Importancia del conocimiento óptimo de los profesionales sanitarios en el diagnóstico inicial de la hipertensión arterial / Importance of the optimal knowledge of healthcare professionals in the initial diagnosis of high blood pressure

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Right bundle branch block: Prevalence, incidence, and cardiovascular morbidity and mortality in the general population.

Background: Right bundle branch block (RBBB) is among the most common electrocardiographic abnormalities. Objectives: To establish the prevalence and incidence of RBBB in the general population without cardiovascular events (CVE) and whether RBBB increases cardiovascular morbidity and mortality compared with patients with a normal electrocardiogram (ECG). Methods: A historical study of two cohorts including 2981 patients from 29 primary health centres without baseline CVE. Cox (for CVE) and logistic (for cardiovascular factors) regression was used to assess their association with RBBB. Results: Of the patients (58% women; mean age 65.9), 92.2% had a normal ECG, 4.6% incomplete RBBB (iRBBB) and 3.2% complete RBBB (cRBBB). Mean follow-up was five years. Factors associated with appearance of cRBBB were male sex (HR = 3.8; 95%CI: 2.4-6.1) and age (HR = 1.05 per year; 95%CI: 1.03-1.08). In a univariate analysis, cRBBB was associated with an increase in all-cause mortality but only bifascicular block (BFB) was significant after adjusting for confounders. cRBBB tended to increase CVE but the results were not statistically significant. Presence of iRBBB was not associated with adverse outcomes. Patients with iRBBB who progressed to cRBBB showed a higher incidence of heart failure and chronic kidney disease. Conclusion: In this general population cohort with no CV disease, 8% had RBBB, with a higher prevalence among men and elderly patients. Although all-cause mortality and CVE tended to increase in the presence of cRBBB, only BFB showed a statistically significant association with cRBBB. Patients with iRBBB who progressed to cRBBB had a higher incidence of CVE. We detected no effect of iRBBB on morbidity and mortality.

[Determination of arm circumference for correct measurement of blood pressure. Results of an intervention study]. / La determinación del perímetro braquial para una adecuada medida de la presión arterial. Resultados de un estudio de intervención.

OBJECTIVE: To assess the effectiveness of an intervention to promote standardized arm circumference measurement as way to choose appropriate cuff size to measure blood pressure. PATIENTS AND METHODS: A before-after intervention study was performed in a basic health care area in Barcelona. Doctors, nurses and pharmacy staff participated by filling out an anonymous self-administered questionnaire pre- and post-intervention (3m). Variables included: demographics, type of professional, years since they finished their studies, availability of different cuff sizes, if arm circumference measurement were obtained or not, knowledge about the cutoff values for each cuff size and type of blood pressure monitor. INTERVENTION: The written results were given to the participants and presented in sessions. RESULTS: Pre- and post-intervention: 74.3 and 67.3% answered the questionnaires (P=ns), respectively. Determination of arm circumference varied from 1.3 to 19.1% (P=.009). A total of 37.3% and 44.1% declared that they had 2 or more available cuff sizes (P=ns). Knowledge about the correct measurement of the cuffs was 2.7 to 33.8% regarding the standard cuff size (P=.0198) and 0 to 23.5% for obese subjects (P<.05). When more than one cuff was available, reasons for the choice went from: «making a rough guess¼ or «when velcro stops sticking¼ before and after the intervention. All blood pressure devices in our primary health care center were electronic and automatic as were those of the 9 pharmacies. CONCLUSION: The intervention increased the determination of arm circumference prior to the reading of the blood pressure and the knowledge about the cutoff interval for standard and obese cuff size after intervention. There was greater availability of different sized cuffs. Despite this, the choice of the appropriate cuff size was not made based on arm circumference.

[Knowledge level of hypertensive patients about hypertension. Relationship between knowledge level and hypertension control]. / Estudio Conocimiento: grado de conocimiento sobre hipertensión arterial de nuestros pacientes. Relación con el nivel de control de la misma.

OBJECTIVE: To assess the knowledge of the hypertensive patients about their hypertension and their relation to its control. MATERIAL AND METHODS: Cross-sectional study among 400 hypertensive patients, all over 18 years, selected from 50 primary-care centres, who responded to an hypertension-related survey. Included variables were survey items, age, gender, educational level, professional occupation, blood pressure data and antihypertensive treatment. The obtained differences were analyzed using the chi-square test, Kruskal-Wallis, Wilcoxon, Anova and Bonferroni methods. RESULTS: There were 323 valid surveys. 52.9% of respondents were women, the average age: 65.4 years (SD: 11.2), 54.8% of them had primary education. 39.6% were aware of the objectives of systolic BP control. Only 19.6% having knowledge of those for diastolic BP control, with no differences between controlled and uncontrolled (systolic BP: 39% vs 38.1%, P=.887; diastolic BP: 19.2% vs 21%, P=.721). Over 70% knew about lifestyle changes, without significant differences between controlled and uncontrolled respondents. 82% of controlled respondents, and 79% of those uncontrolled, recognized the chronical nature of the treatment (P=.548), but 15.1% of the controlled respondents and 12.4% of uncontrolled respondents did not see the relation between the treatment and hypertension control (P=.525). 31.1% believed to be well-controlled, but in fact was not. CONCLUSIONS: Our patients doesn't know blood pressure targets of control. There isn't relationship between this knowledge and control of hypertension.

