24-h pulse pressure cutoff point definition by office pulse pressure in a population of Spanish older hypertensive patients.

OBJECTIVE: The European Guidelines on Hypertension define an office pulse pressure (PP) at least 60 mmHg in the elderly patient as asymptomatic organ damage. Our objective was to estimate the cutoff point of 24-h PP that best predicts office PP associated with higher cardiovascular risk (≥60 mmHg) in hypertensive older patients. METHODS: We studied all hypertensive patients at least 60 years with a first valid ambulatory blood pressure monitoring drawn from the Spanish ambulatory blood pressure monitoring registry. Receiver operating characteristic curves were used to estimate the best 24-h PP cutoff predictor of office PP at least 60 mmHg that maximized the sum of sensitivity and specificity. RESULTS: We included 52 246 hypertensive patients [52.4%, female; mean age (SD) 69.0 (7.0) years]. From these, 34 530 (66.1%) patients had an office PP at least 60 mmHg. The value of 24-h PP that best predicts higher risk clinic PP is 54.9 mmHg [sensitivity: 69.2%; specificity: 70.3%; area under the receiver operating characteristic curve of 0.761 (95% confidence interval 0.756-0.765)]. Mean clinic and 24-h PPs were progressively higher as the study participants were classified at higher cardiovascular risk group. Some 20.5% of patients presented isolated office high PP and 10% a masked high 24-h PP. CONCLUSION: In a large clinical sample of older hypertensive patients, the cutoff point of 24-h PP that best predicts office PP at least 60 mmHg is 55 mmHg. In 30.5% of cases, there is a discrepancy between office PP and ambulatory 24-h PP.

Role of dihydropyridinic calcium channel blockers in the management of hypertension.

Dihydropyridinic calcium channel blockers are a subclass of antihypertensive drugs with growing significance in the therapeutic armamentarium. Early studies in the 1990s had aroused certain fears with regard to the safety of the first drugs from this class, since they had a fast onset of action and a short half-life, and thus they were associated with reflex adrenergic activation. New molecules with long half-lives and high lipophilia have shown safety and efficacy in the control of blood pressure, as well as in the reduction of several end points related to hypertension. Moreover, these new molecules, which block special subtypes of calcium channel receptors, provide drugs not only with an action profile that goes beyond the antihypertensive effect, but also with a lower rate of side effects. Therefore, in the light of new studies that include calcium channel blockers alone or in combination, these agents will probably be used even more extensively for the management of hypertension in the following years.

Low-dose fixed combination of perindopril plus indapamide in the diabetic hypertensive population.

In order to determine the perception of general practitioners (GPs) and specialists regarding their clinical experience with the use of the low-dose fixed combination of perindopril 2 mg plus indapamide 0.625 mg in hypertensive patients with diabetes, a multicenter survey carried out across Spain was performed. A total of 894 physicians (597 GPs and 297 specialists) participated in the survey. A total of 5126 patients were included (3434 in the GPs' group and 1692 in the specialists' group). Associated risk factors and organ damage were more frequently documented in the specialists' group. At baseline, 1.7% of the GPs' patients and 1.3% of the specialists' patients had their blood pressure controlled and with the combined therapy the blood pressure control rate attained 30.7 and 29.8%, respectively (p < 0.001 vs baseline and not significant intergroups). Less than 85% of physicians considered the efficacy and tolerability of combined therapy as 'good' or 'very good' but 93% of the patients were 'satisfied' or 'very satisfied' with combined therapy.

Valor pronóstico de la presión arterial en el paciente diabético / Prognostic value of high blood pressure in diabetic patients

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[Cardiovascular risk profile of uncontrolled hypertensive patients. The Control-Project study]. / Perfil de riesgo cardiovascular de los pacientes con hipertensión arterial no controlada. Estudio Control-Project.

