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)

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

[Efficacy of an intervention to improve treatment compliance in hyperlipidemias]. / Eficacia de una intervención para mejorar el cumplimiento terapéutico en las dislipemias.

OBJECTIVE: To analyse the efficacy of the intervention through a telephone call about patients' compliance with lipaemia therapy. DESIGN: Controlled, randomised clinical trial. SETTING: Ten clinics at 6 primary care centres. PARTICIPANTS: 126 people diagnosed with hypercholesterolaemia according to Spanish Consensus criteria were chosen. INTERVENTION: Two groups were formed. The control group (CG) of 63 patients, who received the doctor's normal treatment; and the Intervention group (IG) of 63 patients, who received in addition a telephone call at 2 weeks, 2 months and 4 months. MAIN MEASUREMENTS: Pills were counted and cholesterol, triglycerides, HDL-C and LDL-C determined at the start, and at the third and sixth months. Percentages of patients complying (80%-110%), the mean compliance percentage and the degree of control were compared. The reduction of absolute and relative risk (RAR and RRR) and the mean number of people that required an intervention in order to avoid non-compliance (NI) were calculated. RESULTS: 115 people (91.26%) completed the survey, 56 in the IG and 59 in the CG. 77.1% complied with the therapy (CI, 68.4-85.8), (CG=64.4%, CI, 55.3-73.5; IG=93.5%, CI, 88.8-98 [P<.001]). Mean compliance ran at 88.7 +/- 10.2 overall, at 84.4 +/- 12.8 in the CG and at 93 +/- 8.2 in the IG (P<.001). The RAR was 29.1%, the RRR 81%, and the NI was 3.43 patients. The patients controlled ran at 43.9% in the IG (CI, 34.9-52.9) and 23.1% in the CG (CI, 15.4-30.8) (P<.005). CONCLUSIONS: The telephone intervention is an efficacious way of improving the percentage of patients complying with lipaemia treatment.

¿La hipertensión de bata blanca es un estadioprehipertensivo? Dos años de seguimientomediante monitorización ambulatoria de la presión arterial / Is white coat hypertension a stage of pre-hypertension? Two years of follow-up by means of ambulatory blood pressure monitoring

Propósito del estudio. Analizar la evolución de la hipertensión de bata blanca (HBB) a hipertensión arterial (HTA) mantenida mediante monitorización ambulatoria de la presión arterial (MAPA) a los dos años de seguimiento tras su diagnóstico. Métodos usados. Estudio prospectivo de cohortes en Atención Primaria. Se seleccionaron 86 individuos sin tratamiento antihipertensivo divididos en dos grupos: a) grupo no expuestos (GNE): 43 normotensos voluntarios, y b) grupo expuestos: 43 individuos con HBB (PA clínicas superiores e inferiores, respectivamente, a 140 y/o 90 mmHg y cifras de PA ambulatoria diurna inferiores a 135 y 85 mmHg).Se realizó una MAPA (Spacelabs 90207) al inicio, a los 6 meses, al año y dos años. Se compararon las PA clínicas y ambulatorias, la incidencia de HTA por MAPA y el riesgo relativo. Se consideró HTA mantenida cifras de PA diurnas superiores a 135 y/o 85 mmHg para PA sistólica (PAS) y PA diastólica (PAD), respectivamente. Resultados. Finalizaron el estudio 81 pacientes, 40 en el GE y 41 en el GNE, sin diferencias en edad y sexo al inicio. La incidencia de HTA a los 6 meses fue del 4,87 por ciento (IC = 0-28,2) en GNE y del 20 por ciento (IC = 0-43,5) en el GE (RR = 3,8; IC = 0,86-16,9) (p = 0,052). Al año fue del 9,75 por ciento (IC = 0-30,6) en el GNE frente al 47,5 por ciento (IC = 21,7-73,3) en GE (RR = 4,63; IC = 1,7-12,4) (p = 0,001) y a los dos años fue del 21,95 por ciento (IC = 2,95-40,9 por ciento) en el GNE frente al 55 por ciento (IC = 27-73 por ciento) en el GE (RR = 2,51; IC = 1,32-4,74) (p = 0,0022). La incidencia de HTA mantenida aumenta al incrementar los rangos de valores de PA diurnas, con un mayor porcentaje en los grupos de PA sistólica diurna de 126130 y >130 mmHg. Conclusiones. Los pacientes con HBB presentan una incidencia de HTA superior respecto a los normotensos, tanto al año como a los dos años de seguimiento (AU)

