[New therapeutic strategies to improve control of arterial hypertension and simplify the regimen of drug treatment]. / Nuevas estrategias terapéuticas para mejorar el control de la hipertensión arterial y simplificar la pauta de tratamiento farmacológico.

Hypertension is a public health problem of first magnitude, because of its high prevalence and the associated increase in cardiovascular and renal complications. For this reason, achieving adequate pressure control in a high percentage of patients is a priority for any health system. In our country there have been numerous studies examining the degree of control of hypertension. The percentage of patients achieving adequate control has increased progressively, but the margin of improvement is still very important. Among the factors that have contributed to this improved control is the use of antihypertensive drugs in combination, free or fixed. This article reviews the progress made in controlling hypertension, in which the combined use of antihypertensive drugs has played a key role and future therapeutic options to further improve the pressure control, with special attention to the fixed combination three antihypertensive drugs.

[Relevance of chronic kidney disease and cardiovascular prognosis in arterial hypertension]. / Relevancia de la insuficiencia renal en el pronóstico cardiovascular de los pacientes con hipertensión arterial esencial.

Recently published guidelines recognize the relevance of the finding of chronic kidney disease in the stratification of risk of the hypertensive patient. Determination of the presence of microalbuminuria and estimation of glomerular filtration rate are mandatory in order to ensure an adequate evaluation of global cardiovascular risks in the hypertensive patient. The presence of subtle elevations of serum creatinine concentrations and/or proteinuria are also potent predictors of a poor cardiovascular prognosis. Clustering of associated risk factors seems to justify the elevated cardiovascular risk observed in patients with essential hypertension and mild alterations of renal function.

[Control of cardiovascular risk factors in patients with stroke attended in primary care in Spain. ICTUSCARE study]. / Control de los factores de riesgo cardiovascular en pacientes con ictus atendidos en Atención Primaria en España. Estudio ICTUSCARE.

BACKGROUND: The aim of this cross-sectional, multicenter survey was: 1) To investigate the level of control of cardiovascuar risk factors in patients with a previous stroke. 2) To know the pharmacological therapy used to attain the control. PATIENTS AND METHODS: Data obtained from a total of 955 patients were included in the analysis.. There were evaluated cardiovascular risk factors, parameters related to the degree of control, analytical parameters, antropometric and pharmacological indicated treatment. RESULTS: The majority (61%) had suffered an ischemic stroke and 97.7% presented at least one associated cardiovascular risk factor, being hypertension (84.8%) and dyslipidemia (61.8%) the most frequent. Other factors were abdominal obesity (42.9%), diabetes mellitus (35.6%) and smoking (25.1%). Only 1.2% of the patients presented an adequate control of all cardiovascular risk factors. Only 17.6% had a well controlled blood pressure and in 29.8% LDL-cholesterol was well controlled. In 50.2% of diabetic patients HbA1c was well controlled. Angiotensin receptor blockers were the most widely used antihypertensive drugs (57.6%) while thiazide diuretics were prescribed in 33.4%. Statins were prescribed in 72.8% of patients and metformin, aspirin and acenocumarol in 30.2%, 57.3%, and 15.0% respectively. CONCLUSIONS: In conclusion, in patients with a past history of stroke arterial hypertension is the most common cardiovascular risk factor and the control of these factors requires an improvement.

Sobrepeso y obesidad en personal médico en España; resultados del estudio ICARIA / Overweight and obesity among physicians in Spain; results from the ICARIA Study

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Control de los factores de riesgo cardiovascular en pacientes con ictus atendidos en Atención Primaria en España. Estudio ICTUSCARE / Control of cardiovascular risk factors in patients with stroke attended in primary care in Spain. ICTUSCARE study

Fundamento: 1) Conocer el grado de control de los factores de riesgo cardiovascular en pacientes con ictus. 2) Analizar el tratamiento farmacológico indicado a los pacientes con ictus.Pacientes y método: Estudio epidemiológico, transversal y multicéntrico. Se incluyeron un total de 975 pacientes con ictus, de los cuales 20 pacientes se excluyeron por incumplir criterios de selección, siendo valorables un total de 955 pacientes. Se evaluaron los factores de riesgo cardiovascular, parámetros relacionados con el grado de control, parámetros analíticos, antropométricos y tratamiento farmacológico indicado.Resultados: Los pacientes incluidos en el estudio habían padecido mayoritariamente un ictus isquémico (61%). El 97,7% de los pacientes presentaron algún factor de riesgo cardiovascular (FRCV) siendo los más frecuentes la hipertensión arterial (84,8%) y dislipemia (61,8%), seguido de obesidad abdominal (42,9%), diabetes mellitus (35,6%) y tabaquismo (25,1%). Sólo el 1,2% de los pacientes presentaban control multifactorial. El 17,6% presentaban control de la presión arterial, el 29,8% del colesterol LDL, el 74,9% no presentaba hábito tabáquico y el 50,2% de los pacientes diabéticos presentaba control de la Hb1Ac. Los tratamientos antihipertensivos más frecuentes fueron los ARA II (57,6%) y los diuréticos tiazídicos (33,4%), de los hipolipemiantes las estatinas (72,8%), de los antidiabéticos la metformina (30,2%), de los antiagregantes el AAS (57,3%) y de los anticoagulantes el acenocumarol (15,0%). El 85,9% de los pacientes estaban antiagregados.Conclusiones: Los pacientes que han sufrido un ictus presentan como FRCV más prevalente la hipertensión arterial. El control de los FRCV en los pacientes que han presentado un ictus es deficiente (AU)

