¿Cómo evaluar y mejorar la adherencia en la consulta diaria? / How to assess and to improve adherence in clinical practice?

El incumplimiento del tratamiento farmacológico en la hipertensión arterial se sitúa entre el 35 y el 50%. En todos los hipertensos mal controlados, siempre hay que pensar en un posible incumplimiento farmacológico como su causa. Para detectar el incumplimiento hay que utilizar un método válido de medición, destacando el test de Haynes por su alta especificidad, el recuento de comprimidos y el uso de la receta electrónica. Para mejorar el cumplimiento, lo mejor es una combinación de estrategias eficaces y, de forma individual, la más favorable es la simplificación del tratamiento. Medidas eficaces son el programa de automedida domiciliaria de la presión arterial, la combinación de fármacos en doble o triple terapia fija, la educación sanitaria escrita y en grupos, los calendarios recordatorios y las tarjetas de control del cumplimiento o la mejora de la relación médico-paciente

Prevalence of non-adherence of pharmacological therapy in hypertension is between 35 and 50%. In every uncontrolled hypertensive one should assess drug adherence as the cause. Several validated methods to detect noncompliance exist, being most frequently used Haynes test, pill count, and use of electronic prescription. Strategies to improve compliance should include a combination of adequate information to patients, a simplified scheme of treatment, and periodic adherence assessment. Programs for home self-measurement of blood pressure, use of double or triple drug fixed combinations, group health education, reminders, calendars, and cards enforcement, and improving doctor-patient relationship are also useful tools for compliance optimization

[How to assess and to improve adherence in clinical practice?] / ¿Cómo evaluar y mejorar la adherencia en la consulta diaria?

Prevalence of non-adherence of pharmacological therapy in hypertension is between 35 and 50%. In every uncontrolled hypertensive one should assess drug adherence as the cause. Several validated methods to detect noncompliance exist, being most frequently used Haynes test, pill count, and use of electronic prescription. Strategies to improve compliance should include a combination of adequate information to patients, a simplified scheme of treatment, and periodic adherence assessment. Programs for home self-measurement of blood pressure, use of double or triple drug fixed combinations, group health education, reminders, calendars, and cards enforcement, and improving doctor-patient relationship are also useful tools for compliance optimization.

Adherencia terapéutica en la enfermedad crónica: estado de la situación y perspectiva de futuro / Treatment compliance in chronic illness: current situation and future perspectives

Las enfermedades crónicas de larga duración poseen una elevada mortalidad y afectan por igual a ambos sexos. La falta de adherencia a las recomendaciones terapéuticas continúa siendo un obstáculo para mejorar la salud y la calidad de vida de los pacientes, además de conllevar un elevado coste sociosanitario. En este trabajo se desarrolla el concepto «adherencia terapéutica» que engloba tratamientos farmacológicos (cumplimiento terapéutico) y no farmacológicos (grado de coincidencia entre las recomendaciones ofrecidas, como pueden ser cambios en los hábitos de vida y su implantación por el paciente). También se analiza el impacto clínico y sociosanitario de la «adherencia terapéutica», así como las causas de la falta de adherencia y métodos y estrategias para mejorarla. Concluimos que la adherencia terapéutica debe ser un objetivo esencial del sistema sanitario, englobando todos los agentes implicados en la salud del paciente (AU)

Long-term chronic diseases have a high mortality rate around the world, affecting both genders equally. Despite improvements in the diagnosis and treatment of various health problems, lack of treatment compliance remains an obstacle to improving health and patient quality of life, and it carries a high associated socio-healthcare cost. The objectives of this study were to develop the concept of «therapeutic adherence», which includes both pharmacological compliance as well as non-pharmacological (level of agreement and patient involvement, lifestyle changes, etc.) treatments. The study also aimed to establish the clinical and socio-health impact of non-compliance, the reasons for non-compliance, and methods and strategies to improve compliance. The results of this study support therapeutic adherence as an essential goal of the healthcare system that encompasses all stakeholders involved in patient health (AU)

Treatment compliance in chronic illness: Current situation and future perspectives. / Adherencia terapéutica en la enfermedad crónica: estado de la situación y perspectiva de futuro.

Long-term chronic diseases have a high mortality rate around the world, affecting both genders equally. Despite improvements in the diagnosis and treatment of various health problems, lack of treatment compliance remains an obstacle to improving health and patient quality of life, and it carries a high associated socio-healthcare cost. The objectives of this study were to develop the concept of «therapeutic adherence¼, which includes both pharmacological compliance as well as non-pharmacological (level of agreement and patient involvement, lifestyle changes, etc.) treatments. The study also aimed to establish the clinical and socio-health impact of non-compliance, the reasons for non-compliance, and methods and strategies to improve compliance. The results of this study support therapeutic adherence as an essential goal of the healthcare system that encompasses all stakeholders involved in patient health.

