Aportación del proyecto CARDIORISC al manejo del paciente hipertenso de Atención Primaria en España / Contribution of the CARDIORISC project to the management of hypertensive patients in Primary Health Care in Spain

El proyecto CARDIORISC es una iniciativa de la Sociedad Española de Hipertensión (SEH-LELHA), avalado por la Sociedad Europea de Hipertensión (ESH), iniciado en el año 2004 y que tiene como objetivo general optimizar la asistencia al paciente hipertenso en España. Comprende los registros MAPAPRES que pretende introducir la monitorización ambulatoria de la presión arterial (MAPA) como herramienta rutinaria en la valoración del paciente hipertenso en la práctica clínica en España, el registro AMPAPRES que evaluará el grado de control de la hipertensión arterial (HTA) mediante la automedida de la presión arterial (AMPA) por parte del paciente y el registro piloto FAPRES que evaluará la prevalencia de fibrilación auricular en la población hipertensa en la Comunidad Valenciana. El registro MAPAPRES está generando numerosas evidencias basadas en el análisis de la base de datos de más de 60.000 pacientes, aportadas por más de 1.000 investigadores, que se han incluido hasta la fecha. Se presentan, de manera resumida, en esta publicación algunas de las líneas de investigación más relevantes para la práctica clínica diaria del médico de Atención Primaria

The CARDIORISC project is an initiative of the Spanish Society of Hypertension (SEH-LELHA), endorsed by the European Society of Hypertension (ESH). It was established in the year 2004 and its general purpose is to improve care to the hypertensive patient in Spain. It includes the MAPAPRES registry that aim to introduce ambulatory blood pressure monitoring (ABPM) as a routine tool in the assessment of the hypertensive patient in the clinical practice in Spain, the AMPAPRES registry that will evaluate the control rate of arterial hypertension (AHT) using the self-measurement of blood pressure (SMBP) by the patient and the pilot registry FAPRES that will evaluate the prevalence of atrial fibrillation in the hypertensive population in the Spanish Valencian Community. The MAPAPRES registry is generating a great deal of evidence based on the analysis of the database of more than 60,000 patients provided by more than 1000 investigators. A summary of some of the most relevant lines of research for the daily clinical practice of the Primary Health Care physician are presented in this publication

Factores asociados con el conocimiento de la hipertensión en españoles mayores de 60 años / Factors associated awareness of hypertension among older Spaniards, over 60 years of age

Objetivo. Identificar los factores asociados al conocimiento de padecer hipertensión en varones y mujeres españoles mayores de 60 años. Material y métodos. Estudio poblacional de 4.009 sujetos a partir de los datos del estudio: “Hipertensión arterial y otros factores de riesgo en la población de 60 años y más de España”. Entrevista en el domicilio que recoge información sobre el conocimiento de padecer hipertensión arterial, además de variables sociodemográficas, estilo de vida, uso de servicios de salud y calidad de vida relacionada con la salud. Resultados. Las mujeres conocen más la condición de ser hipertensas que los varones (69,2 % frente a 60,2%; p80 años (OR: 0,57). A medida que dejan de acudir a la consulta médica desconocen más, presentan cifras altas de presión arterial sistólica (OR: 0,98) y peor calidad de vida en el índice sumarial físico (OR: 0,98). Las obesas conocen que son hipertensas (OR: 1,52). Conclusiones. El conocimiento se relaciona con diferencias de género, regional, en el estilo de vida y en la calidad de vida. Es recomendable diseñar estrategias diferenciadas por las anteriores variables a fin de incrementar el conocimiento de la hipertensión arterial

