Vitamin D Deficiency Is Significantly Associated with Retinopathy in Type 2 Diabetes Mellitus: A Case-Control Study.

AIM: Results from meta-analyses point to an association between vitamin D deficiency and the onset of diabetic retinopathy (DR). The objectives of the present study were to evaluate the association of vitamin D for the development of DR and to determine the levels of vitamin D associated with a greater risk of DR. METHODS: Between November 2013 and February 2015, we performed a case-control study based on a sample of patients with diabetes in Spain. The study population comprised all patients who had at least one evaluable electroretinogram and recorded levels of 25(OH)D. We collected a series of analytical data: 25(OH)D, 1,25(OH)2D, iPTH, calcium, albumin, and HbA1c. Glycemic control was evaluated on the basis of the mean HbA1c values for the period 2009-2014. A logistic regression analysis was performed to identify the variables associated with DR. RESULTS: The final study sample comprised 385 patients, of which 30 (7.8%) had DR. Significant differences were found between patients with and without DR for age (69.54 vs. 73.43), HbA1c (6.68% vs. 7.29%), years since diagnosis of diabetes (10.9 vs. 14.17), level of 25(OH)D (20.80 vs. 15.50 ng/mL), level of 1,25(OH)2D (35.0 vs. 24.5 pg/mL), treatment with insulin (14.9% vs. 56.7%), hypertension (77.7% vs. 100%), cardiovascular events (33.2% vs. 53.3%), and kidney failure (22.0% vs. 43.3%). In the multivariate analysis, the factors identified as independent risk factors for DR were treatment of diabetes (p = 0.001) and 25(OH)D (p = 0.025). The high risk of DR in patients receiving insulin (OR 17.01) was also noteworthy. CONCLUSIONS: Levels of 25(OH)D and treatment of diabetes were significantly associated with DR after adjusting for other risk factors. Combined levels of 25(OH)D < 16 ng/mL and levels of 1,25(OH)2D < 29 pg/mL are the variables that best predict the risk of having DR with respect to vitamin D deficiency. The risk factor with the strongest association was the treatment of type 2 diabetes mellitus. This was particularly true for patients receiving insulin, who had a greater risk of DR than those receiving insulin analogues. However, further studies are necessary before a causal relationship can be established.

Impact of variations in blood pressure with orthostatism on mortality: the HOMO study.

OBJECTIVE: The aim of this study was to determine the impact of orthostatic hypotension (OH) and orthostatic hypertension (OHT) on all-cause mortality. PATIENTS AND METHODS: A total of, 1176 adults from the community over 18 years of age were included in this ambispective study. The mean follow-up was 9.4 years. OH and OHT were defined as a decrease or an increase, respectively, in systolic blood pressure (BP) of at least 20 mmHg and/or diastolic BP of at least 10 mmHg from sitting to standing position at 1 and/or 3 min after standing. The impact of systolic or diastolic OH and systolic or diastolic OHT at 1 and 3 min after standing was also analyzed separately. RESULTS: In total, 135 individuals died during the follow-up. Neither OH [hazard ratio (HR) 1.23; 95% confidence interval (CI): 0.72-2.10] nor OHT (HR 0.90; 95% CI: 0.59-1.38) was associated with all-cause mortality in the adjusted models. In contrast, systolic OHT at 3 min (HR 2.31; 95% CI: 1.14-4.68) was independently associated with global mortality. CONCLUSION: Systolic OHT at 3 min is associated with all-cause mortality. The determination of this parameter could add valuable prognostic information during the routine examination of patients.