Control de las cifras de presión arterial en diabéticos tipo 2 tratados con insulina / Blood pressure control in diabetics type 2 treated with insulin

Objetivo: Valorar el control de las cifras de presión arterial (PA) tras 2 añosde seguimiento, en pacientes diabéticos tipo 2 (DM2) tratados con insulina.Métodos: Estudio prospectivo, longitudinal y multicéntrico, realizado en atenciónprimaria, con la participación de 121 pacientes con DM2 que precisaroninicio o modificación del tratamiento con insulina y con seguimiento de 2 años.Se efectuaron 5 visitas (inclusión y 6, 12, 18 y 24 meses). Se midió la PA endos ocasiones. Se calcularon las medias de PA y el grado de control. Se considerócontrol cuando la PA fue <140 y 90 mmHg para la PAS y la PAD, respectivamente.Resultados: Concluyeron 103 pacientes (85,1%) (edad 66,4años; DE 11,6), de los que 45 (43,69%) eran varones. Las PAS y PAD fueron,respectivamente, de 140,2 (DE 14,2) y 86,1 (DE 9,2) mmHg en la visitainicial, de 140,3 (DE 14) y 86,8 (DE 8,6) mmHg al año, y de 141,3 (DE14,5) y 86,9 (DE 8,3) mmHg a los 2 años (p= NS entre la visita inicial y lafinal). Estaban controlados el 37,8% (IC 95%: 28,4-47,2), el 53,4% (IC95%: 43,8-63) y el 38,8% (IC 95%: 29,43-48,17) por visitas (inicial y 12 y24 meses, respectivamente) (p= NS inicial-final). Conclusiones: El controlde la PA en la DM2 tratada con insulina es muy bajo, no modificándose a los2 años de seguimiento(AU)

Objective: To know the blood pressure (BP) control in patients with type 2 diabetestreated with insulin after two years of follow-up. Setting: 9 health centersof Primary Care. Design: Prospective, longitudinal, multicentric study performedin Primary Care settings. 121 patients with type 2 diabetes who needed initiationor modifi cation of insulin therapy were included. During the 2 years of follow-up,5 visits (inclusion, and 6,12,18, and 24 months) were performed. The compliancewas studied by means of count of insulin. BP was measured in two occasionsand mean BP and degree of BP control was evaluated. Good control wasdefi ned when SBP was <140 mmHg, and DBP was <90 mmHg, respectively.Results: 103 patients (85.1%) (mean age 66.4 years, SD 11.6) concluded thestudy, of which 45 were men (43.69%). SBP and DBP were respectively 140.2(SD 14.2) and 86.1 (SD 9.2) mmHg at the initial visit, 140.3 (SD 14) and 86.8(SD 8.6) mmHg at 1 year and 141.3 (SD 14.5) and 86.9 (SD 8.3) at 2 years(p= NS between initial-fi nal visit). 37.8% (CI 95%: 28.4-47.2), 53.4% (CI 95%:43.8-63) and 38.8% (CI 95%: 29.43-48.17) for visits (initial, 12 and 24months, respectively) (p= NS initial-fi nal) had BP controlled. Conclusions:Blood pressure control in patients with type 2 diabetes treated with insulin is verylow, without changes after 2 years of follow-up(AU)

Evaluación de la situación actual del cumplimiento terapéutico en la hipertensión arterial en España, en opinión de los pacientes. Proyecto Cumplex II / No disponible

OBJETIVOS. Evaluar la opinión de los hipertensos españoles sobre diferentes aspectos relacionados con el cumplimiento terapéutico. METODOLOGÍA. Estudio descriptivo transversal mediante una encuesta a pacientes hipertensos en tratamiento antihipertensivo estable, realizada en centros de Atención Primaria de España. Se recogieron datos demográficos, se midió el cumplimiento mediante los cuestionarios de Batalla, Morisky-Green y Haynes-Sackett, y se interrogó sobre las causas por las que dejaban de tomar los comprimidos en alguna ocasión, la causa que consideraban más frecuente de incumplimiento y las estrategias que desearían que su médico o enfermera realizasen para mejorar el cumplimiento. RESULTADOS. Se incluyeron 4.952 pacientes (91,9%)(edad media: 62,6 años; desviación estándar [DE] 10,7 y47,2% mujeres). Fueron cumplidores el 90,3% (intervalo de confianza [IC] 99% = 89,2-91,4) mediante el cuestionario de Haynes-Sackett, el 11,3% (IC 99%=10,1-12,5) según Morisky-Green y el 69,5% (IC 99% = 67,8-71,2) según el de Batalla. Las causas más frecuentes por las cuales dejaron de tomar alguna vez la medicación fueron los olvidos involuntarios(77,4% [IC 99% = 67,8-71,2]) quedarse sin medicación(45,4% [IC 99% = 43,6-47,2]) y no encontrarse bien (34,5%[IC 99% = 32,8-36,2]). La causa de incumplimiento considerada como principal fueron los olvidos (80,3% [IC 99% =78,8-81,8]). Entre las estrategias que los pacientes deseaban para mejorar el cumplimiento, las preferencias oscilaron entre el 88,6% (IC 99% = 87,4-89,8) para la prescripción del menor número posible de comprimidos y el 10,8% (IC 99%= 9,7-11,9) para el contacto con el médico por correo electrónico. CONCLUSIONES. La principal causa de incumplimiento son los olvidos casuales, la estrategia preferida es la simplificación del tratamiento y los pacientes encuestados muestran escasas preferencias por el uso de nuevas tecnologías (AU)

OBJECTIVE. To evaluate the opinion of Spanish hypertensive patients regarding different aspects of treatment adherence. METHODS. Descriptive, cross-sectional study conducted by surveying hypertensive patients on stable anti-hypertensive treatment in Spanish Primary Care centres. Demographic data were collected and compliance was measured using the Batalla, Morisky-Green and Haynes-Sackett tests; the patients were asked why they had not taken the tablets on some occasion, what they considered to be the most common cause of non-compliance and which adherence-enhancing strategies they would like their doctor or nurse to adopt. RESULTS. A total of 4,952 patients (91.9%) were included in the study (mean age: 62.6 years [SD 10.7]; 47.2%women). Compliance was estimated to be 90.3% (CI 99%= 89.2-91.4), 11.3% (CI 99% = 10.1-12.5) and 69.5% (CI99% = 67.8-71.2) according to the Haynes-Sackett, Morisky-Green and Batalla test, respectively. The most common reasons for not taking the medication were forgetfulness(77.4% [CI 99% = 67.8-71.2]), running out of medication(45.4% [CI 99% = 43.6-47.2]) and not feeling well (34.5%[CI 99% = 32.8-36.2]). Forgetfulness was considered to be the primary cause of non-compliance (80.3% [CI 99% =78.8-81.8]). The patients’ preferred strategies for improving adherence varied between 88.6% (CI 99% = 87.4-89.8) for the prescription of the least number of tablets possible and 10.8% (CI 99% = 9.7-11.9) for e-mail contact with the physician. CONCLUSIONS. The main cause of non-compliance is forgetfulness; the preferred strategy for patients is the simplification of treatment regimens and there is little interest in using new technologies (AU)

