[Baseline clinical characteristics and management of patients included in IBERICAN study]. / Características clínicas basales y manejo de los pacientes incluidos en el estudio IBERICAN.

AIMS: To determine the prevalence and incidence of cardiovascular risk factors and cardiovascular events in Spain, as well as the quality of the follow-up in clinical practice. In this study the baseline data of the first interim analysis of IBERICAN are shown (n=830). METHODS: IBERICAN is a multicenter, longitudinal and observational population-based study of patients daily attended in primary care setting according to clinical practice in Spain. Subjects between 18 and 85 years daily attended in primary care setting are being included consecutively. Treatment of patients will be performed according only to clinical criteria of investigators. Blood pressure control was defined according to 2013 European guidelines of hypertension; LDL-cholesterol control was defined according to 2012 European guidelines of cardiovascular prevention; diabetes control was defined as HbA1c<7%. RESULTS: Mean age was 57.9±14.1 years. 54.1% of patients had dyslipidemia, 47.5% hypertension, 17.7% diabetes, and 10.8% history of ischemic heart disease. Regarding drugs, despite 55% of hypertensive patients were taking≥2 antihypertensive agents, only 59.9% achieved blood pressure targets; 65.7% of patients with dyslipidemia were taking statins, but only 35.6% attained LDL-cholesterol goals. Only 51.4% of diabetics achieved HbA1c goals. CONCLUSIONS: Subjects attended in primary care showed a high prevalence of cardiovascular risk factors with a poor control.

[Differences in the degree of control of arterial hypertension according to the measurement procedure of blood pressure in patients ≥ 65 years. FAPRES study]. / Diferencias en el grado de control de la hipertensión arterial según procedimiento de medida de la presión arterial en pacientes de edad ≥ 65 años. Estudio FAPRES.

BACKGROUND AND OBJECTIVES: Control of arterial blood pressure (BP) in hypertensive patients differs based on the evaluation procedure. This fact can be enhanced in subjects over 65 years of age. We have studied the degree of BP control with determinations in the office or ambulatory blood pressure monitoring (ABPM). METHODS: A multicenter, cross-sectional study was conducted in primary care (PC) and hypertension units in the Valencian Community. The first three hypertensive patients ≥ 65 years who attended the consultation on the first day of visits of the week of each investigator were included in the study. Cardiovascular risk factors, target organ damage and associated cardiovascular disease were recorded. Good clinical control values were defined as < 140/90 in the office and < 130/80 by ABPM for 24-hour according to 2007 ESH/ESC guidelines. RESULTS: A total of 1,028 hypertensive patients were included, 52.7% of whom were women, with a mean age of 72.6 years. Mean clinical BP was 146.7/81.1 mmHg and 24-hour ABPM 128.5/70.8 mmHg. Ninety-two percent of the patients were treated with antihypertensive drugs (35.6% monotherapy and 56.4% with combinations of two or more drugs). Good clinical control was found in 35.3% of cases (CI 95%: 32.4-38.2) and 50.9% (CI 95%: 47.8-54.0) (P < .001) had good control of 24-hour BP in ABPM. Male gender, personal background of heart disease and stroke were associated with good control of hypertension (P < .01) in 24-hour ABPM. CONCLUSIONS: In hypertensive patients over 65 years, and compared to the clinical determination of BP, the evaluation of ABMP showed a better proportion of controlled subjects. These findings support a wider use of ABPM to evaluate the control of BP in this population.

