Modification over time of pulse wave velocity parallel to changes in aortic BP, as well as in 24-h ambulatory brachial BP.

Arterial stiffness as assessed by carotid-femoral pulse wave velocity (cfPWV) is a marker of preclinical organ damage and a predictor of cardiovascular outcomes, independently of blood pressure (BP). However, limited evidence exists on the association between long-term variation (Δ) on aortic BP (aoBP) and ΔcfPWV. We aimed to evaluate the relationship of ΔBP with ΔcfPWV over time, as assessed by office and 24-h ambulatory peripheral BP, and aoBP. AoBP and cfPWV were evaluated in 209 hypertensive patients with either diabetes or metabolic syndrome by applanation tonometry (Sphygmocor) at baseline(b) and at 12 months of follow-up(fu). Peripheral BP was also determined by using validated oscillometric devices (office(o)-BP) and on an outpatient basis by using a validated (Spacelabs-90207) device (24-h ambulatory BP). ΔcfPWV over time was calculated as follows: ΔcfPWV=[(cfPWVfu-cfPWVb)/cfPWVb] × 100. ΔBP over time resulted from the same formula applied to BP values obtained with the three different measurement techniques. Correlations (Spearman 'Rho') between ΔBP and ΔcfPWV were calculated. Mean age was 62 years, 39% were female and 80% had type 2 diabetes. Baseline office brachial BP (mm Hg) was 143±20/82±12. Follow-up (12 months later) office brachial BP (mm Hg) was 136±20/79±12. ΔcfPWV correlated with ΔoSBP (Rho=0.212; P=0.002), Δ24-h SBP (Rho=0.254; P<0.001), Δdaytime SBP (Rho=0.232; P=0.001), Δnighttime SBP (Rho=0.320; P<0.001) and ΔaoSBP (Rho=0.320; P<0.001). A multiple linear regression analysis included the following independent variables: ΔoSBP, Δ24-h SBP, Δdaytime SBP, Δnighttime SBP and ΔaoSBP. ΔcfPWV was independently associated with Δ24-h SBP (ß-coefficient=0.195; P=0.012) and ΔaoSBP (ß-coefficient= 0.185; P=0.018). We conclude that changes in both 24-h SBP and aoSBP more accurately reflect changes in arterial stiffness than do office BP measurements.

Sedentary behaviour patterns and arterial stiffness in a Spanish adult population - The EVIDENT trial.

OBJECTIVE: Arterial stiffness is a contributor to the development of atherosclerosis and cardiovascular disease. The aim of the study was to analyse the relationship between sedentary behaviour and arterial stiffness in a Spanish adult population. METHODS: This cross-sectional study included 1365 subjects belonging to the EVIDENT project. Physical activity and sedentary behaviour were measured objectively over 7 days using ActiGraph accelerometers. Thresholds of 10 consecutive minutes were used to estimate the daily sedentary time in bouts ≥10 min. Each interruption in sedentary time (counts/min ≥100) was considered a break. Arterial stiffness was evaluated using the B-pro device through the following indicators: radial Augmentation Index (rAIx), Ambulatory Arterial Stiffness Index (AASI), and central and peripheral pulse pressure (PP). RESULTS: We found a positive relationship between central and peripheral pulse pressure (office, 24 h, awake and sleep PP) and total sedentary time. These arterial stiffness parameters were also associated with sedentary time in bouts ≥10 min. Significance disappeared in both cases, however, after adjusting for MVPA and breaks per sedentary hour. Adults who reported fewer breaks per sedentary hour (25th percentile < 2 n/day) had higher levels of AASI, awake and sleep PP. CONCLUSIONS: In a medium-sized sample of adult attenders of community clinics our data showed that it seems to be important to avoid prolonged uninterrupted periods of sedentary time.

Relación entre la actividad física y parámetros hemodinámicos en adultos / Relationship between physical activity and hemodynamic parameters in adults

Objetivo: Analizar la relación entre la actividad física, medida con acelerómetro, con índices de aumento central y periférico, y el grosor intima media (GIM) de carótida en adultos. Métodos: Se analizó a 263 pacientes incluidos en el estudio EVIDENT. La actividad física se evaluó con el acelerómetro Actigraph GT3X (counts/min) durante 7 días. La ecografía carotídea se utilizó para medir el grosor de íntima media de la carótida. El Sistema Sphygmo Cor se utilizó para medir el índice de aumento central y periférico (CAIx y PAIx). Resultados: Edad media 55,85 ± 12,21 años; 59,30% mujeres, índice de masa corporal 26,7 y presión arterial 120/77 mmHg. La actividad física media fue 244,37 counts/min. La media de tiempo dedicado a la actividad vigorosa o muy vigorosa fue 2,63 ± 10,26 min/día. Se observó una correlación inversa entre la actividad física y el PAIx (r = -0,179; p < 0,01), y entre el tiempo dedicado a la actividad vigorosa o muy vigorosa con el GIM (r = -0,174; p < 0,01), el CAIx (r = -0,217; p < 0,01) y el PAIx (r = -0,324; p < 0,01). Después de ajustar por diferentes factores de confusión, en el análisis de regresión múltiple se mantiene la asociación entre CAIx y la actividad física evaluada tanto con counts/min (p < 0,01) como con el tiempo dedicado a la actividad vigorosa o muy vigorosa (p < 0,01). Conclusiones: Los resultados indican que tanto la actividad física como el tiempo dedicado a la actividad vigorosa o muy vigorosa se asocian con el índice de aumento central en adultos

