RESUMO
OBJECTIVE: Review of some of the best-known biological and non-biological complementary/alternative therapies/medicines (CAM) and their relationship with blood pressure (BP) and hypertension (HT). SEARCH STRATEGY: Narrative review assessing a recent series of systematic reviews, meta-analyses, and clinical trials published in recent years, focusing on the effects of CAM on BP and HT. SELECTION OF STUDIES: We searched EMBASE, MEDLINE, Cochrane Library and Google Scholar, obtaining a total of 4336 articles, finally limiting the search to 181 after applying filters. SYNTHESIS OF RESULTS: Some studies on biological therapies show some usefulness in BP reduction with an adequate benefit-risk balance, although there is a scarcity of high-quality trials that support these results. Some mind-body therapies have shown hypothetical benefit; in contrast, others lack robust evidence. CONCLUSIONS: Although some therapies present a reasonable risk-benefit ratio, they should in no case replace pharmacological treatment when indicated.
Assuntos
Terapias Complementares , Hipertensão , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/terapia , Terapias Complementares/métodos , Terapias Mente-Corpo , Pressão Sanguínea/efeitos dos fármacos , Anti-Hipertensivos/uso terapêutico , Anti-Hipertensivos/administração & dosagemRESUMO
BACKGROUND: Delphi technique allows developing a multidisciplinary consensus to establish solutions. AIM: To identify barriers and solutions to improve control in patients with Type-2 Diabetes Mellitus (DM2). METHODS: An observational study using the 2-round Delphi technique (June-August 2011). A panel of 108 experts in DM2 from medical and nursing fields (primary care providers and specialists) from different regions completed via email a questionnaire with 41 Likert statements and 9 scores for each one. Level of agreement was assessed using measures of central tendency and dispersion. We analysed commonalities/differences between the two groups (Kappa index and McNemar chi-square). RESULTS: Response rate: 65%. Degree of agreement: 63.4% (95% CI 48.7-78.1%) in medicine, and 78.1% (95% CI 65.4-90.8) in nursing (p > 0.05). Overall level of agreement: Kappa = 0.43, (χ(2) = 2.5 p > 0.05). Regarding non-compliance with therapy, it improves with: the information to the partner/family/caregiver, patient education degree in diabetes, patient motivation and ability to share and agree on decisions with the patient. Clinical inertia improves with: motivation degree of healthcare professionals and the calculation of cardiovascular risk; and gets worse with: the shortage of time in consultation, absence of data in medical record, border high limits measurements accepted as normal readings, lack of a treatment goals, lack of teamwork (Physician/Nurse), scarcity of resources and lack of alarm systems in the electronic medical record on goals to achieve. CONCLUSION: The participants achieved an agreement in interventions in non-therapeutic compliance and clinical inertia to improve DM2 control.
Assuntos
Diabetes Mellitus Tipo 2/prevenção & controle , Adesão à Medicação , Prática Profissional/normas , Atitude do Pessoal de Saúde , Consenso , Técnica Delphi , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Espanha , Inquéritos e Questionários , Falha de TratamentoRESUMO
The method typically used to diagnose and monitor hypertensive patients has been to measure blood pressure in the physician's surgery; however, it is a well-known fact that this approach poses certain drawbacks, such as observer bias, failure to detect an alert reaction in the clinic, etc., difficulties that affect its accuracy as a diagnostic method. In recent years, the varying international scientific societies have persistently recommended the use of blood pressure measurements outside the clinic (at home or in the outpatient setting), using validated automatic devices. Data from some studies suggest that if we rely solely on in-office measurements, approximately 15-20% of the time we may be wrong when making decisions, both in terms of diagnosis and patient follow-up. Home blood pressure measurements are a simple and very affordable method that has a similar reproducibility and prognostic value as ambulatory blood pressure monitoring, the availability of which is currently very limited. Moreover, ambulatory self-measurements have the significant benefit of being able to improve control of hypertensive individuals. Healthcare professionals and patients should be aware of the methodology of home blood pressure measurement, its usefulness and limitations.
