[Cardiovascular preventive recommendations. PAPPS 2022 thematic updates. Working groups of the PAPPS]. / Recomendaciones preventivas cardiovasculares. Actualización PAPPS 2022.

The recommendations of the semFYC's Program for Preventive Activities and Health Promotion (PAPPS) for the prevention of cardiovascular diseases (CVD) are presented. The following sections are included: epidemiological review, where the current morbidity and mortality of CVD in Spain and its evolution as well as the main risk factors are described; cardiovascular (CV) risk and recommendations for the calculation of CV risk; main risk factors such as arterial hypertension, dyslipidemia and diabetes mellitus, describing the method for their diagnosis, therapeutic objectives and recommendations for lifestyle measures and pharmacological treatment; indications for antiplatelet therapy, and recommendations for screening of atrial fibrillation, and recommendations for management of chronic conditions. The quality of testing and the strength of the recommendation are included in the main recommendations.

Control de la presión arterial en la población hipertensa española asistida en Atención Primaria. Estudio PRESCAP 2010 / Blood pressure control in hypertensive Spanish population attended in Primary Care setting. The PRESCAP 2010 study

Fundamento y objetivo: Es necesario disponer de información actualizada sobre el control de la hipertensión arterial en condiciones reales de práctica clínica. Este estudio pretende conocer el grado de control de la presión arterial (PA) en hipertensos asistidos en Atención Primaria (AP). Pacientes y método: Estudio transversal realizado en hipertensos españoles ≥18 años asistidos en AP. La PA se midió estandarizadamente 2 veces en consulta matutina o vespertina, considerándose bien controlada cuando el promedio era <140/90mmHg en general y <130/80mmHg en pacientes con diabetes, insuficiencia renal o enfermedad cardiovascular; adicionalmente se analizó el buen control en toda la población con valores tensionales <140/90mmHg. Resultados: Se incluyeron 12.961 hipertensos (52,0% mujeres) con una edad media (DE) de 66,3 (11,4) años. El 46,3% (intervalo de confianza del 95% [IC 95%] 45,4-47,1) presentó buen control de PA sistólica y diastólica; con valores <140/90mmHg el buen control fue del 61,1% (IC 95% 60,2-61,9). El 63,6% recibía terapia combinada (44,1% 2 fármacos, 19,5% 3 o más). El porcentaje de control fue mayor (p<0,001) por las tardes (50,4%) que por las mañanas (45,1%), y en pacientes que habían tomado el tratamiento antihipertensivo el día de la visita (47,9%) frente a los que no lo habían tomado (30,5%). No tomar la medicación el día de la visita, el consumo elevado de alcohol y el antecedente de dislipidemia fueron los factores más asociados al mal control. Conclusiones: El estudio PRESCAP 2010 indica que casi 5 de cada 10 hipertensos tienen bien controlada la PA. Existen diferencias importantes según el horario de consulta y la toma previa de antihipertensivos. El control ha mejorado respecto al PRESCAP 2006 (AU)

Background and objective: This study was aimed at determining the degree of blood pressure (BP) control in hypertensive patients attended in primary care (PC) settings. Patients and method: Cross-sectional, multicenter study. Hypertensive patients ≥18 years under antihypertensive treatment attended in Spanish PC settings were included. BP control was regarded as optimum when BP values were <140/90mmHg in general population and <130/80mmHg in patients with diabetes, chronic renal disease or cardiovascular disease. BP control was also calculated for all patients when it was <140/90mmHg. Results: A total of 12,961 hypertensive patients (52.0% women) with a mean age of 66.3 (±11.4) years were included. A percentage of 46.3 (95% CI: 45.4-47.1) presented good systolic BP and diastolic BP control; 61.1% (IC 95%: 60.2-61.9) of patients presented good BP control <140/90. A percentage of 63.6% was treated with combination therapy (44.1% with 2 drugs, 19.5% with 3 or more). BP control was significantly higher in evening measurements (50.4%) than in morning measurements (45.1%), and in patients who had taken the treatment before the visit (47.9%) compared with those who had not (30.5%). Factors such as not taking the medication before the visit, heavy alcohol consumption and dyslipemia were the risk factors mostly associated with a poor BP control (P<0.001). Conclusions: Five out of 10 hypertensive patients treated in PC settings have an optimal BP control. The degree of control of arterial hypertension has improved with respect to the PRESCAP 2006 study (AU)

[Blood pressure control in hypertensive Spanish population attended in primary care setting. The PRESCAP 2010 study]. / Control de la presión arterial en la población hipertensa española asistida en atención primaria. Estudio PRESCAP 2010.

