Patrones y resultados del cambio de anticoagulantes orales directos en la fibrilación auricular no valvular: experiencia en la práctica clínica en España / Patterns and outcomes of switching direct oral anticoagulants in non-valvular atrial fibrillation: A real-world experience from Spain

Objetivos El objetivo consistía en evaluar un programa de gestión de anticoagulantes orales directos (ACOD) en pacientes con fibrilación auricular no valvular (FANV) según sus perfiles, idoneidad de la dosis, patrones de cambio de tratamiento, efectividad y seguridad Se trató de un estudio observacional, prospectivo y longitudinal en una cohorte de pacientes atendidos en la práctica clínica cotidiana en un hospital regional español con un plan de seguimiento de 3 años para pacientes que iniciaron el tratamiento con dabigatrán, rivaroxabán o apixabán entre enero de 2012 y diciembre de 2016. Métodos Se analizaron 490 episodios de tratamiento (apixabán 2,5mg, 9,4%; apixabán 5mg, 21,4%; dabigatrán 75mg, 0,6%; dabigatrán 110mg, 12,4%; dabigatrán 150mg, 19,8%; rivaroxabán 15mg, 17,8%; rivaroxabán 20mg, 18,6%) en 445 pacientes. En el 13,6% de los pacientes tratados con dabigatrán, el 9,7% de los tratados con rivaroxabán y el 3,9% de los tratados con apixabán se cambió a otros ACOD o se modificó la dosis. Resultados El ACOD al que se cambió con mayor frecuencia fue el apixabán. Los motivos más frecuentes para cambiar de tratamiento fueron toxicidad (23,8%), hemorragia (21,4%) y deterioro renal (16,7%). En el 23,8% de los episodios se constató una inadecuación de la dosis. Las tasas de ictus y accidentes isquémicos transitorios (AIT) fueron de 1,64 y 0,54 eventos/100 años/paciente, respectivamente, mientras que las de hemorragias importantes, no importantes, pero clínicamente relevantes (NICR) e intracraneales fueron de 2,4, 5 y 0,5 eventos/100 años/paciente, respectivamente. Las hemorragias digestivas y genitourinarias fueron el tipo más frecuente de eventos hemorrágicos. En el análisis multifactorial, el ictus previo y la edad fueron factores predictivos independientes de ictus/AIT. El uso concomitante de antiagregantes plaquetarios, el sexo masculino y la edad fueron factores predictivos independientes de eventos hemorrágicos (AU)

Aims The aim is to evaluate a management program for direct oral anticoagulants (DOACs) in non-valvular atrial fibrillation (NVAF) patients according to their profiles, appropriateness of dosing, patterns of crossover, effectiveness and safety. This is an observational and longitudinal prospective study in a cohort of patients attended in daily clinical practice in a regional hospital in Spain with 3-year a follow-up plan for patients initiating dabigatran, rivaroxaban or apixaban between Jan/2012 and Dec/2016. Methods We analyzed 490 episodes of treatment (apixaban 2.5, 9.4%; apixaban 5, 21.4%; dabigatran 75, 0.6%; dabigatran 110, 12.4%; dabigatran 150, 19.8%; rivaroxaban 15, 17.8% and rivaroxaban 20, 18.6%) in 445 patients. 13.6% of patients on dabigatran, 9.7% on rivaroxaban, and 3.9% on apixaban switched to other DOACs or changed dosing. Results Apixaban was the most frequent DOAC switched to. The most frequent reasons for switching were toxicity (23.8%), bleeding (21.4%) and renal deterioration (16.7%). Inappropriateness of dose was found in 23.8% of episodes. Rates of stroke/transient ischemic attack (TIA) were 1.64/0.54 events/100 patients-years, while rates of major, clinically relevant non-major (CRNM) bleeding and intracranial bleeding were 2.4, 5, and 0.5 events/100 patients-years. Gastrointestinal and genitourinary bleeding were the most common type of bleeding events (BE). On multivariable analysis, prior stroke and age were independent predictors of stroke/TIA. Concurrent platelet inhibitors, male gender and age were independent predictors of BE. Conclusion This study complements the scant data available on the use of DOACs in NVAF patients in Spain, confirming a good safety and effectiveness profil (AU)

Patterns and outcomes of switching direct oral anticoagulants in non-valvular atrial fibrillation: A real-world experience from Spain.

