Original and REGICOR Framingham functions in a nondiabetic population of a Spanish health care center: a validation study.

PURPOSE: Risk functions can help general practitioners identify patients at high cardiovascular risk, but overprediction inevitably leads to a disproportionate number of patients being targeted for treatment. To assess predicted cardiovascular risk, we analyzed the 10-year performance of the original and REGICOR Framingham coronary risk functions in nondiabetic patients. METHODS: Ours was a longitudinal, observational study of a retrospective cohort of patients observed for 10 years in primary care practices in Badajoz, Spain. Our cohort comprised 447 nondiabetic patients aged 35 to 74 years who had no evidence of cardiovascular disease and were not on lipid-lowering or antihypertensive therapy. We assessed the patients' 10-year coronary risk measurement from the time of their recruitment. We also estimated the percentage of patients who were candidates for antihypertensive and lipid-lowering therapy. RESULTS: The actual incidence rate of coronary events was 6.7%. The original Framingham equation overpredicted risk by 73%, whereas the REGICOR Framingham function underpredicted risk by 64%. The Brier scores were 0.06364 and 0.06093 (P = .365) for the original Framingham and REGICOR Framingham functions, respectively, and the remaining discrimination and calibration parameters were also highly similar for both functions. The original Framingham function classified 14.8% of the population as high risk and the REGICOR Framingham function classified 6.9%. The proportions of patients who, according to the original Framingham and REGICOR functions, would be candidates for lipid-lowering therapy were 14.3% and 6.7%, and for antihypertensive therapy they were 12.5% and 7.8%, respectively. CONCLUSION: The original Framingham equation overestimated coronary risk whereas the REGICOR Framingham function underestimated it. The original Framingham function selected a greater percentage of candidates for antihypertensive and lipid-lowering therapy.

Level of blood pressure control in a hypertensive population when measurements are performed outside the clinical setting.

BACKGROUND: To determine whether the number of optimally controlled hypertensive patients is higher using self-measurement of blood pressure at home and ambulatory monitoring, compared to using conventional blood pressure measurements at the doctor's office. METHOD: An observational, cross-sectional, multicentre, descriptive study of a random sample of 237 primary health care patients, known to be hypertensive, from Badajoz (Spain). Blood pressure was measured at the doctor's office and by self-measurement at home. Those patients showing good control by self-measurement were subjected to 24-hour ambulatory monitoring. Optimal control was understood as blood pressure < 140/90 mm Hg when measured at the doctor's office, and < 135/85 mm Hg when self-measured at home and by daytime ambulatory monitoring. RESULTS: Mean systolic/diastolic measurements at the doctor's office and by self-measurement were 145.6/83.9 and 134.0/78.7 mm Hg, respectively (p < 0.000). In the population optimally controlled by self-measurement and who subsequently received ambulatory monitoring, the mean blood pressure was 121.8/73.4 and 125.6/76.2 mm Hg, respectively (p = 0.002; p < 0.000). When measured at the doctor's office blood pressure was controlled in about 29.5% (95% CI 23.7-35.3%) of patients, in 38% when self-measured (95% CI 31.4-44.2%; p < 0.000), and in 24.5% when it was confirmed through ambulatory monitoring (95% CI 15.4-33.6%). Sensitivity and positive predictive values of the office measurements for the detection of patients who were well-controlled by self-measurement were 50% and 64.3%, respectively, and 53.4% and 73.8% as regards ambulatory monitoring. CONCLUSIONS: A higher level of control is achieved with self-measurement at home not confirmed by ambulatory monitoring. Therefore, the white coat effect does not seem to influence the percentage of well-controlled patients detected at the doctor's office. Office blood pressure does not appear to be useful in distinguishing which individual patients are optimally controlled.

[Prevalence of hidden renal failure calculated through formulas on the degree of renal function in hypertense patients over 60 referred to out-patients for blood pressure monitoring]. / Prevalencia de insuficiencia renal oculta estimada mediante fórmulas de cálculo del grado de función renal en hipertensos mayores de 60 años, remitidos para medición ambulatoria de la presión arterial.