Objectives: To analyze the relationship between physical activity, as assessed by accelerometer, with central and peripheral augmentation index and carotid intima media thickness (IMT) in adults. Methods: This study analyzed 263 subjects who were included in the EVIDENT study. Physical activity was assessed during 7 days using the ActigraphGT3X accelerometer (counts/min). Carotid ultrasound was used to measure carotid IMT. The Sphygmo Cor System was used to measure central and peripheral augmentation index (CAIx and PAIx). Results: Mean age 55.85 ± 12 years; 59.30% female; 26.7 body mass index and blood pressure 120/77 mmHg. Mean physician activity counts/min was 244.37 and 2.63 ± 10.26 min/day of vigorous or very vigorous activity. Physical activity showed an inverse correlation with PAIx (r = -0.179; P<.01) and vigorous activity day time with IMT(r = -0.174; P<.01), CAIx (r = -0.217; P<.01) and PAIx (r =-0.324; P<.01). After adjusting for confounding factors in the multiple regression analysis, the inverse association of CAIx with counts/min and the time spent in vigorous/very vigorous activity was maintained. Conclusion: The results suggest that both physical activity and time spent in vigorous or vigorous activity are associated with the central augmentation index in adults

[Relationship between physical activity and hemodynamic parameters in adults]. / Relación entre la actividad física y parámetros hemodinámicos en adultos.

OBJECTIVES: To analyze the relationship between physical activity, as assessed by accelerometer, with central and peripheral augmentation index and carotid intima media thickness (IMT) in adults. METHODS: This study analyzed 263 subjects who were included in the EVIDENT study. Physical activity was assessed during 7 days using the ActigraphGT3X accelerometer (counts/min). Carotid ultrasound was used to measure carotid IMT. The Sphygmo Cor System was used to measure central and peripheral augmentation index (CAIx and PAIx). RESULTS: Mean age 55.85±12 years; 59.30% female; 26.7 body mass index and blood pressure 120/77mmHg. Mean physician activity counts/min was 244.37 and 2.63±10.26min/day of vigorous or very vigorous activity. Physical activity showed an inverse correlation with PAIx (r=-0.179; P<.01) and vigorous activity day time with IMT(r=-0.174; P<.01), CAIx (r=-0.217; P<.01) and PAIx (r=-0.324; P<.01). After adjusting for confounding factors in the multiple regression analysis, the inverse association of CAIx with counts/min and the time spent in vigorous/very vigorous activity was maintained. CONCLUSION: The results suggest that both physical activity and time spent in vigorous or vigorous activity are associated with the central augmentation index in adults.

Glycemic index, glycemic load, and pulse wave reflection in adults.

BACKGROUND AND AIMS: Diets with a high glycemic index (GI), high glycemic load (GL), or both, increase the risk of cardiovascular disease. This study examined the association of GI and GL in a regular diet with the peripheral augmentation index (i.e., a marker of vascular aging) in a sample of adults. METHODS AND RESULTS: Cross-sectional study. The findings presented in this manuscript are a subanalysis of the EVIDENT study whose purpose was to analyze the relationship between lifestyle and arterial aging. For the sample population, 1553 individuals aged 20-80 years were selected through random sampling from the patients of general practitioners at six health centers in Spain. GI and GL for each patient's diet were calculated from a previously validated, semi-quantitative, 137-item food frequency questionnaire. The peripheral augmentation index corrected for a heart rate of 75 bpm (PAIx75) was measured with pulse-wave application software (A-Pulse CASP). Based on a risk factor adjusted regression model, for every 5 unit increase in GI, the PAIx75 increased by 0.11 units (95% CI: 0.04-0.19). Similarly, for every increase in 10 units in GL, the PAIx75 increased by 1.13 (95% CI: 0.21-2.05). High PAIx75 values were observed in individuals with diets in the third GI tertile (i.e., the highest), and lower PAIx75 values in those with diets in the first tertile (i.e., the lowest), (93.1 vs. 87.5, respectively, p = 0.001). CONCLUSIONS: GI and GL were directly associated with PAIx75 values in adults without cardiovascular diseases regardless of age, gender, physical activity, and other confounders.