AIMS: The aim is to evaluate a management program for direct oral anticoagulants (DOACs) in non-valvular atrial fibrillation (NVAF) patients according to their profiles, appropriateness of dosing, patterns of crossover, effectiveness and safety. This is an observational and longitudinal prospective study in a cohort of patients attended in daily clinical practice in a regional hospital in Spain with 3-year a follow-up plan for patients initiating dabigatran, rivaroxaban or apixaban between JAN/2012-DEC/2016. METHODS: We analyzed 490 episodes of treatment (apixaban 2.5 9.4%, apixaban 5 21.4%, dabigatran 75 0.6%, dabigatran 110 12,4%, dabigatran 150 19.8%, rivaroxaban 15 17.8% and rivaroxaban 20 18.6%) in 445 patients. 13.6% of patients on dabigatran, 9.7% on rivaroxaban, and 3.9% on apixaban switched to other DOACs or changed dosing. RESULTS: Apixaban was the most frequent DOAC switched to. The most frequent reasons for switching were toxicity (23.8%), bleeding (21.4%) and renal deterioration (16.7%). Inappropriateness of dose was found in 23.8% of episodes. Rates of stroke/transient ischemic attack (TIA) were 1.64/0.54 events/100 patients-years, while rates of major, clinically relevant non-major (CRNM) bleeding and intracranial bleeding were 2.4, 5, and 0.5 events/100 patients-years. Gastrointestinal and genitourinary bleeding were the most common type of bleeding events (BE). On multivariable analysis, prior stroke and age were independent predictors of stroke/TIA. Concurrent platelet inhibitors, male gender and age were independent predictors of BE. CONCLUSION: This study complements the scant data available on the use of DOACs in NVAF patients in Spain, confirming a good safety and effectiveness profile.

Management of Patients with Suspected or Confirmed Antibiotic Allergy: Executive Summary of Guidelines from the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), the Spanish Society of Allergy and Clinical Immunology (SEAIC), the Spanish Society of Hospital Pharmacy (SEFH) and the Spanish Society of Intensive Medicine and Coronary Care Units (SEMICYUC).

Suspected or confirmed antibiotic allergy is a frequent clinical circumstance that influences antimicrobial prescription and often leads to the avoidable use of less efficacious and/or more toxic or costly drugs than first-line antimicrobials. Optimizing antimicrobial therapy in patients with antibiotic allergy labels has become one of the priorities of antimicrobial stewardship programs in several countries. These guidelines aim to make recommendations for the systematic approach to patients with suspected or confirmed antibiotic allergy based on current evidence. An expert panel (11 members of various scientific societies) formulated questions about the management of patients with suspected or confirmed antibiotic allergy. A systematic literature review was performed by a medical librarian. The questions were distributed among panel members who selected the most relevant references, summarized the evidence, and formulated graded recommendations when possible. The answers to all the questions were finally reviewed by all panel members. A systematic approach to patients with suspected or confirmed antibiotic allergy was recommended to improve antibiotic selection and, consequently, clinical outcomes. A clinically oriented, 3-category risk-stratification strategy was recommended for patients with suspected antibiotic allergy. Complementary assessments should consider both clinical risk category and preferred antibiotic agent. Empirical therapy recommendations for the most relevant clinical syndromes in patients with suspected or confirmed ß-lactam allergy were formulated, as were recommendations on the implementation and monitoring of the impact of the guidelines. Antimicrobial stewardship programs and allergists should design and implement activities that facilitate the most appropriate use of antibiotics in these patients.

Management of Patients with Suspected or Confirmed Antibiotic Allergy: Executive Summary of Guidelines from the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), the Spanish Society of Allergy and Clinical Immunology (SEAIC), the Spanish Society of Hospital Pharmacy (SEFH) and the Spanish Society of Intensive Medicine and Coronary Care Units (SEMICYUC)

Suspected or confirmed antibiotic allergy is a frequent clinical circumstance that influences antimicrobial prescription and often leads to the avoidable use of less efficacious and/or more toxic or costly drugs than first-line antimicrobials. Optimizing antimicrobial therapy in patients with antibiotic allergy labels has become one of the priorities of antimicrobial stewardship programs in several countries. These guidelines aim to make recommendations for the systematic approach to patients with suspected or confirmed antibiotic allergy based on current evidence. An expert panel (11 members of various scientific societies) formulated questions about the management of patients with suspected or confirmed antibiotic allergy. A systematic literature review was performed by a medical librarian. The questions were distributed among panel members who selected the most relevant references, summarized the evidence, and formulated graded recommendations when possible. The answers to all the questions were finally reviewed by all panel members. A systematic approach to patients with suspected or confirmed antibiotic allergy was recommended to improve antibiotic selection and, consequently, clinical outcomes. A clinically oriented, 3-category risk-stratification strategy was recommended for patients with suspected antibiotic allergy. Complementary assessments should consider both clinical risk category and preferred antibiotic agent. Empirical therapy recommendations for the most relevant clinical syndromes in patients with suspected or confirmed ß-lactam allergy were formulated, as were recommendations on the implementation and monitoring of the impact of the guidelines. Antimicrobial stewardship programs and allergists should design and implement activities that facilitate the most appropriate use of antibiotics in these patients (AU)

