Home blood pressure self-measurement: “Current situation and new perspectives” / Automedidas domiciliarias de presión arterial: «situación actual y nuevas perspectivas»

The method typically used to diagnose and monitor hypertensive patients has been to measure blood pressure in the physician's surgery; however, it is a well-known fact that this approach poses certain drawbacks, such as observer bias, failure to detect an alert reaction in the clinic, etc., difficulties that affect its accuracy as a diagnostic method.In recent years, the varying international scientific societies have persistently recommended the use of blood pressure measurements outside the clinic (at home or in the outpatient setting), using validated automatic devices. Data from some studies suggest that if we rely solely on in-office measurements, approximately 15–20% of the time we may be wrong when making decisions, both in terms of diagnosis and patient follow-up.Home blood pressure measurements are a simple and very affordable method that has a similar reproducibility and prognostic value as ambulatory blood pressure monitoring, the availability of which is currently very limited. Moreover, ambulatory self-measurements have the significant benefit of being able to improve control of hypertensive individuals.Healthcare professionals and patients should be aware of the methodology of home blood pressure measurement, its usefulness and limitations. (AU)

El método utilizado habitualmente para el diagnóstico y seguimiento de los pacientes hipertensos ha sido la medida de la presión arterial en la consulta, pero es un hecho conocido que este método plantea problemas (sesgos del observador, no detecta reacción de alerta en consulta…) que afectan a su precisión como método diagnóstico.Las diferentes sociedades científicas internacionales, en los últimos años, recomiendan de forma insistente el uso de medidas de presión arterial fuera de la consulta (domiciliarias o ambulatorias) con aparatos automáticos validados para tomar decisiones. Datos de algunos estudios sugieren que si solo utilizamos las medidas de la consulta nos podemos equivocar en torno a un 15-20% de las veces que tomemos decisiones en el diagnóstico y seguimiento de los pacientes.Las medidas domiciliarias de presión arterial son un método sencillo y muy accesible que tienen una reproducibilidad y valor pronóstico similar al de las medidas ambulatorias, cuya disponibilidad actualmente e muy limitada, y que además tienen una utilidad importante que es la posibilidad de mejora del control de los hipertensos.Los profesionales sanitarios y los pacientes deben conocer la metodología de uso de la medida de presión arterial domiciliaria y sus utilidades y limitaciones. (AU)

Home blood pressure self-measurement: "Current situation and new perspectives".

The method typically used to diagnose and monitor hypertensive patients has been to measure blood pressure in the physician's surgery; however, it is a well-known fact that this approach poses certain drawbacks, such as observer bias, failure to detect an alert reaction in the clinic, etc., difficulties that affect its accuracy as a diagnostic method. In recent years, the varying international scientific societies have persistently recommended the use of blood pressure measurements outside the clinic (at home or in the outpatient setting), using validated automatic devices. Data from some studies suggest that if we rely solely on in-office measurements, approximately 15-20% of the time we may be wrong when making decisions, both in terms of diagnosis and patient follow-up. Home blood pressure measurements are a simple and very affordable method that has a similar reproducibility and prognostic value as ambulatory blood pressure monitoring, the availability of which is currently very limited. Moreover, ambulatory self-measurements have the significant benefit of being able to improve control of hypertensive individuals. Healthcare professionals and patients should be aware of the methodology of home blood pressure measurement, its usefulness and limitations.

[Analysis of the control of cardiovascular risk factors in patients with peripheral arterial disease]. / Análisis del control de factores de riesgo cardiovascular en pacientes con enfermedad arterial periférica.

