[Effectiveness of combined therapy at set doses in a cohort of hypertense patients not controlled by single therapy]. / Efectividad de la terapia combinada a dosis fijas en una cohorte de hipertensos no controlados con monoterapia.

OBJECTIVE: To evaluate the effectiveness of the fixed dose of a lisinopril-hydrochlorothiazide combination treatment in the control of blood pressure, in poorly controlled high blood pressure people, treated with monotherapy.Design. Prospective observational study.Setting. Primary care frame.Participants. 931 patients (56.7% women) with an average age of 62.0+/-3 years, were included by 199 primary care physicians. 915 patients (98%) ended the study and finally they were included for the statistical analysis. MAIN MEASUREMENTS: OMS/SIH recommendations on blood pressure measurement and diagnose of poor control were followed. Pulse pressure, body mass index and basic clinical analyses were assessed. Four continuation visits were made during six months. RESULTS: Lisinopril-hidrochlorothiazide (20/12.5 mg) reduced significantly SBP (24.6 +/- 3.5 mm Hg) and DBP (14,3 +/- 0.7 mm Hg) (P<.001). Blood pressure control was only influenced by age (OR, 0.81; 95% CI, 0.71-0.92; P=.001). Pulse pressure was reduced in 10.4 +/- 4.3 mm Hg (P<.001). After 24 weeks of treatment, glycemic and lipidic profiles showed an improvement, as well as HbA1c in diabetic people. CONCLUSIONS: In Primary care, a 52.8% of poorly controlled with monotherapy high blood pressure people were controlled by a combination of lisinopril-hydrochlorothiazide (20/12.5 mg). In addition, pulse pressure was decreased and both lipid and glucose blood profiles improved.

Efectividad de la terapia combinada a dosis fijas en una cohorte de hipertensos no controlados con monoterapia / Effectiveness of combined therapy at set doses in a cohort of hypertense patients not controlled by single therapy

Objetivo. Evaluar la efectividad de lisinoprilhidroclorotiazida a dosis fijas en el control de la presión arterial en hipertensos tratados con monoterapia y mal controlados. Diseño. Estudio observacional, prospectivo. Emplazamiento. Atención primaria. Participantes. Ciento noventa y nueve médicos de atención primaria que incluyeron a 931 pacientes (56,7 por ciento mujeres), con edad media de 62,0 ñ 10,3 años. Finalizaron el estudio 915 pacientes (98 por ciento) que se incluyeron en el análisis. Mediciones principales. Se siguieron las recomendaciones de la OMS/SIH en la medición de la presión arterial y el diagnóstico de mal control. Además, se evaluaron presión del pulso, índice de masa corporal y parámetros analíticos básicos. Se realizaron 4 visitas durante 6 meses de seguimiento. Resultados. Lisinopril-hidroclorotiazida (20/12,5 mg) disminuyó significativamente la PAS (24,6 ñ 3,5 mmHg) y la PAD (14,3 ñ 0,7 mmHg) (p < 0,001). El control de la presión arterial aumentó hasta el 52,8 por ciento (p < 0,001). La edad fue la única variable que influyó en el control de la presión arterial (OR, 0,81; IC del 95 por ciento, 0,71-0,92 por ciento; p = 0,001). La presión del pulso disminuyó 10,4 ñ 4,3 mmHg (p < 0,001). A las 24 semanas de tratamiento, se observó una mejoría en el perfil glucémico y lipídico, y de la HbA1c en los diabéticos. Conclusiones. En atención primaria, lisinopril-hidroclorotiazida (20/12,5 mg), controló la presión arterial del 52,8 por ciento los de hipertensos mal controlados con monoterapia. Además, disminuyó la presión del pulso y mejoró el perfil lipídico y el glucémico (AU)

[The role of diabetes mellitus in cardiac disease in Spain. The CARDIOTENS Study 1999]. / Impacto de la diabetes en las enfermedades cardíacas en España, Estudio CARDIOTENS 1999.

BACKGROUND: We analyse the characteristics of the patients with diabetes and cardiac disease included in the CARDIOTENS 1999 study. PATIENTS AND METHOD: 32,051 outpatients who were seen the same day by 1,159 primary healthcare physicians (79%) and cardiologists (21%) were prospectively registered in a database including demographic and clinical data and therapeutic profile. RESULTS: History of cardiac disease was present in 19% (6,194 patients) of the whole population, and 1,275 of them (20.6%) were diabetics. Hypertension was present in 74% of diabetic patients with cardiac disease. Coronary heart disease (angina pectoris or previous myocardial infarction) was present in 45% of diabetic patients with heart failure. Less than 30% of these patients had blood pressure levels under 130/85 mmHg, as recommended by international guidelines. An LDL-cholesterol level lower than 100 mgrs/dl was observed in only 12% of diabetic patients with coronary heart disease; the mean values of total cholesterol and LDL-cholesterol of these patients were significantly (p < 0.01) higher in those seen by primary healthcare physicians. Less than 40% of diabetic patients with cardiac disease were treated with an angiotensin converting enzyme inhibitor, a therapy which was otherwise used in 50% of diabetic patients with heart failure. A beta-blocker therapy was used in 26% of diabetic patients with coronary heart disease and 39% of them were being treated with statins. CONCLUSIONS: More than 20% of patients with cardiac disease in this study were diabetics. Blood pressure and cholesterol levels recommended by current guidelines were attained in a limited proportion of these patients. The use of drugs with demonstrated prognostic benefit in diabetic patients with heart disease is scarce.