Control de las cifras de presión arterial en diabéticos tipo 2 tratados con insulina / Blood pressure control in diabetics type 2 treated with insulin

Objetivo: Valorar el control de las cifras de presión arterial (PA) tras 2 añosde seguimiento, en pacientes diabéticos tipo 2 (DM2) tratados con insulina.Métodos: Estudio prospectivo, longitudinal y multicéntrico, realizado en atenciónprimaria, con la participación de 121 pacientes con DM2 que precisaroninicio o modificación del tratamiento con insulina y con seguimiento de 2 años.Se efectuaron 5 visitas (inclusión y 6, 12, 18 y 24 meses). Se midió la PA endos ocasiones. Se calcularon las medias de PA y el grado de control. Se considerócontrol cuando la PA fue <140 y 90 mmHg para la PAS y la PAD, respectivamente.Resultados: Concluyeron 103 pacientes (85,1%) (edad 66,4años; DE 11,6), de los que 45 (43,69%) eran varones. Las PAS y PAD fueron,respectivamente, de 140,2 (DE 14,2) y 86,1 (DE 9,2) mmHg en la visitainicial, de 140,3 (DE 14) y 86,8 (DE 8,6) mmHg al año, y de 141,3 (DE14,5) y 86,9 (DE 8,3) mmHg a los 2 años (p= NS entre la visita inicial y lafinal). Estaban controlados el 37,8% (IC 95%: 28,4-47,2), el 53,4% (IC95%: 43,8-63) y el 38,8% (IC 95%: 29,43-48,17) por visitas (inicial y 12 y24 meses, respectivamente) (p= NS inicial-final). Conclusiones: El controlde la PA en la DM2 tratada con insulina es muy bajo, no modificándose a los2 años de seguimiento(AU)

Objective: To know the blood pressure (BP) control in patients with type 2 diabetestreated with insulin after two years of follow-up. Setting: 9 health centersof Primary Care. Design: Prospective, longitudinal, multicentric study performedin Primary Care settings. 121 patients with type 2 diabetes who needed initiationor modifi cation of insulin therapy were included. During the 2 years of follow-up,5 visits (inclusion, and 6,12,18, and 24 months) were performed. The compliancewas studied by means of count of insulin. BP was measured in two occasionsand mean BP and degree of BP control was evaluated. Good control wasdefi ned when SBP was <140 mmHg, and DBP was <90 mmHg, respectively.Results: 103 patients (85.1%) (mean age 66.4 years, SD 11.6) concluded thestudy, of which 45 were men (43.69%). SBP and DBP were respectively 140.2(SD 14.2) and 86.1 (SD 9.2) mmHg at the initial visit, 140.3 (SD 14) and 86.8(SD 8.6) mmHg at 1 year and 141.3 (SD 14.5) and 86.9 (SD 8.3) at 2 years(p= NS between initial-fi nal visit). 37.8% (CI 95%: 28.4-47.2), 53.4% (CI 95%:43.8-63) and 38.8% (CI 95%: 29.43-48.17) for visits (initial, 12 and 24months, respectively) (p= NS initial-fi nal) had BP controlled. Conclusions:Blood pressure control in patients with type 2 diabetes treated with insulin is verylow, without changes after 2 years of follow-up(AU)

Importante hipertrofia de ventrículo izquierdo,ecocardiográficamente, en paciente hipertensode reciente comienzo / Echocardiograph manifestation of significant left-ventricular hypertrophy in early-stage hypertensive patients

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[Treatment compliance in arterial hypertension. A 2-year intervention trial through health education]. / El cumplimiento terapéutico en la hipertensión arterial. Ensayo sobre la intervención durante 2 años mediante educación sanitaria.

