Registro del historial farmacoterapéutico de la historia clínica informatizada en pacientes con hipertensión arterial: un nuevo instrumento para valorar la adherencia terapéutica / A prescription register incorporated into computerized medical records for patients with hypertension: a new instrument to evaluate medication adherence

Objetivo. Estudiar la validez del registro del historial farmacoterapéutico (HF) de la historia clínica electrónica (HCE) comparado con el test de Morisky-Green en pacientes con tratamiento farmacológico de la hipertensión arterial.DiseñoEstudio descriptivo transversal. Emplazamiento. Atención Primaria. Participantes. Doscientos cincuenta y dos pacientes con hipertensión arterial en tratamiento farmacológico, sin cambios de fármacos o dosis, seleccionados aleatoriamente. Mediciones principales. Se estudiaron variables descriptivas, presión arterial, proporción de comprimidos retirados de las farmacias según el HF durante 12 meses respecto a los prescritos en la HCE (mala adherencia terapéutica [AT] si era < 80%) y test de Morisky-Green. La validez del HF se estudió mediante el índice Kappa, comparándolo con el test de Morisky-Green (referencia) y el control de la presión arterial. Resultados. La edad media fue de 68 años (50% de mujeres). Completaron el estudio el 77,4%. La mala AT fue del 51,3% por HF (IC 95% 44,3-58,3%) y del 15,4% (IC 95% 10,3-20,4%) con el test de Morisky-Green. El índice Kappa fue -0,068. Los pacientes con mala AT según el HF presentaron cifras más elevadas de presión arterial sistólica y diastólica (4,3 y 2,9 mmHg, respectivamente, p<0,05), sin diferencias en los pacientes con mala AT según el test de Morisky-Green (0,1 y 1 mmHg, respectivamente, p>0,05).Conclusiones. La mala AT según el HF es elevada y asociada al mal control de la hipertensión arterial, de manera contraria al test de Morisky-Green. Estos resultados sugieren que el HF podría ser útil para valorar la AT y que el test de Morisky-Green infraestima la mala AT(AU)

Objective. To study the validity of a prescription register (PR) incorporated into computerized medical records (CMR) compared with the Morisky-Green test in patients with high blood pressure using anti-hypertensive medication.DesignCross-sectional study. Setting. Primary Care. Participants. A total of 252 patients with hypertension using drug therapy with no changes in drugs or dosage were randomly selected. Main measurements. Descriptive variables, blood pressure, proportion of drug therapy collected from pharmacies according to the PR over 12 months compared with drug therapy prescribed in CMR (poor medication adherence [MA] if <80%), and Morisky-Green test. Validity of the PR was analysed using the Kappa index to compare PR with the Morisky-Green test (reference) and blood pressure levels. Results. Mean age was 68 years, 50% were women, and 77% completed the study. Poor MA was 51.3% according to the PR (95% CI 44.3%-58.3%) and 15.4% (95% CI; 10.3%-20.4%) when using the Morisky-Green test. The Kappa index was -0.068. Patients with poor MA according to the PR had higher levels of systolic and diastolic blood pressure (4.3 and 2.9 mmHg, respectively, P<0.05). No differences in blood pressure were observed in patients with poor MA if the Morisky-Green test was used (0.1 and 1 mmHg, respectively, P>0.05).Conclusions. Poor MA according to the PR is high and is associated with poorer control of blood pressure; the Morisky-Green test does not pick up on these differences. These results suggest that the PR could be useful for evaluating MA and that the Morisky-Green test underestimates poor MA(AU)

[A prescription register incorporated into computerized medical records for patients with hypertension: a new instrument to evaluate medication adherence]. / Registro del historial farmacoterapéutico de la historia clínica informatizada en pacientes con hipertensión arterial: un nuevo instrumento para valorar la adherencia terapéutica.

OBJECTIVE: To study the validity of a prescription register (PR) incorporated into computerized medical records (CMR) compared with the Morisky-Green test in patients with high blood pressure using anti-hypertensive medication. DESIGN: Cross-sectional study. SETTING: Primary Care. PARTICIPANTS: A total of 252 patients with hypertension using drug therapy with no changes in drugs or dosage were randomly selected. MAIN MEASUREMENTS: Descriptive variables, blood pressure, proportion of drug therapy collected from pharmacies according to the PR over 12 months compared with drug therapy prescribed in CMR (poor medication adherence [MA] if <80%), and Morisky-Green test. Validity of the PR was analysed using the Kappa index to compare PR with the Morisky-Green test (reference) and blood pressure levels. RESULTS: Mean age was 68 years, 50% were women, and 77% completed the study. Poor MA was 51.3% according to the PR (95% CI 44.3%-58.3%) and 15.4% (95% CI; 10.3%-20.4%) when using the Morisky-Green test. The Kappa index was -0.068. Patients with poor MA according to the PR had higher levels of systolic and diastolic blood pressure (4.3 and 2.9 mmHg, respectively, P<0.05). No differences in blood pressure were observed in patients with poor MA if the Morisky-Green test was used (0.1 and 1 mmHg, respectively, P>0.05). CONCLUSIONS: Poor MA according to the PR is high and is associated with poorer control of blood pressure; the Morisky-Green test does not pick up on these differences. These results suggest that the PR could be useful for evaluating MA and that the Morisky-Green test underestimates poor MA.

