ABSTRACT
La Hipertensión Arterial (HTA) continúa siendo un problema de Salud Pública relevante a nivel mundial. En Chile es la principal causa de morbimortalidad y el factor de riesgo de mayor carga atribuible para la patología cardiovascular isquèc)mica y el accidente cerebrovascular. En este artículo se revisa su prevalencia, el grado de conocimiento, el logro de su control y tratamiento, así como su riesgo atribuible analizando la carga de enfermedad y la pèc)rdida de años por discapacidad. Se presentan estudios del impacto de su inclusión en el AUGE, resultados de la intervención multidisciplinaria, su interacción con otros factores de riesgo cardiovascular y se comentan algunos aspectos de las actualizaciones de las guías internacionales para su manejo.
Hypertension (HT) remains as an important public health problem worldwide. In Chile constitutes the leading cause of morbidity and mortality and the risk factor with the highest attributable risk burden for ischemic heart disease and stroke. This article reviews HT??s prevalence, degree of knowledge, achievement of its control and treatment. Also the risk burden of disease and disability loss years due to this pathology is analyzed. The results of studies after the inclusion of HT as explicit guaranteed health problem, multidisciplinary approach and its interaction with other cardiovascular risk factors is presented. Finally, some aspects of international updates guidelines for its management are discussed.
Subject(s)
Humans , Cardiovascular Diseases/epidemiology , Hypertension/epidemiology , Patient Care Team , Cardiovascular Diseases/etiology , Comorbidity , Prevalence , Risk Factors , Hypertension/complications , Hypertension/therapyABSTRACT
Antecedentes: El autoreporte se ha utilizado frecuentemente como método para estudiar la prevalencia de los factores de riesgo cardiovascular (FRCV), por lo que es crucial conocer su grado de certeza. Objetivos: Determinar en una población de adultos aparentemente sanos la validez del autoreporte como método paraestimar la prevalencia de hipertensión arterial, hipercolesterolemia e hiperglicemia, comparando estos resultados con los obtenidos a través de la medición objetiva de estos parámetros. Método: En el proyecto RICAR, un total de 12.190 adultos sanos (6.320 mujeres, 5.870 hombres, edad 47,6 +/- 12 años) respondieron un cuestionario acerca de su presión arterial sistólica y diastólica (PAS, PAD), colesterol total (CT) y glicemia(GL). Conocían su PA 2.430, su CT 1.163 y su GL 1.556 personas. A ellos se les preguntó si los valores que estaban reportando eran normales o anormales, y se compararon estas apreciaciones con mediciones objetivas de estos parámetros. Resultados: Un 18,2 por ciento y un 15,6 por ciento refirió incorrectamente su PAS y su PAD como normales, mientras que el error fue de 44,9 por ciento y 15,8 por ciento respecto de CT y GL, respectivamente. Las mujeres tuvieron autoreportes de valores normales significativamente más precisos que los hombres para PAS, PAD y GL: 84,3 vs 77,6 por ciento, 88,7 vs 77 por ciento y 97,5 vs 94 por ciento respectivamente (p<0,0001), a pesar de tener un nivel educacional inferior a los hombres. El VP Positivo para el reporte de valores anormales de la PAS, PAD, CT y GL fue 54.3 por ciento, 46.7 por ciento, 75.1 por ciento y 41.8 por ciento respectivamente. El VP Negativo de los mismos parámetros fue 81.7 por ciento, 84.4 por ciento, 55.1 por ciento y 96.4 por ciento, respectivamente. La prevalencia verdadera versus la aparente en hipertensión sistólica fue de 30 vs 32,6 por ciento, hipertensión diastólica de 25,7 vs 32,6 por ciento y GL elevada de 10 vs 16,7 por ciento (índice de Kappa < 0.6)...
