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BACKGROUND AND AIMS: Diets with a high glycemic index (GI), high glycemic load (GL), or both, increase the risk of cardiovascular disease. This study examined the association of GI and GL in a regular diet with the peripheral augmentation index (i.e., a marker of vascular aging) in a sample of adults. METHODS AND RESULTS: Cross-sectional study. The findings presented in this manuscript are a subanalysis of the EVIDENT study whose purpose was to analyze the relationship between lifestyle and arterial aging. For the sample population, 1553 individuals aged 20-80 years were selected through random sampling from the patients of general practitioners at six health centers in Spain. GI and GL for each patient's diet were calculated from a previously validated, semi-quantitative, 137-item food frequency questionnaire. The peripheral augmentation index corrected for a heart rate of 75 bpm (PAIx75) was measured with pulse-wave application software (A-Pulse CASP). Based on a risk factor adjusted regression model, for every 5 unit increase in GI, the PAIx75 increased by 0.11 units (95% CI: 0.04-0.19). Similarly, for every increase in 10 units in GL, the PAIx75 increased by 1.13 (95% CI: 0.21-2.05). High PAIx75 values were observed in individuals with diets in the third GI tertile (i.e., the highest), and lower PAIx75 values in those with diets in the first tertile (i.e., the lowest), (93.1 vs. 87.5, respectively, p = 0.001). CONCLUSIONS: GI and GL were directly associated with PAIx75 values in adults without cardiovascular diseases regardless of age, gender, physical activity, and other confounders.
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Envejecimiento , Arterias/fisiopatología , Enfermedades Cardiovasculares/etiología , Carbohidratos de la Dieta/efectos adversos , Índice Glucémico , Enfermedad Arterial Periférica/etiología , Adulto , Anciano , Anciano de 80 o más Años , Arterias/fisiología , Biomarcadores , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/fisiopatología , Estudios de Cohortes , Estudios Transversales , Femenino , Frecuencia Cardíaca , Humanos , Estilo de Vida , Masculino , Persona de Mediana Edad , Enfermedad Arterial Periférica/epidemiología , Enfermedad Arterial Periférica/fisiopatología , Análisis de la Onda del Pulso , Factores de Riesgo , España/epidemiología , Adulto JovenRESUMEN
PURPOSE: The objective of this study was to determine the independent relationships of trunk fat, leg fat and arm fat to cardiovascular (CVD) risk factors, after controlling for relevant confounders such as fat mass index, cardiorespiratory fitness and objectively measured physical activity. METHODS: This is a cross-sectional study involving 683 university students, aged 18-30 years. Total and regional body fat distribution was measured using dual-energy X-ray absorptiometry. The associations of trunk, leg and arm fat with CVD risk factors (triglycerides-TG-, high-density lipoprotein cholesterol-HDL-c-, TG/HDL-c ratio, HOMA(IR), mean arterial pressure, C-reactive protein) were examined using regression linear models, controlling for age, sex, fat mass index [total body fat(kg)/height(m(2))], maximal oxygen consumption and physical activity by accelerometer. RESULTS: After controlling for fat mass index, and other confounders, higher levels of trunk fat were found to be associated with a poorer lipid profile, while higher levels of leg fat were found to be associated with a better lipid profile. We did not find any association between arm fat and lipid profile after controlling for total fatness and other confounders. Neither trunk, leg or arm fat was found to be related to insulin resistance, blood pressure or inflammation markers. CONCLUSIONS: Our data suggest that the region where fat is accumulated might have a differential effect on lipid profile: trunk fat has an adverse effect, leg fat has a protective effect, and arm fat has no effect. The differences observed between upper- and lower-body peripheral fat depots should be further explored.