En la práctica clínica, un antecedente de alergia a los antibióticos, confirmada o sospechada, es frecuente y condiciona la selección de antibióticos, requiriendo con frecuencia el uso de fármacos menos eficaces, más tóxicos o más caros que los antibióticos de primera línea. La optimización del uso de antibióticos en pacientes con este antecedente es una de las prioridades de los programas de optimización de uso de antibióticos (PROA) en varios países. Estas guías pretenden formular recomendaciones para evaluar de una manera sistemática a estos pacientes mediante una aproximación basada en la evidencia. Un panel multidisciplinar constituido por alergólogos, infectólogos, farmacéuticos hospitalarios e intensivistas formularon una serie de preguntas sobre el manejo de estos pacientes; una documentalista realizó la revisión bibliográfica. Las preguntas se distribuyeron entre los miembros del grupo de trabajo, quienes seleccionaron las referencias más relevantes y formularon las correspondientes recomendaciones, que fueron revisadas y aprobadas por todos los miembros del grupo. Es necesaria una aproximación sistemática a los pacientes con antecedentes de alergia a antibióticos para optimizar la selección del tratamiento antibiótico y mejorar los resultados clínicos de estos pacientes cuando precisan antibioterapia. El presente documento recomienda una estrategia de estratificación clínica del riesgo en 3 categorías. La recomendación de realizar evaluaciones complementarias se basa en el riesgo clínico y el antibiótico de primera línea necesario. Además, se formulan recomendaciones de tratamiento antibiótico empírico para los principales síndromes infecciosos en pacientes con alergia confirmada o sospechada. Finalmente, se formulan recomendaciones sobre la implementación y monitorización del impacto de las recomendaciones de la guía (AU)

Guía práctica sobre el diagnóstico y tratamiento de la hipertensión arterial en España, 2022. Sociedad Española de Hipertensión - Liga Española para la Lucha contra la Hipertensión Arterial (SEH-LELHA) / 2022 Practice guidelines for the management of arterial hypertension of the Spanish Society of Hypertension

La hipertensión arterial es el principal factor de riesgo de enfermedad y muerte en España. El diagnóstico y el tratamiento de la hipertensión arterial constituyen objetivos básicos de salud porque el control adecuado reduce la morbimortalidad relacionada. El objetivo de esta guía práctica sobre el manejo de la hipertensión arterial de la Sociedad Española de Hipertensión - Liga Española para la Lucha contra la Hipertensión Arterial (SEH-LELHA) es ofrecer unas recomendaciones básicas para la prevención, detección, diagnóstico y tratamiento de la hipertensión arterial. Para ello, la SEH-LELHA asume las directrices de 2018 de la Sociedad Europea de Hipertensión y la Sociedad Europea de Cardiología, si bien se comentan también los aspectos más relevantes de las últimas guías norteamericanas e internacionales. Con respecto al diagnóstico, se mantiene el umbral de 140/90 mmHg como definitorio de hipertensión arterial, se destaca la necesidad de conocer los valores de presión arterial fuera de la consulta, bien mediante monitorización ambulatoria o automedida o ambas, y se establece como prioritaria la estratificación del riesgo cardiovascular del paciente con hipertensión arterial. Con respecto al tratamiento, se destacan las modificaciones del estilo de vida como medida de prevención cardiovascular general y la necesidad de tratamiento antihipertensivo combinado para un control adecuado en la mayoría de los pacientes, reforzando la indicación de dos fármacos como tratamiento inicial, de combinaciones de fármacos en un solo comprimido y de una estrategia activa de consecución del control en un plazo breve de tiempo. El objetivo de control se establece en niveles de presión arterial por debajo de 130/80 mmHg en una amplia mayoría de pacientes. (AU)