INTRODUCTION: The objective was to determine the percentage of patients with peripheral arterial disease (PAD) with good control of their cardiovascular risk factors (CVRF) (LDL cholesterol, blood pressure and smoke cessation). MATERIAL AND METHODS: Cross-sectional multicentre study. The location was Primary Care and other clinics that typically treat patients with peripheral arterial disease (Internal Medicine, Vascular Surgery, Cardiology, Endocrinology and Nephrology). The first 10 patients with peripheral arterial disease were systematically selected by 440 researchers from all regions. RESULTS: The study included 4087 patients. Blood pressure was controlled in 29.5% of the cases. The frequency of patients with optimal control was significantly better in primary care (p<.01). There was an optimal control of LDL-C levels in 30.4% of patients. Factors associated with optimal control of LDL-C was, being diabetic, stage I of La Fontaine, and being seen by a doctor that was not the primary care physician. Control was worse in women and in smokers. CONCLUSIONS: Primary care physicians better manage patients with hypertension. Patients seen in by a specialist as opposed to primary care are more likely to achieve optimal control of CVRF. The situation is far from the ideal, only 6% achieved optimal control of all CVRF.

Análisis del control de factores de riesgo cardiovascular en pacientes con enfermedad arterial periférica / Analysis of the control of cardiovascular risk factors in patients with peripheral arterial disease

Introducción. El objetivo del presente estudio es determinar el porcentaje de pacientes con enfermedad arterial periférica (EAP) con un control óptimo de sus factores de riesgo cardiovascular (FRCV) (colesterol unido a las lipoproteínas de baja densidad [c-LDL], presión arterial [PA] y abandono de tabaco). Material y métodos. Estudio descriptivo transversal multicéntrico, realizado en consultas de atención primaria (AP) y de otras especialidades que habitualmente atienden a pacientes con EAP, medicina interna, cirugía vascular (CV), cardiología, endocrinología y nefrología. Selección sistemática de los 10 primeros pacientes con EAP de las consultas de 440 investigadores pertenecientes a todas las comunidades autónomas. Resultados. Se incluyeron en el estudio a 4.087 pacientes. Tenían controlada la PA el 29,5% de los pacientes. La frecuencia de pacientes con control de la PA fue significativamente mejor en consultas de AP (p<0,01). Se observó un control óptimo de los niveles de c-LDL en un 30,4% de los pacientes. Los factores asociados con un control óptimo de este factor fueron el hecho de ser diabético, el encontrarse en estadio I de La Fontaine y el ser atendido por un médico que no fuese de AP, y se controlaba peor en mujeres y en fumadores activos. Conclusiones. Los médicos de AP manejan mejor al paciente hipertenso. Sin embargo, los pacientes atendidos en especialidad frente a AP tienen mayor probabilidad de conseguir un control óptimo de los FRCV. La situación dista de ser la idónea, ya que solo en un 6% se consiguió el control óptimo de todos los FRCV(AU)

Introduction. The objective was to determine the percentage of patients with peripheral arterial disease (PAD) with good control of their cardiovascular risk factors (CVRF) (LDL cholesterol, blood pressure and smoke cessation). Material and methods. Cross-sectional multicentre study. The location was Primary Care and other clinics that typically treat patients with peripheral arterial disease (Internal Medicine, Vascular Surgery, Cardiology, Endocrinology and Nephrology). The first 10 patients with peripheral arterial disease were systematically selected by 440 researchers from all regions. Results. The study included 4087 patients. Blood pressure was controlled in 29.5% of the cases. The frequency of patients with optimal control was significantly better in primary care (p<.01). There was an optimal control of LDL-C levels in 30.4% of patients. Factors associated with optimal control of LDL-C was, being diabetic, stage I of La Fontaine, and being seen by a doctor that was not the primary care physician. Control was worse in women and in smokers. Conclusions. Primary care physicians better manage patients with hypertension. Patients seen in by a specialist as opposed to primary care are more likely to achieve optimal control of CVRF. The situation is far from the ideal, only 6% achieved optimal control of all CVRF(AU)

Triaje in situ extrahospitalario / Extra-hospital in situ triage

En una catástrofe, el principal objetivo de una intervención sanitaria es proporcionar a la población afectada asistencia médica para asegurar su supervivencia. Para conseguirlo, se ha desarrollado el triaje in situ, cuyo principio fundamental es la priorización de la asistencia en función del grado de urgencia. Su aplicación vendrá marcada por la adecuación entre el número de pacientes a clasificar, su urgencia potencial y los recursos materiales y humanos disponibles en el lugar donde se realiza. Nuestra finalidad es definir conceptualmente el término, revisar los distintos modelos de clasificación existentes y exponer las herramientas actuales disponibles para dicho fin (AU)