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Brazo , Distribución de la Grasa Corporal , HDL-Colesterol/sangre , LDL-Colesterol/sangre , Pierna , Triglicéridos/sangre , Absorciometría de Fotón , Adolescente , Adulto , Antropometría , Presión Arterial , Proteína C-Reactiva , Enfermedades Cardiovasculares/sangre , Enfermedades Cardiovasculares/etiología , Estudios Transversales , Femenino , Humanos , Resistencia a la Insulina , Masculino , Actividad Motora , Factores de Riesgo , Adulto JovenRESUMEN
OBJECTIVE: To analyze the agreement in glomerular filtration rate (GFR) estimated with CKD-EPI and MDRD-IDMS equations in a cohort of hypertensive patients. METHODS: We included consecutively 478 hypertensive patients, mean age 57.58 yr (SD: 12.34), 68.3% males. The estimation of GFR was performed with MDRD-IDMS and CKD-EPI equations and we analyzed the agreement between them. RESULTS: The estimation of GFR with CKD-EPI was 4.37 (95%:3.73-4.19) mL/min/1,73 m2 higher than MDRD-IDMS, overall and by gender (males 3.99; females 5.04). In patients under 65 years the difference was greater, 6.55 (95%:5.95-7.15) mL/min/1.73 m2 in both men 6.07 and women 6.48. However, we found no significant difference over 65 years. Intraclass correlation coefficient was 0.904 (95% CI:0.886-0.919), 0.897 men and 0.917 women and Kappa index 0.848 (95% CI :0.795-0.889), 0.845 men and 0.852 women. CONCLUSION: CKD-EPI equation estimated a higher GFR in hypertensive patients under 65 years and reclassified in stage 1 patients classified in stage 2 by MDRD-IDMS.
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Tasa de Filtración Glomerular , Hipertensión/fisiopatología , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Humanos , Pruebas de Función Renal/estadística & datos numéricos , Masculino , Matemática , Persona de Mediana EdadRESUMEN
OBJECTIVE: To analyze the relationship between pulse wave velocity (PWV) and central blood pressure evaluated by augmentation index (AIx) in hypertensive patients with kidney disease. METHODS: 406 hypertensive patients with normal renal function and 72 with kidney disease. Arterial stiffness was estimated with the PWV and the AIx. We followed the 2007 European Guidelines of Hypertension criteria to assess the presence or absence of kidney disease. RESULTS: PWV was 8.98 ± 2.15 and 10.17 ± 3.01 m/s (p <0.05) and AIx 30.06% ± 12.46 and 30.23% ± 12.56 (p >0.05) in hypertensive patients with normal renal function and kidney disease, respectively. Multiple regression analysis showed the renal function as an important determinant of PWV, but not AIx. CONCLUSION: In hypertensive patients with renal disease PWV is increased, but not the AIx. We believe that the AIx is not a reliable measure of arterial stiffness in hypertensive patients with kidney disease.
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Hipertensión/fisiopatología , Enfermedades Renales/complicaciones , Pulso Arterial , Resistencia Vascular , Adulto , Anciano , Anciano de 80 o más Años , Arteriosclerosis/epidemiología , Comorbilidad , Estudios Transversales , Femenino , Humanos , Hipertensión/complicaciones , Hipertensión/epidemiología , Enfermedades Renales/epidemiología , Pruebas de Función Renal , Lípidos/sangre , Masculino , Persona de Mediana EdadRESUMEN
Arterial stiffness as assessed by carotid-femoral pulse wave velocity (cfPWV) is a marker of preclinical organ damage and a predictor of cardiovascular outcomes, independently of blood pressure (BP). However, limited evidence exists on the association between long-term variation (Δ) on aortic BP (aoBP) and ΔcfPWV. We aimed to evaluate the relationship of ΔBP with ΔcfPWV over time, as assessed by office and 24-h ambulatory peripheral BP, and aoBP. AoBP and cfPWV were evaluated in 209 hypertensive patients with either diabetes or metabolic syndrome by applanation tonometry (Sphygmocor) at baseline(b) and at 12 months of follow-up(fu). Peripheral BP was also determined by using validated oscillometric devices (office(o)-BP) and on an outpatient basis by using a validated (Spacelabs-90207) device (24-h ambulatory BP). ΔcfPWV over time was calculated as follows: ΔcfPWV=[(cfPWVfu-cfPWVb)/cfPWVb] × 100. ΔBP over time resulted from the same formula applied to BP values obtained with the three different measurement techniques. Correlations (Spearman 'Rho') between ΔBP and ΔcfPWV were calculated. Mean age was 62 years, 39% were female and 80% had type 2 diabetes. Baseline office brachial BP (mm Hg) was 143±20/82±12. Follow-up (12 months later) office brachial BP (mm Hg) was 136±20/79±12. ΔcfPWV correlated with ΔoSBP (Rho=0.212; P=0.002), Δ24-h SBP (Rho=0.254; P<0.001), Δdaytime SBP (Rho=0.232; P=0.001), Δnighttime SBP (Rho=0.320; P<0.001) and ΔaoSBP (Rho=0.320; P<0.001). A multiple linear regression analysis included the following independent variables: ΔoSBP, Δ24-h SBP, Δdaytime SBP, Δnighttime SBP and ΔaoSBP. ΔcfPWV was independently associated with Δ24-h SBP (ß-coefficient=0.195; P=0.012) and ΔaoSBP (ß-coefficient= 0.185; P=0.018). We conclude that changes in both 24-h SBP and aoSBP more accurately reflect changes in arterial stiffness than do office BP measurements.