La determinación del perímetro braquial para una adecuada medida de la presión arterial. Resultados de un estudio de intervención / Determination of arm circumference for correct measurement of blood pressure. Results of an intervention study

Objetivo: Evaluar la eficacia de una intervención para promover la determinación del perímetro braquial para seleccionar el manguito adecuado para la toma de la presión arterial. Pacientes y métodos: Estudio de intervención antes-después. Incluyó médicos, enfermeras y personal de oficinas de farmacia de un área básica de salud en Barcelona. Encuesta autoadministrada pre y posintervención (3 m). Variables recogidas: demográficas, tipo de profesional, años desde la finalización de los estudios, disponibilidad de manguitos de diferentes medidas, determinación o no del perímetro braquial, conocimiento o no de los valores de corte para cada manguito y tipo de aparatos de medida. Intervención: entrega de los resultados escritos y presentación en sesiones. Resultados: Pre y posintervención: 74,3 y 67,3% encuestas cumplimentadas (p = ns), respectivamente. La determinación del perímetro braquial varió del 1,3 al 19,1% (p = 0,009). Declararon disponer de 2 o más manguitos de diferente medida el 37,3 y el 44,1% de los encuestados (p = ns). El conocimiento del intervalo de medida correcto de los manguitos fue del 2,7 al 33,8% para el manguito estándar (p = 0,0198) y del 0 al 23,5% para el de obesos (p < 0,05). Cuando disponían de más de un manguito la elección se realizaba por motivos como «a ojo» o «cuando salta el velcro» antes y después de la intervención. La totalidad de los aparatos del centro de atención primaria eran electrónicos automáticos, así como los de 9 farmacias. Conclusión: La intervención aumentó la determinación del perímetro braquial previa a la lectura de la presión arterial y el conocimiento del intervalo de los manguitos estándar y para obesos. Hubo una mayor disponibilidad de manguitos de distinto tamaño. A pesar de ello, la utilización de uno u otro manguito no se realizaba en función de la medida del perímetro braquial

Objective: To assess the effectiveness of an intervention to promote standardized arm circumference measurement as way to choose appropriate cuff size to measure blood pressure. Patients and methods: A before-after intervention study was performed in a basic health care area in Barcelona. Doctors, nurses and pharmacy staff participated by filling out an anonymous self-administered questionnaire pre- and post-intervention (3 m). Variables included: demographics, type of professional, years since they finished their studies, availability of different cuff sizes, if arm circumference measurement were obtained or not, knowledge about the cutoff values for each cuff size and type of blood pressure monitor. Intervention: The written results were given to the participants and presented in sessions. Results: Pre- and post-intervention: 74.3 and 67.3% answered the questionnaires (P = ns), respectively. Determination of arm circumference varied from 1.3 to 19.1% (P = .009). A total of 37.3% and 44.1% declared that they had 2 or more available cuff sizes (P = ns). Knowledge about the correct measurement of the cuffs was 2.7 to 33.8% regarding the standard cuff size (P = .0198) and 0 to 23.5% for obese subjects (P < .05). When more than one cuff was available, reasons for the choice went from: «making a rough guess» or «when velcro stops sticking» before and after the intervention. All blood pressure devices in our primary health care center were electronic and automatic as were those of the 9 pharmacies. Conclusion: The intervention increased the determination of arm circumference prior to the reading of the blood pressure and the knowledge about the cutoff interval for standard and obese cuff size after intervention. There was greater availability of different sized cuffs. Despite this, the choice of the appropriate cuff size was not made based on arm circumference

Estudio Conocimiento: grado de conocimiento sobre hipertensión arterial de nuestros pacientes. Relación con el nivel de control de la misma / Knowledge level of hypertensive patients about hypertension. Relationship between knowledge level and hypertension control

