Definición de los rangos de referencia de T4 libre, TSH y tiroglobulina en sujetos sanos del Distrito Sanitario de Jaén / Definition of reference ranges for free T4, TSH, and thyroglobulin levels in healthy subjects of the Jaén Health District

Antecedentes y objetivos: Las guías de tratamiento de disfunción tiroidea recomiendan definir los intervalos de referencia de las hormonas tiroideas de cada área mediante la evaluación de datos de población local considerando el grado de nutrición yódica de la misma. El objetivo de este estudio fue definir los rangos de referencia de la tiroxina libre (T4L), TSH y tiroglobulina en población general de Jaén, área con un nivel de nutrición yódica adecuado, y si estos estaban afectados por la yoduria. Material y métodos: Estudio descriptivo transversal realizado en 1.003 sujetos de población general en el Distrito Sanitario de Jaén. El yodo urinario, T4L, TSH, tiroglobulina y los anticuerpos antitiroperoxidasa (anti-TPO) fueron analizados en función de la edad y el sexo. Resultados: La mediana de yoduria fue 110,59μg/l y la media 130,11μg/l. La mediana de TSH fue 1,83μUI/ml (p2,5=0,56μUI/ml, p97,5=4,66μUI/ml). La mediana de T4L fue 0,84ng/dl (p2,5=0,62ng/dl, p97,5=1,18ng/dl). El 5,7% de los sujetos tenían anticuerpos anti-TPO positivos. No existía correlación entre los valores de T4L, TSH ni los anticuerpos anti-TPO con los niveles de yoduria. Los sujetos con anticuerpos anti-TPO positivos tenían una TSH más elevada (3,34μUI/ml frente 2,14μUI/ml; p=0,001; odds ratio=2,42). Conclusiones: El yodo urinario en Jaén está dentro de los valores recomendados por la Organización Mundial de la Salud. Los rangos de referencia de T4L, TSH y tiroglobulina no son diferentes a lo descrito en la literatura y no difieren según la yoduria. La prevalencia de anticuerpos anti-TPO positivos es semejante a la descrita en otras poblaciones de España (AU)

Background and objectives: The treatment guidelines for thyroid dysfunction recommend defining reference ranges for thyroid hormones in each area through assessment of local population data considering the iodine nutritional status. The aim of this study was to define the reference ranges of free thyroxine (FT4), TSH, and thyroglobulin levels in a general population from Jaen, an area of southern Spain with an adequate iodine nutritional status, and whether they were associated with urinary iodine levels. Patients and methods: A cross-sectional study was conducted in 1,003 subjects of the general population of the Jaen Health District. Levels of urinary iodine, FT4, TSH, thyroglobulin, and thyroid peroxidase (TPO) antibodies were measured according to age and sex. Results: Median and mean urinary iodine levels were 110.59μg/L and 130.11μg/L respectively. Median TSH level was 1.83μIU/mL (p2.5=0.56μIU/mL, p97.5=4.66μIU/mL). Median FT4 level was 0.84ng/dL (p2.5=0.62ng/dL, p97.5=1.18ng/dL). TPO antibodies were detected in 5.7% of subjects. There was no correlation between urinary iodine levels and FT4, TSH or TPO antibodies. Subjects with positive TPO antibodies had higher TSH levels (3.34μIU/L versus 2.14μIU/mL, P=.001; odds ratio=2.42). Conclusions: Urinary iodine levels in Jaen are optimal according to World Health Organization standards. Reference ranges of FT4, TSH, and thyroglobulin do not differ from those reported in the literature and are no associated to urinary iodine levels. The prevalence of positive TPO antibodies was similar to that reported in other Spanish areas (AU)

Definition of reference ranges for free T4, TSH, and thyroglobulin levels in healthy subjects of the Jaén Health District. / Definición de los rangos de referencia de T4 libre, TSH y tiroglobulina en sujetos sanos del Distrito Sanitario de Jaén.

