Impact of gastroesophageal reflux disease on the quality of life of Spanish patients: the relevance of the biometric factors and the severity of symptoms.

BACKGROUND: Gastroesophageal reflux disease (GERD) has a negative impact on health-related quality of life (HRQoL). AIM: (i) To evaluate HRQoL in the general Spanish population with GERD. (ii) To analyze the influence of biometric factors and symptoms profile on HRQoL. MATERIALS AND METHODS: A multicenter and population-based evaluation was performed. Surveys were sent out to the general population and 335 responders (16%) fulfilled symptomatic criteria of GERD. They filled out two HRQoL questionnaires [Short Form-36 (SF-36) and Quality of Life in Reflux and Dyspepsia]. Biometric factors and symptoms profile were collected. The SF-36 physical and mental component summary scores were calculated. RESULTS: Two hundred and fifty-two individuals (75.2%) participated. SF-36 and Quality of Life in Reflux and Dyspepsia (QoLRAD) punctuations were lower compared with the general population. Female sex, severity of symptoms, and nocturnal symptoms were associated with a greater deterioration of HRQoL. Obese participants had a negative impact on the physical component summary score, but mental component summary score was better than in participants with normal weight. Adjusted by age, punctuations of smokers, exsmokers, and nonsmokers were similar. No differences in HRQoL with regard to alcohol consumption were observed. CONCLUSION: In participants who fulfill symptomatic criteria of GERD, the HRQoL is very deteriorated. The factors that worsen the QoL are being female, increase in BMI, and nocturnal symptoms.

Electrocardiographic left ventricular hypertrophy regression induced by an angiotensin receptor blocker-based regimen in daily clinical practice: the SARA study.

AIM: Clinical trials have proved that angiotensin receptor blockers (ARB) are more effective than other antihypertensive agents in reducing left ventricular hypertrophy (LVH); however, information about the efficacy of ARB on LVH regression in daily medical practice is scarce. The aim of the SARA study was to investigate the effect of an ARB on electrocardiographic LVH (ECG-LVH) in a hypertensive outpatient population attending clinical practice. METHODS: From 276 recruited patients with mild-to-moderate essential hypertension (245 uncontrolled, 31 newly diagnosed), 264 (age: 62.9+/-11.6 years; 51.2% women) completed the study and were valid for the analysis. The patients were treated for a 12-month period with a candesartan-based regimen [(8/16 mg+hydrochlorothiazide 12.5 mg+additional drugs to target BP<140/90 mmHg (<130/80 in diabetics)]. ECG changes were measured at a core laboratory and Cornell product (CorP), Sokolow-Lyon product (SokP) and QRS duration (QRSd) criteria were determined. RESULTS: At baseline, 27.4% of patients fulfilled the criteria of LVH by CorP. The proportion of patients with ECG-LVH by CorP criteria decreased to 21.1% at the end of the study, relative risk reduction (RRR) was 22.9%, P<0.001. When using SokP the percentage of ECG-LVH reduced from 24.1 to 21.7% (RRR 9.6%, P=0.1). Quantitatively, CorP was reduced by 84.4 mmxms [95% confidence interval (CI): -8.14, -160.66; P=0.03]; a greater reduction was detected in obese patients (P<0.05), diabetics (P<0.07) and patients with baseline ECG-LVH (P<0.05). In the multivariate analysis, female gender, baseline systolic blood pressure, baseline CorP and QRSd values were the main predictive factors for ECG-LVH regression. CONCLUSION: The SARA study demonstrates that a candesartan-based regimen reduces ECG-LVH in the hypertensive population attending daily in clinical practice.

[Prevalence of dyslipidemia in outpatients of the Spanish health service: the HISPALIPID Study]. / Prevalencia de dislipemia en las consultas ambulatorias del Sistema Nacional de Salud: Estudio HISPALIPID.

BACKGROUND AND OBJECTIVE: We intended to estimate the prevalence of dyslipidemia among patients attending outpatient clinics of the Spanish health service. PATIENTS AND METHOD: HISPALIPID is a multicenter, cross-sectional study performed in 33,913 patients (55.7% women) with a mean age of 54.6 +/- 18.3 years attended in outpatient clinics across 15 of the 17 autonomous communities of Spain. 1,461 physicians (78.8% primary care physicians, and 21.2% specialists) participated in the study. Patients were considered having dyslipidemia if their doctor had established a previous diagnosis. RESULTS: A total of 8,256 patients (52.4% women, mean age 62.4 +/- 12.4 years) had been diagnosed with dyslipidemia, representing a global prevalence of 24.3% (CI95%: 23.8-24.8) (M: 26.2%; W:22.9%; P<0.001). The communities with the higher and lower prevalence were the Canary Islands (33.9%) and Cantabria (18.6%), respectively. About 87% dyslipemic patients presented an additional cardiovascular risk factor and 36.7% of dyslipemic patients had an associated cardiovascular disease. CONCLUSIONS: The prevalence of dyslipidemia is high in patients attending outpatient clinics of the Spanish health service (one out of four patients). In addition, these patients are at a high cardiovascular risk.

