mean patient age was 83.4±3.1 years, 61.9% of patients were women and 49.3% of patients had cardiovascular disease. Of the patients, 27.7% were on monotherapy and 72.3% were on combined therapy (47.4% on two antihypertensive agents and 24.9% on three or more antihypertensive agents). A total of 40.8% (95% confidence interval (CI): 38.4-43.3%) of patients achieved BP goals (<140/90 mm Hg; <130/80 in patients with diabetes, chronic renal disease or cardiovascular disease). Patients with uncontrolled BP were more likely to have metabolic syndrome, diabetes, obesity, a history of cardiovascular disease, ischemic heart disease, renal disease and stroke and were more frequently smokers. Physicians modified the antihypertensive regimens for 27.4% (95% CI: 23.9-30.8%) of the patients with uncontrolled BP, and the addition of another antihypertensive agent was the most frequent modification. With regard to the physicians' perception of patients' BP control, the BPs of 44.1% of the patients with uncontrolled BP were considered well controlled by the physicians.

[Blood pressure control in hypertensive Spanish population attended in primary care setting. The PRESCAP 2010 study]. / Control de la presión arterial en la población hipertensa española asistida en atención primaria. Estudio PRESCAP 2010.

BACKGROUND AND OBJECTIVE: This study was aimed at determining the degree of blood pressure (BP) control in hypertensive patients attended in primary care (PC) settings. PATIENTS AND METHOD: Cross-sectional, multicenter study. Hypertensive patients ≥18 years under antihypertensive treatment attended in Spanish PC settings were included. BP control was regarded as optimum when BP values were <140/90mmHg in general population and <130/80mmHg in patients with diabetes, chronic renal disease or cardiovascular disease. BP control was also calculated for all patients when it was <140/90mmHg. RESULTS: A total of 12,961 hypertensive patients (52.0% women) with a mean age of 66.3 (±11.4) years were included. A percentage of 46.3 (95% CI: 45.4-47.1) presented good systolic BP and diastolic BP control; 61.1% (IC 95%: 60.2-61.9) of patients presented good BP control<140/90. A percentage of 63.6% was treated with combination therapy (44.1% with 2 drugs, 19.5% with 3 or more). BP control was significantly higher in evening measurements (50.4%) than in morning measurements (45.1%), and in patients who had taken the treatment before the visit (47.9%) compared with those who had not (30.5%). Factors such as not taking the medication before the visit, heavy alcohol consumption and dyslipemia were the risk factors mostly associated with a poor BP control (P<.001). CONCLUSIONS: Five out of 10 hypertensive patients treated in PC settings have an optimal BP control. The degree of control of arterial hypertension has improved with respect to the PRESCAP 2006 study.

Percepción de los médicos sobre los factores que influyen en la elección de un dicumarínico o de un nuevo anticoagulante oral en pacientes con fibrilación auricular no valvular / Perception of physicians on factors that influence the choice of a dicoumarin or a new oral anticoagulant in patients with non-valvular atrial fibrillation

