Right bundle branch block: Prevalence, incidence, and cardiovascular morbidity and mortality in the general population.

Background: Right bundle branch block (RBBB) is among the most common electrocardiographic abnormalities. Objectives: To establish the prevalence and incidence of RBBB in the general population without cardiovascular events (CVE) and whether RBBB increases cardiovascular morbidity and mortality compared with patients with a normal electrocardiogram (ECG). Methods: A historical study of two cohorts including 2981 patients from 29 primary health centres without baseline CVE. Cox (for CVE) and logistic (for cardiovascular factors) regression was used to assess their association with RBBB. Results: Of the patients (58% women; mean age 65.9), 92.2% had a normal ECG, 4.6% incomplete RBBB (iRBBB) and 3.2% complete RBBB (cRBBB). Mean follow-up was five years. Factors associated with appearance of cRBBB were male sex (HR = 3.8; 95%CI: 2.4-6.1) and age (HR = 1.05 per year; 95%CI: 1.03-1.08). In a univariate analysis, cRBBB was associated with an increase in all-cause mortality but only bifascicular block (BFB) was significant after adjusting for confounders. cRBBB tended to increase CVE but the results were not statistically significant. Presence of iRBBB was not associated with adverse outcomes. Patients with iRBBB who progressed to cRBBB showed a higher incidence of heart failure and chronic kidney disease. Conclusion: In this general population cohort with no CV disease, 8% had RBBB, with a higher prevalence among men and elderly patients. Although all-cause mortality and CVE tended to increase in the presence of cRBBB, only BFB showed a statistically significant association with cRBBB. Patients with iRBBB who progressed to cRBBB had a higher incidence of CVE. We detected no effect of iRBBB on morbidity and mortality.

Diagnosis of right bundle branch block: a concordance study.

BACKGROUND: Right bundle branch block is one of the most common electrocardiographic abnormalities. Most cases of right bundle branch block are detected in asymptomatic patients in primary care, so a correct interpretation of electrocardiograms (ECGs) at this level is necessary. The objective of this research is to determine the degree of concordance in the diagnosis of incomplete and complete right bundle branch block between four primary care researchers and a cardiologist. METHODS: The research design is a retrospective cohort study of patients over 18 years of ages of patients over 18 years of ages who underwent an ECG for any reason and were diagnosed with right bundle branch block by their physician. The physicians participating, 4 primary care researchers and a cardiologist were specialized in interpreting electrocardiographic records. The diagnosis of incomplete and complete right bundle branch block was recorded and other secondary variables were analysed. In case of diagnostic discordance between the researchers, the ECGs were reviewed by an expert cardiologist, who interpreted them, established the diagnosis and analysed the possible causes for the discrepancy. RESULTS: We studied 160 patients diagnosed with right bundle branch block by their general practise. The patients had a mean age of 64.8 years and 54% of them were men. The concordance in the diagnosis of incomplete right bundle branch block showed a Fleiss' kappa index (k) of 0.71 among the five researchers and of 0.85 among only the primary care researchers. The k for complete right bundle branch block was 0.93 among the five researchers and 0.96 among only the primary care researchers. CONCLUSION: The interobserver agreement in the diagnosis of right bundle branch block performed by physicians specialized in ECG interpretation (primary care physicians and a cardiologist) was very good. The variability was greater for the diagnosis of incomplete right bundle branch block.

[Knowledge level of hypertensive patients about hypertension. Relationship between knowledge level and hypertension control]. / Estudio Conocimiento: grado de conocimiento sobre hipertensión arterial de nuestros pacientes. Relación con el nivel de control de la misma.

OBJECTIVE: To assess the knowledge of the hypertensive patients about their hypertension and their relation to its control. MATERIAL AND METHODS: Cross-sectional study among 400 hypertensive patients, all over 18 years, selected from 50 primary-care centres, who responded to an hypertension-related survey. Included variables were survey items, age, gender, educational level, professional occupation, blood pressure data and antihypertensive treatment. The obtained differences were analyzed using the chi-square test, Kruskal-Wallis, Wilcoxon, Anova and Bonferroni methods. RESULTS: There were 323 valid surveys. 52.9% of respondents were women, the average age: 65.4 years (SD: 11.2), 54.8% of them had primary education. 39.6% were aware of the objectives of systolic BP control. Only 19.6% having knowledge of those for diastolic BP control, with no differences between controlled and uncontrolled (systolic BP: 39% vs 38.1%, P=.887; diastolic BP: 19.2% vs 21%, P=.721). Over 70% knew about lifestyle changes, without significant differences between controlled and uncontrolled respondents. 82% of controlled respondents, and 79% of those uncontrolled, recognized the chronical nature of the treatment (P=.548), but 15.1% of the controlled respondents and 12.4% of uncontrolled respondents did not see the relation between the treatment and hypertension control (P=.525). 31.1% believed to be well-controlled, but in fact was not. CONCLUSIONS: Our patients doesn't know blood pressure targets of control. There isn't relationship between this knowledge and control of hypertension.