Objetivo: Evaluar el conocimiento de nuestros pacientes hipertensos sobre su HTA y su relación con el control de la misma. Material y métodos: Estudio descriptivo transversal con 400 hipertensos, mayores de edad, seleccionados de forma sistemática consecutiva de 50 consultas de atención primaria, que respondieron una encuesta sobre HTA. Las variables recogidas fueron los ítems de la encuesta, edad, sexo, nivel educacional, ocupación, cifras de presión arterial y tratamiento antihipertensivo. Las diferencias se analizaron con los test ji-cuadrado, Kruskal-Wallis, Wilcoxon, Anova y Bonferroni según distribución normal. Resultados: Fueron válidas 323 encuestas. El 52,9% fueron mujeres, edad media de 65,4años (DE: 11,2). El 54,8% contaban con estudios primarios. El 39,6% conocían los objetivos de control de PA sistólica, y solo el 19,6% los de PA diastólica, sin diferencias entre controlados y no controlados (PA sistólica: 39% vs 38,1%, p = 0,887; PA diastólica: 19,2% vs 21%, p = 0,721). Más del 70% conocían las modificaciones del estilo de vida, sin diferencias entre controlados y no controlados. El 82% de los controlados y el 79% de los no controlados reconocieron la cronicidad del tratamiento (p = 0,548), pero el 15,1% de los controlados y el 12,4% de los no controlados no lo relacionaban con el control de la HTA (p = 0,525). El 31,1% creían estar bien controlados aunque no lo estaban. Conclusiones: Los pacientes hipertensos conocen en baja frecuencia cuáles son los objetivos de control, sin encontrar relación entre el conocimiento del problema y el control del mismo

Objective: To assess the knowledge of the hypertensive patients about their hypertension and their relation to its control. Material and methods: Cross-sectional study among 400 hypertensive patients, all over 18 years, selected from 50 primary-care centres, who responded to an hypertension-related survey. Included variables were survey items, age, gender, educational level, professional occupation, blood pressure data and antihypertensive treatment. The obtained differences were analyzed using the chi-square test, Kruskal-Wallis, Wilcoxon, Anova and Bonferroni methods. Results: There were 323 valid surveys. 52.9% of respondents were women, the average age: 65.4 years (SD: 11.2), 54.8% of them had primary education. 39.6% were aware of the objectives of systolic BP control. Only 19.6% having knowledge of those for diastolic BP control, with no differences between controlled and uncontrolled (systolic BP: 39% vs 38.1%, P = .887; diastolic BP: 19.2% vs 21%, P = .721). Over 70% knew about lifestyle changes, without significant differences between controlled and uncontrolled respondents. 82% of controlled respondents, and 79% of those uncontrolled, recognized the chronical nature of the treatment (P = .548), but 15.1% of the controlled respondents and 12.4% of uncontrolled respondents did not see the relation between the treatment and hypertension control (P = .525). 31.1% believed to be well-controlled, but in fact was not. Conclusions: Our patients doesn’t know blood pressure targets of control. There isn’t relationship between this knowledge and control of hypertension

Estudio transversal comparativo de las fórmulas CKD-EPI y MDRD-4 a partir de la historia clínica informatizada de Atención Primaria de Barcelona / A comparative, cross-sectional study of the CKD-EPI and MDRD-4 equations from the Primary Care computerized clinical history of Barcelona

Antecedentes: La prevalencia de enfermedad renal crónica (ERC) en España supera el 7%. Su diagnóstico precoz puede ayudar a frenar la evolución. En Atención Primaria (AP) se calcula el filtrado glomerular estimado (FGe) mediante fórmulas basadas en la creatinina plasmática(CrP).Objetivos: Comparar los FG e según las fórmulas MDRD-4 y CKD-EPI a partir de la historia clínica informatizada (HCI) y la clasificación de ERC en una población de AP. Material y métodos: Estudio transversal. Se incluyó a pacientes de 20-99 años, asignados a centros de AP de Barcelona, con CrP entre julio de 2008 y junio de 2010. Se obtuvieron losdatos de la HCI. Se calculó el FGe mediante CKD-EPI y MDRD-4.Resultados: Se estudió a un total de 447.140 personas: 58,7% mujeres, 56,6 (DE 18,8) años. El 32,5% con diagnóstico de hipertensión arterial, 11% con diabetes mellitus y 9,3% con enfermedad cardiovascular asociada. La CrP media fue 0,89 (0,28) mg/dL, FGe por MDRD-4 de 80,59(21,04) mL/min/1,73 m2y por CKD-EPI de 85,03 (21,13) mL/min/1,73 m2. La CKD-EPI, respecto a MDRD-4, clasificó el 2,3% de los pacientes en estadios menos avanzados de ERC, el 96,8% en el mismo y el 0,9% en más avanzados. El índice kappa fue de 0,87. En números absolutos clasificó en estadios 3b-4-5 (posible derivación a nefrología) a 958 pacientes más, con 691 personas >69 años en estadio 3b.Conclusiones: Utilizar una u otra fórmula puede variar el FGe. La CKD-EPI tiende a clasificar enestadios más avanzados en > 69 años. El uso de cada fórmula puede hacer cambiar el número y tipo de derivaciones a nefrología