Diferencias en el grado de control de la hipertensión arterial según procedimiento de medida de la presión arterial en pacientes de edad >= 65 años. Estudio FAPRES / Differences in the degree of control of arterial hypertension according to the measurement procedure of blood pressure in patients >= 65 years. FAPRES study

Antecedentes y objetivos. El control de la presión arterial (PA) en pacientes hipertensos difiere en función del procedimiento de valoración. Este hecho puede estar acentuado en los mayores de 65 años. Hemos examinado el grado de control de la PA con determinaciones en consulta y monitorización ambulatoria de la PA (MAPA). Metodología. Estudio transversal multicéntrico realizado en Atención Primaria y unidades de HTA de la Comunidad Valenciana. Se incluyeron los tres primeros pacientes hipertensos ≥ 65 años que acudieron a consulta el primer día de visita de la semana de cada investigador. Se registraron factores de riesgo cardiovascular, lesión de órgano diana y enfermedad cardiovascular. Se definió buen control clínico. Valores < 140/90 mmHg y buen control ambulatorio valores por MAPA en 24 horas < 130/80 mmHg. Resultados. Se incluyó a 1.028 pacientes, edad media 72,8 años (52,7% de mujeres). La PA clínica media fue de 146,7/81,1 mmHg y con MAPA de 24 horas 128,5/70,8 mmHg. El 92% de los pacientes estaba tratado con antihipertensivos (35,6% monoterapia y 56,4% con combinaciones de dos o más fármacos). El 35,3% (IC95%,32,4-38,2) presentó buen control clínico y un 50,9% (IC95%: 47,8-54,0). Buen control con MAPA (p < 0,001). El género masculino y los antecedentes personales de cardiopatía e ictus fueron los factores significativamente asociados al buen control de la PA (p < 0,01) con MAPA. Conclusiones. En los pacientes hipertensos mayores de 65 años y en comparación con las determinaciones clínicas de PA, la valoración con MAPA muestra una mayor proporción de sujetos controlados. Estos hallazgos sustentan un uso más amplio de la MAPA para valorar el control de la PA en esta población(AU)

Background and objectives. Control of arterial blood pressure (BP) in hypertensive patients differs based on the evaluation procedure. This fact can be enhanced in subjects over 65 years of age. We have studied the degree of BP control with determinations in the office or ambulatory blood pressure monitoring (ABPM). Methods. A multicenter, cross-sectional study was conducted in primary care (PC) and hypertension units in the Valencian Community. The first three hypertensive patients ≥ 65 years who attended the consultation on the first day of visits of the week of each investigator were included in the study. Cardiovascular risk factors, target organ damage and associated cardiovascular disease were recorded. Good clinical control values were defined as < 140/90 in the office and < 130/80 by ABPM for 24-hour according to 2007 ESH/ESC guidelines. Results. A total of 1,028 hypertensive patients were included, 52.7% of whom were women, with a mean age of 72.6 years. Mean clinical BP was 146.7/81.1 mmHg and 24-hour ABPM 128.5/70.8 mmHg. Ninety-two percent of the patients were treated with antihypertensive drugs (35.6% monotherapy and 56.4% with combinations of two or more drugs). Good clinical control was found in 35.3% of cases (CI 95%: 32.4-38.2) and 50.9% (CI 95%: 47.8-54.0) (P < .001) had good control of 24-hour BP in ABPM. Male gender, personal background of heart disease and stroke were associated with good control of hypertension (P < .01) in 24-hour ABPM. Conclusions. In hypertensive patients over 65 years, and compared to the clinical determination of BP, the evaluation of ABMP showed a better proportion of controlled subjects. These findings support a wider use of ABPM to evaluate the control of BP in this population(AU)

Prevalence of low HDL cholesterol, and relationship between serum HDL and cardiovascular disease in elderly Spanish population: the PREV-ICTUS study.

