Conducta del médico ante el mal control de la hipertensión arterial. Aportaciones de los estudios PRESCAP 2002 y PRESCAP 2006 al conocimiento de la inercia terapéutica en España / Attitude of the physician towards poorly controlled arterial hypertension. Contributions of the PRESCAP 2002 and PRESCAP 2006 studies to knowledge on the therapeutic inertia in Spain

En España tan solo 4 de cada 10 hipertensos tratados con fármacos antihipertensivos que reciben asistencia sanitaria en Atención Primaria tienen bien controlada la PA. La inercia terapéutica está reconocida como una de las principales causas de mal control de la HTA y de otras enfermedades crónicas. Los PRESCAP fueron estudios tranversales y multicéntricos diseñados para estimación de prevalencias, que se realizaron en los años 2002 y 2006 con la misma metodolología en poblaciones similares asistidas en AP. Uno de los objetivos de ambos estudios fue analizar la conducta terapéutica del médico ante pacientes mal controlados (PA sistólica o diastólica ≥140 o ≥90mmHg, respectivamente, en población hipertensa en general, o PA≥130 o ≥80mmHg en pacientes con diabetes, nefropatía o enfermedad cardiovascular). El estudio PRESCAP 2002 mostró que el porcentaje de pacientes con inadecuado control de la PA en los que el médico modificó la pauta terapéutica fue del 18,3% (IC 95%: 17,5–19,1), siendo el cambio de fármaco la opción más elegida (47%), seguida de la combinación (34,7%) y del aumento de dosis (18,3%). En el estudio PRESCAP 2006 el médico modificó el tratamiento en el 30,4% (IC 95%: 29,2–31,6) de los sujetos mal controlados, resultando las acciones más frecuentemente llevadas a cabo la combinación con otro fármaco (46,3%), el incremento de dosis (26,1%) y la sustitución del antihipertensivo (22,8%). La percepción de buen control de la PA por parte del médico fue la variable que más se relacionó con la no modificación del tratamiento farmacológico. Aunque la conducta terapéutica del médico dista de ser idónea, nuestros resultados parecen indicar que se ha producido una mejora importante en la inercia terapéutica de los médicos de Atención Primaria ante los hipertensos mal controlados que siguen tratamiento farmacológico antihipertensivo (AU)

In Spain, only 4 out of 10 hypertensive patients treated with antihypertensive drugs who are attended in Primary Care (PC) have well-controlled blood pressure (BP). Therapeutic inertia (TI) is recognized as one of the main causes for poorly controlled arterial hypertension and other chronic diseases. The PRESCAPs were cross-sectional and multicenter studies designed to calculate prevalence. These studies were conducted in the years 2002 and 2006 using the same methodology in similar populations attended in PC. One of the purposes of both studies was to analyze the therapeutic attitude of the physician in regards to poorly-controlled patients (systolic or diastolic BP≥140 or ≥90mmHg, respectively, in hypertensive population in general, or BP PA≥130 or ≥80mmHg in patients with diabetes, nephropathy or cardiovascular disease). The PRESCAP 2002 study showed that the percentage of patients with inadequate control of PB in whom the physician changed the therapeutic regime was 18.3% (95% CI: 17.5–19.1), the change in the drug of choice being the action chosen the most (47%), followed by combination (34.7%) and dose increase (18.3%). In the PRESCAP 2006 study, the physician modified the treatment in 30.4% (95% CI: 29.2–31.6) of the poorly controlled subjects. The most frequently performed actions were combination with another drug (46.3%), dose increase (26.1%) and substitution of the antihypertensive drug (22.8%). Perception of good control of BP by the physician was the variable that was most related with the non-modification of the drug treatment. Although the therapeutic attitude of the physician is far from being the best, our results seem to indicate that there has been an important improvement in the therapeutic inertia of the primary care physicians in regards to poorly controlled hypertensive patients who follow a treatment with antihypertensive drugs (AU)

Socioeconomic level, sedentary lifestyle, and wine consumption as possible explanations for geographic distribution of cerebrovascular disease mortality in Spain.

BACKGROUND AND PURPOSE: The geographic distribution of cerebrovascular disease (CVD) mortality in Spain spans a wide range, from provinces where mortality is low (70/100,000) and close to that of the United States and other Anglo-Saxon countries, to others where mortality is high (180/100,000) and more akin to that of Portugal and the Mediterranean and central European countries. This report seeks to identify the socioeconomic and lifestyle factors that most contribute to the geographic pattern of CVD mortality in Spain. METHODS: We performed a study using data collected at a provincial level. Mortality data were taken from official vital statistics, and data on risk factors were obtained from surveys of representative large Spanish population samples. Correlation and multiple linear regression analyses were performed on standardized CVD mortality ratios and potential determinants of mortality for the period 1989 to 1993. RESULTS: CVD mortality, unemployment and illiteracy rates, blond cigarette smoking, and sedentary lifestyle proved substantially higher in the south and east (Mediterranean coast) of Spain. Saturated fatty acid intake and wine consumption were both lower in these regions, however. Illiteracy, wine consumption, sedentary lifestyle, high blood pressure, blond cigarette smoking, prevalence of diabetes, and body mass index > or = 30 explained 59% of the variation in CVD mortality. Only illiteracy, sedentary lifestyle, and wine consumption registered a statistically significant relationship (P < .05) with CVD mortality. Whereas lower consumption of wine showed a negative association with CVD mortality, higher consumption revealed a positive association. CONCLUSIONS: Socioeconomic level, as measured by illiteracy, sedentary lifestyle, and wine consumption, may partly explain the higher CVD mortality registered for regions situated in the south and east of Spain.