Background: The prevalence of chronic kidney disease (CKD) in Spain is higher than 7%. Its early diagnóstico can help to delay its progression. Glomerular filtration rate (GFR) based on serum creatinine (SC) is calculated in primary care (PC) to identify CKD. Objectives: To compare GFR by MDRD-4 and CKD-EPI equations obtained from clinical records(CR) and to compare the classification of CKD in a primary care population. Material and methods: A cross-sectional study was performed, including patients 20-99 years old, assigned to primary care centers of Barcelona, with a SC recorded between July 2008 and June 2010. Data were obtained from the CRs. GFR was calculated from MDRD-4 and CKD-EPI equations. Results: A total of 447,140 persons were studied (58.7% females, 56.6 [SD 18.8] years old).Of these 32.5% were diagnosed of hypertension, 11.0% diabetes and 9.3% had some associated cardiovascular disease. SC 0.89 (0.28) mg/dL (78.7 [SD 24.8] mol/L), GFR being 80.59(21.04) mL/min/1.73 m2by MDRD-4, and 85.03 (21.13) mL/min/1.73 m2by CKD-EPI. CKD-EPI compared to MDRD-4 classified 2.3% of patients in less advanced stages of CKD, 96.8% in the same stage and 0.9% in more advanced stages. Kappa coefficient: 0.87. In absolute numbers, CKD-EPI classified in 3b-4-5 stages (candidates for referral to nephrology) 958 patients more,691 of them being patients > 69 years old and stage 3b.Conclusions: Using one equation or another could vary the estimation of GFR. CKD-EPI tends to classify patients older than 69 into more advanced stages. Each equation can change the number and type of referral to nephrology (AU)

El filtrado glomerular reducido según las fórmulas de Cockcroft-Gault y MDRD no siempre predice la morbimortalidad cardiovascular en los pacientes hipertensos atendidos en atención primaria / Decreased glomerular filtration rate using the Cockgroft-Gaultand MDRD formulas does not always predict cardiovascular morbidity and mortality in hypertensive primary care patients

Antecedentes: El deterioro de la función renal se ha asociado con un incremento de la morbimortalidad cardiovascular. El objetivo del estudio fue analizar la asociación del filtrado glomerular (FG) basal, según las fórmulas de Cockcroft-Gault y MDRD, con la incidencia de eventos cardiovasculares (ECV) en una cohorte de personas hipertensas seguida durante 12 años. Métodos: Estudio prospectivo de una muestra aleatoria de 223 hipertensos libres de ECV atendidos en un centro de atención primaria urbano. Se estimó el FG mediante ambas fórmulas. Se consideró ECV la aparición de cardiopatía isquémica, insuficiencia cardíaca, accidente cerebrovascular, vasculopatía periférica o muerte por ECV. Se analizaron los datos mediante el método actuarial y modelos de regresión de Cox. Resultados: La mediana de tiempo de seguimiento fue de 10,7 años (rango intercuartílico,6,5-12,1). El seguimiento fue completo en 191 participantes (85,7%). La supervivencia acumulada fue del 64,7% (intervalo de confianza [IC] del 95%: 57,9-71,6%). La tasa media de incidencia de ECV durante todo el período de seguimiento fue de 3,6 (IC del 95%, 2,7-4,4%) por 100 personas hipertensas/año. El modelo multivariable final mostró que las variables con mayor poder predictivo de ECV en la población de estudio fueron la diabetes y la estimación del FG >60ml/min/1,73 m2mediante fórmula MDRD. Conclusiones: Se observó una relación entre la aparición de ECV y los valores de FG estimados por la fórmula MDRD al inicio del seguimiento superiores a 60 ml/min/1,73 m2, inversa a la eserada. La estimación del FG mediante fórmula de Cockcroft-Gault no se asoció con el riesgo cardiovascular (AU)

Background: Renal function decrease is associated with cardiovascular morbidity and mortality. The aim was to analyze the association of cardiovascular morbidity and mortality with baseline glomerular filtration rate (GFR), according Cockcroft-Gault and MDRD formulas, with incidence of major adverse cardiovascular events (MACEs) in a cohort of hypertensive individuals followed for 12 years. Methods: We performed a prospective study of a random sample of 223 hypertensive patients free of MACEs followed in an urban Primary Care Center. GFR was estimated using both formulas. MACEs were considered the onset of ischemic heart disease, heart failure, stroke, peripheral vascular disease or cardiovascular death. Data were analyzed using the life-table method and Cox regression modeling. Results: Follow-up median was 10.7 (interquartile range, 6.5-12.1) years. Follow-up was complete in 191 participants (85.7%). The cumulative survival was 64.7% (95%Confidence Interval (CI) 57.9%-71.6%). The incidence of MACEs during the follow-up period was 3.6 (95% CI, 2.7-4.4) per 100 subject-years. The final multivariable model showed that the most predictive variables of MACEs in the study population were the presence of diabetes and the estimation of GFR >60 ml/min/1.73 m2by MDRD equation. Conclusions: There was a relationship between the occurrence of MACEs and MDRD formula estimated GFR above60 ml/min/1.73 m2at study entry, inversely to what expected. C-G formula estimated GFR by was not associated with cardiovascular risk (AU)