Importante hipertrofia de ventrículo izquierdo,ecocardiográficamente, en paciente hipertensode reciente comienzo / Echocardiograph manifestation of significant left-ventricular hypertrophy in early-stage hypertensive patients

No disponible

El incumplimiento terapéutico en el tratamiento de la hipertensión arterial en España. Análisis de los estudios publicados entre 1984 y 2001 / Therapy non-compliance in the treatment of arterial hypertension in Spain. Analysis of reported studies between 1984 and 2001

Tradicionalmente, y de forma general en las publicaciones españolas, el término "cumplimiento" Objetivo. Analizar de forma conjunta el incumplimiento terapéutico farmacológico de la hipertensión arterial (HTA) en España por medio de una revisión de todos los estudios publicados entre 1984 y 2001.Material y métodos. Estudio descriptivo de una revisión bibliográfica de todos los estudios publicados en España entre los años 1984 hasta el día 1 de junio de 2001 que analicen el incumplimiento terapéutico farmacológico en la HTA. Se ha realizado una búsqueda en Medline, una revisión manual de las revistas españolas Medicina Clínica, Revista Clínica Española, Atención Primaria, Hipertensión, Semer, Centro de Salud y Medifam y una búsqueda bibliográfica manual sobre todas las referencias, de todos los artículos detectados sobre cumplimiento en España. Se incluyeron estudios que analizaran el incumplimiento en la HTA, artículos originales publicados en revistas médicas y que utilizan como método de medida el recuento de comprimidos y consideran como incumplidores un valor del porcentaje de cumplimiento inferior al 80 por ciento y superior al 110 por ciento. Se calculó el porcentaje de cumplidores e incumplidores y sus intervalos de confianza al 95 por ciento y la media ponderada del porcentaje de incumplidores de cada estudio. Resultados. Se han obtenido un total de 19 estudios de investigación publicados en España. El número total de pacientes incluidos ha sido de 2.313 hipertensos, de los cuales fueron incumplidores el 39,56 por ciento (intervalo de confianza [IC] : 37,53-41,59) (n = 915) y cumplidores el 60,44 por ciento (IC: 58,44-62,47) (n = 1.398).La media ponderada del porcentaje de incumplimiento fue del 44,91 por ciento. Conclusiones. El porcentaje de incumplimiento en el tratamiento farmacológico de la HTA en España es alto, aunque de forma global se observa un ligero descenso en los últimos estudios (AU)

La normotensión de bata blanca como causa de un accidente isquémico transitorio / White coat normotension as cause of a transitory isquemic accident

Se describe el caso de un paciente varón de 58 años que presenta en el último mes 2 episodios de pérdida de fuerzas en ambas extremidades izquierdas, con disartria y caída al suelo y resolución espontánea. Fue diagnosticado de accidente isquémico transitorio (AIT). No presentaba ningún factor de riesgo cardiovascular, con presiones arteriales normales.Tras estudio neurológico específico y estudio de la posible etiología o factores de riesgo no se observó ninguna evidencia. Se practicó una monitorización ambulatoria de la presión arterial durante 24 horas, observándose el fenómeno de normotensión de bata blanca como posible factor de riesgo favorecedor del accidente isquémico. Se analiza la prevalencia, diagnóstico, reproducibilidad, asociación a otras variables y su significado clínico. (AU)

El cumplimiento terapéutico con irbesartán. Influencia en la variabilidad de la presión arterial en el tratamiento de la HTA leve-moderada / Therapeutic compliance with irbesartan influences variability of blood pressure in the treatment of light-moderate hypertension