OBJETIVO: Estudios recientes han demostrado la eficacia y la seguridad de los nuevos anticoagulantes orales (NACO) en la prevención de tromboembolias en pacientes con fibrilación auricular no valvular (FANV). Nuestro objetivo es evaluar qué factores influyen en los médicos para elegir entre dicumarínicos o NACO. DISEÑO: Se analizaron distintas variables, que fueron discutidas y puntuadas siguiendo una metodología Workmat®. EMPLAZAMIENTO: Se realizaron 6 reuniones regionales en España (Levante, Cataluña, Andalucía Extremadura, Madrid, Noroeste y Norte de España). PARTICIPANTES: Participaron 39 especialistas (cardiólogos, neurólogos, hematólogos, internistas y médicos de urgencias y atención primaria). Mediciones: Cada participante puntuó de 1 a 10 (de menor a mayor) el grado de acuerdo con cada variable analizada. RESULTADOS: Se elegiría preferiblemente un NACO en pacientes con fracaso previo del tratamiento dicumarínico (9,7 ± 0,5), riesgo hemorrágico elevado (8,7 ± 1), antecedentes de hemorragia (7,8 ± 1,5) y riesgo trombótico alto (7,7 ± 1,2). Se decantarían por un dicumarínico en casos de disfunción renal grave (1,2 ± 0,4) o moderada (4,2 ± 2,5), buen control con dicumarínicos (2,3 ± 1,5), deterioro cognitivo (3,2 ± 3) y riesgo hemorrágico bajo (4,3 ± 3). La edad, el sexo, el peso, el coste del fármaco, la polimedicación y la existencia de un riesgo trombótico bajo obtuvieron puntuaciones intermedias. CONCLUSIONES: El riesgo trombótico y hemorrágico elevado y el fracaso del tratamiento previo con dicumarínicos predisponen a elegir un NACO. La insuficiencia renal, el deterioro cognitivo, el buen control con dicumarínicos y un riesgo hemorrágico bajo inclinan a decantarse por un dicumarínico clásico

AIMS: Recent studies have demonstrated the efficacy and safety of new oral anticoagulant drugs for the prevention of thromboembolic events in patients with non-valvular atrial fibrillation. Our aim was to evaluate the factors that can influence physicians in their choice between a classic and a new anticoagulant in these patients. DESIGN: Several variables of interest were discussed and analysed using a WorkmatTM methodology. Sites: Six regional meetings were held in Spain (East, Catalonia, Andalusia-Extremadura, Madrid, North-east, and North of Spain). PARTICIPANTS: Meetings were attended by 39 specialists (cardiologists, neurologists, haematologists, internists, and emergency and Primary Care physicians). Measurements: Each participant graded their level of agreement, with a score from 1 to 10, on every analysed variable. RESULTS: A new anticoagulant drug was preferred in patients with previous failure of dicoumarin therapy (9.7 ± 0.5), high haemorrhagic risk (8.7 ± 1), prior bleeding (7.8 ± 1.5), and high thrombotic risk (7.7 ± 1.2). Dicoumarins were preferred in cases of severe (1.2 ± 0.4) or moderate (4.2 ± 2.5) kidney failure, good control with dicoumarins (2.3°æ 1.5), cognitive impairment (3.2 ± 3), and low haemorrhagic risk (4.3 ± 3). Age, sex, weight, cost of drug, polymedication, and low thrombotic risk achieved intermediate scores. There were no differences between the different specialists or Spanish regions. CONCLUSIONS: The presence of a high thrombotic or haemorrhagic risk and the failure of previous dicoumarin therapy lead to choosing a new oral anticoagulant in patients with non-valvular atrial fibrillation, while kidney failure, cognitive impairment, good control with dicoumarins, and a low bleeding risk predispose to selecting a classic dicoumarin anticoagulant

Edad vascular de una muestra de población general del área sanitaria de Toledo (España). Estudio RICARTO / Vascular age in a sample of general population of the sanitary area of Toledo (Spain). RICARTO study

