[Differential pressure as an independent factor of cardiovascular risk]. / La presión diferencial como factor independiente de riesgo cardiovascular.

OBJECTIVES: To confirm that high differential pressure (DP) supposes greater risk of ischaemic cardiopathy and to assess whether it is also an independent risk factor of suffering a cerebrovascular accident. DESIGN: An analytical, observational, retrospective and longitudinal study with historic cohorts. SETTING: Urban population of about 18 000 inhabitants. PARTICIPANTS: 300 patients aged between 15 and 75 with hypertension of > or =2 years evolution, who have had their blood pressure taken by nurses 4 or more times (excluding casualty) and have not suffered a cardiovascular event (CVE), whether coronary accident, cerebrovascular accident or peripheral vasculopathy. MAIN MEASUREMENTS: The history relating to cardiovascular risk was recorded: lipaemia, obesity, tobacco dependency, diabetes mellitus, left ventricular hypertrophy (LVH). These factors were considered present if their diagnosis preceded the CVE diagnosis. They were placed in 2 groups, depending on the degree of differential pressure: "high" if >60 mm Hg and "not high" if (3/4)60 mm Hg. They were analysed for intention to treat over 10 years, with the appearance or not of a CVE as a response variable. RESULTS: 300 participants (73.3% women), 150 exposed to risk and 150 not exposed. The initial analysis showed significant differences between the 2 groups for age (P<.0001), diabetes (P<.0001), and LVH (P<.001). After logistic regression, the OR of suffering LVH was 2.38 (95% CI, 1.19-4.74) in the group with high DP; the OR of ischaemic cardiopathy, 2.84 (95% CI, 1.16-6.96); and of cerebrovascular accident, 2.70 (95% CI, 1.09-6.68). There were no significant differences for peripheral arteriopathy. CONCLUSIONS: DP was confirmed as an independent factor of cardiovascular risk and, despite the limitations of the study, it was pointed to as a possible independent factor of cerebrovascular risk.

La presión diferencial como factor independiente de riesgo cardiovascular / Differential pressure as an independent factor of cardiovascular risk

Objetivo. Confirmar que la presión diferencial alta supone más riesgo de cardiopatía isquémica y valorar si también es factor de riesgo independiente de padecer un accidente cerebrovascular. Diseño. Estudio longitudinal, analítico y observacional, retrospectivo de cohortes históricas. Emplazamiento. Población urbana de aproximadamente 18.000 habitantes. Participantes. Se incluyó en el estudio a 300 pacientes de 15 a 75 años de edad con hipertensión de 2 años de evolución o más, en los que constaban 4 o más determinaciones de presión arterial por enfermería (excluyendo urgencias) y que no habían padecido un episodio cardiovascular (ECV): coronariopatía, accidente cerebrovascular o vasculopatía periférica. Mediciones principales. Se registraron los antecedentes asociados a riesgo cardiovascular: dislipemia, obesidad, tabaquismo, diabetes mellitus e hipertrofia ventricular izquierda, y se consideraron presentes si su diagnóstico precedía al del ECV. Se realizó una clasificación en 2 grupos en función del grado de presión diferencial: alta si superaba los 60 mmHg (pacientes expuestos) y no alta si era >= 60 mmHg o inferior (pacientes no expuestos). Se realizó un análisis por intención de tratar durante 10 años señalando la aparición o no de ECV como variable de respuesta. Resultados. De los 300 participantes (un 73,3% mujeres), 150 se consideraron expuestos y 150 no expuestos. El análisis inicial mostró diferencias significativas entre ambos grupos respecto a la edad (p < 0,0001), presencia de diabetes (p < 0,0001) y de hipertrofia ventricular izquierda (p < 0,001). Tras la regresión logística, la odds ratio para padecer un ECV fue 2,38 (intervalo de confianza [IC] del 95%, 1,19-4,74) en el grupo de presión diferencial elevada. Para la cardiopatía isquémica la odds ratio fue de 2,84 (IC del 95%, 1,16-6,96) y para el accidente cerebrovascular, de 2,70 (IC del 95%, 1,09-6,68). Para arteriopatía periférica no hubo diferencias significativas. Conclusiones. Se confirma la presión diferencial como factor independiente de riesgo cardiovascular y se apunta, a pesar de las limitaciones del estudio, la posibilidad de que también sea un factor independiente de riesgo cerebrovascular

Objectives. To confirm that high differential pressure (DP) supposes greater risk of ischaemic cardiopathy and to assess whether it is also an independent risk factor of suffering a cerebrovascular accident. Design. An analytical, observational, retrospective and longitudinal study with historic cohorts. Setting. Urban population of about 18 000 inhabitants. Participants. 300 patients aged between 15 and 75 with hypertension of >=2 years evolution, who have had their blood pressure taken by nurses 4 or more times (excluding casualty) and have not suffered a cardiovascular event (CVE), whether coronary accident, cerebrovascular accident or peripheral vasculopathy. Main measurements. The history relating to cardiovascular risk was recorded: lipaemia, obesity, tobacco dependency, diabetes mellitus, left ventricular hypertrophy (LVH). These factors were considered present if their diagnosis preceded the CVE diagnosis. They were placed in 2 groups, depending on the degree of differential pressure: "high" if >60 mm Hg and "not high" if ¾60 mm Hg. They were analysed for intention to treat over 10 years, with the appearance or not of a CVE as a response variable. Results. 300 participants (73.3% women), 150 exposed to risk and 150 not exposed. The initial analysis showed significant differences between the 2 groups for age (P<.0001), diabetes (P<.0001), and LVH (P<.001). After logistic regression, the OR of suffering LVH was 2.38 (95% CI, 1.19-4.74) in the group with high DP; the OR of ischaemic cardiopathy, 2.84 (95% CI, 1.16-6.96); and of cerebrovascular accident, 2.70 (95% CI, 1.09-6.68). There were no significant differences for peripheral arteriopathy. Conclusions. DP was confirmed as an independent factor of cardiovascular risk and, despite the limitations of the study, it was pointed to as a possible independent factor of cerebrovascular risk

[Benefits of treatment to eradicate Helicobacter pylori infection in patients with ulcer at a primary care center]. / Beneficios del tratamiento erradicador de la infección por Helicobacter pylori en pacientes ulcerosos en un centro de atención primaria.

