ABSTRACT
The purpose of this study was to calculate and compare individual cardiovascular risk (CVR) and the development of cardiovascular events and mortality in patients with and without ocular pseudoexfoliation (PEX). A cohort study was carried out to compare two groups of patients who underwent cataract surgery: patients with (n = 99) and without PEX (n = 239). The CVR factors were recorded for all the subjects, and CVR was calculated for each individual using ERICE risk assessment charts. After a six-year follow-up, the cardiovascular events and mortality rates were compared between the two groups. The mean CVR was 36.41% in the PEX group and 33.72% in the non-PEX group (p = 0.13). High blood pressure was detected in significantly more PEX patients (71.4%) than non-PEX patients (58.6%, p = 0.035), yet no differences were found in the other CVR factors. The prevalence of cardiovascular events in the PEX and non-PEX patients was 17.1% and 12.5%, respectively (p = 0.26), with 5% of patients in the PEX group and 5% in the non-PEX group suffering an acute coronary event (p = 0.9). Moreover, 12% of the PEX patients and 7.5% of the non-PEX patients experienced a stroke (p = 0.17), and the six-year mortality rate was 29.3% in the PEX group and 25.9% in the non-PEX group (p = 0.52). PEX was associated with high blood pressure in our cohort of patients, although cardiovascular risk was not shown to be higher in this group. In addition, patients with PEX did not experience more cardiovascular events or have a higher mortality rate than patients without PEX during the period studied.
ABSTRACT
BACKGROUND: The objective of this study is to evaluate the antihypertensive effect of bedtime administration of low doses of aspirin in patients with treated hypertension and high cardiovascular risk on low-dose aspirin for secondary prevention, in order to optimize their usual treatment and reduce their cardiovascular risk. METHODS/DESIGN: This is a prospective phase IV multicentre, randomised, triple-blind, placebo-controlled, cross-over clinical trial. We will include 258 individuals with hypertension treated with low-dose aspirin for secondary prevention. These patients will be randomly recruited, by approximately 40 primary care physicians collaborating in the study, mainly in the Guipúzcoa West, Bilbao and Barcelona areas. The 258 patients will be randomly allocated to treatments to create two comparable groups. In the first period, the intervention group will take aspirin at night and placebo in the morning, while the control group will take their aspirin in the morning and placebo in the evening for 2 months. After a washout period of 15 to 30 days, there will be a second 2-month period for which groups will swap treatments. Participants will undergo ambulatory blood pressure monitoring at baseline, at the end of first period and then again at the beginning and end of the second period. The main outcome measure is the change in mean blood pressure over 24 h, and as secondary outcomes we will also assess changes in systolic and diastolic blood pressure, during the day and night, and the relationship between them. Lastly, we will explore whether non-dipper patients convert into dippers with the intervention. DISCUSSION: The goal of this research is to provide the scientific basis for indicating a change in the time of aspirin administration from morning to evening, by primary health practitioners, to improve the patient control of blood pressure and more effectively reduce their cardiovascular risk, by combining this hypotensive effect with the well-known anti-platelet effect of low-dose aspirin. TRIAL REGISTRATION: ClinicalTrials.gov NCT01741922.