Hypertension is the most important risk factor for global disease burden. Detection and management of hypertension are considered as key issues for individual and public health, as adequate control of blood pressure levels markedly reduces morbidity and mortality associated with hypertension. Aims of these practice guidelines for the management of arterial hypertension of the Spanish Society of Hypertension include offering simplified schemes for diagnosis and treatment for daily practice, and strategies for public health promotion. The Spanish Society of Hypertension assumes the 2018 European guidelines for management of arterial hypertension developed by the European Society of Cardiology and the European Society of Hypertension, although relevant aspects of the 2017 American College of Cardiology/American Heart Association guidelines and the 2020 International Society of Hypertension guidelines are also commented. Hypertension is defined as a persistent elevation in office systolic blood pressure ≥ 140 and/or diastolic blood pressure ≥ 90 mmHg, and assessment of out-of-office blood pressure and global cardiovascular risk are considered of key importance for evaluation and management of hypertensive patients. The target for treated blood pressure should be < 130/80 for most patients. The treatment of hypertension involves lifestyle interventions and drug therapy. Most people with hypertension need more than one antihypertensive drug for adequate control, so initial therapy with two drugs, and single pill combinations are recommended for a wide majority of hypertensive patients. (AU)

[2022 Practice guidelines for the management of arterial hypertension of the Spanish Society of Hypertension]. / Guía práctica sobre el diagnóstico y tratamiento de la hipertensión arterial en España, 2022. Sociedad Española de Hipertensión - Liga Española para la Lucha contra la Hipertensión Arterial (SEH-LELHA).

Hypertension is the most important risk factor for global disease burden. Detection and management of hypertension are considered as key issues for individual and public health, as adequate control of blood pressure levels markedly reduces morbidity and mortality associated with hypertension. Aims of these practice guidelines for the management of arterial hypertension of the Spanish Society of Hypertension include offering simplified schemes for diagnosis and treatment for daily practice, and strategies for public health promotion. The Spanish Society of Hypertension assumes the 2018 European guidelines for management of arterial hypertension developed by the European Society of Cardiology and the European Society of Hypertension, although relevant aspects of the 2017 American College of Cardiology/American Heart Association guidelines and the 2020 International Society of Hypertension guidelines are also commented. Hypertension is defined as a persistent elevation in office systolic blood pressure ≥ 140 and/or diastolic blood pressure ≥ 90 mmHg, and assessment of out-of-office blood pressure and global cardiovascular risk are considered of key importance for evaluation and management of hypertensive patients. The target for treated blood pressure should be < 130/80 for most patients. The treatment of hypertension involves lifestyle interventions and drug therapy. Most people with hypertension need more than one antihypertensive drug for adequate control, so initial therapy with two drugs, and single pill combinations are recommended for a wide majority of hypertensive patients.

Dinámica del control de la hipertensión en función del tiempo a través de la plataforma SEFAC e_XPERT / Dynamics of hypertension control as a function of time using the SEFAC e_XPERT platform

JUSTIFICACIÓN: diversos estudios apuntan a que cuanto antes se alcanzan objetivos de control en la hipertensión arterial (HTA), mejor es el pronóstico de los afectados. El uso de la plataforma SEFAC e_XPERT podría facilitar la monitorización del control de la HTA. OBJETIVOS: determinar el grado de control de la presión arterial en función del tiempo de seguimiento de los pacientes realizado por farmacéuticos comunitarios. MATERIAL Y MÉTODOS: estudio longitudinal, descriptivo, de cohortes y retrospectivo de los datos de pacientes introducidos por farmacéuticos comunitarios, en SEFAC e_XPERT con el programa SPSS Statistics Ver 25 (IBM).Las variables estudiadas fueron: sexo, edad, talla, perímetro abdominal, IMC, presión arterial sistólica (PAS) y diastólica (PAD) en la visita basal y en la visita final y tiempo de seguimiento. Para estimar adecuadamente la influencia del tiempo en el control de la HTA, dividimos el tiempo de seguimiento en terciles. RESULTADOS: de los 4291 incluidos en SEFAC e_XPERT, seleccionamos 1387 en los que disponíamos de las variables estudiadas en al menos dos visitas consecutivas. El 57,9 % (803) eran mujeres, las medias globales fueron: edad 6317 años, peso 67,714 vs. 86,016 kg (p<0.001), para mujeres y hombres, respectivamente. Definimos la HTA como PAS/PAD ≥140 y/o 90(46,1 %). La media del tiempo de seguimiento fue de 141 dias, la mediana de 41 días, oscilando entre 1 día y 5 años. (AU)