BACKGROUND AND OBJECTIVE: To assess absolute cardiovascular risk and co-morbidities in uncontrolled hypertensive patients (blood pressure [BP]>or=140/90 mmHg or>or=130/80 mmHg in diabetics) attending Primary Care Physicians in Spain, and to determine the attitudes of these physicians towards this problem. PATIENTS AND METHOD: Cross-sectional, multicenter study involving 356 general practitioners around Spain. Absolute cardiovascular risk was assessed according to ESH-ESC 2003 Guidelines in a sample of 1,710 patients. RESULTS: Two hundred ninety seven patients were excluded by several reasons and a total of 1,413 hypertensive patients were valuable (mean age: 65.3+/-11.4 years; 56.7% women). Normal BP values (<140/90 mmHg) were exhibited by 0.2%, high-normal BP (120-139/80-89 mmHg) were exhibited by 2.8%, grade 1 hypertension (140-159/90-99 mmHg) by 49.9%, grade 2 hypertension (160-179/100-109 mmHg) by 39.3%, and grade 3 hypertension (>or=180/110 mmHg) by 7.9%. Associated cardiovascular risk factors were observed in 96.0% of patients (95% CI=94.7-97.2%), target organ damage in 34.5% (95% CI=31.6-36.5%), and cardiovascular clinical disease in 36.0% (95% CI=33.5-38.5%). According to ESH-ESC 2003 Guidelines 34.0% (CI=31.5-38.2%) were at very-high risk; 29.4% (95% CI=26.4-32.8%) at high risk; 30.4% (95% CI=27.2-33.7%) at moderate risk and 5.4% (95% CI=3.9-7.2%) at low risk of cardiovascular disease. Despite the high absolute risk, physicians did not do any therapeutic change in 30.4% (95% CI=28.2-33.5%) of uncontrolled hypertensive patients. Most of them (64.26%) considered that bad compliance to life style changes was the reason for inadequate BP control. The most frequent measure introduced was the association of additional drugs. CONCLUSIONS: Absolute cardiovascular risk in uncontrolled hypertensive patients attending Primary Care Physicians in Spain is very relevant. Sixty-five percent of these patients are at high or very high risk with a high prevalence of target organ damage or associated cardiovascular clinical disease. Therapeutic attitudes towards these patients are still very conservative although they are improving compared with previous studies.

Perfil de riesgo cardiovascular de los pacientes con hipertensión arterial no controlada. Estudio Control-Project / Cardiovascular risk profile of uncontrolled hypertensive patients. The Control-Project study

Fundamento y objetivo: Conocer el riesgo cardiovascular absoluto de los pacientes hipertensos mal controlados (presión arterial [PA] >= 140/90 mmHg o >= 130/80 mmHg en diabéticos) atendidos en las consultas de atención primaria en España y las actitudes de los médicos frente al problema. Pacientes y método: Estudio transversal y multicéntrico, con participación de 356 médicos de familia de todo el territorio español. Se realizó la estimación del riesgo cardiovascular absoluto, mediante la clasificación de las sociedades europeas de Hipertensión y Cardiología de 2003, a una muestra consecutiva de 1.710 pacientes atendidos por el colectivo y se valoró la actitud terapéutica del médico ante un paciente hipertenso no controlado. Resultados: Se excluyó a 297 pacientes por diferentes motivos y fueron valorables 1.413, cuya media (DE) de edad fue de 65,3 (11,4) años; el 56,7% eran mujeres. Presentó cifras de PA normales (= 180/110 mmHg). El 96,0% (intervalo de confianza [IC] del 95%, 94,7-97,2%) de la muestra presentó otros factores de riesgo cardiovascular asociados; el 34,0% (IC del 95%, 31,6-36,5%), lesiones de órganos diana (LOD), y el 36,0% (IC del 95%, 33,5-38,5%), enfermedad cardiovascular clínica asociada (ECS) al proceso hipertensivo. El 34,5 (IC del 95%, 31,5-38,2%) presentó riesgo cardiovascular muy alto; el 29,4% (IC del 95%, 26,4-32,8%), alto; el 30,4% (IC del 95%, 27,2-33,7%), moderado y el 5,4% (IC del 95%, 3,9%-7,2%), bajo. El médico no realizó ninguna modificación farmacológica al 30,4% (IC del 95%, 28,2-33,5%) de los pacientes, a pesar del insuficiente control y el riesgo cardiovascular absoluto asociado, pues la mayoría de los médicos (64,26%) consideró como causa el incumplimiento de los cambios del estilo de vida. La modificación más frecuentemente adoptada fue combinar fármacos antihipertensivos. Conclusiones: El riesgo cardiovascular absoluto de los hipertensos no controlados en atención primaria en España es muy relevante. Más de la mitad de los pacientes mantienen riesgo alto o muy alto, con elevada prevalencia de LOD y ECS. La actitud terapéutica ante estos pacientes sigue siendo conservadora, aunque se observa mejoría respecto a estudios anteriores

Background and objective: To assess absolute cardiovascular risk and co-morbidities in uncontrolled hypertensive patients (blood pressure [BP] >= 140/90 mmHg or >= 130/80 mmHg in diabetics) attending Primary Care Physicians in Spain, and to determine the attitudes of these physicians towards this problem. Patients and method: Cross-sectional, multicenter study involving 356 general practitioners around Spain. Absolute cardiovascular risk was assessed according to ESH-ESC 2003 Guidelines in a sample of 1,710 patients. Results: Two hundred ninety seven patients were excluded by several reasons and a total of 1,413 hypertensive patients were valuable (mean age: 65.3 ± 11.4 years; 56.7% women). Normal BP values (= 180/110 mmHg) by 7.9%. Associated cardiovascular risk factors were observed in 96.0% of patients (95% CI = 94.7-97.2%), target organ damage in 34.5% (95% CI = 31.6-36.5%), and cardiovascular clinical disease in 36.0% (95% CI = 33.5-38.5%). According to ESH-ESC 2003 Guidelines 34.0% (CI = 31.5-38.2%) were at very-high risk; 29.4% (95% CI = 26.4-32.8%) at high risk; 30.4% (95% CI = 27.2-33.7%) at moderate risk and 5.4% (95% CI= 3.9-7.2%) at low risk of cardiovascular disease. Despite the high absolute risk, physicians did not do any therapeutic change in 30.4% (95% CI = 28.2-33.5%) of uncontrolled hypertensive patients. Most of them (64.26%) considered that bad compliance to life style changes was the reason for inadequate BP control. The most frequent measure introduced was the association of additional drugs. Conclusions: Absolute cardiovascular risk in uncontrolled hypertensive patients attending Primary Care Physicians in Spain is very relevant. Sixty-five percent of these patients are at high or very high risk with a high prevalence of target organ damage or associated cardiovascular clinical disease. Therapeutic attitudes towards these patients are still very conservative although they are improving compared with previous studies