BACKGROUND AND OBJECTIVES: The treatment guidelines for thyroid dysfunction recommend defining reference ranges for thyroid hormones in each area through assessment of local population data considering the iodine nutritional status. The aim of this study was to define the reference ranges of free thyroxine (FT4), TSH, and thyroglobulin levels in a general population from Jaen, an area of southern Spain with an adequate iodine nutritional status, and whether they were associated with urinary iodine levels. PATIENTS AND METHODS: A cross-sectional study was conducted in 1,003 subjects of the general population of the Jaen Health District. Levels of urinary iodine, FT4, TSH, thyroglobulin, and thyroid peroxidase (TPO) antibodies were measured according to age and sex. RESULTS: Median and mean urinary iodine levels were 110.59µg/L and 130.11µg/L respectively. Median TSH level was 1.83µIU/mL (p2.5=0.56µIU/mL, p97.5=4.66µIU/mL). Median FT4 level was 0.84ng/dL (p2.5=0.62ng/dL, p97.5=1.18ng/dL). TPO antibodies were detected in 5.7% of subjects. There was no correlation between urinary iodine levels and FT4, TSH or TPO antibodies. Subjects with positive TPO antibodies had higher TSH levels (3.34µIU/L versus 2.14µIU/mL, P=.001; odds ratio=2.42). CONCLUSIONS: Urinary iodine levels in Jaen are optimal according to World Health Organization standards. Reference ranges of FT4, TSH, and thyroglobulin do not differ from those reported in the literature and are no associated to urinary iodine levels. The prevalence of positive TPO antibodies was similar to that reported in other Spanish areas.

Evaluación del estado de nutrición yódica en población general en la provincia de Jaén / Assessment of iodine nutritional status in the general population in the province of Jaén

ANTECEDENTES Y OBJETIVO: En Jaén se conoce que existe una deficiencia de yodo (DY) de leve a moderada, y que afecta tanto a escolares como a mujeres embarazadas. Se sabe que la DY es una de las causas principales de disfunción tiroidea y bocio, habiéndose establecido que una yodoprofilaxis adecuada en zonas yododeficientes, tanto en forma de sal yodada, leche y sus derivados, o la toma de suplementos yodados, en caso de gestación, conlleva una mejoría significativa de estos problemas. El objetivo de este estudio es evaluar el grado de nutrición yódica en población general en una zona catalogada como yododeficiente y sin que se hayan llevado a cabo, por el momento, campañas institucionales de yodoprofilaxis. MATERIAL Y MÉTODOS: Estudio descriptivo de corte transversal. Se ha realizado determinación de la yoduria en población general en el distrito sanitario de Jaén, separando en grupos según la edad y el género, y se ha encuestado sobre del consumo de sal yodada. RESULTADOS: La mediana de yoduria fue de 110,59 μg/l y la media de 130,11 μg/l. Se encuentran diferencias estadísticamente significativas en los niveles de yoduria en los escolares con respecto al resto de grupos de edad, siendo la media de yoduria en este grupo de 161,52 μg/l vs 109,33 μg/l en los mayores de 65 años. Encontramos que el 43% de la población tiene una yoduria menor de 100 μg/l y que en las mujeres, en el grupo de edad fértil, hay un 66,8% con niveles de yoduria inferior a 150 μg/l. CONCLUSIONES: la situación nutricional de yodo indicaría que se encuentra dentro de lo que se considera una nutrición adecuada, si bien encontramos que el porcentaje de población que presenta yodurias por debajo de 100 μg/l es aún muy elevado, y que la prevalencia del consumo de sal yodada en hogares es del 30,9%, muy por debajo de las recomendaciones de la OMS

