[Factors associated with cardiovascular risk and cardiovascular and renal disease in the IBERICAN study: Final results]. / Factores asociados al riesgo cardiovascular y enfermedad cardiovascular y renal en el estudio IBERICAN (Identificación de la poBlación Española de RIesgo CArdiovascular y reNal): resultados definitivos.

OBJECTIVE: To analyse the prevalence in clinical practice of cardiovascular risk factors (CVRF) and cardiovascular disease (CVD), as well as their causal relationship, in the study inclusion visit. MATERIAL AND METHODS: Cross-sectional analysis of the study inclusion visit of 8,066 patients of 18 to 85years of age included in the IBERICAN study. By reviewing the medical history, analytics and medical visits, the patient's physician has collected socio-demographic information, personal and family history and prevalence of CVRF and CVD and renal disease. A multivariate analysis was carried out using a logistic regression that included the autonomous region variable as a random effect variable, in order to analyse the impact of certain variables on the development of each CVRF, metabolic syndrome, subclinical organ damage, renal disease, and CVD. RESULTS: Dyslipidaemia was 2.4 times more frequent in diabetics, and the risk was increased by 59% in hypertensive patients. Arterial hypertension was twice as frequent in diabetics, and increased 94% in hyperuricaemic patients and 62.1% in dyslipidaemia patients. Diabetes mellitus was 2.5 times higher in dyslipidaemia patients, and 2.2 times higher in hypertensive patients. CVD was four times more frequent in patients with a family history, and the risk in women was increased by 90.8% and by 53.8% in patients with renal disease. CONCLUSIONS: The Spanish population seen in Primary Care that were analysed in the IBERICAN study had a high prevalence of CVRF and CVD, which gives it a high CVR. The multivariate analysis performed shows a close causal relationship between the CVRF with each other, and with renal disease and CVD.

Prevalence of hypotension in hypertensive treated patients within the Primary Care setting. The PRESCAP 2010 study.

OBJECTIVE: To determine the prevalence of hypotension and associated factors in hypertensive patients treated in the Primary Care setting. MATERIALS AND METHODS: A cross-sectional, descriptive, and multicentre study was conducted with a total of 2635 general practitioners consecutively including 12,961 hypertensive patients treated in a Primary Care setting in Spain. An analysis was performed on the variables of age, gender, weight, height, body mass index, waist circumference, cardiovascular risk factors (diabetes, dyslipidaemia, smoking, obesity, sedentary lifestyle), fasting plasma glucose, complete lipid profile, as well as the presence of target organ damage (left ventricular hypertrophy, microalbuminuria, carotid atherosclerosis) and associated clinical conditions. Hypotension was defined as a systolic blood pressure less than 110mmHg or a diastolic blood pressure less than 70mmHg. A multivariate analysis was performed to determine the variables associated with the presence of hypotension. RESULTS: The mean age was 66.2 years, and 51.7% of patients were women. The mean time of onset of hypertension was 9.1 years. A total of 13.1% of patients (95% confidence interval 12.4-13.6%) had hypotension, 95% of whom had low diastolic blood pressure. The prevalence of hypotension was higher in elderly patients (25.7%) and in those individuals with coronary heart disease (22.6%). The variables associated with the presence of hypotension included a history of cardiovascular disease, being treated with at least 3 antihypertensive drugs, diabetes, and age. CONCLUSIONS: One out of 4-5 elderly patients, or those with cardiovascular disease, had hypotension. General practitioners should identify these patients in order to determine the causes and adjust treatment to avoid complications.

[Description of the sample, design and methods of the study for the identification of the Spanish population at cardiovascular and renal risk (IBERICAN)]. / Descripción de la muestra, diseño y métodos del estudio para la identificación de la población española de riesgo cardiovascular y renal (IBERICAN).

BACKGROUND AND OBJECTIVE: Cardiovascular diseases (CVD) are the leading cause of death in Spain, and although the incidence rates have been declining for years due to improvements in prevention and treatment, there is still room for further reduction. Primary Care has a leading role in the prevention and control of these diseases. Determining the prevalence and incidence of cardiovascular risk factors and cardiovascular diseases in the Spanish adult population attended in Primary Care is the objective of the study to identify the Spanish population at cardiovascular and renal risk (IBERICAN). MATERIAL AND METHODS: A prospective cohort study was conducted using a consecutive non-probabilistic sampling population between 18 and 85 years that attended Primary Care centres between April 1, 2014 and October 31, 2018. By reviewing the medical history, laboratory results, and medical visits, the Primary Care physicians collected socio-demographic information, personal and family history of the patients, as well as prevalence and incidence of cardiovascular risk factors and cardiovascular and renal disease. The incidents and associated factors will be estimated using proportional risk models of Cox and Kaplan-Meier Curves. RESULTS: A total of 8,066 patients have been recruited by 531 Primary Care physicians from all Autonomous Communities of Spain as part of the IBERICAN cohort, with the exception of Ceuta. The mean age of the cohort is 57.9 years with 54.5% women. Obesity, dyslipidaemia, and hypertension are the most prevalent cardiovascular risk factors. There was a history of CVD in16.3%, and 25.5% had a subclinical organ lesion. CONCLUSION: The IBERICAN study is a cohort of people treated in Primary Care that expects to provide relevant information on the factors that determine the incidence of cardiovascular and renal disease in Spain.