Objetivos: Conocer la edad vascular (EV) de una muestra de población general del área sanitaria de Toledo incluida en el estudio RICARTO.Pacientes y métodoEstudio epidemiológico transversal realizado en población general ≥18 años, aleatorizada según tarjeta sanitaria. La EV se calculó a partir del riesgo cardiovascular (RCV) absoluto estimado con las escalas de Framingham y SCORE (la presencia de diabetes mellitus duplicó el RCV obtenido en varones y lo cuadruplicó en mujeres). Se excluyeron los sujetos con patología cardiovascular o renal. Se realizó ANCOVA para ajustar y comparar las medias de EV por edad y sexo.ResultadosSe analizaron 1.496 individuos (53,54% mujeres), con una edad media (DE) de 48,77 (14,89) años. La EV media fue 51,37 (19,13) años con Framingham y 57,09 (17,63) años con SCORE, resultando significativamente mayor en varones, nivel de estudios bajo, hipertensión arterial, dislipidemia, hipertrigliceridemia, diabetes mellitus, obesidad abdominal, obesidad general, tabaquismo y en sujetos con 5 factores de RCV frente a ninguno (p<0,001 en todos). Las mayores diferencias (D de Cohen >0,5) se hallaron entre no diabéticos y diabéticos (1,58 Framingham; 2,44 SCORE), normotensos e hipertensos (1,64 Framingham; 1,19 SCORE) y no dislipidémicos y dislipidémicos (0,95 Framingham; 0,66 SCORE).ConclusionesEn nuestra muestra la EV es 2,5años superior a la cronológica con la ecuación de Framingham y más de 8años con la del SCORE. El control de los factores de RCV es clave para lograr una EV más próxima a la real y lograr una mejor salud cardiovascular de la población. (AU)

Objective: To know the vascular age (VA) of a sample of general population included in the RICARTO study.Patients and methodEpidemiological study of the general population aged ≥18 from the Health Area of Toledo, based on the health card database. VA was calculated from the absolute cardiovascular risk (CVR) estimated with the Framingham and SCORE equations (type2 diabetes increased CVR in SCORE 2-fold in men and 4-fold in women). Patients with cardiovascular or renal disease were excluded. An ANCOVA analysis was conducted to adjust and compare the mean of VA by age and sex.Results1,496 subjects (53.54% women) were analyzed. Mean (SD) age was 48.77 (14.89) years old and. Mean VA was 51.37 (19.13) with Framingham equation and 57.09 (17.63) years old with SCORE equation. VA was significantly higher in men, low education level, arterial hypertension, dyslipidemia, hypertriglyceridemia, diabetes mellitus, abdominal obesity, general obesity, smoking and in individuals with 5CVR factors vs none (P<.001 in all). Higher differences (Cohen's D >0.5) were found in non-diabetic vs diabetic people (1.58 Framingham; 2.44 SCORE), normotensive vs hypertensive subjects (1.64 Framingham; 1.19 SCORE), and non-dyslipidemia vs presence of dyslipidemia (0.95 Framingham; 0.66 SCORE).ConclusionsVA of our sample is two and a half years older than chronological one with Framingham equation and more than eight years with SCORE equation. Control of CVR factors is the key to get a VA closer to real and to obtain a better cardiovascular health in the population. (AU)

Blood pressure control and physicians' therapeutic behavior in a very elderly Spanish hypertensive population.

This study sought to assess blood pressure (BP) control rates by determining the factors associated with poor BP control, therapeutic management and physicians' therapeutic behavior among elderly Spanish hypertensive patients in a primary care setting. This cross-sectional multicenter study included hypertensive patients at least 80 years of age in primary care settings throughout Spain who were on pharmacologic treatment. BP was considered well controlled at <140/90 mm Hg (<130/80 in patients with diabetes, chronic renal disease or cardiovascular disease). A total of 923 patients were included (83.3+/-3.5 years; 62.9% women). Almost two-thirds (64.0%) of the patients were taking a combined therapy (68.7%; 2 drugs) and approximately one-third (35.6%; 95% CI 32.6-38.7) of the patients attained BP goals. Physicians modified the antihypertensive treatment in 26.1% (95% CI 22.3-29.9) of patients with uncontrolled BP, which most frequently involved the addition of another drug (47.6%). Predictive factors for no BP control and no therapeutic modification in patients with uncontrolled BP included diabetes (OR 2.8 (95% CI 2.0-3.9); P<0.0001) and mistaken physician perceptions about BP control (OR 108.1 (95% CI 40.5-288.6); P<0.0001), respectively. Only three out of 10 hypertensive patients 80 years or older in Spain achieved the BP goals. Physicians only modified the treatment in one out of four patients with uncontrolled BP. Diabetes was associated with a threefold increase in the likelihood of uncontrolled BP, and the mistaken physician perceptions about BP control were associated with a 100-fold rise in the probability of not modifying antihypertensive therapy.