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Presión Arterial , Análisis de la Onda del Pulso , Anciano , Monitoreo Ambulatorio de la Presión Arterial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Rigidez VascularRESUMEN
OBJECTIVES: To analyze the relationship between physical activity, as assessed by accelerometer, with central and peripheral augmentation index and carotid intima media thickness (IMT) in adults. METHODS: This study analyzed 263 subjects who were included in the EVIDENT study. Physical activity was assessed during 7 days using the ActigraphGT3X accelerometer (counts/min). Carotid ultrasound was used to measure carotid IMT. The Sphygmo Cor System was used to measure central and peripheral augmentation index (CAIx and PAIx). RESULTS: Mean age 55.85±12 years; 59.30% female; 26.7 body mass index and blood pressure 120/77mmHg. Mean physician activity counts/min was 244.37 and 2.63±10.26min/day of vigorous or very vigorous activity. Physical activity showed an inverse correlation with PAIx (r=-0.179; P<.01) and vigorous activity day time with IMT(r=-0.174; P<.01), CAIx (r=-0.217; P<.01) and PAIx (r=-0.324; P<.01). After adjusting for confounding factors in the multiple regression analysis, the inverse association of CAIx with counts/min and the time spent in vigorous/very vigorous activity was maintained. CONCLUSION: The results suggest that both physical activity and time spent in vigorous or vigorous activity are associated with the central augmentation index in adults.
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Grosor Intima-Media Carotídeo , Ejercicio Físico , Aptitud Física , Adulto , Anciano , Presión Sanguínea , Determinación de la Presión Sanguínea , Índice de Masa Corporal , Femenino , Hemodinámica , Humanos , Persona de Mediana Edad , Actividad Motora , Túnica ÍntimaRESUMEN
OBJECTIVE: Arterial stiffness is a contributor to the development of atherosclerosis and cardiovascular disease. The aim of the study was to analyse the relationship between sedentary behaviour and arterial stiffness in a Spanish adult population. METHODS: This cross-sectional study included 1365 subjects belonging to the EVIDENT project. Physical activity and sedentary behaviour were measured objectively over 7 days using ActiGraph accelerometers. Thresholds of 10 consecutive minutes were used to estimate the daily sedentary time in bouts ≥10 min. Each interruption in sedentary time (counts/min ≥100) was considered a break. Arterial stiffness was evaluated using the B-pro device through the following indicators: radial Augmentation Index (rAIx), Ambulatory Arterial Stiffness Index (AASI), and central and peripheral pulse pressure (PP). RESULTS: We found a positive relationship between central and peripheral pulse pressure (office, 24 h, awake and sleep PP) and total sedentary time. These arterial stiffness parameters were also associated with sedentary time in bouts ≥10 min. Significance disappeared in both cases, however, after adjusting for MVPA and breaks per sedentary hour. Adults who reported fewer breaks per sedentary hour (25th percentile < 2 n/day) had higher levels of AASI, awake and sleep PP. CONCLUSIONS: In a medium-sized sample of adult attenders of community clinics our data showed that it seems to be important to avoid prolonged uninterrupted periods of sedentary time.
