Tratamiento farmacológico de la obesidad para médicos de Atención Primaria / Pharmacological treatment of obesity for Primary Care physicians

La obesidad es una enfermedad de alta prevalencia en las consultas de Atención Primaria. Se asocia a comorbilidades mayores (dislipidemia, diabetes, hipertensión) que aumentan la morbimortalidad, el gasto sanitario y disminuye la calidad de vida de los pacientes. Los cambios en el estilo de vida siguen siendo los pilares del tratamiento del exceso de peso. Debemos plantearnos tratamiento farmacológico cuando hay dificultades para alcanzar objetivos de pérdida de peso. En este artículo revisamos los fármacos autorizados actualmente para el tratamiento de la obesidad y del sobrepeso con comorbilidades mayores

Obesity is a disease of high prevalence in Primary Care clinics. It is associated with major comorbidities (dyslipidaemia, diabetes, hypertension) that increase morbidity and mortality, health expenditure, and reduces the quality of life of patients. Changes in lifestyle are still the pillars of the treatment of excess weight. Pharmacological treatment should be considered when there are difficulties in achieving weight loss goals. In this article, a review is presented on the currently authorised drugs for the treatment of obesity and overweight with major comorbidities

[Pharmacological treatment of obesity for Primary Care physicians]. / Tratamiento farmacológico de la obesidad para médicos de Atención Primaria.

Obesity is a disease of high prevalence in Primary Care clinics. It is associated with major comorbidities (dyslipidaemia, diabetes, hypertension) that increase morbidity and mortality, health expenditure, and reduces the quality of life of patients. Changes in lifestyle are still the pillars of the treatment of excess weight. Pharmacological treatment should be considered when there are difficulties in achieving weight loss goals. In this article, a review is presented on the currently authorised drugs for the treatment of obesity and overweight with major comorbidities.

Posicionamiento para el manejo de la hipertensión arterial en atención primaria a partir del análisis crítico de las guías americana (2017) y europea (2018). Sociedad Española de Médicos de Atención Primaria (EMERGEN) / Positioning for the management of arterial hypertension in Primary Care from the critical analysis of the American (2017) and European (2018) guidelines. Spanish Society of Primary Care Physicians (SEMERGEN)

Parece necesario que las sociedades científicas de AP, ámbito en el cual la prevalencia de HTA es considerable, evalúen periódicamente las directrices internacionales para el manejo de la HTA, sobre todo ante recomendaciones dispares que dificultan la toma de decisiones, en la práctica clínica diaria. El presente documento tiene como objetivo analizar los cambios y novedades propuestos en la guía del American College of Cardiology y de la American Heart Association (ACC/AHA 2017) y en la guía de la European Society of Cardiology y de la European Society of Hypertension (ESC/ESH 2018). Además, analizar las posibles diferencias, limitaciones y su aplicabilidad a la AP de España. En definitiva, se trata de extraer la información más relevante disponible y pertinente, e integrarla para homogeneizar la asistencia al paciente hipertenso desde una perspectiva crítica, pero también razonada. Las discrepancias entre ambas GPC en aspectos tan trascendentales como el manejo de la enfermedad obligan a la recopilación y análisis crítico de la información que nos permita tomar posición como sociedad científica, interesada en trasladar a todos los médicos de AP las recomendaciones más relevantes, pero a la vez sensatas, de ambas GPC

The Scientific Societies of Primary Care, being the area in which there is a considerable prevalence of Arterial Hypertension (AHT), need to periodically evaluate the international guidelines for its management. This is particularly relevant when disparate guidelines make it difficult to make decisions in daily clinical practice. The present document has as its aim to analyse the changes and new developments proposed in the guidelines of the American College of Cardiology and the American Heart Association (ACC/AHA 2017), as well as in the guidelines of the European Society of Cardiology and European Society of Hypertension (ESC/ESH 2018). An analysis will be made of any differences, limitations, and their applicability to Primary Care in Spain. Finally, the most relevant available and appropriate information is extracted and integrated in order to homogenise the care of the hypertensive patient, from a critical, but also a reasoned, perspective. The discrepancies between the recommendations in such essential aspects as the management of the disease, require the compiling and critical analysis of the information that enables us as scientific society, interested in providing all PC physicians with the most relevant, and at the same time, sensible, recommendations of all the guidelines

[Positioning for the management of arterial hypertension in Primary Care from the critical analysis of the American (2017) and European (2018) guidelines. Spanish Society of Primary Care Physicians (SEMERGEN)]. / Posicionamiento para el manejo de la hipertensión arterial en atención primaria a partir del análisis crítico de las guías americana (2017) y europea (2018). Sociedad Española de Médicos de Atención Primaria (SEMERGEN).