In a catastrophe, the main purpose of health intervention is to provide medical care to the affected population, to ensure their survival. To achieve this, in situ triaje has been developed, with the fundamental principle of focusing on care depending on the level of urgency. Its application will be set by the adecuacy between the number of patients we have to classify, their potential emergency, the workforce and available resources in the place where it is performed. The purpose of this article is to define the concept of this term, compare the different types and existing models of classification and to discuss the currently available tools for in situ triage (AU)

Tos crónica: a propósito de un caso / Chronic cough: a case report

Es muy inusual encontrar como origen de tos crónica algún tipo de cáncer de pulmón. Debido a la mayor letalidad que las otras etiologías más frecuentes, el origen neoplásico debe estar presente en el despistaje final. Así mismo, la normalidad en la radiología convencional no descarta la neoplasia pulmonar.Presentamos el caso de un varón de 58 años de edad que presenta tos seca como única manifestación clínica. La radiología de tórax en dos proyecciones, la espirometría, la analítica general y la fibrolaringoscopia fueron normales.La persistencia de la tos como único síntoma a pesar de diversos tratamientos, condujo a la determinación de marcadores tumorales. Siendo la alteración de estos parámetros decisivo para la solicitud de otras pruebas de imagen, y contribuyendo así al diagnóstico definitivo de adenocarcinoma de pulmón (AU)

Finding some kind of lung cancer as a source of chronic cough is very uncommon. However, due to the greater mortality than that of other more frequent etiologies, the neoplastic origin should be present in the final screening. Furthermore, a normal X-ray does not rule out lung cancer.We report the case of a 58-year-old man who presented dry cough as the only clinical manifestation. The chest radiology with two projections, spirometry, general blood analysis and laryngoscopy were normal.Due to the persistent cough as the only symptom in spite of various treatments, a request was made for tumor markers. These abnormal parameters were conclusive for the application of other imaging tests, thus contributing to the definitive diagnosis of adenocarcinoma of the lung (AU)

Ecografía en Atención Primaria: estado de la cuestión / Ultrasonography in Primary Care: State of the question

Introducción. Cíclicamente nos preguntamos si es útil y conveniente introducir la ecografía en Atención Primaria, al tratarse de un procedimiento diagnóstico inocuo y rápido realizable en nuestra consulta, y con la que se obtienen imágenes de calidad diagnóstica equiparables a técnicas más costosas y menos accesibles. Material y Métodos. Realizamos una revisión bibliográfica en INAHTA, Pubmed y las páginas web de distintas sociedades científicas, entre los años 1996-2006, buscando estudios que confirmasen si la realización de ecografías en Atención Primaria era factible y fiable en el terreno diagnóstico. Resultados. Encontramos un bajo número de artículos sobre la cuestión, con baja calidad y centrados en cuestiones parciales. Este hecho contrasta con una actividad intensa de las sociedades científicas en este tema: grupos de trabajo, cursos acreditados, etc. Conclusiones. La realización de la ecografía en Atención Primaria es factible, quedando por definir y reglamentar sus indicaciones, criterios de formación del médico de familia, y las consideraciones legales que la rodean (AU)

Introduction. Periodically, we question if introducing ultrasonography into Primary Health Care would be useful and suitable because it is a safe and rapid diagnostic procedure that could be used in our consulting room. This method can obtain quality diagnostic images comparable to more expensive and less accessible techniques. Material and methods. We have performed a review of the literature in INAHTA, Pubmed, and the websites of some scientific societies between the years 1996-2006 to find studies that would confirm whether performing ultra-sound in Primary Health Care was feasible and reliable in the field of diagnosis. Results. We only found a small number of articles on the subject that were of low quality and focused on partial issues. This contrasts with the intense activities of the scientific societies on this subject: work groups, accredited courses, etc. Conclusions. Performing ultrasound in Primary Care is feasible. However, its indications, training criteria of the medical practitioner and the legal considerations surrounding it still need to be defined (AU)