[Cardiovascular morbidity and mortality and electrocardiographic criteria of left ventricular hypertrophy in hypertensive patients treated in primary care]. / Morbilidad y mortalidad cardiovascular y criterios electrocardiográficos de hipertrofia ventricular izquierda en pacientes hipertensos en atención primaria.

UNLABELLED: FUNDAMENTALS AND OBJECTIVE: Electrocardiographic voltage criteria are the preferred method for diagnosis of left ventricular hypertrophy (LVH) in Primary Health Care (PHC). Several of these have been described as major adverse cardiovascular events (MACE) predictors. The aim of this study was to analyse the relationship between MACE occurrence in a cohort of hypertensive subjects in PHC and different electrocardiographic criteria recorded. PATIENTS AND METHODS: 265 hypertensive subjects attending PHC were randomly selected and followed up for 12 years. Standard 12-lead electrocardiograms were recorded at the beginning of the study. The occurrence of ischemic heart disease, heart failure, stroke, peripheral vascular disease, arrhythmia or cardiovascular death was considered as MACE. Electrocardiographic voltage criteria recorded were: Sokolow-Lyon, Minnesota code 3.1, Gubner and Ungerleider, Cornell voltage and Schillaci and Dalfó modifications. Data were analyzed using the life-table method and Cox regression models. RESULTS: 14,3% of patients lost to follow-up showed no differences in baseline characteristics from the rest of the cohort. The median follow-up was 10.1 years (IQR: 5.8-12.0). The cumulative survival rate was 53.5% (95% CI, 45.7-61.3%). The incidence of MACE was 5.85 (95% CI, 4.73-6.97) per 100 hypertensive patients-year. In the multivariate analysis none of the ECG criteria showed statistical association with the occurrence of MACE. CONCLUSIONS: No association has been found between different electrocardiographic LVH criteria and the incidence of MACE in a cohort of hypertensive patients followed-up in a PHC setting for 12 years.

Morbilidad y mortalidad cardiovascular y criterios electrocardiográficos de hipertrofia ventricular izquierda en pacientes hipertensos en atención primaria / Cardiovascular morbidity and mortality and electrocardiographic criteria of left ventricular hypertrophia in hypertensive patients treated in primary care

Fundamento y objetivo: Los criterios electrocardiográficos de voltaje son el método de elección para el diagnóstico de hipertrofia ventricular izquierda (HVI) en atención primaria (AP). Algunos de estos se han descrito como predictores de episodios cardiovasculares (ECV). El objetivo de este estudio fue analizar la relación entre la aparición de ECV en una cohorte de hipertensos atendidos en AP y los criterios registrados. Pacientes y método: Se seleccionó aleatorizadamente a 265 hipertensos, entre todos los atendidos, que se siguieron durante 12 años. Pacientes y método: Se realizó un electrocardiograma estándar de 12 derivaciones al inicio del estudio. Se consideró ECV la aparición de cardiopatía isquémica, insuficiencia cardíaca, accidente cerebrovascular, vasculopatía periférica, arritmias o muerte por ECV. Los criterios de voltaje registrados fueron Sokolow-Lyon, Minnesota code 3.1, Gubner y Ungerleider, voltaje de Cornell y sus modificaciones de Schillaci y Dalfó. Se analizaron los datos mediante el método actuarial y modelos de regresión de Cox.Resultados: Se perdió a un 14,3% de los pacientes, cuyas características basales fueron similares a las de los que lo completaron. La mediana de tiempo de seguimiento fue de 10,1 años (intervalo intercuartílico: 5,8–12,0). La supervivencia acumulada (permanecer libre de ECV) fue del 53,5% (intervalo de confianza del 95%: 45,7–61,3). La tasa relativa media de incidencia de aparición de ECV fue de 5,85 (intervalo de confianza 95%: 4,73–6,97) por cada 100 hipertensos/año. En el análisis multivariable ninguno de los criterios mostró asociación estadística con la aparición de ECV. Conclusiones: No se observó asociación entre los criterios electrocardiográficos de HVI y la incidencia de ECV en la cohorte de hipertensos seguidos en AP durante 12 años (AU)

Fundamentals and objective: Electrocardiographic voltage criteria are the preferred method for diagnosis of left ventricular hypertrophy (LVH) in Primary Health Care (PHC). Several of these have been described as major adverse cardiovascular events (MACE) predictors. Fundamentals and objective:The aim of this study was to analyse the relationship between MACE occurrence in a cohort of hypertensive subjects in PHC and different electrocardiographic criteria recorded. Patients and methods: 265 hypertensive subjects attending PHC were randomly selected and followed up for 12 years. Standard 12-lead electrocardiograms were recorded at the beginning of the study. The occurrence of ischemic heart disease, heart failure, stroke, peripheral vascular disease, arrhythmia or cardiovascular death was considered as MACE. Electrocardiographic voltage criteria recorded were: Sokolow-Lyon, Minnesota code 3.1, Gubner and Ungerleider, Cornell voltage and Schillaci and Dalfó modifications. Data were analyzed using the life-table method and Cox regression models.Results: 14,3% of patients lost to follow-up showed no differences in baseline characteristics from the rest of the cohort. Results: The median follow-up was 10.1 years (IQR: 5.8–12.0).Results: The cumulative survival rate was 53.5% (95% CI, 45.7–61.3%). The incidence of MACE was 5.85 (95% CI, 4.73–6.97) per 100 hypertensive patients-year. In the multivariate analysis none of the ECG criteria showed statistical association with the occurrence of MACE (AU)