[Evaluation of cardiovascular risk in the longitudinal phase of the Mediterranean study]. / Valoración del riesgo cardiovascular en la fase longitudinal del estudio Mediterránea.

INTRODUCTION AND OBJECTIVES: There is little information on cardiovascular longitudinal studies. In Spanish patients with hypertension (AHT)) and/or hypercholesterolemia (HC), with poor initial control of blood pressure (BP) and/or total cholesterol (TC), incidence rate (IR), cumulative incidence (CI), relative risks (RR), survival curves (SC), therapeutic compliance (TC) were quantified and the Framingham-Anderson scale (FAS) was adjusted to our patients. PATIENTS AND METHODS: A total of 6,893 primary prevention patients with AHT and/or with HC were included in primary prevention, with an average of 1.22 years of follow-up. A total of 480 physicians participated. Incidence rate (IR), cumulative incidence (CIN), relative risks (RR), survival curves (SC) by Kaplan-Meier method, and therapeutic compliance (TCOM) by Haynes-Sackett self-reported questionnaire were calculated. The Framingham-Anderson scale (FAS) was validated with Pearson's correlation coefficient (r) and intraclass correlation index (ICI). RESULTS: CIN was 1.59% (1.31-1.90); the IR 1,321.6 cardiovascular events/ 100,000 patients/year (1,026.6-1,598.8). RRs with statistical significance were: age (p = 0.03). Blood pressure at the end of the study (p = 0.02), coronary background (p = 0.00), left ventricular hypertrophy (LVH) (p = 0.00), microalbuminuria (p = 0.02), CT >/= 250 mg/dl (p = 0.01), fasting glycemia (Gb) >/= 126 mg/dl (p = 0.00), creatinine >/= 1.2 mg/dl at the beginning (p = 0.00) and at the end of the study (p = 0.00), and poor compliance in HC patients (p = 0.00). SC have statistical significance (p < 0.05) for AHT background, fasting glucose >/= 126 mg/dl, target organ damage, and high cardiovascular risk with FAS scale. The adjusted FAS formula for global cardiovascular risk was (0.415 x FAS Risk%) + 0.517%, r = 0.9962 (p = 0.00) and ICI = 0.9969 (p < 0.0001). CONCLUSIONS: The equation for the FAS scale was adjusted for Spanish AHT/HC patients. Prognostic factors and SC were calculated. Benefit between TC and decrease of CVR in HC patients was quantified.

Valoración del riesgo cardiovascular en la fase longitudinal del estudio Mediterránea / Evaluation of cardiovascular risk in the longitudinal phase of the Mediterranean study

Introducción y objetivos. Es escasa la información de estudios cardiovasculares longitudinales. En hipertensos (HTA) y/o hipercolesterolémicos (HCL) españoles, con mal control inicial de la presión arterial (PA) y/o del colesterol total (CT) se cuantifica la tasa de incidencia (TI), la incidencia acumulada (IA), los riesgos relativos (RR), las curvas de supervivencia(CS), el cumplimiento terapéutico (CU) y se ajusta la escala de Framingham-Anderson (FA) a nuestro entorno. Pacientes y métodos. Se analizaron 6.893 HTA y/o HCL en prevención primaria que aportaronun promedio de 1,22 años de seguimiento. Participaron 480 médicos. Se calcularon: la TI, IA y los RR; el método de Kaplan-Meier para la CS; Haynes-Sackett adaptado para el CU; el ajuste de FA por la recta de los mínimos cuadrados, coeficiente de correlación de Pearson (r) e intraclase (cci).Resultados. La IA fue 1,59% (1,31-1,90); la TI de 1.321, 6 eventos cardiovasculares por100.000 pacientes/año (1.026,6-1.598,8). Los RR significativos fueron: edad (p = 0,03),PA final (p = 0,02), antecedentes coronarios (p = 0,00), hipertrofia ventricular izquierda(HVI) (p = 0,00), microalbuminuria (p = 0,02), CT ≥ 250 mg/dl al inicio (p = 0,01), glucemia basal (Gb) ≥ 126 mg/dl al inicio (p = 0,00), creatinina ≥ 1,2 mg/dl al inicio (p = 0,00) y fi nal (p =0,00), y no CU en HCL (p = 0,00). Las CS realizadas por antecedentes de HTAy/o HCL, existencia o no de Gb ≥ 126 mg/dl, existencia o no de lesión de órganos diana, y tener o no riesgo cardiovascular (RCV) alto con FA, fueron significativas (p < 0,05). El ajuste del FA para RCV global fue: (0,415 x Riesgo FA%) + 0,517%, obtuvo una r = 0,9962(p = 0,00) y un cci = 0,9969 (p < 0,0001).Conclusiones. Se ajustó la ecuación FA en nuestros pacientes, con datos propios. Se cuantificaron los factores pronósticos y CS. Se cuantificó un beneficio entre CU y disminución de RCV en HCL (AU)

