Review of the renal endpoints used in cardiovascular safety clinical trials in type 2 diabetes mellitus patients and their importance in primary care.

Chronic kidney disease (CKD) is one of the most common complications of type 2 diabetes mellitus (T2DM). Furthermore, CKD confers a considerable increase in the risk of cardiovascular (CV) morbidity and mortality. In line with the need to improve knowledge in this field, this article aims to describe the renal endpoints used in the different cardiovascular outcome trials (CVOTs). The objective is to better know the renal variables used in the different CVOTs in order to optimize the implementation of advances in the prevention of progressive diabetic kidney disease in patients with T2DM in clinical practice.

Relación del grado de control glucémico con las características de la diabetes y el tratamiento de la hiperglucemia en la diabetes tipo 2. Estudio DIABES / Relationship between the degree of glycemic control and diabetes characteristics and hyperglycemia treatment in type 2 diabetes. DIABES Study

Fundamento y objetivo: Evaluar la relación del grado de control glucémico con las características de la enfermedad y el tratamiento antihiperglucemiante en pacientes con diabetes mellitus tipo 2 en España. Pacientes y método: Estudio epidemiológico transversal y multicéntrico en el territorio español con muestreo consecutivo. Se registraron variables demográficas y clínicas de pacientes con seguimiento en el centro >12 meses. Resultados: Se analizaron datos de 6.801 pacientes reclutados por 734 médicos especialistas y 965 de atención primaria: el 97,8% recibían tratamiento farmacológico (30,3% monoterapia, 51,4% con 2 fármacos, 16,1%≥3 fármacos y 26,6% con insulina). La hemoglobina glucosilada (HbA1c) media (DE) era de 7,3 (1,2) % y el 40,4% de los pacientes tenían HbA1c<7,0%. Esta proporción varió (p<0,0001) según el tiempo de evolución de la diabetes (51,8% con <5 años, 39,6% con 5-10 años, 35,1% con 10-15 años y 31,4% con >15 años) y el tipo de tratamiento (monoterapia 52,9%, biterapia 35,6%, triple terapia 28,0% e insulina 25,2%). En el análisis multivariante, el tratamiento con insulina (odds ratio [OR] 0,329; intervalo de confianza del 95% [IC 95%] 0,267-0,405) y la existencia de componentes del síndrome metabólico (hipertrigliceridemia y/o colesterol unido a lipoproteínas de alta densidad bajo y/u obesidad abdominal) (OR 0,728; IC 95% 0,595-0,890) se asociaron con peor control glucémico. Conclusiones: Se constata el deterioro del control glucémico con la evolución de la enfermedad y la complejidad del proceso y del tratamiento, lo que en parte puede estar relacionado con la inadecuada selección e intensificación del tratamiento (AU)

Background and objective: To evaluate the relationship between the degree of glycemic control and the features of the disease and glucose-lowering treatment in patients with type 2 diabetes mellitus in Spain. Patients and methods: Cross-sectional epidemiological study in Spain with consecutive sampling. We recorded demographic and clinical variables of patients who were followed up in the center for >12 months. Results: We analyzed data from 6,801 patients enrolled by 734 specialist and 965 primary care physicians: 97.8% received pharmacological treatment (30.3% monotherapy, 51,4% dual therapy, 16.1% triple therapy and 26.6% insulin). HbA1c was 7.3 (1.2) % and 40.4% of patients had HbA1c<7.0%. This proportion varied (P<.0001) according to the duration of diabetes (51.8% with <5 years, 39.6% with 5-10 years, 35.1% with 10-15 years and 31 4%>15 years) and the type of treatment (52.9% monotherapy, 35.6% dual therapy, 28.0% triple therapy and 25.2% insulin). In the multivariate analysis, insulin therapy (odds ratio [OR] 0.329; IC95% 0,267-0,405) and the presence of components of metabolic syndrome (hypertriglyceridemia and/or low HDL and/or abdominal obesity (OR 0.728; IC95% 0,595-0,890) were associated with poor glycemic control. Conclusions: We observed an impairment of glycemic control with the progression of the disease and the complexity of the process and treatment, which in part may be related to the inadequate treatment selection and intensification (AU)

[Relationship between the degree of glycemic control and diabetes characteristics and hyperglycemia treatment in type 2 diabetes. DIABES Study]. / Relación del grado de control glucémico con las características de la diabetes y el tratamiento de la hiperglucemia en la diabetes tipo 2. Estudio DIABES.

