Prognosis of Systolic Pressure 130 to 139 According to Risk. A Prospective Cohort Study Between 1992 and 2019.

BACKGROUND: Guidelines recommend pharmacological treatment for systolic blood pressure (SBP) of 130 to 139 mm Hg in secondary prevention. However, uncertainty persists in primary prevention in low cardiovascular risk patients (CVR). METHODS: Cohort study representative of the general population of Albacete/Southeast Spain. We examined 1029 participants with untreated blood pressure and free of cardiovascular disease, followed-up during 1992 to 2019. Cox regression modeled the association of SBP with cardiovascular morbidity and mortality (outcome-1) and cardiovascular morbidity and all-cause mortality (outcome-2). RESULTS: Participants' mean age was 44.8 years (53.8%, women; 77.1% at low-CVR); 20.3% had SBP 120 to 129; 13.0% 130 to 139 at low-CVR and 3.4% at high-CVR; and 27.4% ≥140 mm Hg. After a 25.7-year median follow-up, 218 outcome-1 and 302 outcome-2 cases occurred. Unadjusted hazard ratios of outcome-1 for these increasing SBP categories (versus <120) were 2.72, 2.27, 11.54, and 7.52, respectively; and 2.69, 2.32, 10.55, and 7.34 for outcome-2 (all P<0.01). After adjustment for other risk factors, hazard ratio (95% CI) of outcome-1 were 1.49 (0.91-2.44), 1.65 (0.94-2.91, P=0.08), 1.36 (0.72-2.57), and 1.82 (1.15-2.88), respectively, and 1.39 (0.91-2.11), 1.69 (1.05-2.73), 1.09 (0.63-1.88), and 1.64 (1.11-2.41) for outcome-2. Compared with 130 to 139 at low-CVR, hazard ratio for 130 to 139 at high-CVR was 4.85 for outcome-1 (P<0.001) and 4.43 for outcome-2 (P<0.001). CONCLUSIONS: In this primary prevention population of relatively young average age, untreated SBP of 130 to 139 mm Hg at low-CVR had long-term prognostic value and might benefit from stricter SBP targets. High-CVR patients had nonsignificant higher risk (limited sample size) but 4-fold greater risk when compared with low-CVR. Overall, results indicate the importance of risk stratification, supporting risk-based decision-making.

Concordance between automated oscillometric measurement of ankle-brachial index and traditional measurement by eco-Doppler in patients without peripheral artery disease.

AIM: To evaluate the concordance between automated oscillometric measurement (WatchBP® Office ABI) of the ankle- brachial index (ABI) and the traditional measurement by eco-Doppler in a Spanish population without peripheral artery disease attended in primary care. METHODS: The ABI was determined by both methods in a general population aged ≥ 18 years, from the RICARTO study. The intraclass correlation coefficient was calculated to assess the concordance between both techniques and the Bland-Altman plot was determined to analyze the agreement between them. RESULTS: A total of 322 subjects (mean age 47.7 ± 16.0 years; 54.3% women) were included in the study. With regard to cardiovascular risk factors, 70.5% of subjects had dyslipidemia, 26.7% hypertension, 24.8% obesity, 8.4% diabetes and 25.5% were smokers. Mean ABI measured by eco-Doppler and the automated method were 1.17 ± 0.1 and 1.2 ± 0.1, respectively (mean differences - 0.03 ± 0.09; p < 0.001). The Pearson correlation coefficient and the intraclass correlation coefficient were in both cases 0.70. CONCLUSIONS: The automated oscillometric measurement of ABI is a reliable and useful alternative to conventional eco-Doppler determination in the general population without peripheral artery disease attended in primary care.

Framingham risk score for prediction of cardiovascular diseases: a population-based study from southern Europe.