Background: The aim of this cross-sectional, multicenter survey was: 1) To investigate the level of control of cardiovascuar risk factors in patients with a previous stroke. 2) To know the pharmacological therapy used to attain the control. Patients and methods: Data obtained from a total of 955 patients were included in the analysis.. There were evaluated cardiovascular risk factors, parameters related to the degree of control, analytical parameters, antropometric and pharmacological indicated treatment. Results: The majority (61%) had suffered an ischemic stroke and 97.7% presented at least one associated cardiovascular risk factor, being hypertension (84.8%) and dyslipidemia (61.8%) the most frequent. Other factors were abdominal obesity (42.9%), diabetes mellitus (35.6%) and smoking (25.1%). Only 1.2% of the patients presented an adequate control of all cardiovascular risk factors. Only 17.6% had a well controlled blood pressure and in 29.8% LDL-cholesterol was well controlled. In 50.2% of diabetic patients HbA1c was well controlled. Angiotensin receptor blockers were the most widely used antihypertensive drugs (57.6%) while thiazide diuretics were prescribed in 33.4%. Statins were prescribed in 72.8% of patients and metformin, aspirin and acenocumarol in 30.2%, 57.3%, and 15.0% respectively.Conclusions: In conclusion, in patients with a past history of stroke arterial hypertension is the most common cardiovascular risk factor and the control of these factors requires an improvement (AU)

Nuevas estrategias terapéuticas para mejorar el control de la hipertensión arterial y simplificar la pauta de tratamiento farmacológico / New therapeutic strategies to improve control of arterial hypertension and simplify the regimen of drug treatment

La hipertensión arterial (HTA) constituye un problema de salud pública de primera magnitud, tanto por su elevada prevalencia como por el incremento asociado de complicaciones cardiovasculares y renales. Por este motivo, la consecución de un adecuado control tensional en un porcentaje elevado de pacientes es un objetivo prioritario para cualquier sistema de salud. En nuestro país se han realizado numerosos estudios que analizan el grado de control de la HTA. El porcentaje de pacientes que alcanzan un adecuado control se ha incrementado progresivamente, pero el margen de mejora es aún muy importante. Entre los factores que han contribuido en esta mejora del control se encuentra el uso de fármacos antihipertensivos en combinación, libre o fija. Este artículo revisa los avances conseguidos en el control de la HTA, en los que el uso combinado de fármacos antihipertensivos ha tenido un papel clave, y las futuras opciones terapéuticas dirigidas a mejorar más aún este control tensional, con especial atención a la combinación fija de 3 fármacos antihipertensivos (AU)

Hypertension is a public health problem of first magnitude, because of its high prevalence and the associated increase in cardiovascular and renal complications. For this reason, achieving adequate pressure control in a high percentage of patients is a priority for any health system. In our country there have been numerous studies examining the degree of control of hypertension. The percentage of patients achieving adequate control has increased progressively, but the margin of improvement is still very important. Among the factors that have contributed to this improved control is the use of antihypertensive drugs in combination, free or fixed. This article reviews the progress made in controlling hypertension, in which the combined use of antihypertensive drugs has played a key role and future therapeutic options to further improve the pressure control, with special attention to the fixed combination three antihypertensive drugs (AU)

Réplica. Metabolismo glucídico en la hipertensión arterial: papel de la sobrecarga oral de la glucosa / Reply. Abnormal glycemic metabolism in essential hypertension. Role of the oral glucose tolerance test

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Relevancia de la insuficiencia renal en el pronóstico cardiovascular de los pacientes con hipertensión arterial esencial / Relevance of chronic kidney disease and cardiovascular prognosis in arterial hypertension

Las guías para el tratamiento de la hipertensión arterial publicadas han reconocido recientemente la importancia de la insuficiencia renal crónica en la estratificación de riesgo en el paciente hipertenso. Por primera vez, la presencia de microalbuminuria y la estimación de la tasa de filtración glomerular se consideran indispensables en la evaluación adecuada del riesgo cardiovascular global del paciente hipertenso. Además, la aparición de leves incrementos de la concentración de creatinina sérica y/o proteinuria ha mostrado ser también un potente predictor de un pronóstico cardiovascular desfavorable. Los pacientes con hipertensión esencial e insuficiencia renal ligera presentan un elevado riesgo cardiovascular, que parece estar relacionado con la asociación de varios factores de riesgo (AU)