Rigidez arterial en sujetos normotensos e hipertensos: frecuencia en farmacias comunitarias / Arterial stiffness in normotensive and hypertensive subjects: Frequency in community pharmacies

Antecedentes y objetivo: La rigidez arterial (RA) es una lesión de órgano diana reconocida. El objetivo es determinar: 1) su frecuencia en farmacias comunitarias; 2) si sujetos con RA presentan más factores de riesgo CV, y 3) su dependencia de una definición ajustada por grupos de edad o valores fijos. Pacientes y método: Estudio observacional transversal en 32 farmacias comunitarias de la Comunidad Valenciana entre noviembre de 2015 y abril de 2016. La RA como velocidad de onda de pulso (VOP) se midió mediante un dispositivo validado semiautomático (Mobil-O-Graph(R), IEM), seguido de un cuestionario de 10 preguntas. Resultados: La edad media de los 1.427 participantes consecutivos fue 56,6 años. La proporción de pacientes con RA fue 17,4% (9,4% en normotensos, 28,3% en hipertensos) con ajuste por grupos de edad. La regresión logística multivariante mostró en normotensos una asociación de la RA con el sexo masculino, la obesidad, una mayor presión de pulso y la frecuencia cardiaca, y en hipertensos, con una mayor presión de pulso y una menor edad. Definiendo RA por VOP>10m/s, el 20,5% global (6,2% en normotensos, 40,2% en hipertensos) presentó RA. Se asoció a mayor edad y presión de pulso en normotensos e hipertensos. La concordancia de RA entre ambas definiciones fue del 74,6%. Conclusiones: La RA varió entre el 17,4 y el 20,5%. La RA ajustada por edad se asocia en normotensos a sexo masculino, presión de pulso, obesidad y frecuencia cardiaca, y en hipertensos, a mayor presión de pulso y menor edad. Los determinantes de RA medida como VOP>10m/s son mayor presión de pulso y mayor edad. Ambas definiciones de RA no son superponibles (AU)

Background and objective: Arterial stiffness (AS) is a well-recognized target organ lesion. This study aims to determine: 1) the frequency of AS in community pharmacies; 2) if stiffened subjects identified by brachial oscillometry have more CV risk factors than normal subjects, and 3) the dependence of stiffness on using either age-adjusted values or a fixed threshold. Patients and method: Observational, cross-sectional study in 32 community pharmacies of the Valencia Community, between November/2015 and April/2016. Stiffness was as pulse wave velocity (PWV) measured with a semi-automatic, validated device (Mobil-O-Graph(R), IEM), followed by a 10-item questionnaire. Results: Mean age of the 1,427 consecutive recruited patients was 56.6 years. Overall proportion of patients with AS was 17.4% with age-adjusted PWV (9.4% in normotensives, 28.3% in hypertensives). Multivariate logistic regression showed independent association of stiffness in normotensives with male gender, obesity, higher pulse pressure and heart rate, in hypertensives, with higher pulse pressure and lower age. AS was globally found in 20.5% of subjects, defining stiffness by PWV>10m/s (6.2% in normotensives, 40.2% in hypertensives). It was associated with higher age and pulse pressure in both groups. Concordance in classifying stiffness was 74.6%. Conclusions: Frequency of AS varied between 17.4-20.5%. Age-adjusted stiffness is associated in normotensives with male gender, pulse pressure, obesity and heart rate, in hypertensives with pulse pressure and inversely to age. Stiffness by 10m/s is determined by higher pulse pressure and higher age. Both definitions of PWV are not interchangeable (AU)

Arterial stiffness in normotensive and hypertensive subjects: Frequency in community pharmacies. / Rigidez arterial en sujetos normotensos e hipertensos: frecuencia en farmacias comunitarias.

BACKGROUND AND OBJECTIVE: Arterial stiffness (AS) is a well-recognized target organ lesion. This study aims to determine: 1) the frequency of AS in community pharmacies; 2) if stiffened subjects identified by brachial oscillometry have more CV risk factors than normal subjects, and 3) the dependence of stiffness on using either age-adjusted values or a fixed threshold. PATIENTS AND METHOD: Observational, cross-sectional study in 32 community pharmacies of the Valencia Community, between November/2015 and April/2016. Stiffness was as pulse wave velocity (PWV) measured with a semi-automatic, validated device (Mobil-O-Graph®, IEM), followed by a 10-item questionnaire. RESULTS: Mean age of the 1,427 consecutive recruited patients was 56.6 years. Overall proportion of patients with AS was 17.4% with age-adjusted PWV (9.4% in normotensives, 28.3% in hypertensives). Multivariate logistic regression showed independent association of stiffness in normotensives with male gender, obesity, higher pulse pressure and heart rate, in hypertensives, with higher pulse pressure and lower age. AS was globally found in 20.5% of subjects, defining stiffness by PWV>10m/s (6.2% in normotensives, 40.2% in hypertensives). It was associated with higher age and pulse pressure in both groups. Concordance in classifying stiffness was 74.6%. CONCLUSIONS: Frequency of AS varied between 17.4-20.5%. Age-adjusted stiffness is associated in normotensives with male gender, pulse pressure, obesity and heart rate, in hypertensives with pulse pressure and inversely to age. Stiffness by 10m/s is determined by higher pulse pressure and higher age. Both definitions of PWV are not interchangeable.

Construction and validation of a model to predict nonadherence to guidelines for prescribing antiplatelet therapy to hypertensive patients.