OBJECTIVE: To analyse the efficacy of health education (HE) through a group session with two years of intervention by postal back-up on compliance with therapy for light-to-moderate essential hypertension. DESIGN: Controlled, randomised clinical trial. SETTING: La Orden Health Centre. PARTICIPANTS: 110 hypertense patients diagnosed with de novo or unmonitored hypertension. INTERVENTION: 1. Control group (CG): 55 patients who received HE from their doctor. 2. Intervention group (IG): 55 patients who also received a controlled intervention. a) Group HE session, b) Postal back-up to the home every three months for two years. MEASUREMENTS AND RESULTS: After two years, on two surprise home visits made at a month's interval, blood pressure was measured and pressure-lowering pills counted. The person whose consumption was at 80-110% of the amount prescribed was defined as compliant. The percentages of compliant patients and mean compliance were compared for the two visits. The reduction of absolute risk (RAR), of relative risk (RRR) and the number of patients needed to avoid non-compliance (NNT) were calculated. 92 people finished the trial. The two groups (n: CG = 45, IG = 47) did not differ for age, sex, time of evolution, number of illnesses or dosages of medicines prescribed. 78.26% were compliant (CI: 61.5-94.9), CG = 55.6% and IG = 95.7% (p < 0.0001). Mean overall compliance was 90.9 +/- 14, CG = 88.1 +/- 12 and IG = 93.86 +/- 11 (p = 0.01). RAR was 40.1%, RRR 90.3 and NNT 2.49% respectively. CONCLUSIONS: HE intervention is an effective measure to improve therapeutic compliance in essential hypertension and lasts for up to two years.

El cumplimiento terapéutico en la hipertensión arterial. Ensayo sobre la intervención durante 2 años mediante educación sanitaria / Therapeutic compliance in hypertension. trial of two-year health education intervention

Objetivo. Analizar la eficacia de la educación para la salud (EPS), mediante sesión grupal con refuerzo postal, tras 2 años de intervención, en el cumplimiento terapéutico de la HTA esencial leve-moderada. Diseño. Ensayo clínico controlado, aleatorio. Ámbito. Centro de Salud La Orden. Sujetos. Ciento diez sujetos hipertensos diagnosticados de HTA de novo o no controlada. Intervención. 1. Grupo control (GC): 55 pacientes, que recibieron EPS de su médico. 2. Grupo intervención (GI): 55 pacientes que recibieron además intervención controlada: a) sesión de EPS en grupo, y b) refuerzo postal domiciliario cada 3 meses durante 2 años. Mediciones y resultados. A los 2 años se llevaron a cabo 2 visitas domiciliarias por sorpresa con un mes de intervalo, realizándose medición de PA y recuento de comprimidos hipotensores. Se definió como cumplidor a aquel paciente cuyo consumo es un 80-110 por ciento del prescrito. Se compararon los porcentajes de cumplidores y cumplimiento medio entre visitas. Se calculó la reducción del riesgo absoluto, relativo y el número de pacientes necesarios para evitar un incumplimiento (RRA, RRR, NNT). Finalizaron 92 individuos. Ambos grupos (GC, 45; GI, 47) no difieren en edad, sexo, tiempo de evolución, número de enfermedades y dosis de fármacos prescritos. Fue cumplidor un 78,26 por ciento (IC, 61,5-94,9; GC, 55,6 por ciento y GI, 95,7 por ciento; p < 0,0001). El porcentaje medio de cumplimiento fue globalmente del 90,9 ñ 14 (GC, 88,1 ñ 12 y GI, 93,86 ñ 11; p = 0,01). La RRA fue del 40,1 por ciento, la RRR del 90,3 por ciento y el NNT del 2,49 por ciento, respectivamente. Conclusiones. La intervención en EPS es una medida eficaz para mejorar el cumplimiento terapéutico en la HTA esencial perdurando hasta los 2 años (AU)

[Analysis of arterial pressure variability among individuals with white coat hypertension and essential arterial hypertension using blood pressure ambulatory monitoring]. / Análisis de la variabilidad de la presión arterial entre individuos con hipertensión de bata blanca e hipertensión arterial esencial mediante monitorización ambulatoria de la presión arterial.