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Enfermedades Cardiovasculares/fisiopatología , Conducta Sedentaria , Rigidez Vascular , Actigrafía/instrumentación , Adulto , Anciano , Anciano de 80 o más Años , Presión Sanguínea , Monitoreo Ambulatorio de la Presión Arterial , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/epidemiología , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Actividad Motora , Medición de Riesgo , Factores de Riesgo , España/epidemiología , Factores de Tiempo , Adulto JovenRESUMEN
The objective of this study was to determine the electrocardiographic left ventricular hypertrophy (LVH) criterion that best correlated with vascular structure and function parameters in hypertensive patients. A cross-sectional study involving 347 hypertensive patients was performed. The mean age of the subjects was 54.9±11.8 years, and 61% were male. Electrocardiography was used to detect LVH based on the evaluation of 10 criteria, and we defined the voltage-duration product (VDP) complex criterion. The vascular structure was evaluated according to carotid intima-media thickness (C-IMT), and vascular function was evaluated according to pulse wave velocity (PWV), the ambulatory arterial stiffness index (AASI), the home arterial stiffness index, and the peripheral (PAIx) and central (CAIx) augmentation indices. LVH according to at least some electrocardiographic criteria was recorded in 29.10% of the patients (34.10% of females; 25.90% of males). The vascular structure and function parameters showed higher values in the hypertensive patients with LVH. The criterion most closely correlated with C-IMT was Lewis-VDP (r=0.257); with PWV and AASI, the criterion was the Framingham-adjusted Cornell voltage (r=0.228 and r=0.195, respectively); and with CAIx and PAIx, the criterion was Novacode (r=0.226 and r=0.277, respectively). In the multivariate analysis, the association of the vascular structure and function parameters, the VDP complex (multiple linear regression) and the presence of LVH (logistic regression) disappeared after adjusting for age, sex and antihypertensive drugs. The relationship between the electrocardiographic criteria used to detect LVH in hypertensive patients and the vascular structure and function parameters were fundamentally conditioned by age and antihypertensive drug treatment.
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Electrocardiografía , Hipertensión/fisiopatología , Hipertrofia Ventricular Izquierda/fisiopatología , Adulto , Anciano , Determinación de la Presión Sanguínea/métodos , Grosor Intima-Media Carotídeo , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Análisis de la Onda del Pulso , Factores de Riesgo , Rigidez VascularRESUMEN
INTRODUCTION AND OBJECTIVES: To evaluate the effectiveness of a quality improvement intervention on professionals sanitary in blood pressure control in hypertensive patients. METHODS: Quality improvement trials with cuasi-experimental design. Two primary care health centres. One centre was assigned intervention group (7 family doctors and 419 patients) and the other was control group (7 family doctors and 419 patients). The quality improvement intervention consisted of a combined program comprising audit, feedback, training sessions about main hypertension clinical guidelines during 6 months. The main measurement were blood pressure, lipid levels, diabetes, smoking and body index mass, antihypertensive drugs and record treatment adherence and therapeutic plan in march 2002 the baseline measurement and march 2004 the post intervention. RESULTS: In study group blood pressure systolic and diastolic decreased 8.16/3.71 mmHg and control group increased 1.56/0.13 mmHg, respectively. The intervention effect was a drop of 9.72 mmHg (IC 95%: 7.50-11.94) and diastolic blood pressure in 3.84 mmHg (IC 95%: 2.40-5.28). The rate of hypertensive patients with blood pressure < 140/90 mmHg increased from 37.5% to 68.8% in study group, without changes in control group (p < 0.05). The drugs and combination drugs prescribed increased in both group, while the records of therapeutics plans and adherence increased only in intervention group (p < 0.05). CONCLUSIONS: The quality improvement intervention was associated to a systolic and diastolic blood pressure reduction and a increase of rate patients with blood pressure controlled.
