[Factors associated with cardiovascular risk and cardiovascular and renal disease in the IBERICAN study: Final results]. / Factores asociados al riesgo cardiovascular y enfermedad cardiovascular y renal en el estudio IBERICAN (Identificación de la poBlación Española de RIesgo CArdiovascular y reNal): resultados definitivos.

OBJECTIVE: To analyse the prevalence in clinical practice of cardiovascular risk factors (CVRF) and cardiovascular disease (CVD), as well as their causal relationship, in the study inclusion visit. MATERIAL AND METHODS: Cross-sectional analysis of the study inclusion visit of 8,066 patients of 18 to 85years of age included in the IBERICAN study. By reviewing the medical history, analytics and medical visits, the patient's physician has collected socio-demographic information, personal and family history and prevalence of CVRF and CVD and renal disease. A multivariate analysis was carried out using a logistic regression that included the autonomous region variable as a random effect variable, in order to analyse the impact of certain variables on the development of each CVRF, metabolic syndrome, subclinical organ damage, renal disease, and CVD. RESULTS: Dyslipidaemia was 2.4 times more frequent in diabetics, and the risk was increased by 59% in hypertensive patients. Arterial hypertension was twice as frequent in diabetics, and increased 94% in hyperuricaemic patients and 62.1% in dyslipidaemia patients. Diabetes mellitus was 2.5 times higher in dyslipidaemia patients, and 2.2 times higher in hypertensive patients. CVD was four times more frequent in patients with a family history, and the risk in women was increased by 90.8% and by 53.8% in patients with renal disease. CONCLUSIONS: The Spanish population seen in Primary Care that were analysed in the IBERICAN study had a high prevalence of CVRF and CVD, which gives it a high CVR. The multivariate analysis performed shows a close causal relationship between the CVRF with each other, and with renal disease and CVD.

Prevalence of hypotension in hypertensive treated patients within the Primary Care setting. The PRESCAP 2010 study.

OBJECTIVE: To determine the prevalence of hypotension and associated factors in hypertensive patients treated in the Primary Care setting. MATERIALS AND METHODS: A cross-sectional, descriptive, and multicentre study was conducted with a total of 2635 general practitioners consecutively including 12,961 hypertensive patients treated in a Primary Care setting in Spain. An analysis was performed on the variables of age, gender, weight, height, body mass index, waist circumference, cardiovascular risk factors (diabetes, dyslipidaemia, smoking, obesity, sedentary lifestyle), fasting plasma glucose, complete lipid profile, as well as the presence of target organ damage (left ventricular hypertrophy, microalbuminuria, carotid atherosclerosis) and associated clinical conditions. Hypotension was defined as a systolic blood pressure less than 110mmHg or a diastolic blood pressure less than 70mmHg. A multivariate analysis was performed to determine the variables associated with the presence of hypotension. RESULTS: The mean age was 66.2 years, and 51.7% of patients were women. The mean time of onset of hypertension was 9.1 years. A total of 13.1% of patients (95% confidence interval 12.4-13.6%) had hypotension, 95% of whom had low diastolic blood pressure. The prevalence of hypotension was higher in elderly patients (25.7%) and in those individuals with coronary heart disease (22.6%). The variables associated with the presence of hypotension included a history of cardiovascular disease, being treated with at least 3 antihypertensive drugs, diabetes, and age. CONCLUSIONS: One out of 4-5 elderly patients, or those with cardiovascular disease, had hypotension. General practitioners should identify these patients in order to determine the causes and adjust treatment to avoid complications.

[Description of the sample, design and methods of the study for the identification of the Spanish population at cardiovascular and renal risk (IBERICAN)]. / Descripción de la muestra, diseño y métodos del estudio para la identificación de la población española de riesgo cardiovascular y renal (IBERICAN).

