[Validity of epidemiologic criteria in the detection of hypertension]. / Validez del criterio epidemiológico en la detección de hipertensos.

We wish to find out the quality of the diagnostic test commonly used in epidemiological studies to detect hypertension, and in so doing, we study the validity of epidemiological criteria in the detection of hypertension (diagnostic test) and compare the diagnostic thresholds of the World Health Organization (WHO) and the Joint National Committee (JNC). Two methods of detection for arterial hypertension are used in this study of 674 people. One is population-based (mobile unit), and the other is opportunistic sampling. (systematic measurements of blood pressure in medical consultations). As a test of certainty, clinical confirmation is performed. The methodology of Haynes and Sackett is used in the validation study. The epidemiological criteria obtains a sensibility of 90.4 percent and a specificity of 94.4 percent with the diagnostic thresholds of WHO, and a sensibility of 97 percent and a specificity of 81.2 percent with those of JNC, which are defined as effective methods of screening in the detection of hypertension. The excess prevalence of HBP obtained using the diagnostic criteria of WHO is 4.5 percent (that is to say of 12.2 percent of the cases of hypertension found by the epidemiological criteria, that figure decreases to 7.7% percent with clinical confirmation). With the JNC criteria, it is 14.5 percent (from 34.1 percent, it goes to 19.6 percent). This excess can be used to adjust numbers found in epidemiological studies to their real values.(ABSTRACT TRUNCATED AT 250 WORDS)

[Factors involved in the hypertensive patient non-compliance with treatment]. / Estudio de los factores implicados en la no observancia terapéutica de pacientes hipertensos.

BACKGROUND: It is impossible to evaluate the therapeutic efficacy in hypertension without knowing the compliance of the treatment. The lack of compliance does not allow therapeutic efficacy to be achieved. This study evaluates possible factors involved in the non compliance of treatment in hypertensive patients and the characteristics defining the non compliant patient. METHODS: The control technique was tablet counting. The study was carried out in 157 hypertensive patients belonging to the Centro de Carrús (Elche-Alicante, Spain). RESULTS: 53.3% of the sample were shown to follow the therapy. 45.2% of patients not fulfilling the treatment believed that they were doing it correctly. Non compliance was found to be associated to the following factors: hypertensive patients of older age (p = 0.0054), low cultural level (p = 0.0027), bad knowledge of the disease (p = 0.0166), recent or lengthy knowledge of the disease (p = 0.00677), presence of other associated chronic diseases (p = 0.003), bad control of blood pressure (p = 0.0108), receiving more than two drugs for treatment (p = 0.0071), carrying out more than two medication intakes per day (p = 0.00309), saying that the diet is not well followed (p = 0.0187) and performing other associated pharmacologic treatments (p = 0.0024). CONCLUSIONS: Non compliance is a very frequent fact in patients with hypertension. Knowledge and evaluation of the factors involved in non compliance allows identification and intervention in patients who do not take the medication.

[Validity of four indirect methods which evaluate therapeutic compliance for arterial hypertension]. / Validez de cuatro métodos indirectos que valoran el cumplimiento terapéutico en la hipertensión arterial.

OBJECTIVES: To validate 4 indirect methods for detecting therapeutic non-compliance in 157 patients in a community health center Centro de Salud "Carrus" in Elche, Alicante. MATERIALS AND METHODS: The methods employed are self related compliance (SC), therapeutic gains obtained, Morinsky-Green Test, and the level of knowledge of Batalla disease (LK). For verification purposes, pills were counted, allowing the formation of 2x2 tables to calculate indices of validity. The statistical analysis employed is the calculation of 95% confidence intervals. RESULTS: SC yields significantly the lowest sensitivity (13.7 +/- 7.9%) and the highest specificity (85.7% +/- 7.5%). The LK presents the highest sensitivity 79.5 +/- 9.3%. SC underestimates non-compliance (32.5%) significantly, and the LK overestimates noncompliance (23.6%). CONCLUSIONS: The LK is a good method for detecting problems of low compliance and SC those of high compliance. It is recommended that both methods should be employed in a systematic fashion in clinical practice. However, the LK and SC cannot be used to calculate prevalences of therapeutic noncompliance in population-based studies.

[Results of 5 campaigns to detect previously unidentified cases of hypertension]. / Resultados de cinco campañas de detección de hipertensos desconocidos.

OBJECTIVE: To find the efficacy of two methods of detecting previously unknown hypertension--systematic taking of blood pressure (ST) and the Mobile Unit (MU)--and to evaluate the over-diagnosis of arterial hypertension (AHT) in crossover studies which only use epidemiological criteria (EC). DESIGN: A descriptive study with population and opportunist strategies. An operative MU team attended commercial and work centres within the chosen area. ST looked for AHT in patients attending Health Centre clinics. INTERVENTION: EC in screening, in line with WHO guidelines and clinical confirmation (CC) in the Health Centres. SETTING: MU in the catchment areas of Novelda, Carrús and C. Jardin Health areas. ST in the San Miguel de Salinas and C. Jardin Health Centres. PATIENTS: 1654 people over 19 with the MU and 4138 through ST. RESULTS: Both methods discovered more hypertension in men (MU p = 0.009 and ST p = 0.000) and in the 20 to 39 age group (MU p = 0.000 and ST p = 0.000). EC led to over-diagnosis (5.8% MU and 6.3% ST); greater in men (6.6% and 6.5%) and +/- 60 years old (8.7% and 7.5%). Positive predictive values obtained were 59.8% with MU and 47.4% with ST. CONCLUSIONS: Both methods are useful ways of identifying people suffering hypertension: both young people and men. But CC is essential in order to make a real diagnosis of AHT. Out of every 10 people detected by using EC, only 5 were confirmed by ST and 6 by MU. This information must be borne in mind when evaluating the the prevalence of AHT in epidemiological studies.