BACKGROUND AND OBJECTIVE: This study was aimed at determining the degree of blood pressure (BP) control in hypertensive patients attended in primary care (PC) settings. PATIENTS AND METHOD: Cross-sectional, multicenter study. Hypertensive patients ≥18 years under antihypertensive treatment attended in Spanish PC settings were included. BP control was regarded as optimum when BP values were <140/90mmHg in general population and <130/80mmHg in patients with diabetes, chronic renal disease or cardiovascular disease. BP control was also calculated for all patients when it was <140/90mmHg. RESULTS: A total of 12,961 hypertensive patients (52.0% women) with a mean age of 66.3 (±11.4) years were included. A percentage of 46.3 (95% CI: 45.4-47.1) presented good systolic BP and diastolic BP control; 61.1% (IC 95%: 60.2-61.9) of patients presented good BP control<140/90. A percentage of 63.6% was treated with combination therapy (44.1% with 2 drugs, 19.5% with 3 or more). BP control was significantly higher in evening measurements (50.4%) than in morning measurements (45.1%), and in patients who had taken the treatment before the visit (47.9%) compared with those who had not (30.5%). Factors such as not taking the medication before the visit, heavy alcohol consumption and dyslipemia were the risk factors mostly associated with a poor BP control (P<.001). CONCLUSIONS: Five out of 10 hypertensive patients treated in PC settings have an optimal BP control. The degree of control of arterial hypertension has improved with respect to the PRESCAP 2006 study.

[Cross-sectional epidemiological study of clinical profiles and glycemic control in diabetic patients in primary care in Spain (the EPIDIAP study)]. / Estudio epidemiológico del perfil clínico y control glucémico del paciente diabético atendido en centros de atención primaria en España (estudio EPIDIAP).

OBJECTIVE: To assess the degree of glycemic control and its associated factors in patients with diabetes mellitus (DM) attended by primary care teams in Spain. MATERIAL AND METHODS: A cross-sectional multicenter study was carried out using a structured questionnaire in diabetic patients consecutively attended from January to August 2007. Three groups were assessed: patients with type 1 diabetes mellitus (DM) and those with insulin-treated or non-insulin-treated type 2 DM. The diagnosis of DM was established according to the American Diabetes Association (ADA) criteria. Good glycemic control was defined as a glycated hemoglobin (HbA1c) value

Cardiovascular risk and blood pressure control in a Spanish hypertensive population attended in a Primary Care setting. Data from the PRESCAP 2006 study.

AIMS: To analyse the cardiovascular risk of a broad sample of hypertensive patients and to examine whether there are differences in blood pressure control and associated factors according to the different cardiovascular risk categories. MAJOR FINDINGS: A total of 10,520 patients > or = 18 years old were included (mean age 64.6+/-11.3 years; 53.7% women). In this cohort, 3.3% were average risk, 22.6% low added risk, 22.2% moderate added risk, 33.5% high added risk and 18.4% very high added risk. Blood pressure was controlled in 41.4% (95% CI 40.5-42.4) of the total population, in 91.7% of patients with low added risk, in 19.4% with moderate added risk, in 27.4% with high added risk and in 6.8% with very high added risk. Diabetes was the factor most strongly associated with poor blood pressure control in patients with high to very high added risk (OR=7.2; p<0.0001). PRINCIPAL CONCLUSION: More than half of the hypertensive patients treated in primary health care have a high or very high added cardiovascular risk. In these patients, blood pressure control is inadequate and diabetes is associated with a sevenfold increase in the likelihood of poor blood pressure control.

Estudio epidemiológico del perfil clínico y control glucémico del paciente diabético atendido en centros de atención primaria en España (estudio EPIDIAP) / Cross-Sectional epidemiological study of clinical profiles and glycemic control in diabetic patients in primary care in Spain (the epidiap study)

Objetivo: Estimar el grado de control glucémico y los factores relacionados en pacientes con diabetes mellitus (DM) atendidos por equipos de atención primaria de todo el territorio español. Material y métodos: Diseño transversal multicéntrico, realizado a partir de un cuestionario estructurado aplicado a sujetos diabéticos atendidos consecutivamente durante el periodo enero-agosto de 2007. Se analizaron 3 grupos: diabetes mellitus tipo 1 (DM1), DM2 no tratados con insulina y DM2 en tratamiento con insulina. El diagnóstico de DM se realizó según criterios de la American Diabetes Association (ADA). El grado de control satisfactorio se estableció en glucohemoglobina (HbA1c) = 7%. Se recogieron variables sociodemográficas y clínicas, antecedentes personales y complicaciones clínicas. Los factores asociados al control se estudiaron mediante análisis de regresión logística múltiple. Resultados: Se reclutó a 679 pacientes, clasificados en DM1 (11,5%), DM2 con insulina (26,2%) y DM2 no tratados con insulina (62,3%). La media de edad fue 65,2 ± 13,7 años; el 52,4% eran mujeres; el 35,6% tenía obesidad; el 86%, dislipemia, y el 78,9%, hipertensión. El 53,1% (intervalo de confianza, 49,3-56,9) tuvo un control satisfactorio (por grupos: el 31,5, el 32,7 y el 65,4% respectivamente; p < 0,001). Como factores predictivos del control insatisfactorio se hallaron: edad (odds ratio [OR] = 0,984), el tiempo de evolución (OR = 1,033) y el tratamiento con insulina (OR = 4,054) (p < 0,001). El 5,8% de los sujetos cumplían todos los objetivos recomendados por la ADA. Conclusiones: El control glucémico de los pacientes es mejorable. Sólo 1 de cada 2 pacientes con DM atendidos en atención primaria presenta un control glucémico adecuado. El porcentaje de pacientes con un control glucémico satisfactorio en el grupo de pacientes en tratamiento con insulina (tipo 1 y 2) fue la mitad que el de los pacientes no tratados con insulina (AU)