OBJECTIVE: To assess the prevalence of low serum high-density lipoprotein cholesterol (HDL-C) concentration and the relationship between HDL-C and established cardiovascular disease (CVD) in an elderly Mediterranean population. METHODS: Analysis of Prevención del Riesgo de Ictus, a population-based study on Spanish subjects aged > or = 60 years. Low HDL-C was defined following the European guidelines for cardiovascular prevention [men: < 40 mg/dl (< 1.0 mmol/l); women: < 46 mg/dl (< 1.2 mmol/l)]. The relationship between low HDL-C or HDL-C concentration (in quintiles) and CVD was assessed through multivariate models that included cardiovascular risk factors, statins and subclinical organ damage. RESULTS: On 6010 subjects (71.7 years, 53.5% women), low HDL-C was present in 17.5% [95% confidence interval (CI): 16.5-18.5] and was more frequent in women [20.4% (19.0-21.8) vs. 14.1% (12.8-15.4) in men p < 0.001] and in patients with diabetes, CVD or statin therapy. Low HDL-C was independently associated with CVD [adjusted odds ratio (OR): 1.46, 95% CI: 1.22-1.74, p < 0.001]. The prevalence of CVD was higher as HDL-C concentration was lower (chi-square trend < 0.001). Compared with the highest quintile [> 65 mg/dl (> 1.67 mmol/l)], adjusted OR for CVD were 1.39 (1.10-1.76), 1.41 (1.11-1.80), 1.49 (1.18-1.89) and 1.91 (1.52-2.39), respectively for those in the fourth [57-65 mg/dl (1.46-1.67 mmol/l)], third [51-56 mg/dl (1.31-1.45 mmol/l)], second [46-50 mg/dl (1.18-1.30 mmol/l)] and first [< 46 mg/dl (< 1.18 mmol/l)] quintiles of HDL-C. This association was seen in males and females. CONCLUSIONS: A total of 17.5% of this Spanish population aged > or = 60 years had low HDL-C. We found a strong, independent and inverse association between HDL-C concentrations and established CVD, even at ranges of HDL-C considered as normal.

High doses of lercanidipine are better tolerated than other dihydropyridines in hypertensive patients with metabolic syndrome: results from the TOLERANCE study.

AIMS/INTRODUCTION: The TOlerabilidad de LERcanidipino 20 mg frente a Amlodipino y Nifedipino en CondicionEs normales de uso study was aimed to compare the tolerability of high doses of lercanidipine with amlodipine and nifedipine gastro-intestinal therapeutic system (GITS) in the treatment of hypertension in daily clinical practice. PATIENTS/METHODS: Essential hypertensives >or= 18 years, treated during at least 1 month with lercanidipine 20 mg, amlodipine 10 mg or nifedipine GITS 60 mg, after a previous treatment course of at least 1 month with half the dose of the corresponding drugs were included. We present the data of the subgroup of patients with metabolic syndrome (MetS). RESULTS: Three hundred and thirty-seven of the 650 study population fulfilled criteria of MetS, 233 (69.1%) on lercanidipine and 104 (30.9%) on amlodipine/nifedipine GITS. Overall, a significantly lower proportion of lercanidipine-treated patients showed adverse reactions (ARs) when compared with patients receiving other-dihydropyridines (DHPs) (60.1% vs. 73.1%, p = 0.003). Similarly, the most common vasodilation-related ARs (oedema, swelling, flushing and headache) were significantly less frequent in lercanidipine group (all p < 0.01). CONCLUSION: In conclusion, lercanidipine appears to exhibit a better tolerability profile and less vasodilation-related ARs compared with other DHPs in hypertensive patients with MetS.

[Diabetes mellitus in hypertensive population attended in Primary Care in Spain. Blood pressure and lipid control rates]. / Diabetes mellitus en la población hipertensa asistida en Atención Primaria en España.Grado de control tensional y lipídico.