Background: Accuracy and validity of self reported data is a crucial aspect as massive populations´ surveys had become a common method of establishing populations cardiovascular risk factors (CVRF) prevalence. Objective: To determine in a healthy adult population the accuracy of their self reported normal or abnormal values of Blood Pressure (BP), Total Cholesterol (TC) and Blood Sugar (BS), compared with clinical findings. Methods: A questionnaire about their own BP, TC and BS was answered by 12,190 healthy adults from the RICAR Project, (6320 women and 5870 men, mean age 47.6 +/- 12 y). Those who knew their parameters (BP n= 2,430, TC n= 1,163 and BS n = 1,556) were asked if they had normal or abnormal values. Using standardized methods we measured Systolic (SBP) and Diastolic Blood Pressure (DBP), Total Cholesterol and Blood Sugar (BS) and compare the referred data of normality/abnormality with clinical findings. Results: SBP and DBP were respectively uncorrectly reported as normal in 18,2 percent and 15,6 percent of the population. For TCand BS the mistaken reported normal values were 44,9 percent y 15,8 percent respectively. Women had significant more accurate selfreported normal values than men for SBP, DBP and BS: 84,3 vs 77,6 percent; 88,7 vs 77 percent y 97,5 vs 94 percent respectively (p<0,0001), eventhough they had a significant less educational level than men. Positive PV for abnormal SBP, DBP, TC and BS were 54.3 percent, 46.7 percent, 75.1 percent and 41.8 percent respectively. Negative PV for the same parameters were 81.7 percent, 84.4 percent, 55.1 percent and 96.4 percent respectively. True versus apparent prevalences evidenced differences with an overestimation of systolic hipertension 30 vs 32,6 percent, diastolic hipertension 25,7 vs 32,6 percent and high BS 10 vs 16,7 percent. Kappa index was low between these methods...
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged, 80 and over , Cardiovascular Diseases/etiology , Cardiovascular Diseases/prevention & control , Health Behavior , Self Care , Age and Sex Distribution , Chile/epidemiology , Data Collection , Cardiovascular Diseases/epidemiology , False Negative Reactions , Health Education , Health Surveys , Perception , Predictive Value of Tests , Primary Prevention , Risk Factors , Sensitivity and SpecificityABSTRACT
In recent years the main focus of cardiovascular prevention has been to identify people without clinical evidence of coronary disease, but with a high risk of developing a clinical event. Long term follow up studies show that a young person with a high "Relative Risk" of presenting a cardiovascular event becomes an adult with a high "Absolute Risk" of suffering it. The aim of primary prevention is to avoid the appearance of cardiovascular diseases, delaying the development of atherosclerosis and its consequences. In this scenario, the first step is to increase awareness among healthy people of their own cardiovascular risk, enhancing their knowledge of their risk parameter values and generating a correct perception of the risk burden that those values mean. Literature review reveals that significant percentages of healthy individuals are unaware of their own values of blood pressure, total cholesterol and blood glucose. Furthermore, people aware of having abnormal parameters have low treatment compliance rates or evidence inconsistency between knowledge and behavior. This paper reviews educational strategies and other factors that influence this knowledge-behavior gap, such as the stages of behavior changes of the Prochaska and Diclemente Model. Evidence has shown that knowledge about cardiovascular risk factors is not enough to influence behavior and that the degree of preparation of people towards behavior changes is a strong predictor of the success of educational and counseling interventions. Local Chilean data from the RICAR project also shows that the profile of behavior change is different for each modifiable cardiovascular risk factor.
Subject(s)
Humans , Cardiovascular Diseases/prevention & control , Health Knowledge, Attitudes, Practice , Health Promotion , Risk FactorsABSTRACT
Background: International studies show a low compliance with norms for the management of cardiovascular risk factors. Aim: To assess the prevalence of risk factors in patients admitted for a coronary or vascular event and to evaluate the proportion of patients that normalize these factors after one year of follow up. Material and Methods: Three hundred and fifty seven patients aged 64±13 years (264 males), admitted to a University Clinical Hospital for a coronary or vascular event were studied. They were educated about cardiovascular risk factors and followed by their treating physicians for a mean of 11.9±2 months. During this period, smoking habits, body mass index. blood pressure, serum lipid levels, blood glucose and the appearance of new cardiovascular events were registered. Results: One year survival was 96% (all 13 deaths were of cardiac origin). Eighty seven percent of patients were free of major cardiovascular events. At discharge from hospital and at the end of follow up 49% and 44% had a total cholesterol over 200 mg/dl respectively, 9,6% and 20,8% had systolic pressure over 140 mmHg. There was no diastolic hypertension in these patients, 27% and 31% had a body mass index over 25 kg/m2 and 2% smoked (versus 32% before the event). Conclusions: After one year of follow up, the prevalence of risk factors in patients that had suffered a cardiovascular event, continues to be high.