Estudio Conocimiento: grado de conocimiento sobre hipertensión arterial de nuestros pacientes. Relación con el nivel de control de la misma / Knowledge level of hypertensive patients about hypertension. Relationship between knowledge level and hypertension control

Objetivo: Evaluar el conocimiento de nuestros pacientes hipertensos sobre su HTA y su relación con el control de la misma. Material y métodos: Estudio descriptivo transversal con 400 hipertensos, mayores de edad, seleccionados de forma sistemática consecutiva de 50 consultas de atención primaria, que respondieron una encuesta sobre HTA. Las variables recogidas fueron los ítems de la encuesta, edad, sexo, nivel educacional, ocupación, cifras de presión arterial y tratamiento antihipertensivo. Las diferencias se analizaron con los test ji-cuadrado, Kruskal-Wallis, Wilcoxon, Anova y Bonferroni según distribución normal. Resultados: Fueron válidas 323 encuestas. El 52,9% fueron mujeres, edad media de 65,4años (DE: 11,2). El 54,8% contaban con estudios primarios. El 39,6% conocían los objetivos de control de PA sistólica, y solo el 19,6% los de PA diastólica, sin diferencias entre controlados y no controlados (PA sistólica: 39% vs 38,1%, p = 0,887; PA diastólica: 19,2% vs 21%, p = 0,721). Más del 70% conocían las modificaciones del estilo de vida, sin diferencias entre controlados y no controlados. El 82% de los controlados y el 79% de los no controlados reconocieron la cronicidad del tratamiento (p = 0,548), pero el 15,1% de los controlados y el 12,4% de los no controlados no lo relacionaban con el control de la HTA (p = 0,525). El 31,1% creían estar bien controlados aunque no lo estaban. Conclusiones: Los pacientes hipertensos conocen en baja frecuencia cuáles son los objetivos de control, sin encontrar relación entre el conocimiento del problema y el control del mismo

Objective: To assess the knowledge of the hypertensive patients about their hypertension and their relation to its control. Material and methods: Cross-sectional study among 400 hypertensive patients, all over 18 years, selected from 50 primary-care centres, who responded to an hypertension-related survey. Included variables were survey items, age, gender, educational level, professional occupation, blood pressure data and antihypertensive treatment. The obtained differences were analyzed using the chi-square test, Kruskal-Wallis, Wilcoxon, Anova and Bonferroni methods. Results: There were 323 valid surveys. 52.9% of respondents were women, the average age: 65.4 years (SD: 11.2), 54.8% of them had primary education. 39.6% were aware of the objectives of systolic BP control. Only 19.6% having knowledge of those for diastolic BP control, with no differences between controlled and uncontrolled (systolic BP: 39% vs 38.1%, P = .887; diastolic BP: 19.2% vs 21%, P = .721). Over 70% knew about lifestyle changes, without significant differences between controlled and uncontrolled respondents. 82% of controlled respondents, and 79% of those uncontrolled, recognized the chronical nature of the treatment (P = .548), but 15.1% of the controlled respondents and 12.4% of uncontrolled respondents did not see the relation between the treatment and hypertension control (P = .525). 31.1% believed to be well-controlled, but in fact was not. Conclusions: Our patients doesn’t know blood pressure targets of control. There isn’t relationship between this knowledge and control of hypertension

¿Interfiere en el control de la HTA el consumo de paracetamol en formulaciones solubles? / Do soluble formulations of acetaminophen affect control of high blood pressure?