Objective. To identify factors associated with the awareness of hypertension among man and women Spaniards age 60 years and older. Material and methods. The data of the study: “Arterial hypertension and other factors of risk in the elderly (?60 years) Spanish population”. This was a population-based survey of 4,009 older Spaniards. Information for this survey was obtained thorough household personal interviews to evaluate the awareness of hypertension and associated factors socio-demographic variables, the use of health system, lifestyles and the quality of life related to health. Results. The women more awareness of hypertension that men (69.2% versus 60.2 %). In men, aged ? 80 years the unawareness to hypertension (OR: 0,61). The less being counseled more knowledge their condition (p trends <0,0001). The awareness associated who having had a previous hospitalization (OR: 1,46) having drunk alcoholic products moderately (OR: 1,63). In women ?80 years of age, unawareness of hypertension (OR: 0,57). The reason is that in according to stop attending medical appointments (OR: 0,98), the systolic pressure will increase 1 mmHg (OR: 0,98) and likewise the physical summary index of life quality will do, but in one point (OR: 0,98). However who know more their situation of hypertension they are the obese ones (OR: 1,52). Conclusions. There are regional differences, gender, lifestyles and to measure health-related quality of life. This demonstrates poor awareness about high blood pressure, so the strategy should be directed toward in these variables mentioned

Epidemiología de la hipertensión arterial en España. Situación actual y perspectivas / Epidemiology of arterial hypertension in Spain. Present situation and perspectives

Si el control de la hipertensión arterial (HTA) y de otros importantes factores de riesgo no mejora, la carga sanitaria y económica de las enfermedades cardiovasculares, renales y neurológicas consiguientes podría incrementarse sustancialmente en las próximas décadas debido al envejecimiento de la población y a la alta prevalencia de estos factores de riesgo. Realmente se ha logrado cierto grado de progreso en el control de la HTA, pero se necesita investigación adicional y mejoras en las tres áreas de conocimiento, tratamiento y control de la HTA. En este artículo se postula que el paradigma de definición y manejo de la HTA puede estar cambiando hacia el concepto de "presión arterial susceptible de tratamiento" (en función de sus cifras y el riesgo cardiovascular). Por último, es preciso no olvidar que para que el sistema sanitario pueda asumir los costes implicados en la carga y el manejo de la HTA debería potenciarse la prevención, sobre todo la prevención primaria, que debe contemplar también a la infancia y la adolescencia

If the control of arterial hypertension (AHT) and other important risk factors do not improve, health care and economic burden of the resulting cardiovascular, renal and neurological diseases could increase substantially in the next decades due to the aging of the population and high prevalence of these risk factors. Truly, a certain degree of progress has been achieved in the control of AHT, but additional investigation and improvements are needed in the three areas of knowledge, treatment and control of AHT. In this article, it is postulated that the definition paradigm and management of ATH may be changing towards the concept of "blood pressure susceptible to treatment" (based on its values and cardiovascular risk). Finally, it must be remembered that prevention, above all primary prevention, that should also contemplate childhood and adolescence, should be strengthened for the health care system to be able to assume the costs involved in the burden and management of AHT

Actividades preventivas cardiovasculares en atención primaria / Cardiovascular preventive activities in primary care

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Relation between body weight and health-related quality of life among the elderly in Spain.