[Anthropometric measurements of general and central obesity and discriminative capacity on cardiovascular risk: RICARTO study]. / Medidas antropométricas de obesidad general y central y capacidad discriminativa sobre el riesgo cardiovascular: estudio RICARTO.

INTRODUCTION AND OBJECTIVES: Overweight and obese patients have an increased risk of cardiovascular disease and general mortality. It is not clear which obesity index should be used in the clinic. The objective is to compare the relationship between body mass index (BMI), waist circumference (WC), waist-height ratio (WHR), and conicity index (Conicity-I) with 10-year Framingham cardiovascular risk (CVR). MATERIAL AND METHODS: Population cross-sectional study in subjects ≥18years, residents in the Toledo (Spain) Health Area. Selection by random sampling. Measurements were made of the BMI, WC, and weight to height ratio with standardised methods. Framingham CVR. Calculation of AUC, and optimal cut-off points. RESULTS: The study included 1,309 subjects, with mean age of 48.9±15.8years, and 55% women. The response rate was 36.6%. In women, the index that was best associated with CVR in women was the WC with an AUC=0.85 (95%CI: 0.81-0.88). In men it was the I-Conicity, with an AUC=0.81 (95%CI: 0.77-0.84). Cut points for BMI were similar in women (27.08kg/m2) and men (26.99kg/m2). The WC was lower in women (87.75cm) than in men (94.5cm). The WHR was higher in women (0.59) than in men (0.56). The I-Conicity was slightly lower in women (1.25) than in men (1.28). In women, all the ROC curves were closest to each other. CONCLUSIONS: The central obesity indexes (WC and WHR) discriminated better than the BMI the CVR. In women, all the indices had greater AUCs than in men, except for the I-Conicity.

[Prevalence of obesity and cardiovascular comorbidity associated in patients included in the IBERICAN study]. / Prevalencia de obesidad y comorbilidad cardiovascular asociada en los pacientes incluidos en el estudio IBERICAN (Identificación de la poBlación Española de RIesgo CArdiovascular y reNal).

OBJECTIVES: To analyse the prevalence of obesity and its association with other cardiovascular risk factors and cardiovascular disease in a sample of patients from the (Identification of the Spanish population at cardiovascular and renal risk) IBERICAN study. MATERIAL AND METHODS: Analysis of the inclusion visit of the first 5,013 patients of the IBERICAN longitudinal, observational, and multicentre study in which individuals aged 18 to 85 years were included in Primary Care Clinics in the different regions of Spain. In this work obesity was defined as a body mass index ≥ 30kg/m2. RESULTS: The prevalence of obesity was 35.7% (95% CI: 35.0-36.4%), of which 36.6% were men and 34.9% were women (P=0.214), and significantly increasing with age (0.001). The obesity had the associated higher prevalence of hypertension (62.8% vs. 39.4%, P<001), dyslipidaemia (56.9% vs. 47.1%, P<0.001), sedentary lifestyle (40.6% vs. 24.6%, P<.001), diabetes (27.5% vs. 14.8%, P<.001), hyperuricaemia (23.6% vs. 12.7%, P<.001), subclinical organ injury (33.7% vs. 26.5%, P<.001) and cardiovascular disease (21.2% vs. 15.3%, P<.001). The multivariate analysis showed that the variables associated with obesity were: arterial hypertension (P<.001), hyperuricemia (P<.001), sedentary lifestyle (P<.001), diabetes mellitus (P<0.001), age (P<0.001), low educational level (P<0.001) and lower consumption of tobacco (P<0.001). CONCLUSIONS: The analysis of the IBERICAN study shows that approximately one third of the analysed population meets criteria of obesity and cardiovascular risk factors. Target organ damage and cardiovascular disease were more frequent in obese patients.

[Cardiovascular risk and cardiovascular events in the general population of the sanitary area of Toledo. RICARTO Study]. / Justificación, objetivos y diseño metodológico del estudio RICARTO (RIesgo CARdiovascular y eventos cardiovasculares en la población general del área sanitaria de TOledo).