Cardiovascular morbidity and mortality and left ventricular geometric patterns in hypertensive patients treated in primary care.

INTRODUCTION AND OBJECTIVES: Numerous hospital studies have shown that different left ventricular (LV) geometric patterns have different effects on cardiovascular risk. The aims of this study were to estimate the risk of major adverse cardiovascular events (MACEs) in hypertensive patients seen in primary care and to identify any association with LV geometric pattern. METHODS: In total, 265 hypertensive subjects attending primary care were randomly selected and followed up for 12 years. Those with cardiovascular disease, secondary hypertension, complete bundle branch block or electrocardiographic signs of ischemic heart disease were excluded. The LV geometric pattern was characterized as either concentric hypertrophy, eccentric hypertrophy, concentric remodeling or normal. A MACE was the occurrence of ischemic heart disease, heart failure, stroke, peripheral vascular disease, arrhythmia or cardiovascular death. Data were analyzed using the life-table method and Cox regression modeling. RESULTS: Although 14% of patients were lost to follow-up, their baseline characteristics were similar to those of patients who completed the study. The cumulative survival rate was 56.3% (95% confidence interval [CI], 49.8%-62.8%). The incidence of MACEs was 4.67 (95% CI, 3.79-5.55) per 100 subject-years. Moreover, the incidence was similar in the four LV geometric pattern groups (P=.889). Only age (hazard ratio [HR]=1.03; 95% CI, 1-1.05) and the presence of diabetes at study entry (HR=1.67; 95% CI, 1.03-2.69) were associated with an increased risk of a MACE. CONCLUSIONS: In the study population, only age and diabetes at study entry were associated with the occurrence of a MACE. There was no evidence for an association between MACEs and the LV geometric pattern.

Morbimortalidad cardiovascular y patrones geométricosdel ventrículo izquierdo en pacientes hipertensos atendidosen atención primaria / Cardiovascular Morbidity and Mortality and Left Ventricular Geometric Patterns in Hypertensive Patients Treated in Primary Care

Introducción y objetivos. Numerosos estudios hospitalariosmuestran el diferente impacto de los patronesgeométricos ventriculares izquierdos (VI) en el riesgo cardiovascular.El objetivo fue determinar el riesgo de eventoscardiovasculares (ECV) entre los hipertensos atendidosen atención primaria y analizar su relación con elpatrón geométrico VI.Métodos. Se seleccionó aleatoriamente a 265 hipertensosentre todos los atendidos que fueron seguidosdurante 12 años. Se excluyó a los que presentaban enfermedadcardiovascular, hipertensión arterial secundaria,bloqueo completo de rama o signos de cardiopatíaisquémica electrocardiográficos. Se los clasificó según elpatrón geométrico VI en hipertrofia concéntrica o excéntrica,remodelado concéntrico y normal. Se consideróECV la aparición de cardiopatía isquémica, insuficienciacardiaca, accidente cerebrovascular, vasculopatía periférica,arritmias o muerte por ECV. Se analizaron los datosmediante el método actuarial y modelos de regresión deCox.Resultados. Se perdió un 14% de los pacientes duranteel seguimiento, cuyas características basales fueronsimilares a las de los que lo completaron. La supervivenciaacumulada fue del 56,3% (intervalo de confianza[IC] del 95%, 49,8%-62,8%). La tasa de incidencia deECV fue 4,67 (IC del 95%, 3,79-5,55)/100 hipertensos/año. La incidencia de ECV fue similar en los cuatro gruposde patrón geométrico VI (p = 0,889). Únicamente laedad (años) (hazard ratio [HR] = 1,03; IC del 95%, 1-1,05)y la diabetes (HR = 1,67; IC del 95%, 1,03-2,69) al iniciodel estudio se asociaron con un mayor riesgo de ECV.Conclusiones. En la población de estudio sólo la edady la diabetes al inicio del estudio se asociaron con laaparición de ECV. No se evidenció asociación entre eltipo de patrón geométrico VI y los ECV (AU)