Prevalencia de dislipemia en las consultas ambulatorias del Sistema Nacional de Salud: Estudio HISPALIPID / Prevalence of dyslipidemia in outpatients of the Spanish health service: The HISPALIPID Study

Fundamento y objetivo: Conocer la prevalencia de la dislipemia entre los pacientes atendidos en las consultas ambulatorias del Sistema Nacional de Salud (SNS). Pacientes y método: HISPALIPID es un estudio transversal y multicéntrico realizado en una muestra de 33.913 pacientes (55,7% mujeres), con una edad media (DE) de 54,6 (18,3) años, de 15 de las 17 comunidades autónomas de España. Participaron 1.461 médicos (78,8% de atención primaria y 21,2% especialistas). Se consideró dislipémicos a los pacientes que ya tenían el diagnóstico previamente establecido por su médico y control óptimo a valores de la PA < 130/85 mmHg. Resultados: Estaban diagnosticados de dislipemia 8.256 pacientes (52,4% mujeres), con una edad media de 62,4 (12,4) años, y representaban una prevalencia global del 24,3% (intervalo de confianza del 95%, 23,8-24,8) (varones: 26,2%; mujeres: 22,9%; p < 0,001). Las comunidades con mayor y menor prevalencia ajustada por edad, sexo e índice de masa corporal fueron, respectivamente, Canarias (33,9%) y Cantabria (18,6%). El 86,8% de los pacientes tenía al menos otro factor de riesgo cardiovascular asociado. El 36,7% de los pacientes dislipémicos presentaba alguna enfermedad cardiovascular asociada. Conclusiones: La prevalencia de la dislipemia es alta entre los pacientes atendidos en las consultas ambulatorias del SNS, ya que uno de cada cuatro pacientes está diagnosticado de este factor de riesgo cardiovascular. Estos pacientes tienen un perfil de alto riesgo cardiovascular

Background and objective: We intended to estimate the prevalence of dyslipidemia among patients attending outpatient clinics of the Spanish health service. Patients and Method: HISPALIPID is a multicenter, cross-sectional study performed in 33,913 patients (55.7% women) with a mean age of 54.6 ± 18.3 years attended in outpatient clinics across 15 of the 17 autonomous communities of Spain. 1,461 physicians (78.8% primary care physicians, and 21.2% specialists) participated in the study. Patients were considered having dyslipidemia if their doctor had established a previous diagnosis. Results: A total of 8,256 patients (52.4% women, mean age 62.4 ± 12.4 years) had been diagnosed with dyslipidemia, representing a global prevalence of 24.3% (CI95%: 23.8-24.8) (M: 26.2%; W:22.9%; P<0.001). The communities with the higher and lower prevalence were the Canary Islands (33.9%) and Cantabria (18.6%), respectively. About 87% dyslipemic patients presented an additional cardiovascular risk factor and 36.7% of dyslipemic patients had an associated cardiovascular disease. Conclusions: The prevalence of dyslipidemia is high in patients attending outpatient clinics of the Spanish health service (one out of four patients). In addition, these patients are at a high cardiovascular risk

The gap between dyslipidemia control perceived by physicians and objective control patterns in Spain.

OBJECTIVE: It is well-known that adequate control of dyslipidemia is low. But little is known about how well physicians perceive the control of their dyslipidemic patients. This study examines physicians' subjective perception of dyslipidemia control, and compares it with control determined objectively with published guidelines. METHODS: A total of 33,913 patients were studied cross-sectionally in 164 Spanish outpatients' clinics. Of these patients, 5583 were evaluable patients with a documented diagnosis of dyslipidemia. Control of dyslipidemia was evaluated by two methods: the physician's opinion on their patient's lipid levels (adequate control or inadequate control), and the proportion of patients who objectively reach the LDL-cholesterol goals of the National Cholesterol Education Program (NCEP/ATPIII). RESULTS: Physicians perceived that 44% (95% CI 42.7-45.3%) of their patients had an adequate control of their dyslipidemia, but only 32.8% (95% CI 31.6-34.0%) were objectively controlled. Subjective control hardly changed across the NCEP cardiovascular risk groups, but objective control was lower in the 2372 coronary heart disease patients (15.1%) and in the 1407 moderately high-risk patients (29.6%) than in the 1804 lower risk patients (58.5%). Physicians' perception of control was significantly and independently associated with objective control (P<0.001). CONCLUSIONS: Physicians overestimate dyslipidemia control in the majority of their patients. Misperception of control by physicians may contribute to the low achievement of objective control.