[Decreased glomerular filtration rate using the Cockckroft-Gault and MDRD formulas does not always predict cardiovascular morbidity and mortality in hypertensive primary care patients]. / El filtrado glomerular reducido según las fórmulas de Cockcroft-Gault y MDRD no siempre predice la morbimortalidad cardiovascular en los pacientes hipertensos atendidos en atención primaria.

BACKGROUND: A decrease in renal function is associated with cardiovascular morbidity and mortality. The aim of this study was to analyse the association of cardiovascular morbidity and mortality with baseline glomerular filtration rate (GFR), calculated according to the Cockcroft-Gault and MDRD formulas, with the incidence of major adverse cardiovascular events (MACEs) in a cohort of hypertensive individuals followed for 12 years. METHOD: We performed a prospective study of a random sample of 223 hypertensive patients free of MACEs, who were followed in an urban Primary Care Centre. GFR was estimated using both formulas. MACEs were considered as the onset of ischaemic heart disease, heart failure, heart attacks, peripheral vascular disease or cardiovascular death. Data were analysed using the life-table method and Cox regression modeling. RESULTS: The median follow-up was 10.7 (interquartile range, 6.5-12.1) years. Follow-up was completed in 191 participants (85.7%). The cumulative survival was 64.7% (95% Confidence Interval (CI), 57.9-71.6). The incidence of MACEs during the follow-up period was 3.6 (95% CI, 2.7-4.4) per 100 subject-years. The final multivariable model showed that the most predictive variables of MACEs in the study population were the presence of diabetes mellitus and the estimation of GFR ≥60 ml/min/1.73 m2 by MDRD equation. CONCLUSIONS: There was a relationship between the occurrence of MACEs and an estimated GFR by MDRD above 60 ml/min/1.73 m2 at study entry, inversely to what was expected. GFR estimated by the C-G formula was not associated with cardiovascular risk.

DISEHTAE: diagnóstico, seguimiento y control de la HTA. Visión de su abordaje global en España / The DISEHTAE study: Diagnosis, follow-up and control of AHT. View of its global approach in Spain

IntroducciónPocos estudios valoran mediante indicadores específicos aspectos cruciales, como diagnóstico y seguimiento. El objetivo de este trabajo fue evaluar diagnóstico, seguimiento y control de la HTA en España, mediante indicadores establecidos.Material y métodosEstudio descriptivo transversal con auditoría externa de 7.802 hipertensos de 107 centros de salud españoles, visitados durante 2003. Se analizó edad, sexo, lugar de diagnóstico, cifras de presión, fecha de las visitas, medicación prescrita y cambios realizados, lugar de seguimiento, utilización de automedida o monitorización, revisión de los esfigmomanómetros y disposición de manguitos de distinto tamaño.ResultadosDe los 1.635 casos diagnosticados entre 1999 y 2003, un 14,3% (IC del 95%: 12,6–16%), lo fue de forma correcta. Durante el 2003, el 68,3% (IC 95%: 67,4–69,8) de los pacientes realizaron al menos 3 visitas de seguimiento. El 36,7%(IC del 95%: 35,7–36,9%) presentó un control óptimo, con tendencia al mejor control en los pacientes con más visitas de seguimiento. La combinación terapéutica estaba presente en el 44,1 % de los pacientes (IC 95%: 42,9; 45,3). Ante el mal control, se realizaron cambios en la prescripción en un 17,4% de los casos (IC 95%: 16,4; 18,4), siendo la asociación farmacológica el más frecuente (49,9% IC 95%: 47; 52,8). Los pacientes con presión arterial entre 140–150 y 90–95mmHg presentaron menor probabilidad de recibir cambios terapéuticos (OR: 0,19; IC 95%: 0,15–0,25). El 33% de los centros disponía de manguitos de distinto tamaño y realizaba revisión de los esfigmomanómetros.ConclusiónEl diagnóstico correcto de HTA se realiza en un porcentaje bajo de casos. Asimismo es bajo el porcentaje de pacientes bien controlados. Se observa un elevado número de visitas de seguimiento, pero con pocas modificaciones terapéuticas(AU)