Cumplimiento terapéutico y seguimiento del paciente hipertenso en atención primaria / Therapeutic compliance and follow-up of hypertensive patients in primary care

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Medida de la presión arterial en consulta y automatizada (BPTru®) para evaluar el efecto de bata blanca / Measurement of blood pressure in consultation and automated mesurement (BPTru ®) to evaluate the white coat effect

Fundamento y objetivo: El efecto de bata blanca (EBB) es uno de los principales sesgos que pueden modificar la medida de la presión arterial (PA) en consulta, por lo que se debe considerar para evitar errores diagnóstico-terapéuticos en los pacientes hipertensos. La utilización de aparatos automatizados en consulta podría disminuir dicho efecto. Método: Se diseñaron 2 estudios con el objetivo de evaluar las diferencias entre la medida rutinaria en consulta y la obtenida por el aparato automatizado de medida de PA en consulta, BPTru®, así como su influencia en el EBB. El primero de los estudios, TRUE-ESP, incluyó pacientes normotensos e hipertensos atendidos en consultas especializadas de Cardiología, Nefrología, Medicina Interna, Endocrinología y Medicina Familiar. El segundo, TRUE-HTA, incluyó pacientes hipertensos atendidos en una Unidad de HTA, protocolizada, con personal entrenado. Resultados: El estudio TRUE-ESP incluyó 300 pacientes, 76% hipertensos. Se observó una diferencia significativa entre la medida clínica y la medida BPTru® (media [DE] de PA sistólica/PA diastólica [PAS/PAD] de 9,8 [6,11]/3,4 [7,9] mmHg, p<0,001). El porcentaje de pacientes que cumplió criterios de EBB fue del 27,7%. El estudio TRUE-HTA incluyó 101 pacientes hipertensos. Se observó una diferencia significativa entre la medida clínica y la medida mediante BPTru® (media [DE] de PAS/PAD de 5,7 [3,9]/2,1 [3,5] mmHg, p<0,001) y la medida del período de actividad de la monitorización ambulatoria de la PA (MAPA) (media [DE] de PAS/PAD de 8,5 [6,7]/3,5 [2,5] mmHg, p<0,001). El porcentaje de pacientes que cumplió criterios de EBB fue del 32,1%. Conclusiones: El empleo de aparatos automatizados de medida de PA en consulta, como el BPTru®, puede colaborar a disminuir el EBB y mejorar la precisión de la medida de la PA en consulta (AU)

Background and objective: White coat effect (WCE) is one of the main bias that can affect office blood pressure (BP) measurement. Therefore, it is a factor must be considered in hypertensives to avoid mistakes in diagnosis and/or treatment. Employment of automated office BP (AOBP) devices could diminish that effect. Methods: Two studies were designed with the objective of evaluating differences between routinely office and AOBP measurements. WCE was also assessed. First, the TRUE-ESP study included normotensive and hypertensive patients attending specialized consultations at Cardiology, Nephrology, Internal Medicine, Endocrinology and Family Practice. Second, the TRUE-HTA study included hypertensives attending a protocoled Hypertension Unit, with a trained staff. Results: TRUE-ESP study included 300 patients, 76% being hypertensives. A significant difference between office BP and AOBP measurement (SBP/DBP 9.8±11.6/3.4±7.9mmHg, P<.001) was observed. Percentage of patients gathering WCE criteria was 27.7%. TRUE-HTA study included 101 hypertensive patients. A significant difference between office BP and AOBP measurement (SBP/DBP 5.7±9.3/2.1±5.3mmHg, P<.001) and activity period-ABPM (SBP/DBP 8.5±6.7/3.5±2.5mmHg, P<.001) was observed. Percentage of WCE patients was 32.1%. Conclusions: Use of AOBP devices can contribute to decrease WCE and to improve accuracy of office BP measurement (AU)

[Measurement of blood pressure in consultation and automated mesurement (BPTru(®)) to evaluate the white coat effect]. / Medida de la presión arterial en consulta y automatizada (BPTru®) para evaluar el efecto de bata blanca.