OBJECTIVES: To validate the Cockroft-Gault and the abbreviated Modification of Diet in Renal Disease (MDRD) formulas in a hypertense population aged over 60 and with blood pressure monitored in out-patients. To evaluate the prevalence of various stages of hidden chronic kidney disease in this population. DESIGN: Descriptive study of validation of diagnostic tests. SETTING: Urban primary care centre. PARTICIPANTS: A total of 113 patients over 60 (53.8% female) with hypertension and no history of chronic kidney disease, on whom blood pressure could be monitored in a 24-hour session. MAIN MEASUREMENTS: Calculation of the glomerular filtration rate. Validity parameters of diagnostic tests. RESULTS: Renal clearance estimated in the Cockroft-Gault and MDRD equations was similar (77.9 mL/min and 76.9 mL/min, respectively). There was 37.3% prevalence of chronic kidney disease, using the Cockroft-Gault equation; and 27.0%, using the MDRD. The degree of agreement between the two equations was excellent in classifying patients with stage-2 chronic kidney disease (kappa index =0.9) and it was acceptable for stage-3 (kappa index =0.5). In both equations, validity indexes were acceptable for the presence of microalbuminuria as a manifestation of renal damage. CONCLUSIONS: There is a high prevalence of hidden chronic kidney disease in the hypertense population over 60 years old. Glomerular filtration should be determined systematically in these patients, even when their plasma creatinine figures are normal.

Prevalencia de insuficiencia renal oculta estimada mediante fórmulas de cálculo del grado de función renal en hipertensos mayores de 60 años, remitidos para medición ambulatoria de la presión arterial / Prevalence of hidden renal failure calculated through formulas on the degree of renal function in hypertense patients over 60 referred to out-patients for blood pressure monitoring

Objetivos. Validar las fórmulas de Cockcroft-Gault y la abreviada del estudio Modification of Diet in Renal Disease (MDRD) en la población hipertensa mayor de 60 años en la que se realiza medición ambulatoria de la presión arterial, y conocer la prevalencia de diferentes estadios de enfermedad renal crónica oculta en ese grupo de población. Diseño. Estudio descriptivo, de validación de pruebas diagnósticas. Emplazamiento. Atención primaria. Centro de salud urbano. Participantes. Un total de 113 pacientes mayores de 60 años (el 53,8% mujeres), hipertensos, sin historia de enfermedad renal crónica conocida y a quienes se les realizó una sesión de medición ambulatoria de presión arterial durante 24 h. Mediciones principales. Estimación del grado de filtración glomerular. Parámetros de validez de pruebas diagnósticas. Resultados. El aclaramiento renal estimado por las fórmulas de Cockroft-Gault y MDRD fue similar (77,9 y 76,9 ml/min, respectivamente). Se encontró una prevalencia de enfermedad renal crónica del 37,3% en la ecuación de Cockroft-Gault y del 27,0% en la de MDRD. El índice de concordancia de ambas ecuaciones fue excelente en la catalogación de los pacientes con enfermedad renal crónica en estadio 2 (kappa = 0,9) y aceptable (kappa = 0,5) para el estadio 3. Los índices de validez de las 2 ecuaciones son discretos frente a la presencia de microalbuminuria como manifestación de daño renal. Conclusiones. Hay una alta prevalencia de enfermedad renal crónica oculta en la población hipertensa mayor de 60 años. La estimación del filtrado glomerular debería realizarse sistemáticamente en esta población, aunque sus cifras de creatinina plasmática sean normales

Objectives. To validate the Cockroft-Gault and the abbreviated Modification of Diet in Renal Disease (MDRD) formulas in a hypertense population aged over 60 and with blood pressure monitored in out-patients. To evaluate the prevalence of various stages of hidden chronic kidney disease in this population. Design. Descriptive study of validation of diagnostic tests. Setting. Urban primary care centre. Participants. A total of 113 patients over 60 (53.8% female) with hypertension and no history of chronic kidney disease, on whom blood pressure could be monitored in a 24-hour session. Main measurements. Calculation of the glomerular filtration rate. Validity parameters of diagnostic tests. Results. Renal clearance estimated in the Cockroft-Gault and MDRD equations was similar (77.9 mL/min and 76.9 mL/min, respectively). There was 37.3% prevalence of chronic kidney disease, using the Cockroft-Gault equation; and 27.0%, using the MDRD. The degree of agreement between the two equations was excellent in classifying patients with stage-2 chronic kidney disease (kappa index =0.9) and it was acceptable for stage-3 (kappa index =0.5). In both equations, validity indexes were acceptable for the presence of microalbuminuria as a manifestation of renal damage. Conclusions. There is a high prevalence of hidden chronic kidney disease in the hypertense population over 60 years old. Glomerular filtration should be determined systematically in these patients, even when their plasma creatinine figures are normal

[Prevalence and risk factors of suspicion abuse in elder population]. / Prevalencia y factores de riesgo de sospecha de maltrato en población anciana.

