ABSTRACT
Background: In Mexico less than half of the treated hypertensive patients reach blood pressure (BP) targets. Most hypertensive individuals rely on the standard medical care (SMC) to achieve the BP control goals; however, the efficacy of BP telemonitoring (BPT) to achieve BP targets has been poorly studied. Aim: To compare the efficacy of BPT versus SMC to achieve BP goals in patients with uncontrolled hypertension. Methods: A two-arm, open-label clinical trial was conducted in patients ≥18 years with uncontrolled hypertension. The participants were randomized to 2 arms (BPT vs SMC) and followed for 12 weeks. For the statistical analysis, the chi-squared test and covariance were used. Results: One hundred and seventy-eight participants were included, BPT (n = 94) and SMC (n = 84), after 12 weeks of follow up, we observed a baseline-adjusted reduction in systolic BP with both BPT (-13.5 [1.3]â mmHg) and the SMC (-5.9 [1.4]â mmHg; p < 0.001) but a greater decrease with BPT (p < 0.001). Likewise, we found a baseline-adjusted reduction of diastolic BP with BPT (-6.9 [0.9]â mmHg) and SMC (-2.7 [0.9]â mmHg) (p = 0.007) with a more significant percentage change from baseline with BPT (-6.8% [1.0] vs 2.5% [1.1]; p = 0.007). In the BPT arm, a larger proportion of patients achieved the BP target versus SMC (30.5% vs 12.8%; p = 0.005). Conclusion: BPT showed a greater proportion of patients achieving office BP control goals (<140/90â mmHg), compared to standard medical care.
ABSTRACT
Antecedentes: Entre las condiciones crónicas a nivel mundial, la hipertensión arterial se presenta en uno de cada 3 adultos>40 años, mientras que uno de cada 10 adultos padece de diabetes de tipo 2. Para ambas enfermedades la adherencia al tratamiento farmacológico es>30% y la autogestión, que considera además la dieta y la actividad física, es desconocida porque ningún instrumento permite medirla. El objetivo del siguiente trabajo fue adaptar y validar el instrumento SMP-T2D en español, en pacientes con hipertensión arterial y diabetes de tipo 2. Métodos: Se hizo un proceso de adaptación del cuestionario SMP-T2D mediante la traducción al español, para ser utilizado en pacientes con hipertensión arterial más diabetes de tipo 2. Se realizó la validación convergente y discriminante. Se incluyó a pacientes mayores de 50 años con hipertensión arterial y a pacientes con hipertensión arterial más diabetes de tipo 2. Se eliminó a aquellas personas con cuestionario incompleto o sin consentimiento informado. Resultados: El PAG-DT2 + HTA fue aplicado a 145 pacientes; de ellos, el 54,4% tenían solo hipertensión y el 43,6% hipertensión arterial más diabetes de tipo 2. La edad promedio fue de 66,14 años (DE = 10,78), con una proporción de mujeres del 34,7% y de hombres del 65,3%. La consistencia interna por α de Cronbach del cuestionario fue 0,561 (p = 0,000). La correlación del PAG-DT2+HTA y Morisky-Green fue significativa (p < 0,05). Interesantemente, las personas con mayor educación y mayor remuneración económica alcanzaron una mejor gestión (validez de discriminación). Conclusión: El SMP-T2D que mide la autogestión en pacientes con diabetes de tipo 2, modificado y adaptado al español (PAG-DT2+HTA), también puede medirla en personas con diabetes de tipo 2 + hipertensión arterial
Background: High blood pressure is one of the most common chronic conditions worldwide. It affects one in every 3 adults over 40, while one in 10 suffers from diabetes. For both diseases, adherence to pharmacological treatment is over 30%, and self-management, which takes into account diet and physical activity, is still unknown, as there is no tool available to measure self-management. Therefore, the object of this study was to adapt and validate the Spanish version of the self-management profile for type 2 diabetes (SMP-T2D) questionnaire in patients with type 2 diabetes and high blood pressure among users of first level care in the social security institution of Mexico. Methods: The SMP-T2D was adapted to Spanish by translation into Spanish, and being used only in patients with high blood pressure and type 2 diabetes-hypertension. A convergent and discriminatory validation was performed. Patients over 50 years old with high blood pressure were include. Those that did not complete the questionnaire or give informed consent were rejected. Results: The Spanish version of the SMP-T2D was called PAG-DT2+HTA, and was applied to 145 people with hypertension: 54.4% with hypertension only, and 43.6% with hypertension and type 2 diabetes. Mean age was 66.14 years (SD = 10.78), with 34.7% women and 65.3% men. Internal consistency by α-Cronbach for the questionnaire was 0.561 (P = .000). The correlation between the PAG-DT2+HTA and Morisky-Green was significant. The ability to discriminate between people with and without education and with and without economic means was obtained. Conclusion: The Spanish version of SMP-T2D (PAG-DT2+HTA) that measures self-management in type 2 diabetes, can be used to measure self-management in people with type 2 diabetes-hypertension
Subject(s)
Humans , Male , Female , Middle Aged , Hypertension/complications , Diabetes Mellitus, Type 2/epidemiology , Blood Glucose/physiology , Diet, Healthy/methods , Exercise/physiology , Surveys and Questionnaires , Cross-Sectional Studies/methods , Self Efficacy , Translating , 28599ABSTRACT