BACKGROUND: The question about what risk function should be used in primary prevention remains unanswered. The Framingham Study proposed a new algorithm based on three key ideas: use of the four risk factors with the most weight (cholesterol, blood pressure, diabetes and smoking), prediction of overall cardiovascular diseases and incorporating the concept of vascular age. The objective of this study was to apply this new function in a cohort of the general non Anglo-Saxon population, with a 10-year follow-up to determine its validity. METHODS: The cohort was studied in 1992-94 and again in 2004-06. The sample comprised 959 randomly-selected persons, aged 30-74 years, who were representative of the population of Albacete, Spain. At the first examination cycle, needed data for the new function were collected and at the second examination, data on all events were recorded during the follow-up period. Discrimination was studied with ROC curves. Comparisons of prediction models and reality in tertiles (Hosmer-Lemeshow) were performed, and the individual survival functions were calculated. RESULTS: The mean risks for women and men, respectively, were 11.3% and 19.7% and the areas under the ROC curve were 0.789 (95%CI, 0.716-0.863) and 0.780 (95%CI, 0.713-0.847) (P<0.001, both). Cardiovascular disease events occurred in the top risk tertiles. Of note were the negative predictive values in both sexes, and a good specificity in women (85.6%) and sensitivity in men (79.1%) when their risk for cardiovascular disease was high. This model overestimates the risk in older women and in middle-aged men. The cumulative probability of individual survival by tertiles was significant in both sexes (P<0.001). CONCLUSIONS: The results support the proposal for "reclassification" of Framingham. This study, with a few exceptions, passed the test of discrimination and calibration in a random sample of the general population from southern Europe.

[Trends in prevalence of risk factors and global cardiovascular risk in general population of albacete, Spain (1992-94 a 2004-06)]. / Evolución de la prevalencia de los factores de riesgo y del riesgo cardiovascular global en población mayor de 18 años de la provincia de Albacete (1992-94 a 2004-06).

BACKGROUND: To establish strategies for prevention of cardiovascular disease implies to know its epidemiology and evolution in time. The objective of this study is to know the prevalence of risk factors and cardiovascular risk in two moments during the following of a grownup general population. METHODS: Study of cohorts, followed at random selected general population during 12 years (1992-94 to 2204-06). Two transversal studies were made, one at the beginning and the other one at the end of this follow-up. The population in this study was 18 years and older registered in the province of Albacete. Random sampling, stratified and two-stage. The sample size for the first cut was 2121 subjects and for second one 1577. One specific anamnesis was made, physical examination, measurement of blood pressure, electrocardiogram and extraction of venous blood. The studied variables were: age, sex, personal and familiar antecedents, risk factors and global cardiovascular risk. RESULTS: 1322 subjects went to the appointment for the first examination (mean age 48.2 years. 53.6% women) and 997 for the second (mean age 52.8 years. 56.7% women). Has Increased the prevalence of hypertension (32.7% to 41,2%), diabetes (9,8 to 11,4%), obesity (27,8 to 34,3%) and hypercolesterolemia (47,5 to 53,5%), whereas smokers have decreased (32,6 to 23,7%) and have handicapped the average values of arterial pressure (132/81 to 129/73 mmHg), glycaemia (100,8 to 92,8 mg/dl) and LDL-cholesterol (128,7 to 116,7 mg/dl) and also a lowering of cardiovascular risk with Framingham (10,8% to 8,2%) and Score (2,3% to 1,6%). CONCLUSIONS: In the last years an increasing prevalence of risk factors has been seen (hypertension, diabetes and hypercolesterolemia), a better control of them, and lower prevalence of smoking and cardiovascular risk in the population has also be seen.

Evolución de la prevalencia de los factories de riesgo y del riesgo cardiovascular global en población mayor de 18 añor de la provincia de Albacete (1992-94 a 2004-06) / Trends in prevalence of risk factors and global cardiovascular risk in general population of Albacete, Spain (1992-94 a 2004-06)