Assuntos
Monitorização Ambulatorial da Pressão Arterial , Hipertensão , Humanos , Pressão Sanguínea , Monitorização Ambulatorial da Pressão Arterial/métodos , Reprodutibilidade dos Testes , Hipertensão/diagnóstico , Determinação da Pressão Arterial/métodosRESUMO
Hypertension is the most important risk factor for global disease burden. Detection and management of hypertension are considered as key issues for individual and public health, as adequate control of blood pressure levels markedly reduces morbidity and mortality associated with hypertension. Aims of these practice guidelines for the management of arterial hypertension of the Spanish Society of Hypertension include offering simplified schemes for diagnosis and treatment for daily practice, and strategies for public health promotion. The Spanish Society of Hypertension assumes the 2018 European guidelines for management of arterial hypertension developed by the European Society of Cardiology and the European Society of Hypertension, although relevant aspects of the 2017 American College of Cardiology/American Heart Association guidelines and the 2020 International Society of Hypertension guidelines are also commented. Hypertension is defined as a persistent elevation in office systolic blood pressure ≥ 140 and/or diastolic blood pressure ≥ 90 mmHg, and assessment of out-of-office blood pressure and global cardiovascular risk are considered of key importance for evaluation and management of hypertensive patients. The target for treated blood pressure should be < 130/80 for most patients. The treatment of hypertension involves lifestyle interventions and drug therapy. Most people with hypertension need more than one antihypertensive drug for adequate control, so initial therapy with two drugs, and single pill combinations are recommended for a wide majority of hypertensive patients.
Assuntos
Anti-Hipertensivos , Hipertensão , Humanos , Anti-Hipertensivos/uso terapêutico , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Pressão Sanguínea , Monitorização Ambulatorial da Pressão Arterial , Determinação da Pressão ArterialRESUMO
BACKGROUND: The efficacy and safety of acetylsalicylic acid (ASA) prophylaxis for the primary prevention of atherosclerotic cardiovascular disease (ACVD) remain controversial in people with diabetes (DM) without ACVD, because the possible increased risk of major bleeding could outweigh the potential reduction in the risk of mortality and of major adverse cardiovascular events (MACE) considered individually or together. OBJECTIVE: To evaluate the overall risk-benefit of ASA prophylaxis in primary prevention in people with DM and to compare the recommendations of the guidelines with the results of the meta-analyses (MA) and systematic reviews (SR). MATERIAL AND METHODS: We searched Medline, Google Scholar, Embase, and the Cochrane Library for SR and MA published from 2009 to 2020 which compared the effects of ASA prophylaxis versus placebo or control followed up for at least one year in people with DM without ACVD. Heterogeneity among the randomized clinical trials (RCT) included in the SR and MA was assessed. Cardiovascular outcomes of efficacy (all-cause mortality [ACM], cardiovascular mortality [CVM], myocardial infarction [MI], stroke and MACE) and of safety (major bleeding events [MBE], major gastrointestinal bleeding events [MGIBE], and intracranial and extracranial bleeding) were shown. RESULTS: The recommendations of 12 guidelines were evaluated. The results of 25 SR and MA that included a total of 20 RCT were assessed. None of the MA or SR showed that ASA prophylaxis decreased the risk of ACM, CVM or MI. Only two of the 19 SR and MA that evaluated ischemic stroke showed a decrease in the stroke risk (mean 20.0% [SD±5.7]), bordering on statistical significance. Almost half of the MA and SR showed, bordering on statistical significance, a risk reduction for the MACE composite endpoint (mean 10.5% [SD±3.3]). The significant increases in MGIBE risk ranged from 35% to 55%. The significant increases in the risk of MBE and extracraneal bleeding were 33.4% (SD±14.9) and 54.5% (SD±0.7) respectively. CONCLUSION: The overall risk-benefit assessment of ASA prophylaxis in primary prevention suggests that it should not be applied in people with DM.
Assuntos
Diabetes Mellitus , Infarto do Miocárdio , Acidente Vascular Cerebral , Aspirina/efeitos adversos , Diabetes Mellitus/tratamento farmacológico , Hemorragia/induzido quimicamente , Humanos , Infarto do Miocárdio/tratamento farmacológico , Prevenção PrimáriaRESUMO
Patent foramen ovale (FOP) is the most prevalent cause of cryptogenic strokes in people under 60 years old. Although it is usually asymptomatic, it has a high risk of producing paradoxical embolism and, therefore, stroke with indeterminate outcomes. The study should be started based on clinical suspicion, and includes a multidisciplinary assessment and a determination of the type of treatment to be performed. The therapeutic possibilities range from conservative treatment (indefinite antithrombotic treatment), to its percutaneous closure (currently the most widely used). The first objective is to decrease the number of stroke recurrences. Conservative treatment should be reserved for those cases of low embolic risk. The risk assessment must be individualised, fundamentally based on the anatomical characteristics of the FOP and the patient clinic picture. The use of the RoPE risk scale (The Risk of Paradoxical Embolism) should be a tool to consider.
