Prevalencia de la enfermedad renal crónica y factores asociados en la población asistida en atención primaria de España: resultados del estudio IBERICAN / Prevalence of chronic kidney disease and associated factors in the Spanish population attended in primary care: Results of the IBERICAN study

Objetivos: Conocer la prevalencia de enfermedad renal crónica (ERC) y determinar los factores asociados al deterioro de la función renal en población asistida en atención primaria.Pacientes y métodoEstudio transversal y multicéntrico realizado en los pacientes basales del estudio IBERICAN (identificación de la población española de riesgo cardiovascular y renal). Se consideró ERC a un filtrado glomerular estimado (FGe)<60ml/min/1,73m2 o albuminuria elevada (≥30mg/g). Según el FGe se clasificó la ERC en 6 estadios (1, 2, 3a, 3b, 4 y 5) y según la albuminuria en 3 (A1 o normal/ligeramente aumentada, A2 o moderadamente aumentada y A3 o gravemente aumentada). Se analizaron las características clínicas y la relación de la ERC con los principales factores de riesgo cardiovascular (FRCV) y otras variables de interés mediante regresión logística no condicional.ResultadosSe incluyeron 7.895 pacientes (edad media 57,9±14,8 años; 54,5% mujeres). El 14,4% (IC 95%: 13,6-15,1) presentaba ERC; en hombres un 16,1% (IC 95%: 14,9-17,3) y en mujeres un 12,9% (IC 95%: 11,9-14,0). Se observó un aumento continuo de la prevalencia con la edad (24,8%≥65años) y con la agregación de FRCV. Las variables que más se asociaron a la probabilidad de padecer ERC fueron hipertrofia ventricular izquierda (OR: 1,95; p<0,001), diabetes (OR: 1,58; p<0,001) e hipertensión (OR: 1,56; p<0,001).ConclusionesCatorce de cada 100 pacientes incluidos en el estudio IBERICAN presenta ERC. La prevalencia de ERC afecta a la cuarta parte de pacientes≥65 años y aumenta exponencialmente con la agregación de FRCV. (AU)

Objectives: To determine the prevalence of chronic kidney disease (CKD) and the factors associated with impaired renal function in the population attended in primary care (PC).Patients and methodCross-sectional and multicentre study carried out in the baseline patients of the IBERICAN study (Identificación de la poBlación Española de RIesgo CArdiovascular y reNal). CKD was considered with an estimated glomerular filtration (eGF) <60ml/min/1.73 m2 or elevated albuminuria (≥ 30mg/g). According to the eGF, the CKD was classified in six stages (1, 2, 3a, 3b, 4 and 5) and according to albuminuria in three stages (A1 or normal / slightly increased, A2 or moderately increased and A3 or severely increased). The clinical characteristics and the relationship of CKD with the main cardiovascular risk factors (CVRF) and other variables of interest were analysed using unconditional logistic regression.Results7,895 patients were included (mean age 57.9±14.8 years; 54.5% women). 14.4% (95% CI: 13.6-15.1) had CKD; 16.1% (95% CI: 14.9-17.3) in men and 12.9% (95% CI: 11.9-14.0) in women. A continuous increase of the prevalence was observed with age (24.8% in≥65 years) and with CVFR aggregation. The variables that were most associated with the probability of suffering CKD were left ventricular hypertrophy (OR: 1.95; p <.001), diabetes (OR: 1.58; P<.001) and hypertension (OR: 1.56; P<.001).ConclusionsFourteen out of every 100 patients included in the IBERICAN study have CKD. The prevalence of CKD affects a quarter of patients ≥ 65 years and increases exponentially with the aggregation of FRCV. (AU)

Prevalence of chronic kidney disease and associated factors in the Spanish population attended in primary care: Results of the IBERICAN study. / Prevalencia de la enfermedad renal crónica y factores asociados en la población asistida en atención primaria de España: resultados del estudio IBERICAN.