2021 Spanish Society of Hypertension position statement about telemedicine / Documento de consenso sobre consulta telemática en hipertensión y riesgo vascular. Sociedad Española de Hipertensión-Liga Española para la Lucha contra la Hipertensión Arterial (SEH-LELHA)

The pandemic caused by coronavirus SARS-CoV-2 (COVID-19) has forced, in many cases, to replace face-to-face consultation with the telematic consultation, in order to reduce the risk of contagion associated with the presence of patients in health centres. This change may represent an opportunity for a different and more effective communication between professionals and patients, allowing better accessibility to medical care and more systematic and comprehensive approach to patients with hypertension and cardiovascular risk. However, organisational tools are needed to facilitate communication between patients and professionals, specifically with the exchange of clinical data by remote monitoring of variables associated with hypertension and cardiovascular risk (blood pressure, weight, height, blood tests…), and allow monitoring of adherence to treatments, lifestyles and risk factors. It would be desirable for this to be carried out by multidisciplinary teams, both from primary care, hospital and community pharmacy, with an adequate coordination of care. This document of the Spanish Society of Hypertension (SEH-LELHA) tries to give the keys to improve the quality of care of telematic consultations of patients with hypertension and cardiovascular risk, provide basic criteria of telematic or face to face attention and systematise their content. Likewise, the follow-up criteria are proposed by the different professionals. (AU)

La pandemia producida por el coronavirus SARS-CoV-2 (COVID-19) ha obligado, en muchos casos a sustituir la consulta presencial por la consulta telemática para reducir el riesgo de contagio asociado a la presencia de pacientes en los centros sanitarios. Este cambio puede representar una oportunidad para una comunicación diferente y más eficiente entre profesionales y pacientes, permitiendo mejorar la accesibilidad a la atención médica y un abordaje más sistemático e integral a los pacientes con hipertensión y riesgo cardiovascular. No obstante, se necesitan herramientas organizativas que faciliten la comunicación entre pacientes y profesionales, específicamente con intercambio de datos clínicos que favorezcan la monitorización remota de las variables asociadas a la hipertensión y riesgo cardiovascular (presión arterial, peso, talla, variables analíticas…) y permitan realizar un seguimiento adecuado en aspectos como la adherencia a los tratamientos, estilos de vida y factores de riesgo. Todo ello sería deseable que fuera realizado por equipos multidisciplinares, tanto de atención primaria como hospitalaria y farmacia comunitaria, con una coordinación adecuada del cuidado en este tipo de pacientes. Este documento de la Sociedad Española de Hipertensión-Liga Española para la Lucha contra la Hipertensión Arterial (SEH-LELHA) trata de dar las claves para mejorar la calidad asistencial de las consultas telemáticas de los pacientes con hipertensión y riesgo cardiovascular, proporcionar criterios básicos de atención telemática o presencial y sistematizar el contenido de estas. Así mismo se plantean los criterios de seguimiento por los diferentes profesionales. (AU)

Campaña de medida de la presión arterial (May Measurement Month) desde las farmacias comunitarias en el 2018: análisis del cribado en España / Blood pressure measurement campaign (May Measurement Month) from community pharmacies in 2018: analysis of screening in Spain

Introducción: Dentro del proyecto internacional May Measurement Month (MMM) en España, la farmacia comunitaria es el establecimiento sanitario en el que se llevan a cabo el mayor número de mediciones y donde se puede sensibilizar a la población sobre la importancia de la medida periódica de la presión arterial (PA). Objetivo: Conocer la situación de la PA de la población española y la difusión de la importancia de su medida periódica, a través de las farmacias comunitarias. Material y métodos: Estudio descriptivo transversal realizado en las farmacias comunitarias españolas durante el mes de mayo de 2018, entre los usuarios de las mismas, mayores de edad. Como variables principales se midieron la presión arterial sistólica (PAS), presión arterial diastólica (PAD) y frecuencia cardíaca. Resultados: Se llevaron a cabo 5.785 determinaciones por 891 farmacéuticos. 1.755 (34,8%) personas no se habían medido la PA en el último año. El 31,2% de los participantes tenía cifras elevadas de PA. PAS media (PASm) fue de 127,1 ± 20,1 y PAD media (PADm) de 77,5 ± 12,5, mayor en hombres (p < 0,001). Los pacientes con valores de PA de normalidad fueron 3.981 (68,8%); elevadas una 1.226 (21,2%) y dos 578 (10%). Los pacientes con PAS ≥ 140 fueron 912 (15,76%) y con PAD ≥ 90 fueron 314 (5,4%). Se detectaron cuatro (0,07%) emergencias hipertensivas. Conclusiones: Tres de cada diez personas participantes tenían algún valor alto de PA. Por lo que, las determinaciones de PA protocolizadas realizadas en un establecimiento sanitario como la farmacia comunitaria, ha permitido identificar un número significativo de sujetos con PA elevada y no tratada. (AU)