The Scientific Societies of Primary Care, being the area in which there is a considerable prevalence of Arterial Hypertension (AHT), need to periodically evaluate the international guidelines for its management. This is particularly relevant when disparate guidelines make it difficult to make decisions in daily clinical practice. The present document has as its aim to analyse the changes and new developments proposed in the guidelines of the American College of Cardiology and the American Heart Association (ACC/AHA 2017), as well as in the guidelines of the European Society of Cardiology and European Society of Hypertension (ESC/ESH 2018). An analysis will be made of any differences, limitations, and their applicability to Primary Care in Spain. Finally, the most relevant available and appropriate information is extracted and integrated in order to homogenise the care of the hypertensive patient, from a critical, but also a reasoned, perspective. The discrepancies between the recommendations in such essential aspects as the management of the disease, require the compiling and critical analysis of the information that enables us as scientific society, interested in providing all PC physicians with the most relevant, and at the same time, sensible, recommendations of all the guidelines.

[Medical conduct in primary care as regards blood pressure control. PRESCAP 2010 study]. / Conducta del médico de atención primaria ante el mal control de la hipertensión arterial. Estudio PRESCAP 2010.

INTRODUCTION: There is a need for more information on therapeutic inertia in blood pressure (BP) treatment. The purpose of this study was to determine the therapeutic behaviour and associated factors of Primary Care (PC) physicians on uncontrolled hypertensive patients. PATIENTS AND METHODS: Cross-sectional multicentre study of patients with hypertension attending Spanish PC centres. Data was collected from patients (social-demographics, clinical status and treatment), as well as data from physicians (medical practice, background and therapeutic behaviour) were collected. Uncontrolled BP was considered when average BP values where ≥140/90mmHg. RESULTS: A total of 12,961 patients (52.0% women) were included. The mean age was 66.3 (SD 11.4) years, and mean number of years from diagnosis of hypertension was 9.1 (6.7) years. Almost two-thirds (62.4%) of the patients were taking a combined blood pressure treatment, (44.2% with two drugs and 18.2% with three drugs, or more). An uncontrolled BP was observed in 38.9% (95% CI: 38.1-39.7) of patients. Treatment was changed by physicians in 41.8% (95% CI: 40.4-43.2) out of 5,036 uncontrolled patients. Adding another drug was the most frequent behaviour (55.6%). The physician's perception of good BP control in uncontrolled patients, together with the presence of combined blood pressure treatment, were the two variables most strongly associated with therapeutic inertia. CONCLUSIONS: The Spanish PC Physician modified antihypertensive treatment in only 4 out of 10 uncontrolled patients. The physician's perception of good BP control was the variable most strongly associated with therapeutic inertia.

Conducta del médico de atención primaria ante el mal control de la hipertensión arterial. Estudio PRESCAP 2010 / Medical conduct in Primary Care as regards blood pressure control. PRESCAP 2010 Study