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Antihipertensivos/uso terapéutico , Hipertensión/tratamiento farmacológico , Anciano , Determinación de la Presión Sanguínea , Femenino , Humanos , Hipertensión/epidemiología , Masculino , Cooperación del Paciente , Atención Primaria de Salud , Garantía de la Calidad de Atención de Salud , España/epidemiología , Resultado del TratamientoRESUMEN
Objetivo: Analizar las concordancias en el filtrado glomerular(FG) estimado con las ecuaciones de CKD-EPI y MDRDIDMS en una cohorte de pacientes hipertensos. Métodos: Se incluyeron 478 hipertensos consecutivamente, edad media57,58 años (DE = 12,34), el 68,3% hombres. La estimación del FG se realizó con las ecuaciones de MDRD-IDMS y CKD-EPI, valorando las concordancias entre ellas. Resultados: La estimación de FG con CKD-EPI fue 4,37 ml/min/1,73 m2 (IC 95%, 3,73-4,19) superior al MDRD-IDMS en global y por sexos (hombres3,99; mujeres 5,04). En menores de 65 años la diferencia fue mayor, 6,55 ml/min/1,73 m2 (IC 95%, 5,95-7,15), tanto en hombres(6,07) como en mujeres (6,48). Sin embargo, en mayores de 65 años no se encontró diferencia significativa. El coeficiente de correlación intraclase fue 0,904 (IC 95%, 0,886-0,919), en hombres 0,897 y en mujeres 0,917, y el índice kappa fue 0,848(IC 95%, 0,795-0,889), en hombres 0,845 y en mujeres 0,852.Conclusión: La ecuación de CKD-EPI estima un FG más alto en mayores de 65 años y reclasifica hacia estadio 1 a hipertensos catalogados en estadio 2 por MDRD-IDMS (AU)
Objective: To analyze the agreement in glomerular filtration rate (GFR) estimated with CKD-EPI and MDRD-IDMS equations in a cohort of hypertensive patients. Methods: We included consecutively 478 hypertensive patients, 57.58 (SD: 12.34)aged, 68.3% males. The estimation of GFR was performed with MDRD-IDMS and CKD-EPI equations and we analyzed the agreement between them. Results: The estimation of GFR with CKD-EPI was 4.37 (95%:3,73-4,19) mL/min/1,73 m2 higher than MDRD-IDMS, overall and by gender (males 3.99; females5.04). In patients under 65 years the difference was greater,6.55 (95%: 5,95-7,15) ml/min/1,73 m2 in both men 6.07 and women6.48. However, in over 65 years we found no significant difference. Intraclass correlation coefficient was 0.904 (95%CI:0,886-0,919), 0.897 men and 0.917 women and Kappa index0.848 (95% CI: 0.795-0.889), 0.845 men and 0.852 women. Conclusion: CKD-EPI equation estimated a higher FG in hypertensive patients under 65 years and reclassified in stage 1 patients classified in stage 2 by MDRD-IDMS (AU)
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Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Hipertensión/fisiopatología , Tasa de Filtración Glomerular , Insuficiencia Renal Crónica/fisiopatología , Creatinina/análisis , Pruebas de Función Renal/métodos , Factores de Riesgo , Enfermedades Cardiovasculares/epidemiologíaRESUMEN
Objetivo Analizar la relación del calibre de los vasos de la retina con el riesgo cardiovascular estimado en una muestra de sujetos hipertensos. Métodos Seleccionamos 202 pacientes hipertensos de 34 a 75 años. Con un retinógrafo Topcon TRC NW 200 se obtuvieron imágenes digitalizadas de la retina; mediante el software semiautomático AV Index Calculator se midió el grosor de los vasos temporales superior e inferior en una área de 0,5 a 1 diámetros del disco óptico y se calculó el índice arteriovenoso. El riesgo cardiovascular fue estimado con el Framingham-DAgostino score. Se ha considerado riesgo bajo < 10%; riesgo moderado entre 10-20% y riesgo alto ≥ 20%. Resultados La edad media fue de 59,1 ± 8,4 años, siendo mujeres el 41,6% (84). Los grosores de las arterias y las venas tienden a incrementarse a medida que aumenta el riesgo, mientras que el índice arteriovenoso tiende a disminuir, aunque solo alcanza la significación estadística la diferencia de grosor de las venas entre los 3 grupos de riesgo. El calibre arterial y venoso tiene correlación positiva con el riesgo cardiovascular, aunque solo alcanza la significación estadística con el calibre venoso (r = 0,189; p < 0,010). Esta asociación se mantiene la regresión lineal múltiple, después de ajustar por edad y sexo. Conclusión Los hallazgos encontrados con esta nueva herramienta desarrollada para evaluar los vasos de la retina apoyan el papel más relevante que podría tener la valoración del calibre venoso, y no solo del arterial o el índice arteriovenoso, como se ha visto en estudios previos, en la evaluación del riesgo cardiovascular asociado a las alteraciones de la circulación retiniana (AU)