BACKGROUND AND OBJECTIVE: To evaluate the relationship between the degree of glycemic control and the features of the disease and glucose-lowering treatment in patients with type 2 diabetes mellitus in Spain. PATIENTS AND METHODS: Cross-sectional epidemiological study in Spain with consecutive sampling. We recorded demographic and clinical variables of patients who were followed up in the center for >12 months. RESULTS: We analyzed data from 6,801 patients enrolled by 734 specialist and 965 primary care physicians: 97.8% received pharmacological treatment (30.3% monotherapy, 51,4% dual therapy, 16.1% triple therapy and 26.6% insulin). HbA(1c) was 7.3 (1.2) % and 40.4% of patients had HbA(1c)<7.0%. This proportion varied (P<.0001) according to the duration of diabetes (51.8% with <5 years, 39.6% with 5-10 years, 35.1% with 10-15 years and 31 4%>15 years) and the type of treatment (52.9% monotherapy, 35.6% dual therapy, 28.0% triple therapy and 25.2% insulin). In the multivariate analysis, insulin therapy (odds ratio [OR] 0.329; IC(95%) 0,267-0,405) and the presence of components of metabolic syndrome (hypertriglyceridemia and/or low HDL and/or abdominal obesity (OR 0.728; IC(95%) 0,595-0,890) were associated with poor glycemic control. CONCLUSIONS: We observed an impairment of glycemic control with the progression of the disease and the complexity of the process and treatment, which in part may be related to the inadequate treatment selection and intensification.

Clinical applicability of B-type natriuretic peptide in patients with suspected heart failure in primary care in Spain: the PANAMA study.

AIM: To assess the predictive value of B-type natriuretic peptide (BNP) in the diagnosis of heart failure (HF) in a primary-care setting in Spain. METHODS: PANAMA was a multicenter and cross-sectional study. Patients ≥18 years of age with a clinical diagnosis of HF (Framingham criteria) were consecutively included in the study by primary-care investigators. BNP determination and an echocardiogram were performed in every patient. The cut-off point of BNP for the criterion of exclusion of HF was considered as <100 pg/ml, as suggested by European guidelines. Sensitivity, specificity, positive-predictive value and negative-predictive value were calculated. RESULTS: A total of 72 patients (mean age: 75.1 ± 8.7 years; 74.6% women) were included. The most frequent associated risk factors were hypertension (75.6%) and dyslipidemia (54.3%). The most common major and minor criteria of HF according to Framingham criteria were radiographic cardiomegaly (90.2%) and dyspnea on ordinary exertion (100%), respectively. BNP median was 49 pg/ml (33.3 pg/ml in those with a doubtful diagnosis of HF and 83.3 pg/ml in those with a likely diagnosis of HF). Approximately 60% of patients exhibited diastolic dysfunction. Concerning accuracy parameters comparing BNP >100 pg/ml with echocardiogram, sensitivity was 25%, the specificity 80.8%, and the positive- and negative-predictive values were 68.8 and 38.9%, respectively. CONCLUSION: In patients attended by general practitioners, BNP >100 pg/ml may be a useful diagnostic tool with a high specificity for the diagnosis of HF.

Pulse pressure and the metabolic syndrome in patients with hypertension.

The authors examined the clinical profile of the hypertensive population with the metabolic syndrome (MetS) and elevated pulse pressure (PP) in a sample of 5866 patients (3291 women and 2575 men) included in a large hypertension survey performed in primary care setting. Elevated PP was defined as >or=80 mm Hg in women and >or=75 mm Hg in men; 92.7% of women and 87.6% of men had normal PP values. Patients with higher PP levels were older, were more commonly diabetic, and exhibited more frequently target organ damage and associated clinical conditions. Blood pressure was less well controlled in the subgroup of patients with elevated PP: control rates were 4.1% vs 19.2%, P<.001; men, 3.9% vs 19.0%, P<.001; P=NS between sexes. Low-density lipoprotein cholesterol was similarly controlled regardless of PP: control rates were, 17.0% vs 17.8%; in women with high PP vs normal PP and 25.2% vs 25.1% in men with high PP vs normal PP, both P=NS; P<.001 between sexes with high PP. In the patients with high PP, the female subgroup was older, was more obese, and had more left ventricular hypertrophy and fewer associated clinical conditions than did men. The odds ratio of having high PP in women with MetS vs no MetS was 3.13 and in men was 1.9 (both P<.01).