OBJECTIVES AND METHODS: The aim of this study was to determine the blood pressure and LDL-cholesterol (LDL-c) control rates of hypertensive patients with diabetes mellitus attended in primary care setting in Spain, and to compare the data with those of the hypertensive population without diabetes. For this purpose, we analyzed the subset of diabetic patients of those included in the PRESCOT study (a cross-sectional survey of hypertensive subjects > 18 years attended in primary care). 12,954 patients (49.9% females; 62.1 +/- 10.7 years) were included in the PRESCOT study. Good controls were considered blood pressure < 130/80 mmHg (according to European Society of Hypertension-European Society of Cardiology [ESH-ESC] guidelines) and LDL-c < 100 mg/dl (National Cholesterol Education Program-Adult Treatment Panel III [NCEP-ATP III]). RESULTS: Overall, 3868 (29.9%) of PRESCOT patients were diabetics (mean age 64.2 +/- 9.8 years; 47.5% males). Almost all the diabetic patients (98.5%) were taking some drug besides the antidiabetic treatment and 84.9% were taking at least 2 drugs. Although diabetic patients were treated with more antihypertensive medication than those without diabetes (48.75% vs 40.85% were on > 2 drugs, p < 0.001), blood pressure control was much lower in diabetics (6.3% vs 32.7%, p < 0.0001). In the same way, LDL-c control was also lower in these patients (12.0% vs 31.9%, p < 0.0001). Only 1.0% of diabetic hypertensives were well controlled for both risk factors (vs 11.9% of non-diabetics, p < 0.0001). Predictors of bad blood pressure control were sedentarism and presence of associated clinical conditions, and for lipid control the younger age, female gender, overweight, alcoholism and non-use of lipid-lowering agents. CONCLUSIONS: The presence of diabetes in hypertensive population attended in Spanish primary health care is frequent. One out of every three hypertensives who attend the outpatient clinic daily is diabetic. Even though more drugs are prescribed in these patients, blood pressure and LDL-c control rates are significantly lower than in patients without diabetes. In the daily practice of primary care setting, almost no diabetic hypertensive subject is well controlled for blood pressure and LDL-c.

[Blood pressure and lipid control and coronary risk in the hypertensive population attended in Primary Care setting in Spain. The PRESCOT study]. / Control de presión arterial y lípidos y riesgo coronario en la población hipertensa asistida en Atención Primaria en España. Estudio PRESCOT.

OBJECTIVES AND METHODS: The aim of this cross-sectional and multicenter study was to determine the coronary risk of hypertensive patients attended in Spanish Primary Care and to evaluate whether blood pressure and LDL-cholesterol (LDL-c) control rates could change according to the ATP-III risk groups. Good blood pressure control was considered <140/90 mmHg (<130/80 mmHg for diabetics) and LDL-c according to the established by ATP-III for every risk group. RESULTS: A total of 12,954 patients were included in the study (49.9 % women, mean age 62.1+/-10.7 years). Of these, 12.6% belonged to the group of low risk, 45% to the medium risk group and 42.4% to the high risk group. The control rates were different according to the risk group (p <0.0001). Blood pressure control: 37.5 % in low risk, 30.2 % in medium and 15.4 % in high risk group. LDL-c control: 65.6 % in low risk group, 28 % in medium risk group and 12.3 % in high risk group. Only 25.8 % of the patients of low risk were controlled for both blood pressure and LDL-c, 9.6 % of medium risk group and 2.7 % of high risk group. CONCLUSIONS: The majority of hypertensive patients daily attended in Primary Care setting in Spain belongs to the medium or high coronary risk groups. Blood pressure and LDL-c controls rates in hypertensive population are low, and very few patients have both risk factors controlled. The control rates decline when the risk increases. In fact, less than 3% of high-risk patients have both parameters well controlled, what may result in significant clinical implications.

Automedida de la presión arterial. Documento de Consenso Español 2007 / Self-measurement of blood pressure. Consensus Paper Spain 2007

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Automedida de la presión arterial. Documento de Consenso Español 2007 / Self-measurement of blood pressure. Consensus Paper Spain 2007

No disponible

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[Strategies for effective control of arterial hypertension in Spain. Consensus document]. / Estrategias para un control eficaz de la hipertensión arterial en España. Documento de consenso.

Blood pressure (BP) control is inadequate among treated hypertensive patients in Spain. Control rates are lower than 40% of all treated patients and the cause of this problem is multifactorial. Despite the fact that possible solutions to this problem have been repeatedly suggested by expert groups along the last 10 years, BP control rates are still low. This fact have a negative impact on cardiovascular morbidity and mortality of patients with hypertension. The aim of the present document has been to achieve a consensus on effective specific measures in order to improve hypertension control rates in Spain. These measures involve health care professionals (physicians, nurses, pharmaceutics), health care authorities and patients. The document summarizes the consensus conference of several scientific societies involved in cardiovascular medicine in five group of measures: a) improvement of the methodology of office BP measurement; b) improvement of compliance to treatment by patients; c) clarification of pressure targets to be achieved in hypertensive patients; d) optimization of life style modifications and pharmacological treatment of hypertension; and e) continuous medical education. The document emphasize life style changes as a crucial aspect to be implemented in all patients. These changes have a beneficial impact on pressure reduction, contribute to a better control of associated cardiovascular risk factors, and increase the effectiveness of antihypertensive drugs. Health care professionals should base their clinical practice on the recommendations of guidelines in order to modify their therapeutic attitudes in patients whose targets have not been achieved.