Subject(s)
Antihypertensive Agents/administration & dosage , Aspirin/administration & dosage , Blood Pressure/drug effects , Circadian Rhythm , Hypertension/drug therapy , Platelet Aggregation Inhibitors/administration & dosage , Research Design , Secondary Prevention/methods , Blood Pressure Monitoring, Ambulatory , Clinical Protocols , Cross-Over Studies , Drug Administration Schedule , Humans , Hypertension/diagnosis , Hypertension/physiopathology , Prospective Studies , Spain , Time Factors , Treatment OutcomeABSTRACT
OBJECTIVE: To determine the validity of Spirometry tests done in primary care in our province and to find in what parts of the test errors are committed. DESIGN: Transversal, descriptive study. SETTING: All the primary care units in the province of Gipuzkoa, Spain. PARTICIPANTS: Thirty of the 44 existing units took part, contributing the last 10 spirometry tests conducted in November, 2005. MAIN MEASUREMENTS: Two primary care doctors who were skilled in spirometry analysed the acceptability, reproducibility, possible utility of invalid tests and their spirometric patterns. They also looked at aspects of the curve that were not sufficient. Tests were considered acceptable, reproducible and possibly useful when the 2 doctors coincided. Where they did not coincide, these characteristics were determined by a pneumologist. The validity criteria of the ATS were followed. RESULTS: Of the 44 units in our province, 30 took part. They contributed 300 spirometry tests, of which 12 were excluded as illegible. A total of 48% were considered acceptable, 78% met reproducibility criteria and 38.5% met both characteristics. The most common error was the scant length of exhalation, insufficient in 38.19% of cases. The most usual pattern found was the normal one with 58%, followed by the restrictive with 18%, the obstructive with 13%, and the mixed one, with 11%. CONCLUSIONS: Quality of spirometry tests in primary care is deficient. The most common error is that exhalation is too brief. We think this is why we find a predominance of restrictive patterns over obstructive ones. Just by prolonging the spirometry operation, we would manage to increase markedly the number of valid tests.
Subject(s)
Primary Health Care , Spirometry/standards , Adolescent , Adult , Aged , Aged, 80 and over , Child , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , SpainABSTRACT
Objetivo. Determinar la validez de las espirometrías realizadas en atención primaria en nuestra provincia y conocer en qué aspectos de la maniobra se cometen los errores. Diseño. Estudio descriptivo, transversal. Emplazamiento. Provincia de Guipúzcoa. Participantes. Participaron 30 de las 44 unidades existentes aportando las últimas 10 espirometrías. Mediciones principales. Dos médicos de atención primaria analizaron las espirometrías siguiendo los criterios de validez de la American Thoracic Society. Un neumólogo revisó los resultados no coincidentes. Resultados. De las 300 espirometrías analizadas se excluyeron 12 por ser ilegibles. El 48% fueron aceptables, un 78% reunía criterios de reproducibilidad y un 38,5% reunía ambas características. El patrón más habitual era el normal con un 58%, seguido del restrictivo con un 18%, el obstructivo un 13% y el mixto un 11%. El error más frecuente (38,19%) era la escasa prolongación de la espiración. Conclusiones. La calidad de las espirometrías realizadas en atención primaria es deficiente. El error más frecuente es la brevedad de la espiración, por ello encontramos un predominio de patrones restrictivos. Simplemente prolongando la maniobra espiratoria se conseguiría aumentar considerablemente el número de espirometrías válidas
Objective. To determine the validity of Spirometry tests done in primary care in our province and to find in what parts of the test errors are committed. Design. Transversal, descriptive study. Setting. All the primary care units in the province of Gipuzkoa, Spain. Participants. Thirty of the 44 existing units took part, contributing the last 10 spirometry tests conducted in November, 2005. Main measurements. Two primary care doctors who were skilled in spirometry analysed the acceptability, reproducibility, possible utility of invalid tests and their spirometric patterns. They also looked at aspects of the curve that were not sufficient. Tests were considered acceptable, reproducible and possibly useful when the 2 doctors coincided. Where they did not coincide, these characteristics were determined by a pneumologist. The validity criteria of the ATS were followed. Results. Of the 44 units in our province, 30 took part. They contributed 300 spirometry tests, of which 12 were excluded as illegible. A total of 48% were considered acceptable, 78% met reproducibility criteria and 38.5% met both characteristics. The most common error was the scant length of exhalation, insufficient in 38.19% of cases. The most usual pattern found was the normal one with 58%, followed by the restrictive with 18%, the obstructive with 13%, and the mixed one, with 11%. Conclusions. Quality of spirometry tests in primary care is deficient. The most common error is that exhalation is too brief. We think this is why we find a predominance of restrictive patterns over obstructive ones. Just by prolonging the spirometry operation, we would manage to increase markedly the number of valid tests