OBJECTIVE: This study examines the relation between body weight and the physical and mental components of health-related quality of life (HRQL) in the population aged 60 y and over in Spain. RESEARCH METHODS AND PROCEDURES: Cross-sectional study covering 3605 subjects, representative of the noninstitutionalised Spanish population aged 60 y and over. Information was collected through home-based personal interview and measurement of blood pressure and anthropometric variables. Logistic regression was used to examine the relation of suboptimal HRQL (score<100) on each SF-36 questionnaire scale with body mass index (BMI) and waist circumference. Separate regression models were constructed for each sex and adjusted for sociodemographic variables, tobacco and alcohol consumption, physical activity, arterial hypertension and diagnosed chronic disease. RESULTS: Mean age of the study population was 70.9 y for men and 72.2 y for women. The percentage of overweight subjects was 48.5% in men and 39.8% in women, and of obese subjects, 31.9 and 41.1% respectively. Men registered a better HRQL than women on most of the SF-36 scales. Compared to normal-weight subjects (BMI: 18.5-24.9 kg/m(2)), frequency of suboptimal physical functioning was higher among obese subjects (BMI>or=30 kg/m(2)), both male (OR: 1.91; 95% CI: 1.22-3.00) and female (OR: 2.58; 95% CI: 1.59-4.19). The aspects of physical functioning most affected were bending, kneeling or stooping, climbing stairs and strenuous effort. Male, though not female, obesity was nonetheless associated with a better HRQL on the SF-36 mental scales. Frequencies of suboptimal scores for overweight persons (BMI: 25-29.9 kg/m(2)) were similar to those for normal-weight subjects on most of the SF-36 scales. Results proved similar for subjects in both the 60-74 and 75-and-over age groups, and also when waist circumference was used as the measure of obesity (>102 cm in men and >88 cm in women). CONCLUSIONS: Obese men and women showed worse physical functioning than normal-weight persons. This occurred irrespective of whether subjects were over or under 74 y of age, or whether obesity was measured by BMI or waist circumference, and was not explained by unhealthy lifestyles or obesity-related chronic disease.

Self-perception of being overweight in Spanish adults.

OBJECTIVE: To describe the frequency, distribution and trend in misperceived overweight and obesity. DESIGN: Three independent cross-sectional studies carried out in 1987, 1995 and 1997 over representative samples of Spanish adult population. SETTING: Spanish adult population aged 20 y and over. SUBJECTS AND INTERVENTIONS: A total of 11 496 men and women aged 20 y and over with a body mass index (BMI) >or=25 kg/m(2). MAIN OUTCOME MEASURES: Prevalence and time trend of misperceived overweight and obesity based on self-perceived weight and height. RESULTS: Some 28.4% of the population did not perceive themselves to be overweight or obese in 1987 (26.9% in 1995/97). Overweight was more frequently misperceived among men, persons over 64 y of age, those residing in rural areas and those with an elementary educational level. The largest percentages of misperceived overweight were in the more moderate levels of BMI: 50% of men and 30% of women with a BMI of 25-26.9 kg/m(2) in 1995/1997 did not perceive themselves to be overweight. CONCLUSIONS: Misperceived overweight and obesity is frequent in the adult population in Spain. Some social and cultural factors may explain its higher frequency in men, older individuals and those with elementary level of education. The fact that most of those who do not perceive themselves to be overweight are in the moderate levels of overweight should be taken into account when designing strategies for the prevention and control of overweight and obesity in the general population.

The size of obesity differences associated with educational level in Spain, 1987 and 1995/97.

OBJECTIVE: To determine the size of obesity differences associated with educational level in the adult population in Spain. DESIGN: Three cross sectional studies representative of the adult population in Spain were carried out in 1987, 1995, and 1997. SETTING: The general population in Spain. PARTICIPANTS: 11 461 men and 10 219 women aged 25 to 64 years. MAIN RESULTS: For both men and women the obesity prevalence was highest in those with elementary education. In 1987 the obesity prevalence proportion associated with less than third level education (PA) was 24.5% (95% CI 6.0 to 42.8) and 47.9% (15.7 to 71.8) in men and women, respectively. The PAs in 1995/97 were 19.8% (0.2 to 40.2) and 55.1% (21.3 to 72.8). CONCLUSIONS: In 1995/97 the burden of obesity associated with less than third level education was 20% in men and 55% in women aged 25 to 64 years. Between 1987 and 1997 the obesity prevalence proportion associated with less than third level education increased in women and decreased in men.

The relationship of overweight and obesity with subjective health and use of health-care services among Spanish women.