BACKGROUND: High blood pressure is one of the most common chronic conditions worldwide. It affects one in every 3 adults over 40, while one in 10 suffers from diabetes. For both diseases, adherence to pharmacological treatment is over 30%, and self-management, which takes into account diet and physical activity, is still unknown, as there is no tool available to measure self-management. Therefore, the object of this study was to adapt and validate the Spanish version of the self-management profile for type 2 diabetes (SMP-T2D) questionnaire in patients with type 2 diabetes and high blood pressure among users of first level care in the social security institution of Mexico. METHODS: The SMP-T2D was adapted to Spanish by translation into Spanish, and being used only in patients with high blood pressure and type 2 diabetes-hypertension. A convergent and discriminatory validation was performed. Patients over 50 years old with high blood pressure were include. Those that did not complete the questionnaire or give informed consent were rejected. RESULTS: The Spanish version of the SMP-T2D was called PAG-DT2+HTA, and was applied to 145 people with hypertension: 54.4% with hypertension only, and 43.6% with hypertension and type 2 diabetes. Mean age was 66.14 years (SD=10.78), with 34.7% women and 65.3% men. Internal consistency by α-Cronbach for the questionnaire was 0.561 (P=.000). The correlation between the PAG-DT2+HTA and Morisky-Green was significant. The ability to discriminate between people with and without education and with and without economic means was obtained. CONCLUSION: The Spanish version of SMP-T2D (PAG-DT2+HTA) that measures self-management in type 2 diabetes, can be used to measure self-management in people with type 2 diabetes-hypertension.
Subject(s)
Diabetes Mellitus, Type 2/therapy , Hypertension/therapy , Self-Management , Surveys and Questionnaires , Aged , Antihypertensive Agents/therapeutic use , Combined Modality Therapy , Comorbidity , Female , Humans , Hypoglycemic Agents/therapeutic use , Language , Male , Mexico , Middle Aged , Pilot Projects , TranslationsABSTRACT
The immunosuppressive activity of cyclosporine is mediated by inhibiting calcineurin phosphatase. However, calcineurin is widely distributed in other tissues. We examined the degree of calcineurin inhibition by cyclosporine in various tissues. In vitro, the cyclosporine concentration inhibiting 50% (IC50) of calcineurin was to approximately 10 ng/mL in human and mouse leukocytes suspensions. In vitro and in vivo IC50s of cyclosporine in homogenates of mouse kidney, heart, liver, testis, and spleen were also comparable (9-48 ng/mL). The maximum calcineurin inhibition by cyclosporine varied, from 83 to 95% of calcineurin activity in spleen, kidney, liver, and testis to 60% in heart and only 10% in brain. Maximum calcineurin inhibition was increased by the addition of cyclophilin A, indicating that cyclophilin concentrations were limiting in some tissues, at least in this assay. Western analysis of mouse tissues showed significantly less cyclophilin in heart than other tissues. cyclosporine concentrations per weight of tissue protein were highest in kidney and liver and lowest in brain and testis after oral dosing, with intermediate levels in spleen, heart, and whole blood. Thus each cyclosporine dose produces rapid and wide-spread inhibition of calcineurin in tissues, with differences in total susceptibility of each tissue.
Subject(s)
Calcineurin/pharmacokinetics , Cyclosporine/pharmacology , Leukocytes/physiology , Animals , Calcineurin/deficiency , Calcineurin/genetics , Cells, Cultured , Cyclophilin A/pharmacology , Cyclosporine/pharmacokinetics , Humans , Mice , Mice, Inbred BALB C , Mice, Inbred CBA , Mice, Knockout , T-Lymphocytes/drug effects , T-Lymphocytes/physiology , Tissue DistributionABSTRACT
UNLABELLED: The scope of this work is to analyze the usefulness and indications of preoperative evaluation. PATIENTS AND METHODS: 791 consecutive patients candidate for surgical treatment, were studied prospectively under the next inclusion criteria: 40 years old or less than 40 years old. Blood count cell, glucose, urea, creatinine, sodium, potassium, prothrombin time, partial thromboplastin time, platelets count, liver function tests, chest x-ray and electrocardiograph made before entry. In the the post liver, lung, bleeding, infectious or metabolic complications was done, while visiting the patients every day until discharge. Relative risk (RR) was calculated for every variable, analyzing differences with X2 and Fisher's Test. Those variables with statistical significance value were analyzed with logistic regression. Only 751 patients were studied, there were 335 male (44%) and 416 female (56%), with mean age of 63.9 years. Metabolic disorders (16.9%) and postoperative infections (7.0%) were the more frequent complications. Hemorrhage during of after surgery occurred in 2.2% of the patients. There were seventeen deaths (2.2%) related directly with surgery, with systemic illness or with postoperative complications. Selection of auxiliary tests for preoperative evaluation must be agree with clinical evaluation. The major objective of clinical evaluation is to estimate risk factors for surgery.