Determination of emission factors from a landfill through an inverse methodology: Experimental determination of ambient air concentrations and use of numerical modelling.

The application of numeric modelling for determining the impact of landfills needs for reliable emission source data. In this study, a methodology for the characterization of the emission profiles of the different sources present in landfills for emission factors determination, applying an indirect methodology, is presented. Ambient air concentrations of volatile organic compounds (VOCs), hydrogen sulphide (H2S) and ammonia (NH3) were determined in three potentially emission sources in Can Mata landfill (Hostalets de Pierola, Catalonia, Spain): dumping areas, pre-closed zone and leachate reservoir as well as in biogas, for the determination of emission factors. Multi-sorbent bed and Tenax TA tubes were used for a wide range of VOCs sampling, and analysis was conducted through TD-GC/MS. H2S and NH3 were sampled and analysed using Radiello passive samplers. The highest total VOC (TVOC) concentrations were found in dumping areas (0.7-3.5 mg m-3), followed by leachate reservoir (0.3-0.6 mg m-3) and pre-closed area (77-165 µg m-3). On the other hand, the highest H2S and NH3 concentrations were found in leachate reservoir, presenting values of 0.8-1.1 mg m-3 and 1.7-1.8 mg m-3, respectively. With the application of odour thresholds to the concentrations obtained, the most critical compounds regarding odour annoyances were determined. The highest odour units (O.U.) were found in leachate reservoir due to H2S concentrations, whereas VOCs contributed mainly to O.U. in the dumping areas. The obtained ambient air concentrations were used for the indirect determination of the emission factors through numerical modelling using a Eulerian dispersion model. The emission factors obtained for the landfill for TVOC, H2S and NH3 were in the range of 0.44-10.9 g s-1, 0.16-1.02 g s-1 and 0.23-1.82 g s-1, respectively, depending on the emission source. Reliable emission factors are crucial to obtain landfill impact maps, which are essential for the correct management of these facilities.

The impact of dietary oregano essential oil supplementation on fatty acid composition and lipid stability in eggs stored at room temperature.

*1. In many countries, eggs are not refrigerated and must be stored at room temperature. The objective of this study was to explore the effects of dietary oregano oil (275 mg/kg; ORE) versus an unsupplemented control diet (CON) on laying hens on the shelf life and fatty acid profile of eggs.2. Treatments were randomly distributed into 10 pens containing 27 birds each. A total of 200 eggs were collected from both groups on the same day and were stored for either 0, 10, 21 and 35 d. At each storage time, egg yolks were analysed for fatty acid profile and lipid peroxidation.3. The main indicator of lipid peroxidation, malondialdehyde (MDA), was significantly lower in ORE eggs compared to CON eggs (p = 0.001). Storage time had a significant impact on MDA concentrations (p = 0.023), with the highest found after 35 d. Significant differences were found for individual fatty acids, saturated (SFA), monounsaturated (MUFA) and polyunsaturated fatty acids (PUFA). Palmitic acid, stearic acid, oleic acid, linoleic acid and arachidonic acid were significantly lower in ORE eggs compared to CON eggs (p < 0.05). Palmitoleic acid (p = 0.002), linolenic acid (p = 0.001) and docosahexaenoic acid (DHA, p = 0.001) were significantly higher in ORE eggs.4. Storage only affected oleic, linolenic, linoleic, arachidonic and docosahexaenoic acids (p < 0.05). Total SFA, MUFA, n-6 and ratio of n-3 to n-6 (n-3:n-6) PUFA were significantly higher in CON eggs (p < 0.05). The ratio of SFA to PUFA (SFA:PUFA, p = 0.005) and total n-3 PUFA (p = 0.001) were significantly higher in ORE eggs.5. The n-3:n-6 ratio was significantly impacted by treatment (p = 0.021) and storage (p = 0.031) with no significant interaction. This ratio is important for human health indication and could lead to the development of designer eggs.

