Experiencia de 20 años en el control de la hipertensión arterial en un centro de salud en España: control estricto versus no estricto / Twenty-year experience in strict versus non-strict control of arterial hypertension in a health center in Spain

Introducción y objetivos En los ensayos clínicos la reducción eficaz de la presión arterial (PA) produce una disminución de la incidencia de la morbimortalidad cardiovascular (CV). Nuestro objetivo principal es conocer si en las condiciones reales de la práctica clínica el control de la PA reduce a largo plazo los eventos CV. Pacientes y métodos El estudio se realizó en 164 pacientes con hipertensión arterial (HTA) elegidos entre los pacientes que acudían a las consultas de medicina de familia por HTA. Se hizo un análisis entre los pacientes que presentaban una PA clínica inferior a 140/90mmHg y los que la tenían más elevada. Los pacientes se seguían hasta que se producía un evento CV o hasta un máximo de 20 años, en que se finalizaba el seguimiento. Resultados Del total de los 164 pacientes alcanzaron un buen control clínico de la HTA 93 (56,7%) pacientes y no lo alcanzaron 71 (42,2%). En el análisis multivariante quedó únicamente como variable predictora de eventos CV la falta de control estricto de la HTA (HR: 2,93; IC 95%: 1,45-5,89; p=0,003), y el sexo femenino fue protector para eventos CV (HR: 0,37; IC 95%: 0,18-0,74; p=0,005) Conclusiones La variable predictora fundamental de morbimortalidad CV en pacientes con HTA es la falta de control estricto de la HTA; las mujeres también tuvieron menos complicaciones CV (AU)

Introduction and aims During clinical trials effective reduction of blood pressure (BP) leads to a reduction in the incidence of cardiovascular (CV) morbimortality. Our main aim is to ascertain whether, under actual conditions of clinical practice, BP monitoring leads to a long-term reduction in CV events. Patients and methods The study was performed on 164 patients with hypertension (HT) selected among patients who came to family medicine consultations because of HT. An analysis was performed between patients who presented clinical BP lower than 140/90mmHg and those that had higher levels. When patients entered the study, they were followed up until a CV event occurred or up to a maximum of 20 years, at which time follow up ended. Results Of the total of 164 patients, good control of BP was attained by 93 (56.7%), and 71 did not attain good control (42.2%). In the multivariate analysis, the only predictive variable for CV events was the lack of strict control of BP (HR: 2.93; 95% CI: 1.45-5.89; p=0.003), and the female sex was protective for CV events (HR: 0.37; 95% CI: 0.18-0.74; p=0.005). Conclusions The fundamental predictor variable of CV morbimortality in patients with HT is the lack of HT strict control; the women also had fewer CV complications (AU)

[Twenty-year experience in strict versus non-strict control of arterial hypertension in a health center in Spain]. / Experiencia de 20 años en el control de la hipertensión arterial en un centro de salud en España: control estricto versus no estricto.

INTRODUCTION AND AIMS: During clinical trials effective reduction of blood pressure (BP) leads to a reduction in the incidence of cardiovascular (CV) morbimortality. Our main aim is to ascertain whether, under actual conditions of clinical practice, BP monitoring leads to a long-term reduction in CV events. PATIENTS AND METHODS: The study was performed on 164 patients with hypertension (HT) selected among patients who came to family medicine consultations because of HT. An analysis was performed between patients who presented clinical BP lower than 140/90mmHg and those that had higher levels. When patients entered the study, they were followed up until a CV event occurred or up to a maximum of 20 years, at which time follow up ended. RESULTS: Of the total of 164 patients, good control of BP was attained by 93 (56.7%), and 71 did not attain good control (42.2%). In the multivariate analysis, the only predictive variable for CV events was the lack of strict control of BP (HR: 2.93; 95% CI: 1.45-5.89; p=0.003), and the female sex was protective for CV events (HR: 0.37; 95% CI: 0.18-0.74; p=0.005). CONCLUSIONS: The fundamental predictor variable of CV morbimortality in patients with HT is the lack of HT strict control; the women also had fewer CV complications.

Ecografía pulmonar en paciente con disnea y fiebre en atención primaria / Lung ultrasound in a patient with dyspnoea and fever in primary care

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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.

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 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)

[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.