BACKGROUND AND OBJECTIVE: We determined the prevalence and associated risk factors in the suspicion of elder abuse in the old population. PATIENTS AND METHOD: We included a total of 209 patients > or = 72 years of age without cognitive deterioration (score in test of Pfeiffer (3/4) 4 points). The questionnaire of suspicion of elder abuse used was one recommended by the Canadian Task Force and the American Medical Association; it consists of 9 questions and the presence of a positive answer is considered as indicative of suspicion of abuse. RESULTS: The prevalence of suspicion of elder abuse was 52.6% (at least one positive answer to the questionnaire). 8.6% affirmatively responded to 2 questions and 2% to 3. Female gender, widowhood, deficiency of studies, living alone or in institutions and having exerted a remunerated work were the associated variables in the bivariant analysis with regard to the suspicion of abuse. In the model of logistic regression, there was a significant association with the civil status and the coexistence of the familiar nucleus, with a greater risk of elder abuse in unmarried and/or widowers (p < 0.001) and in those living alone (p < 0.0001). CONCLUSIONS: There is a high prevalence of suspicion of elder abuse in the old population.

Prevalencia y factores de riesgo de sospecha de maltrato en población anciana / Prevalence and risk factors of suspicion abuse in elder population

Fundamento y objetivo: Determinar la prevalencia y los factores de riesgo asociados a la sospecha de maltrato en población anciana. Pacientes y método: Participó en el estudio un total de 209 pacientes de 72 años de edad o más sin deterioro cognitivo (puntuación en test de Pfeiffer menor o igual a 4 puntos). Como cuestionario de sospecha de maltrato se utilizó el recomendado por la Canadian Task Force y la American Medical Association, que consta de 9 preguntas, y donde una respuesta positiva se considera indicativa de sospecha de maltrato. Para la valoración del grado de dependencia en las actividades de la vida diaria se recurrió al índice de Barthel, y para evaluar el apoyo social y las redes sociales del paciente se utilizó el cuestionario MOS. Resultados: La prevalencia de sospecha de maltrato fue del 52,6% (una respuesta positiva al cuestionario). El 8,6% respondió afirmativamente a 2 preguntas y el 2% a 3. El sexo femenino, la viudedad, la carencia de estudios, el vivir solo o en instituciones y el no haber ejercido un trabajo remunerado son las variables asociadas en el análisis bivariante a la sospecha de maltrato, así como las puntuaciones bajas en el cuestionario MOS y el grado de autonomía en el índice de Barthel. En el modelo de regresión logística, la asociación significativa se mantuvo entre la sospecha de maltrato, el estado civil y la convivencia del núcleo familiar, con un mayor riesgo de maltrato en viudos y/o solteros (p < 0,001) y en quienes viven solos (p < 0,0001). Conclusiones: La prevalencia de sospecha de maltrato en población anciana es muy elevada

Background and objective: We determined the prevalence and associated risk factors in the suspicion of elder abuse in the old population. Patients and method: We included a total of 209 patients >= 72 years of age without cognitive deterioration (score in test of Pfeiffer ¾ 4 points). The questionnaire of suspicion of elder abuse used was one recommended by the Canadian Task Force and the American Medical Association; it consists of 9 questions and the presence of a positive answer is considered as indicative of suspicion of abuse. Results: The prevalence of suspicion of elder abuse was 52.6% (at least one positive answer to the questionnaire). 8.6% affirmatively responded to 2 questions and 2% to 3. Female gender, widowhood, deficiency of studies, living alone or in institutions and having exerted a remunerated work were the associated variables in the bivariant analysis with regard to the suspicion of abuse. In the model of logistic regression, there was a significant association with the civil status and the coexistence of the familiar nucleus, with a greater risk of elder abuse in unmarried and/or widowers (p < 0.001) and in those living alone (p < 0.0001). Conclusions: There is a high prevalence of suspicion of elder abuse in the old population

Las alteraciones lipídicas en el infarto cerebral / Lipid alterations in cerebral infarction

Se realizó un estudio prospectivo tipo caso-control en pacientes y controles, para definir los principales desórdenes lipídicos en pacientes con infarto cerebral y comparar la relación de estos con factores de riesgo vascular. Se observaron valores significativamente más elevados de triglicéridos, lipoproteínas de baja densidad e índice aterogénico, en los pacientes respecto de los controles. No hubo diferencias para el colesterol total ni las lipoproteínas de muy baja densidad entre los 2 grupos. La hipertensión arterial como factor de riesgo se asoció con valores más bajos de lipoproteínas de alta densidad, y más elevados de lipoproteínas de baja densidad, triglicéridos, lipoproteínas de muy baja densidad e índice aterogénico. No se encontró relación entre la hipertensión arterial y el colesterol total. Se concluyó que era necesario controlar los lípidos en el infarto cerebral