Grado de adherencia al tratamiento farmacológico en pacientes con insuficiencia cardiaca y fracción de eyección deprimida en consultas de cardiología / Medication adherence in patients with heart failure and a depressed ejection fraction attending cardiology clinics

No disponible

No disponible

[Impact of the presence of cardiovascular disease on blood pressure and lipid control in the hypertense population attended in primary care]. / Impacto de la presencia de enfermedad cardiovascular en el control de presión arterial y lípidos en la población hipertensa asistida en atención primaria.

OBJECTIVES: To determine the impact of cardiovascular disease (CVD) (heart failure, ischaemic heart disease, stroke, renal insufficiency, and peripheral arterial disease) on blood pressure (BP) and LDL-cholesterol (LDL-C) control in hypertense patients. DESIGN: We analysed the subset of patients with CVD from those included in the PRESCOT study (a cross-sectional study of hypertense patients attended in primary care). SETTING: A total of 2000 primary care physicians participated in the study. PARTICIPANTS: In an analysis of 12 954 patients (50.1% males; aged 62.1 [10.7]), good BP control was defined as <140/90 mm Hg (<130/80 mm Hg for diabetics) and good LDL-C control, according to the ATP-III stipulations for every risk group. RESULTS: Overall, 3294 (25.43%) patients had established CVD (mean age, 66.0 [10.2] years; 56.3% males). Of these, 82.2% had dyslipidaemia and 45.6% were diabetics (vs 72.3% and 23.9%, respectively, in non-CVD group; P< .0001). Patients with CVD were treated with more anti-hypertensives (55.7% vs 30.4% were on é2 drugs; P< .001) and more lipid-lowering drugs (67.6% vs 55.4%, P< .001) than patients without CVD. BP was controlled in 25.3% of patients with CVD versus 26.7% (P=.095); and LDL-C in 13.3% versus 40.2% (P< .001). Only 7.0% of patients with CVD were well controlled for both parameters versus 18.7% of those without CVD (P< .001). The main predictive factors of poor BP control were Diabetes (OR, 1.20; 95% CI, 1.10-1.30), sedentary lifestyle (OR, 1.19; 95% CI, 1.11-1.29) and female gender (OR, 1.12; 95% CI, 1.02-1.23), among others; whilst the main factors for poor LDL-C control were a family history of CVD (OR, 1.34; 95% CI, 1.24-1.46), sedentary lifestyle (OR, 1.28; 95% CI, 1.18-1.39), and diabetes (OR, 1.15; 95% CI, 1.06-1.26). CONCLUSIONS: BP and LDL-C control in the hypertense population with CVD is very poor. In fact, only 7% of these patients have both parameters well controlled.

Impacto de la presencia de enfermedad cardiovascular en el control de presión arterial y lípidos en la población hipertensa asistida en atención primaria / Impact of the presence of cardiovascular disease on blood pressure and lipid control in the hypertense population attended in primary care

Objetivos. Determinar el impacto de la enfermedad cardiovascular (ECV) (insuficiencia cardíaca, cardiopatía isquémica, enfermedad cerebrovascular, insuficiencia renal y arteriopatía periférica) en el control de la presión arterial (PA) y del colesterol de las lipoproteínas de baja densidad (cLDL) en una población de pacientes hipertensos. Diseño. Se analizó al subgrupo de pacientes incluidos en el estudio PRESCOT (estudio transversal de sujetos hipertensos asistidos en atención primaria). Emplazamiento. En el estudio participaron 2.000 médicos de atención primaria, en España. Participantes. Se analizó a 12.954 pacientes (el 50,1%, varones; media de edad, 62,1 ± 10,7 años). Se consideró buen control de PA cifras < 140/90 mmHg (< 130/80 mmHg en diabéticos), y de cLDL, los establecidos por ATP III para cada grupo de riesgo. Resultados. Del total de pacientes incluidos, 3.294 (25,43%) tenían ECV establecida (media de edad, 66,0 ± 10,2 años; el 56,3%, varones). El 82,2% de los pacientes con ECV eran dislipémicos, y el 45,6%, diabéticos (frente al 72,3 y el 23,9%, respectivamente, del grupo de pacientes sin ECV; p < 0,0001). Los pacientes con ECV tomaban más antihipertensivos (el 55,7 frente al 30,4% tomaban 2 o más fármacos; p < 0,001) y más hipolipemiantes (el 67,6 frente al 55,4%; p < 0,001) que los pacientes sin ECV. La PA se controló en el 25,3% de los pacientes con ECV frente al 26,7% (p = 0,095), y el cLDL en el 13,3 frente al 40,2% (p < 0,001). El 7% de los pacientes con ECV tenían bien controlados ambos parámetros frente al 18,7% (p < 0,001). Los principales factores relacionados con el mal control de PA fueron la diabetes (odds ratio [OR] = 1,20; intervalo de confianza [IC] del 95%, 1,10-1,30), el sedentarismo (OR = 1,19; IC del 95%, 1,11-1,29) y el sexo femenino (OR = 1,12; IC del 95%, 1,02-1,23), entre otros, mientras que para el control del cLDL, los antecedentes familiares de ECV (OR = 1,34; IC del 95%, 1,24-1,46), el sedentarismo (OR = 1,28; IC del 95%, 1,18-1,39) y la diabetes (OR = 1,15; IC del 95%, 1,06-1,26), entre otros. Conclusiones. El control de la PA y del cLDL es muy pobre en la población hipertensa con ECV. Únicamente el 7% tienen ambos parámetros bien controlados