Assuntos
Forame Oval Patente , Atenção Primária à Saúde , Embolia , Embolia Paradoxal , Humanos , Pessoa de Meia-Idade , Fatores de Risco , Acidente Vascular Cerebral , Resultado do TratamentoRESUMO
The American College of Cardiology (ACC) and the American Heart Association (AHA) have recently published their guidelines for the prevention, detection, evaluation, and management of hypertension in adults. The most controversial issue is the classification threshold at 130/80mmHg, which will allow a large number of patients to be diagnosed as hypertensive who were previously considered normotensive. Blood pressure (BP) is considered normal (<120mmHg systolic and <80mmHg diastolic), elevated (120-129 and <80mmHg), stage 1 (130-139 or 80-89mmHg), and stage 2 (≥140 or ≥90mmHg). Out-of-office BP measurements are recommended to confirm the diagnosis of hypertension and for titration of BP-lowering medication. In management, cardiovascular risk would be determinant since those with grade 1 hypertension and an estimated 10-year risk of atherosclerotic cardiovascular disease ≥10%, and those with cardiovascular disease, chronic kidney disease and/or diabetes will require pharmacological treatment, the rest being susceptible to non-pharmacological treatment up to the 140/90mmHg threshold. These recommendations would allow patients with level 1 hypertension and high atherosclerotic cardiovascular disease to benefit from pharmacological therapies and all patients could also benefit from improved non-pharmacological therapies. However, this approach should be cautious because inadequate BP measurement and/or lack of systematic atherosclerotic cardiovascular disease calculation could lead to overestimation in diagnosing hypertension and to overtreatment. Guidelines are recommendations, not impositions, and the management of hypertension should be individualized, based on clinical decisions, preferences of the patients, and an adequate balance between benefits and risks.
RESUMO
Cardiovascular risk assessment is of key importance for a global diagnosis of the hypertensive patient. Card iovascular risk stratification accord ing blood pressure levels, presence of accompanying cardiovascular risk factors, and presence of subclinical and/or clinical organ damage, constitute a systematic approach to assess risk for cardiovascular morbidity and mortality, to decide about initial antihypertensive treatment, and to promote global cardiovascular risk management. Several recent clinical practice guidelines recommend this approach, although there are no clinical trials demonstrating advantages of this management versus treating cardiovascular risk factors individually. Guidelines for management of high blood pressure and that for management of dyslipidemias constitute examples of agreement about the convenience of assessing global cardiovascular risk. Both qualitative (European guidelines for management of arterial hypertension) and quantitative (SCORE) tables are available, both useful for id entification of high-risk patients, and indicating the necessity of starting simultaneous non-pharmacological and pharmacological treatment. Family doctors should include in their usual clinical practice a systematic approach to cardiovascular risk assessment, thus diagnosing the individual cardiovascular risk burden, and consequently applying therapeutic management to reduce future risk of cardiovascular morbidity and mortality.
Assuntos
Doenças Cardiovasculares/prevenção & controle , Hipertensão/fisiopatologia , Medição de Risco/métodos , Aterosclerose/complicações , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Doença das Coronárias/epidemiologia , Doença das Coronárias/etiologia , Humanos , Hipertensão/complicações , Hipertensão/terapia , Doenças Vasculares Periféricas/epidemiologia , Doenças Vasculares Periféricas/etiologia , Guias de Prática Clínica como Assunto , Estatística como Assunto , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologiaRESUMO
INTRODUCTION: Atrial fibrillation (AF) is the most frequent arrhythmia in clinical practice and has important prognostic implications. The objective of this study was to demonstrate the validity and the reliability of taking the arterial pulse (TAP) in patients over 65 years for detecting in AF and other rhythm disorders. MATERIALS AND METHODS: A descriptive, observational, multicentre study to validate a diagnostic test within in a controlled clinical trial. SETTING: 39 Primary Care Centres in the Spanish National Health Service. A total of 318 physicians and nurses took part in the analysis of validity, and 166 of them took part in the analysis of reliability. The professionals were previously called to a meeting in which they took the arterial pulses, and were given 4 ECGs to interpret. The participants TAP of 864 patients followed by an ECG to confirm the cardiac rhythm. Sensitivity, specificity and predictive values were estimated to assess the criterial validity and the simple concordance index to check reproducibility. RESULTS: The sensitivity of pulse measurement for detecting AF detection was 99.4% (95% CI: 97.9-100.0), with a specificity of 30.7% (95% CI: 26.1-35.3), a positive predictive value of 36.6% (95% CI 32.0-41.2), and negative predictive value of 99.2% (97.3-100.0). The simple concordance between the researchers and the cardiologist for the ECG diagnosis of AF ranged between 84.9% and 91.6%. CONCLUSIONS: The TAP has a high sensitivity but a low specificity to detect AF. It is a reliable test for the opportunistic screening of arrhythmias in patients aged over 65 years.