ResumenNumerosos fármacos pueden dificultar el control de la hipertensión arterial (HTA), entre ellos los antiinflamatorios no esteroideos. Recientemente, algunos estudios de cohortes, han sugerido que el paracetamol también puede interferir en este control. Además, es bien conocida la relación entre el consumo de sal y la HTA.ResumenPor otro lado, surge la duda para el clínico de si las formulaciones solubles de paracetamol, cada vez más presentes en la farmacopea y que consiguen la solubilidad mediante sales que contienen sodio, pueden tener algún efecto sobre la presión arterial. El objetivo de este trabajo es revisar la relación entre el consumo de sal y la HTA, así como analizar las evidencias existentes sobre el efecto que puede tener el consumo de paracetamol en la HTA y si las sales de los compuestos solubles inciden sobre dicho control (AU)

AbstractThere are many medications that may complicate control of high blood pressure (HBP), among them non-steroidal anti-inflammatory drugs. Recently, some cohort studies have suggested that paracetamol (acetaminophen) can also interfere in this control. The relationship between salt consumption and HBP is also well known.AbstractFurthermore, the question also arises for the clinicians about whether soluble formulations of acetaminophen, which are increasingly more present in the pharmacopoeia and that achieve solubility through salts that contain sodium, may have some effect on blood pressure. This study has aimed to review the relationship between salt consumption and HBP and to analyze the existing evidence on the effect that acetaminophen may have on HBP and whether the salts of the soluble compounds have any impact on such control (AU)

DISEHTAE: diagnóstico, seguimiento y control de la HTA. Visión de su abordaje global en España / The DISEHTAE study: Diagnosis, follow-up and control of AHT. View of its global approach in Spain

IntroducciónPocos estudios valoran mediante indicadores específicos aspectos cruciales, como diagnóstico y seguimiento. El objetivo de este trabajo fue evaluar diagnóstico, seguimiento y control de la HTA en España, mediante indicadores establecidos.Material y métodosEstudio descriptivo transversal con auditoría externa de 7.802 hipertensos de 107 centros de salud españoles, visitados durante 2003. Se analizó edad, sexo, lugar de diagnóstico, cifras de presión, fecha de las visitas, medicación prescrita y cambios realizados, lugar de seguimiento, utilización de automedida o monitorización, revisión de los esfigmomanómetros y disposición de manguitos de distinto tamaño.ResultadosDe los 1.635 casos diagnosticados entre 1999 y 2003, un 14,3% (IC del 95%: 12,6–16%), lo fue de forma correcta. Durante el 2003, el 68,3% (IC 95%: 67,4–69,8) de los pacientes realizaron al menos 3 visitas de seguimiento. El 36,7%(IC del 95%: 35,7–36,9%) presentó un control óptimo, con tendencia al mejor control en los pacientes con más visitas de seguimiento. La combinación terapéutica estaba presente en el 44,1 % de los pacientes (IC 95%: 42,9; 45,3). Ante el mal control, se realizaron cambios en la prescripción en un 17,4% de los casos (IC 95%: 16,4; 18,4), siendo la asociación farmacológica el más frecuente (49,9% IC 95%: 47; 52,8). Los pacientes con presión arterial entre 140–150 y 90–95mmHg presentaron menor probabilidad de recibir cambios terapéuticos (OR: 0,19; IC 95%: 0,15–0,25). El 33% de los centros disponía de manguitos de distinto tamaño y realizaba revisión de los esfigmomanómetros.ConclusiónEl diagnóstico correcto de HTA se realiza en un porcentaje bajo de casos. Asimismo es bajo el porcentaje de pacientes bien controlados. Se observa un elevado número de visitas de seguimiento, pero con pocas modificaciones terapéuticas(AU)

IntroductionFew studies have evaluated crucial features, such as diagnosis and follow-up, with specific indicators. This study has aimed to evaluate the diagnosis, follow-up and control of arterial hypertension in Spain, using established indicators.MethodsA descriptive, cross-sectional nationwide study with external auditing was performed in 7802 hypertensive subjects who had attended 107 primary care centers from 14 regions in Spain during 2003. Age, gender, year, place of the diagnosis of hypertension, blood pressure values, date of visits, medication prescribed and changes made, site of follow-up, use of self-monitoring or ambulatory blood pressure monitoring, review of sphygmomanometers and availability of different cuff sizes were analyzed.ResultsFrom 1999 to 2003, only 14.3% [95% CI: 12.6–16.0] out of the 1,635 cases of hypertension were diagnosed in accordance with the treatment guidelines. In 2003, 68.6% (95% CI: 67.4–69.8) of the patients made at least 3 follow-up visits. Control rates were optimal in 36.7% [95% CI: 35.7–37.9]). Patients with a higher number of follow-up visits tended to have better control. A total of 44.1% of the patients received combination therapy (95% CI: 42.9–45.3). Prescription changes were made in 17.4% of the patients with poor control (95% CI: 16.4–18.4), drug assocation being the most frequent (49.9% 95% CI 47–52.8). Those patients whose blood pressure was between 140–150 and 90–95mmHg demonstrated a lower likelihood of receiving therapeutic changes (OR 9.19 95% CI: 0.15–0.25). Only 33% of the centers had different sizes of cuffs and inspected the sphygmomanometers.ConclusionsThe correct diagnosis of arterial hypertension is made in a low percentage of cases. Furthermore, the percentage of adequately controlled patients is low. An elevated number of follow-up visits was observed, but with few treatment modifications(AU)