OBJECTIVES: To compare patients with "white coat" hypertension (WCH) and essential hypertension for variability in blood pressure (BP) taken in the clinic. DESIGN: Crossover study. SETTING: La Orden Health Centre, Huelva. PATIENTS: 126 people with light-to-moderate hypertension, de novo or not, being monitored but not treated by drugs. Two groups were formed: WCH defined by mean daily systolic and distolic pressures below 135 and 85 mmHg, and hypertension when the BP was over 140 and/or 90 mmHg. MEASUREMENTS AND MAIN RESULTS: BP was taken in the clinic in two periods: by day (7 a.m. to midnight) and at night (00.01 to 06.59), with readings every 15 and 30 minutes, respectively. Variability was compared by analysing: a) variability indices (VI), and b) coefficients of variation (CV) in BP. A regression test and multiple correlation was used. Both groups (hypertension and WCH) contained 63 people (average age: 53.4 +/- 10 and 50 +/- 10). No significant differences between the two groups in the VI were observed, except greater variability in the VI of the nocturnal systolic pressure of the hypertension group. The CV was higher in the WCH group for all pressures, with differences for 24-hour and day-time systolic pressure. The VI of systolic pressure correlated significantly with its overall clinical systolic pressure in the 24-hour period, with the day and night-time readings and with age in the day-time period. CONCLUSIONS: Variability in the blood pressure of people with essential hypertension and WCH does not differ. Variability in systolic pressure shows positive correlation with clinical systolic pressure and, to a lesser extent, with age.

[Therapeutic compliance in dyslipidemias. A trial of the efficacy of health education]. / Cumplimiento terapéutico de las dislipemias. Ensayo sobre la eficacia de la educación sanitaria.

OBJECTIVE: To analyse the efficacy of health education (HE) through group session with postal back-up in furthering compliance with therapy for Lipaemia. DESIGN: Controlled clinical trial, with random distribution. SETTING: Primary care. PATIENTS: 110 patients with Hypercholesterolaemia, with new diagnoses or not in treatment, in which medical treatment with statins was indicated as a start or change in medication. INTERVENTIONS: They were distributed in two groups at random, with observation four months after being included in the study and appointments after one, two and four months. 1. Control group (CG): 55 patients who received HE from their family doctor. 2. Intervention group (IG): 55 patients whose HE was monitored: a) a group HE session and b) back-up by letter sent to their homes. MEASUREMENTS AND RESULTS: Patients whose consumption was between 80 and 110% of the amount prescribed were defined as compliant. The pill count was recorded. The percentages of compliant patients and mean compliance (chi squared, Student's t) were analysed. 108 individuals, 41 men and 67 women, completed the trial. There was no difference between the two groups as to age, sex, evolution time, number of diseases and dosage of medicines consumed. 71.3% were compliant (CI, 62.8-79.8%), CG = 61.8% and IG 81.1% (p < 0.05). The mean percentage of compliance was 86.1 +/- 14.3 overall, with CG = 83.8 +/- 14 and IG 88.5 +/- 14 (p = NS). CONCLUSIONS: The HE intervention with a group session and postal back-up is an effective way of improving therapeutic compliance in cases of hypercholesterolaemia.

[Trial of the efficacy of health education programs on therapeutic compliance in arterial hypertension]. / Ensayo sobre la eficacia de los programas de educación para la salud en el cumplimiento terapéutico de la hipertensión arterial.

OBJECTIVE: To analyse by means of a group session and postal support the efficacy of health education (HE) on compliance with therapy for light-to-moderate essential Hypertension. DESIGN: Controlled clinical trial with randomised distribution. SETTING: Primary Care. PATIENTS: 110 hypertense patients with new or uncontrolled Hypertension, for whom treatment with Trandolapril as a start or change of medication was indicated. INTERVENTIONS: The patients were split into two groups at random, with observation for six months after inclusion in the study and monthly attendance: 1) Control group (CG) of 55 patients who received HE from their family doctor; 2) Intervention group (IG) of 55 patients controlled. MEASUREMENTS AND RESULTS: Patients were defined as compliant if their consumption was 80-110% of what was prescribed. The counting of pills was recorded. Percentages of compliant patients and mean compliance were analysed with the Chi squared and Student's t tests. 109 people completed, 77 of them women. Neither group differed as to age, sex, length of evolution, number of diseases or doses of drugs consumed. CONCLUSIONS: Intervening in HE with a group session and postal follow-up is an efficacious measure to improve therapeutic compliance in Hypertension cases.