IntroductionFew studies have evaluated crucial features, such as diagnosis and follow-up, with specific indicators. This study has aimed to evaluate the diagnosis, follow-up and control of arterial hypertension in Spain, using established indicators.MethodsA descriptive, cross-sectional nationwide study with external auditing was performed in 7802 hypertensive subjects who had attended 107 primary care centers from 14 regions in Spain during 2003. Age, gender, year, place of the diagnosis of hypertension, blood pressure values, date of visits, medication prescribed and changes made, site of follow-up, use of self-monitoring or ambulatory blood pressure monitoring, review of sphygmomanometers and availability of different cuff sizes were analyzed.ResultsFrom 1999 to 2003, only 14.3% [95% CI: 12.6–16.0] out of the 1,635 cases of hypertension were diagnosed in accordance with the treatment guidelines. In 2003, 68.6% (95% CI: 67.4–69.8) of the patients made at least 3 follow-up visits. Control rates were optimal in 36.7% [95% CI: 35.7–37.9]). Patients with a higher number of follow-up visits tended to have better control. A total of 44.1% of the patients received combination therapy (95% CI: 42.9–45.3). Prescription changes were made in 17.4% of the patients with poor control (95% CI: 16.4–18.4), drug assocation being the most frequent (49.9% 95% CI 47–52.8). Those patients whose blood pressure was between 140–150 and 90–95mmHg demonstrated a lower likelihood of receiving therapeutic changes (OR 9.19 95% CI: 0.15–0.25). Only 33% of the centers had different sizes of cuffs and inspected the sphygmomanometers.ConclusionsThe correct diagnosis of arterial hypertension is made in a low percentage of cases. Furthermore, the percentage of adequately controlled patients is low. An elevated number of follow-up visits was observed, but with few treatment modifications(AU)

¿Existen diferencias en el cribado de la hipertensión arterial entre la población inmigrante y la autóctona? / Are there differences in screening of high blood pressure between the immigrant and native population?

Introducción. El objetivo del estudio es analizar si la procedencia de la población influye en la incidencia de la hipertensión arterial (HTA) y en el cribado de ésta según las recomendaciones del Programa de Actividades Preventivas y de Promoción de la Salud. Material y métodos. Estudio de cohortes retrospectivo en el ámbito de Atención Primaria. Se incluyó la población atendida asignada desde el 1/1/2000 al 1/7/2005 en un centro de salud. Se excluyeron los que no tenían registrado el país de origen y los hipertensos conocidos. Mediante el registro informatizado de historias clínicas se recogió: procedencia, edad, sexo, incidencia de HTA y prevalencia de otros factores de riesgo cardiovascular (FRC) (diabetes mellitus, dislipemia, hábito tabáquico y sobrepeso-obesidad). Para analizar el efecto del origen en el correcto o incorrecto cribado de la HTA se realizó una regresión logística. Resultados. De los 21.055 pacientes asignados y atendidos se incluyeron 8.420, el 62,8 % de los cuales eran españoles. Se encontraron diferencias estadísticamente significativas entre autóctonos e inmigrantes en la edad, género y en todos los FRC. Se realizó un buen cribado de la HTA en un 94,6 % de los autóctonos y en un 94,3 % de los inmigrantes sin diferencias a nivel multivariante. La incidencia acumulada de hipertensión fue del 10,8 % (14,7 % en autóctonos y 4,2 % en inmigrantes). Conclusión. No se encontraron diferencias en el efecto del origen sobre el cribado correcto o no de la HTA. La incidencia de la HTA, así como la prevalencia de la mayoría de FRC es mayor en los autóctonos, lo que se podría deber a la mayor edad de este grupo (AU)

Introduction. This study aims to analyze if the origin of the population influences the incidence of high blood pressure (HBP) and in its screening according to the recommendations of the Preventive Activities and Health Promotion program. Material and methods. Retrospective cohort study in the scope of Primary Care. The population seen and assigned to a health care site from 1/1/2000 to 1/7/2005 was included. Those in whom country of origin was not registered and known hypertensive subjects were excluded. By the computerized registry of clinical histories, the following were collected: origin, age, gender, incidence of HBP and prevalence of other CRM (diabetes mellitus, dyslipidemia, smoking habit and overweightness-obesity). In order to analyze the effect of the origin on correct or incorrect screening of HBP, a logistic progression was performed. Results. A total of 8,420 out of 21,055 patients who were assigned to the site and seen with included. Of these, 62.8 % were Spanish. Statistically significant differences were found between natives and immigrants in age, gender and in all of the CRF. Good screening of HBP is performed in 94.6 % of the natives and in 94.3 % of the immigrants with no differences on the multivariant level. Accumulated incidence of hypertension was 10.8 % (14.7 % in natives and 4.2 % in the immigrants). Conclusion. No differences were found regarding the effect on correct screening or not of HBP. The incidence of H and prevalence of most of the CRF is greater in the natives, which could be due to the older age of this group (AU)

Control de la hipertensión arterial cuando existe afectación de órganos diana / Control of arterial hypertension when the target organs are affected

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Revisión y valoración de 5 guías de manejo de la hipertensión arterial / Review and appraisal of 5 guidelines for managing hypertension

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[Effectiveness of self-monitoring of blood pressure in white coat hypertension diagnosis. Rationale and design]. / Efectividad de la automedida de la presión arterial en el diagnóstico de la hipertensión clínica aislada. Justificación y diseño del estudio.