Obesity is an independent risk factor for heart failure: Zona Franca Cohort study.

BACKGROUND: Heart failure (HF) is a major problem in developed countries. However, its relationship with obesity remains unclear, especially in low-risk populations. The objective of the study was to analyze the relationship between obesity and HF in a low-risk Mediterranean population. HYPOTHESIS: Obesity is an independent predictor for HF. METHODS: A prospective community-based population cohort study with 10 years' follow-up was conducted at 2 healthcare centers in the city of Barcelona, Spain. From a registered population of 35 275, the study included 932 randomly selected patients without HF, age 35-84 years. Obesity was defined as body mass index (BMI) ≥30 and HF according to European Society of Cardiology guidelines, confirmed by echocardiography. Cox proportional hazards regression was used to examine the association between obesity and heart failure. RESULTS: The difference in HF incidence between obese subjects (4.7%) and nonobese subjects (1.6%) was 3.1% (95% confidence interval [CI]: 0.7-5.5). In the unadjusted model, incident HF was significantly associated with BMI: the hazard ratio [HR] was 1.09 for every 1 kg/m² increase (95% CI: 1.05-1.14) and 3.01 for BMI ≥30 (95% CI: 1.34-6.77). After adjusting for age, sex, hypertension, ischemic heart disease, and diabetes mellitus, the results were similar: HR 1.06 (95% CI: 1.01-1.10) and HR 2.45 for BMI ≥30 (95% CI: 1.02-5.61). Overweight was not associated with HF in any of the models. The population-attributable risk of HF due to obesity was 43.0% (95% CI: 13.9-74.9). CONCLUSIONS: High rate differences, HRs, and attributable risk indicate that obesity is an important risk factor for incident HF.

The epidemiology of cardiovascular disease in primary care. the Zona Franca Cohort study in Barcelona, Spain.

INTRODUCTION AND OBJECTIVES: Knowledge about the incidence of cardiovascular disease in Spain is limited, particularly about emergent conditions such as peripheral arterial disease and heart failure. The objective of this study was to determine the incidence of these conditions in a primary care setting. METHODS: A prospective population-based cohort study was carried out in two health centers in Barcelona, Spain. It included 931 randomly selected individuals, aged 35 to 84 years, without cardiovascular disease who were followed for 10 years. We assessed the incidence of ischemic heart disease (i.e. myocardial infarction and angina), cerebrovascular disease (i.e. stroke and transient ischemic attack), peripheral arterial disease of the lower extremities, and heart failure. RESULTS: The most frequently occurring condition was ischemic heart disease (cumulative incidence, 6.1%), followed by cerebrovascular disease (4.3%), heart failure (3.0%), and peripheral arterial disease (1.9%). These conditions were more frequent in patients aged >65 years (cumulative incidence, 9.6%, 8.9%, 4.6% and 3.1%, respectively). The most frequent comorbid conditions were ischemic heart disease and cerebrovascular disease. The incidence of acute myocardial infarction was greater in men (P< .001), but there was no significant difference for other conditions. The adjusted incidence (European population) per 100,000 inhabitants per year in men and women, respectively, was: 605 and 115 for acute myocardial infarction; 238 and 220 for angina; 300 and 327 for stroke; 125 and 115 for transient ischemic attack; 136 and 178 for peripheral arterial disease; and 219 and 267 for heart failure. CONCLUSIONS: The incidence of cardiovascular disease was lower than in other developed countries. Disease occurred more frequently in patients aged >65 years. Ischemic heart disease remained the most common, with heart failure being a notable emergent condition.

Epidemiología de las enfermedades cardiovasculares en atención primaria. Estudio cohorte zona franca de barcelona / The epidemiology of cardiovascular disease in primary care. The zona franca cohort study in Barcelona, Spain