Introducción. Es necesario tener mayor información sobre la inercia terapéutica en la hipertensión arterial (HTA). El objetivo de este estudio fue conocer la conducta del médico de atención primaria (AP) en pacientes hipertensos que presentan mal control de presión arterial (PA) y determinar los factores asociados. Pacientes y métodos. Estudio transversal y multicéntrico realizado en hipertensos asistidos en el ámbito de la AP española. Se registraron datos de los pacientes (sociodemográficos, clínicos y tratamiento) y médicos (asistenciales, formativos y conducta ante el mal control de PA). Se consideró mal control cuando el promedio de PA era >= 140/90mmHg. Resultados. Se incluyeron 12.961 hipertensos (52,0% mujeres), con una edad media de 66,3 (11,4) años y antigüedad media de la HTA de 9,1 (6,7) años. El 62,4% recibía terapia combinada (44,2%, 2 fármacos, y 18,2%, 3 o más). El 38,9% (IC 95%: 38,1-39,7) presentó mal control de PA. El médico modificó el tratamiento en el 41,8% (IC 95%: 40,4-43,2) de los 5.036 pacientes mal controlados. La conducta terapéutica más frecuente fue la asociación farmacológica (55,6%). La percepción por parte del médico de buen control de PA en el hipertenso mal controlado y la presencia de terapia combinada fueron las variables que mostraron mayor probabilidad de no modificar el tratamiento farmacológico. Conclusiones. El médico de AP modifica el tratamiento antihipertensivo en tan solo 4 de cada 10 hipertensos mal controlados. La percepción por parte del médico de buen control de PA es la variable que más incrementa la probabilidad de no modificar el tratamiento farmacológico (AU)

Introduction. There is a need for more information on therapeutic inertia in blood pressure (BP) treatment. The purpose of this study was to determine the therapeutic behaviour and associated factors of Primary Care (PC) physicians on uncontrolled hypertensive patients. Patients and methods. Cross-sectional multicentre study of patients with hypertension attending Spanish PC centres. Data was collected from patients (social-demographics, clinical status and treatment), as well as data from physicians (medical practice, background and therapeutic behaviour) were collected. Uncontrolled BP was considered when average BP values where >=140/90mmHg. Results. A total of 12,961 patients (52.0% women) were included. The mean age was 66.3 (SD 11.4) years, and mean number of years from diagnosis of hypertension was 9.1 (6.7) years. Almost two-thirds (62.4%) of the patients were taking a combined blood pressure treatment, (44.2% with two drugs and 18.2% with three drugs, or more). An uncontrolled BP was observed in 38.9% (95% CI: 38.1-39.7) of patients. Treatment was changed by physicians in 41.8% (95% CI: 40.4-43.2) out of 5,036 uncontrolled patients. Adding another drug was the most frequent behaviour (55.6%). The physician's perception of good BP control in uncontrolled patients, together with the presence of combined blood pressure treatment, were the two variables most strongly associated with therapeutic inertia. Conclusions. The Spanish PC Physician modified antihypertensive treatment in only 4 out of 10 uncontrolled patients. The physician's perception of good BP control was the variable most strongly associated with therapeutic inertia (AU)

Actividades de ocio-tiempo libre y paseo fuera del hogar en ancianos de la provincia de Guadalajara / Leisure/free time activities and walking outside the home among the elderly in the province of guadalajara

Objetivo. Conocer cuáles son las actividades de ocio-tiempo libre y paseo diario en ancianos de la provincia de Guadalajara, en la hipótesis que éstas son susceptibles de mejorarse. Diseño. Se trata de un estudio descriptivo, transversal, de base poblacional. Emplazamiento. Efectuado en el ámbito comunitario, en el marco de la atención primaria. Participantes. Personas mayores de 65 años, sin deterioro cognitivo y residentes en la comunidad, seleccionados de modo aleatorio a partir de bases de datos poblacionales. La muestra finalmente estudiada está compuesta en el medio rural por 192 varones y 196 mujeres. En el medio urbano por 172 varones y 220 mujeres. Intervenciones. Cada persona era entrevistada en su domicilio o en el centro de salud según sus preferencias mediante cuestionario, previamente sometido a estudio de estabilidad en las respuestas mediante coeficiente kappa test-retest. Efectuamos cribado de deterioro cognitivo mediante test de Pfeiffer. Resultados principales. Caminan menos de media hora al día en el medio rural un 43,6 por ciento (IC, 38,6-48,7) de los ancianos y el 34,4 por ciento (IC, 29,8-39,4) en el medio urbano. En el caso de los varones, un 24,7 por ciento (IC, 20,4-29,6) y en las mujeres el 51,4 por ciento (IC, 46,5-56,3). Las diferencias son significativas en ambos casos. No tienen aficiones en el medio rural un 12,1 por ciento (IC, 9,1-15,9) de los ancianos y el 9,4 por ciento (IC, 6,8-12,9) en el urbano. En el caso de los varones, un 11,3 por ciento (8,315,1) y el 10,1 por ciento (IC, 7,5-13,5) en las mujeres. No existen diferencias significativas. Conclusiones. Es necesario fomentar las actividades de ocio-tiempo libre, pero sobre todo el paseo diario superior a media hora en las personas mayores de 65 años de la provincia de Guadalajara (AU)