Sumario de las recomendaciones y puntos clave del Consenso de las Sociedades Científicas Españolas (SEPAR, SEMICYUC, SEMES; SECIP, SENeo, SEDAR, SENP) para la utilización de la ventilación no invasiva y terapia de alto flujo con cánulas nasales en el paciente adulto, pediátrico y neonatal con insuficiencia respiratoria aguda grave / Summary of recommendations and key points of the consensus of Spanish scientific societies (SEPAR, SEMICYUC, SEMES; SECIP, SENEO, SEDAR, SENP) on the use of non-invasive ventilation and high-flow oxygen therapy with nasal cannulas in adult, pediatric, and neonatal patients with severe acute respiratory failure

El soporte respiratorio no invasivo (SRNI) comprende 2 modalidades de tratamiento, la ventilación mecá-nica no invasiva (VMNI) y la terapia de alto flujo con cánulas nasales (TAFCN) que se aplican en pacientes adultos, pediátricos y neonatales con insuficiencia respiratoria aguda (IRA). Sin embargo, el grado de acuerdo entre las distintas especialidades sobre el beneficio de estas técnicas en diferentes escenarios clínicos es controvertido. El objetivo del presente consenso fue elaborar una serie de recomendaciones de buena práctica clínica para la aplicación de soporte no invasivo en pacientes con IRA, avaladas por todas las sociedades científicas involucradas en el manejo del paciente adulto y pediátrico/neonatal con IRA. Para ello se contactó con las diferentes sociedades implicadas, quienes designaron a su vez a un grupo de 26 profesionales con suficiente experiencia en su aplicación. Se realizaron 3 reuniones presenciales para consensuar las recomendaciones (hasta un total de 71) fundamentadas en la revisión de la literatura y en la actualización de la evidencia disponible en relación con 3 categorías: indicaciones, monitorización yseguimiento del SRNI. Finalmente, se procedió a votación telemática de cada una de las recomendaciones, por parte de los expertos de cada sociedad científica implicada. Para la clasificación del grado de acuerdo se optó por un sistema analógico de clasificación fácil e intuitivo de usar, y que expresara con claridad si el procedimiento relacionado con el SRNI debía hacerse, podía hacerse o no debía hacerse. (AU)

Non-invasive respiratory support (NIRS) in adult, pediatric, and neonatal patients with acute respiratory failure (ARF) comprises two treatment modalities, non-invasive mechanical ventilation (NIMV) and high-flow nasal cannula (HFNC) therapy. However, experts from different specialties disagree on the benefit of these techniques in different clinical settings. The objective of this consensus was to develop a series of good clinical practice recommendations for the application of non-invasive support in patients with ARF, endorsed by all scientific societies involved in the management of adult and pediatric/neonatal patients with ARF. To this end, the different societies involved were contacted, and they in turn appointed a group of 26 professionals with sufficient experience in the use of these techniques. Three face-to-face meetings were held to agree on recommendations (up to a total of 71) based on a literature review and the latest evidence associated with 3 categories: indications, monitoring and follow-up of NIRS. Finally, the experts from each scientific society involved voted telematically on each of the recommendations. To classify the degree of agreement, an analogue classification system was chosen that was easy and intuitive to use and that clearly stated whether the each NIRS intervention should be applied, could be applied, or should not be applied. (AU)

Identification of Albizia lebbeck seed coat chitin-binding vicilins (7S globulins) with high toxicity to the larvae of the bruchid Callosobruchus maculatus

Seed coat is a specialized maternal tissue that interfaces the embryo and the external environment during embryogenesis, dormancy and germination. In addition, it is the first defensive barrier against penetration by pathogens and herbivores. Here we show that Albizia lebbeck seed coat dramatically compromises the oviposition, eclosion and development of the bruchid Callosobruchus maculatus. Dietary supplementation of bruchid larvae with A. lebbeck seed coat flour causes severe weight loss and reduces survival. By means of protein purification, mass spectrometry and bioinformatic analyses, we show that chitin-binding vicilins are the main source of A. lebbeck tegumental toxicity to C. maculatus. At concentrations as low as 0.1 percent, A. lebbeck vicilins reduce larval mass from 8.1 ± 1.7 (mass of control larvae) to 1.8 ± 0.5 mg, which corresponds to a decrease of 78 percent. Seed coat toxicity constitutes an efficient defense mechanism, hindering insect predation and preventing embryo damage. We hypothesize that A. lebbeck vicilins are good candidates for the genetic transformation of crop legumes to enhance resistance to bruchid predation.

