[Current situation of hypertensive patients over 75 years old: the DISEHTAE study]. / Situación actual del paciente hipertenso y mayor de 75 años en España. Estudio DISEHTAE.

OBJECTIVE: To assess in patients over 75 years old the degree of their compliance with recommendations on follow-up, control and treatment of hypertension. DESIGN: Descriptive, multi-centre study, covering the whole of Spain. SETTING: A total of 107 health centres from 14 autonomous communities. PARTICIPANTS: Hypertensive patients over 75: 1,369 clinical charts. INTERVENTIONS AND MAIN MEASUREMENTS: The variables studied were: age and sex, place monitored, blood pressure figures, screening for, and diagnosis of diabetes, hypercholesterolaemia, smoking, left ventricular hypertrophy (LVH) and obesity. Blood creatinine, proteinuria, prescribed medication, and infrastructure variables were also included. RESULTS: The most often screened cardiovascular risk factor (CRF) was obesity (76.1%), whilst the most prevalent was hypercholesterolaemia (31.3%). Of the patients, 25.5% had associated diabetes and 48.5% had a body mass index (BMI) >25. Low microalbuminuria (8.4%) was found. The proportion of patients with their blood pressure controlled was higher among those monitored in primary care (32.8%) than out of primary care (23.2%). No drug treatment was prescribed for 7.9%, only hygiene-dietary measures. The most common pharmacological group was that of the diuretics, followed by IECAS and ARA II. CONCLUSIONS: Though we can say that the degree of control of hypertension in elderly patients is steadily increasing, it is still far from optimal in most of our patients.

Situación actual del paciente hipertenso y mayor de 75 años en España. Estudio DISEHTAE / Current situation of hypertensive patients over 75 years old. The DISEHTAE study

Objetivo. Valorar, en el paciente mayor de 75 años, el grado de cumplimiento de las recomendaciones de seguimiento, control y tratamiento de la hipertensión arterial. Diseño. Estudio descriptivo, multicéntrico, de ámbito nacional. Emplazamiento. Ciento siete centros de salud de 14 comunidades autónomas de España. Participantes. Un total de 1.369 historias clínicas de pacientes hipertensos mayores de 75 años. Intervenciones y mediciones principales. Las variables estudiadas fueron edad y sexo, lugar de seguimiento, cifras de presión arterial, cribado y diagnóstico de diabetes, hipercolesterolemia, hábito tabáquico, hipertrofia ventricular izquierda y obesidad. También se estudiaron la creatinina plasmática, proteinuria, tratamiento farmacológico prescrito y variables de infraestructura. Resultados: El factor de riesgo cardiovascular más cribado fue la obesidad (76,1%), mientras que el más prevalente fue la hipercolesterolemia (31,3%). El 25,5% de los pacientes presentaba diabetes asociada, y el 48,5% de la muestra presentaba un índice de masa corporal (IMC) superior a 25. Se observó un bajo cribado de la microalbuminuria (8,4%). La proporción de pacientes con la presión arterial controlada es mayor entre los que se siguen en atención primaria, con un 32,8%, respecto a los seguidos fuera del ámbito de la atención primaria, con un 23,2%. A un 7,9% no se le había prescrito tratamiento farmacológico alguno, únicamente medidas higiénico-dietéticas. El grupo farmacológico más utilizado fueron los diuréticos, seguidos de inhibidores de la enzima conversiva de la angiotensina (IECA) y antagonistas de los receptores de la angiotensina II (ARA II). Conclusiones: Se puede llegar a la conclusión de que el grado de control de la hipertensión arterial en el paciente anciano va aumentando de forma progresiva, pero aún está muy lejos de lograrse un control óptimo en la mayoría de los pacientes

Objective. To assess in patients over 75 years old the degree of their compliance with recommendations on follow-up, control and treatment of hypertension. Design. Descriptive, multi-centre study, covering the whole of Spain. Setting. A total of 107 health centres from 14 autonomous communities. Participants. Hypertensive patients over 75: 1369 clinical charts. Interventions and main measurements. The variables studied were: age and sex, place monitored, blood pressure figures, screening for, and diagnosis of diabetes, hypercholesterolaemia, smoking, left ventricular hypertrophy (LVH) and obesity. Blood creatinine, proteinuria, prescribed medication, and infrastructure variables were also included. Results. The most often screened cardiovascular risk factor (CRF) was obesity (76.1%), whilst the most prevalent was hypercholesterolaemia (31.3%). Of the patients, 25.5% had associated diabetes and 48.5% had a body mass index (BMI) >25. Low microalbuminuria (8.4%) was found. The proportion of patients with their blood pressure controlled was higher among those monitored in primary care (32.8%) than out of primary care (23.2%). No drug treatment was prescribed for 7.9%, only hygiene-dietary measures. The most common pharmacological group was that of the diuretics, followed by IECAS and ARA II. Conclusions. Though we can say that the degree of control of hypertension in elderly patients is steadily increasing, it is still far from optimal in most of our patients

[Effectiveness of an intervention to improve quality care in reducing cardiovascular risk in hypertense patients]. / Efectividad de una intervención de mejora de calidad en la reducción del riesgo coronario y del riesgo de mortalidad cardiovascular en pacientes hipertensos.

