[Do the morning peak in blood pressure, age and gender affect the need to change hypertension treatment because of inefficacy?]. / Influyen el pico matutino de la presión arterial, la edad y el sexo en la necesidad de cambio de tratamiento antihipertensivo por ineficacia?

OBJECTIVE: To evaluate if the timing coincidence of morning rise of arterial blood pressure (BP) and morning turn of clinic BP measurement in our primary healthcare center implies an increased risk of switching antihypertensive drugs because of inefficacy with respect to afternoon staff turn. We also describe age and sex differences. DESIGNAND SETTING: A historical cohort study. We recorded all changes of antihypertensive drugs because of inefficacy of patients of 7 urban primary care clinics during the period from october 1997 to september 1999. MEASUREMENTS: We compared the incidence of changes per 1000 months of prescription of morning and afternoon turns, men and women, older and younger patients than 75 and 65 years old. RESULTS: The mean age of 1152 patients was 69.5 years old. The relation men:women in morning and afternoon turns was similar. Relative risk of switching in morning/afternoon turns was 0.82 (95% CI, 0.61-1.10). Sex and age did not affect the results. If the turn was not considered, younger patients and men had increased risk of being switched. Male adults (< 65 years old) relative risk against female was 1.62 (95% CI, 1.07-2.47). Older patients than 65 year had the RR inverted: RR men/women: 0.78 (95% CI, 0.51-1.21). CONCLUSION: Morning rise of BP did not provoque an increased risk of switching antihypertensive drugs in morning turn with respect to afternoon turn. Male adults had increased risk of switching with respect to women. Older women than 65 years old had more risk than men to be changed.

¿Influyen el pico matutino de la presión arterial, la edad y el sexo en la necesidad de cambio de tratamiento antihipertensivo por ineficacia? / Have morning rise of arterial blood pressure, age and gender any influence on antihypertensive drug switching of because of inefficacy?

Objetivo. Comprobar si la coincidencia del horario de toma de presión arterial (PA) del turno de mañana con el pico matutino de PA supone una necesidad mayor de cambio de fármacos hipotensores por ineficacia respecto al turno de tarde. Analizamos también la influencia de la edad y el género en los cambios de tratamiento globales por ineficacia. Diseño. Estudio de cohorte histórico. Emplazamiento. Siete consultas médicas urbanas de atención primaria. Participantes. Todos los pacientes registrados como hipertensos. Mediciones principales. Revisión de las historias clínicas, registrando los cambios de fármacos hipotensores por ineficacia entre octubre de 1997 y septiembre de 1999. Se comparó la incidencia de cambios por mil meses de prescripción entre el turno de mañana y tarde, entre varones y mujeres y entre mayores y menores de 75 y 65 años. Resultados. La edad media de los 1.152 pacientes fue de 69,5 años, con una distribución por sexo similar en los grupos de mañana y tarde. El riesgo relativo (RR) de cambio del turno de mañana respecto al de tarde fue de 0,82 (IC del 95 por ciento, 0,61-1,10) sin influir la edad y el sexo. Independientemente del turno, los pacientes más jóvenes y los varones tenían más probabilidad de cambiarles el tratamiento. El riesgo era mayor en adultos varones menores de 65 años respecto a mujeres: RR, 1,62 (IC del 95 por ciento, 1,07-2,47). En mayores de 65 años el riesgo se invertía con más cambios en mujeres: RR, 0,78 (IC del 95 por ciento, 0,51-1,21).Conclusiones. El pico matutino de PA no provoca más cambios de tratamiento por ineficacia en los pacientes atendidos en el turno de mañana. En nuestra población se cambia el tratamiento antihipertensivo por ineficacia con más frecuencia a los varones menores de 65 años que a las mujeres, y en mayores de 65 años esta proporción se invierte (AU)

[A population-based study of need for changes and continuing rates of antihypertensive drugs]. / Análisis poblacional de la necesidad de cambios y tasas de continuidad de los diferentes fármacos antihipertensivos.

BACKGROUND: Antihypertensive drugs are frequently changed because of inefficacy and adverse effects. The aim of this study was to compare the incidence of changes of the new classes of drugs from the classical beta-blockers and diuretics. We also have calculated the probability of continuing with each class of drug. MATERIAL AND METHOD: Clinical reports of hypertensive patients of a general practice centre were examined. All changes of treatment and their causes were registered between october 1997 and september 1999. The incidences for global changes and also for intolerance and inefficacy changes were calculated for each drug. Relative risks for beta-blockers, diuretics, ACE inhibitors of anhidride carbonic enzyme and angiotensine II-receptor-antagonists were analized. The cumulated probability for continuing therapy was also studied. RESULTS: 27.6% out of 786 courses of treatment were changed, 51.4% due to intolerance and 29,8% due to inefficacy. The probability for continuing was 88% after 3 months, 81% after 6 months, 71% after one year and 54% after 2 years. The probability for discontinuing because of intolerance was higher in the first 3 months (51%), but afterwards it remained stable along the time. CONCLUSIONS: Antihypertensive drugs are discontinued more frequently than what it would be desirable and their continuing rates are low. Differences observed among each class of drugs are not argument enough for changing the general recommendation of using beta-blockers and diuretics as first choice drugs for initial treatment of hypertension.