Objetivo. Analizar la influencia del cumplimiento terapéutico de la hipertensión arterial (HTA), en la variabilidad de la presión arterial (PA) mediante monitorización ambulatoria (MAPA), tras tratamiento con irbesartán. Ámbito. Atención Primaria. Diseño. Estudio prospectivo. Sujetos. Ciento un individuos con HTA leve-moderada cuya MAPA inicial presentó PA sistólica (PAS) y PA diastólica (PAD) medias diurnas > 140 y/o 90 mmHg. Mediciones. Se realizó MAPA (Spacelabs 90207) al inicio y tras 8 semanas. Recibieron 2 visitas domiciliarias por sorpresa (4 y 8 semanas), con recuento de hipotensores y medición de PA. Se prescribió irbesartán 150 mg/día, duplicándose al mes si la PA no estaba controlada. Se calculó el índice de variabilidad (IV) = magnitud de la media de desviaciones estándar en cada parámetro (PAS, PAD, presión arterial media [PAM]) y cada período (global, diurno, nocturno). Se comparó el IV inicial y final según el porcentaje de cumplimiento (PC) por grupos: GA = PC 90 por ciento (PC = comprimidos presumiblemente consumidos/comprimidos que debiera haber consumido × 100).Resultados. Finalizaron 91 individuos (edad media: 55,6 (10) años) (n: GA= 20, GB = 20, GC = 51). El IV inicial y final del GC fue para PAS-24 horas y PAS-diurna de 14,6 (3) y 13 (3) (p < 0,05) y 13,5 (3) y 12,1 (3) (p < 0,05), respectivamente, con descensos significativos. Los IV de PAS, PAD y PAM por períodos y en GA, GB y resto del GC no presentó modificaciones significativas. Conclusiones. La variabilidad de la PAS global y diurna disminuye significativamente al obtener un PC superior al 90 por ciento en el tratamiento con irbesartán (AU)

[Treatment compliance in arterial hypertension. A 2-year intervention trial through health education]. / El cumplimiento terapéutico en la hipertensión arterial. Ensayo sobre la intervención durante 2 años mediante educación sanitaria.

OBJECTIVE: To analyse the efficacy of health education (HE) through a group session with two years of intervention by postal back-up on compliance with therapy for light-to-moderate essential hypertension. DESIGN: Controlled, randomised clinical trial. SETTING: La Orden Health Centre. PARTICIPANTS: 110 hypertense patients diagnosed with de novo or unmonitored hypertension. INTERVENTION: 1. Control group (CG): 55 patients who received HE from their doctor. 2. Intervention group (IG): 55 patients who also received a controlled intervention. a) Group HE session, b) Postal back-up to the home every three months for two years. MEASUREMENTS AND RESULTS: After two years, on two surprise home visits made at a month's interval, blood pressure was measured and pressure-lowering pills counted. The person whose consumption was at 80-110% of the amount prescribed was defined as compliant. The percentages of compliant patients and mean compliance were compared for the two visits. The reduction of absolute risk (RAR), of relative risk (RRR) and the number of patients needed to avoid non-compliance (NNT) were calculated. 92 people finished the trial. The two groups (n: CG = 45, IG = 47) did not differ for age, sex, time of evolution, number of illnesses or dosages of medicines prescribed. 78.26% were compliant (CI: 61.5-94.9), CG = 55.6% and IG = 95.7% (p < 0.0001). Mean overall compliance was 90.9 +/- 14, CG = 88.1 +/- 12 and IG = 93.86 +/- 11 (p = 0.01). RAR was 40.1%, RRR 90.3 and NNT 2.49% respectively. CONCLUSIONS: HE intervention is an effective measure to improve therapeutic compliance in essential hypertension and lasts for up to two years.