BACKGROUND AND OBJECTIVE: Cardiovascular diseases (CVD) are the leading cause of death in Spain, and although the incidence rates have been declining for years due to improvements in prevention and treatment, there is still room for further reduction. Primary Care has a leading role in the prevention and control of these diseases. Determining the prevalence and incidence of cardiovascular risk factors and cardiovascular diseases in the Spanish adult population attended in Primary Care is the objective of the study to identify the Spanish population at cardiovascular and renal risk (IBERICAN). MATERIAL AND METHODS: A prospective cohort study was conducted using a consecutive non-probabilistic sampling population between 18 and 85 years that attended Primary Care centres between April 1, 2014 and October 31, 2018. By reviewing the medical history, laboratory results, and medical visits, the Primary Care physicians collected socio-demographic information, personal and family history of the patients, as well as prevalence and incidence of cardiovascular risk factors and cardiovascular and renal disease. The incidents and associated factors will be estimated using proportional risk models of Cox and Kaplan-Meier Curves. RESULTS: A total of 8,066 patients have been recruited by 531 Primary Care physicians from all Autonomous Communities of Spain as part of the IBERICAN cohort, with the exception of Ceuta. The mean age of the cohort is 57.9 years with 54.5% women. Obesity, dyslipidaemia, and hypertension are the most prevalent cardiovascular risk factors. There was a history of CVD in16.3%, and 25.5% had a subclinical organ lesion. CONCLUSION: The IBERICAN study is a cohort of people treated in Primary Care that expects to provide relevant information on the factors that determine the incidence of cardiovascular and renal disease in Spain.

[Anthropometric measurements of general and central obesity and discriminative capacity on cardiovascular risk: RICARTO study]. / Medidas antropométricas de obesidad general y central y capacidad discriminativa sobre el riesgo cardiovascular: estudio RICARTO.

INTRODUCTION AND OBJECTIVES: Overweight and obese patients have an increased risk of cardiovascular disease and general mortality. It is not clear which obesity index should be used in the clinic. The objective is to compare the relationship between body mass index (BMI), waist circumference (WC), waist-height ratio (WHR), and conicity index (Conicity-I) with 10-year Framingham cardiovascular risk (CVR). MATERIAL AND METHODS: Population cross-sectional study in subjects ≥18years, residents in the Toledo (Spain) Health Area. Selection by random sampling. Measurements were made of the BMI, WC, and weight to height ratio with standardised methods. Framingham CVR. Calculation of AUC, and optimal cut-off points. RESULTS: The study included 1,309 subjects, with mean age of 48.9±15.8years, and 55% women. The response rate was 36.6%. In women, the index that was best associated with CVR in women was the WC with an AUC=0.85 (95%CI: 0.81-0.88). In men it was the I-Conicity, with an AUC=0.81 (95%CI: 0.77-0.84). Cut points for BMI were similar in women (27.08kg/m2) and men (26.99kg/m2). The WC was lower in women (87.75cm) than in men (94.5cm). The WHR was higher in women (0.59) than in men (0.56). The I-Conicity was slightly lower in women (1.25) than in men (1.28). In women, all the ROC curves were closest to each other. CONCLUSIONS: The central obesity indexes (WC and WHR) discriminated better than the BMI the CVR. In women, all the indices had greater AUCs than in men, except for the I-Conicity.

[Prevalence of obesity and cardiovascular comorbidity associated in patients included in the IBERICAN study]. / Prevalencia de obesidad y comorbilidad cardiovascular asociada en los pacientes incluidos en el estudio IBERICAN (Identificación de la poBlación Española de RIesgo CArdiovascular y reNal).

OBJECTIVES: To analyse the prevalence of obesity and its association with other cardiovascular risk factors and cardiovascular disease in a sample of patients from the (Identification of the Spanish population at cardiovascular and renal risk) IBERICAN study. MATERIAL AND METHODS: Analysis of the inclusion visit of the first 5,013 patients of the IBERICAN longitudinal, observational, and multicentre study in which individuals aged 18 to 85 years were included in Primary Care Clinics in the different regions of Spain. In this work obesity was defined as a body mass index ≥ 30kg/m2. RESULTS: The prevalence of obesity was 35.7% (95% CI: 35.0-36.4%), of which 36.6% were men and 34.9% were women (P=0.214), and significantly increasing with age (0.001). The obesity had the associated higher prevalence of hypertension (62.8% vs. 39.4%, P<001), dyslipidaemia (56.9% vs. 47.1%, P<0.001), sedentary lifestyle (40.6% vs. 24.6%, P<.001), diabetes (27.5% vs. 14.8%, P<.001), hyperuricaemia (23.6% vs. 12.7%, P<.001), subclinical organ injury (33.7% vs. 26.5%, P<.001) and cardiovascular disease (21.2% vs. 15.3%, P<.001). The multivariate analysis showed that the variables associated with obesity were: arterial hypertension (P<.001), hyperuricemia (P<.001), sedentary lifestyle (P<.001), diabetes mellitus (P<0.001), age (P<0.001), low educational level (P<0.001) and lower consumption of tobacco (P<0.001). CONCLUSIONS: The analysis of the IBERICAN study shows that approximately one third of the analysed population meets criteria of obesity and cardiovascular risk factors. Target organ damage and cardiovascular disease were more frequent in obese patients.

