Antithrombotic therapy and clinical outcomes at 1 year in the Spanish cohort of the EORP-AF Long-term General Registry.

BACKGROUND: Atrial fibrillation (AF) increases the risk of thromboembolism. We investigate the efficacy and safety of oral anticoagulation (OAC) therapy and explored the number needed to treat for net effect (NNTnet) of OAC in the Spanish cohort of the EURObservational Research Programme-AF (EORP-AF) Long-term General Registry. METHODS: The EORP-AF General Registry is a prospective, multicentre registry conducted in ESC countries, including consecutive AF patients. For the present analysis, we used the Spanish cohort, and the primary outcome was any thromboembolism (TE)/acute coronary syndrome (ACS)/cardiovascular death during the first year of follow-up. RESULTS: 729 AF patients were included (57.1% male, median age 75 [IQR 67-81] years, median CHA2 DS2 -VASc and HAS-BLED of 3 [IQR 2-5] and 2 [IQR 1-2], respectively). 548 (75.2%) patients received OAC alone (318 [43.6%] on VKAs and 230 [31.6%] on DOACs). After 1 year, the use of OAC alone showed lower rates of any TE/ACS/cardiovascular death (3.0%/year; p < 0.001) compared to other regimens, and non-use of OAC alone (HR 4.18, 95% CI 2.12-8.27) was independently associated with any TE/ACS/cardiovascular death. Balancing the effects of treatment, the NNTnet to provide an overall benefit of OAC therapy was 24. The proportion of patients on OAC increased at 1 year (87% to 88.1%), particularly on DOACs (33.6% to 39.9%) (p = 0.015), with low discontinuation rates. CONCLUSIONS: In this contemporary cohort of AF patients, OAC therapy was associated with better clinical outcomes at 1 year and positive NNTnet. OAC use slightly increased during the follow-up, with low discontinuation rates and higher prescription of DOACs.

Adherence to the "Mediterranean Diet" in Spain and Its Relationship with Cardiovascular Risk (DIMERICA Study).

BACKGROUND: Nutritional studies focus on traditional cultural models and lifestyles in different countries. The aim of this study was to examine the adherence to the Mediterranean diet, life habits, and risk factors associated with cardiovascular diseases among people living in different geographical regions in Spain. METHODS: A descriptive cross-sectional study was conducted in each region. The sampling scheme consisted of a random three-stage stratified sampling program according to geographic region, age, and gender. A total of 1732 subjects were asked to complete a questionnaire designed to assess their nutrient intake, dietary habits, and exercise. A diet score that assesses the adherence of participants to the Mediterranean diet (range 0-10) was also applied. RESULTS: Southeastern Spain had the lowest score for adherence to the Mediterranean diet because of the low consumption of fish and plant products. A lower adherence score to the Mediterranean diet was strongly associated with the prevalence of hypertension (p = 0.018). CONCLUSIONS: A low level of adherence to the Mediterranean diet is accompanied by a high prevalence of hypertension and, therefore, a raised cardiovascular risk in the country. The adherence score could help identify individuals at greater cardiovascular risk.

Análisis del uso racional de antihipertensivos en la región de Murcia / Analysis of the rational use of anti-hypertensives in the murcia (Spain) region

Objetivo: El objetivo del presente estudio ha sido conocer el patrón de uso de los fármacos antihipertensivos en la Región de Murcia, contrastando los resultados con los datos nacionales (patrón de referencia), pudiendo de esta manera detectar posibles puntos de mejora o establecer hipótesis para posteriores estudios. Diseño: Estudio farmacoepidemiológico (2004 a 2008), conforme a las recomendaciones de la OMS. Emplazamiento: Región de Murcia. Participantes: Censo poblacional anual. Mediciones principales: El uso de antihipertensivos se ha medido mediante el cálculo de la dosis diaria definida por mil habitantes-día (DHD). Resultados: La utilización de antihipertensivos se ha incrementado significativamente de 196,6 DHD a 235,8 DHD. Los antihipertensivos más usados en 2008 eran los ARA-II (38,6%), seguido de los IECA (21,8%). Se ha producido un cambio de tendencia en el uso de los bloqueantes del sistema renina angiotensina (BSRA), con un incremento del 77,5% en los ARA-II y una disminución del 9,5% en los IECA. La comparación con los datos nacionales muestran un menor uso de antihipertensivos y un diferente patrón en la Región de Murcia. Conclusiones: Se constata un menor uso de antihipertensivos respecto a España, por lo que podría haber infratratamiento de esta u otras enfermedades cardiovasculares en las que se usan estos fármacos en la Región de Murcia. Se observa un mayor uso de ARA-II, así como un menor uso de IECA. Las diferencias encontradas ponen de manifiesto la necesidad de realizar estudios encaminados a esclarecer sus causas, para lograr un uso más racional y eficiente de los antihipertensivos(AU)