OBJECTIVES: To determine the prevalence of chronic kidney disease (CKD) and the factors associated with impaired renal function in the population attended in primary care (PC). PATIENTS AND METHOD: Cross-sectional and multicentre study carried out in the baseline patients of the IBERICAN study (Identificación de la poBlación Española de RIesgo CArdiovascular y reNal). CKD was considered with an estimated glomerular filtration (eGF) <60ml/min/1.73 m2 or elevated albuminuria (≥ 30mg/g). According to the eGF, the CKD was classified in six stages (1, 2, 3a, 3b, 4 and 5) and according to albuminuria in three stages (A1 or normal / slightly increased, A2 or moderately increased and A3 or severely increased). The clinical characteristics and the relationship of CKD with the main cardiovascular risk factors (CVRF) and other variables of interest were analysed using unconditional logistic regression. RESULTS: 7,895 patients were included (mean age 57.9±14.8 years; 54.5% women). 14.4% (95% CI: 13.6-15.1) had CKD; 16.1% (95% CI: 14.9-17.3) in men and 12.9% (95% CI: 11.9-14.0) in women. A continuous increase of the prevalence was observed with age (24.8% in≥65 years) and with CVFR aggregation. The variables that were most associated with the probability of suffering CKD were left ventricular hypertrophy (OR: 1.95; p <.001), diabetes (OR: 1.58; P<.001) and hypertension (OR: 1.56; P<.001). CONCLUSIONS: Fourteen out of every 100 patients included in the IBERICAN study have CKD. The prevalence of CKD affects a quarter of patients ≥ 65 years and increases exponentially with the aggregation of FRCV.

Mean Blood Pressure of the General Population with the Mean of Three Measurements Versus the Mean of the Second and Third Measurements. Ricarto Study.

INTRODUCTION: Our aim was to determine the difference between measuring blood pressure (BP) with the mean of three determinations versus the mean of the second and the third determinations in a random general population sample. METHODS: Epidemiological study of the general population aged ≥ 18 from the Health Area of Toledo (Spain), based on the health card database. Three readings of systolic and diastolic BP were taken with validated oscillometric devices OMRON HEM-907. The mean of the three readings was compared with the mean of the second and third readings after discarding the first measurement. We analyzed age, sex, BMI, abdominal obesity, dyslipidemia, diabetes mellitus, smoking and sedentary lifestyle. A descriptive study was conducted, as well as the agreement in the diagnosis of hypertension. RESULTS: 1532 subjects were analyzed (mean age 49.01 ± 15.79 years old, 55.5% women). Response rate 36.3%. The mean systolic BP with three readings was 125.39 ± 17.43 mmHg, versus 124.33 ± 17.07 mmHg with the mean of the second and third readings (mean difference 1.01 ± 4.31; Cohen's D = 0.059). The mean diastolic BP was 73.93 ± 10.89 versus 73.71 ± 10.93 mmHg with both methods (mean difference 0.19 ± 2.11; Cohen's D = 0.017). Differences by age, sex, BMI, abdominal obesity, dyslipidemia, diabetes, smoking and sedentary lifestyle were all small (Cohen's D < 0.08). The agreement between both models for classifying subjects as hypertensive/non-hypertensive showed a Kappa value = 0.936 (McNemar's test p < 0.001). CONCLUSIONS: Determining the mean of three readings of BP does not make a significant difference in relation to the reading of the second and third measurements in a sample of general population.