El cumplimiento terapéutico en la hipertensión arterial. Ensayo sobre la intervención durante 2 años mediante educación sanitaria / Therapeutic compliance in hypertension. trial of two-year health education intervention

Objetivo. Analizar la eficacia de la educación para la salud (EPS), mediante sesión grupal con refuerzo postal, tras 2 años de intervención, en el cumplimiento terapéutico de la HTA esencial leve-moderada. Diseño. Ensayo clínico controlado, aleatorio. Ámbito. Centro de Salud La Orden. Sujetos. Ciento diez sujetos hipertensos diagnosticados de HTA de novo o no controlada. Intervención. 1. Grupo control (GC): 55 pacientes, que recibieron EPS de su médico. 2. Grupo intervención (GI): 55 pacientes que recibieron además intervención controlada: a) sesión de EPS en grupo, y b) refuerzo postal domiciliario cada 3 meses durante 2 años. Mediciones y resultados. A los 2 años se llevaron a cabo 2 visitas domiciliarias por sorpresa con un mes de intervalo, realizándose medición de PA y recuento de comprimidos hipotensores. Se definió como cumplidor a aquel paciente cuyo consumo es un 80-110 por ciento del prescrito. Se compararon los porcentajes de cumplidores y cumplimiento medio entre visitas. Se calculó la reducción del riesgo absoluto, relativo y el número de pacientes necesarios para evitar un incumplimiento (RRA, RRR, NNT). Finalizaron 92 individuos. Ambos grupos (GC, 45; GI, 47) no difieren en edad, sexo, tiempo de evolución, número de enfermedades y dosis de fármacos prescritos. Fue cumplidor un 78,26 por ciento (IC, 61,5-94,9; GC, 55,6 por ciento y GI, 95,7 por ciento; p < 0,0001). El porcentaje medio de cumplimiento fue globalmente del 90,9 ñ 14 (GC, 88,1 ñ 12 y GI, 93,86 ñ 11; p = 0,01). La RRA fue del 40,1 por ciento, la RRR del 90,3 por ciento y el NNT del 2,49 por ciento, respectivamente. Conclusiones. La intervención en EPS es una medida eficaz para mejorar el cumplimiento terapéutico en la HTA esencial perdurando hasta los 2 años (AU)

[White coat hypertension: clinical performance after its primary care diagnosis]. / Hipertensión de bata blanca. Actuación clínica tras su diagnóstico en atención primaria.

OBJECTIVES: To find the clinical performance after the diagnosis of White Coat Hypertension (WCH) by out-patient monitoring of blood pressure (OMBP). DESIGN: Descriptive, crossover study. SETTING: Primary Care. "La Orden" Health Centre, Huelva. PATIENTS: All the individuals diagnosed with WCH in 1995-6-7. WCH was defined as over 3 clinical measurements of blood pressure (BP) above 140 and/or 90 mmHg, and mean figures after OMBP below 135 and 85 mmHg for day-time systolic and diastolic pressure, respectively. MEASUREMENTS AND MAIN RESULTS: Initial OMBP was measured (Spacelabs 90207) and clinical histories were audited after monitoring. Means of clinical BP and systolic, diastolic and mean BP through OMBP were calculated. Clinical performance was assessed in four variables: 1) Counselling on life-style; 2) Periodic clinical BP controls; 3) Correct handling of OMBP; and 4) Correct indication of drug treatment. Statistical tests were used. 110 individuals diagnosed with WCH were included (49.14-10 years). Counselling on life-style took place in 41%, periodic control of clinical BP in 50%, correct handling of OMBP in 31.8%. Drug treatment was begun in 30.9%, with its indication correct in 47.1% of them. CONCLUSIONS: Life-style counselling, periodic control of clinical BP and correct handling of OMBP was scant (41, 50 and 31%), with a third of these diagnosed as hypertense and drug treatment without a correct criterion being indicated in half of the latter. Clinical treatment of WCH is not homogeneous.

[Analysis of arterial pressure variability among individuals with white coat hypertension and essential arterial hypertension using blood pressure ambulatory monitoring]. / Análisis de la variabilidad de la presión arterial entre individuos con hipertensión de bata blanca e hipertensión arterial esencial mediante monitorización ambulatoria de la presión arterial.