Introduction: Within the international project May Measurement Month, in Spain, the community pharmacy is where the greatest number of measurements are carried out and where the population can be made aware of the importance of regular blood pressure measurement. Objectiv: To ascertain the situation of the Spanish population's blood pressure and dissemination of the importance of its regular measurement through the community pharmacies. Methods: Cross-sectional descriptive study carried out in Spanish community pharmacies during the month of May 2018, among pharmacy users of legal age. Systolic blood pressure, diastolic blood pressure and heart rate were measured as main variables. Results: Five thousand, seven hundred and eighty-five readings were made by 891 pharmacists. One thousand, seven hundred and fifty-five (34.8%) people had not had their blood pressure measured in the last year. Of the participants, 31.2% had high blood pressure readings. Mean systolic blood pressure was 127.1±20.1 and mean diastolic blood pressure 77.5±12.5, higher in men (p<.001). There were normal blood pressure values in 3,981 (68.8%) patients; one high reading in 1,226 (21.2%); and two in 578 (10%). There were 912 (15.76%) patients with SBP≥140 and 314 (5.4%) with DBP≥90. Four (0.07%) hypertensive emergencies were detected. Conclusions: Three out of ten participants had a high blood pressure reading. Therefore, protocolized blood pressure readings carried out in a health care facility such as the community pharmacy, allowed the identification of a significant number of subjects with high and untreated blood pressure. (AU)

Brachial-ankle pulse wave velocity with a custom device.

BACKGROUND AND OBJECTIVES: The brachial-ankle pulse wave velocity (baPWV) is one of the most widely used arterial stiffness variables for assessing vascular risk. The abiPWV is a device that calculates various PWVs and the blood pressure ankle-brachial index (ABI). The device can also determine baPWV. The aim of this study was to calculate the baPWV with abiPWV, validate it with a reference device (VaSera) and study its clinical usefulness. PATIENTS AND METHODS: We studied 113 patients (mean age, 53 ±â€¯12 years), 59 (52%) of whom were women, and 10 (8.8%) of whom had a previous cardiovascular event. The participants were classified according to cardiovascular risk factors (CRFs) into group I (none), group II (1 or 2 CRFs) and group III (3 or more CRFs). The patients with a previous cardiovascular event were included in group III. All participants had their baPWV measured with abiPWV and VaSera. RESULTS: The baPWV correlation between the 2 devices was r = 0.93 (p < .001), and the percentage error calculated with the Bland-Altman analysis was 4.5%. The baPWV measured with abiPWV (in m/s) was as follows: group I, 10.5 ±â€¯1.6; group II, 13.8 ±â€¯2.9 (p < .001 when compared with group I); and group III, 14.1 ±â€¯2.7 (p < .001 when compared with group I). There were no differences between groups II and III. The results with VaSera were comparable to those of abiPWV. CONCLUSIONS: Measuring baPWV with the abiPWV is safe and has a similar clinical utility to that of VaSera. Incorporating this function into the options of abiPWV makes it a complete device for assessing arterial stiffness.

[Blood pressure measurement campaign (May Measurement Month) from community pharmacies in 2018: analysis of screening in Spain]. / Campaña de medida de la presión arterial (May Measurement Month) desde las farmacias comunitarias en el 2018: análisis del cribado en España.

INTRODUCTION: Within the international project May Measurement Month, in Spain, the community pharmacy is where the greatest number of measurements are carried out and where the population can be made aware of the importance of regular blood pressure measurement. OBJECTIV: To ascertain the situation of the Spanish population's blood pressure and dissemination of the importance of its regular measurement through the community pharmacies. METHODS: Cross-sectional descriptive study carried out in Spanish community pharmacies during the month of May 2018, among pharmacy users of legal age. Systolic blood pressure, diastolic blood pressure and heart rate were measured as main variables. RESULTS: Five thousand, seven hundred and eighty-five readings were made by 891 pharmacists. One thousand, seven hundred and fifty-five (34.8%) people had not had their blood pressure measured in the last year. Of the participants, 31.2% had high blood pressure readings. Mean systolic blood pressure was 127.1±20.1 and mean diastolic blood pressure 77.5±12.5, higher in men (p<.001). There were normal blood pressure values in 3,981 (68.8%) patients; one high reading in 1,226 (21.2%); and two in 578 (10%). There were 912 (15.76%) patients with SBP≥140 and 314 (5.4%) with DBP≥90. Four (0.07%) hypertensive emergencies were detected. CONCLUSIONS: Three out of ten participants had a high blood pressure reading. Therefore, protocolized blood pressure readings carried out in a health care facility such as the community pharmacy, allowed the identification of a significant number of subjects with high and untreated blood pressure.