BACKGROUND AND OBJECTIVE: Iodine deficiency affecting both pregnant women and schoolchildren has been reported in Jaén. Iodine deficiency is one of the leading causes of thyroid dysfunction and goiter, and adequate iodine prophylaxis with iodized salt, milk, and dairy products, or iodine supplementation have been shown to significantly improve iodine status in pregnancy. The purpose of this study was to assess iodine nutritional status in the general population of a iodine-deficient area with no previous institutional campaigns of iodine prophylaxis. MATERIAL AND METHODS: A descriptive, cross-sectional study. Urinary iodine levels were measured in subjects from the Jaén healthcare district. The data were stratified by sex and age groups, and a survey was conducted on iodized salt consumption. RESULTS: Median and mean urinary iodine levels were 110.59 mcg/L and 130.11 mcg/L respectively. Urinary iodine levels were significantly higher in schoolchildren as compared to other age groups (161.52 μg/L vs 109.33 μg/L in subjects older than 65 years). Forty-three percent of the population had urinary iodine levels less than 100 μg/L, and 68% of women of childbearing age had levels less than 150 μg/L. CONCLUSIONS: Iodine nutritional status appears to be adequate, but the proportion of the population with urinary iodine levels less than 100 μg/L is still very high, and iodized salt consumption is much less common than recommended by the WHO

Assessment of iodine nutritional status in the general population in the province of Jaén.

BACKGROUND AND OBJECTIVE: Iodine deficiency affecting both pregnant women and schoolchildren has been reported in Jaén. Iodine deficiency is one of the leading causes of thyroid dysfunction and goiter, and adequate iodine prophylaxis with iodized salt, milk, and dairy products, or iodine supplementation have been shown to significantly improve iodine status in pregnancy. The purpose of this study was to assess iodine nutritional status in the general population of a iodine-deficient area with no previous institutional campaigns of iodine prophylaxis. MATERIAL AND METHODS: A descriptive, cross-sectional study. Urinary iodine levels were measured in subjects from the Jaén healthcare district. The data were stratified by sex and age groups, and a survey was conducted on iodized salt consumption. RESULTS: Median and mean urinary iodine levels were 110.59 mcg/L and 130.11 mcg/L respectively. Urinary iodine levels were significantly higher in schoolchildren as compared to other age groups (161.52µg/L vs 109.33µg/L in subjects older than 65 years). Forty-three percent of the population had urinary iodine levels less than 100µg/L, and 68% of women of childbearing age had levels less than 150µg/L. CONCLUSIONS: Iodine nutritional status appears to be adequate, but the proportion of the population with urinary iodine levels less than 100µg/L is still very high, and iodized salt consumption is much less common than recommended by the WHO.

Concordancia entre observadores en el diagnóstico electrocardiográfico de la hipertrofia ventricular izquierda en hipertensos de Andalucía. Estudio PREHVIA / Interobserver agreement on electrocardiographic diagnosis of left ventricular hypertrophy in hypertensive patients in Andalusia. PREHVIA study

Objetivo: Estimar la concordancia en el diagnóstico de la hipertrofia ventricular izquierda electrocardiográfica (HVI-ECG) en sujetos hipertensos entre médicos de atención primaria (AP) y un cardiólogo experto.Diseño: Estudio transversal y multicéntrico.EmplazamientoCentros de AP de Andalucía.Participantes: 120 médicos de AP que mediante muestreo aleatorio seleccionaron a pacientes de 35 o más años con hipertensión arterial de al menos 6 meses de evolución.Mediciones principales: Se recogieron datos demográficos, de factores de riesgo y de enfermedades cardiovasculares. La HVI-ECG se evaluó aplicando los criterios de voltaje de Cornell, producto de Cornell y de Sokolow-Lyon. Los investigadores de AP realizaron una primera lectura y un cardiólogo, una segunda ciega.Resultados: Se estudió a 570 pacientes (media±desviación estándar de edad, 65±11 años; mujeres, 54,5%); la prevalencia de HVI-ECG fue del 13,7% (intervalo de confianza [IC] del 95%, 10,8-16,6; el 12,6% por Cornell y el 1,6% por Sokolow-Lyon). La concordancia en el diagnóstico de HVI-ECG entre el médico de AP y el cardiólogo fue 0,378 (IC del 95%, 0,272-0,486; desacuerdos en el 15,5% de los casos). Los investigadores de AP subestimaron levemente la prevalencia de HVI-ECG por Cornell y la sobreestimaron levemente por el criterio de Sokolow-Lyon; también fue baja la concordancia para cada uno de ellos (Cornell: κ=0,367; IC del 95%, 0,252-0,482; Sokolow-Lyon: κ=0,274; IC del 95%, 0,093-0,454).Conclusiones: La concordancia entre el diagnóstico de los médicos de AP y el cardiólogo es baja. Los resultados de este estudio indican la necesidad de mejorar la medición electrocardiográfica entre los médicos de AP; la utilización de sistemas informatizados podría ser una buena opción(AU)