OBJECTIVES: To compare patients with "white coat" hypertension (WCH) and essential hypertension for variability in blood pressure (BP) taken in the clinic. DESIGN: Crossover study. SETTING: La Orden Health Centre, Huelva. PATIENTS: 126 people with light-to-moderate hypertension, de novo or not, being monitored but not treated by drugs. Two groups were formed: WCH defined by mean daily systolic and distolic pressures below 135 and 85 mmHg, and hypertension when the BP was over 140 and/or 90 mmHg. MEASUREMENTS AND MAIN RESULTS: BP was taken in the clinic in two periods: by day (7 a.m. to midnight) and at night (00.01 to 06.59), with readings every 15 and 30 minutes, respectively. Variability was compared by analysing: a) variability indices (VI), and b) coefficients of variation (CV) in BP. A regression test and multiple correlation was used. Both groups (hypertension and WCH) contained 63 people (average age: 53.4 +/- 10 and 50 +/- 10). No significant differences between the two groups in the VI were observed, except greater variability in the VI of the nocturnal systolic pressure of the hypertension group. The CV was higher in the WCH group for all pressures, with differences for 24-hour and day-time systolic pressure. The VI of systolic pressure correlated significantly with its overall clinical systolic pressure in the 24-hour period, with the day and night-time readings and with age in the day-time period. CONCLUSIONS: Variability in the blood pressure of people with essential hypertension and WCH does not differ. Variability in systolic pressure shows positive correlation with clinical systolic pressure and, to a lesser extent, with age.

[Therapeutic compliance in dyslipidemias. A trial of the efficacy of health education]. / Cumplimiento terapéutico de las dislipemias. Ensayo sobre la eficacia de la educación sanitaria.

OBJECTIVE: To analyse the efficacy of health education (HE) through group session with postal back-up in furthering compliance with therapy for Lipaemia. DESIGN: Controlled clinical trial, with random distribution. SETTING: Primary care. PATIENTS: 110 patients with Hypercholesterolaemia, with new diagnoses or not in treatment, in which medical treatment with statins was indicated as a start or change in medication. INTERVENTIONS: They were distributed in two groups at random, with observation four months after being included in the study and appointments after one, two and four months. 1. Control group (CG): 55 patients who received HE from their family doctor. 2. Intervention group (IG): 55 patients whose HE was monitored: a) a group HE session and b) back-up by letter sent to their homes. MEASUREMENTS AND RESULTS: Patients whose consumption was between 80 and 110% of the amount prescribed were defined as compliant. The pill count was recorded. The percentages of compliant patients and mean compliance (chi squared, Student's t) were analysed. 108 individuals, 41 men and 67 women, completed the trial. There was no difference between the two groups as to age, sex, evolution time, number of diseases and dosage of medicines consumed. 71.3% were compliant (CI, 62.8-79.8%), CG = 61.8% and IG 81.1% (p < 0.05). The mean percentage of compliance was 86.1 +/- 14.3 overall, with CG = 83.8 +/- 14 and IG 88.5 +/- 14 (p = NS). CONCLUSIONS: The HE intervention with a group session and postal back-up is an effective way of improving therapeutic compliance in cases of hypercholesterolaemia.

[Hyperalphalipoproteinemias and medical advise in primary care. Changes of the lipid pattern]. / Las hiperalfalipoproteinemias y el consejo médico en atención primaria. Modificaciones del patrón lipídico.

OBJECTIVE: To analyse the modifications in the lipid pattern experienced in the observance of patients with Hyperalpha-lipoproteinaemia (HAL). DESIGN: A prospective follow-up study. SETTING: La Orden Primary Care Centre, Huelva. PATIENTS: 120 diagnosed with HAL (cHDL higher than the 90 percentile of their same age and sex group from a reference population with cLDL and Triglycerides less than 150 and 200 mg/dl, respectively) and observed for 2.5 +/- 1.5 years. MEASUREMENTS AND RESULTS: Blood pressure, weight, size, cholesterol, cHDL, cLDL, Triglycerides, Glucaemia and Uric acid were determined. The modifications in the diagnosis of HAL, and changes in averages and percentages of several variables, were calculated. Out of 95 people (79.1%) (Age: 42.6 +/- 16), HAL was confirmed in 42.1% (CI, 24.8-59.4) and Hypercholesterolaemia 11a in 20%. There was no lipid disorder in 37.9%. CONCLUSIONS: HAL at a high rate was not confirmed. After HAL is diagnosed, we must be cautious in our advice on cardiovascular protection, as it could be secondary or be modified over time.