[Cardiovascular risk and cardiovascular events in the general population of the sanitary area of Toledo. RICARTO Study]. / Justificación, objetivos y diseño metodológico del estudio RICARTO (RIesgo CARdiovascular y eventos cardiovasculares en la población general del área sanitaria de TOledo).

INTRODUCTION: The main aim of this study is to ascertain the prevalence of cardiovascular risk factors (CVRF), target organ damage (TOD), cardiovascular disease (CVD), as well as life habits (physical exercise, alcohol consumption, and Mediterranean diet) in the population of a Health Area in Toledo, Spain, to assess cardiovascular risk (CVR). MATERIAL AND METHODS: Epidemiological and observational study that will analyse a sample from the general population aged 18 years or older, randomly selected from a database of health cards, and stratified by age and gender. Clinical history, physical examination, and complementary tests will be performed. Aliquots of whole blood and serum samples will be stored at a temperature of-85°C to evaluate future genetic studies. CVR will be estimated by using SCORE project scales calibrated for Spanish population and the Framingham Heart Study scale. When the estimated sample size has been achieved and after a minimum follow-up of 5 years, a final visit will performed in which CVRF, TOD, CVD, CVRF control, and fatal and non-fatal outcomes will be evaluated. DISCUSSION: The RICARTO study is aimed to assess the prevalence of the main CVRF, TOD and CVD in order to determine the CVR in the general population of a health area of Toledo. An analysis will be repeated on the final sample after at least 5 years of follow-up to ascertain the incidence of CV outcomes and the temporal trends of life style, as well as the prevalence of CVRF, TOD, and CVD.

[Characteristics and cardiovascular events in a general population included in the RICARTO (RIesgo CARdiovascular TOledo) study: Data from the first 1,500 individuals included in the study]. / Características de la población general incluida en el estudio RICARTO (RIesgo CARdiovascular y eventos cardiovasculares en la población general del área sanitaria de TOledo): resultados con los primeros 1.500 individuos incluidos en el estudio.

INTRODUCTION: The aim of this study was to assess cardiovascular risk (CVR) by investigating the prevalence of CVR factors (CVRF), target organ damage (TOD), and cardiovascular disease (CVD) in general population of the health area of Toledo, Spain. MATERIAL AND METHODS: Epidemiological and observational study that analysed a sample from the general population aged 18years or older, randomly selected from a database of health cards stratified by age and gender. Clinical history, physical examination, and complementary tests were performed. Total blood and serum samples were frozen at -85°C to evaluate genetic studies in the future. Standard statistical analysis was performed. CVR was assessed by the SCORE scale calibrated for the Spanish population, and the Framingham Heart Study scale. RESULTS: A total of 1,500 individuals (mean age 49.1±15.8years, 55.6% women) were included. Prevalences: dyslipidaemia 56.9% (95% confidence interval [95% CI]: 54.3-59.4), hypertension 33.0% (95%CI: 30.6-35.4), diabetes mellitus 8.6% (95%CI: 7.17-10.1), smoking 24.2% (95%CI; 122.0-26.4), obesity 25.3% (95%CI; 23.1-27.5), and sedentary life-style 39.4% (95%CI; 36.9-41.8). No CVRF was reported in 21.1% of cases, and 18.6% had 3-5 CVRF. TOD: electrocardiographic left ventricular hypertrophy, 4.3%, peripheral artery disease, 10.1% (Doppler ultrasound), and 15.3% (oscillometric device), microalbuminuria, 4.3%, sub-clinical renal disease, 3.2%, and nephropathy in 3.8% (CKD-EPI). At least one CVD was reported in 9.2% of cases. A low CVR (SCORE) was present in 44.6% of individuals. CONCLUSIONS: Dyslipidaemia was found in 60% of individuals, 40% had a sedentary life-style, 30% with hypertension, 20% smoked, 20% obesity, and almost 10% with diabetes. More than a half of individuals have a moderate-high-very high risk. The prevalence of TOD and CVD are significant.