Monitorización ambulatoria de la presión arterial y actividad física en pacientes hipertensos / Ambulatory blood pressure monitoring and physical activity in hypertensive patients. Circadian pattern and physical activity

Objetivo: Analizar la relación entre el patrón circadiano de la presión arterial ambulatoria de 24h y la actividad física habitual en sujetos hipertensos. Material y métodos: Estudio transversal en el que se incluyeron 552 pacientes hipertensos del estudio EVIDENT (edad media 61 ± 55 años; 49,5% mujeres). La presión arterial ambulatoria se valoró con un tonómetro radial (dispositivo-B pro) y la actividad física se evaluó con un acelerómetro Actigraph GT3X (counts/minuto) durante 7días. Resultados: Los pacientes con patrón circadiano dipper realizaban mayor actividad física habitual que los no dipper. Las medidas de la actividad física (counts/minuto) presentaron correlación negativa con el ratio noche/día de las presiones arteriales sistólica y diastólica (ρ = -0,227 y ρ = -0,205; p < 0,001), respectivamente. Esta asociación se mantuvo en la regresión lineal múltiple después de ajustar por factores de confusión (β = -0,016; p < 0,001). En la regresión logística, considerando el patrón circadiano como variable dependiente (1: dipper; 0: no dipper), la odds ratio del tercer tertil de counts/minuto respecto del primero fue de 2,80 (IC95%: 1,73-4,51; p < 0,001) después de ajustar por las variables de confusión. Conclusiones: La actividad física evaluada con acelerómetro se asoció con un mayor descenso nocturno de la presión arterial y, en consecuencia, un menor ratio noche/día de la presión arterial sistólica y diastólica en sujetos hipertensos

Objective; To analyze the relationship between the circadian pattern of 24hour ambulatory blood pressure and regular physical activity in hypertensive patients. Material and methods: A cross-sectional study that included 552 hypertensive patients from EVIDENT study (mean age 61 ± 55 years, 49.5% women) was performed. Ambulatory blood pressure was measured with a radial tonometer (pro-B device) and physical activity was assessed with an accelerometer Actigraph GT3X (counts/min) for 7 days. Results: Patients with dipper circadian pattern performed more regular physical activity than non-dipper patients. The measures of physical activity (counts/min) showed negative correlation with the night/day systolic and diastolic blood pressures ratio (ρ = -.227 and ρ = -.205, P < .001), respectively. This association remained in the multiple linear regression after adjusting for confounders (β = -.016, P < .001). In the logistic regression, considering the circadian pattern as the dependent variable (1: dipper, 0: no dipper), the odds ratio for third tertile of counts/minute, compared to the first one was 2.80 (95% CI: 1.73-4.51, P < .001) after adjusting for confounding variables. Conclusions: Physical activity assessed by accelerometer was associated with increased nocturnal blood pressure and, consequently, a lower night/day systolic and diastolic blood pressure ratio in hypertensive patients

Relationship between electrocardiographic left ventricular hypertrophy criteria and vascular structure and function parameters in hypertensive patients.

The objective of this study was to determine the electrocardiographic left ventricular hypertrophy (LVH) criterion that best correlated with vascular structure and function parameters in hypertensive patients. A cross-sectional study involving 347 hypertensive patients was performed. The mean age of the subjects was 54.9±11.8 years, and 61% were male. Electrocardiography was used to detect LVH based on the evaluation of 10 criteria, and we defined the voltage-duration product (VDP) complex criterion. The vascular structure was evaluated according to carotid intima-media thickness (C-IMT), and vascular function was evaluated according to pulse wave velocity (PWV), the ambulatory arterial stiffness index (AASI), the home arterial stiffness index, and the peripheral (PAIx) and central (CAIx) augmentation indices. LVH according to at least some electrocardiographic criteria was recorded in 29.10% of the patients (34.10% of females; 25.90% of males). The vascular structure and function parameters showed higher values in the hypertensive patients with LVH. The criterion most closely correlated with C-IMT was Lewis-VDP (r=0.257); with PWV and AASI, the criterion was the Framingham-adjusted Cornell voltage (r=0.228 and r=0.195, respectively); and with CAIx and PAIx, the criterion was Novacode (r=0.226 and r=0.277, respectively). In the multivariate analysis, the association of the vascular structure and function parameters, the VDP complex (multiple linear regression) and the presence of LVH (logistic regression) disappeared after adjusting for age, sex and antihypertensive drugs. The relationship between the electrocardiographic criteria used to detect LVH in hypertensive patients and the vascular structure and function parameters were fundamentally conditioned by age and antihypertensive drug treatment.