[Hepatitis C in primary care: a study of carriers and their families]. / Hepatitis C en atención primaria: estudio de los portadores y sus familiares.

OBJECTIVE: A clinical epidemiological study at a health centre of carriers of hepatitis C virus (HCV) antibodies. The prevalence of HCV antibodies in immediate family members. DESIGN: Crossover and descriptive. SETTING: Chopera I Primary Care team. PATIENTS AND FAMILY MEMBERS: 37 carriers of HCV antibodies in the Centre's records. 52 family members of 21 carriers. MEASUREMENTS AND MAIN RESULTS: A form containing the clinical and epidemiological data of each carrier was filled out. The diagnosis of HCV infection was made at the Health Centre in 72.22% of cases. 80% evolved towards a chronic hepatitis. 56.75% had a history of parenteral transmission. 37.75% had no history of risk factors. The epidemiological data of the family members was recorded and transaminasaemia and the HCV antibodies were determined. Four cases (8.33%) with altered transaminase and three cases (6.82%) of positive antibodies were found. CONCLUSIONS: Existence of a high percentage of Hepatitis C of no known origin and a greater prevalence of carriers among family contacts than in the population as a whole. Essential role of Primary Care in the detection and follow-up of HCV carriers. A need for definitive studies on sexual transmission and the possible existence of other transmission routes. The setting-up of preventive measures against these routes.

[Atypical presentations of primary hypothyroidism in primary care]. / Formas "atípicas" de presentación del hipotiroidismo primario en atención primaria.

OBJECTIVE: To present three cases of primary Hypothyroidism with an atypical beginning. DESIGN: Retrospective clinical observations. SITE. Health Centre (Primary Care). PATIENTS OR OTHERS PARTICIPANTS: Three women (aged 38, 43 and 51) who were studied in the consulting room: one who presented Macrocytosis and Hypercholesterolemia; the second, a bilateral palpebral oedema; and the third, dysfonia unaccompanied by any other symptom of Hypothyroidism. MAIN MEASUREMENTS AND RESULTS: In the three cases, hypercholesterolemia was objectified, I4 diminished and TSH raised; in one of them T3 was normal, while it was low in the remainder. CONCLUSIONS: The alteracions observed are frequent in primary Hypothyroidism. But it is rare to find them on their own in the presentation of the clinical picture. Given this pathology's high prevalence, it is important to think of the pathology when presented with these atypical symptoms, and possibly to request the determination of TSH in isolation.

[Family outbreak of hepatitis B]. / Brote familiar de hepatitis B.

Hepatitis B virus (HBV) causes one of the most widespread infections worldwide. We report a family outbreak where a male with Down's syndrome attending an open institution for mentally retarded individuals probably was the source of the infection. We consider the prevention as the only means to attack the infection with intervention on the transmission mechanisms and immuniprophylaxis. We emphasize eh need of a perfect communication between the several institutions involved in epidemiological surveillance. This might have prevented the present outbreak. Finally, we insist on the importance that the primary care physician could have in the prescription and indication of immunoprophylaxis. To this end, the disappearance of the administrative barriers established by the Secretaría General de Asistencia Sanitaria from the Health Ministry would be needed.

[Familial outbreak of Mycoplasma pneumoniae pneumonia]. / Brote familiar de neumonía por Mycoplasma pneumoniae.

Mycoplasma pneumoniae is a pathogen of the human species which causes primarily acute respiratory diseases including pneumonia. It is transmitted from person through the respiration, and results in small epidemics. Most infected persons only develop pharyngitis or tracheobronchitis, whereas pneumonia develops in 3-30% depending on the age and characteristics of the evaluated group. Mycoplasma pneumoniae is the causative organism of 20% of community acquired pneumonias in the general population; this proportion rises to 60% in closed groups and in individuals below age 20 years. Two cases of Mycoplasma pneumoniae pneumonia identified in a single family are reported, together with a case of tracheobronchitis most likely caused by the same organism. The clinical, diagnostic, therapeutic and preventive approaches to the mycoplasma infections are discussed, and also the therapeutic approach to be recommended, in primary care, to young patients with pneumonia.