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.

Eficiencia entre los diferentes patrones de medida de la automonitorización de la presión arterial en el seguimiento del hipertenso en atención primaria / Efficiency between the different measurement patterns of home blood pressure monitoring in the follow-up of hypertensive patients in primary care

Objetivo: Identificar el patrón de medición de la automonitorización de la presión arterial (AMPA) más eficiente para el seguimiento del hipertenso en atención primaria. Diseño: Estudio validación de prueba diagnóstica. Emplazamiento: Equipo de atención primaria en Murcia. Población: Ciento cincuenta y tres hipertensos menores de 80 años que cumplieran con los criterios de inclusión; y con AMPA y monitorización ambulatoria de su presión arterial válidos. Mediciones principales: Realización de monitorización ambulatoria de presión arterial durante 24 h (MAPA). El protocolo de AMPA consistió en registrar 2 mediciones en la mañana y 2 en la noche durante 7 días. Con los registros obtenidos se establecieron los diferentes patrones de AMPA (7, 6, 5, 4, 3 días). Para el análisis utilizamos las curvas COR, el coeficiente de correlación intraclase y el diagrama de Bland-Altman. Resultados: Las mejores áreas bajo la curva para la presión sistólica de los diferentes patrones de la AMPA correspondieron al patrón de 4 días: 0,837 (0,77-0,90); y al de 3 días: 0,834 (0,77-0,90). En cuanto a la diastólica, el patrón de 7 días presentó un área bajo la curva de 0,889 (0,84-0,94); y en segundo lugar, coincidiendo con la misma cifra, los patrones de 3 y 4 días: 0,834 (0,83-0,94). No hubo diferencias significativas entre los coeficientes de correlación intraclase para las presiones arteriales sistólicas y diastólicas. El patrón de 3 días mostró en conjunto una menor dispersión en el diagrama de Bland-Altman. Conclusión: Proponemos el patrón de AMPA de 3 días para el seguimiento del paciente hipertenso, ya que no presenta una eficiencia inferior a los demás patrones

Objective: To identify the most efficient measurement pattern of home blood pressure monitoring (HBPM) for the follow-up of hypertensive patients in primary care. Design: Validation study of a diagnostic test. Setting: Primary care team in Murcia, Spain. Population: One hundred and fifty three hypertensive patients younger than 80 years who met the inclusion criteria, who used HBPM and ambulatory blood pressure monitoring. Main measurements: Performing HBPM for 24hours. The HBPM protocol consisted of recording 2 measurements in the morning and 2 in the evening for 7 days. With the records obtained, the different HBPM patterns were established (7, 6, 5, 4, 3 days). The ROC curves were used for the analysis, together with the correlation coefficients and the Bland-Altman plots. Results: The best areas under the curve for the systolic pressure of the different HBPM patterns corresponded to the 4-day pattern: 0.837 (0.77-0.90); and the 3 day one: 0.834 (0.77-0.90). As for diastolic pressure, the 7-day pattern had an area under the curve of 0.889 (0.84-0.94); followed by the 3 and 4 days patterns, which had the same statistical result both: 0.834 (0.83-0.94). There were no significant differences between correlation coefficients for systolic and diastolic blood pressures. The 3-day pattern showed a lower dispersion in the Bland-Altman plots. Conclusion: The 3 days HBPM pattern is proposed for the follow-up of the hypertensive patient, since it does not have an inferior efficiency to the other patterns

[Efficiency between the different measurement patterns of home blood pressure monitoring in the follow-up of hypertensive patients in primary care]. / Eficiencia entre los diferentes patrones de medida de la automonitorización de la presión arterial en el seguimiento del hipertenso en atención primaria.

OBJECTIVE: To identify the most efficient measurement pattern of home blood pressure monitoring (HBPM) for the follow-up of hypertensive patients in primary care. DESIGN: Validation study of a diagnostic test. SETTING: Primary care team in Murcia, Spain. POPULATION: One hundred and fifty three hypertensive patients younger than 80 years who met the inclusion criteria, who used HBPM and ambulatory blood pressure monitoring. MAIN MEASUREMENTS: Performing HBPM for 24hours. The HBPM protocol consisted of recording 2 measurements in the morning and 2 in the evening for 7 days. With the records obtained, the different HBPM patterns were established (7, 6, 5, 4, 3 days). The ROC curves were used for the analysis, together with the correlation coefficients and the Bland-Altman plots. RESULTS: The best areas under the curve for the systolic pressure of the different HBPM patterns corresponded to the 4-day pattern: 0.837 (0.77-0.90); and the 3 day one: 0.834 (0.77-0.90). As for diastolic pressure, the 7-day pattern had an area under the curve of 0.889 (0.84-0.94); followed by the 3 and 4 days patterns, which had the same statistical result both: 0.834 (0.83-0.94). There were no significant differences between correlation coefficients for systolic and diastolic blood pressures. The 3-day pattern showed a lower dispersion in the Bland-Altman plots. CONCLUSION: The 3 days HBPM pattern is proposed for the follow-up of the hypertensive patient, since it does not have an inferior efficiency to the other patterns.