Hábitos alimentarios en personas mayores de 65 años del Área Sanitaria de Guadalajara, sin deterioro cognitivo y residentes en la comunidad / Eating habits on persons over 65 in the health area of Guadalajara, without cognitive deterioration and residents and non institutionalized

OBJETIVO: Conocer las características de los hábitos alimentarios en personas mayores de 65 años, sin deterioro cognitivo y residentes en la comunidad. DISEÑO: Estudio descriptivo, transversal, de base poblacional, con distribución aleatoria. EMPLAZAMIENTO: A nivel comunitario, en el marco de la atención primaria, incluye toda la provincia. PERSONAS: Muestra finalmente necesaria, con unas pérdidas teóricas del 26 por ciento, compuesta por 473 personas (228 varones y 245 mujeres) en el medio rural y 477 personas en el medio urbano (210 varones y 267 mujeres). Muestra finalmente estudiada, tras las pérdidas (en el ámbito rural la mayoría por negativa y en el urbano, por no localización-cambio de domicilio), de 388 personas en el medio rural y 392 en el medio urbano. INTERVENCIONES: Por medio de cuestionario, previo estudio de la fiabilidad en las respuestas mediante test-retest, analizamos las variables que determinan los hábitos alimentarios. Cribado de deterioro cognitivo, a cada participante, mediante test de Pfeiffer (SPMSQ). MEDICIONES Y RESULTADOS PRINCIPALES: Consumo de alcohol (30 por ciento V, 5 por ciento M), Café ( 95 por ciento), Tendencia no cenar ( 20 por ciento), Grasa visible (> 60 por ciento), Líquidos adecuados ( 75 por ciento), Consumo semanal en frecuencia saludable, peor en el caso de legumbres y verduras, Dieta saludable (< 45 por ciento). CONCLUSIONES: Hábitos alimentarios con notables deficiencias en el colectivo de ancianos de nuestra provincia, sin distinción de sexo ni ámbito. Sería necesario implementar medidas correctoras (AU)

[Leisure-free time activities and walking outside their homes among the elderly in the province of Guadalajara]. / Actividades de ocio-tiempo libre y paseo fuera del hogar en ancianos de la provincia de Guadalajara.

OBJECTIVE: To find out what elderly people in the province of Guadalajara do in their leisure/free time and daily walking, in the supposition that these can be improved. DESIGN: This was a descriptive, crossover study based on a population-group. SETTING: At community level, in the primary care context. PARTICIPANTS: People over 65 without cognitive deterioration and resident in the community, selected at random on the basis of population data bases. The sample finally studied was made up of 192 men and 196 women from the country-side, and 172 men and 220 women from an urban background. INTERVENTIONS: Everyone was interviewed at home or the health centre according to their preferences through a questionnaire, which had undergone a stability study of the replies beforehand through the kappa test-retest coefficient. We screened cognitive deterioration through the Pfeiffer test. MAIN RESULTS: In the country, 43.6% of elderly people (CI: 38.6-48.7) walked under half an hour a day; in the urban context, 34.4% (CI: 29.8-39.4) did so. 24.7% of men (CI: 20.4-29.6) did so; and 51.4% of women (CI: 46.5-56.3). The differences were significant in the two cases. 12.1% (CI: 9.1-15.9) of elderly people in the country had no hobbies, and 9.4% (CI: 6.8-12.9) in the town. Among men and women, this broke down as 11.3% (CI: 8.3-15.1) and 10.1% (CI: 7.5-13.5). respectively. There were no significant differences. CONCLUSIONS: Leisure and free time activities among people over 65 in the province of Guadalajara must be fostered; but above all a daily walk for over half an hour must be encouraged.