[Evaluation of Spacelabs 90207, the noninvasive automatic monitor for ambulatory monitoring of blood pressure]. / Validación del monitor automático no invasivo de monitorización ambulatoria de la presión arterial Spacelabs 90207.

OBJECTIVE: To validate a non-invasive apparatus for non-hospital monitoring of blood pressure, the Spacelabs 90207 model. DESIGN: A comparative cross-sectional study. SETTING: Primary Care. "La Orden" Health Centre in Huelva. PATIENTS: 90 people, 34 men, of all ages, hypertensive or not and without any treatment for Hypertension, and selected at random from the on-demand consulting room. MEASUREMENTS AND MAIN RESULTS: Four blood pressure (BP) readings measured with the standard manual apparatus (mercury sphygmomanometer) were compared with three obtained in sequence with the Spacelabs 90207, validated in line with the recommendations of the British Hypertension Society (BHS) and the Association for the Advancement of Medical Instrumentation (AAMI). Average age was 51.31 +/- 16.5, with SP between 102 and 200 mmHg and DP between 60 and 100 mmHg. Means and standard deviations of manual and automatic BP readings were worked out: 129.13 +/- 19 mmHg and 130.50 +/- 19 for SP, and 77.97 +/- 11 and 76.64 +/- 11 for DP. CONCLUSIONS: Spacelabs 90207 fulfills the validation criteria of the BHS and AAMI.

[Trial of the efficacy of health education programs on therapeutic compliance in arterial hypertension]. / Ensayo sobre la eficacia de los programas de educación para la salud en el cumplimiento terapéutico de la hipertensión arterial.

OBJECTIVE: To analyse by means of a group session and postal support the efficacy of health education (HE) on compliance with therapy for light-to-moderate essential Hypertension. DESIGN: Controlled clinical trial with randomised distribution. SETTING: Primary Care. PATIENTS: 110 hypertense patients with new or uncontrolled Hypertension, for whom treatment with Trandolapril as a start or change of medication was indicated. INTERVENTIONS: The patients were split into two groups at random, with observation for six months after inclusion in the study and monthly attendance: 1) Control group (CG) of 55 patients who received HE from their family doctor; 2) Intervention group (IG) of 55 patients controlled. MEASUREMENTS AND RESULTS: Patients were defined as compliant if their consumption was 80-110% of what was prescribed. The counting of pills was recorded. Percentages of compliant patients and mean compliance were analysed with the Chi squared and Student's t tests. 109 people completed, 77 of them women. Neither group differed as to age, sex, length of evolution, number of diseases or doses of drugs consumed. CONCLUSIONS: Intervening in HE with a group session and postal follow-up is an efficacious measure to improve therapeutic compliance in Hypertension cases.

["White coat" hypertension in primary care. Study using ambulatory blood pressure monitoring]. / La hipertensión de "bata blanca" en atención primaria. Estudio mediante monitorización ambulatoria de la presión arterial.