OBJECTIVES: To evaluate the clinical evolution and the use of Primary Care health resources one year after treatment to eradicate Helicobacter pylori (Hp) infection in patients with peptic ulcers and Hp infection. DESIGN: Retrospective study on the effect of an intervention. SETTING: Urban, reformed primary care centre. PATIENTS: 102 patients with peptic ulcers and Hp infection. INTERVENTION: Treatment to eradicate Hp. MEASUREMENTS AND MAIN RESULTS: a) Total medical attendance; b) attendance for dyspepsia; c) number of ulcerous outbreaks; d) medicines taken to treat dyspepsia. 79.4% of the patients treated were male. Overall mean age was 47.8 +/- 12.4. After the intervention, total attendance (from 8.3 to 6.6, p < 0.001), attendance for dyspepsia (from 3.1 to 1.1, p < 0.00001), and ulcerous outbreaks (from 1.2 to 0.06, p < 0.00001) all dropped sharply. The mean number of medicines prescribed for dyspepsia per patient fell from 1.24 to 0.43, p < 0.0001. Ranitidine prescription fell from 72.7 to 13.8 days (p < 0.001); and omeprazol from 35.1 to 12.2 days (p < 0.03). Estimated total saving per patient was 26,792 pesetas at 1998 values. CONCLUSIONS: Treatment in primary care to eradicate Hp(+) in ulcerous patients reduced the needs of attendance and the prescription of drugs for ulcers. Just in the first year this supposed a clinical benefit for these patients and important economic savings for the public health service.

Beneficios del tratamiento erradicador de la infección por Helicobacter pylori en pacientes ulcerosos en un centro de atención primaria / Benefits of treatment to eradicate Helicobacter pylori infection in patients with ulcers attending a primary care centre

Objetivo. Evaluar la evolución clínica y la utilización de recursos sanitarios en atención primaria un año después del tratamiento erradicador de Helicobacter pylori (Hp) en pacientes con úlcera péptica e infección por Hp. Diseño. Estudio retrospectivo sobre el efecto de una intervención. Ámbito del estudio. Centro de atención primaria urbano y reformado. Pacientes. Ciento dos pacientes con enfermedad ulcerosa péptica e infección por Hp. Intervención. Tratamiento erradicador de Hp. Mediciones y resultados principales. a) número de visitas totales (VT); b) visitas por dispepsia (VD); c) número de brotes ulcerosos (BU), y d) fármacos consumidos para tratamiento de la dispepsia. De los pacientes tratados un 79,4 por ciento era varón. La edad media global fue de 47,8 ñ 12,4 años. Después de la intervención, disminuyeron significativamente las VT (de 8,3 a 6,6; p < 0,001), las VD (3,1 a 1,1; p < 0,00001), y los BU (de 1,2 a 0,06; p < 0,00001). El número medio de fármacos prescritos para la dispepsia por paciente disminuyó de 1,24 a 0,43 (p < 0,0001). La prescripción de ranitidina pasó de 72,7 a 13,8 días (p < 0,001) y la de omeprazol disminuyó de 35,1 a 12,2 días (p < 0,03). El ahorro total estimado por paciente fue de 26.792 pts. con valores económicos de 1998. Conclusiones. En nuestro medio el tratamiento erradicador en pacientes ulcerosos Hp (+) disminuye las necesidades de asistencia y la prescripción de medicamentos antiulcerosos. Ya durante el primer año esto supone un beneficio clínico para estos pacientes y un ahorro económico importante para la sanidad pública (AU)

[Follow-up of the quality of drug prescriptions: the Primary Care Center of Badia City (1986-1990)]. / Seguimiento en la calidad de la prescripción de medicamentos: el CAP de Ciudad Badía (1986-1990).

OBJECTIVE: To determine the variation in the quality of prescription of medicines in Primary Attention Centre in two different periods, 1986 and 1990. DESIGN: Longitudinal, retrospective study with direct intervention. SITE. Primary Attention Centre, Ciudad Badía. PARTICIPANTS: 1986: 9 general practitioners in medicine (GPs) and 7 pediatricians. 1990: 9 Gps, 7 pediatricians, and 7 residential doctors (MFC based) who were not included in the earlier evaluation. INTERVENTION: Once the 1986 prescriptions had been analysed qualitatively, the results were made available to and discussed with the doctors who made out the prescriptions (passive feedback). As ongoing intervention the periodic clinical sessions should be considered. MAIN MEASUREMENTS AND RESULTS: Increase in the substances included in Index/Guide: MG 6.5% and P 13% (p < 0.00001). Increase in the number of substances with an active principle and in the combinations accepted: MG 2.3% and P 9% (p < 0.00001). Increase in the percentage of specialties with high V1: MG 1% (p = 0.12) and P 10% (p < 0.00001). CONCLUSIONS: There has been an increase in the quality of medical prescriptions according to the indicators analysed. There are other external factors that effect prescriptions that are difficult to measure. This type of study allows one to pinpoint the excessive or wrong use of intrinsically not very valuable sub-groups of therapeutic substances, and will serve as a base for indication-prescription studies.