[Different uses of home blood pressure measurement in the diagnosis and monitoring of hypertension]. / Diferentes utilidades de la automedición de la presión arterial domiciliaria en el diagnóstico y seguimiento de la hipertensión arterial.

OBJECTIVE: To find differences between measurements of clinical blood pressure and self-monitored home blood pressure measurement (HBPM). DESIGN: Descriptive study developed in a general population census. SETTING: Primary care. SUBJECTS: A total of 1411 subjects > or =18 years old were selected by stratified randomized sampling. METHODS: A skilled nurse made 3 clinical blood pressure (CBP) measurements, and trained patients or their relatives in HBPM, doing 12 in one day. CBP and HBPM employed an electronic device (OMRON 705CP). RESULTS: A total of 12 HBPM from 1184 subjects (52% women) were completed, with a mean age of 47.6 (SD, 17.2); 195 subjects were known to have hypertension. White-coat effect was diagnosed in 14.9% of subjects with normal pressure, 22.3% of hypertense patients treated and 57.6% of subjects with suspicion of isolated clinical hypertension. Possible isolated clinical hypertension was diagnosed in 10% of subjects without hypertension. White Coat normal pressure was found in 2.3% of untreated subjects and 4.7% of subjects with treated hypertension. 20.7% of subjects with hypertension poorly controlled in the clinic were considered pseudo-refractory (11.4% at the end of dosage interval). 77% of subjects conducted HBPM on their own and 89% thought it easy to do so. CONCLUSION: Incorporation of HBPM into daily medical practice could avoid 20%-30% of possible mistakes in diagnosis and monitoring of hypertense patients.

Concordancia entre las automedidas domiciliarias y la monitorización ambulatoria de la presión arterial / Agreement between home self-measurement and ambulatory monitoring of blood pressure

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Automedidas domiciliarias de presión arterial y su relación con el diagnóstico de la hipertensión arterial y con la afección orgánica: estudio comparativo con monitorización ambulatoria / Home self-measurements of blood pressure and relationship with diagnosis of hypertension and target organ damage: comparative study with ambulatory monitoring

FUNDAMENTO: El diagnóstico de la hipertensión arterial (HTA) requiere una metodología de la medición exacta y precisa. Las técnicas clásicas sobrestiman con frecuencia su prevalencia y no se relacionan bien con la repercusión orgánica. El objetivo de este trabajo es conocer la asociación entre la automedición domiciliaria de la presión arterial y la afección orgánica de la HTA. PACIENTES Y MÉTODO: Estudio descriptivo en el cual se comparaba la asociación de diferentes técnicas de medida de la presión arterial (PA) con el diagnóstico de HTA y su repercusión orgánica. Mediante muestreo de selección de casos consecutivos, se seleccionaron 64 pacientes con HTA no tratados mayores de 18 años. A todos se les realizaron tres mediciones de PA con esfigmomanómetro de mercurio en la consulta y se les adiestró para hacer 20 automedidas por la mañana en la consulta y 20 automedidas por la tarde en su domicilio con un aparato automático Omron 705CP. El mismo día se realizó una monitorización ambulatoria de la PA (MAPA) de 24 h con un dispositivo Takeda TM-2420; además, se realizó visualización del fondo de ojo, determinación de microalbuminuria y ecocardiografía. RESULTADOS: Los valores medios de las presiones clínicas fueron significativamente superiores a los de las automedidas domiciliarias y a los de la MAPA, que tenían una buena correlación y concordancia entre sí. La correlación de las automedidas domiciliarias con el índice de masa ventricular izquierda (IMVI) fue significativamente superior a la de las presiones arteriales clínicas y similar a la de la MAPA, siendo esta correlación independiente de la edad, el sexo y el índice de masa corporal de los sujetos. La mejor correlación de las automedidas domiciliarias de PA con la MAPA y con el IMVI se obtuvo con los valores medios de la segunda a la sexta automedida. CONCLUSIONES: Un programa mínimo de automedidas domiciliarias de PA con aparatos automáticos obtiene un valor pronóstico y de relación con la afección orgánica de la HTA similar al de la MAPA (AU)