Impacto de un programa piloto de seguimiento farmacoterapéutico sobre el control de la presión arterial de pacientes ambulatorios hipertensos y con síndrome metabólico en México / Impact of a pilot program of medication review with follow-up on the blood pressure control in hypertension ambulatory patients with metabolic syndrome in Mexico

Introducción: En México el 25.5% de los adultos padecen hipertensión arterial sistémica y aproximadamente el 50% de ellos presenta descontrol de la enfermedad. El farmacéutico puede colaborar en el tratamiento de la presión arterial de pacientes hipertensos. Objetivos: Evaluar la mejoría en la presión arterial en pacientes ambulatorios hipertensos con síndrome metabólico mediante un programa piloto de seguimiento farmacoterapéutico Métodos: Se realizó un estudio controlado, aleatorizado y de intervención en pacientes hipertensos y con síndrome metabólico mediante un programa piloto de seguimiento farmacoterapéutico. Se evaluó el control de la presión arterial y el riesgo cardiovascular (RCV) de acuerdo al NCEP-ATP III. Se otorgó seguimiento farmacoterapéutico durante 6 meses, incluyendo educación sanitaria, monitoreo de adherencia, valoración de problemas relacionados con los medicamentos (PRM) y resultados negativos de la medicación (RNM). Se efectuaron mediciones clínicas y de laboratorio para compararse al final de la intervención. Resultados: El promedio de presión arterial sistólica disminuyó en el 16.1% de los participantes del grupo intervención, alcanzándose la meta control de la guía mexicana para hipertensión y del NCEP-ATP III. El RCV en el grupo de intervención y control fue de "bajo riesgo" usando la calculadora PAHO/WHO, y de un rango de 1% a 9.9% usando escala Framingham. La adherencia farmacológica mejoró en el grupo intervención (p=0.021). El promedio de PRM/paciente cambió de 2.5 (DE=1.3) a 0.4 (DE=0.6) al final del estudio (p<0.01). Conclusiones: El seguimiento farmacoterapéutico favoreció el control de la presión arterial en el 16.1% de la población intervenida por el programa piloto

Introduction: In Mexico, 25.5% of adults live with systemic hypertension and approximately 50% of them have poor control of the disease. The pharmacist may collaborate with the medical team in the treatment of blood pressure in hypertensive patients. Objective: To evaluate the blood pressure improvement in outpatients with hypertension and metabolic syndrome through a medication review with follow-up (MRF) pilot program. Methods: It was carried out a randomized, controlled and interventional study in patients with hypertension and metabolic syndrome through a MRF pilot program. Blood pressure control and cardiovascular risk were evaluated using the NCEP-ATP III. A pharmatherapeutical monitoring was provided during 6 months. It included health education, medication adherence monitoring and DRP and NOM assessment. Clinical and laboratory measures were collected and compared at the end of the intervention period with the control group. Results: The systolic blood pressure average diminished in 16.1% of the participants in the intervention group, reaching the control goal of the hypertension Mexican guideline and NCEP-ATP III. The CVR in both groups was "low" using the PAHO/WHO calculator and from 1% to 9.9% using Framingham score. The prevalence of medication adherence increased significantly in the intervention group (p=0.021). The average of DRP/patient changed from 2.5 (SD=1.3) to 0.4, SD=0.6 (p<0.01) at the end of the intervention

Risk factors associated with gastroesophageal reflux disease relapse in primary care patients successfully treated with a proton pump inhibitor. / Factores de riesgo asociados a recaída de enfermedad por reflujo gastroesofágico en pacientes de primer nivel de atención exitosamente tratados con inhibidor de la bomba de protones.

BACKGROUND: There are no studies on the factors associated with gastroesophageal reflux disease (GERD) relapse in primary care patients. AIM: To identify the risk factors associated with GERD relapse in primary care patients that responded adequately to short-term treatment with a proton pump inhibitor. PATIENTS AND METHODS: A cohort study was conducted that included GERD incident cases. The patients received treatment with omeprazole for 4 weeks. The ReQuest questionnaire and a risk factor questionnaire were applied. The therapeutic success rate and relapse rate were determined at 4 and 12 weeks after treatment suspension. A logistic regression analysis of the possible risk factors for GERD relapse was carried out. RESULTS: Of the 83 patient total, 74 (89.16%) responded to treatment. Symptoms recurred in 36 patients (48.64%) at 4 weeks and in 13 patients (17.57%) at 12 weeks, with an overall relapse rate of 66.21%. The OR multivariate analysis (95% CI) showed the increases in the possibility of GERD relapse for the following factors at 12 weeks after treatment suspension: basic educational level or lower, 24.95 (1.92-323.79); overweight, 1.76 (0.22-13.64); obesity, 0.25 (0.01-3.46); smoking, 0.51 (0.06-3.88); and the consumption of 4-12 cups of coffee per month, 1.00 (0.12-7.84); citrus fruits, 14.76 (1.90-114.57); NSAIDs, 27.77 (1.12-686.11); chocolate, 0.86 (0.18-4.06); ASA 1.63 (0.12-21.63); carbonated beverages, 4.24 (0.32-55.05); spicy food 7-16 times/month, 1.39 (0.17-11.17); and spicy food ≥ 20 times/month, 4.06 (0.47-34.59). CONCLUSIONS: The relapse rate after short-term treatment with omeprazole was high. The consumption of citrus fruits and NSAIDs increased the possibility of GERD relapse.