Introduction and objectives: There is little information on cardiovascular longitudinal studies. In Spanish patients with hypertension (AHT)) and/or hypercholesterolemia (HC), with poor initial control of blood pressure (BP) and/or total cholesterol (TC), incidence rate (IR), cumulative incidence (CI), relative risks (RR), survival curves (SC), therapeutic compliance (TC) were quantified and the Framingham-Anderson scale (FAS) was adjusted to our patients. Patients and Methods: A total of 6,893 primary prevention patients with AHT and/or with HC were included in primary prevention, with an average of 1.22 years of follow-up. A total of 480 physicians participated. Incidence rate (IR), cumulative incidence (CIN), relative risks (RR), survival curves (SC) by Kaplan-Meier method, and therapeutic compliance (TCOM) by Haynes-Sackett self-reported questionnaire were calculated. The Framingham-Anderson scale (FAS) was validated with Pearson's correlation coefficient (r) and intraclass correlation index (ICI). Results: CIN was 1.59% (1.31-1.90); the IR 1,321.6 cardiovascular events/ 100,000 patients/year (1,026.6-1,598.8). RRs with statistical significance were: age (p=0.03). Blood pressure at the end of the study (p=0.02), coronary background (p=0.00), left ventricular hypertrophy (LVH) (p=0.00), microalbuminuria (p=0.02), CT≥250mg/dl (p=0.01), fasting glycemia (Gb)≥126mg/dl (p=0.00), creatinine≥1.2mg/dl at the beginning (p=0.00) and at the end of the study (p=0.00), and poor compliance in HC patients (p=0.00). SC have statistical significance (p<0.05) for AHT background, fasting glucose≥126mg/dl, target organ damage, and high cardiovascular risk with FAS scale. The adjusted FAS formula for global cardiovascular risk was (0.415 x FAS Risk%) + 0.517%, r=0.9962 (p=0.00) and ICI=0.9969 (p<0.0001). Conclusions: The equation for the FAS scale was adjusted for Spanish AHT/HC patients. Prognostic factors and SC were calculated. Benefitbetween TC and decrease of CVR in HC patients was quantified (AU)

[Prevalence and risk of developing heart failure in hypertensive patients managed in Spanish primary care centres. HICAP study]. / Prevalencia y riesgo de desarrollar insuficiencia cardíaca en los hipertensos españoles atendidos en Atención Primaria. Estudio HICAP.

OBJECTIVE: The objective was to establish the proportion of hypertensive patients diagnosed with heart failure (HF) and at high risk of developing it in Primary Care (PC) centres in Spain. METHODS: Observational, multicentre study. Each investigator included data from 5 consecutive hypertensive patients. A routine laboratory test and a electrocardiogram performed in the previous 6 months had to be available for each patient. RESULTS: Data from 6,375 patients were suitable for the study objectives. The proportion of patients diagnosed with HF was 18.9% (95% confidence interval: 17.97-19.90%), and increased with age. Among the patients not previously diagnosed with HF, 59.1% (95%CI: 57.7-60.5%) had a high risk of developing it. Blood pressure and other cardiovascular risk factors control in high risk patients was insufficient. CONCLUSION: The proportion of hypertensive patients diagnosed with HF and at high risk for developing it is high in PC. Blood pressure and other cardiovascular risk factors control should be improved to avoid the development of HF among high risk patients.

Prevalencia y riesgo de desarrollar insuficiencia cardíaca en los hipertensos españoles atendidos en Atención Primaria. Estudio HICAP / Prevalence and risk of developing heart failure in hypertensive patients managed in Spanish primary care centres. HICAP study

Objetivos. Conocer la proporción de pacientes coninsuficiencia cardíaca (IC) y con alto riesgo dedesarrollarla entre los hipertensos atendidos en lasconsultas de Atención Primaria (AP) en España.Métodos. Estudio transversal y multicéntrico en elque cada investigador incluyó datos de 5hipertensos consecutivos que acudieron a suconsulta y que contaban con una analítica y unelectrocardiograma realizados en los últimos 6meses.Resultados. Se recogieron datos válidos de 6.375hipertensos. La proporción de pacientes condiagnóstico de IC fue de 18,9% (intervalo deconfianza al 95% [IC95%]: 17,97-19,90) yaumentaba progresivamente con la edad. De lospacientes que no habían sido previamentediagnosticados de IC, el 59,1% (IC95%: 57,7-60,5)presentaba un alto riesgo de desarrollar IC. Elcontrol de la presión arterial y otros factores deriesgo cardiovascular en estos pacientes «conalto riesgo» era insuficiente.Conclusión. Los datos indican que la proporción dehipertensos diagnosticados de IC y con altoriesgo de desarrollar la enfermedad es alta en AP.Se debería mejorar el control de la presión arterial yotros factores de riesgo para intentar evitar eldesarrollo de la IC en los hipertensos con altoriesgo

Objective. The objective was to establish theproportion of hypertensive patients diagnosed withheart failure (HF) and at high risk of developing it inPrimary Care (PC) centres in Spain.Methods. Observational, multicentre study. Eachinvestigator included data from 5 consecutivehypertensive patients. A routine laboratory test anda electrocardiogram performed in the previous 6months had to be available for each patient.Results. Data from 6,375 patients were suitable forthe study objectives. The proportion of patientsdiagnosed with HF was 18.9% (95% confidenceinterval: 17.97-19.90%), and increased with age.Among the patients not previously diagnosed withHF, 59.1% (95%CI: 57.7-60.5%) had a high risk ofdeveloping it. Blood pressure and othercardiovascular risk factors control in high riskpatients was insufficient.Conclusion. The proportion of hypertensivepatients diagnosed with HF and at high risk fordeveloping it is high in PC. Blood pressure andother cardiovascular risk factors control should beimproved to avoid the development of HF amonghigh risk patients