Objective To analyze the association between retinal vessel caliber and cardiovascular risk estimated in a sample of hypertensive patients. Methods We selected 202 hypertensive patients aged 34 to 75 years. Retinal photographs, obtained by Topcon TRC NW 200, were digitized, and superior and inferior temporal caliber vessel were measured in an area 0.5 to 1 disc diameter from the optic disc with semiautomatic software (AV Index Calculator), followed by calculation of the estimated arteriole/venule index. Cardiovascular risk was estimated through the Framingham-DAgostino score. Risk was classified as follows: low risk < 10%, moderate risk 10-20%, and high risk ≥ 20%. Results The mean age of the patients was 59.1 ± 8.4 years and 41.6% (84) were women. The caliber of arterial and venous vessels tended to increase with higher cardiovascular risk, while the arteriole/venule index tended to decrease, but the only factor that was statistically significant was differences in caliber among the 3 cardiovascular risk groups. Arterial and venous caliber showed a positive correlation with cardiovascular risk, although this association was significant only for venous caliber (r=.189; P<.010). This association was maintained in a multiple linear regression model after adjustment by age and sex. Conclusion The findings with this new tool, which was developed to evaluate retinal vessels, indicate the importance of assessing venous caliber, and not just the arterial or arteriole/venule index, as in previous studies, when evaluating cardiovascular risk associated with changes in the retinal vessels (AU)
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Humanos , Enfermedades Cardiovasculares/fisiopatología , Vena Retiniana/fisiopatología , Hipertensión/fisiopatología , Factores de Riesgo , AngiografíaRESUMEN
Fundamento y objetivo. Existen diferentes instrumentospara la medida de la presión arterial, pero los resultadosno siempre son coincidentes. El objetivo delpresente trabajo es analizar la relación entre la presiónarterial clínica (PAC) y la ambulatoria obtenidacon la monitori zación ambulatoria de presión arterial(MAPA) y la automedida de la presión arterial (AMPA)y valorar el grado de concordancia y discrepancia existenteen el porcentaje de control de la presión arterialentre los diferentes métodos en pacientes hipertensos.Material y métodos. Estudio descriptivo transversal enel que se determinó la presión arterial ambulatoria a241 pacientes hipertensos mediante una MAPA y unaAMPA y se compararon con los valores de la PAC. Comocriterios de buen control se siguieron los establecidospor la Guía Europea de Hipertensión de 2007.Resultados. Los valores de PA medidos fuera de laconsulta con MAPA y con AMPA fueron inferiores alos de la consulta. Presentaban buen control de la PAel 27% con la PAC, un 56% con la segunda toma dela AMPA, un 61, 64 y 56% con la MAPA de 24 horas,en actividad y en reposo, respectivamente. Entre un23% y un 39% presentaban cifras elevadas en la consultay normales con la MAPA o con la AMPA. La concordanciavalorada con el índice de Kappa obtienevalores próximos a 0,5 o inferiores.Conclusiones. La proporción de pacientes con presiónarterial controlada con AMPA y MAPA es superior quecon PAC. El grado de concordancia entre diferentesinstrumentos valorado con el índice de Kappa fue bajo (AU)
