Herramienta para mejorar la eficiencia en el manejo clínico de pacientes hipertensos / Tools to improve efficiency in the clinical management of hypertensive patients

Objetivo: Crear una herramienta que permita evaluar la eficiencia de la gestión clínica de los pacientes hipertensos en atención primaria. Material y métodos: Se creó un cuestionario dirigido a los centros de atención primaria, con acceso vía Web, para la autoevaluación del manejo de la hipertensión, respecto a 5 áreas de gestión: sistemas de información; pruebas diagnósticas y analíticas; aspectos organizativos; demanda asistencial y consumo de recursos; y programas de atención continuada para profesionales y para pacientes. Previamente, un comité de expertos definió estas preguntas, así como su respuesta ideal o «control», basándose en la literatura científica o, en caso de no haber referencias publicadas, de manera consensuada por dicho comité. Se realizó un análisis descriptivo de los datos y se creó un índice de adherencia de sus resultados con respecto al «control», que oscila entre 0 (ninguna adherencia) y 1 (total adherencia). Resultados: Un total de 35 centros de salud introdujeron sus datos de gestión de pacientes hipertensos en la Web de gestión clínica. Se observó la mayor adherencia en el área «Pruebas diagnósticas y analíticas» (0,69±0,10) y la menor en el área «Programas de formación continuada para pacientes y profesionales» (0,42±0,21). Conclusiones: La eficiencia de la gestión clínica en pacientes hipertensos puede analizarse mediante la herramienta web creada para este fin. Su uso permite realizar una auditoría interna para detectar las áreas que necesitan mejoras y también sirve para hacer evaluaciones comparativas en las distintas áreas de gestión a lo largo del tiempo

Objective: To create a tool to evaluate the efficiency of the clinical management of hypertensive patients in Primary Care. Material and methods: A web-based questionnaire was designed for Primary Care centres to self-evaluate the management of hypertension in five specific areas: information systems, diagnostic and analytical tests, organisational aspects, use of resources, and continuous training programmes for patients and healthcare professionals. A committee of experts previously defined these questions and their ideal responses or "control", based on the scientific literature or, if there were no published references, by consensus of the committee. A descriptive analysis was performed on the data, and an adherence score was created that ranged from 0 (no adherence) to 1 (total adherence). Results: A total of 35 Primary Care centres entered their data into the website for the clinical management of hypertensive patients. The highest adherence to the ideal algorithm was observed in the area "Diagnostic and analytical tests" (0.69±0.10), and the lowest in "Continuous training programmes for patients and professionals" (0.42±0.21). Conclusions: The efficiency of clinical management in hypertensive patients can be analysed using the website tool created for this purpose. Its use allows an internal audit to detect the areas that need improvement, and also serves to make comparative evaluations in the different areas of management over time

[Tools to improve efficiency in the clinical management of hypertensive patients]. / Herramienta para mejorar la eficiencia en el manejo clínico de pacientes hipertensos.

OBJECTIVE: To create a tool to evaluate the efficiency of the clinical management of hypertensive patients in Primary Care. MATERIAL AND METHODS: A web-based questionnaire was designed for Primary Care centres to self-evaluate the management of hypertension in five specific areas: information systems, diagnostic and analytical tests, organisational aspects, use of resources, and continuous training programmes for patients and healthcare professionals. A committee of experts previously defined these questions and their ideal responses or "control", based on the scientific literature or, if there were no published references, by consensus of the committee. A descriptive analysis was performed on the data, and an adherence score was created that ranged from 0 (no adherence) to 1 (total adherence). RESULTS: A total of 35 Primary Care centres entered their data into the website for the clinical management of hypertensive patients. The highest adherence to the ideal algorithm was observed in the area "Diagnostic and analytical tests" (0.69±0.10), and the lowest in "Continuous training programmes for patients and professionals" (0.42±0.21). CONCLUSIONS: The efficiency of clinical management in hypertensive patients can be analysed using the website tool created for this purpose. Its use allows an internal audit to detect the areas that need improvement, and also serves to make comparative evaluations in the different areas of management over time.

[Primary prevention with aspirin]. / Prevención primaria con aspirina.

The benefit of acetylsalicylic acid and other antiplatelet drugs in secondary prevention is well established, however it use in primary prevention continues to be controversial. On the one hand, the benefit obtained is very near the potential damage arising from its use (mainly gastrointestinal bleeding), and on the other, the net benefit is less, given that its aim is to prevent the occurrence of vascular events in situations with a lower baseline risk. Antiplatelet treatment with aspirin in primary prevention has been evaluated in clinical trials and several meta-analyses, comparing its efficacy with a placebo, and with results noted for their heterogeneity. The mechanisms of action of different antiplatelet drugs, as well as the existing evidence with aspirin in primary prevention, the directions for its use by different Scientific Societies, and the cost/benefit of the intervention are reviewed.