Fundamento: Establecer estrategias de prevención de la enfermedad cardiovascular implica conocer su epidemiología y evolución en el tiempo. El objetivo del estudio es conocer las prevalencias de los factores de riesgo y del riesgo cardiovascular en dos momentos de seguimiento de una población general adulta. Métodos: Dentro de un estudio longitudinal y prospectivo con población general seleccionada al azar seguida durante 12 años (1992-94 a 2004-2006) se hacen dos análisis trasversales al inicio y en el último corte de seguimiento. La población objeto de estudio fueron personas mayores de 18 años censadas en la provincia de Albacete. Muestreo aleatorio, estratificado y bietápico. Tamaño muestral 2.121 y 1.577 sujetos en cada uno de los cortes. Se hizo anamnesis, exploración física, medida de presión arterial, electrocardiograma y extracción de sangre venosa. Las variables estudiadas fueron: edad, sexo, antecedentes personales y familiares, factores de riesgo y riesgo cardiovascular global. Resultados: En el primer examen acudieron a la cita 1.322 sujetos (edad media 48,2 años. 53,6% mujeres) y 997 en el segundo (edad media 52,8 años. 56,7% mujeres). Hubo un aumento en la prevalencia de hipertensión (32,7% a 41,2%) diabetes mellitus (9,8 a 11,4%), obesidad (27,8 a 34,3%) e hipercolesterolemia (47,5 a 53,5%), una disminución de fumadores (32,6 a 23,7%), de valores medios de presión arterial (132/81 a 129/73 mmHg), glucemia (100,8 a 92,8 mg/dl) y col-LDL (128,7 a 116,7 mg/dl) y un descenso del riesgo cardiovascular con Framingham (10,8% a 8,2%) y Score (2,3% a 1,6%). Conclusiones: En los últimos años se observa un aumento en la prevalencia de factores de riesgo (hipertensión, diabetes e hipercolestrerolemia), un mejor control de los mismos, una menor prevalencia de fumadores y menor riesgo cardiovascular en la población(AU)

Background: To establish strategies for prevention of cardiovascular disease implies to know its epidemiology and evolution in time. The objective of this study is to know the prevalence of risk factors and cardiovascular risk in two moments during the following of a grownup general population. Methods: Study of cohorts, followed at random selected general population during 12 years (1992-94 to 2204-06). Two transversal studies were made, one at the beginning and the other one at the end of this followup. The population in this study was 18 years and older registered in the province of Albacete. andom sampling, stratified and two-stage. The sample size for the first cut was 2121 subjects and for second one 1577. One specific anamnesis was made, physical examination, measurement of blood pressure, electrocardiogram and extraction of venous blood. The studied variables were: age, sex, personal and familiar antecedents, risk factors and global cardiovascular risk. Results: 1322 subjects went to the appointment for the first examination (mean age 48.2 years. 53.6% women) and 997 for the second (mean age 52.8 years. 56.7% women). Has Increased the prevalence of hypertension (32.7% to 41,2%), diabetes (9,8 to 11,4%), obesity (27,8 to 34,3%) and hypercolesterolemia (47,5 to 53,5%), whereas smokers have decreased (32,6 to 23,7%) and have handicapped the average values of arterial pressure (132/81 to 129/73 mmHg), glycaemia (100,8 to 92,8 mg/dl) and LDL-cholesterol (128,7 to 116,7 mg/dl) and also a lowering of cardiovascular risk with Framingham (10,8% to 8,2%) and Score (2,3% to 1,6%). Conclusions: In the last years an increasing prevalence of risk factors has been seen (hypertension, diabetes and hypercolesterolemia), a better control of them, and lower prevalence of smoking and cardiovascular risk in the population has also be seen(AU)

[Control of hypertension in elderly patients receiving primary care in Spain]. / Control de la hipertensión arterial en la población española > or = 65 años asistida en atención primaria.