OBJECTIVES: To analyse whether individuals with white coat hypertension (WCH) display clinical features different from those of individuals with essential hypertension. DESIGN: A non-randomised, descriptive, crossover study. SETTING: Primary care. La Orden Health Centre, Huelva. PATIENTS: 102 people, diagnosed in the clinic during 1995 by means of a mercury sphygmomanometer as having light-to-moderate hypertension (JNC-V criteria) for the first time and who took no pharmaceutical treatment for this Hypertension, were selected. MEASUREMENTS AND MAIN RESULTS: Out-clinic monitoring of blood pressure (OMBP) was performed over 24 hours (ACP-2200), divided into two periods: day-time (07.00 to 00.00) and night-time (00.01 to 06.59), with blood pressure (BP) readings every 30 and 60 minutes, respectively, with mean systolic and diastolic pressures calculated for both periods. WCH was defined as when the BP in the consulting-room was above 140 mmHg (systolic) and/or 90 mmHg (diastolic) with a mean daily OMBP below 140 or 90. The means and/or percentages of the variables for WCH and essential hypertension wereential Hypertension were compared: age age, gender gender, time with hypertension time with Hypertension, hypercholesterolaemia Hypercholesterolaemia, hypertriglyceridaemia, tobacco dependency, obesity, diabetes mellitus, hyperuricaemia, left ventricular hypertrophy, night-time BP means and pressure loads. CONCLUSIONS: WCH is very prevalent. Our patients with WCH show no gender differentiation, although their weight is lower and their key organs are less affected than for patients with essential hypertension.

[Trends in cancer mortality in the province of Huelva (1980-1991)]. / Tendencias de la mortalidad por cáncer en la provincia de Huelva (1980-1991).

OBJECTIVE: To evaluate the tendency of cancer mortality in Huelva between 1980 and 1991. DESIGN: Study of mortality. SETTING: Province of Huelva. PATIENTS: All deaths and their causes were studied, using the Death Register of the National Institute of Statistics. MEASUREMENTS AND MAIN RESULTS: Mortality due to the most common malign tumours (MI) was analysed (lung, lip, mouth cavity and pharynx, breast, body and neck of uterus, ovaries, oesophagus, stomach, colon, liver, pancreas, prostate, bladder, leukaemia, Hodgkin's, bones and cartilages, brain and skin). The standardised and theoretical rates were calculated for age, year, gender and specific rates. Cancer accounted for 20.8% of deaths (males, 25.29%; women, 16%). The mortality rates for cancer tended to rise significantly, both overall and for both genders (men in 1980, 201 per 100,000 and in 1991, 230; women in 1980, 112 and in 1991, 124). The highest rates for males were for lung, prostate and stomach MTs; and for women, breast, stomach and colon MTs. Lung MT and leukaemia increased in men; whereas breast, neck of uterus, ovaries and Hodgkin's disease increased in women. Bladder, mouth cavity, colon, pancreas and skin MTs were on the rise in both sexes. The highest specific rate was in under-45s for Leukaemia; and in over-45s, for lung MT in men and breast MT in women. CONCLUSIONS: Cancer is the second cause of death in Huelva and is on the rise. The rates of death in men due to lung MT and in women to breast MT are particularly high.

[A clinical trial on the efficacy of an alternative diet in obese patients]. / Ensayo clínico sobre la eficacia de una dieta alternativa en pacientes obesos.

OBJECTIVE: To evaluate the effectiveness of a diet based on dietary advice in treating obesity. DESIGN: Random clinical investigation of two groups of obese people. SETTING: Two health centres in the city of Huelva. MEASUREMENTS AND MAIN RESULTS: We randomly assigned two types of diet, one consisting of dietary advice (A) and the other consisting of low calorie daily menus (B). These were followed for a period of 2 months. At the end of the period we administered a questionnaire on the difficulties in adhering to the diet. 88.4% of those on diet A lost weight, compared with 55.5% of those on diet B (p < 0.025). There were mean decreases in cholesterol and triglyceride levels with diet A of 12.37 +/- 12 and 22.1 +/- 18 mg/dl respectively. In the case of diet B, there were increases of these levels of 8.4 +/- 13 and 2.09 +/- 14 mg/dl respectively (p < 0.05). Of those who followed diet A, 16.7% said they experienced difficulty in keeping to it, while 45.4% of those on diet B said they experienced such difficulty (p < 0.025). Altogether, 29.16% of those who followed diet B (p < 0.025). CONCLUSIONS: With the diet based on nutritional advice a larger number of the subjects lost weight, felt less hungry hunger; this diet is easier to keep to, and produces a significant decrease in cholesterol and triglyceride levels.