INTRODUCTION: The main aim of this study is to ascertain the prevalence of cardiovascular risk factors (CVRF), target organ damage (TOD), cardiovascular disease (CVD), as well as life habits (physical exercise, alcohol consumption, and Mediterranean diet) in the population of a Health Area in Toledo, Spain, to assess cardiovascular risk (CVR). MATERIAL AND METHODS: Epidemiological and observational study that will analyse a sample from the general population aged 18 years or older, randomly selected from a database of health cards, and stratified by age and gender. Clinical history, physical examination, and complementary tests will be performed. Aliquots of whole blood and serum samples will be stored at a temperature of-85°C to evaluate future genetic studies. CVR will be estimated by using SCORE project scales calibrated for Spanish population and the Framingham Heart Study scale. When the estimated sample size has been achieved and after a minimum follow-up of 5 years, a final visit will performed in which CVRF, TOD, CVD, CVRF control, and fatal and non-fatal outcomes will be evaluated. DISCUSSION: The RICARTO study is aimed to assess the prevalence of the main CVRF, TOD and CVD in order to determine the CVR in the general population of a health area of Toledo. An analysis will be repeated on the final sample after at least 5 years of follow-up to ascertain the incidence of CV outcomes and the temporal trends of life style, as well as the prevalence of CVRF, TOD, and CVD.

[Characteristics and cardiovascular events in a general population included in the RICARTO (RIesgo CARdiovascular TOledo) study: Data from the first 1,500 individuals included in the study]. / Características de la población general incluida en el estudio RICARTO (RIesgo CARdiovascular y eventos cardiovasculares en la población general del área sanitaria de TOledo): resultados con los primeros 1.500 individuos incluidos en el estudio.

INTRODUCTION: The aim of this study was to assess cardiovascular risk (CVR) by investigating the prevalence of CVR factors (CVRF), target organ damage (TOD), and cardiovascular disease (CVD) in general population of the health area of Toledo, Spain. MATERIAL AND METHODS: Epidemiological and observational study that analysed a sample from the general population aged 18years or older, randomly selected from a database of health cards stratified by age and gender. Clinical history, physical examination, and complementary tests were performed. Total blood and serum samples were frozen at -85°C to evaluate genetic studies in the future. Standard statistical analysis was performed. CVR was assessed by the SCORE scale calibrated for the Spanish population, and the Framingham Heart Study scale. RESULTS: A total of 1,500 individuals (mean age 49.1±15.8years, 55.6% women) were included. Prevalences: dyslipidaemia 56.9% (95% confidence interval [95% CI]: 54.3-59.4), hypertension 33.0% (95%CI: 30.6-35.4), diabetes mellitus 8.6% (95%CI: 7.17-10.1), smoking 24.2% (95%CI; 122.0-26.4), obesity 25.3% (95%CI; 23.1-27.5), and sedentary life-style 39.4% (95%CI; 36.9-41.8). No CVRF was reported in 21.1% of cases, and 18.6% had 3-5 CVRF. TOD: electrocardiographic left ventricular hypertrophy, 4.3%, peripheral artery disease, 10.1% (Doppler ultrasound), and 15.3% (oscillometric device), microalbuminuria, 4.3%, sub-clinical renal disease, 3.2%, and nephropathy in 3.8% (CKD-EPI). At least one CVD was reported in 9.2% of cases. A low CVR (SCORE) was present in 44.6% of individuals. CONCLUSIONS: Dyslipidaemia was found in 60% of individuals, 40% had a sedentary life-style, 30% with hypertension, 20% smoked, 20% obesity, and almost 10% with diabetes. More than a half of individuals have a moderate-high-very high risk. The prevalence of TOD and CVD are significant.

[Resistant arterial hypertension in Primary Care patients in Spain. PRESCAP Study 2010]. / Hipertensión arterial resistente en pacientes hipertensos atendidos en Atención Primaria de España. Estudio PRESCAP 2010.

OBJECTIVE: To determine the prevalence and clinical and epidemiological characteristics of Primary Care patients with resistant hypertension (RHT) in Spain. PATIENTS AND METHODS: A cross-sectional multicenter study was conducted on hypertensive patients aged 18 or over and seen in a Primary Care clinic. RHT was considered as the presence of uncontrolled blood pressure in patients treated with at least 3 drugs, one of which is a diuretic. RESULTS: Of the 12,961 hypertensive patients in the PRESCAP 2010 study, 962 (7.4%) fulfilled criteria for RHT, of whom 51% were women, and with a mean age (SD) 68.8 [11.4] years. Patients with RHT were older (68.80 [10.69] years vs. 66.06 [11.44] years, P<.001), had a higher prevalence of obesity (55.2 vs. 38.6%, P<.001), a higher waist circumference (103.90 [13.89] vs. 99.32 [13.69] cm, P<.001), and a higher prevalence of DM (48.3 vs. 29.5%, P<.001). The prevalence of target organ damage (73.0 vs. 61.4%, P<.001) and cardiovascular disease (46.7 vs. 26.8%, P<.001) were higher in patients with resistant hypertension. The multivariate analysis showed that the variables associated with resistant hypertension were the presence of cardiovascular disease, diabetes mellitus, sedentary life style, microalbuminuria, body mass index, duration of AHT, and triglycerides. CONCLUSIONS: The prevalence of RHT in Primary Care patients is related to inappropriate lifestyles, the presence of target organ damage, and cardiovascular disease.

