[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.