Objectives. To determine the impact of cardiovascular disease (CVD) (heart failure, ischaemic heart disease, stroke, renal insufficiency, and peripheral arterial disease) on blood pressure (BP) and LDL-cholesterol (LDL-C) control in hypertense patients. Design. We analysed the subset of patients with CVD from those included in the PRESCOT study (a cross-sectional study of hypertense patients attended in primary care). Setting. A total of 2000 primary care physicians participated in the study. Participants. In an analysis of 12 954 patients (50.1% males; aged 62.1 [10.7]), good BP control was defined as <140/90 mm Hg (<130/80 mm Hg for diabetics) and good LDL-C control, according to the ATP-III stipulations for every risk group. Results. Overall, 3294 (25.43%) patients had established CVD (mean age, 66.0 [10.2] years; 56.3% males). Of these, 82.2% had dyslipidaemia and 45.6% were diabetics (vs 72.3% and 23.9%, respectively, in non-CVD group; P<.0001). Patients with CVD were treated with more anti-hypertensives (55.7% vs 30.4% were on é2 drugs; P<.001) and more lipid-lowering drugs (67.6% vs 55.4%, P<.001) than patients without CVD. BP was controlled in 25.3% of patients with CVD versus 26.7% (P=.095); and LDL-C in 13.3% versus 40.2% (P<.001). Only 7.0% of patients with CVD were well controlled for both parameters versus 18.7% of those without CVD (P<.001). The main predictive factors of poor BP control were Diabetes (OR, 1.20; 95% CI, 1.10-1.30), sedentary lifestyle (OR, 1.19; 95% CI, 1.11-1.29) and female gender (OR, 1.12; 95% CI, 1.02-1.23), among others; whilst the main factors for poor LDL-C control were a family history of CVD (OR, 1.34; 95% CI, 1.24-1.46), sedentary lifestyle (OR, 1.28; 95% CI, 1.18-1.39), and diabetes (OR, 1.15; 95% CI, 1.06-1.26). Conclusions. BP and LDL-C control in the hypertense population with CVD is very poor. In fact, only 7% of these patients have both parameters well controlled

[Blood pressure findings in Spanish dyslipidemic primary-care patients. LIPICAP-PA Study]. / Características de la presión arterial en una población dislipémica española asistida en atención primaria. Estudio LIPICAPPA.