Objective: To assess the degree of glycemic control and its associated factors in patients with diabetes mellitus (DM) attended by primary care teams in Spain. Material and methods: A cross-sectional multicenter study was carried out using a structured questionnaire in diabetic patients consecutively attended from January to August 2007. Three groups were assessed: patients with type 1 diabetes mellitus (DM) and those with insulin-treated or non-insulin-treated type 2 DM. The diagnosis of DM was established according to the American Diabetes Association (ADA) criteria. Good glycemic control was defined as a glycated hemoglobin (HbA1c) value = 7%. Sociodemographic characteristics, medical history, and clinical complications were collected. Factors associated with glycemic control were analyzed by means of multiple logistic regression analysis. Results: A total of 679 patients were included, classified into type 1 DM (11.5%), insulin-treated type 2 DM (26.2%) and non-insulin-treated type 2 DM (62.3%). The mean age was 65.2 ± 13.7 years, 52.4% were women, 35.6% were obese, 86.0%, were dyslipidemic and 78.9% had hypertension. A total of 53.1% (CI: 49.356.9) showed good glycemic control (distribution among groups: 31.5%, 32.7% and 65.4%, respectively; p < 0.001). Predictive factors for unsatisfactory control were age (odds ratio [OR] = 0.984), time from diagnosis (OR = 1.033) and insulin treatment (OR = 4.054) (p < 0.001). Only 5.8% of the individuals achieved all the objectives recommended by the American Diabetes Association. Conclusions: Glycemic control in diabetic patients can be improved. Only one in two patients with diabetes attended in primary care is properly controlled. The percentage of patients with satisfactory control in the insulin-treated group (types 1 and 2) was half that in the non-insulin-treated group (AU)

[Control of blood pressure in Spanish hypertensive population attended in primary health-care. PRESCAP 2006 Study]. / Control de la presión arterial en la población hipertensa española atendida en atención primaria. Estudio PRESCAP 2006.

BACKGROUND AND OBJECTIVES: More information is needed on hypertension control and its evolution in clinical practice. This study aimed to determine the degree of blood pressure (BP) control in Spanish hypertensive patients attended in primary care (PC) and to determine the factors associated with poor BP control. PATIENTS AND METHOD: Cross-sectional, multicenter study, carried out in PC settings throughout Spain. Hypertensive patients >or= 18 years, with antihypertensive treatment (>or= 3 months) were consecutively recruited. BP measurement was performed in surgery hours (morning and evening) following standardized methods and averaging 2 consecutive readings. BP control was regarded as optimum when BP values were < 140/90 mmHg in general population and <130/80 mmHg in patients with diabetes, chronic renal disease or cardiovascular disease. RESULTS: 10,520 hypertensive patients were included (53.7% women), mean age (SD) 64.6 (11.3) years. 41.4% (95% confidence interval [CI], 40.5-42.4) presented good systolic BP (SBP) and diastolic BP (DBP) control, 46.5% (95% CI, 45.5-47.4) only SBP control and 67.1% (95% CI, 66.2-68.0) only DBP control. 55.6% of patients were treated with combination therapy (41.2% 2 drugs, 11.7% 3 and 2.8% more than 3). BP control was significantly (p<0.001) higher in the evening measurement (48.9%) than in the morning measurement (40.5%), and if patients had taken the treatment before measurement (42.0%) compared with those who had not taken it (38.8%). Factors such as diabetes, cardiovascular disease, sedentary lifestyle, alcohol consumption and surgery hour were associated with poor BP control (p<0.001). CONCLUSIONS: The results of the PRESCAP 2006 study indicate that 4 out of 10 hypertensive patients treated in PC in Spain have an optimal BP control. The degree of control of arterial hypertension has improved remarkably with respect to the PRESCAP 2002 study.

Control de la presión arterial en la población hipertensa española atendida en atención primaria. Estudio PRESCAP 2006 / Control of blood pressure in Spanish hypertensive population attended in primary health-care. PRESCAP 2006 Study