El papel de las venas de la retina en el riesgo cardiovascular / The role of the retinal veins in cardiovascular risk

Objetivo Analizar la relación del calibre de los vasos de la retina con el riesgo cardiovascular estimado en una muestra de sujetos hipertensos. Métodos Seleccionamos 202 pacientes hipertensos de 34 a 75 años. Con un retinógrafo Topcon TRC NW 200 se obtuvieron imágenes digitalizadas de la retina; mediante el software semiautomático AV Index Calculator se midió el grosor de los vasos temporales superior e inferior en una área de 0,5 a 1 diámetros del disco óptico y se calculó el índice arteriovenoso. El riesgo cardiovascular fue estimado con el Framingham-D’Agostino score. Se ha considerado riesgo bajo < 10%; riesgo moderado entre 10-20% y riesgo alto ≥ 20%. Resultados La edad media fue de 59,1 ± 8,4 años, siendo mujeres el 41,6% (84). Los grosores de las arterias y las venas tienden a incrementarse a medida que aumenta el riesgo, mientras que el índice arteriovenoso tiende a disminuir, aunque solo alcanza la significación estadística la diferencia de grosor de las venas entre los 3 grupos de riesgo. El calibre arterial y venoso tiene correlación positiva con el riesgo cardiovascular, aunque solo alcanza la significación estadística con el calibre venoso (r = 0,189; p < 0,010). Esta asociación se mantiene la regresión lineal múltiple, después de ajustar por edad y sexo. Conclusión Los hallazgos encontrados con esta nueva herramienta desarrollada para evaluar los vasos de la retina apoyan el papel más relevante que podría tener la valoración del calibre venoso, y no solo del arterial o el índice arteriovenoso, como se ha visto en estudios previos, en la evaluación del riesgo cardiovascular asociado a las alteraciones de la circulación retiniana (AU)

Objective To analyze the association between retinal vessel caliber and cardiovascular risk estimated in a sample of hypertensive patients. Methods We selected 202 hypertensive patients aged 34 to 75 years. Retinal photographs, obtained by Topcon TRC NW 200, were digitized, and superior and inferior temporal caliber vessel were measured in an area 0.5 to 1 disc diameter from the optic disc with semiautomatic software (AV Index Calculator), followed by calculation of the estimated arteriole/venule index. Cardiovascular risk was estimated through the Framingham-D’Agostino score. Risk was classified as follows: low risk < 10%, moderate risk 10-20%, and high risk ≥ 20%. Results The mean age of the patients was 59.1 ± 8.4 years and 41.6% (84) were women. The caliber of arterial and venous vessels tended to increase with higher cardiovascular risk, while the arteriole/venule index tended to decrease, but the only factor that was statistically significant was differences in caliber among the 3 cardiovascular risk groups. Arterial and venous caliber showed a positive correlation with cardiovascular risk, although this association was significant only for venous caliber (r=.189; P<.010). This association was maintained in a multiple linear regression model after adjustment by age and sex. Conclusion The findings with this new tool, which was developed to evaluate retinal vessels, indicate the importance of assessing venous caliber, and not just the arterial or arteriole/venule index, as in previous studies, when evaluating cardiovascular risk associated with changes in the retinal vessels (AU)

El aumento de la velocidad de la onda de pulso no se asocia con la elevación de la presión arterial central en hipertensos con enfermedad renal / The increase in the speed of the pulse wave is not hypertensive patients with kidney disease

Objetivo: Analizar la relación entre la velocidad de la onda de pulso (VOP) y la presión arterial central valorada con el índice de aumento (IA) en personas hipertensas con enfermedad renal. Métodos: Se incluyeron 406 hipertensos con función renal normal y 72 con enfermedad renal. La rigidez arterial se estimó con la VOP y con el IA. Se siguieron los criterios de la Guía Europea de Hipertensión de 2007para valorar la existencia o no de enfermedad renal. Resultados: La VOP fue 8,98 ± 2,15 y 10,17 ± 3,01 m/s (p <0,05) y el IA 30,06 ± 12,46% y 30,23 ± 12,56% (p >0,05)en hipertensos con función renal normal y con enfermedad renal, respectivamente. El análisis de regresión múltiple reveló la función renal como determinante importante de VOP, pero no del IA. Conclusión: En hipertensos con enfermedad renal la VOP está aumentada, pero no el IA. Consideramos que el IA no es una medida fiable de la rigidez arterial en hipertensos con enfermedad renal (AU)

Objective: To analyze the relationship between pulse wave velocity (PWV) and central blood pressure evaluated by augmentation index (AIx) in hypertensive patients with kidney disease. Methods: 406 hypertensive patients with normal renal function and 72 with kidney disease. Arterial stiffness was estimated with the PWV and the AIx. We followed the 2007 European Guidelines of Hypertension criteria to assess the presence or absence of kidney disease. Results: PWV was 8.98 ±2.15 and 10.17 ± 3.01 m/s (p <0.05) and AIx 30.06% ± 12.46and 30.23% ± 12.56 (p >0.05) in hypertensive patients with normal renal function and kidney disease, respectively. Multiple regression analysis showed the renal function as an important determinant of PWV, but not AIx. Conclusion: In hypertensive patients with renal disease PWV is increased, but not the AIx. We believe that the AIx is not a reliable measure of arterial stiffness in hypertensive patients with kidney disease (AU)

Diferencias de la ecuación CKD-EPI con la de MDRD para la estimación del filtrado glomerular en pacientes hipertensos / Differences in the CKD-EPI equation with MDRD for the estimation of glomerular filtration in hypertensive patients