Assuntos
Arritmias Cardíacas/diagnóstico , Fibrilação Atrial/diagnóstico , Frequência Cardíaca/fisiologia , Programas de Rastreamento/métodos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Eletrocardiografia , Feminino , Humanos , Masculino , Valor Preditivo dos Testes , Atenção Primária à Saúde/métodos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , EspanhaAssuntos
COVID-19 , Doenças Cardiovasculares , Anticoagulantes/efeitos adversos , Vacina BNT162 , Vacinas contra COVID-19 , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Fatores de Risco de Doenças Cardíacas , Humanos , RNA Mensageiro , Fatores de Risco , SARS-CoV-2RESUMO
OBJECTIVE: To assess the knowledge of the hypertensive patients about their hypertension and their relation to its control. MATERIAL AND METHODS: Cross-sectional study among 400 hypertensive patients, all over 18 years, selected from 50 primary-care centres, who responded to an hypertension-related survey. Included variables were survey items, age, gender, educational level, professional occupation, blood pressure data and antihypertensive treatment. The obtained differences were analyzed using the chi-square test, Kruskal-Wallis, Wilcoxon, Anova and Bonferroni methods. RESULTS: There were 323 valid surveys. 52.9% of respondents were women, the average age: 65.4 years (SD: 11.2), 54.8% of them had primary education. 39.6% were aware of the objectives of systolic BP control. Only 19.6% having knowledge of those for diastolic BP control, with no differences between controlled and uncontrolled (systolic BP: 39% vs 38.1%, P=.887; diastolic BP: 19.2% vs 21%, P=.721). Over 70% knew about lifestyle changes, without significant differences between controlled and uncontrolled respondents. 82% of controlled respondents, and 79% of those uncontrolled, recognized the chronical nature of the treatment (P=.548), but 15.1% of the controlled respondents and 12.4% of uncontrolled respondents did not see the relation between the treatment and hypertension control (P=.525). 31.1% believed to be well-controlled, but in fact was not. CONCLUSIONS: Our patients doesn't know blood pressure targets of control. There isn't relationship between this knowledge and control of hypertension.
Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Hipertensão , Idoso , Anti-Hipertensivos , Pressão Sanguínea , Determinação da Pressão Arterial , Estudos Transversais , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Masculino , Pessoa de Meia-IdadeRESUMO
Objective: Review of some of the best-known biological and non-biological complementary/alternative therapies/medicines (CAM) and their relationship with blood pressure (BP) and hypertension (HT). Search strategy: Narrative review assessing a recent series of systematic reviews, meta-analyses, and clinical trials published in recent years, focusing on the effects of CAM on BP and HT. Selection of studies: We searched EMBASE, MEDLINE, Cochrane Library and Google Scholar, obtaining a total of 4336 articles, finally limiting the search to 181 after applying filters. Synthesis of results: Some studies on biological therapies show some usefulness in BP reduction with an adequate benefitrisk balance, although there is a scarcity of high-quality trials that support these results. Some mind-body therapies have shown hypothetical benefit; in contrast, others lack robust evidence. Conclusions: Although some therapies present a reasonable riskbenefit ratio, they should in no case replace pharmacological treatment when indicated.(AU)
Objetivo: Revisar algunas de las más conocidas terapias/medicinas biológicas y no biológicas complementarias/alternativas (MCA), y su relación con la presión arterial (PA) e hipertensión arterial (HTA). Estrategia de búsqueda: Revisión narrativa en la que se valoraron una serie reciente de revisiones sistemáticas, metaanálisis y ensayos clínicos publicados en los últimos años, centrada en los efectos de la MCA sobre la PA y HTA. Selección de estudios: Se realizaron búsquedas en EMBASE, MEDLINE, Cochrane Library y Google Scholar, obteniéndose un total de 4.336 artículos, limitándose finalmente a 181 tras aplicar filtros. Síntesis de resultados: Algunos trabajos sobre terapias biológicas parecen demostrar cierta utilidad en reducción de la PA con adecuado balance beneficio/riesgo, aunque existe escasez de ensayos de alta calidad que avalen estos resultados. Algunas terapias cuerpo/mente han mostrado un hipotético beneficio; en cambio, otras carecen de evidencia robusta. Conclusiones: Aunque algunas terapias presentan una relación riesgo/beneficio razonable, no deberían sustituir en ningún caso al tratamiento farmacológico cuando este esté indicado.(AU)
Assuntos