[Blood pressure findings in Spanish dyslipidemic primary-care patients. LIPICAP-PA Study]. / Características de la presión arterial en una población dislipémica española asistida en atención primaria. Estudio LIPICAPPA.

BACKGROUND AND OBJECTIVES: Despite the well-known significant relationship between blood pressure and cardiovascular mortality, few data are available on the blood pressure characteristics of dyslipidemic patients. The aims of this study were to determine the blood pressure characteristics of dyslipidemic patients being treated in primary care, and to identify factors associated with poor blood pressure control. METHODS: This multicentre cross-sectional study involved patients of both sexes aged > or =18 years who were diagnosed with dyslipidemia (i.e., hypercholesterolemia, hypertriglyceridemia, mixed dyslipidemia, or a low high-density lipoprotein cholesterol level) in the 17 Spanish autonomous regions. Blood pressure was measured according to standard procedures, and was considered well-controlled if it was <140/90 mm Hg (or <130/80 mm Hg in patients with diabetes, nephropathy or cardiovascular disease). RESULTS: In total, 7054 patients were studied (mean age 61.3 [11.2] years, 50.8% male). Mean systolic and diastolic blood pressures were 134.6 [14.2]/79.8 [8.9] mm Hg, with significant differences (P< .001) between hypertensives (140.8 [14.6]/82.8 [9.0] mmHg) and normotensives (128.5 [10.7]/76.9 [7.7] mm Hg). Good blood pressure control was observed in 47.4% (95% confidence interval, 46.3-48.5%) of subjects overall, in 29.3% of hypertensives, and in 12.8% of hypertensive diabetics. Poor control was associated with an increased cardiovascular disease risk (hazard ratio [HR]=2.89), poor control of low-density lipoprotein cholesterol (HR=1.43), a higher body mass index (HR=1.06), and older age (HR=1.02). CONCLUSIONS: Fewer than half of dyslipidemic primary-care patients in Spain had good blood pressure control. Poor control was associated, in particular, with increased cardiovascular risk and poor control of the low-density lipoprotein cholesterol level.

Cost-effectiveness of ambulatory blood pressure monitoring in the follow-up of hypertension.

AIMS: To study the cost of the follow-up of hypertension in primary care (PC) using clinical blood pressure (CBP) and ambulatory blood pressure monitoring (ABPM), and to analyse the cost-effectiveness (CE) of both methods. MAJOR FINDINGS AND PRINCIPAL CONCLUSION: Good control of hypertension was achieved in 8.3% with CBP (95% CI 4.8-11.8) and in 55.6% with ABPM (95% CI 49.3-61.9). The cost of one patient with good control of hypertension is almost four times higher with CBP than with ABPM (Euro 940 vs Euro 238). Reaching the gold standard (ABPM) involved an after-cost of Euro 115 per patient. The results for a 5% discount rate showed a saving of Euro 68,883 if ABPM was performed in all the patients included in the study (n = 241, Euro 285 per patient). An analysis of sensitivity, changing the discount rate and life expectancy indicated that ABPM provides a better CE ratio and a lower global cost. ABPM is more cost-effective than CBP. However, if we include the new treatment cost of poorly monitored patients, it is less cost-effective. Excellent control of hypertension is still an important challenge for all healthcare professionals, especially for those working in PC, where most monitoring of hypertensive patients takes place.

