RESUMO
Background: Orthostatic hypotension (OH) is a common disorder, and possibly underdiagnosed. In the elderly, OH has been considered a common cause of falls, fractures, and fear of falling. Its prevalence increases with age, probably related to the number of drug treatments, decreased fluid intake, and the progressive dysfunction of the autonomic nervous system. Objectives: To evaluate the prevalence of OH in a non-institutionalised population ≥80 years, according to different criteria based on sequential measurements taken at minute 0, 1, 3 and 5 of standing. Methods design: A diagnostic accuracy study using an oscillometric device. Setting and participants: Convenience sampling of 176 people ≥80 years attended in an urban Primary Health Care Centre. Measurements: Supine and standing blood pressure (BP) measurements, at minutes 0, 1, 3 and 5 using the OMRON 705-CP blood pressure device. OH definition: decrease ≥20 mmHg in systolic BP (SBP) and/or ≥10 mmHg in diastolic BP (DBP). Results: Mean age (Standard Deviation) was 85.2 (3.7) years, and 60.2% were women. Prevalence of OH: 30.7% at minute 0; 19.3% at minute 1; 18.2% at minute 3; and 20.5% at minute 5. Age, sedentary life, smoking, diabetes and SBP values were significantly associated with a greater BP decrease at minute 0. Conclusion: A third of the sample had OH, with a maximum prevalence at minute 0. From a clinical point of view, it is suggested that the definition of OH is prioritized according to the BP at minute 0
Introducción: La hipotensión ortostática (HO) es un fenómeno muy común posiblemente infradiagnosticado. En ancianos, la HO puede causar caídas, fracturas y miedo a caerse. Su prevalencia aumenta con la edad, seguramente en relación con el número fármacos prescritos, la disminución de ingesta de líquidos y la disfunción progresiva de su sistema nervioso autónomo. Objetivos: Evaluar la prevalencia de OH en ancianos mayores de 80años no institucionalizados según el criterio diagnóstico de HO en medidas secuenciales tomadas en los minutos 0, 1, 3 y 5 de bipedestación. Sujetos y métodos: Diseño: estudio de diagnóstico mediante aparato de presión oscilométrico. Muestra: muestreo a conveniencia de 176 pacientes ≥80 años atendidos en un centro de atención primaria urbano. Medidas: Presión Arterial (PA) en supinación y a los minutos 0, 1, 3 y 5 mediante un tensiómetro OMRON 705-CP. Definición de HO: descenso ≥20 mmHg en la PA sistólica (PAS) y/o ≥10 mmHg en la PA diastólica. Resultados: La media de edad (desviación estándar) fue de 85,2 (3,7) años, y el 60,2% fueron mujeres. Prevalencia de HO: 30,7% al minuto 0; 19,3% al minuto 1; 18,2% al minuto 3; 20,5% al minuto 5. Edad, sedentarismo, tabaquismo, diabetes y valores de PAS mostraron una asociación significativa con un mayor descenso de la PA en el minuto 0. Conclusión: Un tercio de la muestra presenta HO, con un máximo de prevalencia en el minuto 0. Desde el punto de vista clínico parece recomendable priorizar la definición de la HO según la PA en el minuto 0
Assuntos
Humanos , Masculino , Feminino , Idoso de 80 Anos ou mais , Hipotensão Ortostática/epidemiologia , Oscilometria/métodos , Serviços de Saúde para Idosos/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Hipertensão/epidemiologia , Fatores de RiscoRESUMO
BACKGROUND: Orthostatic hypotension (OH) is a common disorder, and possibly underdiagnosed. In the elderly, OH has been considered a common cause of falls, fractures, and fear of falling. Its prevalence increases with age, probably related to the number of drug treatments, decreased fluid intake, and the progressive dysfunction of the autonomic nervous system. OBJECTIVES: To evaluate the prevalence of OH in a non-institutionalised population ≥80 years, according to different criteria based on sequential measurements taken at minute 0, 1, 3 and 5 of standing. METHODS DESIGN: A diagnostic accuracy study using an oscillometric device. SETTING AND PARTICIPANTS: Convenience sampling of 176 people ≥80 years attended in an urban Primary Health Care Centre. MEASUREMENTS: Supine and standing blood pressure (BP) measurements, at minutes 0, 1, 3 and 5 using the OMRON 705-CP blood pressure device. OH definition: decrease ≥20mmHg in systolic BP (SBP) and/or ≥10mmHg in diastolic BP (DBP). RESULTS: Mean age (Standard Deviation) was 85.2 (3.7) years, and 60.2% were women. Prevalence of OH: 30.7% at minute 0; 19.3% at minute 1; 18.2% at minute 3; and 20.5% at minute 5. Age, sedentary life, smoking, diabetes and SBP values were significantly associated with a greater BP decrease at minute 0. CONCLUSION: A third of the sample had OH, with a maximum prevalence at minute 0. From a clinical point of view, it is suggested that the definition of OH is prioritized according to the BP at minute 0.