Objective: To assess the agreement between Primary Care (PC) doctors and a cardiology specialist in diagnosing left ventricular hypertrophy in the electrocardiograph (LVH-ECG) in hypertensive patients.Design: Cross-sectional, multicentre study.Setting: Andalusian Primary Care Centres.Participants: A total of 120 PC doctors who using a random sample selected patients of 35 years or more with AHT of at least 6 months of progression.Primary variables: Demographic data, risk factors and cardiovascular diseases were recorded. The LVH-ECG was evaluated by applying Cornell voltage criteria, Cornell and Sokolow-Lyon product. The PC researchers read the ECG first and the cardiologist made a second reading blind.Results: A total of 570 patients (mean±SD of age, 65±11 years; 54.5% females); the LVH-ECG prevalence was 13.7% (95% CI, 10.8-16.6; 12.6% by Cornell and 1.6% by Sokolow-Lyon). The agreement in the diagnosis between the PC doctors and the cardiologist was 0.378 (95% CI, 0.272-0.486; disagreements in 15.5% of cases). The PC doctors slightly underestimated the LVH-ECG prevalence by Cornell and slightly overestimated it by the Sokolow-Lyon criteria. The agreement was also low for all of them (κ=0.367; 95% CI, 0.252-0.482, for Cornell, and κ=0.274; 95% CI: 0.093-0.454 for Sokolow-Lyon).Conclusions: The agreement between the diagnosis by the PC doctors and the cardiologist was low. The implications of this study suggest the need to improve the reading of ECG among PC doctors. The use of computerised systems could be a good option(AU)

[Interobserver agreement on electrocardiographic diagnosis of left ventricular hypertrophy in hypertensive patients in Andalusia. PREHVIA study]. / Concordancia entre observadores en el diagnóstico electrocardiográfico de la hipertrofia ventricular izquierda en hipertensos de Andalucía. Estudio PREHVIA.

OBJECTIVE: To assess the agreement between Primary Care (PC) doctors and a cardiology specialist in diagnosing left ventricular hypertrophy in the electrocardiograph (LVH-ECG) in hypertensive patients. DESIGN: Cross-sectional, multicentre study. SETTING: Andalusian Primary Care Centres. PARTICIPANTS: A total of 120 PC doctors who using a random sample selected patients of 35 years or more with AHT of at least 6 months of progression. PRIMARY VARIABLES: Demographic data, risk factors and cardiovascular diseases were recorded. The LVH-ECG was evaluated by applying Cornell voltage criteria, Cornell and Sokolow-Lyon product. The PC researchers read the ECG first and the cardiologist made a second reading blind. RESULTS: A total of 570 patients (mean +/- SD of age, 65 +/- 11 years; 54.5% females); the LVH-ECG prevalence was 13.7% (95% CI, 10.8-16.6; 12.6% by Cornell and 1.6% by Sokolow-Lyon). The agreement in the diagnosis between the PC doctors and the cardiologist was 0.378 (95% CI, 0.272-0.486; disagreements in 15.5% of cases). The PC doctors slightly underestimated the LVH-ECG prevalence by Cornell and slightly overestimated it by the Sokolow-Lyon criteria. The agreement was also low for all of them (kappa = 0.367; 95% CI, 0.252-0.482, for Cornell, and kappa = 0.274; 95% CI: 0.093-0.454 for Sokolow-Lyon). CONCLUSIONS: The agreement between the diagnosis by the PC doctors and the cardiologist was low. The implications of this study suggest the need to improve the reading of ECG among PC doctors. The use of computerised systems could be a good option.