La inercia clínica profesional y el incumplimiento farmacológico: ¿cómo influyen en el control de la hipertensión arterial? Estudio CUMAMPA / Clinical and professional inertia and drug non-compliance. How do they influence control of hypertension? The CUMAMPA study

Objetivo. Comprobar si el cumplimiento del tratamiento farmacológico de la hipertensión (HTA) y la inercia clínica terapéutica (ICT) influyen en las cifras de presión arterial (PA) y en el control de la HTA. Material y método. Estudio longitudinal realizado en Atención Primaria con seguimiento de 6 meses. Se incluyeron 350 hipertensos no controlados. Recibieron un OMRON y un monitor electrónico para control de medicación (MEMS-Aardex). Se calcularon las cifras medias de PA y el grado de control por automedición domiciliaria de la PA (AMPA) según su cumplimiento y presencia de ICT. Resultados. Finalizaron 302 pacientes. Fueron cumplidores globalmente el 86,09 % con un intervalo de confianza (IC) de ± 3,91 %, n = 260 y presentaron ICT según la PA clínica el 40,39 % de los pacientes (IC: ± 5,34 %; n = 122) y según las medidas domiciliarias el 34,43 % (IC: ± 5,04 %; n = 104). Las PA medias fueron menores en los pacientes cumplidores respecto a los pacientes sin ICT. El porcentaje de individuos controlados por AMPA fue del 33,1 % (n = 100) en el primer mes, el 53,64 % (n = 162) en el tercer mes y al final del estudio fue del 61,58 % (n = 186) (IC: ± 5,48 %). Se observaron mayores diferencias en el control en cumplidores respecto a incumplidores que en pacientes con y sin inercia clínica. Conclusiones. El cumplimiento terapéutico y la ICT influyen en las cifras domiciliarias de PA y en el control de la HTA, aunque influye más relevantemente, de forma individual, el incumplimiento (AU)

Objective. To evaluate the influence of antihypertensive therapy compliance and clinical therapeutical inertia (CTI) on home blood pressure measurement (HBPM) and control of arterial hypertension (AHT). Material and method. A longitudinal study conducted in primary health care centers, with a 6-month follow-up. A total of 350 patients with uncontrolled hypertension were included. All patients received an OMRON and an electronic monitor to control the medication (MEMS-Aardex). Mean values of BP, and grade of control by Ambulatory Blood Pressure Measurement (ABPM) according to compliance and presence of CTI were calculated Results. A total of 302 patients completed the study. Overall, 86.09 % (CI: ± 3.91 %) were compliers and CTI according to the clinical BP was present in 40.39 % of the patients (IC: ± 5.34 %; n = 122) and according to the home measurements in 34.43 % (CI: 5.04 %; n = 104). Mean HBPM were lower in the compliant group in respect to without CTI. The percentage of patients controlled was 33.1 %, 53.64 % and 61.58 % (first, second and third month) with greater differences in the degree of control of AHT in compliant patients in respect to non compliers that in patients with or without CTI. Conclusions. Therapeutic compliance and CTI influence BP and the degree of control of AHT measured by HBPM. In the hypertensive patient, compliance is more important that CTI (AU)

Evaluación del incumplimiento en la práctica clínica / Evaluation of non-compliance in the clinical practice

Los beneficios obtenidos en los ensayos clínicos con antihipertensivos no se observan en la práctica clínica como eran de esperar. Una de sus causas es el incumplimiento del tratamiento farmacológico. Son escasos los médicos que miden el incumplimiento del tratamiento, y cuando lo hacen utilizan métodos de medida no validados y escasamente recomendados. La medición del cumplimiento es difícil e inexacta, pues no existe un método ideal que se pueda generalizar en la práctica clínica, de ahí la importancia de conocer los métodos más útiles ya que en caso contrario no seremos capaces de detectar el incumplimiento. Los métodos de medida se pueden clasificar en directos e indirectos, siendo estos últimos los utilizados habitualmente. Entre ellos destacan el cumplimiento autocomunicado de Haynes-Sackett o el recuento de comprimidos mediante monitores electrónicos de control de la medicación (MEMS) o mediante recuento simple de comprimidos. Se ha observado que los métodos que valoran el cumplimiento por entrevista clínica son de escasa utilidad en estudios de cumplimiento al ofrecer escasa concordancia con el recuento de comprimidos. Sin embargo, gracias a su alta especificidad se recomienda en la práctica clínica el cumplimiento autocomunicado, de tal forma que si el paciente nos afirma que incumple, la probabilidad de que sea cierto es muy alta. Si el paciente refiere ser cumplidor mediante esta prueba y seguimos sospechando el incumplimiento debe utilizarse el recuento de comprimidos. El recuento en consulta o en domicilio es el método de elección en la investigación en general, pero si deseamos conocer el patrón de incumplimiento se utilizará el recuento a través de MEMS (AU)