Características clínicas basales y manejo de los pacientes incluidos en el estudio IBERICAN / Baseline clinical characteristics and management of patients included in IBERICAN study

Objetivos. Determinar la prevalencia e incidencia de los factores de riesgo y eventos cardiovasculares en España, así como la calidad de su seguimiento en la práctica clínica. En este artículo se presentan los datos correspondientes a los primeros 830 pacientes incluidos en el IBERICAN. Metodología. IBERICAN es un estudio longitudinal, observacional y multicéntrico en el que se están incluyendo pacientes atendidos en las consultas de atención primaria en España. El estudio está abierto a sujetos entre 18 y 85 años, seleccionados de manera consecutiva en las consultas de atención primaria. El tratamiento de los pacientes se realizará de acuerdo a los criterios clínicos del médico investigador sin ninguna intervención por parte del estudio. Se han considerado como criterios de adecuado control de hipertensión arterial los de las guías europeas de 2013, para el control del colesterol LDL los de las guías europeas de prevención cardiovascular de 2012, y para la diabetes una HbA1c < 7%. Resultados. La edad media fue de 57,9 ± 14,1 años. El 54,1% tenían dislipidemia; el 47,5% hipertensión arterial; el 17,7% diabetes; y el 10,8% ya presentaban historia de cardiopatía isquémica. Respecto a la prescripción de fármacos, el 55% de los hipertensos tomaba ≥ 2 fármacos antihipertensivos pero solo el 59,9% lograron los objetivos. Entre los hiperlipidémicos, el 65,7% tomaban estatinas pero solo el 35,6% estaban controlados. Entre los diabéticos, únicamente el 51,4% conseguían los niveles de HbA1c recomendados. Conclusiones. Los sujetos atendidos en atención primaria muestran una elevada prevalencia de factores de riesgo y un pobre control de los mismos (AU)

Aims. To determine the prevalence and incidence of cardiovascular risk factors and cardiovascular events in Spain, as well as the quality of the follow-up in clinical practice. In this study the baseline data of the first interim analysis of IBERICAN are shown (n = 830). Methods. IBERICAN is a multicenter, longitudinal and observational population-based study of patients daily attended in primary care setting according to clinical practice in Spain. Subjects between 18 and 85 years daily attended in primary care setting are being included consecutively. Treatment of patients will be performed according only to clinical criteria of investigators. Blood pressure control was defined according to 2013 European guidelines of hypertension; LDL-cholesterol control was defined according to 2012 European guidelines of cardiovascular prevention; diabetes control was defined as HbA1c < 7%. Results. Mean age was 57.9 ± 14.1 years. 54.1% of patients had dyslipidemia, 47.5% hypertension, 17.7% diabetes, and 10.8% history of ischemic heart disease. Regarding drugs, despite 55% of hypertensive patients were taking ≥ 2 antihypertensive agents, only 59.9% achieved blood pressure targets; 65.7% of patients with dyslipidemia were taking statins, but only 35.6% attained LDL-cholesterol goals. Only 51.4% of diabetics achieved HbA1c goals. Conclusions. Subjects attended in primary care showed a high prevalence of cardiovascular risk factors with a poor control (AU)

[Baseline clinical characteristics and management of patients included in IBERICAN study]. / Características clínicas basales y manejo de los pacientes incluidos en el estudio IBERICAN.

AIMS: To determine the prevalence and incidence of cardiovascular risk factors and cardiovascular events in Spain, as well as the quality of the follow-up in clinical practice. In this study the baseline data of the first interim analysis of IBERICAN are shown (n=830). METHODS: IBERICAN is a multicenter, longitudinal and observational population-based study of patients daily attended in primary care setting according to clinical practice in Spain. Subjects between 18 and 85 years daily attended in primary care setting are being included consecutively. Treatment of patients will be performed according only to clinical criteria of investigators. Blood pressure control was defined according to 2013 European guidelines of hypertension; LDL-cholesterol control was defined according to 2012 European guidelines of cardiovascular prevention; diabetes control was defined as HbA1c<7%. RESULTS: Mean age was 57.9±14.1 years. 54.1% of patients had dyslipidemia, 47.5% hypertension, 17.7% diabetes, and 10.8% history of ischemic heart disease. Regarding drugs, despite 55% of hypertensive patients were taking≥2 antihypertensive agents, only 59.9% achieved blood pressure targets; 65.7% of patients with dyslipidemia were taking statins, but only 35.6% attained LDL-cholesterol goals. Only 51.4% of diabetics achieved HbA1c goals. CONCLUSIONS: Subjects attended in primary care showed a high prevalence of cardiovascular risk factors with a poor control.

[Resistant arterial hypertension in Primary Care patients in Spain. PRESCAP Study 2010]. / Hipertensión arterial resistente en pacientes hipertensos atendidos en Atención Primaria de España. Estudio PRESCAP 2010.