Fundamento y objetivos: Es necesario tener mayor información sobre el grado de control de la hipertensión arterial (HTA) en condiciones reales de la práctica clínica. Los objetivos de este estudio fueron conocer el grado de control de presión arterial (PA) en pacientes hipertensos en atención primaria (AP) y determinar los factores asociados al mal control. Pacientes y método: Estudio transversal y multicéntrico que incluyó a individuos hipertensos de 18 o más años, que seguían tratamiento farmacológico antihipertensivo desde hacía al menos 3 meses, y que fueron seleccionados consecutivamente en consultas de AP de España. La medida de PA se realizó siguiendo normas estandarizadas según el horario de consulta (matutina o vespertina) y se calculó la media aritmética de 2 tomas sucesivas. Se consideró que había buen control cuando el promedio era inferior a 140/90 mmHg en general, y menor de 130/80 mmHg en pacientes con diabetes, insuficiencia renal o enfermedad cardiovascular. Resultados: Se incluyó a 10.520 hipertensos (53,7% mujeres), con edad media (desviación estándar) de 64,6 (11,3) años. El 41,4% (intervalo de confianza [IC] del 95%, 40,5-42,4) presentó un buen control de PA sistólica (PAS) y PA diastólica (PAD), el 46,5% (IC del 95%, 45,5-47,4) sólo de PAS y el 67,1% (IC del 95%, 66,2-68,0) sólo de PAD. El 55,6% recibía tratamiento combinado (41,2% 2 fármacos, 11,7% 3 fármacos, y 2,8% más de 3). El porcentaje de pacientes controlados fue significativamente mayor (p < 0,001) por las tardes (48,9%) que por las mañanas (40,5%), y en pacientes que habían tomado tratamiento antihipertensivo el día de la visita (42,0%) frente a los que no lo habían tomado (38,8%). La diabetes, la enfermedad cardiovascular, el sedentarismo, el consumo elevado de alcohol y el horario de consulta fueron los factores más asociados al mal control de la HTA (p < 0,001). Conclusiones: Los resultados del estudio PRESCAP 2006 indican que 4 de cada 10 pacientes hipertensos tratados y atendidos en AP en España tienen controlada óptimamente su HTA. Hay diferencias importantes en el grado de control según el horario de consulta y la toma previa de antihipertensivos. El control de la HTA ha mejorado apreciablemente respecto al PRESCAP 2002

Background and objectives: More information is needed on hypertension control and its evolution in clinical practice. This study aimed to determine the degree of blood pressure (BP) control in Spanish hypertensive patients attended in primary care (PC) and to determine the factors associated with poor BP control. Patients and method: Cross-sectional, multicenter study, carried out in PC settings throughout Spain. Hypertensive patients $ 18 years, with antihypertensive treatment ($ 3 months) were consecutively recruited. BP measurement was performed in surgery hours (morning and evening) following standardized methods and averaging 2 consecutive readings. BP control was regarded as optimum when BP values were < 140/90 mmHg in general population and < 130/80 mmHg in patients with diabetes, chronic renal disease or cardiovascular disease. Results: 10,520 hypertensive patients were included (53.7% women), mean age (SD) 64.6 (11.3) years. 41.4% (95% confidence interval [CI], 40.5-42.4) presented good systolic BP (SBP) and diastolic BP (DBP) control, 46.5% (95% CI, 45.5-47.4) only SBP control and 67.1% (95% CI, 66.2-68.0) only DBP control. 55.6% of patients were treated with combination therapy (41.2% 2 drugs, 11.7% 3 and 2.8% more than 3). BP control was significantly (p < 0,001) higher in the evening measurement (48.9%) than in the morning measurement (40.5%), and if patients had taken the treatment before measurement (42.0%) compared with those who had not taken it (38.8%). Factors such as diabetes, cardiovascular disease, sedentary lifestyle, alcohol consumption and surgery hour were associated with poor BP control (p < 0,001). Conclusions: The results of the PRESCAP 2006 study indicate that 4 out of 10 hypertensive patients treated in PC in Spain have an optimal BP control. The degree of control of arterial hypertension has improved remarkably with respect to the PRESCAP 2002 study

[Prevalence of undetected chronic kidney disease in dyslipidemic population treated in primary care. LIPICAP study]. / Prevalencia de la enfermedad renal crónica oculta en la población dislipémica asistida en atención primaria. Estudio LIPICAP.

BACKGROUND AND OBJECTIVE: Information about the prevalence of chronic kidney disease (CKD) in population treated in primary care (PC) is scarce. The aim of this study was to determine undetected CKD prevalence in dyslipidemic population measuring creatinine clearance according to the Cockcroft-Gault equation corrected for surface area. PATIENTS AND METHOD: Cross-sectional study including patients with diagnosis of dyslipidemia selected by consecutive sampling in PC. CKD was diagnosed when the glomerular filtration rate (GFR) was < 60 ml/min/1.73 m2. We assessed sociodemographic and clinical data, cardiovascular risk factors, coronary disease risk categories, dyslipidemia characteristics, functional CKD stage, and pharmacological treatments. RESULTS: The sample included 5,990 patients (50.2% women). The mean (standard deviation) age was 60.9 (11.1) years. The main reason for iclusion was hypercholesterolemia (65%), followed by mixed hyperlipidemia (26.4%), low high density lipoproteins (HDL)-cholesterol (4.9%) and hypertrigliceridemia (3.7%). According to the Cockcroft-Gault equation, CKD prevalence was 16.2% (95% confidence interval, 15.3-17.1) and it was significantly higher in women (22.7%) than in men (9.8%) (p < 0.0001). Patients with CKD were older compared with patients with normal GFR, and had higher systolic blood pressure, glucose and HDL-cholesterol (p < 0.001), as well as lower levels of total cholesterol, low density lipoproteins-cholesterol, and triglycerides (p < 0.01). The probability of presenting CKD was related to female gender, age, and lower body mass index. CONCLUSIONS: The LIPICAP study results indicate that almost 20% of PC dyslipidemic patients in Spain present undetected CKD when the GFR is measured according to the Cockcroft-Gault equation corrected for surface area.