The expected benefits obtained in clinical trials with antihypertensive agents have not been observed in the clinical practice. One of the reasons for this is non-compliance of the drug treatment. Few doctors measure treatment non-compliance and when they do so, they use non-validated and scarcely recommended measurement methods. Measuring compliance is difficult and inexact, since there is no ideal method that can be generalized to the clinical practice. That is why it is important to know the methods used most, since, on the contrary, we will not be capable of detecting non-compliance. The measurement methods can be classified into direct and indirect methods, these being the most commonly used. Among them, Haynes-Sachett's self-reported compliance or the counting of tablets by medical event monitoring system (MEMS) or by simple counting of the tables stand out the most. It has been observed that the methods that evaluate compliance by clinical interview have little utility in compliance studies as they offer little concordance with tablet count. However, thanks to its high specificity, self-reported compliance is recommended in the clinical practice. Thus, if the patient affirms non-compliance, the likelihood of this being true is very high. If the patient reports compliance by this test and we continue to suspect non-compliance, tablet counting should be used. Counting in the medical office or at home is the method of choice in the investigation in general, but if we want to know the non-compliance pattern, counting should be done with the MEMS (AU)

Características clínicas y manejo de pacientes hipertensos con diagnóstico de insuficiencia cardíaca en Atención Primaria en España. Estudio HICAP / Clinical characteristics and management of hypertense patients diagnosed of heart failure in primary health care in Spain. HICAP Study

Objetivos. Conocer la proporción de pacientes hipertensos con insuficiencia cardíaca y su manejo en Atención Primaria. Métodos. Estudio observacional, multicéntrico, realizado en Atención Primaria. La técnica de selección de la muestra fue no probabilística de selección de casos consecutivos, se incluyeron pacientes hipertensos con analítica y electrocardiograma realizados en los últimos 6 meses. Resultados. Participaron 1.288 médicos que incluyeron 6.719 pacientes, se consideraron válidos 6.375. La proporción de pacientes con diagnóstico de insuficiencia cardíaca fue del 18,9%. En un 36,9% de los casos el diagnóstico lo hizo Atención Primaria y a un 57,5% de los pacientes se les había hecho un ecocardiograma. Un 76,7% de los pacientes eran de clase funcional I-II y un 36,1% tenía disfunción sistólica. En un 33,6% de los casos el seguimiento lo hacía solo Atención Primaria. Un 77% de los pacientes no estaba tratado con bloqueadores beta y un 11% no tomaba fármacos bloqueadores del sistema renina-angiotensina. Conclusiones. La proporción de pacientes hipertensos con diagnóstico de insuficiencia cardíaca es elevada, pero su manejo diagnóstico y terapéutico no parece adecuado (AU)

Objective. To know the proportion of hypertensive patients with heart failure and its treatment in Primary Health Care. Methods. Observational, multicenter study conducted in Primary Health Care. The sample selection technique was a non-probabilistic selection of consecutive cases. Hypertensive patients with blood test and electrocardiogram performed in the last 6 months were included in this study. Results. A total of 1288 physicians who included 6719 patients participated in the study. Only 6375 were considered valid. The proportion of patients diagnosed of heart failure was 18.9%. In 39% of the cases, the diagnosis was made in Primary Health Care and 57.5% of the patients had undergone an electrocardiography. A total of 76.7% of the patients were functional class I-II and 36.1% had systolic dysfunction. Follow-up was performed in 33.6% of cases only in Primary Health Care. Seventy-seven percent of the patients were not treated with beta blockers and 11% did not take renin-angiotensin system blocker drugs. Conclusion. The proportion of hypertensive patients diagnosed of heart failure is high but their diagnostic management and therapy does not seem to be appropriate (AU)

[Clinical characteristics and management of hypertense patients diagnosed of heart failure in primary health care in Spain. HICAP Study]. / Características clínicas y manejo de pacientes hipertensos con diagnóstico de insuficiencia cardíaca en Atención Primaria en España. Estudio HICAP.

OBJECTIVE: To know the proportion of hypertensive patients with heart failure and its treatment in Primary Health Care. METHODS: Observational, multicenter study conducted in Primary Health Care. The sample selection technique was a non-probabilistic selection of consecutive cases. Hypertensive patients with blood test and electrocardiogram performed in the last 6 months were included in this study. RESULTS: A total of 1288 physicians who included 6719 patients participated in the study. Only 6375 were considered valid. The proportion of patients diagnosed of heart failure was 18.9%. In 39% of the cases, the diagnosis was made in Primary Health Care and 57.5% of the patients had undergone an electrocardiography. A total of 76.7% of the patients were functional class I-II and 36.1% had systolic dysfunction. Follow-up was performed in 33.6% of cases only in Primary Health Care. Seventy-seven percent of the patients were not treated with beta blockers and 11% did not take renin-angiotensin system blocker drugs. CONCLUSION. The proportion of hypertensive patients diagnosed of heart failure is high but their diagnostic management and therapy does not seem to be appropriate.

Pharmacological compliance and acceptability of lansoprazole orally disintegrating tablets in primary care.

OBJECTIVE: To evaluate the pharmacological compliance of patients treated with lansoprazole orally disintegrating tablets (LODT) in Primary Care (PC) and their acceptability of this formulation. RESEARCH DESIGN AND METHODS: A multicenter, observational, cross-sectional study involving 433 PC physicians that included 433 patients aged at least 18 years, either diagnosed with gastroesophageal reflux disease (GERD) or taking LODT to prevent NSAID-induced gastric ulcers. Compliance with LODT treatment was assessed with the Haynes-Sackett self-reported test. Acceptability was based on global patient assessment, rating the drug's organoleptic characteristics and properties recorded with a self-administered 15-item ad hoc questionnaire with 2 and 5-point Likert-type scales. RESULTS: 423 patients (mean age 50.6 years, SD = 13.4) were evaluable for the main endpoint. Of these, 57.16% were men and 53.5% were treated with 30 mg doses of LODT for an average of 37.8 days (SD = 35.5). Compliance was achieved by 92.4% of the patients, mean percentage of compliance was 93.3. Demographical and clinical variables had no effect on compliance. Treatment with LODT was assessed as 'acceptable' or 'highly acceptable' by 91.7% of the sample. One adverse reaction, not serious, was reported by one patient (0.2%). CONCLUSIONS: In this observational study, compliance with lansoprazole orally disintegrating tablets was very high. Patients reported that this formulation improved their compliance. LODT was clearly preferred to previous medication and the drug was well tolerated.