[Prevalence of left ventricular hypertrophy, atrial fibrillation and cardiovascular disease in hypertensive patients of Andalusia, Spain. PREHVIA study]. / Prevalencia de hipertrofia ventricular izquierda, fibrilación auricular y enfermedad cardiovascular en hipertensos de Andalucía. Estudio PREHVIA.

OBJECTIVES: The objective of the PREHVIA study was to assess the prevalence of electrocardiographic left ventricular hypertrophy (ECG-LVH) and of atrial fibrillation (AF) among Andalusian hypertensive patients, and the relationship of this complications with cardiovascular disease (CVD). PATIENTS AND METHODS: Cross-sectional study with selection of study centres following the distribution of the Andalusian population by provinces and habitat, and randomization of patients included in the sample. Personal history was recorded, and ECG-LVH was assessed using the Cornell (voltage and product) and Sokolow-Lyon criteria, applied by the participant physicians and by an expert cardiologist. The association with ECG-HVH or CVD was studied by logistic regression models. RESULTS: In 570 patients (mean age 65 years, 54.5% women, 50.6% with obesity, 28,2% with diabetes), the prevalence of ECG-LVH was 13.7% (95% confidence interval [CI], 10.8-16.6%). Cornell criterion was fulfilled by 12.6% and Sokolow-Lyon by 1.6%. The prevalence of AF was 5.1% (95% CI, 3.9-7.5%) and 22.1% (95% CI, 18.4-25.4%) had established CVD. In the multivariate analysis, ECG-LVH was associated with female gender (odds ratio=5.10; 95% CI, 2.44-10.64) and with the presence of CVD (odds ratio=2.18; 95% CI, 1.09-4.12). The antecedent of CVD was independently associated with an advanced age, male gender, AF and, less strongly, with low glomerular filtration rate and diabetes mellitus. CONCLUSIONS: In Andalusian hypertensives, the prevalence of ECG-LVH was significantly lower than that found in other studies, greater in women and at the expense of the Cornell criterion, the prevalence of AF was 5.1% and it was 22.1% for CVD with independent associations between ECG-LVH and between CVD and AF.

Prevalencia de hipertrofia ventricular izquierda, fibrilación auricular y enfermedad cardiovascular en hipertensos de Andalucía. Estudio PREHVIA / Prevalence of left ventricular hypertrophy, atrial fibrillation and cardiovascular disease in hypertensive patients of Andalusia, Spain. PREHVIA study