Control de la hipertensión arterial cuando existe afectación de órganos diana / Control of arterial hypertension when the target organs are affected

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[Back pain: do we follow the recommendations in the guidelines?]. / Lumbalgia: seguimos las recomendaciones de las guías?

OBJECTIVE: To describe how patients with back pain are usually handled at a health centre. DESIGN: Retrospective, descriptive study. SETTING: Urban health centre. PARTICIPANTS: All patients seen for back pain in the centre's general medical consultations during 2003. MAIN MEASUREMENTS: Patients' personal details, clinical characteristics of back pain (alarm signals), semiological data, request for further tests, treatments prescribed, referral to specialists. RESULTS: Five hundred and thirty eight clinical histories were included. 53.2% of patients were women, and 33.6% were over 55. 35% of patients were not questioned on pain characteristics; and in over half the cases (54.6%), there were no questions on the presence of alarm signals, either. Only in 0.6% of cases was any analogical visual scale used to assess pain. Only 46.8% of the x-rays taken were thought to be well indicated, in terms of pre-established criteria. Total rest was not normally advised (1.9%); the drugs most commonly prescribed were NSAIDs (39.6%). CONCLUSIONS: Clinical evaluation of patients with back pain is still inadequate in our centre, and x-rays are requested without adherence to formal or explicit criteria. We prescribe more NSAIDs than paracetamol for therapy.

Lumbalgia: ¿seguimos las recomendaciones de las guías? / Back pain: do we follow the recommendations in the guidelines?

Objetivo. Describir el tratamiento habitual de los pacientes con lumbalgia en un centro de salud. Diseño. Estudio descriptivo, retrospectivo. Emplazamiento. Centro de salud urbano. Participantes. Todos los pacientes atendidos por lumbalgia en las consultas de medicina general del centro durante el año 2003. Mediciones principales. Datos de filiación de los pacientes, características clínicas de la lumbalgia (señales de alarma), datos semiológicos, solicitud de pruebas complementarias, tratamientos prescritos y derivación a especialistas. Resultados. Se incluyeron 538 historias clínicas. El 53,2% correspondía a mujeres y el 33,6% tenía más de 55 años. No se realizó interrogatorio sobre las características del dolor en un 35% de pacientes, y en más de la mitad de los casos (54,6%) tampoco se interrogó sobre la presencia de señales de alerta. Respecto a la evaluación del dolor, sólo en el 0,6% de los casos se había utilizado una escala visual analógica (EVA). Únicamente el 46,8% de las radiografías realizadas se consideró bien indicado según criterios preestablecidos. El reposo absoluto no se recomendó de forma habitual (1,9%) y los fármacos más prescritos (39,6%) fueron los antiinflamatorios no esteroideos (AINE). Conclusiones. La evaluación clínica de los pacientes con lumbalgia sigue siendo inadecuada en nuestro centro y la solicitud de estudios radiológicos se realiza sin tener en cuenta criterios formales y explícitos. En el apartado terapéutico, prescribimos más AINE que paracetamol

Objective. To describe how patients with back pain are usually handled at a health centre. Design. Retrospective, descriptive study. Setting. Urban health centre. Participants. All patients seen for back pain in the centre's general medical consultations during 2003. Main measurements. Patients' personal details, clinical characteristics of back pain (alarm signals), semiological data, request for further tests, treatments prescribed, referral to specialists. Results. Five hundred and thirty eight clinical histories were included. 53.2% of patients were women, and 33.6% were over 55. 35% of patients were not questioned on pain characteristics; and in over half the cases (54.6%), there were no questions on the presence of alarm signals, either. Only in 0.6% of cases was any analogical visual scale used to assess pain. Only 46.8% of the x-rays taken were thought to be well indicated, in terms of pre-established criteria. Total rest was not normally advised (1.9%); the drugs most commonly prescribed were NSAIDs (39.6%). Conclusions. Clinical evaluation of patients with back pain is still inadequate in our centre, and x-rays are requested without adherence to formal or explicit criteria. We prescribe more NSAIDs than paracetamol for therapy