2021 Spanish Society of Hypertension position statement about telemedicine.

The pandemic caused by coronavirus SARS-CoV-2 (COVID-19) has forced, in many cases, to replace face-to-face consultation with the telematic consultation, in order to reduce the risk of contagion associated with the presence of patients in health centres. This change may represent an opportunity for a different and more effective communication between professionals and patients, allowing better accessibility to medical care and more systematic and comprehensive approach to patients with hypertension and cardiovascular risk. However, organisational tools are needed to facilitate communication between patients and professionals, specifically with the exchange of clinical data by remote monitoring of variables associated with hypertension and cardiovascular risk (blood pressure, weight, height, blood tests…), and allow monitoring of adherence to treatments, lifestyles and risk factors. It would be desirable for this to be carried out by multidisciplinary teams, both from primary care, hospital and community pharmacy, with an adequate coordination of care. This document of the Spanish Society of Hypertension (SEH-LELHA) tries to give the keys to improve the quality of care of telematic consultations of patients with hypertension and cardiovascular risk, provide basic criteria of telematic or face to face attention and systematise their content. Likewise, the follow-up criteria are proposed by the different professionals.

Velocidad de onda de pulso brazo-tobillo con un dispositivo propio / Brachial-ankle pulse wave velocity with a custom device

Antecedentes y objetivos La velocidad de onda de pulso brazo-tobillo (VOPbt) es una de las variables de rigidez arterial más empleada en la valoración del riesgo vascular. VOPITB es un dispositivo que calcula distintas VOP y el índice tobillo-brazo de presión arterial (ITB). Además, con sus registros se podría determinar la VOPbt. El objetivo de este estudio fue: calcular la VOPbt con VOPITB, validarlo con un equipo de referencia (VaSera) y estudiar su utilidad clínica. Pacientes y métodos Se estudiaron 113 pacientes, con edad media de 53±12años; 59 (52%) eran mujeres y 10 (8,8%) presentaban evento cardiovascular previo. Los participantes se estatificaron según factores de riesgo vascular (FRV) en: grupoI, ninguno; grupoII, uno o 2; y grupoIII, 3 o más FRV. Los pacientes con algún evento vascular previo se incluyeron en el grupoIII. A todos se les midió la VOPbt con VOPITB y VaSera. Resultados La correlación de VOPbt entre ambos equipos fue r=0,93 (p<0,001) y el porcentaje de error calculado con análisis de Bland-Altman: 4,5%. La VOPbt con VOPITB fue (m/s): grupoI, 10,5±1,6 comparado con grupoII, 13,8±2,9 (p<0,001) y grupoIII, 14,1±2,7 (p<0,001). No se observaron diferencias entre gruposII y III. Los resultados obtenidos con VaSera fueron equiparables a los de VOPITB. Conclusiones La medición de la VOPbt con el equipo VOPITB es segura y de utilidad clínica similar a la realizada con VaSera. La incorporación de esta función a las prestaciones de VOPITB lo convertirá en un dispositivo completo para valorar la rigidez arterial (AU)

Background and objectives The brachial-ankle pulse wave velocity (baPWV) is one of the most widely used arterial stiffness variables for assessing vascular risk. The abiPWV is a device that calculates various PWVs and the blood pressure ankle-brachial index (ABI). The device can also determine baPWV. The aim of this study was to calculate the baPWV with abiPWV, validate it with a reference device (VaSera) and study its clinical usefulness. Patients and methods We studied 113 patients (mean age, 53±12years), 59 (52%) of whom were women, and 10 (8.8%) of whom had a previous cardiovascular event. The participants were classified according to cardiovascular risk factors (CRFs) into groupI (none), groupII (1 or 2 CRFs) and groupIII (3 or more CRFs). The patients with a previous cardiovascular event were included in groupIII. All participants had their baPWV measured with abiPWV and VaSera. Results The baPWV correlation between the 2 devices was r=0.93 (P<.001), and the percentage error calculated with the Bland-Altman analysis was 4.5%. The baPWV measured with abiPWV (in m/s) was as follows: groupI, 10.5±1.6; groupII, 13.8±2.9 (P<.001 when compared with groupI); and groupIII, 14.1±2.7 (P<.001 when compared with groupI). There were no differences between groupsII and III. The results with VaSera were comparable to those of abiPWV. Conclusions Measuring baPWV with the abiPWV is safe and has a similar clinical utility to that of VaSera. Incorporating this function into the options of abiPWV makes it a complete device for assessing arterial stiffness (AU)