OBJECTIVE: To determine the prevalence and clinical and epidemiological characteristics of Primary Care patients with resistant hypertension (RHT) in Spain. PATIENTS AND METHODS: A cross-sectional multicenter study was conducted on hypertensive patients aged 18 or over and seen in a Primary Care clinic. RHT was considered as the presence of uncontrolled blood pressure in patients treated with at least 3 drugs, one of which is a diuretic. RESULTS: Of the 12,961 hypertensive patients in the PRESCAP 2010 study, 962 (7.4%) fulfilled criteria for RHT, of whom 51% were women, and with a mean age (SD) 68.8 [11.4] years. Patients with RHT were older (68.80 [10.69] years vs. 66.06 [11.44] years, P<.001), had a higher prevalence of obesity (55.2 vs. 38.6%, P<.001), a higher waist circumference (103.90 [13.89] vs. 99.32 [13.69] cm, P<.001), and a higher prevalence of DM (48.3 vs. 29.5%, P<.001). The prevalence of target organ damage (73.0 vs. 61.4%, P<.001) and cardiovascular disease (46.7 vs. 26.8%, P<.001) were higher in patients with resistant hypertension. The multivariate analysis showed that the variables associated with resistant hypertension were the presence of cardiovascular disease, diabetes mellitus, sedentary life style, microalbuminuria, body mass index, duration of AHT, and triglycerides. CONCLUSIONS: The prevalence of RHT in Primary Care patients is related to inappropriate lifestyles, the presence of target organ damage, and cardiovascular disease.

[Lipid profile in patients admitted with acute coronary syndrome in Spain: data from Toledo health care area between 2005 and 2008]. / Perfil lipídico en pacientes ingresados por síndrome coronario agudo en España: datos del área sanitaria de Toledo entre los años 2005 y 2008.

INTRODUCTION AND OBJECTIVES: To evaluate the lipid profile of patients admitted with acute coronary syndrome in Toledo (Spain) between 2005 and 2008. METHODS: Total cholesterol, LDL-cholesterol, HDL-cholesterol and triglyceride levels were evaluated. Descriptive analyses and means comparison were performed. RESULTS: 1,381 patients of 3,986 admitted with acute coronary syndrome had a complete lipid profile. The mean age was 67.8±12.9 years (72.4% men). A first event was present in 76.3%. The mean total cholesterol (±SD) was 180.0±43.4, LDL-cholesterol 115±38.0, HDL-cholesterol 44.1±12.3, and triglyceride 145.3±92.4mg/dL, with statistically significant differences between men and women in LDL-cholesterol (116.3±37.8 vs 111.6±38.5mg/dL; p=0.04) and HDL-cholesterol (42.3±11.6 vs 48.4±13.2mg/dL; p=0.0001). In first or recurrent events were found, respectively, total cholesterol 179.1±43.1 and 174.5±44.1 (p<0.05), LDL-cholesterol 116.5±38.4 and 110±36.5 (p=0.007), HDL-cholesterol 44.1±12.2 and 44.2±12.9 (p<0.05), and triglyceride 141.2±81.7 and 158.5±119.7 (p=0.03). Optimal levels of LDL-cholesterol and HDL-cholesterol were found in 14.1 and 11.6% of patients with recurrent episodes, respectively. CONCLUSIONS: While most patients admitted with first episode of acute coronary syndrome to the Toledo Health Area have a lipid profile according to current guidelines, only 10% of those with recurrent acute coronary syndrome presented optimal LDL-cholesterol and HDL-cholesterol levels, which suggest the need to be more aggressive in the lipids control.

Perfil lipídico en pacientes ingresados por síndrome coronario agudo en España: datos del área sanitaria de Toledo entre los años 2005 y 2008 / Lipid profile in patients admitted with acute coronary syndrome in Spain: data from Toledo health care area between 2005 and 2008

