Numerical values and impact of hypertension in Spain.

In Spain, 33% of adults aged 30 to 79 years (10 million) were hypertensive in 2019. Among them, 68% were diagnosed, 57% received drug therapy, and effective therapeutic coverage (control) reached 33%. Both diagnosis and control show geographical and social disparities. Approximately 46 000 cardiovascular deaths per year are attributable to hypertension. In recent decades, the control of hypertension has increased, due to improvements in lifestyle measures and increased use of polytherapy, coinciding with a reduction in stroke mortality. There are several modifiable determinants of the lack of hypertension control: a) white-coat phenomenon affects 22% to 33% of treated individuals, partly due to the limited availability of ambulatory blood pressure monitoring (ABPM) (49%) and self-measured BP (SMBP) (78%); b) inadequate patient adherence to medication and healthy lifestyles (weight loss, the most effective measure, is the least used, ≈40%); and c) insufficient use of polytherapy (≈55%). The remaining challenges include: a) technological aspects, such as measuring BP with more accurate techniques (ABPM, SMBP) and using cardiovascular-risk estimation tools (eg, SCORE); b) clinical challenges, such as reducing therapeutic inertia (≈59%), involving patients in their own management (medication adherence, ≈62%) and effectively implementing clinical guidelines); and c) public health challenges, such as reducing the burden of obesity (≈24%), monitoring progress with updated surveys, and setting national BP control targets.

Safety and Efficacy of Botulinum Toxin in the Treatment of Self-Biting Behavior in Lesch-Nyhan Disease.

BACKGROUND: Lesch-Nyhan disease (LND) is a disease of purine metabolism linked to chromosome X due to the absence or near-absence of enzyme hypoxanthine-guanine phosphoribosyltransferase. Patients with LND have a compulsive autoaggressive behavior that consists of self-mutilation by biting. METHODS: The objective of this study was to explore the safety and efficacy of botulinum toxin (BoNT) injected into the masticatory muscles and biceps brachii to reduce self-mutilation in patients with LND. We retrospectively analyzed six patients with LND who were treated with BoNT to prevent automutilatory behavior. RESULTS: The patient ages when started on treatment with BoNT were 4, 4.5, 6.6, 7.9, 13.9, and 32.3 years. Patients received a mean number of injections of 20, ranging from 3 to 29, over a period that ranged from 1.5 to 7.1 years. The maximum total dose of Botox was 21.3 units/kg mean and the maximum total dose of Dysport was 37.5 units/kg mean. A total of 119 injections were performed. Of these 113 (95%) were partially or completely effective. Only three of 119 injections (2.5%) produced adverse effects. CONCLUSIONS: Botulinum toxin is useful and safe for the treatment of self-biting behavior in patients with LND.

Frequency and Prognosis of Treated Hypertensive Patients According to Prior and New Blood Pressure Goals.

United States and European guidelines have recommended new treatment goals for office blood pressure (BP). We examined 9784 hypertensives of the Spanish Ambulatory BP Monitoring (ABPM) registry with office BP treated to the prior goal (<140/90 mm Hg); and evaluated the frequency and all-cause mortality of 4 BP strata depending on whether or not they attained more conservative or new office BP goal (130-139/80-89 and <130/80 mm Hg, respectively) and whether or not BP was controlled according to ABPM criteria in the European and US guidelines (24-hour ambulatory BP <130/80 and <125/75 mm Hg, respectively). Whether achieving or not the new office BP goal, the total-mortality risk during a 5-year follow-up was only significantly higher than the reference (normal office BP and ABPM) when 24-hour ambulatory BP was above goal (hazard ratio from multivariable Cox models was in the range of 2.4-2.9; P<0.001). The frequency of patients achieving the new office BP goal was 34.4%, and the frequencies of those not achieving the ABPM goal were 31.6% and 53.7% using the 130/80 or the 125/75 ABPM goal, respectively. Mean office systolic BP was 129 mm Hg for patients not achieving the ABPM goal. In hypertensive patients controlled under prior office BP goal, the frequency of those achieving new office BP goal <130/80 was high, suggesting this goal can be attained. In addition, patients had a higher mortality risk only when ABPM was above goal despite having mean office systolic BP under control, a condition that was also common.

