Validity of self blood pressure measurement in the control of the hypertensive patient: factors involved.

BACKGROUND: Improving clinical practice aimed at controlling hypertension is a pending issue in health systems. One of the methods currently used for this purpose is self blood pressure measurement (SBPM) whose use increases every day. The aims of this study are to establish the optimal cut-off point for the 3-day SMBP protocol and to identify factors that could affect the precision of the 3-day SMBP protocol using 24-h ambulatory blood pressure monitoring (ABPM) as a reference. METHOD: This is a cross-sectional descriptive study to validate a diagnostic test performed by a primary care team in Murcia, Spain. A total of 153 hypertensive patients under 80 years of age who met the inclusion criteria were evaluated. ABPM was performed for 24 h. The SBPM protocol consisted of recording 2 measurements in the morning and 2 at night for 3 days. RESULTS: The cut-off point for SBP was set at 135 mmHg (sensitivity: 80.39%, specificity: 74.19%), and for DBP, it was set at 83 mmHg (sensitivity: 76.48%, specificity: 84.89%), which yielded the highest combined sensitivity and specificity. After carrying out the validation study with the new figures, we proceeded to establish which socio-demographic factors prevented a correct classification of patients. These errors were more common in male patients for the assessments of both DBP (OR = 2.4) and SBP (OR = 2.5); hypertensive patients with age < 67,5 years (OR = 1,5); having no work activity (OR = 3,6) and with concomitant chronic kidney disease (CKD) (OR = 5.0). CONCLUSION: Being male, older than 67.5 years, with CKD or with no work activity increases the probability of being misclassified for hypertension during follow-up as assessed by SBPM over 3 days. TRIAL REGISTRATION: This study was approved by the research ethics committee of the University of Murcia under registration number 1018/2015.

Tratando la disfunción eréctil en atención primaria (estudio TRADE-AP): efectividad de la toma a demanda de tadalafilo versus pauta diaria / Treating erectile dysfunction in primary care (TRADE-AP): effectiveness of taking tadalafil on demand versus daily pattern

Objetivo: Valorar la efectividad del tratamiento de la disfunción eréctil con tadalafilo tomado a demanda respecto a la pauta diaria. Material y método: Estudio prospectivo multicéntrico para analizar la disfunción eréctil en atención primaria con un grupo tratado con 20 mg de tadalafilo a demanda versus otro grupo que toma 5 mg de tadalafilo diario, utilizando el índice internacional de función eréctil, el cuestionario de Fulg-Meyer de satisfacción con la vida validado para la disfunción eréctil y la escala visual analógica, con puntuación de 0 a 100, de preferencia de tratamiento por el paciente y la escala visual analógica de preferencia de su pareja, donde se les pregunta su satisfacción con el tratamiento. Resultados: El ascenso medio de puntuación inicial-final de todos los dominios del índice internacional de función eréctil ha sido significativo tanto en el grupo "a demanda" como en el grupo "pauta diaria". Las diferencias observadas en el incremento medio de todos los ítems del cuestionario de satisfacción con la vida en ambos grupos han sido significativas, aunque con mayor intensidad en el grupo "pauta diaria". Respecto a la escala de evaluación analógica, se observaron diferencias significativas entre la puntuación total media inicial y la puntuación total media final en el grupo "a demanda", menores que en el grupo "pauta diaria". Conclusiones: Tanto la terapia a demanda como la pauta diaria con tadalafilo son eficaces en el tratamiento de la disfunción eréctil, pero la mejora en la función sexual, en la calidad de vida y en la satisfacción por la espontaneidad y naturalidad con el tratamiento se manifiestan en mayor medida con la pauta diaria (al menos, en las primeras etapas del tratamiento) debido, básicamente, a la actuación sobre factores psicosexuales que desligan el tratamiento de la relación sexual (AU)

Objective: To assess the effectiveness of the treatment of erectile dysfunction with tadalafil taken on demand versus the pattern daily. Material and method: A prospective, multicenter study was conducted to analyze erectile dysfunction in Primary Care in a group treated with 20 mg tadalafil "on demand" versus another group taking 5 mg of tadalafil "daily" using the international index of erectile function, the LISAT-8 Fulg-Meyer of quality of life validated for erectile dysfunction and the visual analogue scale (EVA with 0 to 100 score) on the treatment preference of the patient and the EVA preference of his partner, in which they are asked about their treatment satisfaction. Results: The mean increase in initial-final score for all domains of the international index of erectile function was significant in both the "on demand" and "daily" group. The differences observed in the mean increase for all the LISAT-8 items in both groups were significant. However, there was greater intensity in the "daily regime." Regarding EVA, significant differences were observed between total mean initial score and total final average score for the "on demand" group, these being lower than in the "daily" group. Conclusions: On demand treatment and the daily regime with tadalafil are effective in the treatment of erectile dysfunction. However, improvement in sexual function, quality of life and satisfactions due to the treatment spontaneity and naturalness are manifested more with the daily regime (at least in the first stages of the treatment), basically because of the action on the psycho-sexual factors that separate the treatment from the sexual relationship (AU)