Control de la presión arterial en la población hipertensa española asistida en Atención Primaria. Estudio PRESCAP 2010 / Blood pressure control in hypertensive Spanish population attended in Primary Care setting. The PRESCAP 2010 study

Fundamento y objetivo: Es necesario disponer de información actualizada sobre el control de la hipertensión arterial en condiciones reales de práctica clínica. Este estudio pretende conocer el grado de control de la presión arterial (PA) en hipertensos asistidos en Atención Primaria (AP). Pacientes y método: Estudio transversal realizado en hipertensos españoles ≥18 años asistidos en AP. La PA se midió estandarizadamente 2 veces en consulta matutina o vespertina, considerándose bien controlada cuando el promedio era <140/90mmHg en general y <130/80mmHg en pacientes con diabetes, insuficiencia renal o enfermedad cardiovascular; adicionalmente se analizó el buen control en toda la población con valores tensionales <140/90mmHg. Resultados: Se incluyeron 12.961 hipertensos (52,0% mujeres) con una edad media (DE) de 66,3 (11,4) años. El 46,3% (intervalo de confianza del 95% [IC 95%] 45,4-47,1) presentó buen control de PA sistólica y diastólica; con valores <140/90mmHg el buen control fue del 61,1% (IC 95% 60,2-61,9). El 63,6% recibía terapia combinada (44,1% 2 fármacos, 19,5% 3 o más). El porcentaje de control fue mayor (p<0,001) por las tardes (50,4%) que por las mañanas (45,1%), y en pacientes que habían tomado el tratamiento antihipertensivo el día de la visita (47,9%) frente a los que no lo habían tomado (30,5%). No tomar la medicación el día de la visita, el consumo elevado de alcohol y el antecedente de dislipidemia fueron los factores más asociados al mal control. Conclusiones: El estudio PRESCAP 2010 indica que casi 5 de cada 10 hipertensos tienen bien controlada la PA. Existen diferencias importantes según el horario de consulta y la toma previa de antihipertensivos. El control ha mejorado respecto al PRESCAP 2006 (AU)

Background and objective: This study was aimed at determining the degree of blood pressure (BP) control in hypertensive patients attended in primary care (PC) settings. Patients and method: Cross-sectional, multicenter study. Hypertensive patients ≥18 years under antihypertensive treatment attended in Spanish PC settings were included. BP control was regarded as optimum when BP values were <140/90mmHg in general population and <130/80mmHg in patients with diabetes, chronic renal disease or cardiovascular disease. BP control was also calculated for all patients when it was <140/90mmHg. Results: A total of 12,961 hypertensive patients (52.0% women) with a mean age of 66.3 (±11.4) years were included. A percentage of 46.3 (95% CI: 45.4-47.1) presented good systolic BP and diastolic BP control; 61.1% (IC 95%: 60.2-61.9) of patients presented good BP control <140/90. A percentage of 63.6% was treated with combination therapy (44.1% with 2 drugs, 19.5% with 3 or more). BP control was significantly higher in evening measurements (50.4%) than in morning measurements (45.1%), and in patients who had taken the treatment before the visit (47.9%) compared with those who had not (30.5%). Factors such as not taking the medication before the visit, heavy alcohol consumption and dyslipemia were the risk factors mostly associated with a poor BP control (P<0.001). Conclusions: Five out of 10 hypertensive patients treated in PC settings have an optimal BP control. The degree of control of arterial hypertension has improved with respect to the PRESCAP 2006 study (AU)

Prevalencia de la enfermedad renal crónica oculta en la población dislipémica asistida en atención primaria. Estudio LIPICAP / Prevalence of undetected chronic kidney disease in dyslipidemic population treated in primary care. LIPICAP study

