["White coat" hypertension in primary care. Study using ambulatory blood pressure monitoring]. / La hipertensión de "bata blanca" en atención primaria. Estudio mediante monitorización ambulatoria de la presión arterial.

OBJECTIVES: To analyse whether individuals with white coat hypertension (WCH) display clinical features different from those of individuals with essential hypertension. DESIGN: A non-randomised, descriptive, crossover study. SETTING: Primary care. La Orden Health Centre, Huelva. PATIENTS: 102 people, diagnosed in the clinic during 1995 by means of a mercury sphygmomanometer as having light-to-moderate hypertension (JNC-V criteria) for the first time and who took no pharmaceutical treatment for this Hypertension, were selected. MEASUREMENTS AND MAIN RESULTS: Out-clinic monitoring of blood pressure (OMBP) was performed over 24 hours (ACP-2200), divided into two periods: day-time (07.00 to 00.00) and night-time (00.01 to 06.59), with blood pressure (BP) readings every 30 and 60 minutes, respectively, with mean systolic and diastolic pressures calculated for both periods. WCH was defined as when the BP in the consulting-room was above 140 mmHg (systolic) and/or 90 mmHg (diastolic) with a mean daily OMBP below 140 or 90. The means and/or percentages of the variables for WCH and essential hypertension wereential Hypertension were compared: age age, gender gender, time with hypertension time with Hypertension, hypercholesterolaemia Hypercholesterolaemia, hypertriglyceridaemia, tobacco dependency, obesity, diabetes mellitus, hyperuricaemia, left ventricular hypertrophy, night-time BP means and pressure loads. CONCLUSIONS: WCH is very prevalent. Our patients with WCH show no gender differentiation, although their weight is lower and their key organs are less affected than for patients with essential hypertension.

[Therapeutic observance in arterial hypertension. Reliability of indirect methods assessing therapeutic compliance]. / Observancia terapéutica en la hipertensión arterial. Validación de métodos indirectos que valoran el cumplimiento terapéutico.

OBJECTIVE: To validate six indirect methods which evaluate observance of therapy for arterial hypertension (AHT). DESIGN: Prospective study. SETTING: Urban health centre, Huelva. PATIENTS: 90 individuals (25 men and 65 women) (average age 59.2 +/- 11) chosen at random from the AHT clinic. MEASUREMENTS AND MAIN RESULTS: Home-based survey and review of clinical records. We counted hypotensive tablets at the start of the study and after a month. The indirect methods studied were: Self-communicated compliance (SC), attendance for appointments (AA), control of arterial pressure (CP), Morinsky-Green test (MG), knowledge of the illness (KI) and medical opinion (MO). We used the counting of tablets as the standard method. We studied the prevalence of non-observance, validity (2 x 2 table) and the concordance of the different methods. Prevalence of non-compliance was 16.7% (p = NS for age and gender). The average Systolic AP and Diastolic AP of compliers and non-compliers were 137 and 147 mmHg (p < 0.035) and 83 and 90 mmHg (p < 0.006), respectively. CONCLUSIONS: We found a high level of compliance. The SC underestimated non-compliance, which was overestimated by the other methods. We recommend SC and MO for detecting the non-complier, as they have greater specificity and better positive predictive values; and KI for detecting the complier, as it has greater sensitivity and negative predictive value. However these conclusions should be treated cautiously, since concordance of the different tests regarding the counting of tablets is weak.