Evaluación de un modelo multidisciplinar de hospitalización alternativa a la hospitalización convencional en la neumonía adquirida en la comunidad / Evaluation of a multidisciplinar y alternative hospitalization model in comparison with conventional hospitalization for patients with community-acquired pneumonia

Objetivo: Evaluar la estancia hospitalaria y la mortalidad de un modelo multidisciplinar de hospitalización alternativa (HA) frente a un sistema de hospitalización convencional(HC) en pacientes con neumonía adquirida en la comunidad (NAC). Método: Estudio observacional prospectivo, en el que se incluyó a todos los pacientes con NAC atendidos en el servicio de urgencias (SU) de un hospital general durante un año. Se recogieron las variables sociodemográficas, de comorbilidad, clínicas y de laboratorio. Se calcularon el Pneumonia Severity Index (PSI) y el índice de Barthel en el momento del ingreso. A su ingreso se asignaron de forma no aleatoria a un modelo de HC o al modelo de HA, consistente en ingreso en la unidad de corta estancia de urgencias y alta con seguimiento en el hospital de día de la unidad de enfermedades infecciosas o seguimiento a través de la unidad de hospitalización a domicilio. Se evaluó la estancia hospitalaria y la mortalidad a los 30 días. Resultados: Ingresaron 425 (77,2%) pacientes, 130 en HA y 252 en HC. Los asignados a HA eran de mayor edad (69 frente a 62,7 años; p < 0,001), con mayor deterioro funcional (47 % frente a 23,8 %; p < 0,001), con mayor puntuación PSI (PSI IV 61,5 %frente al 36,9 %; p < 0,001), con menor estancia media hospitalaria (2,5 frente a 9,6días; p < 0,001) y menor mortalidad a los 30 días (3,9 % frente a 11,2 %; p < 0,05,riesgo relativo 0,3, intervalo de confianza del 95% 0,1-0,8). Conclusiones: Un modelo multidisciplinar de HA alternativo de hospitalización en el manejo de la NAC permite reducir la estancia hospitalaria y la mortalidad asociada (AU)

Objective: To compare duration of hospital stay and mortality between conventional hospitalization and an alternative hospital care model for patients with community-acquired pneumonia (CAP).Patients and methods: Prospective, non randomized study including all patients with CAP treated in our hospital’semergency department (ED) in 1 year. We recorded information on sociodemographic variables, comorbidity, clinical condition, and laboratory findings. The Pneumonia Severity Index (PSI) and the Barthel score were also recorded onadmission to the ED. A care model (alternative or conventional hospitalization) was assigned without randamization on admission. The alternative model consisted of admission to a short-stay unit in the ED, and follow-up on discharge in the day hospital of the infectious diseases department or at home by the home hospitalization staff. Outcome measures were duration of hospital stay and 30-day mortality. Results: Of a total of 550 patients, 425 (77.2%) were admitted; 252 received conventional hospital care and 130 were treated under the alternative model. Those assigned to the alternative model were older (mean age of 69 years vs. 62.7years, P<.001), had greater functional deficits (47% vs 23.8%; P<.001), and a higher PSI (PSI of IV or higher, 61.5% vs36.9%; P<.001). The duration of hospital stay was shorter under the alternative model (2.5 days vs 9.6 days, P<.001) and 30-day mortality was lower (3.9% vs 11.2%, P<.05; relative risk, 0.3 [95% confidence interval, 0.1-0.8]). Conclusions: This alternative model of hospital care for the management of CAP allows hospital stay to be shortened and it is associated with lower mortality (AU)

Influencia del sexo del paciente en el manejo del síndrome coronario agudo con elevación del STen los servicios de urgencias / Sex-related differences in emergency department management of acute coronary syndrome

Objetivos: Existen datos en la literatura que demuestran que existen diferencias en cuanto a la mortalidad en el síndrome coronario agudo con elevación del segmento ST(IAMEST) entre los distintos sexos, y ésta es más elevada en las mujeres. Nuestra intenciónes analizar las características específicas y la atención urgente recibida tanto extra como intrahospitalaria en función de sexo. Pacientes y métodos: Estudio longitudinal, observacional donde se incluyeron de forma consecutiva todos los pacientes asistidos en el servicio de urgencias (SU) de un hospital general por IAMEST desde marzo 2001 hasta junio 2007. El estudio es un subanálisisdel registro multicéntrico RESIM. Se analizaron datos demográficos, variables clínicas, horarios y tratamiento administrado a nivel extra e intrahospitalario. Resultados: De los 214 casos recogidos, un 74,8% (160 pacientes) eran hombres. La edad media fue de 64,4 ± 12,6 años. Las mujeres atendidas eran más mayores (71,7años DE ± 10,6) que los hombres (62 años DE ± 12,3). La diabetes mellitus fue más frecuente en las mujeres y la hipertensión arterial y el tabaquismo en los hombres. Hubodiferencias entre los siguientes tiempos: inicio de los síntomas y llegada al hospital(240,3 min en hombres vs 503,3 min en mujeres; p < 0,05), inicio de los síntomas y realización de un electrocardiiograma (ECG) (240,6 min en hombres vs 516,4 min en mujeres; p < 0,01) y llegada al hospital y realización de un ECG (6,4 min en hombres 13 min en mujeres; p < 0,01). No encontramos diferencias en el medio de transporte utilizado ni en el tratamiento administrado tanto a nivel extra como intrahospitalario. Conclusiones: Existen retrasos en la atención de mujeres que acuden al SU con IAMEST. Su consideración puede mejorar la atención prestada a estos pacientes (AU)