Estrategias para un control eficaz de la hipertensión arterial en España. Documento de consenso / Strategies for effective control of arterial hypertension in Spain. Consensus document

El control de las cifras de presión arterial (PA) en los hipertensos tratados en España es insuficiente, no alcanza al 40% de los pacientes tratados y las causas son múltiples. Las posibles soluciones al problema han sido repetidamente sugeridas por grupos de expertos desde hace años, a pesar de lo cual las tasas de control siguen siendo inadecuadas, lo que repercute negativamente en la morbilidad y mortalidad de los pacientes. El objeto del presente documento ha sido analizar medidas concretas efectivas que mejoren el control de la hipertensión en España. Tales medidas afectan a los profesionales de la salud (médicos, profesionales de enfermería y farmacéuticos), a la administración sanitaria y a los propios pacientes. Este documento resume los resultados de esta conferencia de consenso en cinco grandes grupos: a) medidas para mejorar la metodología habitual en la medición de la PA en la consulta; b) medidas para mejorar el cumplimiento terapéutico por el paciente; c) medidas para clarificar el objetivo de PA que el médico debe fijar; d) medidas para optimizar el tratamiento y control de la hipertensión arterial; y e) aspectos de formación continuada. El documento enfatiza la recomendación de los cambios del estilo de vida en todos los pacientes hipertensos, tanto su acción beneficiosa sobre la hipertensión como por lo que implica en la corrección de otros factores de riesgo y en el aumento de la efectividad del tratamiento farmacológico. Los profesionales deben actuar conforme a guías terapéuticas o algoritmos que obliguen a modificar la conducta en los casos en que los objetivos pautados para cada paciente no hayan sido alcanzados

Blood pressure (BP) control is inadequate among treated hypertensive patients in Spain. Control rates are lower than 40% of all treated patients and the cause of this problem is multifactorial. Despite the fact that possible solutions to this problem have been repeatedly suggested by expert groups along the last 10 years, BP control rates are still low. This fact have a negative impact on cardiovascular morbidity and mortality of patients with hypertension. The aim of the present document has been to achieve a consensus on effective specific measures in order to improve hypertension control rates in Spain. These measures involve health care professionals (physicians, nurses, pharmaceutics), health care authorities and patients. The document summarizes the consensus conference of several scientific societies involved in cardiovascular medicine in five group of measures: a) improvement of the methodology of office BP measurement; b) improvement of compliance to treatment by patients; c) clarification of pressure targets to be achieved in hypertensive patients; d) optimization of life style modifications and pharmacological treatment of hypertension; and e) continuous medical education. The document emphasize life style changes as a crucial aspect to be implemented in all patients. These changes have a beneficial impact on pressure reduction, contribute to a better control of associated cardiovascular risk factors, and increase the effectiveness of antihypertensive drugs. Health care professionals should base their clinical practice on the recommendations of guidelines in order to modify their therapeutic attitudes in patients whose targets have not been achieved

Estrategias para un control eficaz de la hipertensión arterial en España. Documento de Consenso / Strategies for an effective control of arterial hypertension in Spain. Consensus Document

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Estrategias para un control eficaz de la hipertensión arterial en España. Documento de Consenso / No disponible

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Sexual dysfunction in hypertensive patients treated with losartan.