Assuntos
Determinação da Pressão Arterial/instrumentação , Hipotensão Ortostática/diagnóstico , Hipotensão Ortostática/epidemiologia , Oscilometria/instrumentação , Acidentes por Quedas , Idoso de 80 Anos ou mais , Determinação da Pressão Arterial/métodos , Feminino , Humanos , Vida Independente , Masculino , Prevalência , Distribuição por Sexo , Espanha/epidemiologiaRESUMO
Introducción: La American Diabetes Association ha introducido el valor deHbA1c ≥6,5% para el diagnóstico de la diabetes en 2010. Se desconoce elimpacto de su aplicación en la población mediterránea. Objetivos: Determinarcuántos pacientes dejaríamos de diagnosticar y cuánto tiempo se retrasaríael diagnóstico si se aplicara exclusivamente la HbA1c. Material y métodos:Estudio retrospectivo en 598 pacientes con diabetes mellitus tipo 2(DM2) diagnosticados en un centro de atención primaria entre 1991 y 2000.Los pacientes sin HbA1c en los primeros 3 meses después del diagnósticofueron excluidos. Los pacientes incluidos fueron reclasificados según la HbA1c(<5,7% normoglucemia, 5,7-6,4% categoría de riesgo, y ≥6,5% diabetes)globalmente y según el método diagnóstico utilizado (glucemia ≥140 mg/dL,glucemia ≥126 mg/dL y test de tolerancia oral a la glucosa [TTOG]). Se calculóel intervalo entre el diagnóstico y la primera HbA1c ≥6,5% en los pacientescon HbA1c <6,5%. Resultados: Se incluyeron 377 pacientes, 17 (4,5%)fueron reclasificados como normoglucémicos, 87 (23,1%) como categoría deriesgo y 273 (72,4%) como diabéticos. Sólo un 52,7% de los diagnosticadospor glucemia ≥126 mg/dL serían considerados diabéticos. La media de tiempohasta la primera HbA1c ≥6,5% fue de 3,40 años (desviación estándar [DE]2,35), siendo de 3,80 años (DE 2,49) para los normoglucémicos y de 3,33años (DE 2,34) para la categoría de riesgo. Conclusiones: El uso de la HbA1ccomo único criterio dejaría de diagnosticar o retrasaría el diagnóstico DM2 encasi la mitad de los casos, por lo que sería conveniente mantener la glucemiaplasmática como criterio principal y la HbA1c como un criterio adicional(AU)
Introduction: In 2010 the American Diabetes Association introduced thevalue of HbA1c at ≥6.5% for the diagnosis of diabetes. The impact of its implementationin the Mediterranean population is unknown. Objective: To determinehow many patients would not be diagnosed and how long diagnosisof diabetes would be delayed if only HbA1c was applied. Material andmethods: Retrospective study with 598 type 2 diabetes mellitus (T2DM)patients diagnosed between 1991 and 2000 in an urban primary healthcarecentre. Patients without HbA1c during the 3 months after diagnosis were excluded.Included patients were reclassified by HbA1c (<5.7% normoglycaemic,5.7-6.4% risk category and ≥6.5 diabetes), globally and by diagnosticmethod (glycaemia ≥140 mg/dL, glycaemia ≥126 mg/dL and oral glucosetolerance test). The period between diagnosis and the first HbA1c ≥6.5% inpatients with an HbA1c <6.5% was calculated. Results: 377 patients wereincluded, 17 (4.5%) were reclassified as normoglycaemic, 87 (23.1%) asdiabetes risk category and 273 (72.4%) as diabetics. Only 52.7% of patientsdiagnosed with glycaemia ≥126 mg/dL were considered diabetics. Meantime to the first HbA1c ≥6.5% was 3.40 (standard deviation [SD] 2.35) years,while for normoglycaemic patients it was 3.80 (SD 2.49) years and 3.33 (SD2.34) years for the risk category. Conclusions: The use of HbA1c as a singlecriterion could delay diagnosis of T2DM in almost half of cases. It seems appropriateto maintain plasma glucose as the main criteria and HbA1c as anadditional criteria(AU)