Regression of left ventricular hypertrophy by a candesartan-based regimen in clinical practice. The VIPE study.

The VIPE study was a prospective, non-comparative, open-label clinical evaluation of 97 hypertensive patients (69.1% female; 68.9 +/- 9.5 years; mean blood pressure (BP) 160 +/- 12/90 +/- 9 mmHg) with echocardiographic evidence of left ventricular hypertrophy (LVH). Patients were treated for six months with a candesartan-based regimen (8 mg/16 mg + HCTZ 12.5 mg + additional drugs to lower BP < 140/90 mmHg). After six months, systolic/diastolic BP was decreased by 19.3 +/- 8/9.4 +/- 5 mmHg (p<0.001 for both), and left ventricular mass index (LVMI) decreased 17.01 g/m2 (95%CI: -13.2 to -20.99; p<0.001). During treatment with the candesartan-based regimen all echocardiographic parameters related to LVMI were significantly reduced and 28% achieved a target LVMI [< 134 g/m(2) (men) and < 110 g/m(2) (women)]. No significant changes were observed in ejection fraction, shortening fraction or LV diastolic function. Univariate analysis showed that both age (p=0.03) and diabetes (p=0.029) were predictive of LVH regression. Thus, a candesartan-based regimen for six months significantly reduced echocardiographic LVH in hypertensive patients in general practice. The drug was very well tolerated and no serious adverse events were reported.

Effect of AT1 receptor antagonism on vascular and circulating inflammatory mediators in SHR: role of NF-kappaB/IkappaB system.

We investigated the role of angiotensin II in vascular and circulating inflammatory markers in spontaneously hypertensive rats (SHR). IL-1beta, IL-6, and TNF-alpha aortic mRNA expression and plasma levels were measured in adult SHR untreated or treated with the angiotensin II receptor antagonist candesartan (2 mg.kg(-1).day(-1)) or antihypertensive triple therapy (TT; in mg.kg(-1).day(-1): 20 hydralazine + 7 type 1 hydrochlorothiazide + 0.15 reserpine) for 10 wk. Likewise, aortic expression of NF-kappaB p50 subunit precursor p105 and its inhibitor (IkappaB) were measured. Age-matched Wistar-Kyoto rats (WKY) served as normotensive reference. High blood pressure levels were associated with increased (P < 0.05) aortic mRNA expression of IL-1beta, IL-6, and TNF-alpha. Hypertension was also accompanied by increased IL-1beta and IL-6 plasma levels. No differences were observed in circulating TNF-alpha levels between SHR and WKY. SHR presented elevated aortic mRNA expression of the transcription factor NF-kappaB and reduction in its inhibitor, IkappaB. Candesartan decreased (P < 0.05) blood pressure levels, aortic mRNA expression of IL-1beta, IL-6, and TNF-alpha, and (P < 0.05) IL-1beta and IL-6 plasma concentration. However, although arterial pressure decrease was comparable for the treatments, TT only partially reduced the increments in inflammatory markers. In fact, candesartan-treated rats showed significantly lower levels of circulating and vascular inflammatory markers than TT-treated animals. The treatments increased IkappaB mRNA expression similarly. However, only candesartan reduced NF-kappaB mRNA expression. In summary, 1) SHR presented a vascular inflammatory process; 2) angiotensin II, and increased hemodynamic forces associated with hypertension, seems to be involved in stimulation of inflammatory mediators through NF-kappaB system activation; and 3) reduction of inflammatory mediators produced by candesartan in SHR could be partially due to both downregulation of NF-kappaB and upregulation of IkappaB.

A comparison of primary care physicians and pneumologists in the management of asthma in Spain: ASES study.