[Are hypertensive patients managed in primary care well evaluated and controlled? HICAP Study]. / ¿Evaluamos y controlamos adecuadamente a los hipertensos atendidos en atención primaria? Estudio HICAP.

OBJECTIVE: The HICAP study assessed the cardiovascular (CV) global risk and the CV risk factors control in hypertensive patients managed in Primary Care (PC) in Spain. METHODS: Cross-sectional and multilocated study in which each investigator included data from 5 consecutives hypertensive patients. A routine laboratory test and a ECG from the previous 6 months had to be available for each patients CV global risk evaluation, blood pressure (BP) and diabetes control was based on ESH-ESC 2003; lipid profile evaluation was based on NCEP 2001 (ATP III) RESULTS: 1288 PC physicians included 6719 hypertensive patients, and data from 6375 patients were analyzed.64.5% (CI95%: 63.3-65.7) of the hypertensive patients managed in Primary Care showed a high or very high CV global risk.BP was controlled in 39.3% (CI95%: 38.1-40.5) of patients, 10.5% (CI95%: 9.1-11.9)among diabetics. 37.3% (CI95%: 35-38.7) of diabetics showed HbA1c < 6.5% and 18.8% (CI95%: 17.6-20) of dyslipidemic subjects had their LDL-c controlled. The control was lower among the patients at higher CV global risk. CONCLUSIONS: These results demostrate the high proportion of hypertensive patients that present a high CV global risk. The cardiovascular risk factors control, specially among patients at higher CV global risk, is insufficient.

¿Evaluamos y controlamos adecuadamente a los hipertensos atendidos en atención primaria? estudio HICAP / Are hypertensive patients managed in primary care well evaluated and controlled? HICAP study

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Influencia del tratamiento antihipertensivo sobre la variabilidad de la presión arterial y diferencias entre mujeres pre y posmenopáusicas / Influence of antihypertensive treatment on the variability of blood pressure and differences between pre and postmenopausal women

Objetivo. Analizar la influencia del tratamiento antihipertensivo en la variabilidad de la presión arterial (PA) y sus diferencias entre mujeres pre y posmenopáusicas. Métodos. Se realizó un estudio prospectivo en Atención Primaria, seleccionándose 112 mujeres con hipertensión arterial (HTA) leve-moderada no controlada cuya monitorización ambulatoria de la presión arterial (MAPA) (Spacelabs 90207) inicial presentó unas presiones arteriales sistólicas (PAS) y presiones arteriales diastólicas (PAD) medias diurnas superiores a 135 y/o 85 mmHg. Se prescribieron antihipertensivos según práctica clínica habitual. Se compararon las PAS y PAD clínicas y ambulatorias y los índices de variabilidad (IV) de la PAS, PAD, PAM globales, diurnas y nocturnas iniciales y a las 8 semanas. Se compararon en función de su estado hormonal: GA: menopáusicas; GB: premenopáusicas. Resultados. Finalizaron 103 mujeres con una edad media de 53,06 (DE: 10,3 años) (N: GA, 50; GB, 53). El IV de la PAS y PAD diurna inicial fue de 12,2 (DE: 2,9) y 9,9 (DE: 2,08) y el IV final de 12,7 (DE: 10,2) y 8,9 (DE: 1,9) (p = NS), respectivamente, sin diferencias entre los IV de las PA de 24 horas, diurnas o nocturnas. Los IV diurnos iniciales y finales fueron de 11,1 (DE: 2,2) y 10,6 (DE: 2,6) para la PAS y 8,5 (DE: 1,8) y 8,7 (DE: 2) para la PAD en el grupo de premenopáusicas y 13,8 (DE: 3) y 14,7 (DE: 13,8) para la PAS y 9,3 (DE: 2,2) y 9,1 (DE: 1,8) para la PAD en el grupo de posmenopáusicas. No se observaron diferencias en los IV entre ambos grupos, ni en sus descensos medios, excepto para el IV de la PAS 24 horas con descenso medio significativo entre inicio y final en posmenopáusicas. Conclusiones. No se observan diferencias en los IV entre pre y posmenopáusicas. El tratamiento antihipertensivo produce un descenso del IV de las PAS de 24 horas en posmenopáusicas

Objective. Analyze the influence of antihypertensive treatment in variability of blood pressure (BP) and its differences between pre-and postmenopausal women. Methods. A prospective study was conducted in primary health care, enrolling 112 women with uncontrolled mild-moderate HBP whose initial ambulatory blood pressure monitoring (ABPM) (Spacelabs 90207) showed mean daytime SBP and DBP greater than 135 and/or 85 mmHg. Antihypertensive drugs were prescribed according to the usual clinical practice. Clinical and ambulatory SBP and DBP were compared as well as variability indexes (VI) of initial global daytime and nighttime SBP, DBP, MBP at 8 weeks. They were compared based on their hormone status: GA: menopausal; GB: premenopausal. Results. A total of 103 women with a mean age of 53.06 (SD 10.3 years) (N: GA, 50; GB, 53) completed the study. The VI of the initial daytime SBP and DBP was 12.2 (SD: 2.9) and 9.9 (SD: 2.08) and the final VI was 12.7 (SD: 10.2) and 8.9 (SD: 1.9) (p = NS) respectively, without differences between VI of the 24 hour, daytime or nighttime BP. The initial and final daytime VI were 11.1 (SD: 2.2) and 10.6 (SD: 2.6) for SBP and 8.5 (SD: 1.8) and 8.7 (SD: 2) for DBP in the premenopausal group and 13.8 (SD: 3) and 14.7 (SD: 13.8) for SBP and 9.3 (SD 2.2) and 9.1 (SD 1.8) for DBP in the postmenopausal group. No differences were observed in VI between both groups or in their mean decreases except for the VI of the 24-hour SBP that had a significant mean decrease between initial and final VI in postmenopausal subjects. Conclusions. No differences were observed in the VI between pre and postmenopausal subjects. Antihypertensive treatment causes a decrease of 24 hour SBP VI in postmenopausal subjects