BACKGROUND: Impaired erectile function in men is a component of the dysmetabolic syndrome of high blood pressure as well as a sequela of antihypertensive therapy. This prospective interventional study in men with uncontrolled hypertension (blood pressure > or =140/90 mm Hg) used a survey instrument to assay sexual dysfunction before and after therapy with losartan. METHODS: We evaluated the influence of a 12-week therapy with losartan in 82 hypertensive subjects with (n = 82) and without (n = 82) a diagnosis of erectile dysfunction using a self-administered questionnaire validated in another 60 subjects with hypertension. RESULTS: From an initial sample of 323 hypertensive men and women, 82 men, aged 30 to 65 years, with sexual dysfunction underwent a 12-week regimen of losartan therapy (50-100 mg/day). Losartan treatment improved sexual satisfaction from an initial 7.3 to 58.5% (chi2; P = 0.001). Subjects reporting a high frequency of sexual activity improved from 40.5% initially to 62.3% after drug treatment, whereas the number of patients with low or very low frequency of sexual activity decreased significantly (chi2; P = 0.001). At the completion of the 12-week losartan regimen, only 11.8% of the treated subjects reported in improvement in sexual function. Improvement on quality of life was demonstrated in 73.7% of subjects medicated with losartan, 25.5% reported no changes, and only 0.8% felt worse. In the group without sexual dysfunction, losartan had a nonsignificant effect on sexual function. CONCLUSIONS: Our data suggest that losartan improved erectile function and both satisfaction and frequency of sexual activity. Because side effects are one of the most influential factors in the management of hypertension, an added benefit of losartan therapy may be its positive impact on quality of life.

Losartan reduces microalbuminuria in hypertensive microalbuminuric type 2 diabetics.

BACKGROUND: The aim of the present study was to assess the antialbuminuric effect of losartan in a large number of hypertensive type 2 diabetics. METHODS: This was a 6-month, open-label, prospective and multicentre study. A total of 422 patients with type 2 diabetes who were hypertensive [sitting systolic blood pressure (SBP) > or = 140 mmHg and/or diastolic blood pressure (DBP) > or = 90 mmHg] and microalbuminuric [urinary albumin excretion (UAE) 30-300 mg/day] were eligible for the study. After a 2-week run-in period, patients were placed on losartan 50 mg once a day. If the BP did not reach the desired goal (< 140/90 mmHg) after a 4-week period, the losartan dose was doubled. In the absence of control of BP, losartan 50 mg/day+hydroclorothiazide 12.5 mg/day was administrated. Initially and at 12 and 24 weeks of active treatment, BP, UAE, HbA(1c) and other renal function parameters were evaluated. RESULTS: A significant decrease in SBP and DBP was observed, as well as in parameters reflecting metabolic control, fasting glucose and HbA(1c). UAE also decreased significantly, but the percentage of the variance of change in UAE explained by the changes in SBP and HbA(1c) was, however, negligible, i.e. 4%. Moreover, small but significant reductions in uric acid, total cholesterol and triglycerides, and an increase in HDL-cholesterol levels were also observed. CONCLUSION: Antihypertensive treatment with losartan exerts a beneficial effect on UAE, a benchmark for measuring the efficacy of therapeutic interventions in diabetic nephropathy, by reducing BP and allowing better diabetes control. The role of other mechanisms influencing the favourable outcome, beyond these measured effects, needs to be assessed in further studies.

Reducción del riesgo en la hipertensión arterial asociada a factores de riesgo cardiovascular. proyecto hydra

En este artículo se presenta el proyecto HYDRA que pretende evaluar y comparar el efecto que producen, sobre la reducción del riesgo cardiovascular, un betabloqueante y un antagonista AT1 en pacientes con hipertensión arterial y alto riesgo cardiovascular. La edad, el sexo, el colesterol total, el colesterol HDL, la diabetes mellitus, el tabaquismo, la hipertrofia de ventrículo izquierdo y los niveles de la presión arterial son variables que cuantifican la determinación del riesgo cardiovascular. También se estudia la evolución de la proteinuria y la presión del pulso. El estudio se realizará sobre un total de 284 individuos pertenecientes a cinco comunidades autónomas y tendrá una duración de 52 semanas (AU)