[Lipid profile in patients admitted with acute coronary syndrome in Spain: data from Toledo health care area between 2005 and 2008]. / Perfil lipídico en pacientes ingresados por síndrome coronario agudo en España: datos del área sanitaria de Toledo entre los años 2005 y 2008.

INTRODUCTION AND OBJECTIVES: To evaluate the lipid profile of patients admitted with acute coronary syndrome in Toledo (Spain) between 2005 and 2008. METHODS: Total cholesterol, LDL-cholesterol, HDL-cholesterol and triglyceride levels were evaluated. Descriptive analyses and means comparison were performed. RESULTS: 1,381 patients of 3,986 admitted with acute coronary syndrome had a complete lipid profile. The mean age was 67.8±12.9 years (72.4% men). A first event was present in 76.3%. The mean total cholesterol (±SD) was 180.0±43.4, LDL-cholesterol 115±38.0, HDL-cholesterol 44.1±12.3, and triglyceride 145.3±92.4mg/dL, with statistically significant differences between men and women in LDL-cholesterol (116.3±37.8 vs 111.6±38.5mg/dL; p=0.04) and HDL-cholesterol (42.3±11.6 vs 48.4±13.2mg/dL; p=0.0001). In first or recurrent events were found, respectively, total cholesterol 179.1±43.1 and 174.5±44.1 (p<0.05), LDL-cholesterol 116.5±38.4 and 110±36.5 (p=0.007), HDL-cholesterol 44.1±12.2 and 44.2±12.9 (p<0.05), and triglyceride 141.2±81.7 and 158.5±119.7 (p=0.03). Optimal levels of LDL-cholesterol and HDL-cholesterol were found in 14.1 and 11.6% of patients with recurrent episodes, respectively. CONCLUSIONS: While most patients admitted with first episode of acute coronary syndrome to the Toledo Health Area have a lipid profile according to current guidelines, only 10% of those with recurrent acute coronary syndrome presented optimal LDL-cholesterol and HDL-cholesterol levels, which suggest the need to be more aggressive in the lipids control.

Perfil lipídico en pacientes ingresados por síndrome coronario agudo en España: datos del área sanitaria de Toledo entre los años 2005 y 2008 / Lipid profile in patients admitted with acute coronary syndrome in Spain: data from Toledo health care area between 2005 and 2008

Introducción y objetivos. Evaluar el perfil lipídico de los pacientes ingresados por síndrome coronario agudo en Toledo entre 2005 y 2008. Métodos. Se estudiaron los niveles de colesterol total, colesterol unido a las lipoproteínas de baja densidad (cLDL), colesterol unido a las lipoproteínas de alta densidad (cHDL) y triglicéridos. Se realizó estadística descriptiva y comparación de medias. Resultados. De los 3.986 ingresados por síndrome coronario agudo, 1.381 pacientes tenían perfil lipídico completo. El 76,3% eran primeros episodios. La edad media fue 67,8 ± 12,9 años (72,4% hombres). El colesterol total medio (± DE) fue 180,0 ± 43,4, cLDL 115 ± 38,0, cHDL 44,1 ± 12,3, y triglicéridos 145,3 ± 92,4 mg/dl, con diferencias significativas entre hombres y mujeres en el cLDL (116,3 ± 37,8 vs 111,6 ± 38,5 mg/dl; p = 0,04) y cHDL (42,3 ± 11,6 vs 48,4 ± 13,2 mg/dl; p = 0,0001). En primeros episodios y episodios recurrentes se halló, respectivamente, colesterol total 179,1 ± 43,1 y 174,5 ± 44,1 (p < 0,05), cLDL 116,5 ± 38,4 y 110,0 ± 36,5 (p = 0,007), cHDL 44,1 ± 12,2 y 44,2 ± 12,9 (p < 0,05), y triglicéridos 141,2 ± 81,7 y 158,5 ± 119,7 mg/dl (p = 0,03). Se observaron niveles óptimos de cLDL y cHDL en el 14,1 y en el 11,6%, respectivamente, de los episodios recurrentes. Conclusiones. Aunque la mayoría de pacientes ingresados por primeros episodios de síndrome coronario agudo presenta un perfil lipídico adecuado, solo el 10% de pacientes con episodios recurrentes muestran niveles óptimos de c-LDL y c-HDL, lo que sugiere la necesidad de ser más rigurosos en el control lipídico (AU)