Introducción y objetivos. Evaluar el perfil lipídico de los pacientes ingresados por síndrome coronario agudo en Toledo entre 2005 y 2008. Métodos. Se estudiaron los niveles de colesterol total, colesterol unido a las lipoproteínas de baja densidad (cLDL), colesterol unido a las lipoproteínas de alta densidad (cHDL) y triglicéridos. Se realizó estadística descriptiva y comparación de medias. Resultados. De los 3.986 ingresados por síndrome coronario agudo, 1.381 pacientes tenían perfil lipídico completo. El 76,3% eran primeros episodios. La edad media fue 67,8 ± 12,9 años (72,4% hombres). El colesterol total medio (± DE) fue 180,0 ± 43,4, cLDL 115 ± 38,0, cHDL 44,1 ± 12,3, y triglicéridos 145,3 ± 92,4 mg/dl, con diferencias significativas entre hombres y mujeres en el cLDL (116,3 ± 37,8 vs 111,6 ± 38,5 mg/dl; p = 0,04) y cHDL (42,3 ± 11,6 vs 48,4 ± 13,2 mg/dl; p = 0,0001). En primeros episodios y episodios recurrentes se halló, respectivamente, colesterol total 179,1 ± 43,1 y 174,5 ± 44,1 (p < 0,05), cLDL 116,5 ± 38,4 y 110,0 ± 36,5 (p = 0,007), cHDL 44,1 ± 12,2 y 44,2 ± 12,9 (p < 0,05), y triglicéridos 141,2 ± 81,7 y 158,5 ± 119,7 mg/dl (p = 0,03). Se observaron niveles óptimos de cLDL y cHDL en el 14,1 y en el 11,6%, respectivamente, de los episodios recurrentes. Conclusiones. Aunque la mayoría de pacientes ingresados por primeros episodios de síndrome coronario agudo presenta un perfil lipídico adecuado, solo el 10% de pacientes con episodios recurrentes muestran niveles óptimos de c-LDL y c-HDL, lo que sugiere la necesidad de ser más rigurosos en el control lipídico (AU)

Introduction and objectives. To evaluate the lipid profile of patients admitted with acute coronary syndrome in Toledo (Spain) between 2005 and 2008. Methods. Total cholesterol, LDL-cholesterol, HDL-cholesterol and triglyceride levels were evaluated. Descriptive analyses and means comparison were performed. Results. 1,381 patients of 3,986 admitted with acute coronary syndrome had a complete lipid profile. The mean age was 67.8 ± 12.9 years (72.4% men). A first event was present in 76.3%. The mean total cholesterol (±SD) was 180.0 ± 43.4, LDL-cholesterol 115 ± 38.0, HDL-cholesterol 44.1 ± 12.3, and triglyceride 145.3 ± 92.4 mg/dL, with statistically significant differences between men and women in LDL-cholesterol (116.3 ± 37.8 vs 111.6 ± 38.5 mg/dL; p = 0.04) and HDL-cholesterol (42.3 ± 11.6 vs 48.4 ± 13.2 mg/dL; p = 0.0001). In first or recurrent events were found, respectively, total cholesterol 179.1 ± 43.1 and 174.5 ± 44.1 (p < 0.05), LDL-cholesterol 116.5 ± 38.4 and 110 ± 36.5 (p = 0.007), HDL-cholesterol 44.1 ± 12.2 and 44.2 ± 12.9 (p < 0.05), and triglyceride 141.2 ± 81.7 and 158.5 ± 119.7 (p = 0.03). Optimal levels of LDL-cholesterol and HDL-cholesterol were found in 14.1 and 11.6% of patients with recurrent episodes, respectively. Conclusions. While most patients admitted with first episode of acute coronary syndrome to the Toledo Health Area have a lipid profile according to current guidelines, only 10% of those with recurrent acute coronary syndrome presented optimal LDL-cholesterol and HDL-cholesterol levels, which suggest the need to be more aggressive in the lipids control (AU)

[Medical conduct in primary care as regards blood pressure control. PRESCAP 2010 study]. / Conducta del médico de atención primaria ante el mal control de la hipertensión arterial. Estudio PRESCAP 2010.

INTRODUCTION: There is a need for more information on therapeutic inertia in blood pressure (BP) treatment. The purpose of this study was to determine the therapeutic behaviour and associated factors of Primary Care (PC) physicians on uncontrolled hypertensive patients. PATIENTS AND METHODS: Cross-sectional multicentre study of patients with hypertension attending Spanish PC centres. Data was collected from patients (social-demographics, clinical status and treatment), as well as data from physicians (medical practice, background and therapeutic behaviour) were collected. Uncontrolled BP was considered when average BP values where ≥140/90mmHg. RESULTS: A total of 12,961 patients (52.0% women) were included. The mean age was 66.3 (SD 11.4) years, and mean number of years from diagnosis of hypertension was 9.1 (6.7) years. Almost two-thirds (62.4%) of the patients were taking a combined blood pressure treatment, (44.2% with two drugs and 18.2% with three drugs, or more). An uncontrolled BP was observed in 38.9% (95% CI: 38.1-39.7) of patients. Treatment was changed by physicians in 41.8% (95% CI: 40.4-43.2) out of 5,036 uncontrolled patients. Adding another drug was the most frequent behaviour (55.6%). The physician's perception of good BP control in uncontrolled patients, together with the presence of combined blood pressure treatment, were the two variables most strongly associated with therapeutic inertia. CONCLUSIONS: The Spanish PC Physician modified antihypertensive treatment in only 4 out of 10 uncontrolled patients. The physician's perception of good BP control was the variable most strongly associated with therapeutic inertia.