Introduction and objectives. Numerous hospitalstudies have shown that different left ventricular (LV)geometric patterns have different effects on cardiovascularrisk. The aims of this study were to estimate the riskof major adverse cardiovascular events (MACEs) inhypertensive patients seen in primary care and to identifyany association with LV geometric pattern.Methods. In total, 265 hypertensive subjects attendingprimary care were randomly selected and followed up for12 years. Those with cardiovascular disease, secondaryhypertension, complete bundle branch block orelectrocardiographic signs of ischemic heart disease wereexcluded. The LV geometric pattern was characterizedas either concentric hypertrophy, eccentric hypertrophy,concentric remodeling or normal. A MACE was theoccurrence of ischemic heart disease, heart failure, stroke,peripheral vascular disease, arrhythmia or cardiovasculardeath. Data were analyzed using the life-table method andCox regression modeling.Results. Although 14% of patients were lost to followup,their baseline characteristics were similar to those ofpatients who completed the study. The cumulative survivalrate was 56.3% (95% confidence interval [CI], 49.8%-62.8%). The incidence of MACEs was 4.67 (95% CI, 3.79-5.55) per 100 subject-years. Moreover, the incidence wassimilar in the four LV geometric pattern groups (P=.889).Only age (hazard ratio [HR]=1.03; 95% CI, 1-1.05) andthe presence of diabetes at study entry (HR=1.67; 95% CI, 1.03-2.69) were associated with an increased risk ofa MACE.Conclusions. In the study population, only age anddiabetes at study entry were associated with the occurrenceof a MACE. There was no evidence for an associationbetween MACEs and the LV geometric pattern (AU)

[Follow-up and monitoring of hypertension. Is this performed the same in the autochthonous and immigrant populations?]. / Seguimiento y control de la hipertensión arterial. Se efectúa igual en la población autóctona y en la inmigrante?

OBJECTIVES: To evaluate the degree of control of blood pressure (BP) in the autochthonous and immigrant populations and to find the variables linked to good control. DESIGN: Cross-sectional, observational study. SETTING: Urban primary care team, Spain. PARTICIPANTS: All patients with hypertension seen between 1/1/2000 and 1/7/2005 and whose origin was known: 1.063 patients in all, 931 autochthonous and 132 immigrant ones. MAIN MEASUREMENTS: The main variable was hypertension control the last time BP was taken (BP

Seguimiento y control de la hipertensión arterial. ¿Se efectúa igual en la población autóctona y en la inmigrante? / Follow-up and monitoring of hypertension. Is this performed the same in the autochthonous and immigrant populations?

Objetivo. Evaluar el grado de control de la presión arterial (PA) en la población autóctona y la inmigrante y determinar las variables asociadas a un buen control. Diseño. Estudio observacional, transversal. Emplazamiento. Equipo urbano de atención primaria. Participantes. Todos los pacientes con hipertensión arterial (HTA), atendidos entre el 1 de enero de 2000 y el 1 de julio de 2005, de los que se conocía el origen: en total 1.063 pacientes, 931 autóctonos y 132 inmigrantes. Mediciones principales. La variable principal fue el control de la HTA según la última toma de PA (PA ≤ 140/90 y ≤ 130/80 en diabéticos). Además, se recogió: país de origen, edad, sexo, índice de masa corporal, factores de riesgo cardiovascular (diabetes, dislipemia, tabaquismo), exploraciones complementarias (analítica anual y electrocardiograma bienal) y fármacos prescritos. Se realizó una regresión logística para estimar el efecto del origen en el control de la PA. Resultados. Se consiguió un buen control en un 39,2% de los autóctonos y en un 25% de los inmigrantes (odds ratio [OR] = 1,6; intervalo de confianza [IC] del 95%, 1,2-2,1). No obstante, el análisis multivariable señala la edad (OR = 1,029; IC del 95%, 1,017-1,040) como único factor asociado al buen control de la PA. Conclusiones. El origen del paciente no influye en el control de la PA

Objectives. To evaluate the degree of control of blood pressure (BP) in the autochthonous and immigrant populations and to find the variables linked to good control. Design. Cross-sectional, observational study. Setting. Urban primary care team, Spain. Participants. All patients with hypertension seen between 1/1/2000 and 1/7/2005 and whose origin was known: 1.063 patients in all, 931 autochthonous and 132 immigrant ones. Main measurements. The main variable was hypertension control the last time BP was taken (BP ≤140/90 mm Hg and ≤130/80 mm Hg in diabetics). In addition, data on country of origin, age, gender, body mass index, cardiovascular risk factors (diabetes, lipaemia, tobacco dependency), further examinations (annual blood analysis and ECG every 2 years) and prescribed medication were recorded. Logistic regression was used to calculate the effect of origin on blood pressure monitoring. Results. Good BP control was achieved in 39.2% of autochthonous patients and 25% of immigrants (odds ratio [OR], 1.6; 95% confidence interval [CI], 95% CI, 1.2-2.1). Nevertheless, multivariate analysis indicated age (OR, 1.029; 95% CI, 1.017-1.040) as the sole factor determining good or bad BP control. Conclusions. The origin of the patient does not affect BP control