The purpose of the ASES study is to determine the clinical characteristics of Spanish asthmatic patients seen in primary care (PC) and in pneumology (P) departments, comparing the availability of diagnostic methods, morbidity, the type of treatment and follow-up between the two health care settings. ASES is a multicenter, descriptive, cross-sectional study. The physicians were selected by random sampling. The data were collected by the participating physicians using three questionnaires. Data were collected on 2349 asthmatic patients (1298 from hospitals and 1051 from PC). Smokers predominated in the PC setting (P = 0.000). The spirometry was performed at least once a year in 87.2% of the patients seen in P and 39.8% in PC (P = 0.000). Morbidity was high in both groups (P and PC), more than two nighttime awakenings per month (25.5% versus 29%) and emergency visits in previous year (26% versus 21%). A high percent of asthmatic patients was using both inhaled corticoids and long-acting beta2-agonists (49.5% versus 32%). The 30% of PC patients could not be classified into any step of the treatment. In Spain, the morbidity of disease is high, despite the large use of drugs. Objective monitoring tests have very limited use in PC.

[Control of blood pressure in diabetic patients in primary care setting. DIAPA study]. / Control de la presión arterial de los pacientes diabéticos en el ámbito de atención primaria. Estudio DIAPA.

BACKGROUND AND OBJECTIVE: We aimed to assess the blood pressure (BP) control in patients with diabetes mellitus (DM) treated in primary care (PC) and to establish the factors associated with a suboptimal control of BP. PATIENTS AND METHOD: This was a multicenter, transverse study. Ninety investigators included 875 patients with DM (57.8% women), with a mean (SD) age of 64 (11.8) years. BP was measured according to the Sixth Report of Joint National Committee (JNC-VI) and Word Health Organization/International Society Hypertension (WHO/ISH) recommendations, calculating the arithmetic mean of three consecutive measurements. Patients with a previous established diagnosis were considered to be hypertensive, and an optimal control was considered when BP values were lower than 130/85 mmHg. RESULTS: 66.7% (n = 583) patients with DM were previously diagnosed of hypertension (HT); 86.3% (CI 95%: 83.0-89.1) of those with type 2 DM and 87.8% (CI95%: 70.9-96.0) of those with type 1 DM did not have an optimal control of BP at the visit (BP >= 130 and/or 85 mmHg). 56.8% (CI 95%: 50.1-63.3) of those with type 2 DM and 23.8% (CI 95%: 12.6-39.8) of those with type 1 DM with unknown HT had a BP >= 130 and/or 85 mmHg at the visit. The median of antihypertensive drugs used was 1 (1-2). In a multivariate analysis, age, higher body mass index (BMI), higher cholesterol levels and uric acid were associated with a worse BP control (p < 0.001). CONCLUSIONS: In our study, 66.7% of patients with DM attended in PC had known HT and only 13.6% had an optimal BP control. Diabetic patients with HT were undertreated, with a median of one antihypertensive drug.

Effect of AT1 receptor blockade on hepatic redox status in SHR: possible relevance for endothelial function?

The study investigated whether the amelioration of endothelial dysfunction by candesartan (2 mg.kg-1.day-1; 10 wk) in spontaneously hypertensive rats (SHR) was associated with modification of hepatic redox system. Systolic arterial pressure (SAP) was higher (P < 0.05) in SHR than in Wistar-Kyoto rats (WKY) and was reduced (P < 0.05) by candesartan in both strains. Acetylcholine (ACh) relaxations were smaller (P < 0.05) and contractions induced by ACh + NG-nitro-l-arginine methyl ester (l-NAME) were greater (P < 0.05) in SHR than in WKY. Treatment with candesartan enhanced (P < 0.05) ACh relaxations in SHR and reduced (P < 0.05) ACh + l-NAME contractions in both strains. Expression of aortic endothelial nitric oxide synthase (eNOS) mRNA was similar in WKY and SHR, and candesartan increased (P < 0.05) it in both strains. Aortic mRNA expression of the subunit p22phox of NAD(P)H oxidase was higher (P < 0.05) in SHR than in WKY. Treatment with candesartan reduced (P < 0.05) p22phox expression only in SHR. Malonyl dialdehyde (MDA) levels were higher (P < 0.05), and the ratio reduced/oxidized glutathione (GSH/GSSG) as well as glutathione peroxidase activity (GPx) were lower (P < 0.05) in liver homogenates from SHR than from WKY. Candesartan reduced (P < 0.05) MDA and increased (P < 0.05) GSH/GSSG ratio without affecting GPx. Vessel, lumen, and media areas were bigger (P < 0.05) in SHR than in WKY. Candesartan treatment reduced (P < 0.05) media area in SHR without affecting vessel or lumen area. The results suggest that hypertension is not only associated with elevation of vascular superoxide anions but with alterations of the hepatic redox system, where ANG II is clearly involved. The results further support the key role of ANG II via AT1 receptors for the functional and structural vascular alterations produced by hypertension.