BACKGROUND AND OBJECTIVES: Despite the well-known significant relationship between blood pressure and cardiovascular mortality, few data are available on the blood pressure characteristics of dyslipidemic patients. The aims of this study were to determine the blood pressure characteristics of dyslipidemic patients being treated in primary care, and to identify factors associated with poor blood pressure control. METHODS: This multicentre cross-sectional study involved patients of both sexes aged > or =18 years who were diagnosed with dyslipidemia (i.e., hypercholesterolemia, hypertriglyceridemia, mixed dyslipidemia, or a low high-density lipoprotein cholesterol level) in the 17 Spanish autonomous regions. Blood pressure was measured according to standard procedures, and was considered well-controlled if it was <140/90 mm Hg (or <130/80 mm Hg in patients with diabetes, nephropathy or cardiovascular disease). RESULTS: In total, 7054 patients were studied (mean age 61.3 [11.2] years, 50.8% male). Mean systolic and diastolic blood pressures were 134.6 [14.2]/79.8 [8.9] mm Hg, with significant differences (P< .001) between hypertensives (140.8 [14.6]/82.8 [9.0] mmHg) and normotensives (128.5 [10.7]/76.9 [7.7] mm Hg). Good blood pressure control was observed in 47.4% (95% confidence interval, 46.3-48.5%) of subjects overall, in 29.3% of hypertensives, and in 12.8% of hypertensive diabetics. Poor control was associated with an increased cardiovascular disease risk (hazard ratio [HR]=2.89), poor control of low-density lipoprotein cholesterol (HR=1.43), a higher body mass index (HR=1.06), and older age (HR=1.02). CONCLUSIONS: Fewer than half of dyslipidemic primary-care patients in Spain had good blood pressure control. Poor control was associated, in particular, with increased cardiovascular risk and poor control of the low-density lipoprotein cholesterol level.

Prevalence of the metabolic syndrome in patients with hypertension treated in general practice in Spain: an assessment of blood pressure and low-density lipoprotein cholesterol control and accuracy of diagnosis.

This study was designed to evaluate whether primary care physicians in Spain accurately diagnose the metabolic syndrome in hypertensive patients, to define the profile and management of these patients in clinical practice, and to ascertain the level of blood pressure and low-density lipoprotein cholesterol control. Data were analyzed from a cross-sectional survey involving 12,954 patients with hypertension (Prevención Cardiovascular en España en Atención Primaria: Intervención Sobre el Colesterol en Hipertensión [PRESCOT] study), wherein 52% of the cohort fulfilled the National Cholesterol Education Program-Adult Treatment Panel criteria for the metabolic syndrome. The majority of patients (54.6%) had 3 risk factors, 32.4% had 4, and 13% had 5 risk factors. Physician diagnosis of the metabolic syndrome was poor, with 43.7% of physicians missing the diagnosis and 12.9% wrongly diagnosing the metabolic syndrome. Blood pressure and low-density lipoprotein cholesterol control rates were very low, with only 4.7% of metabolic syndrome patients achieving control for both blood pressure and low-density lipoprotein cholesterol vs 13.5% for non-metabolic syndrome patients (P<.0001). These findings demonstrate that the metabolic syndrome is common in patients with hypertension and that it is generally poorly diagnosed and treated by primary care physicians.

Características de la presión arterial en una población dislipémica española asistida en atención primaria. Estudio LIPICAP­PA / Blood pressure findings in spanish dyslipidemic primary-care patients. LIPICAP­PA study

Introducción y objetivos. Aunque la presión arterial se ha relacionado significativamente con la mortalidad cardiovascular, se dispone de escasa información sobre sus características en los pacientes dislipémicos. Los objetivos de este estudio fueron conocer las características de la presión arterial en una población dislipémica asistida en atención primaria y los factores que se asocian con el mal control tensional. Métodos. Estudio transversal multicéntrico en el que se analizó a individuos ≥ 18 años de ambos sexos diagnosticados de dislipemia (hipercolesterolemia, hipertrigliceridemia, dislipemia mixta o bajas concentraciones de colesterol unido a lipoproteínas de alta densidad) en las 17 comunidades autónomas de España. La presión arterial se midió siguiendo normas estandarizadas y se consideró bien controlada cuando era < 140/90 mmHg (< 130/80 mmHg en pacientes con diabetes, nefropatía o enfermedad cardiovascular). Resultados. Se analizó a 7.054 pacientes (edad media 61,3 ± 11,2 años; 50,8% varones). Los valores medios de presión arterial sistólica/diastólica fueron de 134,6 ± 14,2/79,8 ± 8,9 mmHg, con diferencias significativas (p < 0,001) entre hipertensos (140,8 ± 14,6/82,8 ± 9,0 mmHg) y normotensos (128,5 ± 10,7/76,9 ± 7,7 mmHg). Se halló buen control de la presión arterial en el 47,4% (intervalo de confianza [IC] del 95%, 46,3-48,5) del total de sujetos, en el 29,3% de los hipertensos y en el 12,8% de los hipertensos diabéticos. El mal control tensional se asoció con la elevación del riesgo cardiovascular (odds ratio [OR] = 2,89), el mal control del colesterol unido a lipoproteínas de baja densidad (cLDL) (OR = 1,43) y los incrementos del índice de masa corporal (OR = 1,06) y la edad (OR = 1,02). Conclusiones. Menos de la mitad de los dislipémicos españoles asistidos en atención primaria tiene bien controlada la presión arterial. El mal control tensional se asocia especialmente con el aumento del riesgo cardiovascular y el mal control del cLDL (AU)