Introduction and objectives. To evaluate the lipid profile of patients admitted with acute coronary syndrome in Toledo (Spain) between 2005 and 2008. Methods. Total cholesterol, LDL-cholesterol, HDL-cholesterol and triglyceride levels were evaluated. Descriptive analyses and means comparison were performed. Results. 1,381 patients of 3,986 admitted with acute coronary syndrome had a complete lipid profile. The mean age was 67.8 ± 12.9 years (72.4% men). A first event was present in 76.3%. The mean total cholesterol (±SD) was 180.0 ± 43.4, LDL-cholesterol 115 ± 38.0, HDL-cholesterol 44.1 ± 12.3, and triglyceride 145.3 ± 92.4 mg/dL, with statistically significant differences between men and women in LDL-cholesterol (116.3 ± 37.8 vs 111.6 ± 38.5 mg/dL; p = 0.04) and HDL-cholesterol (42.3 ± 11.6 vs 48.4 ± 13.2 mg/dL; p = 0.0001). In first or recurrent events were found, respectively, total cholesterol 179.1 ± 43.1 and 174.5 ± 44.1 (p < 0.05), LDL-cholesterol 116.5 ± 38.4 and 110 ± 36.5 (p = 0.007), HDL-cholesterol 44.1 ± 12.2 and 44.2 ± 12.9 (p < 0.05), and triglyceride 141.2 ± 81.7 and 158.5 ± 119.7 (p = 0.03). Optimal levels of LDL-cholesterol and HDL-cholesterol were found in 14.1 and 11.6% of patients with recurrent episodes, respectively. Conclusions. While most patients admitted with first episode of acute coronary syndrome to the Toledo Health Area have a lipid profile according to current guidelines, only 10% of those with recurrent acute coronary syndrome presented optimal LDL-cholesterol and HDL-cholesterol levels, which suggest the need to be more aggressive in the lipids control (AU)

[Medical conduct in primary care as regards blood pressure control. PRESCAP 2010 study]. / Conducta del médico de atención primaria ante el mal control de la hipertensión arterial. Estudio PRESCAP 2010.

INTRODUCTION: There is a need for more information on therapeutic inertia in blood pressure (BP) treatment. The purpose of this study was to determine the therapeutic behaviour and associated factors of Primary Care (PC) physicians on uncontrolled hypertensive patients. PATIENTS AND METHODS: Cross-sectional multicentre study of patients with hypertension attending Spanish PC centres. Data was collected from patients (social-demographics, clinical status and treatment), as well as data from physicians (medical practice, background and therapeutic behaviour) were collected. Uncontrolled BP was considered when average BP values where ≥140/90mmHg. RESULTS: A total of 12,961 patients (52.0% women) were included. The mean age was 66.3 (SD 11.4) years, and mean number of years from diagnosis of hypertension was 9.1 (6.7) years. Almost two-thirds (62.4%) of the patients were taking a combined blood pressure treatment, (44.2% with two drugs and 18.2% with three drugs, or more). An uncontrolled BP was observed in 38.9% (95% CI: 38.1-39.7) of patients. Treatment was changed by physicians in 41.8% (95% CI: 40.4-43.2) out of 5,036 uncontrolled patients. Adding another drug was the most frequent behaviour (55.6%). The physician's perception of good BP control in uncontrolled patients, together with the presence of combined blood pressure treatment, were the two variables most strongly associated with therapeutic inertia. CONCLUSIONS: The Spanish PC Physician modified antihypertensive treatment in only 4 out of 10 uncontrolled patients. The physician's perception of good BP control was the variable most strongly associated with therapeutic inertia.

[Primary care physicians behaviour on hypertensive patients with poor blood pressure control. The PRESCAP 2006 study]. / Conducta del médico de Atención Primaria ante el mal control de los pacientes hipertensos. Estudio PRESCAP 2006.