Implantación del Examen Clínico Objetivo y Estructurado en la Facultad de Medicina de la Universidad Autónoma de Madrid / Implementation of the Objective Structured Clinical Examination (OSCE) in the Madrid Autonomous University Medical School

El examen clínico objetivo y estructurado (ECOE) evalúa las competencias adquiridas por los estudiantes al terminar el grado de medicina. La competencia es el conjunto de conocimientos y habilidades para resolver un problema profesional, con una actitud adecuada. La Conferencia de decanos de las 40 facultades de medicina de España ha establecido que todos los estudiantes del grado de medicina que finalizasen sus estudios en el curso 2015/2016 deberían superar una prueba (ECOE) que evaluase 8 competencias clínicas: anamnesis; exploración física; comunicación; habilidades técnicas; juicio clínico, manejo diagnóstico y tratamiento; prevención y promoción de la salud; relaciones interprofesionales; y aspectos éticos y legales. La Facultad de Medicina de la Universidad Autónoma de Madrid se ha incorporado a este proyecto y ha organizado su primer ECOE para los 197 alumnos de 6.° curso, con 25 estaciones o pruebas. Este trabajo describe las 7 etapas o procesos esenciales que se han seguido para la instauración del ECOE y que puede resultar de utilidad para la comprensión de este complejo examen y su implantación

The Objective Structured Clinical Examination (OSCE) evaluates clinical skills of medical students at the end of medical school training. Professional competence is the set of knowledge and clinical skills that helps to solve professional problems with the correct attitude. The Conference of Deans from all 40 Schools of Medicine in Spain agreed that all students completing their medical training in the 2015/16 academic year should take an exam to assess 8 competency areas: medical history, physical examination, communication skills, clinical judgment, diagnosis, management and treatment, prevention and health promotion, inter-professional relationships, and ethical and legal aspects. The Madrid Autonomous University Medical School took part in this national project, and conducted its first OSCE, with 25 tests, for the 197 students that concluded their training in 2016. This paper describes the 7 stages, or essential processes followed in order to establish the OSCE. This experience may be useful for the understanding and implementation of this complex competence evaluation process

Automedición en el domicilio frente a lectura de la presión arterial en la consulta en el seguimiento de diabéticos tipo II: efecto sobre la presión arterial ambulatoria y la albuminuria. Estudio aleatorizado / Home blood pressure vs. clinic blood pressure measurement-based follow up in type II diabetics: Effect on 24-h ambulatory BP and albuminuria. Randomised trial

Fundamento y objetivo: Comparar la eficacia en el control de la hipertensión arterial (HTA) y la albuminuria de 2 estrategias de seguimiento basadas en diferentes métodos de evaluación de la presión arterial (PA). Pacientes y métodos: Estudio de intervención aleatorizado, abierto, con grupo control, de 2 años de duración, realizado en 19 centros de atención primaria y una consulta de medicina interna. Se incluyó a diabéticos adultos tipo 2 con PA sistólica (PAS) ≥ 140mmHg sin nefropatía relevante. Los pacientes fueron aleatorizados a: 1) grupo de seguimiento convencional, con un objetivo de PA en la consulta < 140/90mmHg; y 2) grupo de seguimiento basado en cifras de automedición domiciliaria de la PA (AMPA), con un objetivo de PA en el domicilio < 135/85mmHg. En las visitas basal, anual y final se realizaron un perfil bioquímico, medición de albuminuria y monitorización ambulatoria de la PA de 24h. La principal variable de eficacia fue la variación de la PAS ambulatoria de 24h. Como variable secundaria se analizó la albuminuria. Resultados: Fueron evaluados 116 pacientes (edad media: 66,8 años). El descenso medio de la PAS ambulatoria de 24h en 2 años fue de 3,9mmHg (IC del 95%: 1,8-6,1), sin observarse diferencias significativas entre los 2 grupos (p=0,706), así como tampoco entre el resto de valores de PA ambulatoria. La albuminuria inicial fue similar en ambos grupos y no se modificó significativamente durante el seguimiento. Conclusión: En pacientes diabéticos sin nefropatía relevante, un seguimiento basado en AMPA mostró una eficacia similar en el control de la HTA y la albuminuria que el seguimiento convencional