Generadores de radiofrecuencia disponibles en el mercado español / No disponible

En España se ha producido un incremento en la realización de Técnicas de Radiofrecuencia (RF), como muestra la reciente encuesta publicada en la Revista Española del Dolor. Desde el Grupo de Interés de la Sociedad Española hemos querido difundir la RF mediante la realización de cursos. Una pregunta repetida en los cursos era ¿Qué "aparatos de RF" existen? En el presente artículo no hemos querido valorar cuáles eran mejores o peores, sino describir sus características técnicas más relevantes. Objetivos: analizar los diferentes generadores de ondas de radiofrecuencia presentes en el mercado español (AU)

There has been an important increase in radiofrequency procedures in Spain during the past five years. The Spanish Society RF Interest Group has always wanted to spread the use of RF techniques among pain practitioners. In this paper we analyze the different RF generators available in the spanish market, with their most relevant technical features (AU)

Situación actual de la radiofrecuencia en España / No disponible

Introducción: el tratamiento de procesos dolorosos agudos y crónicos puede ser todo un reto para el personal médico. Se han desarrollado numerosas técnicas farmacológicas e invasivas para tratar el dolor. Dentro de estas últimas se sitúan las técnicas de radiofrecuencia. La radiofrecuencia (RF) es una técnica mínimamente invasiva cuyo uso se está implementando en las unidades del dolor, neurocirugía y traumatología de toda Europa. Objetivos: valorar la situación de la radiofrecuencia en el estado español. Material y métodos: se realizó una encuesta remitida a las unidades del dolor de España a lo largo de 2010. Población diana: Unidades del Dolor incluidas en el directorio de la Sociedad Española del Dolor (SED). Resultados: aunque de las 119 encuestas enviadas se recogieron tan solo 59 (49,57%), se sobreentiende que las 60 (50,43%) restantes o no están interesadas por contestar la encuesta o no están realizando técnicas de RF. Teniendo en cuenta este posible sesgo de selección, se puede concluir que un 39,49% de las Unidades del Dolor del directorio de la SED realizan técnicas de RF. La media de pacientes sometidos a procedimientos de RF es de 23 al mes, con un máximo de 60 y un mínimo de 2. Las técnicas más frecuentemente realizadas son RF de Facetas Lumbares y RF de Nervios Periféricos. El 85% de los centros que realizan RF han recibido formación específica en estas técnicas. El 95% de los centros que realizan RF estarían interesados en recibir o mejorar esta formación (AU)

Introduction: the use of minimally invasive techniques to treat patients with pain is a common practice in the field of medicine. Multiple percutaneous and minimally invasive techniques to treat moderate to severe pain have been introduced recently. Radiofrequency is one of these minimally invasive techniques that has grown substantially over the past decade in pain units, orthopaedic surgery units, radiology units and neurosurgery units. Objective: to evaluate the situation of radiofrequency procedures in Spain. Material and methods: a national survey was sent to the pain units in Spain through 2010. Results: 119 surveys were sent. Only 59 were completed. 60 didn’t answer the survey. Admitting this conclusion can be a bias, at least 39% of the pain units in Spain are performing radiofrequency techniques. The mean number of procedures is 23 per month, with a maximum of 60 and a minimum of 2. The most frequently performed techniques are lumbar facet denervation and peripheral nerve pulsed radiofrequency. 85% of the pain units that perform Radiofrequency procedures had received specific training. 95% of the pain units are interested in receiving specific training for radiofrequency procedures (AU)

[Primary care physicians behaviour on hypertensive patients with poor blood pressure control. The PRESCAP 2006 study]. / Conducta del médico de Atención Primaria ante el mal control de los pacientes hipertensos. Estudio PRESCAP 2006.