Valoración de la eficacia de lercanidipino en el tratamiento de la hipertensión arterial ligera-moderada de pacientes mayores y menores de 65 años / Evaluation of the effectiveness of lercanidipine in the treatment of mild-to-moderate hypertension in patients under and over the age of 65

Introducción. Evaluar el perfil antihipertensivo clínico y de 24 horas, mediante monitorización ambulatoria de la presión arterial, de lercanidipino en dos grupos de pacientes: a) mayores de 65 años, y b) menores de 65 años. Material y métodos. Ciento cuarenta y dos pacientes con hipertensión ligera a moderada (presión arterial sistólica entre 140 y 180 mmHg y presión arterial diastólica entre 90 y 114 mmHg) mayores de 40 años fueron incluidos secuencialmente en el estudio tras una fase de lavado con placebo de dos semanas, asignándose 72 de ellos al grupo A y 70 al grupo B. Se comenzó con 10 mg/día de lercanidipino en una sola toma. Al cabo de 4 semanas esta dosis podía ser doblada si la presión arterial diastólica era mayor de 90 mmHg o había descendido menos de 10 mmHg. A las 8 semanas si no habían conseguido controlar la presión arterial por debajo de 140/90 mmHg eran excluidos del estudio y remitidos para su seguimiento en nuestra Unidad de Riesgo Cardiovascular. Se practicaron controles clínicos cada 15 días (toma de la presión arterial y recogida de efectos secundarios). En la visita basal y al finalizar el ensayo (6 meses) se les realizó monitorización ambulatoria de presión arterial de 24 horas, electrocardiograma y analítica. Resultados. El perfil de eficacia antihipertensiva fue en ambos grupos, A y B, similar, siendo a los 6 meses significativos los descensos de presión arterial sistólica y presión arterial diastólica tanto clínica como de 24 horas (de día y de noche) con respecto a los valores basales. Por otra parte se observó un mayor descenso de la presión arterial sistólica (p=0,017) en los pacientes del grupo A que en los del B cuando se utilizó la monitorización ambulatoria de presión arterial (de 141,01ñ 9,91 hasta 125,88ñ7,76 en A y desde 139,55ñ11,54 hasta 127,68ñ 10,07 en B). No hubo diferencias en la frecuencia cardíaca, valores analíticos ni en los efectos secundarios. Conclusiones. Lercanidipino presenta una eficacia antihipertensiva similar en ambos grupos, excepto en lo que hace referencia a la presión arterial sistólica, medida con la monitorización ambulatoria de la presión arterial, en que el descenso es mayor en los pacientes del grupo A que en los del B, con diferencia estadísticamente significativa. El perfil de eventos adversos generales y ligados a vasodilatación fue excelente (AU)

[Effectiveness of an intervention to provide information to patients with hypertension as short text messages and reminders sent to their mobile phone (HTA-Alert)]. / Eficacia de una intervención informativa a hipertensos mediante mensajes de alerta en el teléfono móvil (HTA-ALERT).

OBJECTIVE: To analyze the effect of an intervention to provide information with mobile phone text messages to patients with hypertension on compliance with therapy for hypertension. DESIGN: Comparative, controlled, multicenter, randomized cluster study. SETTING: 26 primary care health centers in Spain. PARTICIPANTS: 26 researchers were randomized to a control group or an intervention group (52 patients each, for a total of 104 patients). All patients were receiving monotherapy for uncontrolled hypertension. INTERVENTION: Patients in the control group received their physician's usual interventions. Patients in the intervention group received messages and reminders sent to their mobile phones 2 days per week during 4 months. MAIN OUTCOME MEASURES: Tablets were counted and blood pressure was measured at the start of the study and 1, 3, and 6 months later. The percentage of compliers, mean percentage of compliance and degree of control of hypertension were compared. The reduction in absolute and relative risk was calculated, as was the number of individuals needed to treat to avoid noncompliance. RESULTS: The results were evaluated for a total of 67 individuals (34 in the intervention group and 33 in the control group). The rate of compliance was 85.1% (CI, 74.9%-95.3%) overall, 85.7% (CI, 70.5%-100.9%) in the control group and 84.4% in the intervention group (CI, 70.7%-95.3%) (P=NS). Mean percentage compliance was 90.2%+/-16.3% overall, 88.1%+/-20.8% in the control group and 91.9%+/-11.6% in the intervention group (P=NS). The percentage of patients whose hypertension was controlled at the end of the study was 51.5% (CI, 34.4%-68.6%) in the control group and 64.7% (CI, 48.6%-80.8%) in the intervention group (P=NS). CONCLUSIONS: The telephone messaging intervention with alerts and reminders sent to mobile phones did not improve compliance with therapy in patients with hypertension.