Introducción y objetivos. La incidencia de las enfermedades cardiovasculares no se conoce suficientemente en España, sobre todo en enfermedades emergentes como la arteriopatía periférica y la insuficiencia cardiaca. El objetivo es estudiar la incidencia de estas enfermedades en atención primaria. Métodos. Estudio prospectivo de cohortes de base poblacional, realizado en dos centros de salud de Barcelona (España). Se incluyó a 931 sujetos entre 35 y 84 años, sin enfermedades cardiovasculares, seleccionados aleatoriamente y seguidos 10 años. Se estudió la incidencia de cardiopatía isquémica (infarto agudo de miocardio y angina), enfermedad cerebrovascular (ictus y accidente isquémico transitorio), arteriopatía periférica de extremidades inferiores e insuficiencia cardiaca. Resultados. La enfermedad más frecuente fue la cardiopatía isquémica (incidencia acumulada, 6,1%), seguida de la enfermedad cerebrovascular (4,3%), la insuficiencia cardiaca (3%) y la arteriopatía periférica (1,9%). Fueron más frecuentes en mayores de 65 años (incidencias acumuladas, 9,6, 8,9, 4,6 y 3,1% respectivamente). La superposición más frecuente fue entre cardiopatía isquémica y enfermedad cerebrovascular. La incidencia de infarto agudo de miocardio fue superior en varones (p < 0,001), sin diferencias significativas en otras enfermedades. Las tasas ajustadas (población europea) cada 100.000 habitantes/año en varones y mujeres respectivamente fueron: infarto agudo de miocardio, 605 y 115; angina, 238 y 220; ictus, 200 y 327; accidente isquémico transitorio, 125 y 115; arteriopatía periférica, 136 y 178, e insuficiencia cardiaca, 219 y 267. Conclusiones. La incidencia de enfermedades cardiovasculares es inferior que en otros países desarrollados y son especialmente frecuentes en mayores de 65 años. La cardiopatía isquémica sigue siendo la más frecuente y destaca la insuficiencia cardiaca como enfermedad emergente (AU)

Introduction and objectives. Knowledge about the incidence of cardiovascular disease in Spain is limited, particularly about emergent conditions such as peripheral arterial disease and heart failure. The objective of this study was to determine the incidence of these conditions in a primary care setting. Methods. A prospective population-based cohort study was carried out in two health centers in Barcelona, Spain. It included 931 randomly selected individuals, aged 35 to 84 years, without cardiovascular disease who were followed for 10 years. We assessed the incidence of ischemic heart disease (i.e. myocardial infarction and angina), cerebrovascular disease (i.e. stroke and transient ischemic attack), peripheral arterial disease of the lower extremities, and heart failure. Results. The most frequently occurring condition was ischemic heart disease (cumulative incidence, 6.1%), followed by cerebrovascular disease (4.3%), heart failure (3.0%), and peripheral arterial disease (1.9%). These conditions were more frequent in patients aged >65 years (cumulative incidence, 9.6%, 8.9%, 4.6% and 3.1%, respectively). The most frequent comorbid conditions were ischemic heart disease and cerebrovascular disease. The incidence of acute myocardial infarction was greater in men (P<.001), but there was no significant difference for other conditions. The adjusted incidence (European population) per 100,000 inhabitants per year in men and women, respectively, was: 605 and 115 for acute myocardial infarction; 238 and 220 for angina; 300 and 327 for stroke; 125 and 115 for transient ischemic attack; 136 and 178 for peripheral arterial disease; and 219 and 267 for heart failure. Conclusions. The incidence of cardiovascular disease was lower than in other developed countries. Disease occurred more frequently in patients aged >65 years. Ischemic heart disease remained the most common, with heart failure being a notable emergent condition (AU)

[Role of pulse pressure, systolic blood pressure, and diastolic blood pressure in the prediction of cardiovascular risk. Cohort study]. / Papel de la presión de pulso, presión arterial sistólica y presión arterial diastólica en la predicción del riesgo cardiovascular. Estudio de cohortes.

BACKGROUND AND OBJECTIVE: To analize the role of pulse pressure (PP), systolic (SBP) and diastolic blood pressure (DBP), in the prediction of cardiovascular risk. PATIENTS AND METHOD: A prospective cohort study carried out in 2 primary care center, including 932 patients aged between 35-84 years old, without cardiovascular events, selected by simple random sampling, and with an 8 year follow-up. PP, SBP, and DBP were categorized in tertiles, comparing the upper with the 2 lowers. First cardiovascular event, whether fatal or not, such as coronary heart disease, cerebrovascular disease, and peripheral arterial disease was recorded as a composite variable. Results were studied according to Cox models, adjusting for age, sex, smoking, total cholesterol, high density lipoprotein cholesterol, and diabetes mellitus. We studied the correlation between PP with SBP, DBP, and cardiovascular risk factors. RESULTS: We registered 85 cardiovascular events: 43 cases of coronary heart disease, 27 cerebrovascular disease, and 17 peripheral arterial disease. The adjusted hazard ratios for composite variable were: upper PP tertile (>/= 59 mmHg) = 1.3 (95% confidence interval [CI], 0.8-2.1); upper SBP tertile (>/= 140 mmHg) = 1.5 (95% CI, 1.0-2.5); upper DBP tertile (>/= 84 mmHg) = 1.1 (95% CI, 0.7-1.8). Results were similar for specific cardiovascular events. PP was correlated with SBP (r = 0.825; p < 0.001), age (r = 0.422; p < 0.001), diabetes mellitus (r = 0.242; p < 0.001), and smoking (r = -0.158; p = 0.01), with adjusted hazard ratio for these variables of 1.0 (95% CI, 0.6-1.9). CONCLUSIONS: PP is an arterial pressure component very correlated with SBP and other factors, but is not a better cardiovascular risk predictor than SBP.