OBJECTIVE: To examine the relationship of overweight and obesity with subjective health and use of health-care services among women in Spain. METHODS: Data were drawn from the 1993 Spanish National Health Survey, covering a 13 244-woman sample representative of the non-institutionalised Spanish population aged 16 y and over. Information was collected through home-based interviews. Multiple logistic regression models were used to calculate odds ratios for suboptimal health (fair, poor or very poor) and utilisation of health-care services by women with normal weight (BMI 18.5-24.9 kg/m(2)), overweight (BMI 25.0-29.9 kg/m(2)) and obesity (BMI>or=30 kg/m(2)). Analyses were adjusted for age, education level, occupation, civil status, social support, tobacco use, alcohol consumption, physical activity at work and during leisure time, job status and town of residence. RESULTS: Frequency of suboptimal health was higher in women with overweight (OR 1.7; 95% CI 1.5-1.9) and obesity (OR 2.1; 95% CI 1.8-2.5) than in those with normal weight. Overweight and obese women visited the physician, used hospital emergency services and took medication with greater frequency than did women of normal weight. There was a positive dose-response relationship (P<0.05) of BMI>or=18.5 kg/m(2) with suboptimal health and utilisation of health-care services. These associations were not wholly explained by BMI-related risk factors and chronic diseases, since their statistical significance remained unchanged and their magnitude was only slightly reduced after adjustment for those factors. The association of overweight and obesity with the use of health-care services did not vary with age, educational level or presence of chronic disease. CONCLUSION: Overweight and obese women have worse subjective health and make greater use of health-care services. This finding is an additional argument for implementing weight-control programmes in Spain.

El problema de la hipertensión arterial en España / The problem of arterial hypertension in Spain

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[Smoking-attributable deaths in Spain in 1998]. / Mortalidad atribuible al tabaquismo en España en 1998.

BACKGROUND: Between 1993 and 1997, smoking prevalence remained stable in Spain yet age-adjusted death rates by smoking-related diseases decreased. Our study aimed to estimate the burden of smoking-attributable mortality in Spain in 1998. POPULATION AND METHOD: Spain's smoking prevalence, mortality and relative risks for death from the Cancer Prevention Study II were used to estimate smoking-attributable mortality in the population aged 35 years and over. RESULTS: In 1998, 55,613 deaths were attributable to smoking. One out of 4 deaths in males and one out of 40 deaths in females were attributable to tobacco. Two thirds of the attributable mortality corresponded to deaths due to lung cancer, chronic obstructive pulmonary disease, ischemic heart disease and stroke. CONCLUSIONS: Smoking actually represents a remarkable burden of avoidable deaths in Spain. Smoking-attributable mortality appears to continue increasing in the last years.

La transición de la cardiopatía isquémica aguda a la crónica en España, 1980-1994 / The transition from acute to ischemic heart disease in Spain, 1980-1994

Objetivos. El gran aumento de las hospitalizaciones por insuficiencia cardíaca en España en los últimos años puede resultar paradójico porque coincide con una disminución de la mortalidad por cardiopatía isquémica, la causa más importante de la insuficiencia cardíaca. Una posible explicación es el aumento de la supervivencia de la cardiopatía isquémica producida por los últimos avances terapéuticos, que se traduciría en un aumento de las formas crónicas de la enfermedad. Por ello se estudia las tendencias en la mortalidad y en las hospitalizaciones por cardiopatía isquémica aguda y crónica en el período 1980-1994 en España. Métodos. Estudio poblacional de tendencias temporales con datos de diagnóstico primario de cardiopatía isquémica aguda (CIE-9: 410-411) y crónica (CIE-9: 412-414) obtenidos de las Estadísticas Vitales Nacionales y de la Encuesta Nacional de Morbilidad Hospitalaria. Resultados. El número de muertes por cardiopatía isquémica aguda ha aumentado un 8,3 por ciento, pasando de 18.559 en 1980 a 20.101 en 1994. Las muertes por cardiopatía isquémica crónica aumentaron un 49,3 por ciento, pasando de 4.703 en 1980 a 7.020 en 1994. Como consecuencia, las formas crónicas produjeron el 20,2 por ciento de todas las muertes por cardiopatía isquémica en 1980 y el 25,8 por ciento en 1994. Las tasas de mortalidad ajustadas por edad por cardiopatía isquémica aguda han descendido un 20,1 por ciento, mientras que las de la crónica han aumentando un 14,6 por ciento. El número y las tasas de hospitalización ajustadas por edad han crecido de forma muy importante para la cardiopatía isquémica aguda y crónica. Sin embargo, el crecimiento de la crónica ha sido mayor y ha pasado de representar el 39,4 por ciento de todas las hospitalizaciones por cardiopatía isquémica en 1980 al 58,4 por ciento en 1994. La cronificación de la cardiopatía isquémica es mayor en los varones y entre los más jóvenes. Conclusión. Se está produciendo una transición de la cardiopatía isquémica aguda a la crónica en España. Ello explica, en parte, el aumento de las necesidades de asistencia hospitalaria por enfermedades del corazón, en especial la cardiopatía isquémica y la insuficiencia cardíaca (AU)