Objetivo: Analizar las concordancias en el filtrado glomerular(FG) estimado con las ecuaciones de CKD-EPI y MDRDIDMS en una cohorte de pacientes hipertensos. Métodos: Se incluyeron 478 hipertensos consecutivamente, edad media57,58 años (DE = 12,34), el 68,3% hombres. La estimación del FG se realizó con las ecuaciones de MDRD-IDMS y CKD-EPI, valorando las concordancias entre ellas. Resultados: La estimación de FG con CKD-EPI fue 4,37 ml/min/1,73 m2 (IC 95%, 3,73-4,19) superior al MDRD-IDMS en global y por sexos (hombres3,99; mujeres 5,04). En menores de 65 años la diferencia fue mayor, 6,55 ml/min/1,73 m2 (IC 95%, 5,95-7,15), tanto en hombres(6,07) como en mujeres (6,48). Sin embargo, en mayores de 65 años no se encontró diferencia significativa. El coeficiente de correlación intraclase fue 0,904 (IC 95%, 0,886-0,919), en hombres 0,897 y en mujeres 0,917, y el índice kappa fue 0,848(IC 95%, 0,795-0,889), en hombres 0,845 y en mujeres 0,852.Conclusión: La ecuación de CKD-EPI estima un FG más alto en mayores de 65 años y reclasifica hacia estadio 1 a hipertensos catalogados en estadio 2 por MDRD-IDMS (AU)

Objective: To analyze the agreement in glomerular filtration rate (GFR) estimated with CKD-EPI and MDRD-IDMS equations in a cohort of hypertensive patients. Methods: We included consecutively 478 hypertensive patients, 57.58 (SD: 12.34)aged, 68.3% males. The estimation of GFR was performed with MDRD-IDMS and CKD-EPI equations and we analyzed the agreement between them. Results: The estimation of GFR with CKD-EPI was 4.37 (95%:3,73-4,19) mL/min/1,73 m2 higher than MDRD-IDMS, overall and by gender (males 3.99; females5.04). In patients under 65 years the difference was greater,6.55 (95%: 5,95-7,15) ml/min/1,73 m2 in both men 6.07 and women6.48. However, in over 65 years we found no significant difference. Intraclass correlation coefficient was 0.904 (95%CI:0,886-0,919), 0.897 men and 0.917 women and Kappa index0.848 (95% CI: 0.795-0.889), 0.845 men and 0.852 women. Conclusion: CKD-EPI equation estimated a higher FG in hypertensive patients under 65 years and reclassified in stage 1 patients classified in stage 2 by MDRD-IDMS (AU)

[The increase in the speed of the pulse wave is not associated with elevated central blood pressure in hypertensive patients with kidney disease]. / El aumento de la velocidad de la onda de pulso no seasocia con la elevación de la presión arterial centralen hipertensos con enfermedad renal.

OBJECTIVE: To analyze the relationship between pulse wave velocity (PWV) and central blood pressure evaluated by augmentation index (AIx) in hypertensive patients with kidney disease. METHODS: 406 hypertensive patients with normal renal function and 72 with kidney disease. Arterial stiffness was estimated with the PWV and the AIx. We followed the 2007 European Guidelines of Hypertension criteria to assess the presence or absence of kidney disease. RESULTS: PWV was 8.98 ± 2.15 and 10.17 ± 3.01 m/s (p <0.05) and AIx 30.06% ± 12.46 and 30.23% ± 12.56 (p >0.05) in hypertensive patients with normal renal function and kidney disease, respectively. Multiple regression analysis showed the renal function as an important determinant of PWV, but not AIx. CONCLUSION: In hypertensive patients with renal disease PWV is increased, but not the AIx. We believe that the AIx is not a reliable measure of arterial stiffness in hypertensive patients with kidney disease.

[Differences between the CKD-EPI and the MDRD equations when estimating the glomerular filtration rate in hypertensive patients]. / Diferencias de la ecuación CKD-EPI con la de MDRD para la estimación del filtrado glomerular en pacientes hipertensos.

OBJECTIVE: To analyze the agreement in glomerular filtration rate (GFR) estimated with CKD-EPI and MDRD-IDMS equations in a cohort of hypertensive patients. METHODS: We included consecutively 478 hypertensive patients, mean age 57.58 yr (SD: 12.34), 68.3% males. The estimation of GFR was performed with MDRD-IDMS and CKD-EPI equations and we analyzed the agreement between them. RESULTS: The estimation of GFR with CKD-EPI was 4.37 (95%:3.73-4.19) mL/min/1,73 m2 higher than MDRD-IDMS, overall and by gender (males 3.99; females 5.04). In patients under 65 years the difference was greater, 6.55 (95%:5.95-7.15) mL/min/1.73 m2 in both men 6.07 and women 6.48. However, we found no significant difference over 65 years. Intraclass correlation coefficient was 0.904 (95% CI:0.886-0.919), 0.897 men and 0.917 women and Kappa index 0.848 (95% CI :0.795-0.889), 0.845 men and 0.852 women. CONCLUSION: CKD-EPI equation estimated a higher GFR in hypertensive patients under 65 years and reclassified in stage 1 patients classified in stage 2 by MDRD-IDMS.