INTRODUCTION: There is little information available on Therapeutic Inertia in Primary Care (PC). This study aimed to know the therapeutic behavior of the physician for uncontrolled hypertensive patients. PATIENTS AND METHODS: Cross-sectional, multicenter study that included hypertensive patients of both genders, under pharmacological treatment who were recruited consecutively in the PC out-patient clinic in all of Spain. Social-demographic, clinical and treatment data were recorded, as well as the motives for eventual therapeutic modification. Adequate BP control was considered when BP values were below 140/90 mmHg in general, and below 130/80 mmHg in diabetes, renal insufficiency or cardiovascular disease. RESULTS: A total of 10,520 patients (53.7% women) were included with average age of 64.6 (11.3 years). Of these, 44.4% the patients were receiving monotherapy and 55.6% were treated with combined therapy (two drugs 41.2%, three drugs 11.7%, and more than three 2.8%). Uncontrolled hypertension was found in 58.6% (95% CI. 57.6-59.5) of the patients. Treatment was modified by physicians in 30.4% (95% CI. 29.2-31.6) of the uncontrolled patients, combination with another drug being the most frequent behavior (46.3%), followed by dose increase (26.1%), and antihypertensive drug switch (22.8%). The perception of the physician of good BP control was the factor most associated with not modifying the treatment in uncontrolled patients. CONCLUSIONS: Study results showed that the PC physician modified antihypertensive treatment in only 3 out of 10 uncontrolled patients. When treatment modification was made, association of drugs was the most frequent behavior.

[Clinical characteristics of patients diagnosed of chronic heart failure attended in Primary Care. The CARDIOPRES study]. / Características clínicas de los pacientes diagnosticados de insuficiencia cardíaca crónica asistidos en Atención Primaria. Estudio CARDIOPRES.

INTRODUCTION: Scarce information is available on the clinical characteristics and risk factors of patients with chronic heart failure (CHF) attended in Primary Care (PC) setting. The aim of this study was to analyze the clinical characteristics of this population in PC. PATIENTS AND METHODS: Multicenter, cross-sectional study in patients with CHF, consecutively recruited by 232 physicians in PC. The collected data included sociodemographic, etiologic, clinical and therapeutic variables. RESULTS: Eight hundred forty seven (847) patients were included (age 73.0 +/- 9.6 years; 50.5% men). Of these, 84.3% had arterial hypertension (AHT), 59.2% hypercholesterolemia and 34.9% diabetes mellitus. The most frequent associated clinical disorders were ischemic heart disease (40.1%) and peripheral artery disease (28.6%). In 69.6% of the patients the physicians knew the type of dysfunction (32.4% systolic, 37.2% diastolic). The main etiologies of CHF were the hypertensive cardiomyopathy (75.0%) and ischemic heart disease (40.1%); the most frequent trigger factor was atrial fibrillation (43.9%). Loop diuretics (72.3%) and angiotensin-converting enzyme inhibitors (60.9%) were the treatments used most and 6.7% of the patients were receiving treatment with beta blockers. CONCLUSIONS: AHT appears to be primary cause of CHF in PC. Diastolic dysfunction is more frequent than the systolic one, and the PC physicians do not know the cause of the ventricular dysfunction in one third of the cases. Loop diuretics and angiotensin-converting enzyme inhibitors were the most frequently used in these patients; the use of beta blockers in CHF is very scarce in PC.

[Diabetes mellitus in hypertensive population attended in Primary Care in Spain. Blood pressure and lipid control rates]. / Diabetes mellitus en la población hipertensa asistida en Atención Primaria en España.Grado de control tensional y lipídico.

OBJECTIVES AND METHODS: The aim of this study was to determine the blood pressure and LDL-cholesterol (LDL-c) control rates of hypertensive patients with diabetes mellitus attended in primary care setting in Spain, and to compare the data with those of the hypertensive population without diabetes. For this purpose, we analyzed the subset of diabetic patients of those included in the PRESCOT study (a cross-sectional survey of hypertensive subjects > 18 years attended in primary care). 12,954 patients (49.9% females; 62.1 +/- 10.7 years) were included in the PRESCOT study. Good controls were considered blood pressure < 130/80 mmHg (according to European Society of Hypertension-European Society of Cardiology [ESH-ESC] guidelines) and LDL-c < 100 mg/dl (National Cholesterol Education Program-Adult Treatment Panel III [NCEP-ATP III]). RESULTS: Overall, 3868 (29.9%) of PRESCOT patients were diabetics (mean age 64.2 +/- 9.8 years; 47.5% males). Almost all the diabetic patients (98.5%) were taking some drug besides the antidiabetic treatment and 84.9% were taking at least 2 drugs. Although diabetic patients were treated with more antihypertensive medication than those without diabetes (48.75% vs 40.85% were on > 2 drugs, p < 0.001), blood pressure control was much lower in diabetics (6.3% vs 32.7%, p < 0.0001). In the same way, LDL-c control was also lower in these patients (12.0% vs 31.9%, p < 0.0001). Only 1.0% of diabetic hypertensives were well controlled for both risk factors (vs 11.9% of non-diabetics, p < 0.0001). Predictors of bad blood pressure control were sedentarism and presence of associated clinical conditions, and for lipid control the younger age, female gender, overweight, alcoholism and non-use of lipid-lowering agents. CONCLUSIONS: The presence of diabetes in hypertensive population attended in Spanish primary health care is frequent. One out of every three hypertensives who attend the outpatient clinic daily is diabetic. Even though more drugs are prescribed in these patients, blood pressure and LDL-c control rates are significantly lower than in patients without diabetes. In the daily practice of primary care setting, almost no diabetic hypertensive subject is well controlled for blood pressure and LDL-c.