BACKGROUND AND OBJECTIVE: White coat effect (WCE) is one of the main bias that can affect office blood pressure (BP) measurement. Therefore, it is a factor must be considered in hypertensives to avoid mistakes in diagnosis and/or treatment. Employment of automated office BP (AOBP) devices could diminish that effect. METHODS: Two studies were designed with the objective of evaluating differences between routinely office and AOBP measurements. WCE was also assessed. First, the TRUE-ESP study included normotensive and hypertensive patients attending specialized consultations at Cardiology, Nephrology, Internal Medicine, Endocrinology and Family Practice. Second, the TRUE-HTA study included hypertensives attending a protocoled Hypertension Unit, with a trained staff. RESULTS: TRUE-ESP study included 300 patients, 76% being hypertensives. A significant difference between office BP and AOBP measurement (SBP/DBP 9.8±11.6/3.4±7.9 mmHg, P<.001) was observed. Percentage of patients gathering WCE criteria was 27.7%. TRUE-HTA study included 101 hypertensive patients. A significant difference between office BP and AOBP measurement (SBP/DBP 5.7±9.3/2.1±5.3 mmHg, P<.001) and activity period-ABPM (SBP/DBP 8.5±6.7/3.5±2.5 mmHg, P<.001) was observed. Percentage of WCE patients was 32.1%. CONCLUSIONS: Use of AOBP devices can contribute to decrease WCE and to improve accuracy of office BP measurement.

[Prevalence of overweight and obesity in Cantabria [Spain]]. / Prevalencia de sobrepeso y obesidad en Cantabria.

OBJECTIVE: To estimate the prevalence of overweight and obesity in Cantabria (Spain). METHODS: In the framework of the CANHTABRIA study, carried out in 2002-2004, measurements of height and weight were performed on a representative sample of 1197 subjects aged 18 years or over. RESULTS: The overall prevalence of overweight was 37.6% (95%CI: 34.2-41); 43.8% (95%CI: 37.2-50.5) in males, and 32.4% (95%CI: 28.6-36.1) in females (p<0.01). Prevalence of obesity was 22.3% (95%CI: 19.1-25.5); 23.2% (95%CI: 16.9-29.5) in males, and 21.5% (95%CI: 18.3-24.8) in females. Compared to persons with higher education, individuals with lowest level of education had two-fold higher prevalence of overweight and obesity. CONCLUSIONS: The Increase in weight is a public health problem in Cantabria as it affects 6 out of 10 adults of the general population, mainly males and individuals with low educational level.

Prevalencia de sobrepeso y obesidad en Cantabria / Prevalence of overweight and obesity in Cantabria [Spain]

Objetivo: Estimar la prevalencia del sobrepeso y la obesidaden Cantabria.Métodos: En el marco del estudio CANHTABRIA, se realizaron,entre los años 2002 y 2004, mediciones de peso y tallaa una muestra de1.197 sujetos 18 años de edad representativade la población general.Resultados: La prevalencia de sobrepeso fue del 37,6%(intervalo de confianza del 95% [IC95%]: 34,2-41), en hombresun 43,8% (IC95%: 37,2-50,5) y en mujeres un 32,4%(IC95%: 28,6-36,1; p < 0,01). La prevalencia de obesidad fuedel 22,3% (IC95%: 19,1-25,5), un 23,2% (IC95%: 16,9-29,5)en hombres y un 21,5% (IC95%: 18,3-24,8) en mujeres. Elsobrepeso y la obesidad fueron 2 veces más frecuentes enlas personas con menor nivel de estudios respecto a las demayor nivel.Conclusiones: El aumento de peso constituye un importanteproblema de salud pública en Cantabria, ya que afecta a6 de cada 10 adultos de su población general, especialmentehombres y personas con menor nivel educativo(AU)

