ABSTRACT
Objetivo. Analizar la influencia del tratamiento antihipertensivo en la variabilidad de la presión arterial (PA) y sus diferencias entre mujeres pre y posmenopáusicas. Métodos. Se realizó un estudio prospectivo en Atención Primaria, seleccionándose 112 mujeres con hipertensión arterial (HTA) leve-moderada no controlada cuya monitorización ambulatoria de la presión arterial (MAPA) (Spacelabs 90207) inicial presentó unas presiones arteriales sistólicas (PAS) y presiones arteriales diastólicas (PAD) medias diurnas superiores a 135 y/o 85 mmHg. Se prescribieron antihipertensivos según práctica clínica habitual. Se compararon las PAS y PAD clínicas y ambulatorias y los índices de variabilidad (IV) de la PAS, PAD, PAM globales, diurnas y nocturnas iniciales y a las 8 semanas. Se compararon en función de su estado hormonal: GA: menopáusicas; GB: premenopáusicas. Resultados. Finalizaron 103 mujeres con una edad media de 53,06 (DE: 10,3 años) (N: GA, 50; GB, 53). El IV de la PAS y PAD diurna inicial fue de 12,2 (DE: 2,9) y 9,9 (DE: 2,08) y el IV final de 12,7 (DE: 10,2) y 8,9 (DE: 1,9) (p = NS), respectivamente, sin diferencias entre los IV de las PA de 24 horas, diurnas o nocturnas. Los IV diurnos iniciales y finales fueron de 11,1 (DE: 2,2) y 10,6 (DE: 2,6) para la PAS y 8,5 (DE: 1,8) y 8,7 (DE: 2) para la PAD en el grupo de premenopáusicas y 13,8 (DE: 3) y 14,7 (DE: 13,8) para la PAS y 9,3 (DE: 2,2) y 9,1 (DE: 1,8) para la PAD en el grupo de posmenopáusicas. No se observaron diferencias en los IV entre ambos grupos, ni en sus descensos medios, excepto para el IV de la PAS 24 horas con descenso medio significativo entre inicio y final en posmenopáusicas. Conclusiones. No se observan diferencias en los IV entre pre y posmenopáusicas. El tratamiento antihipertensivo produce un descenso del IV de las PAS de 24 horas en posmenopáusicas
Objective. Analyze the influence of antihypertensive treatment in variability of blood pressure (BP) and its differences between pre-and postmenopausal women. Methods. A prospective study was conducted in primary health care, enrolling 112 women with uncontrolled mild-moderate HBP whose initial ambulatory blood pressure monitoring (ABPM) (Spacelabs 90207) showed mean daytime SBP and DBP greater than 135 and/or 85 mmHg. Antihypertensive drugs were prescribed according to the usual clinical practice. Clinical and ambulatory SBP and DBP were compared as well as variability indexes (VI) of initial global daytime and nighttime SBP, DBP, MBP at 8 weeks. They were compared based on their hormone status: GA: menopausal; GB: premenopausal. Results. A total of 103 women with a mean age of 53.06 (SD 10.3 years) (N: GA, 50; GB, 53) completed the study. The VI of the initial daytime SBP and DBP was 12.2 (SD: 2.9) and 9.9 (SD: 2.08) and the final VI was 12.7 (SD: 10.2) and 8.9 (SD: 1.9) (p = NS) respectively, without differences between VI of the 24 hour, daytime or nighttime BP. The initial and final daytime VI were 11.1 (SD: 2.2) and 10.6 (SD: 2.6) for SBP and 8.5 (SD: 1.8) and 8.7 (SD: 2) for DBP in the premenopausal group and 13.8 (SD: 3) and 14.7 (SD: 13.8) for SBP and 9.3 (SD 2.2) and 9.1 (SD 1.8) for DBP in the postmenopausal group. No differences were observed in VI between both groups or in their mean decreases except for the VI of the 24-hour SBP that had a significant mean decrease between initial and final VI in postmenopausal subjects. Conclusions. No differences were observed in the VI between pre and postmenopausal subjects. Antihypertensive treatment causes a decrease of 24 hour SBP VI in postmenopausal subjects
Subject(s)
Female , Adolescent , Adult , Middle Aged , Aged , Humans , Blood Pressure , Antihypertensive Agents/pharmacokinetics , Hypertension/drug therapy , Premenopause , PostmenopauseABSTRACT
OBJECTIVE: To analyse the efficacy of health education (HE) through a group session with two years of intervention by postal back-up on compliance with therapy for light-to-moderate essential hypertension. DESIGN: Controlled, randomised clinical trial. SETTING: La Orden Health Centre. PARTICIPANTS: 110 hypertense patients diagnosed with de novo or unmonitored hypertension. INTERVENTION: 1. Control group (CG): 55 patients who received HE from their doctor. 2. Intervention group (IG): 55 patients who also received a controlled intervention. a) Group HE session, b) Postal back-up to the home every three months for two years. MEASUREMENTS AND RESULTS: After two years, on two surprise home visits made at a month's interval, blood pressure was measured and pressure-lowering pills counted. The person whose consumption was at 80-110% of the amount prescribed was defined as compliant. The percentages of compliant patients and mean compliance were compared for the two visits. The reduction of absolute risk (RAR), of relative risk (RRR) and the number of patients needed to avoid non-compliance (NNT) were calculated. 92 people finished the trial. The two groups (n: CG = 45, IG = 47) did not differ for age, sex, time of evolution, number of illnesses or dosages of medicines prescribed. 78.26% were compliant (CI: 61.5-94.9), CG = 55.6% and IG = 95.7% (p < 0.0001). Mean overall compliance was 90.9 +/- 14, CG = 88.1 +/- 12 and IG = 93.86 +/- 11 (p = 0.01). RAR was 40.1%, RRR 90.3 and NNT 2.49% respectively. CONCLUSIONS: HE intervention is an effective measure to improve therapeutic compliance in essential hypertension and lasts for up to two years.