Prevalencia de la enfermedad renal crónica oculta en la población dislipémica asistida en atención primaria. Estudio LIPICAP / Prevalence of undetected chronic kidney disease in dyslipidemic population treated in primary care. LIPICAP study

Fundamento y objetivo: Se dispone de poca información sobre la prevalencia de la enfermedad renal crónica (ERC) en atención primaria (AP). El objetivo del estudio LIPICAP ha sido determinar la prevalencia de ERC oculta en población dislipémica mediante el cálculo del aclaramiento de creatinina con la fórmula de Cockcroft-Gault corregida por superficie corporal. Pacientes y método: Se ha realizado un estudio transversal en pacientes dislipémicos seleccionados consecutivamente en AP. Se diagnosticó ERC cuando la tasa de filtrado glomerular (TFG) era inferior a 60 ml/min/1,73 m2. Se evaluaron datos sociodemográficos, clínicos, factores de riesgo cardiovascular, características de la dislipemia, estadio funcional de ERC y tratamientos farmacológicos. Resultados: Se incluyó a 5.990 pacientes (un 50,2% mujeres) con una edad media (desviación estándar) de 60,9 (11,1) años. El principal motivo de inclusión fue la hipercolesterolemia (65%), seguida de la hiperlipemia mixta (26,4%), cifras bajas de colesterol unido a lipoproteínas de alta densidad (cHDL) (4,9%) e hipertrigliceridemia (3,7%). El 16,2% (intervalo de confianza del 95%, 15,3-17,1) presentó ERC según la fórmula de Cockcroft-Gault, siendo la prevalencia mayor en las mujeres (22,7%) que en los varones (9,8%) (p < 0,0001). En comparación con los pacientes con una TFG normal, los pacientes con ERC tenían más edad, cifras mayores de presión arterial sistólica, glucosa y cHDL (p < 0,001) y valores inferiores de colesterol total, colesterol unido a lipoproteínas de baja densidad y triglicéridos (p < 0,01). La probabilidad de presentar ERC se relacionó con el sexo femenino, la edad y un índice de masa corporal inferior. Conclusiones: Los resultados del estudio LIPICAP indican que casi 2 de cada 10 pacientes diagnosticados de dislipemia y atendidos en AP presentan ERC oculta cuando se estima la TFG con la fórmula de Cockcroft-Gault corregida por superficie corporal

Background and objective: Information about the prevalence of chronic kidney disease (CKD) in population treated in primary care (PC) is scarce. The aim of this study was to determine undetected CKD prevalence in dyslipidemic population measuring creatinine clearance according to the Cockcroft-Gault equation corrected for surface area. Patients and method: Cross-sectional study including patients with diagnosis of dyslipidemia selected by consecutive sampling in PC. CKD was diagnosed when the glomerular filtration rate (GFR) was < 60 ml/min/1.73 m2. We assessed sociodemographic and clinical data, cardiovascular risk factors, coronary disease risk categories, dyslipidemia characteristics, functional CKD stage, and pharmacological treatments. Results: The sample included 5,990 patients (50.2% women). The mean (standard deviation) age was 60.9 (11.1) years. The main reason for iclusion was hypercholesterolemia (65%), followed by mixed hyperlipidemia (26.4%), low high density lipoproteins (HDL)-cholesterol (4.9%) and hypertrigliceridemia (3.7%). According to the Cockcroft-Gault equation, CKD prevalence was 16.2% (95% confidence interval, 15.3-17.1) and it was significantly higher in women (22.7%) than in men (9.8%) (p < 0.0001). Patients with CKD were older compared with patients with normal GFR, and had higher systolic blood pressure, glucose and HDL-cholesterol (p < 0.001), as well as lower levels of total cholesterol, low density lipoproteins-cholesterol, and triglycerides (p < 0.01). The probability of presenting CKD was related to female gender, age, and lower body mass index. Conclusions: The LIPICAP study results indicate that almost 20% of PC dyslipidemic patients in Spain present undetected CKD when the GFR is measured according to the Cockcroft-Gault equation corrected for surface area

[Arterial hypertension in immigrant patients in Spanish primary health care]. / Prevalencia de la hipertensión arterial en la población inmigrante asistida en atención primaria en España.

BACKGROUND AND OBJECTIVE: To evaluate the arterial hypertension (AHT) prevalence in a wide sample of immigrant patients. PATIENTS AND METHOD: A transversal and multicentric study that has included immigrant patients aged 18 years or more, consecutive sampling recruitment in primary healthcare consultations. The patient was defined with AHT hypertension when the average of 6 measurements in 3 visits (2 measurements per visit) was > or = 140 mmHg for the systolic blood pressure and/or 90 mmHg for diastolic blood pressure or if the patient had been previously diagnosed. RESULTS: 1,424 immigrants were followed-up (53.1% women) with average age (standard deviation) of 42.8 (13.1) years and mean stay in our country of 5.6 (5.7) years. Most of the patients' origin was Central and South America (40.2%) and Eastern Europe (21.9%). The prevalence of AHT was 31.4% (95% confidence interval [CI], 30.1-32.7%), of which the 62.1% where known patients. Patients coming from Asia showed a significant higher prevalence of AHT (40.0%; 95% CI, 38.7-41.3). CONCLUSIONS: Three of each 10 immigrant patients have AHT. There are significant differences according to the gender, the origin and period of residence of these patients.