Objetive: To estimate the prevalence of overweight and obesityin Cantabria (Spain).Methods: In the framework of the CANHTABRIA study, carriedout in 2002-2004, measurements of height and weightwere performed on a representative sample of 1197 subjectsaged 18 years or over.Results: The overall prevalence of overweight was 37.6%(95%CI: 34.2-41); 43.8% (95%CI: 37.2-50.5) in males, and32.4% (95%CI: 28.6-36.1) in females (p < 0.01). Prevalenceof obesity was 22.3% (95%CI: 19.1-25.5); 23.2% (95%CI: 16.9-29.5) in males, and 21.5% (95%CI: 18.3-24.8) in females. Comparedto persons with higher education, individuals with lowestlevel of education had two-fold higher prevalence of overweigthand obesity.Conclusions: The Increase in weight is a public health problemin Cantabria as it affects 6 out of 10 adults of the generalpopulation, mainly males and individuals with low educationallevel(AU)

Postural changes in blood pressure in the general population of Cantabria (northern Spain).

OBJECTIVE: To describe the postural changes in blood pressure and correlates among the general population of Cantabria, a region in the north of Spain. METHODS: Between 2002 and 2004 blood pressure measurements were taken in a seated position and after 1 and 3 min standing on a random sample of 1178 individuals aged 18 years and above, stratified by age and sex. RESULTS: The prevalence of orthostatic hypotension was 7%, whereas 30% of the participants presented an exaggerated increase in blood pressure when standing and 36% presented one of the two alterations (postural dysregulation in blood pressure syndrome). Sixteen percent of the nonhypertensive participants presented a blood pressure figure when standing that was above or equal to 140/90 mmHg (orthostatic hypertension). In logistic regression analysis the existence of a high level of blood pressure when sitting was the only variable related to orthostatic hypotension (odds ratio: 2.407; confidence interval: 1.413-4.099). CONCLUSION: When evaluating and treating hypertensive patients, it should be taken into account that orthostatic hypotension is more frequent among those individuals who present poor levels of control of their blood pressure figures. Postural dysregulation in blood pressure syndrome is frequent among the general population, and therefore it is worthy of detailed study.

[Prevalence of chronic kidney disease in hypertensive patients under treatment at primary care health centres in Spain and the monitoring of their blood pressure: the DISEHTAE Study]. / Prevalencia de enfermedad renal crónica en los hipertensos seguidos en los centros de salud de España y grado de control de su presión arterial (estudio DISEHTAE).

OBJECTIVE: To establish what proportion of hypertensive patients being treated in the primary care health centres of Spain have diminished renal function, and to ascertain their level of blood pressure (BP) control. DESIGN: Descriptive, cross-sectional study, based on an external audit of clinical charts. SETTING: Primary care health centres in 14 autonomous regions. PARTICIPANTS: A total of 6,113 charts of hypertensive patients from 107 primary care health centres were checked. The selection of primary care health centres and charts was randomized. MAIN MEASUREMENTS: Creatinine and BP figures of the patients included were analyzed. Chronic kidney disease was defined as a glomerular filtration rate (GFR), as calculated by the equation developed by the Modification of Diet in Renal Disease (MDRD) Study, at under 60 mL/min per 1.73 m(2) of body surface area. A good level of BP control was defined as having figures lower than 130/80 mm Hg. RESULTS: Of all patients, 25.7% (95% CI, 24.3-27.2) had a diminished GFR. Of these, 19.1% (95% CI, 16.6-21.9) had a good level of control of systolic BP, 49.9% (95% CI, 46.6-53.2) had a good level of control of diastolic BP, and 15.2% (95% CI, 12.9-17.8) had a good level of control of both. CONCLUSIONS: A considerable proportion of hypertensive patients under treatment in the primary care health centres of Spain have a diminished GFR. Only 1 in 6 of these have their BP under control.

[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.

