[Hypertension and heart failure in Primary Care and Cardiology consultations of in Spain]. / Hipertensión arterial e insuficiencia cardíaca en las consultas de Atención Primaria y de Cardiología en España.

OBJECTIVE: Analyze the results concerning the heart failure population of CARDIOTENS 99, a cross-sectional study of hypertension associated with cardiovascular disease carried out on 32,051 patients seen in Cardiology and Primary Care consultations. METHODS: In the analysis we included prospectively demographic, clinical, blood pressure, and therapeutic data of all patients seen on a single day by 1,159 physicians (21% cardiologists; 79% Primary Care physicians). RESULTS: 4% of the total sample of 32,051 patient had heart failure, representing 23% of the patients with heart disease. Median age was 70,8 6,7 years; 53% were women. Hypertension was the most frequent risk factor, appearing in 71% of the patients with heart failure. Hypertension was most frequent in Primary Care patients (76% versus 63%; p < 0,01), while ischemic heart disease was most frequent in cardiology patients (38% versus 27%; p < 0,01). Cardiology patients showed a trend for greater use of drugs in comparison with patients seen in primary care consultations but without significant differences (3,39 versus 3,35; p > 0,05). Diuretics were the drugs with greater prescription (63%). 44% patients with heart failure were on an angiotensin-conversing enzyme inhibitor and 14% on beta-adrenergic blockers. Systolic blood pressure was well controlled in only 19% of hypertensive patients with heart failure, according to the international recommendations (< 130 mmHg). The proportion of patients with blood pressure higher than 140 mmHg was superior among the patients seen by cardiologists than between those seen by Primary Care physicians (57% versus 47%; p < 0.01). CONCLUSIONS: Heart failure is often associated with hypertension. Control of blood pressure is inadequate in the majority of patients with heart failure. Ischemic heart disease is a more frequent cause of in the patients seen by cardiologists than in those seen by Primary Care physicians, and hypertension is the leading cause of heart failure in these patients. Prescription of drugs recommended for the treatment of heart failure it is generally very scant.

Tratamiento de la hipertensión arterial esencial no complicada / No disponible

No disponible

Diferencias de presión arterial entre días laborables y festivos utilizando dispositivos automáticos de automedida en el domicilio / Differences in arterial blood pressure between working days and public holidays using automated devices for domiciliary AP self-measurement

Objetivo. Valorar las diferencias de presión arterial (PA) en el domicilio según se mida ésta en días laborales o festivos y la influencia del día festivo en el grado de control. Pacientes y métodos. Obtuvimos una muestra de 114 pacientes hipertensos antiguos (47 mujeres) de 47 a 81 años en ocho consultas de Atención Primaria diagnosticados consecutivamente de mal control de PA en la consulta ( 140 y/o 90 mmHg) y en el domicilio ( 135 y/o 85 mmHg), con monitor electrónico certificado. Todos los pacientes fueron entrenados en automedida domiciliaria y recibieron tratamiento anhipertensivo estable durante 24 semanas. Al finalizar este período se compararon las medias de PA de las mediciones obtenidas en cada uno de los tres días programados, dos laborables consecutivos y uno festivo de la misma semana. Mediciones y resultados principales. Las medidas de las PA obtenidas en los días laborables fueron de 127,5ñ9,7/75,3ñ6,8 y de 126,9 ñ 9,1/74,5 ñ 6,9 mmHg de sistólica/diastólica, respectivamente, y ambas superaron al promedio de las presiones en el día festivo que fueron de 124,9 ñ 9,5/73,1 ñ 6,6 mmHg de sistólica/diastólica, respectivamente (p < 0,001). La proporción de pacientes controlados en domicilio considerando el promedio de los tres días fue del 79,8 por ciento. Encontramos diferencias en el control entre el promedio de ambos días laborables y el día festivo (p < 0,01), así como entre el primer día laborable y el promedio de los tres días (p < 0,01). No existen diferencias significativas entre el grado de control del primer día y del segundo día laborable ni entre el promedio de los tres días y el segundo día laborable. Con el índice kappa el grado de acuerdo existente al valorar el grado de control de la hipertensión arterial (HTA) con los diferentes modelos (entre cada uno de los días de observación con el conjunto) fue para el primer día del 83 por ciento, para el segundo día del 77 por ciento, para el festivo 88 por ciento y para los dos días laborables juntos del 90 por ciento. Conclusiones. En pacientes hipertensos tratados con fármacos y entrenados para realizar automedida domiciliaria encontramos diferencias importantes en las mediciones de PA realizadas en días laborables y en días festivos. El grado de control se incrementa significativamente al incluir los días festivos. La mejor concordancia se obtiene entre los días laborables y el total, por lo cual proponemos que en la práctica clínica se recomiende la automedida de PA en domicilio en dos días laborables y no en día festivo (AU)

Sexual dysfunction in hypertensive patients treated with losartan.