OBJECTIVE: To assess the effectiveness of blood pressure self-monitoring at home in front of 24-h blood pressure ambulatory measurement in isolated clinical hypertension diagnosis. DESIGN: Comparative study of repeated measurements of self-monitoring home BP and 24-h ambulatory BP measurement in a hypertensive patients sample. SETTING AND SUBJECTS TO STUDY: Mild-moderate essential hypertensive patients newly diagnosed or previously diagnosed in which suspect isolated clinical hypertension (BP>140/90 mm Hg in clinical setting repeatedly). It needs a sample of 182 hypertensive patients seen at urban primary health care. PRINCIPAL MEASUREMENTS: We compute the isolated clinical hypertension prevalence, the sensibility, specificity and positive and negative predictive values, with 95% confidence intervals. DISCUSSION: Prove the effectiveness of blood pressure self-monitoring at home in insolated clinical hypertension diagnosis, can involve an important cost saving for health care system as in hypertensive patient management (medicines and office visits), as in diagnosis equipment.

Efectividad de la automedida de la presión arterial en el diagnóstico de la hipertensión clínica aislada. Justificación y diseño del estudio / Efectiveness of self-monitoring of blood pressure in white coat hypertension diagnosis. Rationale and design

Objetivo. Determinar la efectividad de la automedida de la presión arterial (AMPA) domiciliaria frente al control ambulatorio (MAPA) de 24 h en el diagnóstico de la hipertensión clínica aislada (HCA). Diseño. Estudio comparativo de medidas repetidas de una prueba (AMPA) con un estándar de referencia (MAPA) en una serie de pacientes con hipertensión arterial esencial. Ámbito y sujetos de estudio. Se incluirá de forma consecutiva en el estudio a todos los pacientes con hipertensión arterial esencial, en estadio I-II o ligera-moderada, recién diagnosticados o diagnosticados previamente en los que se tenga la sospecha de HCA y que son atendidos en 5 centros de salud urbanos. La muestra necesaria calculada es de 182 pacientes. Mediciones principales. Se calcularán la prevalencia de HCA, la sensibilidad, la especificidad, los valores predictivos positivo y negativo de la AMPA, con sus correspondientes intervalos de confianza del 95%. Discusión. Demostrar la fiabilidad de la AMPA en el diagnóstico de la HCA puede suponer un ahorro importante para el sistema sanitario, tanto en costes directos de manejo del paciente hipertenso (fármacos y visitas) como en el utillaje para realizar dicho diagnóstico

Objective. To assess the efectiveness of blood pressure self-monitoring at home in front of 24-h blood pressure ambulatory measurement in isolated clinical hypertension diagnosis. Design. Comparative study of repeated measurements of self-monitoring home BP and 24-h ambulatory BP measurement in a hypertensive pacients sample. Setting and subjects to study. Mild-moderate essential hipertensive patients newly diagnosed or previously diagnosed in wich suspect isolated clinical hypertension (BP>140/90 mm Hg in clinical setting repeatedly). It needs a sample of 182 hypertensive patients seen at urban primary health care. Principal measurements.We compute the isolated clinical hypertension prevalence, the sensibility, specificity and positive and negative predictive values, with 95% confidence intervals. Discusion. Prove the efectiveness of blood pressure self-monitoring at home in insolated clinical hypertension diagnosis, can involve an important cost saving for health care system as in hypertensive patient management (medicines and office visits), as in diagnosis equipment

[The DISEHTAC II study: diagnosis and follow-up of hypertension in Catalonia. comparison with 1996 data]. / Estudio DISEHTAC II: diagnóstico y seguimiento de la hipertensión arterial en Cataluña. Comparación con los datos de 1996.