Humanos , Masculino , Feminino , Terapias Complementares , Hipertensão , Pressão Arterial , Terapia Biológica , Tratamento Farmacológico , TerapêuticaRESUMO
El American College of Cardiology (ACC) y la American Heart Association (AHA) han publicado recientemente la guía para la prevención, detección, evaluación y tratamiento de la hipertensión arterial (HTA) en adultos. El punto más controvertido es el umbral diagnóstico de 130/80 mmHg, lo cual conlleva diagnosticar HTA en un gran número de personas previamente consideradas no hipertensas. La presión arterial (PA) se clasifica como normal (sistólica < 120 y diastólica 80 mmHg), elevada (120-129 y < 80 mmHg), grado 1 (130-139 o 80-89 mmHg) y grado 2 (≥ 140 o ≥ 90 mmHg). Se recomienda la medida de PA fuera de la consulta para confirmar el diagnóstico de HTA o para aumentar el tratamiento. En la toma de decisiones sería determinante el riesgo cardiovascular (RCV), ya que precisarían tratamiento farmacológico personas con HTA grado 1 con riesgo a 10 años de enfermedad cardiovascular aterosclerótica ≥ 10% y aquellas con enfermedad cardiovascular establecida, enfermedad renal crónica y diabetes, siendo el resto susceptibles de medidas no farmacológicas hasta umbrales de 140/90 mmHg. Dichas recomendaciones permitirían a los sujetos con HTA grado 1 y alto RCV beneficiarse de terapias farmacológicas y podrían mejorar las intervenciones no farmacológicas en todos los sujetos. Sin embargo, habría que ser cauteloso ya que sin poder garantizar una toma correcta de PA, ni el cálculo sistemático del RCV, la aplicación de dichos criterios podría sobrestimar el diagnóstico de HTA y suponer un sobretratamiento innecesario. Las guías son recomendaciones, no imposiciones, y el abordaje y manejo de la PA debe ser individualizado, basado en decisiones clínicas, preferencias de los pacientes y en un balance adecuado del beneficio y riesgo al establecer los diferentes objetivos de PA
The American College of Cardiology (ACC) and the American Heart Association (AHA) have recently published their guidelines for the prevention, detection, evaluation, and management of hypertension in adults. The most controversial issue is the classification threshold at 130/80mmHg, which will allow a large number of patients to be diagnosed as hypertensive who were previously considered normotensive. Blood pressure (BP) is considered normal (<120mmHg systolic and <80mmHg diastolic), elevated (120-129 and <80mmHg), stage 1 (130-139 or 80-89mmHg), and stage 2 (≥140 or ≥90mmHg). Out-of-office BP measurements are recommended to confirm the diagnosis of hypertension and for titration of BP-lowering medication. In management, cardiovascular risk would be determinant since those with grade 1 hypertension and an estimated 10-year risk of atherosclerotic cardiovascular disease ≥10%, and those with cardiovascular disease, chronic kidney disease and/or diabetes will require pharmacological treatment, the rest being susceptible to non-pharmacological treatment up to the 140/90mmHg threshold. These recommendations would allow patients with level 1 hypertension and high atherosclerotic cardiovascular disease to benefit from pharmacological therapies and all patients could also benefit from improved non-pharmacological therapies. However, this approach should be cautious because inadequate BP measurement and/or lack of systematic atherosclerotic cardiovascular disease calculation could lead to overestimation in diagnosing hypertension and to overtreatment. Guidelines are recommendations, not impositions, and the management of hypertension should be individualized, based on clinical decisions, preferences of the patients, and an adequate balance between benefits and risks
Assuntos
Humanos , Hipertensão/epidemiologia , Sociedades Médicas/normas , Doenças Cardiovasculares/complicações , Fatores de Risco , Sociedades Médicas/organização & administração , Hipertensão/prevenção & controle , Hipertensão/classificação , Estilo de Vida , Fibrilação AtrialRESUMO
The method typically used to diagnose and monitor hypertensive patients has been to measure blood pressure in the physician's surgery; however, it is a well-known fact that this approach poses certain drawbacks, such as observer bias, failure to detect an alert reaction in the clinic, etc., difficulties that affect its accuracy as a diagnostic method.In recent years, the varying international scientific societies have persistently recommended the use of blood pressure measurements outside the clinic (at home or in the outpatient setting), using validated automatic devices. Data from some studies suggest that if we rely solely on in-office measurements, approximately 1520% of the time we may be wrong when making decisions, both in terms of diagnosis and patient follow-up.Home blood pressure measurements are a simple and very affordable method that has a similar reproducibility and prognostic value as ambulatory blood pressure monitoring, the availability of which is currently very limited. Moreover, ambulatory self-measurements have the significant benefit of being able to improve control of hypertensive individuals.Healthcare professionals and patients should be aware of the methodology of home blood pressure measurement, its usefulness and limitations. (AU)