BACKGROUND: Impaired erectile function in men is a component of the dysmetabolic syndrome of high blood pressure as well as a sequela of antihypertensive therapy. This prospective interventional study in men with uncontrolled hypertension (blood pressure > or =140/90 mm Hg) used a survey instrument to assay sexual dysfunction before and after therapy with losartan. METHODS: We evaluated the influence of a 12-week therapy with losartan in 82 hypertensive subjects with (n = 82) and without (n = 82) a diagnosis of erectile dysfunction using a self-administered questionnaire validated in another 60 subjects with hypertension. RESULTS: From an initial sample of 323 hypertensive men and women, 82 men, aged 30 to 65 years, with sexual dysfunction underwent a 12-week regimen of losartan therapy (50-100 mg/day). Losartan treatment improved sexual satisfaction from an initial 7.3 to 58.5% (chi2; P = 0.001). Subjects reporting a high frequency of sexual activity improved from 40.5% initially to 62.3% after drug treatment, whereas the number of patients with low or very low frequency of sexual activity decreased significantly (chi2; P = 0.001). At the completion of the 12-week losartan regimen, only 11.8% of the treated subjects reported in improvement in sexual function. Improvement on quality of life was demonstrated in 73.7% of subjects medicated with losartan, 25.5% reported no changes, and only 0.8% felt worse. In the group without sexual dysfunction, losartan had a nonsignificant effect on sexual function. CONCLUSIONS: Our data suggest that losartan improved erectile function and both satisfaction and frequency of sexual activity. Because side effects are one of the most influential factors in the management of hypertension, an added benefit of losartan therapy may be its positive impact on quality of life.

[Impact of hypertension in cardiac diseases in Spain. The CARDIOTENS Study 1999]. / Impacto de la hipertensión en las cardiopatías en España. Estudio CARDIOTENS 1999.

INTRODUCTION AND OBJECTIVES: To analyze the prevalence and control of hypertensive patients with associated cardiac diseases in Spain. METHODS: All the 32,051 outpatients seen the same day by 1,159 primary physicians (79%) and cardiologists (21%) were prospectively included in a database including history of cardiac disease (heart failure, coronary disease or atrial fibrillation), casual blood pressure and ongoing treatments. RESULTS: Hypertension was present in 33% of the whole group and 19% had both hypertension and a cardiac disease. Hypertension was present in 77% of the patients with heart failure, in 66% of those with coronary diseases and in 66% with atrial fibrillation. Less than 60% of the hypertensive patients with heart failure were treated with an angiotensin or a converting enzyme inhibitor. Thirty-two percent of the hypertensive patients with coronary disease received a betablocker and 25% of the hypertensive patients with atrial fibrillation were on oral anticoagulation. Less than 20% of the patients with hypertension and cardiac disease had blood pressure levels under 130/85 mmHg as recommended by international guidelines. Patients seen by primary care physicians were found to be slightly better treated than those under cardiologists' care. CONCLUSIONS: High blood pressure is associated with heart failure, coronary disease and atrial fibrillation in a high percentage of patients. The blood pressure levels recommended by current guidelines for cardiac hypertensives were attained in less than 20% of the cases. The control of blood pressure in these high risk hypertensive patients was low and the use of appropriate pharmacological treatment was poor.