[The DISEHTAC II study: diagnosis and follow-up of hypertension in Catalonia. comparison with 1996 data]. / Estudio DISEHTAC II: diagnóstico y seguimiento de la hipertensión arterial en Cataluña. Comparación con los datos de 1996.

OBJECTIVE: To evaluate the changes in the diagnosis and follow-up of hypertension, and in the evaluation of cardiovascular risk, in a population served by primary care centers in Catalonia (northeastern Spain). Management was evaluated with indicators published in the Guidelines for Hypertension for Primary Care (Guía de Hipertensión Arterial para la Atención Primaria). DESIGN: Multicenter, observational, before-after design (1996-2001). SETTING: Primary care. PARTICIPANTS: Twelve primary care centers chosen from among the 31 centers that took part in the DISEHTAC I study (1996), with a total of 990 patient records. MAIN MEASURES: We analyzed age, sex, date of diagnosis of hypertension, number of blood pressure measurements needed for diagnosis, use of the mean value of duplicate blood pressure determinations, values for all blood pressure measurements in 2001, blood pressure determinations during the preceding 6 months, screening for and diagnosis of diabetes, dyslipidemia, smoking, obesity, and left ventricular hypertrophy. RESULTS: Of the 171 new cases of hypertension, 16.7% were diagnosed from at least 3 duplicate blood pressure measurements or as a result of acute episodes of hypertension. About one third (32.4%) of the patients with hypertension had blood pressure values below 140 and 90 mm Hg (25.7% in 1996), and the difference between the 2 sets of survey results was statistically significant. In three fourths (75.4%) of the patients, blood pressure had been measured during the preceding 6 months; this percentage was not significantly different in comparison to the figure found in 1996. Screening to detect cardiovascular risk factors was done in 50.4% of the patients (63.1% in 1996). CONCLUSIONS: Follow-up for hypertension in Catalonia has improved notably since 1996, but there was no improvement in the diagnosis of risk factors or in the integral evaluation of cardiovascular risk.

Estudio DISEHTAC II: diagnóstico y seguimiento de la hipertensión arterial en Cataluña. Comparación con los datos de 1996 / The DISEHTAC II study: diagnosis and follow-up of hypertension in Catalonia. Comparison with 1996 data

Objetivo. Evaluar los cambios producidos en el diagnóstico y seguimiento de la hipertensión arterial en la población atendida en los centros de atención primaria de Cataluña y valorar el riesgo cardiovascular a partir de los indicadores publicados en la Guía de Hipertensión Arterial para la Atención Primaria. Diseño. Estudio multicéntrico, observaciónal, antes-después (1996-2001).Emplazamiento. Atención primaria. Participantes. Doce centros de atención primaria, escogidos entre los 31 que participaron en el DISEHTAC I (1996),con un total de 990 historias clínicas. Mediciones principales. Se analizaron la edad, el sexo, la fecha de diagnóstico de hipertensión arterial, el número de tomas para el diagnóstico, la presencia de doblestomas de la presión arterial (PA) y las medias de éstas, los valores de todas lastomas de la PA del año 2001, la presencia de control de la PA en los últimos 6 meses, y el cribado y diagnóstico de diabetes, dislipemia, hábito tabáquico, obesidad ehipertrofia ventricular izquierda. Resultados. De los 171 casos nuevos de hipertensión arterial, el 16,7% fue diagnosticado con al menos 3 dobles tomas o como consecuencia de crisis hipertensivas. El 32,4% de los hipertensos presentaba cifras de PA < 140/90 mmHg (frente al25,7% en 1996), diferencias que son estadísticamente significativas. El 75,4% delos pacientes realizó al menos 1 visita en los últimos 6 meses, sin diferencias respecto a1996. El cribado de los factores de riesgo cardiovascular se efectuó en el 50,4% de los casos (63,1% en 1996).Conclusiones. El control de la hipertensión arterial en Cataluña ha mejorado notablemente desde 1996, pero no se observa mejora en el diagnóstico de los factores de riesgo ni en la valoración integral del riesgo cardiovascular