Background and objective: Higher mortality rates for women with acute coronary syndrome with ST elevation havebeen reported. Our aim was to analyze patient characteristics and care provided by our emergency department both before and after arrival at the hospital in order to detect sex-related differences in approach to care.Patients and methods: Longitudinal, observational study of consecutive patients with acute coronary syndrome with STelevation attended by a general hospital emergency department between March 2001 and June 2007. The study fell within the scope of work carried out by the Spanish Register of Myocardial Infarction Emergencies (RESIM). Patient characteristics, clinical variables, timing, and treatment administered before and after arrival at the hospital were analyzed. Results: Of the 214 cases registered, 160 (74.8%) were men. The mean (SD) age was 64.4 (12.6) years. The women were older (71.7 [10.6] years) than the men (62 [12.3] years). Diabetes mellitus was more common in women and hypertension and smoking more common in men. Care differed with regard to time elapsed between onset of symptoms to arrival at the hospital (men, 240.3 minutes; women, 503.3 minutes; P<.05), time elapsed between on set of symptoms and an electrocardiogram (ECG) (men, 240.6 minutes; women, 516.4 minutes; P<.01), and time elapsed between arrival at the hospital and an ECG (men, 6.4 minutes; women, 13 minutes; P<.01). There were no differences in type of transport used or in treatment given before or after arrival at the hospital.Conclusions: Care for women with acute coronary syndrome with ST elevation is subject to longer delays. Awareness ofthis may improve emergency care given to women (AU)

Sarcoidosis cutánea. Opciones terapéuticas / Cutaneous sarcoidosis. Therapeutic choices

La Sarcoidosis es una enfermedad multisistémica que se caracteriza histológicamente por existencia de granulomas epiteliodes sin necrosis caseosa. Laafectación cutánea aparece en un 20-35% de los pacientes con sarcoidosis sistémica pero también puede aparecer como única manifestación de laenfermedad. Describimos un paciente afecto de sarcoidosis cutánea sin afectación sistémica. Las lesiones cutáneas no respondieron tras varios tratamientostópicos y sistémicos y finalmente respondieron a metotrexato. Revisamos las diferentes opciones en el tratamiento de la sarcoidosis cutánea (AU)

Sarcoidosis is a multisystemic disorder characterized histollogically by epithelioid granulomas without caseating necrosis. Cutaneous involvementoccurs in 20-35% of patients with systemic sarcoidosis and may occur without systemic involvement. A patient with cutaneous sarcoidosis, withoutsystemic involvement is reported. Cutaneous lesions do not responsive to various forms of topical and systemic treatment and finally were responsiveto metotrexate. We review treatment options for cutaneous sarcoidosis (AU)

Proteomic analysis of cytosolic proteins associated with petite mutations in Candida glabrata

The incidence of superficial or deep-seated infections due to Candida glabrata has increased markedly, probably because of the low intrinsic susceptibility of this microorganism to azole antifungals and its relatively high propensity to acquire azole resistance. To determine changes in the C. glabrata proteome associated with petite mutations, cytosolic extracts from an azole-resistant petite mutant of C. glabrata induced by exposure to ethidium bromide, and from its azole-susceptible parent isolate were compared by two-dimensional polyacrylamide gel electrophoresis. Proteins of interest were identified by peptide mass fingerprinting or sequence tagging using a matrix-assisted laser desorption/ionization tandem time-of-flight mass spectrometer. Tryptic peptides from a total of 160 Coomassie-positive spots were analyzed for each strain. Sixty-five different proteins were identified in the cytosolic extracts of the parent strain and 58 in the petite mutant. Among the proteins identified, 10 were higher in the mutant strain, whereas 23 were lower compared to the parent strain. The results revealed a significant decrease in the enzymes associated with the metabolic rate of mutant cells such as aconitase, transaldolase, and pyruvate kinase, and changes in the levels of specific heat shock proteins. Moreover, transketolase, aconitase and catalase activity measurements decreased significantly in the ethidium bromide-induced petite mutant. These data may be useful for designing experiments to obtain a better understanding of the nuclear response to impairment of mitochondrial function associated with this mutation in C. glabrata.