Background and objectives. Despite the well-known significant relationship between blood pressure and cardiovascular mortality, few data are available on the blood pressure characteristics of dyslipidemic patients. The aims of this study were to determine the blood pressure characteristics of dyslipidemic patients being treated in primary care, and to identify factors associated with poor blood pressure control. Methods. This multicentre cross-sectional study involved patients of both sexes aged ≥18 years who were diagnosed with dyslipidemia (i.e., hypercholesterolemia, hypertriglyceridemia, mixed dyslipidemia, or a low high-density lipoprotein cholesterol level) in the 17 Spanish autonomous regions. Blood pressure was measured according to standard procedures, and was considered well-controlled if it was <140/90 mm Hg (or <130/80 mm Hg in patients with diabetes, nephropathy or cardiovascular disease). Results. In total, 7054 patients were studied (mean age 61.3 [11.2] years, 50.8% male). Mean systolic and diastolic blood pressures were 134.6 [14.2]/79.8 [8.9] mm Hg, with significant differences (P<.001) between hypertensives (140.8 [14.6]/82.8 [9.0] mmHg) and normotensives (128.5 [10.7]/76.9 [7.7] mm Hg). Good blood pressure control was observed in 47.4% (95% confidence interval, 46.3­48.5%) of subjects overall, in 29.3% of hypertensives, and in 12.8% of hypertensive diabetics. Poor control was associated with an increased cardiovascular disease risk (hazard ratio [HR]=2.89), poor control of low-density lipoprotein cholesterol (HR=1.43), a higher body mass index (HR=1.06), and older age (HR=1.02). Conclusions. Fewer than half of dyslipidemic primary-care patients in Spain had good blood pressure control. Poor control was associated, in particular, with increased cardiovascular risk and poor control of the low-density lipoprotein cholesterol level (AU)

[Adequacy of the treatment of hypertensive patients with metabolic syndrome]. / Adecuación del tratamiento de los pacientes hipertensos con síndrome metabólico.

BACKGROUND AND OBJECTIVE: The aim of this study was to know the treatment of hypertensive patients with metabolic syndrome (MetS) attended in primary care setting, as well as the blood pressure and LDL-cholesterol (LDL-c) rates, and to compare these data with those of the hypertensive population without MetS. PATIENTS AND METHOD: We analyzed the subset of patients with MetS from those included in the PRESCOT study (a cross-sectional study of hypertensive subjects >18 years attended in primary care). The PRESCOT population was composed by 12,954 patients (49.9% females; 62.1+/-10.7 years). MetS was diagnosed according to NCEP-ATP-III criteria. RESULTS: 6,736 (52%) patients fulfilled diagnosis criteria of MetS (mean age 62.3+/-10.5 years; 43.9% males). Almost all MetS patients (98.2%) were on any medication, and 80.5% were at least on two drugs. Despite hypertensive MetS patients were treated with more antihypertensive medications (45.3% vs 36.6% were on two or more drugs, p < 0.001) and used more lipid-lowering agents (43% vs 39.1%, p < 0.001) than patients without MetS, the blood pressure control (according to European guidelines) and LDL-c control (according to NCEP-ATP III) rates were lower in patients with MetS (17.2% vs 33.6% and 17.2% vs 35.7%, p < 0.0001). Only 4.7% of patients with MetS were adequately controlled for both factors, LDL-c and blood pressure, vs 13.5% of patients without MetS, (p < 0.0001). CONCLUSIONS: The presence of MetS in the hypertensive population attended in Spanish primary care settings is very common. Even though in hypertensives with MetS more drugs are prescribed, blood pressure and LDL-c control rates are worse in this population than in patients without MetS.

Blood pressure and lipid goal attainment in the hypertensive population in the primary care setting in Spain.