OBJECTIVE: To evaluate the effectiveness of an intervention on health workers, based on quality improvement through reduction of cardiovascular risk in patients with hypertension. DESIGN: Quasi-experimental study. SETTING: Primary care. Two urban health centres. PARTICIPANTS: A thousand hypertense patients selected by stratified random sampling. One centre (500) was assigned to implement a quality improvement intervention, while at the other centre (500) "usual care" procedures were followed (control group). INTERVENTIONS: The quality improvement intervention consisted of a combined program designed for the medical and nursing staff that comprised audit, feedback, training sessions, and implementation of clinical practice guidelines. MAIN MEASUREMENTS: Coronary risk using the Framingham scale and cardiovascular mortality risk using the SCORE project. RESULTS: Absolute coronary risk decreased from 16.94% (95% CI, 15.92-17.66) to 13.81% (95% CI, 13.09-14.52) (P<.001) in the intervention group; whilst there was no significant change in the control group, which dropped from 17.63% (95% CI, 16.68-18.53) to 16.82% (95% CI, 15.91-17.74). The intervention led to a 2.28% point decrease (95% CI, 1.35-3.21) (P<.001) in coronary risk. Cardiovascular mortality risk decreased from 2.48% (95% CI, 2.35-2.62) to 2.19% (95% CI, 2.07-2.31) (P<.001) in the intervention group, with no significant change in the control group, which changed from 2.45% (95% CI, 2.30-2.59) to 2.52% (95% CI, 2.38-2.66). The intervention led to a 0.36% point decrease (95% CI, 0.05-0.73) (P<.001) in cardiovascular mortality risk. CONCLUSIONS: The quality improvement intervention was effective in decreasing coronary risk and cardiovascular mortality risk in patients with hypertension.

Efectividad de una intervención de mejora de calidad en la reducción del riesgo coronario y del riesgo de mortalidad cardiovascular en pacientes hipertensos / Effectiveness of an intervention to improve quality care in reducing cardiovascular risk in hypertense patients

Objetivo. Evaluar la efectividad de una intervención sobre los profesionales sanitarios basada en la metodología de mejora de la calidad mediante la reducción del riesgo cardiovascular en pacientes con hipertensión. Diseño. Estudio de evaluación de calidad con intervención no aleatoria. Emplazamiento. Atención primaria. Dos centros de salud urbanos. Participantes. Muestreo aleatorio estratificado de 1.000 hipertensos de los dos centros de salud. Un centro (500) fue asignado para recibir una intervención de mejora de calidad y el otro (500), la atención habitual (control). Intervenciones. La intervención de mejora de calidad consistió en un programa combinado para el personal sanitario que incluyó: audit, feedback, sesiones de formación e implementación de guías clínicas. Mediciones principales. Riesgo coronario determinado mediante la escala de Framingham y riesgo de mortalidad cardiovascular valorado con la escala del proyecto SCORE. Resultados. El riesgo coronario absoluto decreció del 16,94% (intervalo de confianza [IC] del 95%, 15,92-17,66) al 13,81% (IC del 95%, 13,09-14,52) (p < 0,001) en el grupo de intervención, sin diferencias en el grupo control, del 17,63% (IC del 95%, 16,68-18,53) al 16,82% (IC del 95%, 15,91-17,74). El efecto logrado por la intervención fue un descenso del riesgo de 2,28 puntos porcentuales (IC del 95%, 1,35-3,21) (p < 0,001). El riesgo de mortalidad cardiovascular decreció del 2,48% (IC del 95%, 2,35-2,62) al 2,19% (IC del 95%, 2,07-2,31) (p < 0,001) en el grupo de intervención, sin diferencias en el grupo control del 2,45% (IC del 95%, 2,30-2,59) al 2,52% (IC del 95%, 2,38-2,66). El efecto logrado por la intervención fue un descenso del riesgo de 0,36 puntos porcentuales (IC del 95%, 0,05-0,73) (p < 0,001). Conclusiones. La intervención de mejora de calidad ha sido efectiva en el descenso del riesgo coronario y del riesgo de mortalidad cardiovascular en pacientes hipertensos

Objective. To evaluate the effectiveness of an intervention on health workers, based on quality improvement through reduction of cardiovascular risk in patients with hypertension. Design. Quasi-experimental study. Setting. Primary care. Two urban health centres. Participants. A thousand hypertense patients selected by stratified random sampling. One centre (500) was assigned to implement a quality improvement intervention, while at the other centre (500) "usual care" procedures were followed (control group). Interventions. The quality improvement intervention consisted of a combined program designed for the medical and nursing staff that comprised audit, feedback, training sessions, and implementation of clinical practice guidelines. Main measurements. Coronary risk using the Framingham scale and cardiovascular mortality risk using the SCORE project. Results. Absolute coronary risk decreased from 16.94% (95% CI, 15.92-17.66) to 13.81% (95% CI, 13.09-14.52) (P<.001) in the intervention group; whilst there was no significant change in the control group, which dropped from 17.63% (95% CI, 16.68-18.53) to 16.82% (95% CI, 15.91-17.74). The intervention led to a 2.28% point decrease (95% CI, 1.35-3.21) (P<.001) in coronary risk. Cardiovascular mortality risk decreased from 2.48% (95% CI, 2.35-2.62) to 2.19% (95% CI, 2.07-2.31) (P<.001) in the intervention group, with no significant change in the control group, which changed from 2.45% (95% CI, 2.30-2.59) to 2.52% (95% CI, 2.38-2.66). The intervention led to a 0.36% point decrease (95% CI, 0.05-0.73) (P<.001) in cardiovascular mortality risk. Conclusions. The quality improvement intervention was effective in decreasing coronary risk and cardiovascular mortality risk in patients with hypertension