¿Cómo utilizamos los hipnóticos en atención primaria? / How do we use hypnotics in primary care?

Objetivos. Describir la utilización de hipnóticos y el perfil del consumidor. Material y métodos. Estudio descriptivo transversal multicéntrico, realizado en atención primaria del área de salud de Toledo. Población: pacientes >=18 años con prescripción de hipnóticos en el año 2007, no terminales. Resultados. Al 8,2% de la población en 2007 se le prescribió algún hipnótico. El principio activo más frecuente fue el lorazepam (58,5%), seguido de lormetazepam (13%). Hemos estudiado 639 pacientes, 68,2% mujeres, con una edad media de 64,2±16,7 años y una mediana de frecuentación de 29 consultas/año (R.I. 23 consultas/año). El 19,4% (DE 3,1) de los pacientes tomaron 2–3 principios activos distintos. Duración del tratamiento mediana de 78,4 semanas (R.I. 88,5). Según historia clínica: el 26,6% tienen 2 o más patologías crónicas, en el 30,9% (DE 3,6) constaba el diagnóstico asociado (8,4% insomnio, 69,4% depresión-ansiedad), tomaban fármacos con posibles interacciones con los hipnóticos 73,8% (DE 3,4), al 15% se revisa el tratamiento, 1,9% (DE 1,06) sufrieron reacciones adversas, 4,9% (DE 0,9) tuvieron caídas durante el tratamiento, el 12,5% (DE 2,3) de los tratamientos superaban la dosis máxima permitida. Conclusiones. El consumidor de hipnóticos de nuestro área es una mujer de 64 años, que vive en el medio rural, hiperfrecuentadora, con depresión, ansiedad y riesgo elevado de interacciones medicamentosas, que toma el hipnótico de forma crónica (AU)

Objectives. To describe the use of hypnotics and the consumer profile. Material and methods. A descriptive cross-sectional multicenter study conducted in primary care in a Health Area of Toledo. Population: non-terminal patients >=18 years with prescription of hypnotics in 2007. Results. A hypnotic drug was prescribed to 8.2% of the population in 2007. The most frequent active principle used was lorazepam (58.5%), followed by lormetazepam (13%). We studied 639 patients, 68.2% women with a mean age of 64.2±16.7 years and a median attendance of 29 visits per year (RI 23 consultations/year). A total of 19.4% (SD 3.1) patients took 2 or 3 different active ingredients. Median treatment duration was 78.4 weeks (RI 88.5). According to the clinical records, 26.6% had 2 or more chronic disorders, in 30.9% (SD 3.6). The associated diagnosis (8.4% insomnia, 69.4% depression-anxiety) was stated in 30.9% (SD 3.6), 73.8% (SD 3.4) took drugs with potential interactions with hypnotics, treatment was revised in 15%, 1.9% (SD 1.06) suffered adverse reactions, 4.9% (SD 0.9) had fallen during the treatment, 12.5% (SD 2.3) of treatments exceeded the maximum permitted dose. Conclusions. The consumer of hypnotics in our area is a woman of 64, who lives in rural areas, is a frequent visitor to the doctor, with anxiety and depression and with high risk of drug interactions, who receive chronic treatment with hypnotic drugs (AU)

Bothrops insularis venomics: a proteomic analysis supported by transcriptomic-generated sequence data

A joint transcriptomic and proteomic approach employing two-dimensional electrophoresis, liquid chromatography and mass spectrometry was carried out to identify peptides and proteins expressed by the venom gland of the snake Bothrops insularis, an endemic species of Queimada Grande Island, Brazil. Four protein families were mainly represented in processed spots, namely metalloproteinase, serine proteinase, phospholipase A2 and lectin. Other represented families were growth factors, the developmental protein G10, a disintegrin and putative novel bradykinin-potentiating peptides. The enzymes were present in several isoforms. Most of the experimental data agreed with predicted values for isoelectric point and Mr of proteins found in the transcriptome of the venom gland. The results also support the existence of posttranslational modifications and of proteolytic processing of precursor molecules which could lead to diverse multifunctional proteins. This study provides a preliminary reference map for proteins and peptides present in Bothrops insularis whole venom establishing the basis for comparative studies of other venom proteomes which could help the search for new drugs and the improvement of venom therapeutics. Altogether, our data point to the influence of transcriptional and post-translational events on the final venom composition and stress the need for a multivariate approach to snake venomics studies.