Consumption of alcoholic beverages and subjective health in Spain.

STUDY OBJECTIVE: To examine the relation between alcohol and main alcoholic beverage consumption and subjective health in Spain. DESIGN: Logistic regression analysis using a cross sectional survey based on self reported data on alcohol and alcoholic beverage consumption, subjective health and the principal confounding factors (age, sex, civil status, educational level, job status, social support, region of residence, size of town or city, tobacco consumption, physical activity during leisure time and work hours, and chronic disease). SETTING: The 1993 Spanish National Health Survey. PARTICIPANTS: A 19 573 person sample, representative of the non-institutionalised Spanish population aged 16 years and over. MAIN RESULTS: Among Spaniards, 31.4% reported their health as suboptimal (fair, poor or very poor) and 56.9% consumed alcohol regularly, with the majority having a preference for wine. Light (1-2 drinks per day) or moderate consumption (3-4 drinks per day) was the most frequent pattern. After adjusting for confounding factors, a negative dose-response relation was observed between consumption of total alcohol, wine and beer, and prevalence of suboptimal health (linear trend: p<0.001 for total alcohol, p=0.023 for wine, and p=0.030 for beer). In contrast, for consumption of spirits the prevalence of ill health in moderate drinkers was lower than in non-drinkers, with no clear relation at higher consumption. While persons reporting a preference for wine had a lower frequency of suboptimal health than did abstainers, they showed no difference in frequency of subjective ill health with respect to persons with preference for other types of drink or no preference whatsoever. CONCLUSIONS: The higher the consumption of total alcohol, wine and beer, the lower the prevalence of suboptimal health. These results differ from those obtained in several Nordic countries, where a "J shaped" relation has been observed for total alcohol and wine, and suggest that the relation between alcohol consumption and subjective health may be different in Mediterranean countries.

Resumen del documento "Control de la colesterolemia en España 2000. Un instrumento para la prevención cardiovascular" / Cholesterolemia control in Spain, 2000. A tool for cardiovascular disease prevention

El documento "Control de la colesterolemia en España 2000: un instrumento para la prevención cardiovascular" revisa la evidencia existente en el campo de la prevención cardiovascular y los avances terapéuticos producidos en los últimos años con el objetivo de ayudar a tomar decisiones clínicas basadas en el riesgo cardiovascular. Las enfermedades cardiovasculares son la primera causa de muerte en España. Su impacto demográfico, sanitario y social está aumentando y va a continuar haciéndolo en las próximas décadas. El adecuado tratamiento de la hipercolesterolemia y del resto de los factores de riesgo es fundamental para prevenir las enfermedades cardiovasculares. La estratificación del riesgo de las personas es esencial, por cuanto condiciona la periodicidad del seguimiento y la indicación e intensidad del tratamiento. Basándose en dicha estratificación se han establecido unas prioridades de control de la colesterolemia y del riesgo cardiovascular derivado de la misma. En prevención primaria en los pacientes de riesgo alto el objetivo terapéutico se establece en un c-LDL inferior a 130 mg/dl. En prevención secundaria el tratamiento farmacológico se instaurará con un c-LDL 130 mg/dl y el objetivo terapéutico será c-LDL < 100 mg/dl. Las estatinas son los fármacos de primera elección en el tratamiento de la hipercolesterolemia. Cuando exista hipertrigliceridemia moderada-grave y c-HDL bajo se emplearán los fibratos. En el síndrome coronario agudo el tratamiento hipolipidemiante, cuando esté indicado, debe iniciarse precozmente. Los pacientes con cardiopatía isquémica se deben incluir en programas de prevención secundaria que aseguren, de forma continuada, un buen control clínico y de los factores de riesgo (AU)