Objetivos: el objetivo del estudio PREHVIA ha sido estimar la prevalencia de hipertrofia ventricular izquierda evidenciada en el electrocardiograma (HVI-ECG) y de fibrilación auricular (FA) en pacientes con hipertensión arterial (HTA) de Andalucía, y evaluar la relación de estas variables con la enfermedad cardiovascular (ECV).Pacientes y métodos se realizó un estudio transversal con selección de centros de salud según la distribución de la población andaluza por provincias y hábitat, y selección aleatoria de pacientes incluidos en la muestra. Se recogieron los antecedentes y los médicos participantes y un cardiólogo experto valoraron la HVI-ECG aplicando los criterios de Cornell (voltaje y producto) y de Sokolow-Lyon. Se valoró la asociación con la HVI o la ECV mediante modelos de regresión logística. Resultados: en 570 pacientes (edad media de 65 años, un 54,5% de mujeres, un 50,6% con obesidad y un 28,2% con diabetes), la prevalencia de HVI-ECG fue del 13,7% (intervalo de confianza [IC] del 95%, 10,8–16,6%). El 12,6% cumplió el criterio de Cornell y el 1,6% el de Sokolow-Lyon. Un 5,1% presentó FA (IC del 95%, 3,9–7,5%) y el 22,1% (IC del 95%, 18,4–25,4%) tenía antecedente de ECV. En el análisis multivariante, la HVI-ECG se relacionó con el sexo femenino (odds ratio=5,10; IC del 95%, 2,44–10,64) y la presencia de ECV (odds ratio=2,18; IC del 95%, 1,09–4,12). La ECV se relacionó independientemente con la edad avanzada, el sexo masculino y la FA, y con menos fuerza con un filtrado glomerular bajo y la diabetes mellitus. Conclusiones: en hipertensos de Andalucía la prevalencia de HVI-ECG es considerablemente inferior a la hallada en otros estudios, mucho mayor en mujeres y a expensas principalmente del criterio de Cornell. La prevalencia de FA es del 5,1% y la de ECV similar a la de estudios previos. Se observa una asociación independiente entre HVI-ECG y ECV, y entre ECV y FA (AU)

Objectives: The objective of the PREHVIA study was to assess the prevalence of electrocardiographic left ventricular hypertrophy (ECG-LVH) and of atrial fibrillation (AF) among Andalusian hypertensive patients, and the relationship of this complications with cardiovascular disease (CVD).Patients and methods Cross-sectional study with selection of study centres following the distribution of the Andalusian population by provinces and habitat, and randomization of patients included in the sample. Personal history was recorded, and ECG-LVH was assessed using the Cornell (voltage and product) and Sokolow-Lyon criteria, applied by the participant physicians and by an expert cardiologist. The association with ECG-HVH or CVD was studied by logistic regression models. Results: In 570 patients (mean age 65 years, 54.5% women, 50.6% with obesity, 28,2% with diabetes), the prevalence of ECG-LVH was 13.7% (95% confidence interval [CI], 10.8–16.6%). Cornell criterion was fulfilled by 12.6% and Sokolow-Lyon by 1.6%. The prevalence of AF was 5.1% (95% CI, 3.9–7.5%) and 22.1% (95% CI, 18.4–25.4%) had established CVD. In the multivariate analysis, ECG-LVH was associated with female gender (odds ratio=5.10; 95% CI, 2.44–10.64) and with the presence of CVD (odds ratio=2.18; 95% CI, 1.09–4.12). The antecedent of CVD was independently associated with an advanced age, male gender, AF and, less strongly, with low glomerular filtration rate and diabetes mellitus. Conclusions: In Andalusian hypertensives, the prevalence of ECG-LVH was significantly lower than that found in other studies, greater in women and at the expense of the Cornell criterion, the prevalence of AF was 5.1% and it was 22.1% for CVD with independent associations between ECG-LVH and between CVD and AF (AU)

[Prevalence of chronic kidney disease in hypertensive patients under treatment at primary care health centres in Spain and the monitoring of their blood pressure: the DISEHTAE Study]. / Prevalencia de enfermedad renal crónica en los hipertensos seguidos en los centros de salud de España y grado de control de su presión arterial (estudio DISEHTAE).