Carcinoma renal de istmo en riñón en herradura. A propósito de un caso / Herseshoes kidney isthmus carcinoma. A case report

El riñón en herradura ( RH) es la más común de las anomalías por fusión. La incidencia de carcinoma renal en RH suele ser similar a la del riñón normal. Dadas sus características anatómicas especiales, se deben tener en cuenta para su abordaje quirúrgico, así como para la realización de una posible cirugía conservadora. Presentamos un caso de carcinoma renal en istmo de RH en el que se realizó cirugía conservadora de ambas unidades renales (AU)

Horseshoe kidney is the most frequent fusion abnormality of the kidney. The incidence of renal carcinoma in patients with horseshoe kidney is similar to those with normal anatomy. Its special anatomical features must be borne in mind for both surgical approach and conservative surgery. We present a horseshoe kidney isthmus carcinoma case report in which we performed conservative surgery of both renal units (AU)

Anudación de catéter para analgesia continua del plexo braquial a nivel paraescalénico / Catheter knotting during continuous brachial plexus analgesia by the paraescalene approach

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Insularinase A, a prothrombin activator from Bothrops insularis venom, is a metalloprotease derived from a gene encoding protease and disintegrin domains

The first low-molecular-mass metalloprotease presenting prothrombin activating activity was purified from Bothrops insularis venom and named insularinase A. It is a single-chain protease with a molecular mass of 22 639 Da. cDNA sequence analysis revealed that the disintegrin domain of the precursor protein is post-translationally processed, producing the mature insularinase A. Analysis of its deduced amino acid sequence showed a high similarity with several fibrin(ogen)olytic metalloproteases and only a moderate similarity with prothrombin activators. However, SDS-PAGE of prothrombin after activation by insularinase A showed fragment patterns similar to those generated by group A prothrombin activators, which convert prothrombin into meizothrombin independently of the prothrombinase complex. In addition, insularinase A activates factor X and hydrolyses fibrinogen and fibrin. Chelating agents fully inhibit all insularinase A activities. Insularinase A induced neither detachment nor apoptosis of human endothelial cells and was also not able to trigger an endothelial proinflammatory cell response. Nitric oxide and prostacyclin levels released by endothelial cells were significantly increased after treatment with insularinase A. Our results show that, although its primary structure is related to class P-I fibrin(ogen)olytic metalloproteases, insularinase A is functionally similar to group A prothrombin activators.

Indicadores de calidad mínimos para la mejora de la gestión de la hipertensión arterial en Atención Primaria / Minimun quality indicators for improving the management of hypertension in Primary Care

Propósito. La hipertensión arterial (HTA) sigue siendo un problema sanitario de primer orden por su alta prevalencia, morbimortalidad y alto coste económico, lo que hace necesario un método que permita una mejor gestión de la misma. Desde esta perspectiva hemos planteado un trabajo para la selección de los indicadores de calidad mínimos (ICM) para evaluar, controlar y seguir adecuadamente al paciente hipertenso y cuya supervisión permita evaluar la calidad asistencial que recibe la población hipertensa. Material y métodos. Tras definir el problema, revisar la bibliografía y consultar a expertos en hipertensión, la selección de indicadores se realizó a partir de las principales guías nacionales e internacionales de hipertensión. Para la selección de los ICM utilizamos tres criterios: cumplir requisitos que definen un indicador de calidad, concordancia entre guías y evidencia científica y actualización en función del año de aparición en guía. Resultados. Inicialmente obtuvimos 113 indicadores potenciales; de entre ellos seleccionamos 32 ICM que incluían elementos de anamnesis, exploración física, exploraciones complementarias y tratamiento (de primera visita y visita anual). Conclusiones. La intervención mediante la definición de ICM en HTA y la medición de la cumplimentación de los mismos debe ser el primer paso para el control del paciente hipertenso en Atención Primaria (AU)