Papel de la presión de pulso, presión arterial sistólica y presión arterial diastólica en la predicción del riesgo cardiovascular. Estudio de cohortes / Role of pulse pressure, systolic blood pressure, and diastolic blood pressure in the prediction of cardiovascular risk. Cohort study

FUNDAMENTO Y OBJETIVO: Analizar el papel de la presión de pulso (PP), la presión arterial sistólica(PAS) y la diastólica (PAD) en la predicción del riesgo cardiovascular.PACIENTES Y MÉTODO: Se realizó un estudio de cohortes, prospectivo, en 2 centros de salud, queincluyó a 932 personas de 35-84 años sin episodios cardiovasculares, seleccionadas por muestreoaleatorio simple y seguidas durante 8 años. La PP, PAS y PAD se categorizaron en tercilesy el superior se comparó con los 2 inferiores. Se registró como variable combinada el primerepisodio cardiovascular, mortal o no, en forma de cardiopatía isquémica, enfermedad cerebrovasculary arteriopatía periférica. Los resultados se analizaron mediante modelos de Cox ajustandopor edad, sexo, tabaquismo, colesterol total, colesterol unido a lipoproteínas de alta densidady diabetes mellitus. Se estudió la correlación entre PP y PAS, PAD y factores de riesgocardiovascular.RESULTADOS: Se registraron 85 episodios cardiovasculares: 43 casos de cardiopatía isquémica,27 de enfermedad cerebrovascular y 17 de arteriopatía periférica. Los cocientes de riesgo ajustadospara la variable combinada fueron: tercil superior (>= 59 mmHg) de la PP = 1,3 (intervalode confianza [IC] del 95%, 0,8-2,1); tercil superior (>= 140 mmHg) de la PAS = 1,5 (IC del95%, 1,0-2,5); tercil superior (>= 84 mmHg) de la PAD = 1,1 (IC del 95%, 0,7-1,8). Los resultadosfueron similares para los episodios cardiovasculares específicos. La PP se correlacionócon la PAS (r = 0,825; p < 0,001), la edad (r = 0,422; p < 0,001), la diabetes mellitus(r = 0,242; p < 0,001) y el tabaquismo (r = –0,158; p = 0,01), siendo su cociente de riesgoajustado por estas variables de 1,0 (IC del 95%, 0,6-1,9).CONCLUSIONES: La PP es un componente de la presión arterial muy relacionado con la PAS yotros factores de riesgo, pero no es mejor predictor del riesgo cardiovascular que la PAS

BACKGROUND AND OBJECTIVE: To analize the role of pulse pressure (PP), systolic (SBP) and diastolicblood pressure (DBP), in the prediction of cardiovascular risk.PATIENS AND METHOD: A prospective cohort study carried out in 2 primary care center, including932 patients aged between 35-84 years old, without cardiovascular events, selected by simplerandom sampling, and with an 8 year follow-up. PP, SBP, and DBP were categorized in tertiles,comparing the upper with the 2 lowers. First cardiovascular event, whether fatal or not, such ascoronary heart disease, cerebrovascular disease, and peripheral arterial disease was recorded asa composite variable. Results were studied according to Cox models, adjusting for age, sex,smoking, total cholesterol, high density lipoprotein cholesterol, and diabetes mellitus. We studiedthe correlation between PP with SBP, DBP, and cardiovascular risk factors.RESULTS: We registered 85 cardiovascular events: 43 cases of coronary heart disease, 27 cerebrovasculardisease, and 17 peripheral arterial disease. The adjusted hazard ratios for compositevariable were: upper PP tertile (>= 59 mmHg) = 1.3 (95% confidence interval [CI], 0.8-2.1);upper SBP tertile (>= 140 mmHg) = 1.5 (95% CI, 1.0-2.5); upper DBP tertile (>= 84 mmHg) =1.1 (95% CI, 0.7-1.8). Results were similar for specific cardiovascular events. PP was correlatedwith SBP (r = 0.825; p < 0.001), age (r = 0.422; p < 0.001), diabetes mellitus (r =0.242; p < 0.001), and smoking (r = –0.158; p = 0.01), with adjusted hazard ratio for thesevariables of 1.0 (95% CI, 0.6-1.9).CONCLUSIONS: PP is an arterial pressure component very correlated with SBP and other factors,but is not a better cardiovascular risk predictor than SBP