INTRODUCTION: There is little information available on Therapeutic Inertia in Primary Care (PC). This study aimed to know the therapeutic behavior of the physician for uncontrolled hypertensive patients. PATIENTS AND METHODS: Cross-sectional, multicenter study that included hypertensive patients of both genders, under pharmacological treatment who were recruited consecutively in the PC out-patient clinic in all of Spain. Social-demographic, clinical and treatment data were recorded, as well as the motives for eventual therapeutic modification. Adequate BP control was considered when BP values were below 140/90 mmHg in general, and below 130/80 mmHg in diabetes, renal insufficiency or cardiovascular disease. RESULTS: A total of 10,520 patients (53.7% women) were included with average age of 64.6 (11.3 years). Of these, 44.4% the patients were receiving monotherapy and 55.6% were treated with combined therapy (two drugs 41.2%, three drugs 11.7%, and more than three 2.8%). Uncontrolled hypertension was found in 58.6% (95% CI. 57.6-59.5) of the patients. Treatment was modified by physicians in 30.4% (95% CI. 29.2-31.6) of the uncontrolled patients, combination with another drug being the most frequent behavior (46.3%), followed by dose increase (26.1%), and antihypertensive drug switch (22.8%). The perception of the physician of good BP control was the factor most associated with not modifying the treatment in uncontrolled patients. CONCLUSIONS: Study results showed that the PC physician modified antihypertensive treatment in only 3 out of 10 uncontrolled patients. When treatment modification was made, association of drugs was the most frequent behavior.

Intravitreal bevacizumab (Avastin) for choroidal neovascularisation secondary to pathological myopia: 6-month results.

BACKGROUND: To determine the efficacy and safety of intravitreal Avastin (bevacizumab) in the treatment of choroidal neovascularisation (CNV) secondary to pathological myopia (PM). METHODS: This paper reports on a consecutive prospective study of patients with CNV secondary to PM who were treated with intravitreal bevacizumab (1.25 mg/0.05 ml). Patients underwent complete ophthalmic evaluation, which included best-corrected visual acuity testing measured with Early Treatment Diabetic Retinopathy Study charts, optical coherence tomography (OCT), and fluorescein angiography. RESULTS: There were 17 eyes of 17 patients, and the mean age was 55.4 (SD 10.0) years. At the 6-month follow-up, the mean visual acuity improved by 8.4 letters (p = 0.04). Forty-one per cent of patients increased at least one line, and 17% increased more than six lines. There were no cases of moderate vision loss (>or=3 lines) or severe vision loss (>or=6 lines). The mean OCT foveal thickness decreased by 79.6 mum (p = 0.002). Favourable outcomes were obtained in all subgroups. Patients received an average of one injection. As a complication, there was a tear of the retinal pigment epithelium. No other ocular or systemic side effects were observed. CONCLUSION: In our study, intravitreal bevacizumab appeared to be safe and efficacious in eyes with CNV secondary to PM.

[Multiple neoplasms in patients with uveal melanoma]. / Neoplasias múltiples en pacientes afectos de melanoma de úvea.

PURPOSE: To study the prevalence of multiple neoplasms in patients affected by uveal melanoma in Spain and to relate these with survival. METHOD: We carried out a longitudinal prospective study of the prevalence of multiple neoplasms in patients diagnosed to have a uveal melanoma during the years 1984-2005. The data has been analysed for the following variables: age, sex, date of diagnosis, affected eye, origin and tumoral size, classification according to COMS (Collaborative Ocular Melanoma Study), time of follow-up, presence of other neoplasms, current clinical state, date and cause of death. RESULTS: Three hundred and five patients affected by uveal melanoma have been studied in the Ocular Oncology Unit of our institution; 24 patients (7.9%) had evidence in their medical reports of one or more additional neoplasms. Excluding cutaneous neoplasms originating in basal cells, this number reduced to 22 patients (7.2%). We did not find any statistically significant differences among the presentation age, sex or localization of the melanoma (ciliary body or choroid) and the presence or absence of a second neoplasm. When we analysed the proportion of patients with metastatic disease (both alive and dead) who presented with a second neoplasm (40.9%), we found a statistically significant relationship between these variables (Chi-square test, p=0.004). CONCLUSIONS: We have observed a percentage of second neoplasms similar to that described in other international studies. We did not find a larger proportion with a second neoplasm according to the sex, age, or tumoral localization, nor did we observe a higher frequency of any particular second neoplasm. We have defined a relationship between metastasic uveal melanoma, and the development of a second neoplasm, which clearly indicates a need for increased systemic follow-up in such patients.