La figura de la enfermera educadora hospitalaria mejora la HbA1cy el perfil lipídico de los pacientes con diabetes tipo 1 / The figure of a nurse educator improves HbA1c levels and lipid profile in patients with type 1 diabetes

La educación diabetológica ha demostrado ser esencial en la atención del paciente diabético. Para realizar esta tarea educacional, la Unidad de Diabetes del Área VII Murcia Este, que incorporó a enfermeras especializadas en educación diabetológica avanzada en el Hospital General Universitario Reina Sofía de Murcia. Se realizó un estudio retrospectivo, donde se valoró la actuación de dichas enfermeras mediante la evaluación de los pacientes diabéticos tipo 1 que acudieron a sus consultas entre los años 2007 y 2011. Se analizaron un total de 179 historias clínicas de pacientes con diabetes mellitus tipo 1 (DM1) mayores de 11 años, siendo 103 (52.3 %) varones y 94 (47.7 %) mujeres. Los pacientes presentaban una edad media de 38.25 ± 14.02 años y un tiempo de duración de la diabetes medio de 16.22 ± 11.73 años. El valor de HbA1c inicial medio fue de 8.49 ± 2.04 %. De los 197 pacientes, solo 37 (16.2 %) eran menores de 25 años en el momento de acudir a consulta. Los resultados obtenidos demostraron que la disminución de la HbA1c (-0,57 ± 1,80 %) era significativa a los 6 meses (p: 0,002) de la primera consulta alcanzando valores de 7.86 ± 1.39 y manteniéndose a partir de ese momento. Las dosis de insulina fueron estables a lo largo del estudio. (AU)

Diabetes education has proved to be an essential tool in the care of patients with type 1 diabetes mellitus. To perform this educational task, the VII Area Murcia East Diabetes Unit, incorporated nurses in advanced diabetes education in the Hospital General Universitario Reina Sofía of Murcia. We carried out a retrospective study, which assessed the performance of these nurses by evaluating the type 1 diabetic patients attending inquiries between 2007 and 2011. We analyzed a total of 179 medical records, of patients with type 1 diabetes mellitus over 11 years, with 103 (52.3%) males and 94 (47.7%) women. Patients had a mean age 38.25 ± 14.02 years and a mean duration of diabetes of 16.22 ± 11.73 years. The initial mean value of HbA1c was 8.49 ± 2.04%. Only 37 (16.2%) of the 197 patients were under 25 at the start of the study. The results showed that the decrease in HbA1c (-0.57 ± 1.80%) was significant after 6 months (p = 0.002) from the first query, reaching values of 7.86 ± 1.39 % and remained from that time. Insulin doses were stable throughout the study (AU)

[The figure of a nurse educator improves HbA1c levels and lipid profile in patients with type 1 diabetes]. / La figura de la enfermera educadora hospitalaria mejora la HbA1c y el perfil lipídico de los pacientes con diabetes tipo 1.

Diabetes education has proved to be an essential tool in the care of patients with type 1 diabetes mellitus. To perform this educational task, the VII Area Murcia East Diabetes Unit, incorporated nurses in advanced diabetes education in the Hospital General Universitario Reina Sofía of Murcia. We carried out a retrospective study, which assessed the performance of these nurses by evaluating the type 1 diabetic patients attending inquiries between 2007 and 2011. We analyzed a total of 179 medical records, of patients with type 1 diabetes mellitus over 11 years, with 103 (52.3%) males and 94 (47.7%) women. Patients had a mean age 38.25 ± 14.02 years and a mean duration of diabetes of 16.22 ± 11.73 years. The initial mean value of HbA1c was 8.49 ± 2.04%. Only 37 (16.2%) of the 197 patients were under 25 at the start of the study. The results showed that the decrease in HbA1c (-0.57 ± 1.80%) was significant after 6 months (p = 0.002) from the first query, reaching values of 7.86 ± 1.39% and remained from that time. Insulin doses were stable throughout the study.

La educación diabetológica ha demostrado ser esencial en la atención del paciente diabético. Para realizar esta tarea educacional, la Unidad de Diabetes del Área VII Murcia Este, que incorporó a enfermeras especializadas en educación diabetológica avanzada en el Hospital General Universitario Reina Sofía de Murcia. Se realizó un estudio retrospectivo, donde se valoró la actuación de dichas enfermeras mediante la evaluación de los pacientes diabéticos tipo 1 que acudieron a sus consultas entre los años 2007 y 2011. Se analizaron un total de 179 historias clínicas de pacientes con diabetes mellitus tipo 1 (DM1) mayores de 11 años, siendo 103 (52.3 %) varones y 94 (47.7 %) mujeres. Los pacientes presentaban una edad media de 38.25 ± 14.02 años y un tiempo de duración de la diabetes medio de 16.22 ± 11.73 años. El valor de HbA1c inicial medio fue de 8.49 ± 2.04 %. De los 197 pacientes, solo 37 (16.2 %) eran menores de 25 años en el momento de acudir a consulta. Los resultados obtenidos demostraron que la disminución de la HbA1c (-0,57 ± 1,80 %) era significativa a los 6 meses (p: 0,002) de la primera consulta alcanzando valores de 7.86 ± 1.39 y manteniéndose a partir de ese momento. Las dosis de insulina fueron estables a lo largo del estudio.