[Primary care physicians behaviour in inadequate blood pressure control]. / Conducta del médico de atención primaria ante el mal control de la presión arterial.

PURPOSE: To investigate the behaviour of primary care (PC) physicians on inadequate hypertension control. DESIGN: Cross-sectional and multicentric study. SETTING: PC clinics in the whole of Spain. PATIENTS: Patients > or =18 years old who followed pharmacological antihypertensive treatment since at least 3 months before, selected by a consecutive sampling. MEASUREMENTS: Blood pressure measured by family doctors. The therapeutic diagram used before and after the visit was registered, and in those cases in which some kind of modification was adopted, the reasons why. RESULTS: 12,754 hypertensive patients were included. The average age was 63.3+/-10.9 years (57.3% women). A 65% lived in urban areas and the 35% in semi-urban o rural areas. The 63.9% (95% confidence interval, 63.1%-64.8%) showed a bad control of hypertension. The majority of the patients followed a therapeutic regimen of monotherapy (56%) being the ACE inhibitors the most prescribed drug (34.8%), followed by the calcium antagonist (21.3%), and angiotensin II antagonists (17.4%). The percentage of patients with inadequate control of the blood pressure, in which the therapeutic behaviour was modified was 18.3% (95% confidence interval, 17.5%-19.1%) (a change of drug in 47%, association in 34.7% and an increase in the dose in 18.3%). The main reasons for which the therapeutic behaviour was modified was because no drug efficacy (63.7%) and the presence of adverse events (5.5%). The price of the therapy originated 1.2% of the modifications. CONCLUSIONS: PC physicians behaviour was conservative in uncontrolled hypertension cases. Amongst the doctors who modified their behaviour, by inadequate blood pressure control, the change of drug was the decision most adopted.

Conducta del médico de atención primaria ante el mal control de la presión arterial / Primary care physicians behaviour in inadecuate blood pressure control

Objetivos. Conocer la conducta del médico de atención primaria (AP) ante la falta de control de la hipertensión arterial. Diseño. Estudio descriptivo, multicéntrico. Emplazamiento. Consultas de AP del conjunto de España. Participantes. Hipertensos mayores de 18 años que seguían tratamiento farmacológico antihipertensivo desde al menos 3 meses antes, reclutados mediante muestreo no probabilístico de casos consecutivos. Mediciones principales. Presión arterial medida por los médicos de familia. Se registró el esquema terapéutico utilizado antes y después de la visita, y en los casos en los cuales se adoptó alguna modificación, los motivos de ésta. Resultados. Se incluyó a 12.754 pacientes hipertensos. La edad media fue de 63,3 ± 10,9 años (un 57,3% mujeres). El 65% habitaba en medio urbano y el 35% en medio semiurbano o rural. El 63,9% (intervalo de confianza del 95%, 63,1-64,8%) presentó mal control de la hipertensión arterial. La mayoría de los pacientes seguía un régimen terapéutico de monoterapia (56%). Los fármacos más prescritos fueron los inhibidores de la enzima de conversión de la angiotensina (34,8%), seguidos de los antagonistas del calcio (21,3%) y los antagonistas de los receptores de la angiotensina (17,4%). El porcentaje de pacientes con inadecuado control de la presión arterial en quienes se modificó la pauta terapéutica fue del 18,3% (intervalo de confianza del 95%, 17,5-19,1%) (cambio de fármaco en un 47%, asociación en el 34,7% y aumento de dosis en un 18,3%). Los principales motivos por los que se modificó la pauta terapéutica fueron la falta de eficacia del tratamiento (63,7%) y la presencia de acontecimientos adversos (5,5%). El precio del medicamento originó el 1,2% de las modificaciones en la pauta. Conclusiones. La conducta terapéutica del médico de AP fue conservadora en los hipertensos no controlados. En los médicos que modificaron su conducta ante el mal control, el cambio de fármaco fue la decisión más adoptada