Subject(s)
Hypertension/drug therapy , Patient Compliance/statistics & numerical data , Patient Education as Topic , Humans , Time FactorsABSTRACT
Objetivo. Analizar la eficacia de la educación para la salud (EPS), mediante sesión grupal con refuerzo postal, tras 2 años de intervención, en el cumplimiento terapéutico de la HTA esencial leve-moderada. Diseño. Ensayo clínico controlado, aleatorio. Ámbito. Centro de Salud La Orden. Sujetos. Ciento diez sujetos hipertensos diagnosticados de HTA de novo o no controlada. Intervención. 1. Grupo control (GC): 55 pacientes, que recibieron EPS de su médico. 2. Grupo intervención (GI): 55 pacientes que recibieron además intervención controlada: a) sesión de EPS en grupo, y b) refuerzo postal domiciliario cada 3 meses durante 2 años. Mediciones y resultados. A los 2 años se llevaron a cabo 2 visitas domiciliarias por sorpresa con un mes de intervalo, realizándose medición de PA y recuento de comprimidos hipotensores. Se definió como cumplidor a aquel paciente cuyo consumo es un 80-110 por ciento del prescrito. Se compararon los porcentajes de cumplidores y cumplimiento medio entre visitas. Se calculó la reducción del riesgo absoluto, relativo y el número de pacientes necesarios para evitar un incumplimiento (RRA, RRR, NNT). Finalizaron 92 individuos. Ambos grupos (GC, 45; GI, 47) no difieren en edad, sexo, tiempo de evolución, número de enfermedades y dosis de fármacos prescritos. Fue cumplidor un 78,26 por ciento (IC, 61,5-94,9; GC, 55,6 por ciento y GI, 95,7 por ciento; p < 0,0001). El porcentaje medio de cumplimiento fue globalmente del 90,9 ñ 14 (GC, 88,1 ñ 12 y GI, 93,86 ñ 11; p = 0,01). La RRA fue del 40,1 por ciento, la RRR del 90,3 por ciento y el NNT del 2,49 por ciento, respectivamente. Conclusiones. La intervención en EPS es una medida eficaz para mejorar el cumplimiento terapéutico en la HTA esencial perdurando hasta los 2 años (AU)
Subject(s)
Pregnancy , Child , Child, Preschool , Male , Female , Humans , Infectious Disease Transmission, Vertical , Patient Education as Topic , Pregnancy Complications, Infectious , Socioeconomic Factors , Risk Factors , Time Factors , HIV Infections , Clinical Trial , Patient Compliance , Prospective Studies , Hospitalization , Hypertension , Family CharacteristicsABSTRACT
OBJECTIVE: To analyse by means of a group session and postal support the efficacy of health education (HE) on compliance with therapy for light-to-moderate essential Hypertension. DESIGN: Controlled clinical trial with randomised distribution. SETTING: Primary Care. PATIENTS: 110 hypertense patients with new or uncontrolled Hypertension, for whom treatment with Trandolapril as a start or change of medication was indicated. INTERVENTIONS: The patients were split into two groups at random, with observation for six months after inclusion in the study and monthly attendance: 1) Control group (CG) of 55 patients who received HE from their family doctor; 2) Intervention group (IG) of 55 patients controlled. MEASUREMENTS AND RESULTS: Patients were defined as compliant if their consumption was 80-110% of what was prescribed. The counting of pills was recorded. Percentages of compliant patients and mean compliance were analysed with the Chi squared and Student's t tests. 109 people completed, 77 of them women. Neither group differed as to age, sex, length of evolution, number of diseases or doses of drugs consumed. CONCLUSIONS: Intervening in HE with a group session and postal follow-up is an efficacious measure to improve therapeutic compliance in Hypertension cases.
Subject(s)
Health Education , Hypertension/drug therapy , Patient Compliance , Aged , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Antihypertensive Agents/therapeutic use , Data Interpretation, Statistical , Female , Humans , Indoles/therapeutic use , Male , Middle Aged , Primary Health Care , Time FactorsABSTRACT
OBJECTIVE: To find the prevalence of different family structures in our health district. DESIGN: An epidemiological study of a cross-sectional [correction of crossover] type. SETTING: Primary Care. La Orden Health Centre in Huelva. PARTICIPANTS: 878 individuals, who represented a family unit, selected by random sampling stratified by age and gender, obtained from the 1991 Municipal Census. MEASUREMENTS AND MAIN RESULTS: A questionnaire was administered to all those participating in the study. This included demographic data, the number of people living in their homes, the composition of their family and the presence of close relatives in the neighbourhood. The final sample covered 787 families. Using de La Revilla et al.'s proposal, partially modified by us, the family was classified as: nuclear, extended, single-parent, without family and family equivalents. All of these were in turn sub-classified for the presence of close relatives. The nuclear family was classified as simple, numerous, amplified or binuclear. The predominant family model was nuclear (89.7%), followed by single-parent (4.4%), extended (2.9%), without family (2.4%) and family equivalents (0.6%). The main model of the nuclear family was the simple one (76.5%), followed by amplified (15.4%), leaving the numerous family in 8.1% and the binuclear at 0%. 83.5% of our families had close relatives in the same neighbourhood. CONCLUSIONS: Our family is nuclear, with relatives nearby, a model which has definitively displaced the extended family. The structure proposed makes classification of the nuclear family easier. We believe it is essential to integrate family structure classification into Primary Care family clinical records.