Uso de la mediana para la valoración de los resultados de la automedición de presión arterial / Use of the median to assess blood pressure self measurement result

Objetivo. Uno de los inconvenientes de la automedición de la presión arterial estriba en que obliga al médico a realizar calculos engorrosos con múltiples cifras durante la consulta médica. Se ha valorado el uso de la mediana como criterio diagnóstico frente al uso habitual de las medias de la presión arterial. Diseño y métodos. Se recogieron las automediciones de 157 pacientes (edad media: 58,9 ± 12,3 años; 44 % varones y 56 % mujeres; 47 % recibían tratamiento hipotensor). Cada enfermo recibió un monitor OMROM 705 para realizar mediciones de presión arterial en su domicilio. Se realizaron 12 mediciones en total durante tres días (dos por la mañana y dos por la tarde cada día). Se han calculado la media y la mediana de las mediciones en cada caso. Resultados. La mediana de la presión arterial sistólica (143,01 ± 18,85 mmHg) no era diferente de la media (143,04 ± 18,53 mmHg). Lo mismo ocurría con la presión arterial diastólica (mediana: 82,25 ± 9,56; media: 82,26 ± 9,39 mmHg). Tampoco hubo diferencias significativas en la clasificación de los pacientes según se usara la media o la mediana. El 47,3 % de las mediciones tenían una presión arterial sistólica media < 135 y un 79,8 % tenían una presión arterial diastólica media < 85 mmHg. Usando la mediana, la presión arterial sistólica era < 135 en el 48,4 % de los casos y la presión arterial diastólica < 85 en el 82,01 %. Las diferencias no son significativas. La sensibilidad de la mediana para la presión arterial sistólica era 100 % y la especificidad 98,9 %. Los falsos positivos fueron 1,05 % y no hubo falsos negativos 0,0 %. La sensibilidad de la mediana para la presión arterial diastólica fue 100 % y la especificidad 96,8 %. Los falsos positivos fueron 4,25 % y no hubo falsos negativos 0,0 %. Conclusiones. La mediana parece una medida alternativa a la media en la valoración de los resultados de la automedición de la presión arterial con buena sensibilidad y especificidad y mayor sencillez de realización en la práctica diaria

Objective. One of the disadvantages of blood pressure self measurement (BPSM) is because the physician must make tiresome calculations with many numbers during the medical visit. The use of the median as diagnostic criteria versus the common use of the BP means has been assessed. Design and methods. Self-measurements were collected from 157 patients (mean age: 58.9 ± 12.3 years, 44 % men and 56 % women, 47 % of whom received antihypertensive treatment). Each patient received an OMROM 705 monitor to perform BP measures in their home. A total of 12 measures in all were performed during 3 days (2 in the morning and two in the afternoon of each day). The mean and median of the measurements were calculated in each case. Results. The median of SBP (143.01 ± 18.85 mmHg) was not different from the mean (143.04 ± 18.53 mmHg). The same occurred with DBP (median: 82.25 ± 9.56; mean 82.26 ± 9.39 mmHg). There were also no significant differences in the classification of the patients when the mean or median was used. A total of 47.3 % of the measurements had a mean SBP < 135 and 79.8 % had a mean DBP < 85 mmHg. Using the median, the SBP was < 135 in 48.4 % of the cases and the DBP < 85 in 82.01 %. The differences are not significant. Sensitivity of the median for SPB was 100 % and specificity 98.9 %. False positives were 1.05 % and there were no false negatives 0.0 %. Sensitivity of the median for DBP was 100 % and specificity 96.8 %. False positives were 4.25 % and there were no false negatives 0.0 %. Conclusions. The medians seems to be an alternative measure to the mean in assessment of BPSM results with good sensitivity and specificity and is easier to perform in the daily practiceObjective. One of the disadvantages of blood pressure self measurement (BPSM) is because the physician must make tiresome calculations with many numbers during the medical visit. The use of the median as diagnostic criteria versus the common use of the BP means has been assessed. Design and methods. Self-measurements were collected from 157 patients (mean age: 58.9 ± 12.3 years, 44 % men and 56 % women, 47 % of whom received antihypertensive treatment). Each patient received an OMROM 705 monitor to perform BP measures in their home. A total of 12 measures in all were performed during 3 days (2 in the morning and two in the afternoon of each day). The mean and median of the measurements were calculated in each case. Results. The median of SBP (143.01 ± 18.85 mmHg) was not different from the mean (143.04 ± 18.53 mmHg). The same occurred with DBP (median: 82.25 ± 9.56; mean 82.26 ± 9.39 mmHg). There were also no significant differences in the classification of the patients when the mean or median was used. A total of 47.3 % of the measurements had a mean SBP < 135 and 79.8 % had a mean DBP < 85 mmHg. Using the median, the SBP was < 135 in 48.4 % of the cases and the DBP < 85 in 82.01 %. The differences are not significant. Sensitivity of the median for SPB was 100 % and specificity 98.9 %. False positives were 1.05 % and there were no false negatives 0.0 %. Sensitivity of the median for DBP was 100 % and specificity 96.8 %. False positives were 4.25 % and there were no false negatives 0.0 %. Conclusions. The medians seems to be an alternative measure to the mean in assessment of BPSM results with good sensitivity and specificity and is easier to perform in the daily practice

Risk factors for esophageal candidiasis.

The role of gastric acid inhibitors as predisposing factors for Candida esophagitis is unknown. A retrospective case-control study of esophageal candidiasis was conducted in human immunodeficiency virus (HIV)-negative patients diagnosed from January 1991 to December 1997. The diagnosis of esophageal candidiasis was always made on the basis of endoscopic and histological criteria. Fifty-one patients were diagnosed with esophageal candidiasis, 15 of whom had esophageal complaints and 48 of whom suffered from another previous chronic disease (17 had cancer). In addition, 20 patients had previously been treated with antibiotics, 13 with steroids and 14 with omeprazole. In the multivariate analysis, neoplasm (odds ratio, 5.50; 95% confidence interval, 1.94-15.56) and therapy with antibiotics (odds ratio, 11.97; 95% confidence interval, 3.82-37.45), steroids (odds ratio, 35.52; 95% confidence interval, 3.90-324.01) or omeprazole (odds ratio, 18.23; 95% confidence interval, 4.67-71.03) were all associated with esophageal candidiasis. These data suggest that Candida esophagitis tends to occur in patients with chronic diseases, most of whom have been previously treated with antibiotics, steroids or omeprazole. The findings support the hypothesis that treatment with omeprazole favors the development of esophageal candidiasis.