Although blood pressure (BP) control is crucial in hypertensive patients, clinical practice guidelines agree that the goal of treatment should be aimed at not only decreasing BP but reducing global cardiovascular risk. The aim of this cross-sectional study was to evaluate BP, low-density lipoprotein cholesterol (LDL-C), and composite control rates in a hypertensive population in a primary care setting in Spain. Good BP control was defined as <140/90 mm Hg (<130/80 mm Hg for diabetics).LDL-C control rate was established according to the third report of the National Cholesterol Education Program Adult Treatment Panel criteria. A total of 12,954 patients (49.9% women, aged 62.1+/-10.7 years) were included. BP was controlled in 24.8% of patients, LDL-C in 26% of patients and, when combined, in only 8.6%. The rates of control were significantly worse in high-risk subgroups, such as high-coronary-risk, diabetic, or metabolic syndrome patients. The BP and LDL-C control rates in the hypertensive population attended to daily in primary care settings in Spain are low.

Adecuación del tratamiento de los pacientes hipertensos con síndrome metabólico / Adequacy of the treatment of hypertensive patients with metabolic syndrome

Fundamento y objetivo: El objetivo de este estudio ha sido conocer el tratamiento de los pacientes hipertensos con síndrome metabólico (SM) asistidos en atención primaria y el grado de control de la presión arterial y de los valores de colesterol unido a lipoproteínas de baja densidad (cLDL), y comparar los datos con los de la población hipertensa sin SM. Pacientes y método: Se analizó al subgrupo de pacientes con SM de los incluidos en el estudio PRESCOT (estudio transversal de personas con hipertensión mayores 18 años asistidos en atención primaria). La población PRESCOT fue de 12.954 pacientes (el 49,9% mujeres), con una edad media (desviación estándar [DE]) de 62,1 (10,7) años. Para el diagnóstico de SM se utilizaron los criterios del National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III). Resultados: Cumplían criterios de SM un total de 6.736 (52%) pacientes del estudio PRESCOT, cuya edad media (DE) era de 62,3 (10,5) años; el 43,9% eran varones. El 98,2% de los pacientes con SM tomaba algún fármaco y el 80,5%, al menos 2 fármacos. A pesar de que los hipertensos con SM tomaban más antihipertensivos que aquellos sin SM (un 45,3 frente al 36,6% tomaban más de un fármaco; p < 0,001) y usaban en mayor medida hipolipemiantes (el 43 frente al 39,1%; p < 0,001), el control de la presión arterial (según las guías europeas) y de cLDL (según ATP-III) fue peor en los pacientes con SM (el 17,2 frente al 33,6% y el 17,2 frente al 35,7%, respectivamente; p < 0,0001). Sólo el 4,7% de los pacientes con SM tenía bien controlados ambos factores ­presión arterial y cLDL­, frente al 13,5% del grupo sin SM (p < 0,0001). Conclusiones: La presencia de SM en la población hipertensa de atención primaria en España es muy frecuente. A pesar de que a los pacientes hipertensos con SM se les prescriben más fármacos antihipertensivos y más hipolipemiantes, el control de la presión arterial y del cLDL es peor que en los pacientes sin SM

Background and objective: The aim of this study was to know the treatment of hypertensive patients with metabolic syndrome (MetS) attended in primary care setting, as well as the blood pressure and LDL-cholesterol (LDL-c) rates, and to compare these data with those of the hypertensive population without MetS. Patients and method: We analyzed the subset of patients with MetS from those included in the PRESCOT study (a cross-sectional study of hypertensive subjects >18 years attended in primary care). The PRESCOT population was composed by 12,954 patients (49.9% females; 62.1±10.7 years). MetS was diagnosed according to NCEP-ATP-III criteria. Results: 6,736 (52%) patients fulfilled diagnosis criteria of MetS (mean age 62.3±10.5 years; 43.9% males). Almost all MetS patients (98.2%) were on any medication, and 80.5% were at least on two drugs. Despite hypertensive MetS patients were treated with more antihypertensive medications (45.3% vs 36.6% were on two or more drugs, p < 0.001) and used more lipid-lowering agents (43% vs 39.1%, p < 0.001) than patients without MetS, the blood pressure control (according to European guidelines) and LDL-c control (according to NCEP-ATP III) rates were lower in patients with MetS (17.2% vs 33.6% and 17.2% vs 35.7%, p < 0.0001). Only 4.7% of patients with MetS were adequately controlled for both factors, LDL-c and blood pressure, vs 13.5% of patients without MetS, (p < 0.0001). Conclusions: The presence of MetS in the hypertensive population attended in Spanish primary care settings is very common. Even though in hypertensives with MetS more drugs are prescribed, blood pressure and LDL-c control rates are worse in this population than in patients without MetS