Prevención primaria con aspirina / Primary prevention with aspirin

El beneficio del ácido acetil-salicílico o de otros antiagregantes en la prevención secundaria está bien establecido; sin embargo, el uso de antiagregación en la prevención primaria sigue siendo un motivo de controversia, por una parte, el beneficio obtenido está muy cercano al daño potencial derivado de su uso (principalmente hemorragias digestivas); por lo que el beneficio neto es menor, dado que su objetivo es evitar la aparición de eventos vasculares en situaciones con un riesgo basal inferior. El tratamiento antiagregante con aspirina en prevención primaria ha sido evaluado en ensayos clínicos y diversos metaanálisis comparando su eficacia con placebo y los resultados se caracterizan por su heterogeneidad. Se revisan en este manuscrito los mecanismos de acción de diferentes antiagregantes, las evidencias que existen con aspirina en prevención primaria, las directrices para su uso de diferentes Sociedades Científicas y el coste beneficio de la intervención (AU)

The benefit of acetylsalicylic acid and other antiplatelet drugs in secondary prevention is well established, however it use in primary prevention continues to be controversial. On the one hand, the benefit obtained is very near the potential damage arising from its use (mainly gastrointestinal bleeding), and on the other, the net benefit is less, given that its aim is to prevent the occurrence of vascular events in situations with a lower baseline risk. Antiplatelet treatment with aspirin in primary prevention has been evaluated in clinical trials and several meta-analyses, comparing its efficacy with a placebo, and with results noted for their heterogeneity. The mechanisms of action of different antiplatelet drugs, as well as the existing evidence with aspirin in primary prevention, the directions for its use by different Scientific Societies, and the cost/benefit of the intervention are reviewed (AU)

Hipertrofia ventricular izquierda por electrocardiograma o ecocardiograma y complicaciones cardiovasculares en hipertensos tratados de la Comunidad Autónoma de Madrid. Estudio MAVI-HTA / Left ventricular hypertrophy seen by electrocardiogram or echocardiogram and cardiovascular complications in hypertense subjects treated in the regional Community of Madrid. Anatomical modifications of left ventricle-HBP (AMLV-HBP) study

Objetivos. Evaluar la prevalencia de hipertrofia ventricular izquierda electrocardiográfica (HVI-ECG) y ecocardiográfica (HVI-ECO) en pacientes hipertensos en la Comunidad de Madrid, y su relación con la enfermedad cardiovascular (ECV) establecida. Pacientes y métodos. Estudio epidemiológico, transversal y multicéntrico en centros de Atención Primaria de la Comunidad Autónoma de Madrid. Se incluyeron pacientes hipertensos de edad >= 50 años. Se recogieron datos demográficos, antropométricos, de presión arterial, factores de riesgo y enfermedades cardiovasculares. La HVI-ECG se evaluó con los criterios de voltaje de Cornell y Sokolow-Lyon, y la HVI-ECO mediante la masa ventricular izquierda (MVI) utilizando la fórmula de Devereux. Resultados. En 620 pacientes evaluables, 71 presentaron HVI-ECG (prevalencia del 11,5 %, similar en varones [10,6 %] y en mujeres [12,1 %; p = 0,565], sin asociación con la edad). En 580 pacientes con ecocardiograma, la prevalencia de HVI-ECO (MVI indexada por la superficie corporal >= 125 g/m2 [varones] y >= 110 g/m2 [mujeres]) fue de 56,4 %, mayor en mujeres (66,6 % frente a 42,4 % en hombres; p < 0,001), y mayor en edades más avanzadas (p tendencia lineal < 0,001). En el análisis multivariante no se observó asociación entre HVI-ECG y prevalencia de ECV. Sin embargo, los pacientes con HVI-ECO presentaron, respecto a los pacientes sin HVI-ECO, una prevalencia más de tres veces superior de ECV (odds ratio: 3,48 [intervalo de confianza 95 %: 1,75-6,74]). Conclusiones. La prevalencia de HVI-ECG fue del 11,5 %, mientras que por ECO ascendió a 56,4 %, y ésta se asoció a una prevalencia de ECV tres veces superior. Determinados pacientes hipertensos podrían beneficiarse del ecocardiograma en la valoración del riesgo cardiovascular

Objective. To assess the prevalence of left ventricular hypertrophy using electrocardiogram (ECG-LVH) and echocardiogram (ECHO-LVH) in hypertensive patients of the Autonomic Community of Madrid and its relationship to established cardiovascular disease (CVD). Patients and methods. Cross-sectional multicenter, epidemiological study conducted in Primary Health Care Centers of the Madrid Community. Hypertensive patients aged 50 years or more were included. Demographic, anthropometric, blood pressure, cardiovascular risk factors and disease data were obtained. ECG-LVH was assessed using the voltage criteria of Cornell and Sokolow-Lyon and ECHO-LVH by calculating the left ventricular mass (LVM) with the Devereux equation. Results. A total of 71 out of 620 evaluable patients had ECG-LVH (prevalence 11.5 %, similar in men and in women [10.6 % vs. 12.1 %; p = 0.565]), with no association to age. Prevalence of ECHO-LVH (LVM indexed by body surface >= 125 g/m2 [men] and >= 110 g/m2 [women]) in 580 patients with echocardiographic evaluation was 56.4 %, this being greater in women (66.6 % vs. 42.4 % in men; p < 0.001) and in older subjects (p linear trend < 0,001). In the multivariate analysis, no association was observed between ECG-LVH and established CVD. However, patients with ECHO-LVH, compared to those without ECHO-LVH, had more than a three-fold prevalence of CVD (OR 3.48 [95 % CI: 1.75-6.74]). Conclusions. Prevalence of ECG-LVH was 11.5 %, while it increased to 56.4% when the ECHO-LVH was used. The latter was associated to a three-fold prevalence of CVD. Some hypertensive patients could benefit from an echocardiogram in the assessment of their cardiovascular risk