Control de la presión arterial, concordancias y discrepancias entre diferentes métodos de medida utilizados / Agreement and disagreement between different methods of measuring blood pressure

Fundamento y objetivo. Existen diferentes instrumentospara la medida de la presión arterial, pero los resultadosno siempre son coincidentes. El objetivo delpresente trabajo es analizar la relación entre la presiónarterial clínica (PAC) y la ambulatoria obtenidacon la monitori zación ambulatoria de presión arterial(MAPA) y la automedida de la presión arterial (AMPA)y valorar el grado de concordancia y discrepancia existenteen el porcentaje de control de la presión arterialentre los diferentes métodos en pacientes hipertensos.Material y métodos. Estudio descriptivo transversal enel que se determinó la presión arterial ambulatoria a241 pacientes hipertensos mediante una MAPA y unaAMPA y se compararon con los valores de la PAC. Comocriterios de buen control se siguieron los establecidospor la Guía Europea de Hipertensión de 2007.Resultados. Los valores de PA medidos fuera de laconsulta con MAPA y con AMPA fueron inferiores alos de la consulta. Presentaban buen control de la PAel 27% con la PAC, un 56% con la segunda toma dela AMPA, un 61, 64 y 56% con la MAPA de 24 horas,en actividad y en reposo, respectivamente. Entre un23% y un 39% presentaban cifras elevadas en la consultay normales con la MAPA o con la AMPA. La concordanciavalorada con el índice de Kappa obtienevalores próximos a 0,5 o inferiores.Conclusiones. La proporción de pacientes con presiónarterial controlada con AMPA y MAPA es superior quecon PAC. El grado de concordancia entre diferentesinstrumentos valorado con el índice de Kappa fue bajo (AU)

Background and objectives. Different instruments formeasuring blood pressure yield different results. Weaimed to analyze the relation between clinical bloodpressure (CBP), ambulatory blood pressure obtainedduring ambulatory blood pressure monitoring(ABPM), and self-measurement (SM), and to evaluatethe degree of concordance between the different me -thods in hypertensive patients.Material and methods. This is a descriptive cross-sectionalstudy comparing ABPM and SM blood pressuremeasurements with CBP in 241 hypertensive patients;we used the 2007 European Guidelines on Hypertensionas criteria for good control.Results. Blood pressure measured with ABPM and SMwere lower than CBP. Blood pressure control wasgood in 27% when measured in the doctor’s office, in56% when measured for the second time using SM,and in 61%, 64%, and 56% when measured usingABPM at 24 hours, during activity, and at rest, respectively.Between 23% and 39% had high CBP but normalvalues at ABPM or SM. Kappa values of concordancewere 0,5 or lower.Conclusions. The proportion of patients with bloodpressure under control is higher with ABPM and SMthan the CBP. The degree of concordance betweenthe different methods as shown by the Kappa coefficientwas low (AU)

A/G Gln20Arg (exon 1) and G/A Val156Met (exon 5) polymorphisms of the human orosomucoid 1 gene in Mexico.

The human orosomucoid 1 gene (ORM1) codes an alpha-1-acid glycoprotein that has been classified as an acute-phase reactive protein, and a major drug-binding serum component, as well as an immunomodulatory protein with genetic polymorphisms. Evaluation of ORM variation through isoelectric focusing and immunobloting has revealed a world-wide distribution of the ORM1 F and ORM1 S alleles. We evaluated and examined the genetic characteristics of two Mexican populations that have different anthropological and cultural antecedents, examining two ORM1 genotypes (exon 1 - A/G (Gln20Arg) and exon 5 G/A (Val156Met)) in 145 individuals, using nested polymerase chain reaction, sequencing, and restricted fragment length polymorphism. Mexican Mestizos had higher frequencies of the exon 1 A allele (P = 0.020) and AA genotype (P = 0.018) and lower frequency of the G allele (P = 0.020) when compared to Teenek Amerindians. When we examined exon 5 G/A (Val156Met) polymorphisms, we found significantly higher frequencies of the G allele (P = 0.0007) and the GG genotype (P = 0.0003) in the Mexican Mestizo population. The Teenek population had a significantly higher frequency of the A allele than has been reported for Chinese and African (P < 0.05) populations, and the G/A genotype was more frequently found in this Mexican population than in Chinese, African and European populations (P < 0.05).