Prevalencia de enfermedad renal crónica en los hipertensos seguidos en los centros de salud de España y grado de control de su presión arterial (estudio DISEHTAE) / Prevalence of chronic kidney disease in hypertensive patients under treatment at primary care health centres in Spain and the monitoring of their blood pressure. The DISEHTAE study

Objetivo. Describir la proporción de pacientes hipertensos seguidos en los centros de salud de España que presentan una disminución de la función renal y determinar el grado de control de su presión arterial (PA). Diseño. Descriptivo, transversal, basado en una auditoría externa de historias clínicas. Emplazamiento. Centros de atención primaria de 14 comunidades autónomas. Participantes. Se revisaron 6.113 historias clínicas de pacientes hipertensos pertenecientes a 107 centros de salud. La selección de los centros de salud y de las historias clínicas fue aleatoria. Mediciones principales. En este estudio se analizan los datos obtenidos sobre las cifras de creatinina sérica y de PA de los pacientes incluidos. La enfermedad renal crónica se ha definido como la existencia de un filtrado glomerular (FG), estimado mediante la ecuación del estudio Modification of Diet in Renal Disease (MDRD), menor de 60 ml/min por 1,73 m2 de superficie corporal y el buen control de la PA, como la presencia de cifras menores de 130/80 mmHg. Resultados. El 25,7% (IC del 95%, 24,3-27,2%) de los pacientes presentaba un FG disminuido. De ellos, el 19,1% (IC del 95%, 16,6-21,9%) presentaba un buen control de la PA sistólica (PAS); el 49,9% (IC del 95%, 46,6-53,2%), de la PA diastólica (PAD), y el 15,2% (IC del 95%, 12,9-17,8%), de ambas. Conclusiones. Una considerable proporción de pacientes hipertensos atendidos en los centros de salud de España presentan una disminución del FG. De ellos, sólo 1 de cada 6 presenta cifras de buen control de la PA

Objective. To establish what proportion of hypertensive patients being treated in the primary care health centres of Spain have diminished renal function, and to ascertain their level of blood pressure (BP) control. Design. Descriptive, cross-sectional study, based on an external audit of clinical charts. Setting. Primary care health centres in 14 autonomous regions. Participants. A total of 6113 charts of hypertensive patients from 107 primary care health centres were checked. The selection of primary care health centres and charts was randomized. Main measurements. Creatinine and BP figures of the patients included were analyzed. Chronic kidney disease was defined as a glomerular filtration rate (GFR), as calculated by the equation developed by the Modification of Diet in Renal Disease (MDRD) Study, at under 60 mL/min per 1.73 m2 of body surface area. A good level of BP control was defined as having figures lower than 130/80 mm Hg. Results. Of all patients, 25.7% (95% CI, 24.3-27.2) had a diminished GFR. Of these, 19.1% (95% CI, 16.6-21.9) had a good level of control of systolic BP, 49.9% (95% CI, 46.6-53.2) had a good level of control of diastolic BP, and 15.2% (95% CI, 12.9-17.8) had a good level of control of both. Conclusions. A considerable proportion of hypertensive patients under treatment in the primary care health centres of Spain have a diminished GFR. Only 1 in 6 of these have their BP under control

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

[Arterial hypertension prevalence, detection, treatment and control in Cantabria, Spain, 2002]. / Prevalencia, detección, tratamiento y control de la hipertensión arterial en Cantabria en 2002.

BACKGROUND: Hypertension is a major cardiovascular risk factor. The aim of this study was to establish the prevalence of high blood pressure in a European region in Northern Spain (Cantabria), and also levels of detection, treatment, and control. METHODS: On a random multi-stage sample of 1197 individuals aged 18 or over, stratified by sex and age, blood pressure measurements were taken and other general data were collected from 2002 to 2004. RESULTS: A prevalence of hypertension of 29% was found. The prevalence among males and females was similar, being 29% and 28%, respectively. Sixty five per cent of the hypertensive subjects were aware of their condition, 53% were undergoing treatment, and 22% presented readings below 140/90 mm Hg. CONCLUSIONS: Hypertension constitutes a public health problem in Cantabria, since it affects 1 in 3 of the adult population. Although levels of detection, treatment, and control are superior to those previously described in this region in 1989, the situation could clearly be improved.