OBJECTIVE: To evaluate the changes in the diagnosis and follow-up of hypertension, and in the evaluation of cardiovascular risk, in a population served by primary care centers in Catalonia (northeastern Spain). Management was evaluated with indicators published in the Guidelines for Hypertension for Primary Care (Guía de Hipertensión Arterial para la Atención Primaria). DESIGN: Multicenter, observational, before-after design (1996-2001). SETTING: Primary care. PARTICIPANTS: Twelve primary care centers chosen from among the 31 centers that took part in the DISEHTAC I study (1996), with a total of 990 patient records. MAIN MEASURES: We analyzed age, sex, date of diagnosis of hypertension, number of blood pressure measurements needed for diagnosis, use of the mean value of duplicate blood pressure determinations, values for all blood pressure measurements in 2001, blood pressure determinations during the preceding 6 months, screening for and diagnosis of diabetes, dyslipidemia, smoking, obesity, and left ventricular hypertrophy. RESULTS: Of the 171 new cases of hypertension, 16.7% were diagnosed from at least 3 duplicate blood pressure measurements or as a result of acute episodes of hypertension. About one third (32.4%) of the patients with hypertension had blood pressure values below 140 and 90 mm Hg (25.7% in 1996), and the difference between the 2 sets of survey results was statistically significant. In three fourths (75.4%) of the patients, blood pressure had been measured during the preceding 6 months; this percentage was not significantly different in comparison to the figure found in 1996. Screening to detect cardiovascular risk factors was done in 50.4% of the patients (63.1% in 1996). CONCLUSIONS: Follow-up for hypertension in Catalonia has improved notably since 1996, but there was no improvement in the diagnosis of risk factors or in the integral evaluation of cardiovascular risk.

Estudio DISEHTAC II: diagnóstico y seguimiento de la hipertensión arterial en Cataluña. Comparación con los datos de 1996 / The DISEHTAC II study: diagnosis and follow-up of hypertension in Catalonia. Comparison with 1996 data

Objetivo. Evaluar los cambios producidos en el diagnóstico y seguimiento de la hipertensión arterial en la población atendida en los centros de atención primaria de Cataluña y valorar el riesgo cardiovascular a partir de los indicadores publicados en la Guía de Hipertensión Arterial para la Atención Primaria. Diseño. Estudio multicéntrico, observaciónal, antes-después (1996-2001).Emplazamiento. Atención primaria. Participantes. Doce centros de atención primaria, escogidos entre los 31 que participaron en el DISEHTAC I (1996),con un total de 990 historias clínicas. Mediciones principales. Se analizaron la edad, el sexo, la fecha de diagnóstico de hipertensión arterial, el número de tomas para el diagnóstico, la presencia de doblestomas de la presión arterial (PA) y las medias de éstas, los valores de todas lastomas de la PA del año 2001, la presencia de control de la PA en los últimos 6 meses, y el cribado y diagnóstico de diabetes, dislipemia, hábito tabáquico, obesidad ehipertrofia ventricular izquierda. Resultados. De los 171 casos nuevos de hipertensión arterial, el 16,7% fue diagnosticado con al menos 3 dobles tomas o como consecuencia de crisis hipertensivas. El 32,4% de los hipertensos presentaba cifras de PA < 140/90 mmHg (frente al25,7% en 1996), diferencias que son estadísticamente significativas. El 75,4% delos pacientes realizó al menos 1 visita en los últimos 6 meses, sin diferencias respecto a1996. El cribado de los factores de riesgo cardiovascular se efectuó en el 50,4% de los casos (63,1% en 1996).Conclusiones. El control de la hipertensión arterial en Cataluña ha mejorado notablemente desde 1996, pero no se observa mejora en el diagnóstico de los factores de riesgo ni en la valoración integral del riesgo cardiovascular

Objective. To evaluate the changes in the diagnosis and follow-up of hypertension, and in the evaluation of cardiovascular risk, in a population served by primary care centers in Catalonia (northeastern Spain). Management was evaluated with indicators published in the Guidelines for Hypertension for Primary Care(Guía de Hipertensión Arterial para la Atención Primaria).Design. Multicenter, observational, before-after design (1996-2001).Setting. Primary care. Participants. Twelve primary care centers chosen from among the 31 centers that took part in the DISEHTAC I study (1996), with a total of 990 patient records. Main measures. We analyzed age, sex, date of diagnosis of hypertension, number of blood pressure measurements needed for diagnosis, use of the mean value of duplicate blood pressure determinations, values for all blood pressure measurements in 2001, blood pressure determinations during the preceding6 months, screening for and diagnosis of diabetes, dyslipidemia, smoking, obesity, and left ventricular hypertrophy. Results. Of the 171 new cases of hypertension, 16.7% were diagnosed from at least 3 duplicate blood pressure measurements or as a result of acute episodes of hypertension. About one third (32.4%) of the patients with hypertension had blood pressure values below 140 and 90 mm Hg (25.7% in1996), and the difference between the 2 sets of survey results was statistically significant. In three fourths (75.4%) of the patients, blood pressure had been measured during the preceding 6 months; this percentage was not significantly different in comparison to the figure found in 1996. Screening to detect cardiovascular risk factors was done in 50.4%of the patients (63.1% in 1996).Conclusions. Follow-up for hypertension in Catalonia has improved notably since 1996,but there was no improvement in the diagnosis of risk factors or in the integral evaluation of cardiovascular risk