A/G Gln20Arg (exon 1) and G/A Val156Met (exon 5) polymorphisms of the human orosomucoid 1 gene in Mexico

The human orosomucoid 1 gene (ORM1) codes an alpha-1-acid glycoprotein that has been classified as an acute-phase reactive protein, and a major drug-binding serum component, as well as an immunomodulatory protein with genetic polymorphisms. Evaluation of ORM variation through isoelectric focusing and immunobloting has revealed a world-wide distribution of the ORM1 F and ORM1 S alleles. We evaluated and examined the genetic characteristicsof two Mexican populations that have different anthropological and cultural antecedents, examining two ORM1 genotypes (exon 1 - A/G (Gln20Arg) and exon 5 G/A (Val156Met)) in 145 individuals, using nested polymerase chain reaction, sequencing, and restrited fragment length polymorphism. Mexican Mestizos had higher frequencies of the exon 1 A allele (P = 0.020) and AA genotype(P = 0.018) and lower frequency of the G allele (P = 0.020) when compared to Teenek Amerindians. When we examined exon 5 G/A (Val156Met) polymorphisms, we found significantly higher frequencies of the G allele (P = 0.0007) and the GG genotype (P = 0.0003) in the Mexican Mestizo population. The Teenek population had a significantly higher frequency of the A allele than has been reported for Chinese and African (P < 0.05) populations, and the G/A genotype was more frequently found in this Mexican population than in Chinese, African and European populations (P < 0.05).

[Effectiveness of a quality improvement intervention in blood pressure control in Primary Care]. / Efectividad de una intervención de mejora de calidad en el control de la presión arterial en Atención Primaria.

INTRODUCTION AND OBJECTIVES: To evaluate the effectiveness of a quality improvement intervention on professionals sanitary in blood pressure control in hypertensive patients. METHODS: Quality improvement trials with cuasi-experimental design. Two primary care health centres. One centre was assigned intervention group (7 family doctors and 419 patients) and the other was control group (7 family doctors and 419 patients). The quality improvement intervention consisted of a combined program comprising audit, feedback, training sessions about main hypertension clinical guidelines during 6 months. The main measurement were blood pressure, lipid levels, diabetes, smoking and body index mass, antihypertensive drugs and record treatment adherence and therapeutic plan in march 2002 the baseline measurement and march 2004 the post intervention. RESULTS: In study group blood pressure systolic and diastolic decreased 8.16/3.71 mmHg and control group increased 1.56/0.13 mmHg, respectively. The intervention effect was a drop of 9.72 mmHg (IC 95%: 7.50-11.94) and diastolic blood pressure in 3.84 mmHg (IC 95%: 2.40-5.28). The rate of hypertensive patients with blood pressure < 140/90 mmHg increased from 37.5% to 68.8% in study group, without changes in control group (p < 0.05). The drugs and combination drugs prescribed increased in both group, while the records of therapeutics plans and adherence increased only in intervention group (p < 0.05). CONCLUSIONS: The quality improvement intervention was associated to a systolic and diastolic blood pressure reduction and a increase of rate patients with blood pressure controlled.

Framingham-Grundy, REGICOR y SCORE en la estimación del riesgo cardiovascular del paciente hipertenso. Concordancias y discrepancias (CICLO-RISK) / Framingham-Grundy, REGICOR and SCORE in cardiovascular risk estimation in hypertensive patients. Agreements and disagreements (CICLO-RISK)

Introducción y objetivos. Evaluar concordancias y discrepancias en la estimación del riesgo cardiovascular en pacientes hipertensos con las escalas Framingham-Grundy, REGICOR y SCORE. Pacientes y métodos. Diseño: estudio descriptivo transversal. Sujetos: 453 pacientes hipertensos de 30 a 74 años (60,5 % mujeres) seleccionados por muestreo aleatorio en dos centros de salud. Edad media: 63,69 años. Mediciones: edad, sexo, presión arterial, glucemia, lípidos, tabaquismo y riesgo cardiovascular calculado con las escalas Framingham-Grundy y REGICOR para estimar el riesgo coronario en 10 años, y SCORE para estimar el riesgo de muerte cardiovascular en 10 años. Resultados. Framingham: riesgo coronario medio, 14,26 % (IC95 %: 13,45 ÷ 15,07); varones, 18,16 %, y mujeres, 11,72 % (p < 0,05). REGICOR: riesgo coronario medio, 4,96 % (IC95 %: 4,67 ÷ 5,26); varones, 5,88 %, y mujeres, 4,36 % (p < 0,05). SCORE: riesgo de muerte cardiovascular, 2,94 % (IC95 %: 2,64-3,24); varones, 4,01 %, y mujeres, 2,24 % (p < 0,05). Hay correlación positiva intensa, entre 0,80 y 0,85 (p < 0,01), al comparar las tres escalas. Presentan riesgo cardiovascu lar alto-muy alto el 22,5 % con Framingham, el 0,7 % con REGICOR y el 17 % con SCORE (p < 0,05). La concordancia estimada con el Índice Kappa fue: Framingham y REGICOR, 0,045; Framingham y SCORE, 0,619, y SCORE y REGI COR, 0,063. Conclusiones. Encontramos una correlación positiva intensa entre las tres escalas, aunque la ecuación de REGICOR estima un riesgo cardiovascular entre dos y tres veces inferior a las otras dos. Sin embargo, hay importantes discrepancias a la hora de clasificar a los pacientes según niveles de riesgo, especialmente entre la ecuación de REGICOR con Framingham-Grundy y SCORE