Hipertensión arterial por ingestión de sustancias exógenas / Arterial hypertension caused by consume of exogenous substances

Se analizan las sustancias exógenas que pueden producir elevación de la presión arterial, bien directamente o a través de la expansión del volumen circulante o por un mecanismo presor directo. En otras circunstancias la administración de ciertos fármacos pueden interferir en la absorción intestinal de los hipotensores o inhibir su mecanismo de acción. En estos momentos tiene un interés especial la administración de antiinflamatorios no esteroideos (AINE), el consumo de cocaína como causa de crisis hipertensivas y ciertos inmunosupresores de uso habitual como la ciclosporina. Es de sumo interés en el estado de los pacientes hipertensos realizar una buena anamnesis sobre la posible administración de algunas de estas sustancias (AU)

Prevalencia de la disfunción sexual en una población hipertensa

Objetivo. Conocer la prevalencia de disfunción sexual (DS) y estudiar la actividad y grado de satisfacción sexual en el paciente hipertenso tratado con fármacos en 56 centros de Atención Primaria de la geografía española. Material y métodos. Se realiza un estudio descriptivo transversal en pacientes hipertensos, seleccionados consecutivamente, que contestaron a un cuestionario autocumplimentado validado por los autores (cuestionario 'busca-síntomas'). Mediciones y resultados principales. El grupo de estudio estuvo formado por 126 mujeres (39 por ciento) y 197 varones (61 por ciento), con un rango de edad de 30 a 65 años. La prevalencia global de DS fue del 30,7 por ciento (IC del 95 por ciento: 28,9-32,4). Se detectó DS en 99 pacientes (17 mujeres y 82 varones), lo que supone prevalencias de DS en cada sexo del 13,7 por ciento (IC del 95 por ciento: 8,8-18,5) y del 42,3 por ciento (IC del 95 por ciento: 35,3-49,3), respectivamente. De las características analizadas únicamente se relacionó el sexo y el tipo de tratamiento con la presencia de DS (p < 0,01). El grado de satisfacción sexual alcanzaba el 61,9 por ciento, con una frecuencia de actividad sexual, en el intervalo mayoritario de edad (50 a 59 años), del 30,6 por ciento (relaciones sexuales quincenales). Conclusiones. El grado de satisfacción sexual fue relativamente bajo, con una actividad sexual reducida. Se detecta una prevalencia elevada de DS en los pacientes hipertensos estudiados, sobre todo en el sexo masculino. Los grupos farmacológicos que más parecen influir en la actividad sexual son los -bloqueantes y los diuréticos. Es importante que el médico de Atención Primaria esté formado adecuadamente para detectar DS de cara a optimizar el cumplimiento terapéutico y mejorar la calidad de vida (AU)

Clinico-biochemical evolution and late hepatic lesions in the toxic oil syndrome.

The clinical and biochemical evolution of hepatic lesions in 124 patients with toxic oil syndrome from 1981 to 1986 has been reviewed. Most patients became asymptomatic during the early phase of the disease and abnormal liver function tests gradually normalized. In 1981, liver injury resembled drug-induced cholestatic hepatitis in 31 patients, and in 1 patient chronic destructive nonsuppurative cholangitis was evident. From 1982 to 1986 serial liver biopsies demonstrated toxic cholestatic hepatitis in 14 patients, chronic active hepatitis in 13, and nonalcoholic cirrhosis in 4. Nineteen patients showed lesions suggestive of alcoholic liver disease, but only 8 had a history of heavy alcohol intake. One patient developed biliary cirrhosis, another liver cell adenoma, and 8 nodular regenerative hyperplasia of the liver. We conclude that although liver injury had subsided in most patients, a significant number developed a variety of different liver diseases after follow-up for 5 yr.

Nodular regenerative hyperplasia of the liver associated with the toxic oil syndrome: report of five cases.

Nodular regenerative hyperplasia of the liver developed in five patients who had the toxic oil syndrome caused by ingestion of adulterated cooking oil. This hepatic complication was detected from 19 to 37 months (mean-2.5 years) after the onset of the toxic oil syndrome. Nodular regenerative hyperplasia was asymptomatic, although all patients had persistently abnormal liver function. Hepatomegaly was present in four cases, mild jaundice in three and signs of portal hypertension in two. Pathogenesis of nodular regenerative hyperplasia in toxic oil syndrome is unknown, but probably microcirculatory disturbances within the liver might have played a role. Fibrosis in Zone 3, sinusoidal dilatation and occasionally intralobular hemorrhage were seen in three cases; in one of them, characteristic lesions of veno-occlusive disease were also present. In another case, endarteritis changes of hepatic arterioles were evident.