Prevalencia de la hipertensión arterial en la población inmigrante asistida en atención primaria en España / Arterial hypertension in immigrant patients in Spanish primary health care

Fundamento y objetivo: Valorar la prevalencia de hipertensión arterial (HTA) en una amplia muestra de pacientes inmigrantes. Pacientes y método: Se ha realizado un estudio transversal y multicéntrico en pacientes inmigrantes de 18 años o más seleccionados consecutivamente en consultas de atención primaria de toda España. Se consideró que el paciente presentaba HTA cuando el promedio de 6 medidas de presión arterial en 3 visitas (2 tomas por visita) era igual o mayor de 140 mmHg para la sistólica y/o 90 mmHg para la diastólica, o cuando estaba diagnosticado de tal enfermedad. Resultados: Se estudió a 1.424 inmigrantes (un 53,1% mujeres) con una edad media (desviación estándar) de 42,8 (13,1) años y estancia media en nuestro país de 5,6 (5,7) años. La mayoría procedía de América Central y del Sur (40,2%) y Europa del Este (21,9%). La prevalencia de HTA fue del 31,4% (intervalo de confianza [IC] del 95%, 30,1-32,7%); de éstos, el 62,1% sabía que era hipertenso. Los individuos que procedían de Asia presentaban una prevalencia de HTA significativamente mayor (40,0%; IC del 95%, 38,7-41,3%). Conclusiones: Tres de cada 10 pacientes inmigrantes tienen HTA. Se observan diferencias según el sexo, la procedencia y el tiempo de estancia de los individuos

Background and objective: To evaluate the arterial hypertension (AHT) prevalence in a wide sample of immigrant patients. Patients and method: A transversal and multicentric study that has included immigrant patients aged 18 years or more, consecutive sampling recruitment in primary healthcare consultations. The patient was defined with AHT hypertension when the average of 6 measurements in 3 visits (2 measurements per visit) was >= 140 mmHg for the systolic blood pressure and/or 90 mmHg for diastolic blood pressure or if the patient had been previously diagnosed. Results: 1,424 immigrants were followed-up (53.1% women) with average age (standard deviation) of 42.8 (13.1) years and mean stay in our country of 5.6 (5.7) years. Most of the patients' origin was Central and South America (40.2%) and Eastern Europe (21.9%). The prevalence of AHT was 31.4% (95% confidence interval [CI], 30.1-32.7%), of which the 62.1% where known patients. Patients coming from Asia showed a significant higher prevalence of AHT (40.0%; 95% CI, 38.7-41.3). Conclusions: Three of each 10 immigrant patients have AHT. There are significant differences according to the gender, the origin and period of residence of these patients

[Control of hypertension in elderly patients receiving primary care in Spain]. / Control de la hipertensión arterial en la población española > or = 65 años asistida en atención primaria.

INTRODUCTION AND OBJECTIVES: Little information is available about the control of arterial hypertension in the elderly population. The aim of this study was to investigate hypertension control, factors associated with poor control, and general practitioners' responses to poor control in a large sample of hypertensive patients aged 65 years or older receiving primary care in Spain. PATIENTS AND METHOD: A cross-sectional study of elderly hypertensive patients taking antihypertensives was carried out. Blood pressure was measured in the standard manner. Blood pressure control was regarded as optimum if pressure averaged less than 140/90 mm Hg or, in diabetics, less than 130/85 mm Hg. RESULTS: The study included 5970 patients (mean age, 72.4 years; 62.8% women). Both systolic and diastolic blood pressures were well controlled in 33.5% of patients, systolic blood pressure alone in 35.5%, and diastolic blood pressure alone in 76.2%. Blood pressure control was found to be good more frequently when it was assessed in the evening (39.8%; P<.001), and when patients had taken treatment on the day of assessment (35.1%; P <.001). Some 12.9% of diabetics had pressures less than 130/85 mmHg and 9.7% had pressures less than 130/80 mmHg. General practitioners modified their therapeutic approach with only 17.2% of poorly controlled patients. CONCLUSIONS: Arterial blood pressure control was optimum in only three out of 10 Spanish hypertensive patients aged 65 years or older. Blood pressure control assessment was significantly influenced by surgery hours and by the timing of antihypertensive intake. General practitioners' therapeutic responses to poor control were too conservative.

Control de la hipertensión arterial en la población española ≥ 65 años asistida en atención primaria / Control of hypertension in elderly patients receiving primary care in Spain