Fundamento y objetivo: Se dispone de poca información sobre la prevalencia de la enfermedad renal crónica (ERC) en atención primaria (AP). El objetivo del estudio LIPICAP ha sido determinar la prevalencia de ERC oculta en población dislipémica mediante el cálculo del aclaramiento de creatinina con la fórmula de Cockcroft-Gault corregida por superficie corporal. Pacientes y método: Se ha realizado un estudio transversal en pacientes dislipémicos seleccionados consecutivamente en AP. Se diagnosticó ERC cuando la tasa de filtrado glomerular (TFG) era inferior a 60 ml/min/1,73 m2. Se evaluaron datos sociodemográficos, clínicos, factores de riesgo cardiovascular, características de la dislipemia, estadio funcional de ERC y tratamientos farmacológicos. Resultados: Se incluyó a 5.990 pacientes (un 50,2% mujeres) con una edad media (desviación estándar) de 60,9 (11,1) años. El principal motivo de inclusión fue la hipercolesterolemia (65%), seguida de la hiperlipemia mixta (26,4%), cifras bajas de colesterol unido a lipoproteínas de alta densidad (cHDL) (4,9%) e hipertrigliceridemia (3,7%). El 16,2% (intervalo de confianza del 95%, 15,3-17,1) presentó ERC según la fórmula de Cockcroft-Gault, siendo la prevalencia mayor en las mujeres (22,7%) que en los varones (9,8%) (p < 0,0001). En comparación con los pacientes con una TFG normal, los pacientes con ERC tenían más edad, cifras mayores de presión arterial sistólica, glucosa y cHDL (p < 0,001) y valores inferiores de colesterol total, colesterol unido a lipoproteínas de baja densidad y triglicéridos (p < 0,01). La probabilidad de presentar ERC se relacionó con el sexo femenino, la edad y un índice de masa corporal inferior. Conclusiones: Los resultados del estudio LIPICAP indican que casi 2 de cada 10 pacientes diagnosticados de dislipemia y atendidos en AP presentan ERC oculta cuando se estima la TFG con la fórmula de Cockcroft-Gault corregida por superficie corporal

Background and objective: Information about the prevalence of chronic kidney disease (CKD) in population treated in primary care (PC) is scarce. The aim of this study was to determine undetected CKD prevalence in dyslipidemic population measuring creatinine clearance according to the Cockcroft-Gault equation corrected for surface area. Patients and method: Cross-sectional study including patients with diagnosis of dyslipidemia selected by consecutive sampling in PC. CKD was diagnosed when the glomerular filtration rate (GFR) was < 60 ml/min/1.73 m2. We assessed sociodemographic and clinical data, cardiovascular risk factors, coronary disease risk categories, dyslipidemia characteristics, functional CKD stage, and pharmacological treatments. Results: The sample included 5,990 patients (50.2% women). The mean (standard deviation) age was 60.9 (11.1) years. The main reason for iclusion was hypercholesterolemia (65%), followed by mixed hyperlipidemia (26.4%), low high density lipoproteins (HDL)-cholesterol (4.9%) and hypertrigliceridemia (3.7%). According to the Cockcroft-Gault equation, CKD prevalence was 16.2% (95% confidence interval, 15.3-17.1) and it was significantly higher in women (22.7%) than in men (9.8%) (p < 0.0001). Patients with CKD were older compared with patients with normal GFR, and had higher systolic blood pressure, glucose and HDL-cholesterol (p < 0.001), as well as lower levels of total cholesterol, low density lipoproteins-cholesterol, and triglycerides (p < 0.01). The probability of presenting CKD was related to female gender, age, and lower body mass index. Conclusions: The LIPICAP study results indicate that almost 20% of PC dyslipidemic patients in Spain present undetected CKD when the GFR is measured according to the Cockcroft-Gault equation corrected for surface area

Control de la presión arterial en la población hipertensa española atendida en atención primaria. Estudio PRESCAP 2006 / Control of blood pressure in Spanish hypertensive population attended in primary health-care. PRESCAP 2006 Study