Background and objectives. Different instruments formeasuring blood pressure yield different results. Weaimed to analyze the relation between clinical bloodpressure (CBP), ambulatory blood pressure obtainedduring ambulatory blood pressure monitoring(ABPM), and self-measurement (SM), and to evaluatethe degree of concordance between the different me -thods in hypertensive patients.Material and methods. This is a descriptive cross-sectionalstudy comparing ABPM and SM blood pressuremeasurements with CBP in 241 hypertensive patients;we used the 2007 European Guidelines on Hypertensionas criteria for good control.Results. Blood pressure measured with ABPM and SMwere lower than CBP. Blood pressure control wasgood in 27% when measured in the doctors office, in56% when measured for the second time using SM,and in 61%, 64%, and 56% when measured usingABPM at 24 hours, during activity, and at rest, respectively.Between 23% and 39% had high CBP but normalvalues at ABPM or SM. Kappa values of concordancewere 0,5 or lower.Conclusions. The proportion of patients with bloodpressure under control is higher with ABPM and SMthan the CBP. The degree of concordance betweenthe different methods as shown by the Kappa coefficientwas low (AU)
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Humanos , Determinación de la Presión Sanguínea/métodos , Hipertensión/prevención & control , Monitores de Presión Sanguínea/clasificación , /métodos , Autoexamen/métodos , Atención Primaria de SaludRESUMEN
Introducción y objetivos. Evaluar concordancias y discrepancias en la estimación del riesgo cardiovascular en pacientes hipertensos con las escalas Framingham-Grundy, REGICOR y SCORE. Pacientes y métodos. Diseño: estudio descriptivo transversal. Sujetos: 453 pacientes hipertensos de 30 a 74 años (60,5 % mujeres) seleccionados por muestreo aleatorio en dos centros de salud. Edad media: 63,69 años. Mediciones: edad, sexo, presión arterial, glucemia, lípidos, tabaquismo y riesgo cardiovascular calculado con las escalas Framingham-Grundy y REGICOR para estimar el riesgo coronario en 10 años, y SCORE para estimar el riesgo de muerte cardiovascular en 10 años. Resultados. Framingham: riesgo coronario medio, 14,26 % (IC95 %: 13,45 ÷ 15,07); varones, 18,16 %, y mujeres, 11,72 % (p < 0,05). REGICOR: riesgo coronario medio, 4,96 % (IC95 %: 4,67 ÷ 5,26); varones, 5,88 %, y mujeres, 4,36 % (p < 0,05). SCORE: riesgo de muerte cardiovascular, 2,94 % (IC95 %: 2,64-3,24); varones, 4,01 %, y mujeres, 2,24 % (p < 0,05). Hay correlación positiva intensa, entre 0,80 y 0,85 (p < 0,01), al comparar las tres escalas. Presentan riesgo cardiovascu lar alto-muy alto el 22,5 % con Framingham, el 0,7 % con REGICOR y el 17 % con SCORE (p < 0,05). La concordancia estimada con el Índice Kappa fue: Framingham y REGICOR, 0,045; Framingham y SCORE, 0,619, y SCORE y REGI COR, 0,063. Conclusiones. Encontramos una correlación positiva intensa entre las tres escalas, aunque la ecuación de REGICOR estima un riesgo cardiovascular entre dos y tres veces inferior a las otras dos. Sin embargo, hay importantes discrepancias a la hora de clasificar a los pacientes según niveles de riesgo, especialmente entre la ecuación de REGICOR con Framingham-Grundy y SCORE
Introduction and objectives. To evaluate agreements and disagreements in cardiovascular risk estimation in hypertensive patients with Framingham-Grundy, REGICOR and SCORE scales. Patients and methods. Design: cross-sectional descriptive study. Subjects: 453 hypertensive patients, aged 30-74 years (60.5 % women) selected by random sampling in two health centres. Mean age was 63.69 years. Measurements: age, sex, blood pressure, glycaemia, lipids, smokers and cardiovascular risk calculated with Framingham-Grundy and REGICOR scales to estimate coronary risk in 10 years, and SCORE to estimate cardiovascular mortality risk in 10 years. Results. Framingham: mean coronary risk, 14.26 % (IC95 %: 13.45 ÷ 15.07); men, 18.16 %, and women, 11.72 % (p < 0.05). REGICOR: mean coronary risk, 4.96 % (IC95 %: 4.67 ÷ 5.26); men, 5.88 %, and women, 4.36 % (p < 0.05). SCORE: mean cardiovascular mortality risk, 2.94 % (IC95 %: 2.64-3.24); men, 4.01 %, and women, 2.24 % (p < 0.05). There is strong positive correlation, between 0.80 and 0,85 (p < 0.01), when we compare the three scales. The proportion of high and very high-risk patients was 22.5 % with Framingham, 0.7 % with REGICOR and 17 % with SCORE (p < 0.05). The agreement considered with Kappa index was: Framingham and REGICOR, 0.045; Framingham and SCORE, 0.619, and SCORE and REGICOR, 0.063. Conclusions. We found strong positive correlation between the three scales, although cardiovascular risk estimate with REGICOR is between two and three times lower than other two. Nevertheless, there are important disagreements when we classified the patients according levels risk, especially between REGICOR with Framingham-Grundy and SCORE