Introducción y objetivos. Se dispone de escasa información sobre el control de la hipertensión arterial en la población de mayor edad. El objetivo de este estudio fue analizar el grado de control de la hipertensión arterial en una amplia muestra de españoles ≥ 65 años asistidos en atención primaria, los factores asociados al mal control yla conducta del médico ante esa situación. Pacientes y método. Estudio transversal realizado en hipertensos ≥ 65 años tratados farmacológicamente. Se midió la presión arterial (PA) siguiendo normas estandarizadas y se consideró que había un control óptimo si era <140/90 mmHg (en diabéticos < 130/85 mmHg).Resultados. Se incluyó a 5.970 pacientes (edad media,72,4 años; 62,8%, mujeres). El 33,5% presentó un buen control sistólico-diastólico, el 35,5% sólo sistólico yel 76,2% únicamente diastólico. El grado de control fue significativamente mayor (p < 0,001) por las tardes(39,8%) y en los pacientes que habían tomado la medicación antihipertensiva el día de la visita (35,1%). El 12,9% de los diabéticos mostró una PA < 130/85 mmHg y el9,7% < 130/80 mmHg. El médico modificó su conducta terapéutica en el 17,2% de los no controlados. Conclusiones. Tan sólo 3 de cada 10 hipertensos españoles≥ 65 años tienen la PA bien controlada. Hay diferencias apreciables en el grado de control según el horario de consulta y la toma previa de antihipertensivos. La conducta terapéutica del médico ante el mal control es demasiado tolerante

Introduction and objectives. Little information is available about the control of arterial hypertension in the elderly population. The aim of this study was to investigate hypertension control, factors associated with poor control, and general practitioners’ responses to poor control in a large sample of hypertensive patients aged 65 years or older receiving primary care in Spain. Patients and method. A cross-sectional study of elderly hypertensive patients taking anti-hypertensives was carried out. Blood pressure was measured in the standard manner. Blood pressure control was regarded as optimum if pressure averaged less than 140/90 mm Hg or, in diabetics, less than 130/85 mm Hg. Results. The study included 5970 patients (mean age,72.4 years; 62.8% women). Both systolic and diastolic blood pressures were well controlled in 33.5% of patients, systolic blood pressure alone in 35.5%, and diastolic blood pressure alone in 76.2%. Blood pressure control was found to be good more frequently when it was assessed in the evening (39.8%; P<.001), and when patients had taken treatment on the day of assessment (35.1%; P<.001). Some 12.9% of diabetics had pressures less than130/85 mmHg and 9.7% had pressures less than 130/80mmHg. General practitioners modified their therapeutic approach with only 17.2% of poorly controlled patients. Conclusions. Arterial blood pressure control was optimum in only three out of 10 Spanish hypertensive patients aged 65 years or older. Blood pressure control assessment was significantly influenced by surgery hours and by the timing of antihypertensive intake. General practitioners’ therapeutic responses to poor control were too conservative

[Blood pressure control in Spanish hypertensive patients in Primary Health Care Centres. PRESCAP 2002 Study]. / Control de la presión arterial en la población hipertensa española atendida en atención primaria. Estudio PRESCAP 2002.

BACKGROUND AND OBJECTIVE: More information is needed on hypertension control in clinical practice, which includes taking at least two blood pressure (BP) readings and taking into account surgery times and previous antihypertensive drug intake. Our study aimed to assess the optimum degree of BP control in a broad sample of Spanish hypertensive patients in primary care and to determine factors associated with a poor control. PATIENTS AND METHOD: Cross-sectional, multicenter study of hypertensive patients aged over 18 years and treated with drugs during the preceeding three months, who were recruited by general practitioners through consecutive sampling in primary care settings throughout Spain over 3 consecutive days. BP measurements were performed in surgery hours (morning and evening) following standardized methods and averaging two consecutive readings. An average BP lower than 140/90 mm Hg (values lower than 130/85 mm Hg in diabetics) was regarded as optimum BP control. RESULTS: 12 754 patients were included, mean age 63.3 years (10.8), 57.2% women. 36.1% (95% CI, 35.2-36.9) had good systolic blood pressure (SBP) and diastolic blood pressure (DBP) controls, 39.1% (95% CI, 38.3-40.0) had good SBP control only, and 73.1% (95% CI, 72.3-73.9) had good DBP control only. BP control was significantly (*2, p < 0.001) better during evening than during morning measurements (43.6% vs 37.1%) and in patients who had taken antihypertensive treatment before measurement (37.2%) vs. those who had not taken it (21.0%). Factors such as alcohol consumption, sedentary lifestyle, obesity and age were all associated with poor BP control (Wald's (chi 2, p < 0.001). CONCLUSIONS: The results of the PRESCAP 2002 study indicate that approximately 4 out of 10 hypertensive patients treated pharmacologically by primary health care centers in Spain have optimal BP control. Significant differences were found in the degree of control depending on surgery hours and the previous intake of antihypertensive medication.

[Epidemiology of heart failure]. / Epidemiología de la insuficiencia cardíaca.

Of all persons aged over 40 years, approximately 1% have heart failure. The prevalence of heart failure doubles with each decade of life, and is around 10% in persons over 70 years of age. In Spain, heart failure causes nearly 80,000 hospital admissions every year. As in other developed countries, heart failure is the most frequent cause of hospitalization among persons 65 years of age and over, and is responsible for 5% of all hospitalizations. The incidence of heart failure increases with age, and reaches 1% per year in those over 65. Heart failure is a progressive, lethal disorder, even with adequate treatment. Five-year survival is around 50%, which is no better than that for many cancers. In Spain, heart failure is the third leading cause of cardiovascular mortality, after coronary disease and stroke. In 2000, heart failure caused 4% of all deaths and 10% of cardiovascular deaths in men; the corresponding figures for women were 8% and 18%. In recent decades the prevalence and number of hospitalizations due to heart failure have increased steadily in developed countries. Heart failure will probably continue to increase in coming years: although its incidence has not materially decreased, survival is increasing due to better treatment. The control of risk factors for hypertension and ischemic heart disease, the main causes of heart failure in Spain, is the only method to halt the foreseeable increase in heart failure in the near future.