Fundamento y objetivos: Es necesario tener mayor información sobre el grado de control de la hipertensión arterial (HTA) en condiciones reales de la práctica clínica. Los objetivos de este estudio fueron conocer el grado de control de presión arterial (PA) en pacientes hipertensos en atención primaria (AP) y determinar los factores asociados al mal control. Pacientes y método: Estudio transversal y multicéntrico que incluyó a individuos hipertensos de 18 o más años, que seguían tratamiento farmacológico antihipertensivo desde hacía al menos 3 meses, y que fueron seleccionados consecutivamente en consultas de AP de España. La medida de PA se realizó siguiendo normas estandarizadas según el horario de consulta (matutina o vespertina) y se calculó la media aritmética de 2 tomas sucesivas. Se consideró que había buen control cuando el promedio era inferior a 140/90 mmHg en general, y menor de 130/80 mmHg en pacientes con diabetes, insuficiencia renal o enfermedad cardiovascular. Resultados: Se incluyó a 10.520 hipertensos (53,7% mujeres), con edad media (desviación estándar) de 64,6 (11,3) años. El 41,4% (intervalo de confianza [IC] del 95%, 40,5-42,4) presentó un buen control de PA sistólica (PAS) y PA diastólica (PAD), el 46,5% (IC del 95%, 45,5-47,4) sólo de PAS y el 67,1% (IC del 95%, 66,2-68,0) sólo de PAD. El 55,6% recibía tratamiento combinado (41,2% 2 fármacos, 11,7% 3 fármacos, y 2,8% más de 3). El porcentaje de pacientes controlados fue significativamente mayor (p < 0,001) por las tardes (48,9%) que por las mañanas (40,5%), y en pacientes que habían tomado tratamiento antihipertensivo el día de la visita (42,0%) frente a los que no lo habían tomado (38,8%). La diabetes, la enfermedad cardiovascular, el sedentarismo, el consumo elevado de alcohol y el horario de consulta fueron los factores más asociados al mal control de la HTA (p < 0,001). Conclusiones: Los resultados del estudio PRESCAP 2006 indican que 4 de cada 10 pacientes hipertensos tratados y atendidos en AP en España tienen controlada óptimamente su HTA. Hay diferencias importantes en el grado de control según el horario de consulta y la toma previa de antihipertensivos. El control de la HTA ha mejorado apreciablemente respecto al PRESCAP 2002

Background and objectives: More information is needed on hypertension control and its evolution in clinical practice. This study aimed to determine the degree of blood pressure (BP) control in Spanish hypertensive patients attended in primary care (PC) and to determine the factors associated with poor BP control. Patients and method: Cross-sectional, multicenter study, carried out in PC settings throughout Spain. Hypertensive patients $ 18 years, with antihypertensive treatment ($ 3 months) were consecutively recruited. BP measurement was performed in surgery hours (morning and evening) following standardized methods and averaging 2 consecutive readings. BP control was regarded as optimum when BP values were < 140/90 mmHg in general population and < 130/80 mmHg in patients with diabetes, chronic renal disease or cardiovascular disease. Results: 10,520 hypertensive patients were included (53.7% women), mean age (SD) 64.6 (11.3) years. 41.4% (95% confidence interval [CI], 40.5-42.4) presented good systolic BP (SBP) and diastolic BP (DBP) control, 46.5% (95% CI, 45.5-47.4) only SBP control and 67.1% (95% CI, 66.2-68.0) only DBP control. 55.6% of patients were treated with combination therapy (41.2% 2 drugs, 11.7% 3 and 2.8% more than 3). BP control was significantly (p < 0,001) higher in the evening measurement (48.9%) than in the morning measurement (40.5%), and if patients had taken the treatment before measurement (42.0%) compared with those who had not taken it (38.8%). Factors such as diabetes, cardiovascular disease, sedentary lifestyle, alcohol consumption and surgery hour were associated with poor BP control (p < 0,001). Conclusions: The results of the PRESCAP 2006 study indicate that 4 out of 10 hypertensive patients treated in PC in Spain have an optimal BP control. The degree of control of arterial hypertension has improved remarkably with respect to the PRESCAP 2002 study

Características de la presión arterial en una población dislipémica española asistida en atención primaria. Estudio LIPICAP­PA / Blood pressure findings in spanish dyslipidemic primary-care patients. LIPICAP­PA study

