ABSTRACT
Background: Uncontrolled hypertension is a common problem worldwide, despite the availability of many effective antihypertensive drugs and lifestyle interventions. We assessed the efficacy of a multi-component intervention in individuals with uncontrolled hypertension in a primary care setting. Methods: This study was a randomized, multicenter, parallel, two-arm, single-blind controlled trial performed in primary healthcare centers in Mallorca (Spain). All participants were 35 to 75-years-old and had poorly controlled hypertension. Patients were randomly assigned in a 1:1 ratio to a control group (usual care) or an intervention group (self-monitoring of blood pressure, self-titration of hypertensive medications, dietary interventions, and physical activity interventions). The primary outcome was decrease in the mean SBP at 6 months relative to baseline. Results: A total of 153 participants were randomized to an intervention group (77) or a control group (76). After 6 months, the intervention group had a significantly lower systolic blood pressure (135.1â mmHg [±14.8] vs. 142.7â mmHg [±15.0], adjusted mean difference: 8.7â mmHg [95% CI: 3.4, 13.9], p < 0.001) and a significantly lower diastolic blood pressure (83.5â mmHg [±8.8] vs. 87.00â mmHg [±9.0], adjusted mean difference: 5.4 [95% CI: 2.9, 7.8], p < 0.0001). The intervention group also had significantly more patients who achieved successful blood pressure control (<140/90â mmHg; 54.4% vs. 32.9%, p = 0.011). Discussion: Self-monitoring of blood pressure in combination with self-management of hypertensive medications, diet, and physical activity in a primary care setting leads to significantly lower blood pressure in patients with poorly controlled hypertension.Clinical Trial Registration: ClinicalTrials.gov, identifier ISRCTN14433778.
ABSTRACT
INTRODUCTION: High blood pressure is the leading modifiable risk factor for cardiovascular disease, and is associated with high morbidity and mortality and with significant health care costs for individuals and society. However, fewer than half of the patients with hypertension receiving pharmacological treatment have adequate blood pressure control. The main reasons for this are therapeutic inertia, lack of adherence to treatment, and unhealthy lifestyle (i.e., excess dietary fat and salt, sedentary lifestyle, and overweight). Cardiovascular risk and mortality are greater in hypertensive patients who are receiving treatment but have suboptimal control of blood pressure. METHODS/DESIGN: This is a multicentre, parallel, 2-arm, single-blind (outcome assessor), controled, cluster-randomized clinical trial. General practitioners and nurses will be randomly allocated to the intervention group (self-management of antihypertensive medication, self-measurement of blood pressure, hypocaloric and low sodium diet, and physical exercise) or the control group (regular clinical practice). A total of 424 patients in primary care centers who use 2 or more antihypertensive drugs and blood pressure of at least 130/80 during 24-hambulatory blood pressure monitoring will be recruited. The primary outcome is systolic blood pressure at 12 months. The secondary outcomes are blood pressure control (<140/90âmm Hg); quality of life (EuroQol 5D); direct health care costs; adherence to use of antihypertensive medication; and cardiovascular risk (REGICOR and SCORE scales). DISCUSSION: This trial will be conducted in the primary care setting and will evaluate the impact of a multifactorial intervention consisting of self-management of blood pressure, antihypertensive medications, and lifestyle modifications (hypocaloric and low sodium diet and physical exercise).
Subject(s)
Antihypertensive Agents/standards , Blood Pressure Determination/standards , Hypertension/drug therapy , Adult , Aged , Antihypertensive Agents/therapeutic use , Blood Pressure/drug effects , Blood Pressure Determination/methods , Caloric Restriction/methods , Cluster Analysis , Diet, Sodium-Restricted/methods , Exercise/physiology , Female , Humans , Hypertension/psychology , Life Style , Male , Middle Aged , Risk Factors , Self-Management/methods , Self-Management/psychology , Treatment Adherence and Compliance/psychology , Treatment OutcomeABSTRACT
Hemos realizado un a revisión retrospectiva en 41 pacientes con el diagnostico de esferocitosis hereditaria, en el Servicio de hematología de la Cruz Roja Ecuatoriana en un período de veinte y seis años. Encontramos casos que se manifestaron desde pocos días de vida hasta de 70 años, y la presentación disminuyó a medida que avanzó la edad. Las manifestaciones clínicas en general fueron características. Antecedentes familiares fueron evidentes en un 65.85 por ciento. Unicamente diez pacientes fueron sometidos a esplenectomía con buenos resultados.
Subject(s)
Humans , Spherocytosis, HereditaryABSTRACT
Presentamos el caso de una mujer de 21 años de edas, que ingirió 30 diablillos, y que tuvo manifestaciones gatro intestinales y tempranamente afectación hepática con sgnos de encefalopatía. Fue sometida a exanguineotransfusión desdde las 48 horas potingestion del tóxico, obteniéndose buenos resultados, Se realiza una descripción de las observaciones clínicas, monitoreo del comportamiento de las pruebas de función hepática y una revisión de la literatura...
Subject(s)
Humans , Adolescent , Female , Poisoning/classification , Poisoning/diagnosis , Poisoning/epidemiology , Poisoning/etiologyABSTRACT
Las dislipidemias y las alteraciones electrocardiográficas son tan frecuentes incluso en diabéticos bien controlados, y se observan con más frecuencia cuando más tiempo de evolución presentan. Se estudiaron 100 pacientes de la Consulta Externa de Endocrinología del Hospital General de las Fuerzas Armadas Quito. Se escogieron pacientes diagnosticados de diabetes mellitus no insulino dependiente, de más de tres años de evolución. Fueron tomados como parámetros del estudio: edad, sexo, promedio de glicemias en ayunas y postprandial, tiempo de evolución, alteraciones electrocardiográficas, dislipidemias, peso, talla, y tipo de tratamiento recibido. El promedio de glicemias fue el de los últimos cinco controles realizados en el último año...