INTRODUCTION AND OBJECTIVES: Little information is available about the control of arterial hypertension in the elderly population. The aim of this study was to investigate hypertension control, factors associated with poor control, and general practitioners' responses to poor control in a large sample of hypertensive patients aged 65 years or older receiving primary care in Spain. PATIENTS AND METHOD: A cross-sectional study of elderly hypertensive patients taking antihypertensives was carried out. Blood pressure was measured in the standard manner. Blood pressure control was regarded as optimum if pressure averaged less than 140/90 mm Hg or, in diabetics, less than 130/85 mm Hg. RESULTS: The study included 5970 patients (mean age, 72.4 years; 62.8% women). Both systolic and diastolic blood pressures were well controlled in 33.5% of patients, systolic blood pressure alone in 35.5%, and diastolic blood pressure alone in 76.2%. Blood pressure control was found to be good more frequently when it was assessed in the evening (39.8%; P<.001), and when patients had taken treatment on the day of assessment (35.1%; P <.001). Some 12.9% of diabetics had pressures less than 130/85 mmHg and 9.7% had pressures less than 130/80 mmHg. General practitioners modified their therapeutic approach with only 17.2% of poorly controlled patients. CONCLUSIONS: Arterial blood pressure control was optimum in only three out of 10 Spanish hypertensive patients aged 65 years or older. Blood pressure control assessment was significantly influenced by surgery hours and by the timing of antihypertensive intake. General practitioners' therapeutic responses to poor control were too conservative.

Control de la hipertensión arterial en la población española ≥ 65 años asistida en atención primaria / Control of hypertension in elderly patients receiving primary care in Spain

Introducción y objetivos. Se dispone de escasa información sobre el control de la hipertensión arterial en la población de mayor edad. El objetivo de este estudio fue analizar el grado de control de la hipertensión arterial en una amplia muestra de españoles ≥ 65 años asistidos en atención primaria, los factores asociados al mal control yla conducta del médico ante esa situación. Pacientes y método. Estudio transversal realizado en hipertensos ≥ 65 años tratados farmacológicamente. Se midió la presión arterial (PA) siguiendo normas estandarizadas y se consideró que había un control óptimo si era <140/90 mmHg (en diabéticos < 130/85 mmHg).Resultados. Se incluyó a 5.970 pacientes (edad media,72,4 años; 62,8%, mujeres). El 33,5% presentó un buen control sistólico-diastólico, el 35,5% sólo sistólico yel 76,2% únicamente diastólico. El grado de control fue significativamente mayor (p < 0,001) por las tardes(39,8%) y en los pacientes que habían tomado la medicación antihipertensiva el día de la visita (35,1%). El 12,9% de los diabéticos mostró una PA < 130/85 mmHg y el9,7% < 130/80 mmHg. El médico modificó su conducta terapéutica en el 17,2% de los no controlados. Conclusiones. Tan sólo 3 de cada 10 hipertensos españoles≥ 65 años tienen la PA bien controlada. Hay diferencias apreciables en el grado de control según el horario de consulta y la toma previa de antihipertensivos. La conducta terapéutica del médico ante el mal control es demasiado tolerante

Introduction and objectives. Little information is available about the control of arterial hypertension in the elderly population. The aim of this study was to investigate hypertension control, factors associated with poor control, and general practitioners’ responses to poor control in a large sample of hypertensive patients aged 65 years or older receiving primary care in Spain. Patients and method. A cross-sectional study of elderly hypertensive patients taking anti-hypertensives was carried out. Blood pressure was measured in the standard manner. Blood pressure control was regarded as optimum if pressure averaged less than 140/90 mm Hg or, in diabetics, less than 130/85 mm Hg. Results. The study included 5970 patients (mean age,72.4 years; 62.8% women). Both systolic and diastolic blood pressures were well controlled in 33.5% of patients, systolic blood pressure alone in 35.5%, and diastolic blood pressure alone in 76.2%. Blood pressure control was found to be good more frequently when it was assessed in the evening (39.8%; P<.001), and when patients had taken treatment on the day of assessment (35.1%; P<.001). Some 12.9% of diabetics had pressures less than130/85 mmHg and 9.7% had pressures less than 130/80mmHg. General practitioners modified their therapeutic approach with only 17.2% of poorly controlled patients. Conclusions. Arterial blood pressure control was optimum in only three out of 10 Spanish hypertensive patients aged 65 years or older. Blood pressure control assessment was significantly influenced by surgery hours and by the timing of antihypertensive intake. General practitioners’ therapeutic responses to poor control were too conservative