El método utilizado habitualmente para el diagnóstico y seguimiento de los pacientes hipertensos ha sido la medida de la presión arterial en la consulta, pero es un hecho conocido que este método plantea problemas (sesgos del observador, no detecta reacción de alerta en consulta ) que afectan a su precisión como método diagnóstico.Las diferentes sociedades científicas internacionales, en los últimos años, recomiendan de forma insistente el uso de medidas de presión arterial fuera de la consulta (domiciliarias o ambulatorias) con aparatos automáticos validados para tomar decisiones. Datos de algunos estudios sugieren que si solo utilizamos las medidas de la consulta nos podemos equivocar en torno a un 15-20% de las veces que tomemos decisiones en el diagnóstico y seguimiento de los pacientes.Las medidas domiciliarias de presión arterial son un método sencillo y muy accesible que tienen una reproducibilidad y valor pronóstico similar al de las medidas ambulatorias, cuya disponibilidad actualmente e muy limitada, y que además tienen una utilidad importante que es la posibilidad de mejora del control de los hipertensos.Los profesionales sanitarios y los pacientes deben conocer la metodología de uso de la medida de presión arterial domiciliaria y sus utilidades y limitaciones. (AU)
Assuntos
Humanos , Hipertensão/diagnóstico , Monitorização Ambulatorial da Pressão Arterial/métodos , Pressão Arterial , Determinação da Pressão Arterial/métodos , Reprodutibilidade dos TestesRESUMO
Introducción. La fibrilación auricular es la arritmia más frecuente en la práctica clínica y conlleva importantes implicaciones pronósticas. Comprobar la validez y la fiabilidad de la toma del pulso arterial (TPA) de los profesionales de atención primaria en la detección de fibrilación auricular y otros trastornos del ritmo en pacientes mayores de 65 años ha sido el objeto de este estudio. Material y métodos. Estudio observacional descriptivo, multicéntrico, de validación de una prueba diagnóstica, anidado en un ensayo clínico controlado. Emplazamiento: 39 centros de salud del Sistema Nacional de Salud. Participaron 318 médicos y enfermeros en el análisis de la validez y 166 en el de la fiabilidad. Se convocó a los profesionales a una reunión donde se tomaron el pulso arterial y se les entregó 4 ECG para que los interpretaran. Los participantes realizaron la TPA, seguido de un ECG en 864 pacientes para confirmar el ritmo cardiaco. Para valorar la validez criterial se estimaron la sensibilidad, especificidad y valores predictivos, y para comprobar la reproducibilidad, el índice de concordancia simple. Resultados. La sensibilidad de la TPA para la detección de fibrilación auricular fue del 99,4% (IC 95%: 97,9-100,0), y la especificidad del 30,7% (IC 95%: 26,1-35,3), el valor predictivo positivo fue 36,6% (IC 95%: 32,0-41,2) y el valor predictivo negativo 99,2% (IC 95%: 97,3-100,0). La concordancia simple entre los investigadores y el cardiólogo para el diagnóstico electrocardiográfico de fibrilación auricular osciló entre el 84,9 y el 91,6%. Conclusiones. La TPA tiene una alta sensibilidad pero una baja especificidad para detectar una fibrilación auricular. Es una prueba fiable, por lo que resulta de utilidad para el cribado oportunista de arritmias en pacientes mayores de 65 años que acuden a atención primaria (AU)
Introduction. Atrial fibrillation (AF) is the most frequent arrhythmia in clinical practice and has important prognostic implications. The objective of this study was to demonstrate the validity and the reliability of taking the arterial pulse (TAP) in patients over 65 years for detecting in AF and other rhythm disorders. Materials and methods. A descriptive, observational, multicentre study to validate a diagnostic test within in a controlled clinical trial. Setting: 39 Primary Care Centres in the Spanish National Health Service. A total of 318 physicians and nurses took part in the analysis of validity, and 166 of them took part in the analysis of reliability. The professionals were previously called to a meeting in which they took the arterial pulses, and were given 4 ECGs to interpret. The participants TAP of 864 patients followed by an ECG to confirm the cardiac rhythm. Sensitivity, specificity and predictive values were estimated to assess the criterial validity and the simple concordance index to check reproducibility. Results. The sensitivity of pulse measurement for detecting AF detection was 99.4% (95% CI: 97.9-100.0), with a specificity of 30.7% (95% CI: 26.1-35.3), a positive predictive value of 36.6% (95% CI 32.0-41.2), and negative predictive value of 99.2% (97.3-100.0). The simple concordance between the researchers and the cardiologist for the ECG diagnosis of AF ranged between 84.9% and 91.6%. Conclusions. The TAP has a high sensitivity but a low specificity to detect AF. It is a reliable test for the opportunistic screening of arrhythmias in patients aged over 65 years (AU)
