ABSTRACT
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.
Subject(s)
Antihypertensive Agents , Hypertension , Humans , Antihypertensive Agents/therapeutic use , Hypertension/diagnosis , Hypertension/drug therapy , Blood Pressure , Blood Pressure Monitoring, Ambulatory , Blood Pressure DeterminationABSTRACT
Background: Only between 1% and 10% of patients labelled of penicillin allergy are allergic. The negative events associated with this condition include risk of antimicrobial treatment failure, antimicrobial resistance, side-effects from use of a broader spectrum antibiotic, and increased healthcare costs. Our objective was to know the clinical profile of hospitalized allergic patients to estimate the future need for an allergy study. Method(s): We collected data from 15 Spanish hospitals about hospitalized patients labelled as allergic to antibiotics in February 2020 and October 2020 (one-month sample) outside the peak of the Covid-19 pandemic. Result(s): 620 patients were collected, 59% women. Mean age 70.6 years (3-103). 416 patients were labelled as allergic to beta-lactams (105 aminopenicillins, 18 cephalosporins, 4 carbapenems). 41 to aminoglycosides, 26 to macrolides, 55 to quinolones and 4 to glycopeptides. The causes of hospitalization were: Respiratory infection 221 (35.6%), abdominal infection 95 (15.3%), orthopaedic surgery 58 (9.4%), urine infections 57 (9.2%), skin infections 51 (8.2%), gynaecological/ obstetric pathology 21 (3.4%) Only 163 patients (26%) had previously received a clinical allergy work-up. 70 confirmed allergy to antibiotics, however the rest 93 (74%) were not delabelled. Patients received alone or combined alternative antibiotics: 79 glycopeptides, 49 aminoglycosides, 28 macrolides, 254 quinolones, 205 beta-lactams (102 cephalosporins, 41 carbapenems and 57 aminopenicillins). 74 patients (12%) would need an immediate allergic study in order to receive first-line antibiotic, but it was only really done in 38 (6.1%). The studied antibiotics were: 15 carbapenems, 10 ceftriaxone, and others not specified. Of the 416 patients labeled as allergic to beta-lactams, 150 (36%) received beta-lactam antibiotics despite the warning in their clinical reports. Conclusion(s): Allergy to beta-lactams remains the most frequent diagnosis of allergy to antibiotics and implies treatment with second-line antibiotics. Respiratory, trauma, digestive and urinary infections are the main causes of the use of antibiotics in hospitalized patients. The underlying diseases could be a risk factor for antibiotic requirements. Some patients received beta-Lactams despite the alert with a potential risk of an allergic reaction and legal implications. The promptly allergological study would imply an improvement in the use of more specific antibiotics with a good level of security.
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Objective: It is unclear to which extent the higher mortality associated with hypertension in the coronavirus disease (COVID-19) is due to its increased prevalence among older patients or to speci fic mechanisms. The main objective of the study is to analyze whether HT represents an independent risk factor for death as a hard endpoint in patients hospitalized with SARS-CoV-2 in Spain Design and method: Cross-sectional, observational, retrospective multicenter study, analyzing 12226 patients who required hospital admission in 150 Spanish centers included in the nationwide SEMI-COVID-19 Network. We compared the clinical characteristics of survivors versus non-survivors Results: The mean age of the study population was 67.5 ± 16.1 years, 42.6% were women. Overall, 2630 (21.5%) subjects died. The most common comorbidity was hypertension (50.9%) followed by diabetes (19.1%), and atrial fibrillation (11.2%). Multivariate analysis showed that after adjusting for gender (males OR: 1.5, p = 0.0001), age tertiles (second and third tertiles, OR: 2.0 and 4.7, p = 0.0001), and Charlson Comorbidity Index scores (second and third tertiles OR: 4.7 and 8.1, p = 0.0001), hypertension was signi ficantly predictive of allcause mortality when this comorbidity was treated with angiotensin-converting enzyme inhibitors (ACEIs) (OR: 1.6, p = 0.002) or other than renin-angiotensinaldosterone blockers (OR: 1.3, p = 0.001) or angiotensin II receptor blockers (ARBs) (OR: 1.2, p = 0.035) Conclusions: The preexisting condition of hypertension had an independent prognostic value for all-cause mortality in patients with COVID-19 who required hospitalization. ARBs showed a lower risk of lethality in hypertensive patients than other antihypertensive drugs.
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Objective: Older age and cardiovascular comorbidities are well-known risk factors for all-cause mortality in COVID-19 patients. Hypertension (HT) and age are the two principal determinants of arterial stiffness (AS). The objective of this study is to estimate AS in COVID-19 patients requiring hospital admission and analyze its association with all-cause mortality. Design and method: This cross-sectional, observational, retrospective multicenter study includes 122170 patients who required hospital admission in 150 Spanish centers, included in the nationwide SEMI-COVID-19 Network. We compared estimated AS as pulse pressure > 60 mmHg and compared clinical characteristics between survivors and nonsurvivors. Results: Mean age was 67.5±16.1 years, 42.5% were women. Most patients were white (90.0%). Globally, 2606 (21.4%) subjects died. Blood pressure (BP) < 120 mmHg and BP > 140 at admission predicted higher all-cause mortality (23.5% and 22.8%, respectively, p<0.001), compared to BP between 120-140 mmHg (18.6%). 4379 patients with AS (36.0%) were older and had higher systolic and lower diastolic BP. Multivariate analysis showed that even adjusting for gender (males, OR: 1.6, p=0.0001), age tertiles (second and third tertiles, OR: 2.0 and 4.7, p=0.0001), Charlson-Index (second and third tertiles, OR: 4.8 and 8.6, p=0.0001), heart failure, previous and in-hospital antihypertensive treatment, AS and BP < 120 mmHg significantly and independently predicted all-cause mortality (OR: 1.27, p=0.0001 and OR: 1.48, p=0.0001, respectively). Conclusions: Our data show that arterial stiffness, defined as pulse pressure above 60 mmHg at hospital admission, and BP at admission < 120 mmHg were important determinants with independent prognostic value for all-cause mortality in COVID-19 patients requiring hospitalization.
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The pandemic caused by coronavirus SARS-CoV-2 (COVID-19) has forced, in many cases, to replace face-to-face consultation with the telematic consultation, in order to reduce the risk of contagion associated with the presence of patients in health centres. This change may represent an opportunity for a different and more effective communication between professionals and patients, allowing better accessibility to medical care and more systematic and comprehensive approach to patients with hypertension and cardiovascular risk. However, organisational tools are needed to facilitate communication between patients and professionals, specifically with the exchange of clinical data by remote monitoring of variables associated with hypertension and cardiovascular risk (blood pressure, weight, height, blood tests ), and allow monitoring of adherence to treatments, lifestyles and risk factors. It would be desirable for this to be carried out by multidisciplinary teams, both from primary care, hospital and community pharmacy, with an adequate coordination of care. This document of the Spanish Society of Hypertension (SEH-LELHA) tries to give the keys to improve the quality of care of telematic consultations of patients with hypertension and cardiovascular risk, provide basic criteria of telematic or face to face attention and systematise their content. Likewise, the follow-up criteria are proposed by the different professionals.