[The transition from acute to chronic ischemic heart disease in Spain, 1980-1994]. / La transición de la cardiopatía isquémica aguda a la crónica en España, 1980-1994.

BACKGROUND AND OBJECTIVES: The remarkable increase in hospital admissions from heart failure in Spain in the last few years may result paradoxical because it coincides with a decrease in ischemic heart disease mortality, the leading cause of heart failure. A plausible explanation is the increase in ischemic heart disease survival, derived from the recent therapeutic advances, which will translate into an increase in the chronic forms of disease. Thus, an analysis was made of mortality and hospital admission trends due to acute and chronic ischemic heart diseases in the 1980-1994 period in Spain. METHODS: Population-based study of temporal trends with data of primary diagnosis of acute (CIE-9: 410-411) and chronic (CIE-9: 412-414) ischemic heart disease obtained from the National Vital Statistics and the National Survey of Hospital Morbidity. RESULTS: The number of deaths due to acute ischemic heart disease has increased by 8.3%, from 18,559 in 1980 to 20,101 in 1994. Deaths due to chronic ischemic heart disease increased by 49.3%, from 4,703 in 1980 to 7,020 in 1994. As a result, chronic forms accounted for 20.2% of all deaths attributable to ischemic heart disease in 1980 and 25.8% in 1994. The age-adjusted acute ischemic heart disease mortality rates decreased by 20.1%, whereas those due to chronic increased by 14.6%. The number and rate of age-adjusted hospital admissions increased remarkably for both acute and chronic ischemic heart disease. Nevertheless, the increase observed with chronic form was higher, from 39.4% of all hospital admissions due to ischemic heart disease in 1980 to 58.4% in 1994. This classification of ischemic heart disease was more notorious among males and younger patients. CONCLUSION: Currently, we are witnessing a transition from acute to chronic ischemic heart disease. That partly explains the increase in hospital care for heart diseases, particularly ischemic heart disease and heart failure.

[Cholesterolemia control in Spain, 2000: a tool for cardiovascular disease prevention]. / Control de la colesterolemia en España, 2000: un instrumento para la prevención cardiovascular.

The document "Cholesterolemia control in Spain, 2000: a tool for cardiovascular disease prevention" reviews the current evidence on cardiovascular disease prevention and the therapeutic advances achieved in recent years, in order to aid risk-based clinical decision-making. Cardiovascular diseases rank as the first cause of death in Spain. Their demographic, health and social impact is increasing and it is likely to continue to do so in the next decades. Appropriate treatment for high blood cholesterol and other major risk factors is crucial in cardiovascular disease prevention. Individual risk stratification is essential to determine follow-up periodicity and treatment. Priorities for the control of cholesterolemia and the consequent cardiovascular risk are based on risk stratification. In primary prevention, the therapeutic objective in high risk patients has been established as LDL-cholesterol < 130 mg/dl. In secondary prevention, drug treatment is indicated when LDL-cholesterol > or = 130 mg/dl and the therapeutic objective is LDL-cholesterol < 100 mg/dl. Statins are first line drugs for treatment of high blood cholesterol. In moderate-severe hypertriglyceridemia or low HDL-cholesterol, fibrates are preferred. In acute coronary syndrome, hypolipemiant treatment, should be started as soon as possible, when indicated. Secondary prevention programmes that continually provide good clinical and risk factor control should be provided to coronary heart disease patients.