Assuntos
Humanos , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Pulso Arterial/instrumentação , Atenção Primária à Saúde/métodos , Valor Preditivo dos Testes , Eletrocardiografia/métodosRESUMO
No disponible
Assuntos
Humanos , Feminino , Adulto Jovem , Idoso , Idoso de 80 Anos ou mais , Cefaleia/etiologia , Blefaroptose/etiologia , Trombose do Corpo Cavernoso/complicações , Trombose do Corpo Cavernoso/diagnóstico , Miastenia Gravis/complicações , Miastenia Gravis/diagnóstico , Blefarospasmo/complicações , Blefarospasmo/diagnósticoRESUMO
La valoración del riesgo vascular supone una visión holística y global del paciente. Conocer la probabilidad de la morbimortalidad a la que puede estar expuesto un individuo en función de sus características y de sus factores de riesgo debe ser una aproximación sistemática para decidir cuándo iniciar su tratamiento y si este debe incluir de forma inmediata fármacos para disminuir los factores de riesgo cardiovascular, junto con cambios en el estilo de vida. Son varias las guías de práctica clínica recientes que abogan por esta práctica, aunque no existen ensayos clínicos que hayan demostrado una ventaja sustancial sobre el abordaje de los factores de riesgo cardiovascular individuales. Es en hipertensión arterial, además de en dislipemias, donde existe más acuerdo sobre la eficacia de estas medidas y donde su utilización puede ser más rentable. Tanto las tablas cualitativas (guía europea de hipertensión arterial) como las cuantitativas (en nuestro medio SCORE) están disponibles y son complementarias para conocer qué pacientes son de alto riesgo y, por tanto, susceptibles de iniciar de forma inmediata un tratamiento farmacológico. Los médicos de familia deben introducir la valoración del riesgo vascular en su práctica clínica habitual, y catalogar al paciente y las actividades terapéuticas consecuentes en función de dicho cálculo de forma periódica
Cardiovascular risk assessment is of key importance for a global diagnosis of the hypertensive patient. Cardiovascular risk stratification according blood pressure levels, presence of accompanying cardiovascular risk factors, and presence of subclinical and/or clinical organ damage, constitute a systematic approach to assess risk for cardiovascular morbidity and mortality, to decide about initial antihypertensive treatment, and to promote global cardiovascular risk management. Several recent clinical practice guidelines recommend this approach, although there are no clinical trials demonstrating advantages of this management versus treating cardiovascular risk factors individually. Guidelines for management of high blood pressure and that for management of dyslipidemias constitute examples of agreement about the convenience of assessing global cardiovascular risk. Both qualitative (European guidelines for management of arterial hypertension) and quantitative (SCORE) tables are available, both useful for identification of high-risk patients, and indicating the necessity of starting simultaneous non-pharmacological and pharmacological treatment. Family doctors should include in their usual clinical practice a systematic approach to cardiovascular risk assessment, thus diagnosing the individual cardiovascular risk burden, and consequently applying therapeutic management to reduce future risk of cardiovascular morbidity and mortality
Assuntos
Humanos , Indicadores Básicos de Saúde , Hipertensão/epidemiologia , Doenças Cardiovasculares/epidemiologia , Pressão Arterial/fisiologia , Doenças Cardiovasculares/prevenção & controle , Estilo de Vida , 24960/métodos , Eficácia/organização & administração , Resultado do TratamentoRESUMO