Bakground and objective: To compare the efficacy of two strategies of blood pressure (BP) measurement-based follow-up in hypertension and albuminuria control. Patients and methods: Multicentre, prospective, randomised, open trial with a parallel-group design. Nineteen primary care centres and a hospital clinic participated. Adult type 2 diabetics with systolic BP ≥140mmHg without relevant renal disease were randomised to one of two follow-up strategies: 1) standard follow up, with a clinic BP target <140/90mmHg and 2) self-monitoring home BP (SMHBP)-based follow up, with a BP target <135/85mmHg. Biochemical standard blood variables, albuminuria, and 24-h ambulatory BP monitoring were performed at entry, 12 and 24 months. The main outcome measurement was 24-h ambulatory systolic BP variation. Albuminuria change was analysed as a secondary outcome. Results: 116 patients were analysed (mean age: 66.8 years). Mean systolic ambulatory 24- h BP change in two years was 3.9mmHg (95% CI 1.8-6.1). We did not find significant differences between both groups (p=0.706). Similarly, no differences were found when we compared other ambulatory BP values. Initial albuminuria was similar in both groups and did not significantly changed throughout the follow-up period. Conclusion: In type 2 diabetics without relevant nephropathy a SMHBP- based follow up was equivalent to a standard clinic-based BP follow up in BP and albuminuria control

Home blood pressure vs. clinic blood pressure measurement-based follow up in type ii diabetics: Effect on 24-h ambulatory BP and albuminuria. Randomised trial. / Automedición en el domicilio frente a lectura de la presión arterial en la consulta en el seguimiento de diabéticos tipo ii: efecto sobre la presión arterial ambulatoria y la albuminuria. Estudio aleatorizado.

BAKGROUND AND OBJECTIVE: To compare the efficacy of two strategies of blood pressure (BP) measurement-based follow-up in hypertension and albuminuria control. PATIENTS AND METHODS: Multicentre, prospective, randomised, open trial with a parallel-group design. Nineteen primary care centres and a hospital clinic participated. Adult type 2 diabetics with systolic BP ≥140mmHg without relevant renal disease were randomised to one of two follow-up strategies: 1) standard follow up, with a clinic BP target <140/90mmHg and 2) self-monitoring home BP (SMHBP)-based follow up, with a BP target <135/85mmHg. Biochemical standard blood variables, albuminuria, and 24-h ambulatory BP monitoring were performed at entry, 12 and 24 months. The main outcome measurement was 24-h ambulatory systolic BP variation. Albuminuria change was analysed as a secondary outcome. RESULTS: 116 patients were analysed (mean age: 66.8 years). Mean systolic ambulatory 24- h BP change in two years was 3.9mmHg (95% CI 1.8-6.1). We did not find significant differences between both groups (p=0.706). Similarly, no differences were found when we compared other ambulatory BP values. Initial albuminuria was similar in both groups and did not significantly changed throughout the follow-up period. CONCLUSION: In type 2 diabetics without relevant nephropathy a SMHBP- based follow up was equivalent to a standard clinic-based BP follow up in BP and albuminuria control.

Atherosclerosis as a potential pitfall in the diagnosis of giant cell arteritis.

OBJECTIVES: To explore whether the increase in the intima-media thickness (IMT) in arteriosclerotic disease correlates with the increase in the IMT in temporal arteries (TAs) and if that could mimic the US GCA halo sign. METHODS: Consecutive patients ⩾50 years old with high vascular risk and without signs or symptoms of GCA were included. The carotid US IMT measurements were obtained using a standardized software radiofrequency-tracking technology. Colour Doppler US and grey-scale measurements of the IMT in the branches of both TAs were performed by a second sonographer using a 22 MHz probe. RESULTS: Forty patients were studied (28 men) with a mean age of 70.6 years. The carotid IMT exhibited significant correlation with the TA IMT. A carotid IMT >0.9 mm was associated with a temporal IMT >0.3 mm. Only one patient had an IMT >0.34 mm in two branches. CONCLUSIONS: Atherosclerotic disease with a carotid IMT >0.9 mm increases the TA IMT and might mimic the halo sign. As atherosclerosis is common in this age group, we propose a cut-off of TA IMT >0.34 mm in at least two branches to minimize false positives in a GCA diagnosis.