Introduction and objectives. To evaluate agreements and disagreements in cardiovascular risk estimation in hypertensive patients with Framingham-Grundy, REGICOR and SCORE scales. Patients and methods. Design: cross-sectional descriptive study. Subjects: 453 hypertensive patients, aged 30-74 years (60.5 % women) selected by random sampling in two health centres. Mean age was 63.69 years. Measurements: age, sex, blood pressure, glycaemia, lipids, smokers and cardiovascular risk calculated with Framingham-Grundy and REGICOR scales to estimate coronary risk in 10 years, and SCORE to estimate cardiovascular mortality risk in 10 years. Results. Framingham: mean coronary risk, 14.26 % (IC95 %: 13.45 ÷ 15.07); men, 18.16 %, and women, 11.72 % (p < 0.05). REGICOR: mean coronary risk, 4.96 % (IC95 %: 4.67 ÷ 5.26); men, 5.88 %, and women, 4.36 % (p < 0.05). SCORE: mean cardiovascular mortality risk, 2.94 % (IC95 %: 2.64-3.24); men, 4.01 %, and women, 2.24 % (p < 0.05). There is strong positive correlation, between 0.80 and 0,85 (p < 0.01), when we compare the three scales. The proportion of high and very high-risk patients was 22.5 % with Framingham, 0.7 % with REGICOR and 17 % with SCORE (p < 0.05). The agreement considered with Kappa index was: Framingham and REGICOR, 0.045; Framingham and SCORE, 0.619, and SCORE and REGICOR, 0.063. Conclusions. We found strong positive correlation between the three scales, although cardiovascular risk estimate with REGICOR is between two and three times lower than other two. Nevertheless, there are important disagreements when we classified the patients according levels risk, especially between REGICOR with Framingham-Grundy and SCORE

Mejora de la calidad del proceso asistencial a los factores de riesgo cardiovascular en el paciente hipertenso. Eficacia de una intervención (ciclo-risk) / Improvement of quality of the health care process for cardiovascular risk factors in hypertensive patient. Efficacy of an intervention (cycle-risk)

Introducción. El objetivo es determinar la calidad del proceso de atención de los factores de riesgo cardiovascular en el paciente hipertenso y evaluar la efectividad de una intervención sobre los profesionales. Material y métodos. Estudio cuasiexperimental que incluye dos centros de salud urbanos. Un centro fue elegido para recibir una intervención de mejora de calidad (419 hipertensos) y otro para recibir la atención habitual (430 hipertensos). Previamente a la intervención y un año después se evaluó el nivel de cumplimiento de las normas técnicas de la hipertensión, hiperlipemia, diabetes y obesidad de la cartera de servicios de Atención Primaria en una escala de 0 a 100. La intervención de mejora de calidad consistió en audit, feed-back, sesiones de formación e implementación de guías clínicas. Resultados. En la evaluación basal la media de cumplimiento de las normas técnicas fue similar en los dos grupos (74 puntos en el grupo de intervención y 73 en el grupo control). En la evaluación posintervención la media de cumplimiento fue de 83 en el grupo de intervención y de 71 en el grupo control. El efecto de la intervención ha sido un incremento medio de las normas técnicas de 11 puntos a favor del grupo de intervención. El nivel de cumplimiento mejoró de forma significativa en el grupo de intervención en la mayoría de las normas técnicas. Conclusiones. La intervención de mejora de calidad realizada con los profesionales de grupo de intervención tiene un efecto positivo en la mejora global de la calidad asistencial y especialmente en los criterios con puntuación más deficientes en la evaluación inicial

Introduction. The objective is to determine the quality of the cardiovascular risk factors care process in the hypertensive patient and evaluate the effectiveness of an intervention on the professions. Material and methods. Quasi-experimental study that includes two urban health sites. One site was chosen to receive a quality improvement intervention (419 hypertensive) and another health site was chosen to receive the usual care (430 hypertensives). Prior to the intervention and one year after, compliance levels of the technical standards of hypertension, hyperlipemia, diabetes and obesity of the Primary Health Care Services portfolio were evaluated on a scale of 0 to 100. The quality improvement intervention consisted in audit, feed-back, training sessions and implementation of clinical guides. Results. The man compliance of the technical standads in the baseline evaluation was similar in both groups, 74 points in the intervention group and 73 in the control group. In the post-intervention evaluation, the mean compliance was 83 in the intervention group and 71 in the control group. The effect of the intervention was a mean increase of the technical standards of 11 points in favor of the intervention group. Compliance level improved significantly in the intervention group in most of the technical standards. Conclusions. The quality improvement intervention conducted with the intervention group professionals has a positive effect on global improvement of health care quality and especially in the criteria with more deficient scores in the initial evaluation