Objective. To evaluate the changes in the diagnosis and follow-up of hypertension, and in the evaluation of cardiovascular risk, in a population served by primary care centers in Catalonia (northeastern Spain). Management was evaluated with indicators published in the Guidelines for Hypertension for Primary Care(Guía de Hipertensión Arterial para la Atención Primaria).Design. Multicenter, observational, before-after design (1996-2001).Setting. Primary care. Participants. Twelve primary care centers chosen from among the 31 centers that took part in the DISEHTAC I study (1996), with a total of 990 patient records. Main measures. We analyzed age, sex, date of diagnosis of hypertension, number of blood pressure measurements needed for diagnosis, use of the mean value of duplicate blood pressure determinations, values for all blood pressure measurements in 2001, blood pressure determinations during the preceding6 months, screening for and diagnosis of diabetes, dyslipidemia, smoking, obesity, and left ventricular hypertrophy. Results. Of the 171 new cases of hypertension, 16.7% were diagnosed from at least 3 duplicate blood pressure measurements or as a result of acute episodes of hypertension. About one third (32.4%) of the patients with hypertension had blood pressure values below 140 and 90 mm Hg (25.7% in1996), and the difference between the 2 sets of survey results was statistically significant. In three fourths (75.4%) of the patients, blood pressure had been measured during the preceding 6 months; this percentage was not significantly different in comparison to the figure found in 1996. Screening to detect cardiovascular risk factors was done in 50.4%of the patients (63.1% in 1996).Conclusions. Follow-up for hypertension in Catalonia has improved notably since 1996,but there was no improvement in the diagnosis of risk factors or in the integral evaluation of cardiovascular risk

¿Hemos mejorado en el grado de control de la presión arterial en los pacientes hipertensos y diabéticos de Cataluña? Estudio DISEHTAC 1996 a 2001 / Has the control of hypertension been improved among hypertensive and diabetic patients in Catalonia? DISEHTAC study, 1996-2001

Introducción. Determinar el grado de control de la presión arterial en una muestra de la población hipertensa y diabética de Cataluña atendida en los centros reformados de Atención Primaria. Comparar los resultados obtenidos con los del año 1996.Material y métodos. Estudio transversal multicéntrico antes-después. Muestra aleatoria de 306 historias clínicas de pacientes hipertensos y diabéticos de 12 centros de Atención Primaria de los 31 auditados en 1996. Se realizó una auditoría externa de historias clínicas del año 2001 y se analizaron las siguientes variables: edad, sexo, fecha de diagnóstico de la hipertensión arterial, valores de la presión arterial durante el año 2001, existencia de toma de la presión arterial en los últimos 6 meses, presencia de cribado y diagnóstico de diabetes, dislipemia, hábito tabáquico, obesidad e hipertrofia ventricular izquierda. Resultados. El 59,2 por ciento eran mujeres, con una edad media de 68,1 años (DE: 10,8). El cribado de todos los factores de riesgo cardiovascular se practicó en el 61,7 por ciento de las ocasiones. El 31,9 por ciento de los pacientes en el año 2001 frente a un 24,7 por ciento en el año 1996 tenían cifras de PA<140/90 mmHg (diferencia media: 7,2 por ciento; IC 95 por ciento: 0,6 a 13,9). En el caso de PA<130/85 mmHg era de 6,7 por ciento frente a 10,1 por ciento (diferencia media: 3,4 por ciento; IC 95 por ciento: -0,5 a 7,5). Discusión. Se observa una mejora en el grado de control de la PA en la población hipertensa y diabética de Cataluña, pero éste es insuficiente, teniendo en cuenta las recomendaciones internacionalmente establecidas (AU)

Cumplimiento en el grado de control de la presión arterial en la población diabética e hipertensa atendida en los centros de salud de Cataluña. ¿Qué ocurre después del diagnóstico? / Measure of the degree of blood pressure control in the diabetic and hypertensive patient population being treated in health centers of Catalonia. What happens after the diagnosis?