Grado de control de la dislipemia en los pacientes españoles asistidos en atención primaria. Estudio LIPICAP / Control rates of dyslipidemia in Spanish patients assisted in primary care. LIPICAP Study

Introducción. Se dispone de escasa información sobre el control de la dislipemia en España. Los objetivos de este estudio fueron conocer el grado de control de los pacientes dislipémicos asistidos en atención primaria e investigar su riesgo cardiovascular y los factores que se asocian al mal control. Pacientes y método. Estudio transversal multicéntrico que analizó en las 17 comunidades autónomas españolas a individuos de 18 o más años de ambos sexos con dislipemia (hipercolesterolemia, hipertrigliceridemia, dislipemia mixta o colesterol de las lipoproteínas de alta densidad [cHDL] bajo). Se consideró buen control el hallazgo de colesterol de las lipoproteínas de baja densidad [cLDL] < 160 mg/dl si el riesgo cardiovascular era bajo, < 130 mg/dl si era moderado y < 100 mg/dl si era alto (Adult Treatment Panel III [ATPIII]). Resultados. Se incluyó a 7.054 pacientes (media ± desviación estándar de edad, 61,3 ± 11,2 años; varones, 50,8%). El 40,3% presentó riesgo cardiovascular alto; el 28,6%, moderado, y el 31,1%, bajo. Se halló buen control en el 32,3% (intervalo de confianza del 95%, 31,2-33,4) de la población (el 57,0% de los pacientes con riesgo cardiovascular bajo, el 26,3% con riesgo moderado y el 16,6% con riesgo alto). El mal control se asoció con los antecedentes personales de diabetes, nefropatía y tabaquismo y con los antecedentes familiares de enfermedad cardiovascular prematura; el buen control se asoció con el ejercicio físico (p < 0,001). Conclusiones. Una tercera parte de los pacientes incluidos en el estudio presenta buen control de la dislipemia, y 4 de cada 10 tienen riesgo cardiovascular alto. El grado de control disminuye conforme aumenta el riesgo cardiovascular. Factores de riesgo cardiovascular y enfermedades muy prevalentes en atención primaria se asocian con el mal control de la dislipemia (AU)

Introduction. Scarce information is available about the dyslipidemia control in Spain. The aims of this study were to asses the degree of control of dyslipidemic patients attended in primary care, and to investigate their cardiovascular risk and the factors associated with poor control. Patients and method. A multicentre cross-sectional study analysing dyslipidemic patients in Spain (both sex, >= 18 years) with hypercholesterolemia, hypertriglyceridemia, mixed dyslipidemia or low HDL-cholesterol. Well-controlled dyslipidemia was defined according to NCEP-ATPIII, LDL-cholesterol < 160 in low cardiovascular risk patients, < 130 in moderate, and < 100 mg/dl in high cardiovascular risk patients. Results. 7,054 patients were included (age, 61.3 ± 11.2 years; 50.8% men). 40.3% of patients presented high cardiovascular risk, 28.6% moderate risk and 31.1% low risk. 32.3% (CI 95%, 31.2-33.4) showed good control of LDL-cholesterol (57.0% in low, 26.3% in moderate, and 16.6% in high cardiovascular risk). Poor control was associated with medical history of diabetes, kidney disease and cigarette smoking, and family history of premature cardiovascular disease; optimal control was associated to physical activity (p < 0,001). Conclusions. A third of the patients included in the study achieve target control of dyslipidemia. Four out of 10 present high cardiovascular risk. The control degree decreases as cardiovascular risk increases. Cardiovascular risk factors and very prevalent diseases in Primary Care are associated with a poor control of dyslipidemia (AU)

Carotid angioplasty with cerebral protection and stenting: report of 164 patients (194 carotid percutaneous transluminal angioplasties).

BACKGROUND: The introduction of cerebral protection devices with systematic stent placement has changed the nature of carotid artery stenosis treatment, reducing the immediate periprocedural complications and delayed restenosis. METHODS: We treated 164 patients with 194 carotid artery stenosis procedures; 92% of them were symptomatic patients. RESULTS: The morbidity rate of our series was 1.03% and the mortality was 1.9%. CONCLUSIONS: In the future, carotid stenosis treatment should perhaps be performed as a preventative measure and not used as a cure for full-blown symptoms. This could be effective in reducing the morbidity and mortality rates of this pathology.