Control de la presión arterial de los pacientes diabéticos en el ámbito de atención primaria. Estudio DIAPA / Control of blood pressure in diabetic patients in primary care setting. DIAPA study

FUNDAMENTO Y OBJETIVO: Conocer el control de la presión arterial (PA) en pacientes con diabetes mellitus (DM) visitados en atención primaria (AP), y determinar los factores asociados a un control subóptimo de la PA. PACIENTES Y MÉTODO: Estudio transversal y multicéntrico. Noventa investigadores incluyeron a 875 pacientes con DM (57,8 por ciento mujeres), con edad media (DE) de 64 (11,8) años. La PA se midió según las recomendaciones del Sexto Informe del Joint National Committee (JNC-VI) y de la Organización Mundial de la Salud/Sociedad Internacional de Hipertensión (OMS/ISH), calculándose la media aritmética de tres tomas sucesivas. Se consideró hipertensos a los pacientes con diagnóstico previo establecido, y control óptimo a los valores de PA inferiores a 130/85 mmHg. RESULTADOS: El 66,7 por ciento (n = 583) de los pacientes con DM estaban previamente diagnosticados de hipertensión arterial (HTA); de éstos, el 86,3 por ciento (intervalo de confianza [IC] del 95 por ciento, 83,089,1) de los pacientes con DM tipo 2 y el 87,8 por ciento (IC del 95 por ciento, 70,9-96,0) de los pacientes con DM tipo 1 no tenían un control óptimo de la PA en la visita (PA mayor o igual de 130 y/o 85 mmHg). El 56,8 por ciento (IC del 95 por ciento, 50,1-63,3) de los enfermos con DM tipo 2 y el 23,8 por ciento (IC del 95 por ciento, 12,6-39,8) de los enfermos con DM tipo 1 sin HTA conocida tenían una PA igual o superior a 130 y/o 85 mmHg en la visita. La mediana de fármacos antihipertensivos utilizados fue de 1 (1-2). En el análisis multivariante, la edad, un mayor índice de masa corporal y los valores de colesterol y ácido úrico se asociaron a un peor control de la PA (p < 0,001). CONCLUSIONES: En nuestro estudio, el 66,7 por ciento de los pacientes con DM atendidos en AP eran hipertensos conocidos y sólo el 13,6 por ciento tenía un control óptimo de la PA. Los pacientes diabéticos con HTA estaban infratratados, con una mediana de un fármaco antihipertensivo (AU)

Angiotensin II type 1 receptor blockade to control blood pressure in postmenopausal women: influence of hormone replacement therapy.

BACKGROUND: Hypertension is twice as common in postmenopausal than in premenopausal women. This study evaluated the effectiveness of a blockade of the renin-angiotensin-aldosterone system (RAAS) with candesartan cilexetil (CC) to control blood pressure (BP) in hypertensive menopausal women, and the influence of hormone replacement therapy (HRT). METHODS: This was designed as a prospective, open-label and non-comparative study. Included were 618 hypertensive menopausal women grade I/II according to the Sixth Report of the Joint National Committee (VI-JNC), with an average age 52+/-4.7 years (95% CI 52.3-53.0) and with a last menstrual period (LMP) at least one year before. BP was determined by measurement in four visits during six months of follow-up, according to the recommendations of the OMS/SIH. Optimal control of BP was considered as BP <140/90 mm Hg. RESULTS: A statistically significant decrease in systolic (SBP; 19.9+/-11.2) and diastolic (DBP; 11.5+/-7.3) blood pressure mm Hg values was observed (P<0.01). The control of BP increased significantly over time to 61.2% (P<0.01). In multivariate analysis, only age was associated with control of BP (beta= -0.062; P=0.004). Of the women not controlled in the second visit, 12.5 mg of hydrochlorothiazide (HCTZ) were added to 31.5% (N=122), with 80% more BP control achieved in visit 3 than in the non-supplement group (OR=1.8; 95% CI 1.04-3.05; P<0.03). One hundred and three (16.7%) patients were receiving HRT for 2.01+/-2.23 years (95% CI 1.55-2.46). HRT did not affect the control of BP. No severe adverse reactions were reported. CONCLUSIONS: Candesartan cilexetil significantly reduced SBP and DBP and increased control (61.2%) of BP in hypertensive menopausal women. Only age had an inverse association with control of BP. In this study, HRT did not affect the control of BP.