Purpose. To investigate the behaviour of primary care (PC) physicians on inadequate hypertension control. Design. Cross-sectional and multicentric study. Setting. PC clinics in the whole of Spain. Patients. Patients >=18 years old who followed pharmacological antihypertensive treatment since at least 3 months before, selected by a consecutive sampling. Measurements. Blood pressure measured by family doctors. The therapeutic diagram used before and after the visit was registered, and in those cases in which some kind of modification was adopted, the reasons why. Results. 12 754 hypertensive patients were included. The average age was 63.3±10.9 years (57.3% women). A 65% lived in urban areas and the 35% in semi-urban o rural areas. The 63.9% (95% confidence interval, 63.1%-64.8%) showed a bad control of hypertension. The majority of the patients followed a therapeutic regimen of monotherapy (56%) being the ACE inhibitors the most prescribed drug (34.8%), followed by the calcium antagonist (21.3%), and angiotensin II antagonists (17.4%). The percentage of patients with inadequate control of the blood pressure, in which the therapeutic behaviour was modified was 18.3% (95% confidence interval, 17.5%-19.1%) (a change of drug in 47%, association in 34.7% and an increase in the dose in 18.3%). The main reasons for which the therapeutic behaviour was modified was because no drug efficacy (63.7%) and the presence of adverse events (5.5%). The price of the therapy originated 1.2% of the modifications. Conclusions. PC physicians behaviour was conservative in uncontrolled hypertension cases. Amongst the doctors who modified their behaviour, by inadequate blood pressure control, the change of drug was the decision most adopted

[Factors conditioning pulse pressure in type-2 diabetics in a primary care population suffering from hypertension]. / Factores condicionantes de la presión de pulso en los diabéticos tipo 2 de una población hipertensa de atención primaria.

OBJECTIVE: To analyse the differences in pulse pressure (PP) between type-2 diabetic and non-diabetic hypertense patients, using clinical blood pressure (CBP) measurement and out-patient blood pressure monitoring (OPBPM) over 24 hours in primary care. DESIGN: Cross-sectional descriptive study. SETTING: Primary care. PARTICIPANTS: 163 hypertense patients in a random sample, including the first patient of each day with an appointment. MAIN MEASUREMENTS: CBP (Hg sphygmomanometer) and OPBPM recording. PP was considered high when the difference between systolic and diastolic pressure was over 60 mm Hg. RESULTS: 31.3% (51 patients) were diabetic. Mean clinical PP was 75.9 +/- 18.4 in diabetics and 64.5 +/- 18.9 mm Hg in non-diabetics (P<.001). Mean out-patient PP was 61.4 +/- 13.8 in diabetics and 53.5 +/- 11 mm Hg in non-diabetics (P<.001), with clinical and out-patient PP correlating with age. Clinical and out-patient PP were high in 63.8% and 57.4%, respectively, of hypertense diabetics. The logistical regression model showed more likelihood of high PP in those over 64 and in those with isolated systolic hypertension and/or diabetes mellitus. CONCLUSIONS: We found considerable differences between clinical and out-patient PP, and between the PP of the diabetic and non-diabetic population with hypertension. High out-patient PP in hypertense patients is related to diabetes and isolated systolic hypertension.

Factores condicionantes de la presión de pulso en los diabéticos tipo 2 de una población hipertensa de atención primaria / Factors conditioning pulse pressure in type-2 diabetics in a primary care population suffering from hypertension

Objetivo. Analizar las diferencias de la presión de pulso (PP) en pacientes hipertensos diabéticos tipo 2 y no diabéticos utilizando la medida de la presión arterial (PA) clínica (PAC) y la monitorización ambulatoria de la presión arterial (MAPA) de 24 h en atención primaria (AP).Diseño. Estudio descriptivo transversal. Emplazamiento. Atención primaria. Participantes. Un total de 163 hipertensos de una muestra no seleccionada de pacientes, en la que se incluyó al primer paciente que acudió a la consulta programada cada día. Mediciones principales. Registros de PAC (esfigmomanómetro de Hg) y MAPA. Se consideró PP elevada a la diferencia entre la PA sistólica y diastólica superior a 60 mmHg. Resultados. El 31,3 por ciento (51 pacientes) era diabético. La PP clínica media fue de 75,9 ñ 18,4 mmHg en diabéticos y 64,5 ñ 18,9 mmHg en no diabéticos (p < 0,001) y la PP ambulatoria media fue de 61,4 ñ 13,8 mmHg en diabéticos y 53,5 ñ 11 mmHg en no diabéticos (p < 0,001), correlacionándose la PP clínica y ambulatoria con la edad. La PP clínica y ambulatoria resultaron elevadas en el 63,8 y 57,4 por ciento, respectivamente, de los hipertensos diabéticos. El modelo de regresión logística demostró una mayor probabilidad de PP elevada en los mayores de 64 años y en los que presentaban hipertensión arterial sistólica aislada o diabetes mellitus. Conclusiones. Encontramos importantes diferencias entre la PP clínica y la ambulatoria, así como entre la PP de la población hipertensa diabética y no diabética. La PP ambulatoria elevada en los pacientes hipertensos se asocia con la diabetes y la hipertensión sistólica aislada. (AU)