Cumplimiento terapéutico y seguimiento del paciente hipertenso en atención primaria / Therapeutic compliance and follow-up of hypertensive patients in primary care

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Medida de la presión arterial en consulta y automatizada (BPTru®) para evaluar el efecto de bata blanca / Measurement of blood pressure in consultation and automated mesurement (BPTru ®) to evaluate the white coat effect

Fundamento y objetivo: El efecto de bata blanca (EBB) es uno de los principales sesgos que pueden modificar la medida de la presión arterial (PA) en consulta, por lo que se debe considerar para evitar errores diagnóstico-terapéuticos en los pacientes hipertensos. La utilización de aparatos automatizados en consulta podría disminuir dicho efecto. Método: Se diseñaron 2 estudios con el objetivo de evaluar las diferencias entre la medida rutinaria en consulta y la obtenida por el aparato automatizado de medida de PA en consulta, BPTru®, así como su influencia en el EBB. El primero de los estudios, TRUE-ESP, incluyó pacientes normotensos e hipertensos atendidos en consultas especializadas de Cardiología, Nefrología, Medicina Interna, Endocrinología y Medicina Familiar. El segundo, TRUE-HTA, incluyó pacientes hipertensos atendidos en una Unidad de HTA, protocolizada, con personal entrenado. Resultados: El estudio TRUE-ESP incluyó 300 pacientes, 76% hipertensos. Se observó una diferencia significativa entre la medida clínica y la medida BPTru® (media [DE] de PA sistólica/PA diastólica [PAS/PAD] de 9,8 [6,11]/3,4 [7,9] mmHg, p<0,001). El porcentaje de pacientes que cumplió criterios de EBB fue del 27,7%. El estudio TRUE-HTA incluyó 101 pacientes hipertensos. Se observó una diferencia significativa entre la medida clínica y la medida mediante BPTru® (media [DE] de PAS/PAD de 5,7 [3,9]/2,1 [3,5] mmHg, p<0,001) y la medida del período de actividad de la monitorización ambulatoria de la PA (MAPA) (media [DE] de PAS/PAD de 8,5 [6,7]/3,5 [2,5] mmHg, p<0,001). El porcentaje de pacientes que cumplió criterios de EBB fue del 32,1%. Conclusiones: El empleo de aparatos automatizados de medida de PA en consulta, como el BPTru®, puede colaborar a disminuir el EBB y mejorar la precisión de la medida de la PA en consulta (AU)

Background and objective: White coat effect (WCE) is one of the main bias that can affect office blood pressure (BP) measurement. Therefore, it is a factor must be considered in hypertensives to avoid mistakes in diagnosis and/or treatment. Employment of automated office BP (AOBP) devices could diminish that effect. Methods: Two studies were designed with the objective of evaluating differences between routinely office and AOBP measurements. WCE was also assessed. First, the TRUE-ESP study included normotensive and hypertensive patients attending specialized consultations at Cardiology, Nephrology, Internal Medicine, Endocrinology and Family Practice. Second, the TRUE-HTA study included hypertensives attending a protocoled Hypertension Unit, with a trained staff. Results: TRUE-ESP study included 300 patients, 76% being hypertensives. A significant difference between office BP and AOBP measurement (SBP/DBP 9.8±11.6/3.4±7.9mmHg, P<.001) was observed. Percentage of patients gathering WCE criteria was 27.7%. TRUE-HTA study included 101 hypertensive patients. A significant difference between office BP and AOBP measurement (SBP/DBP 5.7±9.3/2.1±5.3mmHg, P<.001) and activity period-ABPM (SBP/DBP 8.5±6.7/3.5±2.5mmHg, P<.001) was observed. Percentage of WCE patients was 32.1%. Conclusions: Use of AOBP devices can contribute to decrease WCE and to improve accuracy of office BP measurement (AU)

[Measurement of blood pressure in consultation and automated mesurement (BPTru(®)) to evaluate the white coat effect]. / Medida de la presión arterial en consulta y automatizada (BPTru®) para evaluar el efecto de bata blanca.

BACKGROUND AND OBJECTIVE: White coat effect (WCE) is one of the main bias that can affect office blood pressure (BP) measurement. Therefore, it is a factor must be considered in hypertensives to avoid mistakes in diagnosis and/or treatment. Employment of automated office BP (AOBP) devices could diminish that effect. METHODS: Two studies were designed with the objective of evaluating differences between routinely office and AOBP measurements. WCE was also assessed. First, the TRUE-ESP study included normotensive and hypertensive patients attending specialized consultations at Cardiology, Nephrology, Internal Medicine, Endocrinology and Family Practice. Second, the TRUE-HTA study included hypertensives attending a protocoled Hypertension Unit, with a trained staff. RESULTS: TRUE-ESP study included 300 patients, 76% being hypertensives. A significant difference between office BP and AOBP measurement (SBP/DBP 9.8±11.6/3.4±7.9 mmHg, P<.001) was observed. Percentage of patients gathering WCE criteria was 27.7%. TRUE-HTA study included 101 hypertensive patients. A significant difference between office BP and AOBP measurement (SBP/DBP 5.7±9.3/2.1±5.3 mmHg, P<.001) and activity period-ABPM (SBP/DBP 8.5±6.7/3.5±2.5 mmHg, P<.001) was observed. Percentage of WCE patients was 32.1%. CONCLUSIONS: Use of AOBP devices can contribute to decrease WCE and to improve accuracy of office BP measurement.