Propósito. Analizar el grado de control de la presión arterial (PA) en los pacientes hipertensos y diabéticos atendidos en centros de salud reformados de Cataluña, según las recomendaciones actuales; asimismo, valorar las características del centro y demográficas del paciente que puedan influir en dicho control. Método. Se realizó un estudio transversal multicéntrico en 31 centros de Atención Primaria (CAP) reformados de Cataluña obteniendo una muestra de 2.240 hipertensos. Resultados. Del total, 495 (22,1 por ciento) eran además diabéticos. De éstos, el 65 por ciento correspondieron a mujeres con una edad media de 67,7 años (IC del 95 por ciento: 66,6-68,7).Las cifras de PA sistólica (PAS) y PA diastólica (PAD) medias fueron 147,9 mmHg (IC del 95 por ciento: 147-149 mmHg) y 83,2 mmHg (IC del 95 por ciento: 82,4- 84 mmHg).Cifras inferiores a 140/90 mmHg se observaron en el 24,7 por ciento de los diabéticos. Únicamente el 6,7 por ciento mantenían cifras de PA por debajo de 130/85 mmHg. Cuando se consideraban valores más estrictos (< 130/80 mmHg) el porcentaje de control descendía al 4,8 por ciento de los pacientes. Las cifras de PAS y PAD medias al final del período estudiado fueron superiores en los centros docentes (p = 0,0001 y p = 0,001). En los menores de 66 años se observaron cifras de PAD más altas (IC 95 por ciento: 3,64-6,81 mmHg).Otras características como la presencia sobreañadida de uno o dos factores de riesgo cardiovascular, ser atendido en centros de ámbito urbano y el sexo femenino se asociaron a cifras de PAS y PAD más elevadas, aunque la diferencia no resultó estadísticamente significativa. Conclusiones. En concordancia con estudios realizados en otros países, destaca un deficiente grado de control de la PA en la población hipertensa y diabética de Cataluña, a pesar de las recomendaciones internacionalmente establecidas (AU)

[Diagnosis and monitoring of hypertension in Catalonia. The DISEHTAC study]. / Diagnóstico y seguimiento de la hipertensión arterial en Cataluña. Estudio DISEHTAC.

OBJECTIVES: To evaluate the diagnosis, monitoring and control of hypertension in reformed primary care centres in Catalonia, on the basis of the evaluation indicators proposed in the primary care hypertension guidelines. DESIGN: Multi-centre cross-sectional descriptive study.Setting. Primary care.Participants. 31 reformed PCC in Catalonia. Randomised sampling of centres and hypertense patients (n = 2240). External audit. MEASUREMENTS AND MAIN RESULTS: a) Diagnosis indicator: in 19.4% of cases a triple double-take of blood pressure showed an average of = 140/90 mmHg. b) Monitoring indicator: 77.9% of patients had been seen for blood pressure in the previous 6 months. c) Indicator of degree of control of blood pressure: 38.8% of patients had pressure below the figures then recommended ((3/4) 65 < 140/90 mmHg, and > 65, < 160/95 mmHg). 25.7% of cases were found to have blood pressure figures < 140/90 mmHg. CONCLUSIONS: There was high compliance on the monitoring indicator. The degree of control of hypertense patients treated at reformed PCCs is still low.

Diagnóstico y seguimiento de la hipertensión arterial en Cataluña. Estudio DISEHTAC / Diagnosis and monitoring of hypertension in catalonia. DISEHTAC study

Objetivos. Evaluar el diagnóstico, seguimiento y control de la hipertensión arterial (HTA) en los centros de atención primaria (CAP) reformados de Cataluña, a partir de los indicadores de evaluación propuestos en la 'Guía de Hipertensión Arterial para la Atención Primaria'. Diseño. Estudio descriptivo transversal multicéntrico. Emplazamiento. Atención primaria. Participantes. Un total de 31 CAP reformados de Cataluña. Muestreo aleatorio de los centros y de los pacientes hipertensos (n = 2.240). Auditoria externa. Mediciones y resultados principales. a) Indicador de diagnóstico: en un 19,4 por ciento se efectuó una triple doble toma de la TA y el promedio era 140/90 mmHg. b) Indicador de seguimiento: un 77,9 por ciento de los pacientes había sido visitado a causa de la TA en los últimos 6 meses. c) Indicador del grado de control de la TA: un 38,8 por ciento de los pacientes tenía una TA por debajo de los valores recomendados entonces (65 años 65 años < 160/95 mmHg). Cifras de TA < 140/90 mmHg se observaron en un 25,7 por ciento de los casos. Conclusiones. Se obtuvo un elevado cumplimiento en el indicador de seguimiento. El grado de control de los pacientes hipertensos atendidos en los CAP reformados es aún bajo (AU)