Control de la presión arterial en la población hipertensa española atendida en atención primaria. Estudio PRESCAP 2002 / Blood pressure control in Spanish hypertensive patients in Primary Health Care Centres. PRESCAP 2002 Study

FUNDAMENTO Y OBJETIVO: Es necesario tener mayor información sobre el grado de control de la hipertensión arterial en condiciones reales de la práctica clínica, lo que incluye realizar al menos 2 lecturas de la presión arterial, así como considerar el horario de la consulta y la toma previa de la medicación antihipertensiva. Los objetivos de este estudio fueron conocer el grado de control óptimo de la presión arterial en una amplia muestra de pacientes hipertensos españoles atendidos en atención primaria y determinar los factores asociados al mal control. PACIENTES Y MÉTODO: Estudio transversal y multicéntrico que incluyó a pacientes hipertensos mayores de 18 años que seguían tratamiento farmacológico antihipertensivo desde al menos 3 meses antes; fueron seleccionados mediante muestreo consecutivo durante 3 días por médicos de familia en las consultas de atención primaria del conjunto de España. La medida de presión arterial se realizó siguiendo normas estandarizadas según el horario de consulta (matutina o vespertina) y se calculó la media aritmética de 2 tomas sucesivas. Se consideró control óptimo de la hipertensión al promedio de la presión arterial inferior a 140/90 mmHg (en diabéticos, inferior a 130/85 mmHg). RESULTADOS: Se incluyó a 12.754 pacientes (57,2 por ciento mujeres), con edad media (desviación estándar) de 63,3 (10,8) años. El 36,1 por ciento (intervalo de confianza [IC] del 95 por ciento, 35,2-36,9) presentó buen control de la presión arterial sistólica y diastólica, el 39,1 por ciento (IC del 95 por ciento, 38,3-40,0) sólo de la sistólica, y el 73,1 por ciento (IC del 95 por ciento, 72,3-73,9) únicamente de la diastólica. El porcentaje de pacientes controlados fue significativamente mayor (X2, p < 0,001) por las tardes (43,6 por ciento) que por las mañanas (37,1 por ciento), así como de los pacientes que habían tomado el tratamiento antihipertensivo el día de la visita (37,2 por ciento) frente a los que no lo habían tomado (21,0 por ciento). El consumo elevado de alcohol, el sedentarismo, la obesidad y la edad fueron los factores que más se asociaron al mal control de la hipertensión arterial (X2 de Wald, p < 0,001). CONCLUSIONES: Los resultados del estudio PRESCAP 2002 indican que aproximadamente 4 de cada 10 hipertensos tratados farmacológicamente y atendidos en el ámbito de la atención primaria de España tienen un control óptimo de la hipertensión arterial. Existen diferencias apreciables en el grado de control según el horario de consulta y la toma previa de antihipertensivos (AU)

Epidemiología de la insuficiencia cardíaca / Epidemiology of heart failure

Cerca del 1 por ciento de la población mayor de 40 años presenta insuficiencia cardíaca. La prevalencia de esta enfermedad se dobla con cada década de edad y se sitúa alrededor del 10 por ciento en los mayores de 70 años. En España se producen cerca de 80.000 ingresos hospitalarios por insuficiencia cardíaca cada año. Al igual que en otros países desarrollados, la insuficiencia cardíaca es la primera causa de hospitalización en mayores de 65 años y da cuenta, aproximadamente, del 5 por ciento de todas las hospitalizaciones. Se trata de una afección que aumenta con la edad y alcanza el 1 por ciento al año en los sujetos mayores de 65 años. La insuficiencia cardíaca es un trastorno progresivo y letal, aun con tratamiento adecuado. La supervivencia es de alrededor del 50 por ciento a los 5 años del diagnóstico, por lo que no es mejor que la de muchos cánceres. La insuficiencia cardíaca es la tercera causa de muerte cardiovascular en España, por detrás de la cardiopatía isquémica y la enfermedad cerebrovascular. En el año 2000, entre los varones, la insuficiencia cardíaca fue responsable del 4 por ciento de todas las defunciones y del 10 por ciento de todas las muertes por enfermedades cardiovasculares; entre las mujeres, los porcentajes correspondientes fueron del 8 y del 18 por ciento. En las últimas décadas, la prevalencia y las hospitalizaciones por insuficiencia cardíaca han aumentado de manera considerable en los países desarrollados. Se espera que su frecuencia siga creciendo en los próximos años, dado que no se han producido descensos apreciables en su incidencia; sin embargo, su supervivencia está mejorando gracias a la disponibilidad de mejores tratamientos. El control de los factores de riesgo, como la hipertensión y la cardiopatía isquémica, las principales causas de insuficiencia cardíaca en España, es el único medio para controlar el previsible aumento de esta enfermedad en el futuro (AU)

De la ecuación de Framingham a la prevención cardiovascular / From Framingham´s equation to cardiovascular prevention

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