Prevalencia, detección, tratamiento y control de la hipertensión arterial en Cantabria en 2002 / Arterial hypertension prevalence, detection, treatment and control in Cantabria, Spain, 2002

Fundamento: La hipertensión arterial es uno de los principales factores de riesgo cardiovascular. El objetivo de este estudio fue conocer en Cantabria la prevalencia de la hipertensión arterial, así como los grados de detección, tratamiento y control. Métodos: Entre 2002 y 2004 se realizaron mediciones de presión arterial y se recogieron otros datos generales en las personas de una muestra aleatoria de 1.197 individuos de 18 o más años de edad, elegida en varias etapas y estratificada por edad y sexo. Resultados: La prevalencia de hipertensión encontrada fue del 29%, siendo similar en hombres (29%) y en mujeres (28%). Entre las personas hipertensas el 65% conocía su situación, el 53% recibía tratamiento y el 22% presentaba cifras por debajo de 140/90 mm Hg. Conclusiones: La hipertensión arterial afecta a 1 de cada 3 sujetos adultos de la población cántabra. Aunque los niveles de detección, tratamiento y control son superiores a los descritos en esta Comunidad Autónoma en 1989, la situación es claramente mejorable

Background: Hypertension is a major cardiovascular risk factor. The aim of this study was to establish the prevalence of high blood pressure in a European region in Northern Spain (Cantabria), and also levels of detection, treatment, and control. Methods: On a random multi-stage sample of 1197 individuals aged 18 or over, stratified by sex and age, blood pressure measurements were taken and other general data were collected from 2002 to 2004. Results: A prevalence of hypertension of 29% was found. The prevalence among males and females was similar, being 29% and 28%, respectively. Sixty five per cent of the hypertensive subjects were aware of their condition, 53% were undergoing treatment, and 22% presented readings below 140/90 mm Hg. Conclusions: Hypertension constitutes a public health problem in Cantabria, since it affects 1 in 3 of the adult population. Although levels of detection, treatment, and control are superior to those previously described in this region in 1989, the situation could clearly be improved

Reproducibility of postural changes of blood pressure in hypertensive elderly patients in primary care.

OBJECTIVE: To determine the reproducibility of postural changes of blood pressure among hypertensive elderly patients in a primary care setting. METHODS: Measurements of blood pressure were carried out in 60 community-dwelling hypertensive patients aged 65 years or more, in a sitting position and after 1-min and 3-min standing, and were repeated not more than 10 days later. RESULTS: A significant (P<0.05) fall in systolic and diastolic sitting blood pressure was observed between the first visit (151.1+/-20.8/79.7+/-10.1 mmHg) and the second visit (143.5+/-20.6/76.8+/-10.9 mmHg). The intraclass correlation coefficients of the repeated measurements were 0.46 (CI: 0.23-0.65) and 0.42 (CI: 0.17-0.61) for the changes in systolic blood pressure after 1- and 3-min standing, and 0.55 (CI: 0.34-0.71) and 0.40 (CI: 0.16-0.60) for diastolic blood pressure after 1- and 3-min standing, respectively. The repeatability coefficients were greater for the orthostatic changes of blood pressure (54-65%), which indicates lower reproducibility, than for the blood pressure levels on both visits (31-44%). CONCLUSIONS: The reproducibility of the postural changes of blood pressure found in hypertensive elderly patients in primary care is poor. This should be taken into account when making diagnoses of orthostatic hypotension in this type of patient.

Hipotensión ortostática en la guía sobre la hipertensión arterial en España 2005: una propuesta de estandarización de su método de diagnóstico / Orthostaticf hypotension in the 2005 Spanish guidelines on arterial hypertension: a proposal standardization of the method of diagnosis

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Hipotensión ortostática e hipertensión arterial. ¿Son iguales todos los antagonistas del calcio? / Orthostatic hypotension and hypertension. Are all the calcium antagonists similar?

No disponible