Impacto de la guía de HTA del ACC/AHA en la frecuencia y la necesidad de tratamiento de la hipertensión arterial. Estudio RICARTO / Impact of the ACC/AHA AHT guidelines on the frequency of hypertension and the need for treatment. The RICARTO study

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Características basales y manejo clínico de los primeros 3.000 pacientes incluidos en el estudio IBERICAN (Identificación de la población española de riesgo cardiovascular y renal) / Baseline characteristics and clinical management of the first 3.000 patients enrolled in the IBERICAN study (Identification of the Spanish population at cardiovascular and renal risk)

Objetivos. Determinar la prevalencia y la incidencia de los factores de riesgo cardiovascular en España, así como de los eventos cardiovasculares, en población adulta española asistida en atención primaria. Metodología. IBERICAN es un estudio longitudinal, observacional y multicéntrico en el que se están incluyendo pacientes de 18 a 85años atendidos en las consultas de atención primaria en España. La cohorte obtenida se seguirá anualmente durante al menos 5años. La muestra final estimada es de 7.000 pacientes. Se presentan las características basales del segundo corte (n=3.042). Resultados. La edad media de los sujetos incluidos es de 57,9±14,6años, y el 55,5% son mujeres. El 54,9% viven en un hábitat urbano, y el 57,3% tienen estudios primarios. El 50,3% tienen dislipidemia, el 47,4% hipertensión arterial, el 29,7% sedentarismo, el 28,2% obesidad abdominal y el 19% diabetes mellitus. El grado de control de hipertensión arterial, dislipidemia y diabetes mellitus tipo2 fue del 58,5, del 25,8 y del 75,9%, respectivamente. El 28,2% cumplen criterios de síndrome metabólico. El 15,6% de los pacientes presentaban una enfermedad cardiovascular previa. El 7,8% tienen antecedentes de cardiopatía isquémica, el 8,4% de filtrado glomerular (CKD-EPI) <60ml/min, el 9,6% de microalbuminuria, el 5,5% de fibrilación auricular, el 4,6% de ictus y el 2,9% de insuficiencia cardiaca. Conclusiones. A pesar de que la población atendida en atención primaria es relativamente joven, la elevada prevalencia de factores de riesgo, su mal control y la existencia de patología cardiovascular previa condicionarán el impacto en el pronóstico de la cohorte (AU)

Objectives. To determine the prevalence and incidence of cardiovascular risk factors in Spain, as well as cardiovascular events, in Spanish adult population attended in primary care. Methodology. IBERICAN is a longitudinal, observational, multicenter study in which patients aged 18 to 85years attended in primary care health center in Spain are being included. The obtained cohort will be followed annually for at least 5years. The estimated final sample is 7,000 patients. The baseline characteristics of the second cut (n=3,042) are presented. Results. The mean age of the subjects included is 57.9±14.6 years, and 55.5% are women. 54.9% live in urban habitat, and 57.3% have primary education. 50.3% had dyslipidemia, 47.4% hypertension, 29.7% physical inactivity, 28.2% abdominal obesity and 19% diabetes mellitus. The degree of control of hypertension, dyslipidemia and type2 diabetes was 58.5%, 25.8% and 75.9%. 28.2% have criteria for metabolic syndrome. 15.6% of patients had previous cardiovascular disease. 7.8% have a history of coronary heart disease, a glomerular filtration rate <60ml/min (CKD-EPI) 8.4%, microalbuminuria 9.6%, atrial fibrillation 5.5%, stroke 4.6%, and heart failure 2.9%. Conclusions. Although the population treated in primary care is relatively young, the high prevalence of risk factors, their poor control and the existence of previous cardiovascular disease will determine the impact on the prognosis of the cohort (AU)

Diferencias de presión arterial entre una toma y la media de 3 tomas medidas automáticamente. Estudio SPRINT / Blood pressure differences between one automatic measurement and the mean value of 3 automatic measurements. SPRINT trial

Fundamento y objetivos: Existe discrepancia sobre cómo medir la presión arterial (PA). El objetivo de este trabajo fue estudiar la diferencia entre una determinación y la media de 3 determinaciones automáticas de la PA. Pacientes y método: Se utilizan 2 poblaciones de pacientes: una muestra poblacional (n=1.337) en la que la medición se realiza por una enfermera en el centro de salud, y una serie consecutiva de pacientes en los que se realiza delante del médico, en la consulta (n=200). Resultados: Las diferencias halladas entre la primera lectura y el promedio de 3 determinaciones son pequeñas en ambos casos. En la muestra poblacional oscila entre 2,07-3,21mmHg y en los pacientes en los que se determina en presencia del médico, es de 2,71±3,82mmHg en la sistólica, con mínimas diferencia en la PA diastólica. Conclusiones: En la determinación automática de la PA, existe escasa diferencia entre la primera determinación y el promedio de 3 lecturas (AU)