[Current situation of hypertensive patients over 75 years old: the DISEHTAE study]. / Situación actual del paciente hipertenso y mayor de 75 años en España. Estudio DISEHTAE.

OBJECTIVE: To assess in patients over 75 years old the degree of their compliance with recommendations on follow-up, control and treatment of hypertension. DESIGN: Descriptive, multi-centre study, covering the whole of Spain. SETTING: A total of 107 health centres from 14 autonomous communities. PARTICIPANTS: Hypertensive patients over 75: 1,369 clinical charts. INTERVENTIONS AND MAIN MEASUREMENTS: The variables studied were: age and sex, place monitored, blood pressure figures, screening for, and diagnosis of diabetes, hypercholesterolaemia, smoking, left ventricular hypertrophy (LVH) and obesity. Blood creatinine, proteinuria, prescribed medication, and infrastructure variables were also included. RESULTS: The most often screened cardiovascular risk factor (CRF) was obesity (76.1%), whilst the most prevalent was hypercholesterolaemia (31.3%). Of the patients, 25.5% had associated diabetes and 48.5% had a body mass index (BMI) >25. Low microalbuminuria (8.4%) was found. The proportion of patients with their blood pressure controlled was higher among those monitored in primary care (32.8%) than out of primary care (23.2%). No drug treatment was prescribed for 7.9%, only hygiene-dietary measures. The most common pharmacological group was that of the diuretics, followed by IECAS and ARA II. CONCLUSIONS: Though we can say that the degree of control of hypertension in elderly patients is steadily increasing, it is still far from optimal in most of our patients.

Situación actual del paciente hipertenso y mayor de 75 años en España. Estudio DISEHTAE / Current situation of hypertensive patients over 75 years old. The DISEHTAE study

Objetivo. Valorar, en el paciente mayor de 75 años, el grado de cumplimiento de las recomendaciones de seguimiento, control y tratamiento de la hipertensión arterial. Diseño. Estudio descriptivo, multicéntrico, de ámbito nacional. Emplazamiento. Ciento siete centros de salud de 14 comunidades autónomas de España. Participantes. Un total de 1.369 historias clínicas de pacientes hipertensos mayores de 75 años. Intervenciones y mediciones principales. Las variables estudiadas fueron edad y sexo, lugar de seguimiento, cifras de presión arterial, cribado y diagnóstico de diabetes, hipercolesterolemia, hábito tabáquico, hipertrofia ventricular izquierda y obesidad. También se estudiaron la creatinina plasmática, proteinuria, tratamiento farmacológico prescrito y variables de infraestructura. Resultados: El factor de riesgo cardiovascular más cribado fue la obesidad (76,1%), mientras que el más prevalente fue la hipercolesterolemia (31,3%). El 25,5% de los pacientes presentaba diabetes asociada, y el 48,5% de la muestra presentaba un índice de masa corporal (IMC) superior a 25. Se observó un bajo cribado de la microalbuminuria (8,4%). La proporción de pacientes con la presión arterial controlada es mayor entre los que se siguen en atención primaria, con un 32,8%, respecto a los seguidos fuera del ámbito de la atención primaria, con un 23,2%. A un 7,9% no se le había prescrito tratamiento farmacológico alguno, únicamente medidas higiénico-dietéticas. El grupo farmacológico más utilizado fueron los diuréticos, seguidos de inhibidores de la enzima conversiva de la angiotensina (IECA) y antagonistas de los receptores de la angiotensina II (ARA II). Conclusiones: Se puede llegar a la conclusión de que el grado de control de la hipertensión arterial en el paciente anciano va aumentando de forma progresiva, pero aún está muy lejos de lograrse un control óptimo en la mayoría de los pacientes

Objective. To assess in patients over 75 years old the degree of their compliance with recommendations on follow-up, control and treatment of hypertension. Design. Descriptive, multi-centre study, covering the whole of Spain. Setting. A total of 107 health centres from 14 autonomous communities. Participants. Hypertensive patients over 75: 1369 clinical charts. Interventions and main measurements. The variables studied were: age and sex, place monitored, blood pressure figures, screening for, and diagnosis of diabetes, hypercholesterolaemia, smoking, left ventricular hypertrophy (LVH) and obesity. Blood creatinine, proteinuria, prescribed medication, and infrastructure variables were also included. Results. The most often screened cardiovascular risk factor (CRF) was obesity (76.1%), whilst the most prevalent was hypercholesterolaemia (31.3%). Of the patients, 25.5% had associated diabetes and 48.5% had a body mass index (BMI) >25. Low microalbuminuria (8.4%) was found. The proportion of patients with their blood pressure controlled was higher among those monitored in primary care (32.8%) than out of primary care (23.2%). No drug treatment was prescribed for 7.9%, only hygiene-dietary measures. The most common pharmacological group was that of the diuretics, followed by IECAS and ARA II. Conclusions. Though we can say that the degree of control of hypertension in elderly patients is steadily increasing, it is still far from optimal in most of our patients

Hipotensión ortostática e hipertensión arterial. ¿Son iguales todos los antagonistas del calcio? / Orthostatic hypotension and hypertension. Are all the calcium antagonists similar?

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