OBJECTIVE: To construct and validate a model to predict nonadherence to guidelines for prescribing antiplatelet therapy (NGAT) to hypertensive patients. METHODS: This 3 month prospective study was undertaken in 2007-2009 to determine whether 712 hypertensive patients were or were not being prescribed antiplatelet therapy. OUTCOME: NGAT according to clinical guidelines (just for patients in secondary prevention or with Systematic COronary Risk Evaluation (SCORE) ≥10%). Secondary variables: Duration of hypertension (years), blood pressure (BP), age, gender, smoking, diabetes, dyslipidemia, cardiovascular disease, lipid parameters, SCORE. Of the whole sample 80% was used to construct the model and 20% to validate it. To construct the model, we performed a multivariate logistic regression model which was adapted to be a scoring system with risk groups. The adjusted odds ratios (ORs) were obtained through the model. To validate the model we calculated the area under the ROC curve (AUC) and then compared the expected and the observed NGAT. The final model was adapted for use as a mobile application. RESULTS: NGAT: 18.5%, construction; 17.9%, validation. FACTORS: higher duration of hypertension diagnosis, higher systolic BP, older age, male gender, smoking, diabetes, dyslipidemia and cardiovascular disease. VALIDATION: AUC = 0.82 (95% CI: 0.74-0.90, p < 0.001), with no differences between the observed and the expected NGAT (p = 0.334). CONCLUSION: A tool was constructed and validated to predict NGAT. The associated factors were related with a greater cardiovascular risk. The scoring system has to be validated in other areas.

Magnitude of pharmacological nonadherence in hypertensive patients taking antihypertensive medication from a community pharmacy in Spain.

BACKGROUND: The most common factor associated with poor control of hypertension is treatment nonadherence to antihypertensive drug therapy.  OBJECTIVE: To measure drug nonadherence and associated factors in pharmacologically treated hypertensive patients. METHODS: A prospective observational study was carried out from March 2007 to August 2009 at a community pharmacy in Spain. A pharmacist invited a convenience sample of hypertensive patients aged 50 years and older taking antihypertensive medication for at least 3 months prior to participate in the study. Drug nonadherence was analyzed by 3 separate methods: pill count, as the gold standard method, and Haynes-Sackett and Morisky-Green questionnaires. A descriptive analysis of drug nonadherence and variables associated with nonadherence was performed. Logistic regression models were used to determine the variables associated with nonadherence.  RESULTS: Data were recorded from 419 patients. The drug nonadherence ratio varied depending on the method used: 62.8% by pill count, 3.1% by the Haynes-Sackett self-report test, and 36% according to the Morisky-Green test. In the multivariate model, the variable associated with a decrease in drug nonadherence was years of known hypertension (OR = 0.962, 95% CI = 0.937-0.988), and the variables associated with an increase in drug nonadherence were loose-pill combination therapy versus fixed-dose combination therapy or monotherapy (OR = 4.099, 95% CI = 2.494-6.757) and good perception of quality of life (OR = 1.276, 95% CI = 1.109-1.471). CONCLUSIONS: The magnitude of drug nonadherence varies depending on the method of measurement. The pill count method (reference method) revealed that 2 out of 3 patients with hypertension did not have good adherence. This study highlights the lack of antihypertensive drug adherence and the pharmacist's ability to detect the associated factors in order to find the best way to deal with nonadherence.

Estrategias para mejorar el cumplimiento en la práctica clínica diaria / Strategies to improve adherence in daily clinical practice

Si acude a la consulta un diabético mal controlado antes de modificar el tratamiento para conseguir los objetivos adecuados hay que evaluar el cumplimiento de los regímenes prescritos. La mejor estrategia sería preguntar integrando la pregunta del cumplimiento autocomunicado de Hayness-Sackett en la entrevista con el paciente, potenciando la comunicación eficaz, la empatía, la motivación y la toma de decisiones compartidas. Las estrategias para mejorar el cumplimiento en estos pacientes tienen que ser mixtas (ofrecer conocimiento, más técnicas que modifiquen conductas de incumplimiento) e individualizadas. Para ello, una vez que los profesionales sanitarios identifican incumplimiento tienen que valorar los motivos, las formas de incumplir y los factores que influyen en esta falta de adherencia. A continuación se selecciona una intervención mixta adaptada a la situación de cada paciente. No hay que olvidar que los pacientes diabéticos tipo 2 presentan habitualmente cierta complejidad terapéutica al coexistir otros factores de riesgo cardiovascular que, en cierto grado, pueden dificultar su cumplimiento; de ahí, la importancia de integrar protocolos de mejora de cumplimiento en la práctica clínica diaria de estos pacientes. En este trabajo se analizan dichas estrategias (AU)

When patients with poor diabetic control seek medical attention, adherence to the prescribed regimens must be evaluated before treatment is changed to achieve appropriate targets. The best strategy is probably to elicit self-reported adherence using the Haynes-Sackett method in the patient interview, emphasizing effective communication, empathy, motivation and shared decision making. Strategies to improve adherence in these patients should be mixed (provide knowledge and more techniques that modify non-adherent behaviors) and individually tailored. Consequently, when lack of adherence is detected, health professionals should evaluate the reasons, the forms of non-adherence, and the factors influencing this behavior. A mixed intervention, individually adapted to each patient, should then be selected. The treatment of patients with diabetes mellitus type 2 is usually somewhat complex, since their disease coexists with other cardiovascular risk factors, which may hamper their adherence to some extent - hence the importance of integrating protocols to improve adherence in daily clinical practice. The present article analyzes strategies to achieve this aim (AU)