OBJECTIVE: To establish what proportion of hypertensive patients being treated in the primary care health centres of Spain have diminished renal function, and to ascertain their level of blood pressure (BP) control. DESIGN: Descriptive, cross-sectional study, based on an external audit of clinical charts. SETTING: Primary care health centres in 14 autonomous regions. PARTICIPANTS: A total of 6,113 charts of hypertensive patients from 107 primary care health centres were checked. The selection of primary care health centres and charts was randomized. MAIN MEASUREMENTS: Creatinine and BP figures of the patients included were analyzed. Chronic kidney disease was defined as a glomerular filtration rate (GFR), as calculated by the equation developed by the Modification of Diet in Renal Disease (MDRD) Study, at under 60 mL/min per 1.73 m(2) of body surface area. A good level of BP control was defined as having figures lower than 130/80 mm Hg. RESULTS: Of all patients, 25.7% (95% CI, 24.3-27.2) had a diminished GFR. Of these, 19.1% (95% CI, 16.6-21.9) had a good level of control of systolic BP, 49.9% (95% CI, 46.6-53.2) had a good level of control of diastolic BP, and 15.2% (95% CI, 12.9-17.8) had a good level of control of both. CONCLUSIONS: A considerable proportion of hypertensive patients under treatment in the primary care health centres of Spain have a diminished GFR. Only 1 in 6 of these have their BP under control.

Prevalencia de enfermedad renal crónica en los hipertensos seguidos en los centros de salud de España y grado de control de su presión arterial (estudio DISEHTAE) / Prevalence of chronic kidney disease in hypertensive patients under treatment at primary care health centres in Spain and the monitoring of their blood pressure. The DISEHTAE study

Objetivo. Describir la proporción de pacientes hipertensos seguidos en los centros de salud de España que presentan una disminución de la función renal y determinar el grado de control de su presión arterial (PA). Diseño. Descriptivo, transversal, basado en una auditoría externa de historias clínicas. Emplazamiento. Centros de atención primaria de 14 comunidades autónomas. Participantes. Se revisaron 6.113 historias clínicas de pacientes hipertensos pertenecientes a 107 centros de salud. La selección de los centros de salud y de las historias clínicas fue aleatoria. Mediciones principales. En este estudio se analizan los datos obtenidos sobre las cifras de creatinina sérica y de PA de los pacientes incluidos. La enfermedad renal crónica se ha definido como la existencia de un filtrado glomerular (FG), estimado mediante la ecuación del estudio Modification of Diet in Renal Disease (MDRD), menor de 60 ml/min por 1,73 m2 de superficie corporal y el buen control de la PA, como la presencia de cifras menores de 130/80 mmHg. Resultados. El 25,7% (IC del 95%, 24,3-27,2%) de los pacientes presentaba un FG disminuido. De ellos, el 19,1% (IC del 95%, 16,6-21,9%) presentaba un buen control de la PA sistólica (PAS); el 49,9% (IC del 95%, 46,6-53,2%), de la PA diastólica (PAD), y el 15,2% (IC del 95%, 12,9-17,8%), de ambas. Conclusiones. Una considerable proporción de pacientes hipertensos atendidos en los centros de salud de España presentan una disminución del FG. De ellos, sólo 1 de cada 6 presenta cifras de buen control de la PA

Objective. To establish what proportion of hypertensive patients being treated in the primary care health centres of Spain have diminished renal function, and to ascertain their level of blood pressure (BP) control. Design. Descriptive, cross-sectional study, based on an external audit of clinical charts. Setting. Primary care health centres in 14 autonomous regions. Participants. A total of 6113 charts of hypertensive patients from 107 primary care health centres were checked. The selection of primary care health centres and charts was randomized. Main measurements. Creatinine and BP figures of the patients included were analyzed. Chronic kidney disease was defined as a glomerular filtration rate (GFR), as calculated by the equation developed by the Modification of Diet in Renal Disease (MDRD) Study, at under 60 mL/min per 1.73 m2 of body surface area. A good level of BP control was defined as having figures lower than 130/80 mm Hg. Results. Of all patients, 25.7% (95% CI, 24.3-27.2) had a diminished GFR. Of these, 19.1% (95% CI, 16.6-21.9) had a good level of control of systolic BP, 49.9% (95% CI, 46.6-53.2) had a good level of control of diastolic BP, and 15.2% (95% CI, 12.9-17.8) had a good level of control of both. Conclusions. A considerable proportion of hypertensive patients under treatment in the primary care health centres of Spain have a diminished GFR. Only 1 in 6 of these have their BP under control