Objetivo: Evaluar el conocimiento de nuestros pacientes hipertensos sobre su HTA y su relación con el control de la misma. Material y métodos: Estudio descriptivo transversal con 400 hipertensos, mayores de edad, seleccionados de forma sistemática consecutiva de 50 consultas de atención primaria, que respondieron una encuesta sobre HTA. Las variables recogidas fueron los ítems de la encuesta, edad, sexo, nivel educacional, ocupación, cifras de presión arterial y tratamiento antihipertensivo. Las diferencias se analizaron con los test ji-cuadrado, Kruskal-Wallis, Wilcoxon, Anova y Bonferroni según distribución normal. Resultados: Fueron válidas 323 encuestas. El 52,9% fueron mujeres, edad media de 65,4años (DE: 11,2). El 54,8% contaban con estudios primarios. El 39,6% conocían los objetivos de control de PA sistólica, y solo el 19,6% los de PA diastólica, sin diferencias entre controlados y no controlados (PA sistólica: 39% vs 38,1%, p = 0,887; PA diastólica: 19,2% vs 21%, p = 0,721). Más del 70% conocían las modificaciones del estilo de vida, sin diferencias entre controlados y no controlados. El 82% de los controlados y el 79% de los no controlados reconocieron la cronicidad del tratamiento (p = 0,548), pero el 15,1% de los controlados y el 12,4% de los no controlados no lo relacionaban con el control de la HTA (p = 0,525). El 31,1% creían estar bien controlados aunque no lo estaban. Conclusiones: Los pacientes hipertensos conocen en baja frecuencia cuáles son los objetivos de control, sin encontrar relación entre el conocimiento del problema y el control del mismo
Objective: To assess the knowledge of the hypertensive patients about their hypertension and their relation to its control. Material and methods: Cross-sectional study among 400 hypertensive patients, all over 18 years, selected from 50 primary-care centres, who responded to an hypertension-related survey. Included variables were survey items, age, gender, educational level, professional occupation, blood pressure data and antihypertensive treatment. The obtained differences were analyzed using the chi-square test, Kruskal-Wallis, Wilcoxon, Anova and Bonferroni methods. Results: There were 323 valid surveys. 52.9% of respondents were women, the average age: 65.4 years (SD: 11.2), 54.8% of them had primary education. 39.6% were aware of the objectives of systolic BP control. Only 19.6% having knowledge of those for diastolic BP control, with no differences between controlled and uncontrolled (systolic BP: 39% vs 38.1%, P = .887; diastolic BP: 19.2% vs 21%, P = .721). Over 70% knew about lifestyle changes, without significant differences between controlled and uncontrolled respondents. 82% of controlled respondents, and 79% of those uncontrolled, recognized the chronical nature of the treatment (P = .548), but 15.1% of the controlled respondents and 12.4% of uncontrolled respondents did not see the relation between the treatment and hypertension control (P = .525). 31.1% believed to be well-controlled, but in fact was not. Conclusions: Our patients doesnt know blood pressure targets of control. There isnt relationship between this knowledge and control of hypertension
Assuntos
Humanos , Hipertensão/epidemiologia , Anti-Hipertensivos/uso terapêutico , Conhecimentos, Atitudes e Prática em Saúde , Cooperação do Paciente/estatística & dados numéricos , Adesão à Medicação/estatística & dados numéricosRESUMO
OBJECTIVES: To assess reliability in terms of inter-observer agreement of blood pressure (BP) readings. Various health professionals and measuring systems. Influence of observer's experience. DESIGN: Observational, descriptive, cross-sectional study. SETTING: Urban health centre, Córdoba. PARTICIPANTS: 131 hypertensive, randomised patients, belonging to a functional care unit. 11 were excluded. MEASUREMENTS: To reduce variability: course on the right way to take blood pressure, otoscope and verification of visual sharpness of observers, calibration and validation of measuring devices, limited time and blinding of measurements. 4 BP measurements per patient: 3 with mercury sphygmomanometer (2 simultaneously, one individual) and one with an automatic device. Descriptive, clinical and somatometric variables were gathered. Inter-observer agreement was evaluated through the intraclass correlation coefficient (ICC), the mean of differences method (MDM) and the simple concordance index (CI). An ICC > 0.75 was thought acceptable. A difference > 5 mmHg was thought clinically relevant (MDM and CI). MAIN RESULTS: Acceptable consistency for MDM: alone, systolic and diastolic pressure of OBS 1/ OBS 2, bi-auricular, -6.1/+8.9 mmHg and -6.8/+5.8 mmHg. Less favourable results: for systolic and diastolic pressure: OBS 1/AUTO -20.9/25.0 and -16.4/15.1; OBS 2/AUTO -22.8/24.4 and -16.6/15.2. Remaining intervals always > 10 mmHg; CI > 0.75 in all comparisons except diastolic pressure OBS 1/AUTO and diastolic pressure OBS 2/AUTO (0.69 in both cases). 41% of comparisons were > 5 mmHg. No differences in less expert professionals were found. CONCLUSIONS: Inaccuracy of the standard BP measurement method (mercury sphygmomanometer) for MDM and CI. Contradictory conclusions according to method of measurement. Differences not clinically acceptable.