Objective: The objective of this study was to determine the pattern of use of antihypertensive drugs in the Murcia Region, comparing the results with the national data, and detecting problems in order to make improvements, or establish hypotheses and to plan new studies. Design: Pharmacoepidemiological study (from 2004 to 2008) in accordance with the recommendations from World Heath Organization. Setting: Murcia Region. Participans: Annual census of each year. Main measurements: The use of antihypertensive drugs was measured by the daily doses per 1000 inhabitans-day (DHD). Results: The use of antihypertensive drugs has significantly increased from 196.6 DHD to 235.8 DHD. The antihypertensives more used at the end of 2008 were: angiotensin II receptor blockers-ARB- (38.6%) and angiotensin converting enzyme inhibitors-ACEI- (21.8%). There has been a tendency to change the use of rennin-angiotensin system blockers-RASB-, with an increase in ARB of 77.5% and a decrease in ACEI 9.5%. The comparison with the national data shows qualitative and quantitative differences in the pattern of antihypertensive drugs used during the studied period. Conclusions: The use of antihypertensive drugs in Murcia is less than in the rest of Spain. Therefore, this may be due to a problem of under treatment of this illness or other cardiovascular illnesses in the region. A greater use of ARB in Murcia and a lower use of ACEI was observed in Murcia. The differences found suggest that further studies are required to clarify their origins and causes, with the objective of achieving a more rational and efficient use of these drugs(AU)

[Analysis of the rational use of anti-hypertensives in the Murcia (Spain) region]. / Análisis del uso racional de antihipertensivos en la región de Murcia.

OBJECTIVE: The objective of this study was to determine the pattern of use of antihypertensive drugs in the Murcia Region, comparing the results with the national data, and detecting problems in order to make improvements, or establish hypotheses and to plan new studies. DESIGN: Pharmacoepidemiological study (from 2004 to 2008) in accordance with the recommendations from World Heath Organization. SETTING: : Murcia Region. PARTICIPANTS: Annual census of each year. MAIN MEASUREMENTS: The use of antihypertensive drugs was measured by the daily doses per 1000 inhabitans-day (DHD). RESULTS: The use of antihypertensive drugs has significantly increased from 196.6 DHD to 235.8 DHD. The antihypertensives more used at the end of 2008 were: angiotensin II receptor blockers-ARB- (38.6%) and angiotensin converting enzyme inhibitors-ACEI- (21.8%). There has been a tendency to change the use of rennin-angiotensin system blockers-RASB-, with an increase in ARB of 77.5% and and a decrease in ACEI 9.5%. The comparison with the national data shows qualitative and quantitative differences in the pattern of antihypertensive drugs used during the studied period. CONCLUSIONS: The use of antihypertensive drugs in Murcia is less than in the rest of Spain. Therefore, this may be due to a problem of under treatment of this illness or other cardiovascular illnesses in the region. A greater use of ARB in Murcia and a lower use of ACEI was observed in Murcia. The differences found suggest that further studies are required to clarify their origins and causes, with the objective of achieving a more rational and efficient use of these drugs.

Efficacy of moxonidine in the treatment of hypertension in obese, noncontrolled hypertensive patients.

BACKGROUND: Obesity has become an epidemic problem, contributing to metabolic syndrome, type 2 diabetes, hypertension, and cardiovascular disease. An adequate blood pressure control in this population of obese individuals is extremely difficult to achieve, and in most cases, therapeutic combinations are required. Pharmacologic treatment with moxonidine, a central I(1) imidazole receptor agonist, is a very interesting option because it acts upon the mechanisms implicated in the development of arterial hypertension in these patients. In addition, the drug improves the peripheral insulin resistance often found in obese patents, which contributes to maintain high blood pressure. METHODS: An interventional study has been designed, adding moxonidine to noncontrolled hypertensive, obese subjects in whom a hypocaloric diet was previously recommended. A total of 25 primary care centers participated in the study, with a total of 135 patients recruited. RESULTS: One hundred twelve patients were included in the study; 25 of them had type 2 diabetes. The mean reduction in systolic and diastolic blood pressure after 6 months treatment with moxonidine was 23.0 and 12.9 mm Hg, respectively. The mean systolic and diastolic pressures were 158.5 +/- 10.6 and 95.1 +/- 9 mm Hg, respectively, at baseline, versus 135.5 +/- 11.6 and 82.2 +/- 5.8 mm Hg at the end of the study. Creatinine clearance was significantly decreased in hyperfiltrating obese patients (143.6 +/- 31 vs. 128.2 +/- 27.9, P < 0.0001), without any significant change in patients with normal or slightly decreased renal function (81.9 +/- 18.9 vs. 80.9 +/- 17.5). Only 8 mild adverse reactions in 7 patients were recorded during the study. CONCLUSION: Moxonidine is useful and safe for controlling arterial hypertension in obese patients.