Introducción y objetivos. Aunque la presión arterial se ha relacionado significativamente con la mortalidad cardiovascular, se dispone de escasa información sobre sus características en los pacientes dislipémicos. Los objetivos de este estudio fueron conocer las características de la presión arterial en una población dislipémica asistida en atención primaria y los factores que se asocian con el mal control tensional. Métodos. Estudio transversal multicéntrico en el que se analizó a individuos ≥ 18 años de ambos sexos diagnosticados de dislipemia (hipercolesterolemia, hipertrigliceridemia, dislipemia mixta o bajas concentraciones de colesterol unido a lipoproteínas de alta densidad) en las 17 comunidades autónomas de España. La presión arterial se midió siguiendo normas estandarizadas y se consideró bien controlada cuando era < 140/90 mmHg (< 130/80 mmHg en pacientes con diabetes, nefropatía o enfermedad cardiovascular). Resultados. Se analizó a 7.054 pacientes (edad media 61,3 ± 11,2 años; 50,8% varones). Los valores medios de presión arterial sistólica/diastólica fueron de 134,6 ± 14,2/79,8 ± 8,9 mmHg, con diferencias significativas (p < 0,001) entre hipertensos (140,8 ± 14,6/82,8 ± 9,0 mmHg) y normotensos (128,5 ± 10,7/76,9 ± 7,7 mmHg). Se halló buen control de la presión arterial en el 47,4% (intervalo de confianza [IC] del 95%, 46,3-48,5) del total de sujetos, en el 29,3% de los hipertensos y en el 12,8% de los hipertensos diabéticos. El mal control tensional se asoció con la elevación del riesgo cardiovascular (odds ratio [OR] = 2,89), el mal control del colesterol unido a lipoproteínas de baja densidad (cLDL) (OR = 1,43) y los incrementos del índice de masa corporal (OR = 1,06) y la edad (OR = 1,02). Conclusiones. Menos de la mitad de los dislipémicos españoles asistidos en atención primaria tiene bien controlada la presión arterial. El mal control tensional se asocia especialmente con el aumento del riesgo cardiovascular y el mal control del cLDL (AU)

Background and objectives. Despite the well-known significant relationship between blood pressure and cardiovascular mortality, few data are available on the blood pressure characteristics of dyslipidemic patients. The aims of this study were to determine the blood pressure characteristics of dyslipidemic patients being treated in primary care, and to identify factors associated with poor blood pressure control. Methods. This multicentre cross-sectional study involved patients of both sexes aged ≥18 years who were diagnosed with dyslipidemia (i.e., hypercholesterolemia, hypertriglyceridemia, mixed dyslipidemia, or a low high-density lipoprotein cholesterol level) in the 17 Spanish autonomous regions. Blood pressure was measured according to standard procedures, and was considered well-controlled if it was <140/90 mm Hg (or <130/80 mm Hg in patients with diabetes, nephropathy or cardiovascular disease). Results. In total, 7054 patients were studied (mean age 61.3 [11.2] years, 50.8% male). Mean systolic and diastolic blood pressures were 134.6 [14.2]/79.8 [8.9] mm Hg, with significant differences (P<.001) between hypertensives (140.8 [14.6]/82.8 [9.0] mmHg) and normotensives (128.5 [10.7]/76.9 [7.7] mm Hg). Good blood pressure control was observed in 47.4% (95% confidence interval, 46.3­48.5%) of subjects overall, in 29.3% of hypertensives, and in 12.8% of hypertensive diabetics. Poor control was associated with an increased cardiovascular disease risk (hazard ratio [HR]=2.89), poor control of low-density lipoprotein cholesterol (HR=1.43), a higher body mass index (HR=1.06), and older age (HR=1.02). Conclusions. Fewer than half of dyslipidemic primary-care patients in Spain had good blood pressure control. Poor control was associated, in particular, with increased cardiovascular risk and poor control of the low-density lipoprotein cholesterol level (AU)