[Awareness, treatment and control of blood pressure according to place of recruitment and sex in the May Measure Month 2018 survey in Spain]. / Conocimiento, tratamiento y control de la presión arterial según lugar de reclutamiento y sexo en la encuesta May Measure Month 2018 en España.

OBJECTIVE: To analyse the data, according to recruiting place and sex, of the survey May Measure Month in 2018 (MMM18) in Spain, promoted by the International Society of Hypertension. METHODS: Subjects more than 18 years old were studied. MMM18 protocol was performed. Volunteers were recruited through the Spanish Society of Community Pharmacy (SEFAC) and the Spanish Society of Hypertension (SEH-LELHA). General linear models of blood pressure (BP) were carried out in subjects with and without treatment, and adjusted by age, sex, tobacco use, obesity and recruitment site. RESULTS: 7 511 individuals (mean age 51.7 ± 19.6 years, 36.8% males) were screened. Systolic and diastolic BP was higher in males (129.0-16.7/119.6-18.2 mmHg) (78.3-11.1/74.8-10.7 mmHg) (p < 0.001). There was a linear relationship between systolic BP, age and sex, with higher values in males (11.2 mmHg in untreated and 4.5 mmHg in treated) (p < 0.001). Diastolic BP was inverted U-shaped, with highest level in males and between 50-55 years. The proportion of individuals with hypertension (pharmacies; public and clinical area) was 47.2% (54.2; 34.1 and 34.8%). Seventy-five percent were aware of their diagnosis (77.5; 61.5 and 69.2%), with 22% of them without pharmacological treatment (20.7; 26.0 and 27.9%). Sixty-four point five percent of those under antihypertensive treatment met targets (62.9; 65.6 and 69.1%) (p < 0.001). CONCLUSIONS: There is big room for improvement in MMM indicators in Spain. Nearly half of subjects are hypertensive. Of those aware of their condition, 1 in 5 did not follow pharmacological treatment and of those treated, 1 in 3 did not meet targets. BP levels were significantly higher in males. Our study suggests that gender differences described should be considered in the BP thresholds established.

Ecografía clínica en el riesgo cardiovascular / Clinical ultrasonography in cardiovascular risk

En la prevención de la enfermedad cardiovascular, la estimación del riesgo cardiovascular es la piedra angular sobre la que se sustentan las intervenciones preventivas. En esta estimación del riesgo, la detección de daño cardiovascular subclínico supone una herramienta complementaria a la estratificación clásica basada en factores de riesgo. Por su versatilidad, disponibilidad, rapidez, bajo coste e inocuidad, la ecografía se ha situado con ventaja respecto a otras técnicas usadas en la detección de daño cardiovascular subclínico. Las guías de práctica clínica del ámbito de la prevención cardiovascular recomiendan su uso para la valoración de placas de ateroma e hipertrofia del ventrículo izquierdo como moduladores del riesgo cardiovascular. Además, la ecografía tiene otras aplicaciones relevantes en el ámbito del riesgo cardiovascular como son el diagnóstico del aneurisma de aorta abdominal, la valoración renal en pacientes con enfermedad renal crónica o sospecha de hipertensión arterial secundaria y la detección de esteatosis cuando se sospecha enfermedad por hígado graso no alcohólico

In the prevention of cardiovascular disease, determining the cardiovascular risk is the cornerstone of preventive interventions. In this risk estimation, detecting subclinical cardiovascular damage represents a complementary tool to classic stratification based on risk factors. The versatility, availability, speed, low cost and safety of ultrasonography place it ahead of other techniques employed in detecting subclinical cardiovascular damage. The clinical practice guidelines for cardiovascular risk prevention recommend the use of ultrasonography for assessing atheromatous plaques and left ventricular hypertrophy as modulators of cardiovascular risk. Ultrasonography also has other relevant applications in cardiovascular risk, including the diagnosis of abdominal aortic aneurysms, kidney assessments for patients with chronic kidney disease or suspected secondary arterial hypertension and the detection of steatosis when nonalcoholic fatty liver disease is suspected