[Diagnostic assessment of pseudothrombophlebitis syndrome. A report of three cases]. / Síndrome de seudotromboflebitis. Consideraciones diagnósticas a propósito de tres casos.

The pseudothrombophlebitis syndrome is a complication of ruptured or dissecting synovial cyst in the knee joint (Baker's cyst). Three cases are reported of this clinical entity characterized by symptoms and signs suggesting deep vein thrombophlebitis. We mainly discuss the clinicoradiological aspects.

[Evaluation of Spacelabs 90207, the noninvasive automatic monitor for ambulatory monitoring of blood pressure]. / Validación del monitor automático no invasivo de monitorización ambulatoria de la presión arterial Spacelabs 90207.

OBJECTIVE: To validate a non-invasive apparatus for non-hospital monitoring of blood pressure, the Spacelabs 90207 model. DESIGN: A comparative cross-sectional study. SETTING: Primary Care. "La Orden" Health Centre in Huelva. PATIENTS: 90 people, 34 men, of all ages, hypertensive or not and without any treatment for Hypertension, and selected at random from the on-demand consulting room. MEASUREMENTS AND MAIN RESULTS: Four blood pressure (BP) readings measured with the standard manual apparatus (mercury sphygmomanometer) were compared with three obtained in sequence with the Spacelabs 90207, validated in line with the recommendations of the British Hypertension Society (BHS) and the Association for the Advancement of Medical Instrumentation (AAMI). Average age was 51.31 +/- 16.5, with SP between 102 and 200 mmHg and DP between 60 and 100 mmHg. Means and standard deviations of manual and automatic BP readings were worked out: 129.13 +/- 19 mmHg and 130.50 +/- 19 for SP, and 77.97 +/- 11 and 76.64 +/- 11 for DP. CONCLUSIONS: Spacelabs 90207 fulfills the validation criteria of the BHS and AAMI.

["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.

[Validation of an automatic noninvasive arterial pressure monitor: the ACP-2200]. / Validación de un monitor automático no invasivo de presión arterial: el ACP-2200.

OBJECTIVE: To check the validation of the precision in measuring arterial pressure (AP) of an automatic non-invasive machine for out-patient monitoring of arterial pressure, the ACP-2200, comparing the sequential with the simultaneous method in line with the criteria of the Association for the Advancement of Medical Instrumentation. DESIGN: A comparative crossover study. SETTING: Primary Care. "La Orden" Health Centre, Huelva. PATIENTS: 86 individuals, 42 men and 44 women of all ages, both hypertense and not, and without any antihypertension treatment, with SAP intervals between 99 and 160 mmHg and DAP between 59 and 105 mmHg, selected at random from the on-demand consultations. MEASUREMENTS AND MAIN RESULTS: Three AP readings were made with a manual apparatus for reference (a mercury sphygmomanometer) and three simultaneously with the ACP-2200 and the manual apparatus placed in a T on the cuff. The AP means obtained were compared and the mean calculated. The standard deviations of the paired differences between the APs obtained with the ACP-2200 and with the manual method, both in the sequential and simultaneous form, as well as Pearson's lineal correlation coefficient, were all calculated. The means of the paired differences and the standard deviations between the automatic and manual apparatuses were, for the SAP, 1.52 +/- 4 (r = 0.96) and 0.66 +/- 3.38 (r = 0.97) (sequential and simultaneous, respectively) and, for the DAP, 0.86 +/- 2.84 (r = 0.98) and 0.64 +/- 1.73 (r = 0.99) (sequential and simultaneous, respectively). All the values of p were inferior to 0.001. CONCLUSIONS: The ACP-2200 complies with the validation criteria for the two methods used, with the simultaneous method being recommended for use.

[A primary gastric Burkitt's lymphoma in a child]. / Linfoma primitivo gástrico de Burkitt en un niño.

We report a case of a primary gastric Burkitt's lymphoma in a 8-year-old child, which first symptoms were abdominal pain, dysphagia, melena and a constitutional syndrome. The differential characteristics of this case are its peculiar gastric infiltration and the existence of oesophageal extension, which is very infrequent among this kind of tumors.