Asunto(s)
Masculino , Femenino , Adulto , Anciano , Persona de Mediana Edad , Humanos , Ajuste de Riesgo/métodos , Enfermedades Cardiovasculares/epidemiología , Hipertensión/complicaciones , Pronóstico , Epidemiología Descriptiva , Factores de Riesgo , Atención Primaria de Salud , Riesgo AtribuibleRESUMEN
Introducción. El objetivo es determinar la calidad del proceso de atención de los factores de riesgo cardiovascular en el paciente hipertenso y evaluar la efectividad de una intervención sobre los profesionales. Material y métodos. Estudio cuasiexperimental que incluye dos centros de salud urbanos. Un centro fue elegido para recibir una intervención de mejora de calidad (419 hipertensos) y otro para recibir la atención habitual (430 hipertensos). Previamente a la intervención y un año después se evaluó el nivel de cumplimiento de las normas técnicas de la hipertensión, hiperlipemia, diabetes y obesidad de la cartera de servicios de Atención Primaria en una escala de 0 a 100. La intervención de mejora de calidad consistió en audit, feed-back, sesiones de formación e implementación de guías clínicas. Resultados. En la evaluación basal la media de cumplimiento de las normas técnicas fue similar en los dos grupos (74 puntos en el grupo de intervención y 73 en el grupo control). En la evaluación posintervención la media de cumplimiento fue de 83 en el grupo de intervención y de 71 en el grupo control. El efecto de la intervención ha sido un incremento medio de las normas técnicas de 11 puntos a favor del grupo de intervención. El nivel de cumplimiento mejoró de forma significativa en el grupo de intervención en la mayoría de las normas técnicas. Conclusiones. La intervención de mejora de calidad realizada con los profesionales de grupo de intervención tiene un efecto positivo en la mejora global de la calidad asistencial y especialmente en los criterios con puntuación más deficientes en la evaluación inicial
Introduction. The objective is to determine the quality of the cardiovascular risk factors care process in the hypertensive patient and evaluate the effectiveness of an intervention on the professions. Material and methods. Quasi-experimental study that includes two urban health sites. One site was chosen to receive a quality improvement intervention (419 hypertensive) and another health site was chosen to receive the usual care (430 hypertensives). Prior to the intervention and one year after, compliance levels of the technical standards of hypertension, hyperlipemia, diabetes and obesity of the Primary Health Care Services portfolio were evaluated on a scale of 0 to 100. The quality improvement intervention consisted in audit, feed-back, training sessions and implementation of clinical guides. Results. The man compliance of the technical standads in the baseline evaluation was similar in both groups, 74 points in the intervention group and 73 in the control group. In the post-intervention evaluation, the mean compliance was 83 in the intervention group and 71 in the control group. The effect of the intervention was a mean increase of the technical standards of 11 points in favor of the intervention group. Compliance level improved significantly in the intervention group in most of the technical standards. Conclusions. The quality improvement intervention conducted with the intervention group professionals has a positive effect on global improvement of health care quality and especially in the criteria with more deficient scores in the initial evaluation