Background and objectives: There are discrepancies regarding how to measure blood pressure (BP). The goal of this study was to determine the differences between one automatic BP measurement and the mean of 3 automatic BP measurements. Patients and method: Two patient populations were used. A sample population (n=1,337) in which the measurement was performed by a nurse at the health center, and a consecutive series of patients (n=200) who had the measurement performed in front of the doctor in the office. Results: The differences found between the first reading and the average of 3 determinations were small in both cases. In the population sample, BP levels ranged from 2.07 to 3.21mmHg, and in patients who had their BP levels measured in the presence of doctor, this value ranged from 2.71±3.82mmHg (systolic pressure), with minimal differences in diastolic BP levels. Conclusions: Little difference was found between the first determination and the average of 3 automatic BP readings (AU)

Blood pressure differences between one automatic measurement and the mean value of 3 automatic measurements. SPRINT trial. / Diferencias de presión arterial entre una toma y la media de 3 tomas medidas automáticamente. Estudio SPRINT.

BACKGROUND AND OBJECTIVES: There are discrepancies regarding how to measure blood pressure (BP). The goal of this study was to determine the differences between one automatic BP measurement and the mean of 3 automatic BP measurements. PATIENTS AND METHOD: Two patient populations were used. A sample population (n=1,337) in which the measurement was performed by a nurse at the health center, and a consecutive series of patients (n=200) who had the measurement performed in front of the doctor in the office. RESULTS: The differences found between the first reading and the average of 3 determinations were small in both cases. In the population sample, BP levels ranged from 2.07 to 3.21mmHg, and in patients who had their BP levels measured in the presence of doctor, this value ranged from 2.71±3.82mmHg (systolic pressure), with minimal differences in diastolic BP levels. CONCLUSIONS: Little difference was found between the first determination and the average of 3 automatic BP readings.

[Baseline characteristics and clinical management of the first 3,000 patients enrolled in the IBERICAN study (Identification of the Spanish population at cardiovascular and renal risk)]. / Características basales y manejo clínico de los primeros 3.000 pacientes incluidos en el estudio IBERICAN (Identificación de la población española de riesgo cardiovascular y renal).

OBJECTIVES: To determine the prevalence and incidence of cardiovascular risk factors in Spain, as well as cardiovascular events, in Spanish adult population attended in primary care. METHODOLOGY: IBERICAN is a longitudinal, observational, multicenter study in which patients aged 18 to 85years attended in primary care health center in Spain are being included. The obtained cohort will be followed annually for at least 5years. The estimated final sample is 7,000 patients. The baseline characteristics of the second cut (n=3,042) are presented. RESULTS: The mean age of the subjects included is 57.9±14.6 years, and 55.5% are women. 54.9% live in urban habitat, and 57.3% have primary education. 50.3% had dyslipidemia, 47.4% hypertension, 29.7% physical inactivity, 28.2% abdominal obesity and 19% diabetes mellitus. The degree of control of hypertension, dyslipidemia and type2 diabetes was 58.5%, 25.8% and 75.9%. 28.2% have criteria for metabolic syndrome. 15.6% of patients had previous cardiovascular disease. 7.8% have a history of coronary heart disease, a glomerular filtration rate <60ml/min (CKD-EPI) 8.4%, microalbuminuria 9.6%, atrial fibrillation 5.5%, stroke 4.6%, and heart failure 2.9%. CONCLUSIONS: Although the population treated in primary care is relatively young, the high prevalence of risk factors, their poor control and the existence of previous cardiovascular disease will determine the impact on the prognosis of the cohort.