[Management of hypertension and diabetes in Primary Care clinical practice: ATENCION study]. / Práctica clínica en el manejo de la hipertensión y la diabetes en Atención Primaria: estudio ATENCION.

BACKGROUND AND OBJECTIVE: Cardiovascular diseases are the main cause of death in the Spanish population. The detection and control of cardiovascular risk factors are fundamental in the prevention of cardiovascular disease. The main objectives of this study are to analyse the attitudes and therapeutic decisions of Primary Care (PC) physicians when treating hypertension (HT) and diabetes mellitus type 2 (DM2), with the aim of establishing the situation and eventually proposing improvement strategies. MATERIAL AND METHOD: A national ecological, multicentre, cross-sectional, and descriptive study was conducted in 2013. A questionnaire was used and 1,028 PC physicians took part in the study. RESULTS: A total of 92.9% of the investigators consulted have indicated that they follow the guidelines for evaluation, treatment, and diagnosis of HT, and 91.4% in the case of diabetes. The latter is diagnosed as a casual finding, while HT is diagnosed through active investigation in patients with other risk factors. Combined therapy takes more than 6 months to take effect in patients with HT, and between 8 and 9 months in diabetic patients. The percentage of non-compliance is similar (10-40%) in both pathologies. Around half the physicians questioned considered interaction with the specialist to be good or excellent (46% HT and 57.3% DM2). CONCLUSIONS: Clinical practices in PC for HT and DM2 have some basic criteria in common. The interaction with the specialist is good, but there is a considerable margin for improvement.

Prevalence of orthostatic hypotension in non-institutionalised elderly aged 80 and over. A diagnostic study using an oscillometric device.

BACKGROUND: Orthostatic hypotension (OH) is a common disorder, and possibly underdiagnosed. In the elderly, OH has been considered a common cause of falls, fractures, and fear of falling. Its prevalence increases with age, probably related to the number of drug treatments, decreased fluid intake, and the progressive dysfunction of the autonomic nervous system. OBJECTIVES: To evaluate the prevalence of OH in a non-institutionalised population ≥80 years, according to different criteria based on sequential measurements taken at minute 0, 1, 3 and 5 of standing. METHODS DESIGN: A diagnostic accuracy study using an oscillometric device. SETTING AND PARTICIPANTS: Convenience sampling of 176 people ≥80 years attended in an urban Primary Health Care Centre. MEASUREMENTS: Supine and standing blood pressure (BP) measurements, at minutes 0, 1, 3 and 5 using the OMRON 705-CP blood pressure device. OH definition: decrease ≥20mmHg in systolic BP (SBP) and/or ≥10mmHg in diastolic BP (DBP). RESULTS: Mean age (Standard Deviation) was 85.2 (3.7) years, and 60.2% were women. Prevalence of OH: 30.7% at minute 0; 19.3% at minute 1; 18.2% at minute 3; and 20.5% at minute 5. Age, sedentary life, smoking, diabetes and SBP values were significantly associated with a greater BP decrease at minute 0. CONCLUSION: A third of the sample had OH, with a maximum prevalence at minute 0. From a clinical point of view, it is suggested that the definition of OH is prioritized according to the BP at minute 0.

[Effectiveness of an intervention to provide information to patients with hypertension as short text messages and reminders sent to their mobile phone (HTA-Alert)]. / Eficacia de una intervención informativa a hipertensos mediante mensajes de alerta en el teléfono móvil (HTA-ALERT).

OBJECTIVE: To analyze the effect of an intervention to provide information with mobile phone text messages to patients with hypertension on compliance with therapy for hypertension. DESIGN: Comparative, controlled, multicenter, randomized cluster study. SETTING: 26 primary care health centers in Spain. PARTICIPANTS: 26 researchers were randomized to a control group or an intervention group (52 patients each, for a total of 104 patients). All patients were receiving monotherapy for uncontrolled hypertension. INTERVENTION: Patients in the control group received their physician's usual interventions. Patients in the intervention group received messages and reminders sent to their mobile phones 2 days per week during 4 months. MAIN OUTCOME MEASURES: Tablets were counted and blood pressure was measured at the start of the study and 1, 3, and 6 months later. The percentage of compliers, mean percentage of compliance and degree of control of hypertension were compared. The reduction in absolute and relative risk was calculated, as was the number of individuals needed to treat to avoid noncompliance. RESULTS: The results were evaluated for a total of 67 individuals (34 in the intervention group and 33 in the control group). The rate of compliance was 85.1% (CI, 74.9%-95.3%) overall, 85.7% (CI, 70.5%-100.9%) in the control group and 84.4% in the intervention group (CI, 70.7%-95.3%) (P=NS). Mean percentage compliance was 90.2%+/-16.3% overall, 88.1%+/-20.8% in the control group and 91.9%+/-11.6% in the intervention group (P=NS). The percentage of patients whose hypertension was controlled at the end of the study was 51.5% (CI, 34.4%-68.6%) in the control group and 64.7% (CI, 48.6%-80.8%) in the intervention group (P=NS). CONCLUSIONS: The telephone messaging intervention with alerts and reminders sent to mobile phones did not improve compliance with therapy in patients with hypertension.

[Decisions and therapeutic attitudes for patients with white coat hypertension]. / Decisiones y actitudes terapéuticas en los pacientes con hipertensión clínica aislada.

OBJECTIVE: To analyze the different therapeutic attitudes towards patients with arterial hypertension (AH) or white coat hypertension (WCH). DESIGN: Longitudinal, retrospective study after performing a 24 h ambulatory blood pressure monitoring of ABPM. SETTING: Urban health center. PATIENTS: Eighty-six patients aged over 15 years, not treated and with figures of a poor blood pressure control (> 140 and/or > 90 mmHg), followed for a mean of four years. INTERVENTION: Initial 24-h ABPM (SpaceLabs 90202-90207). DETERMINATIONS AND MAIN RESULTS: After ABPM 43 patients were classified as having WCH and 43 patients AH. Both groups were comparable. Pharmacologic treatment was begun from 41.9% (n = 18) of WCH and 88.4% (n = 38) of AH (p < 0.001) patients with a delay, after ABPM, of 19 months (SD 22) and 1.2 months (SD 3.2), respectively (p < 0.01). At the end of the follow-up period patients with AH had more target organs involved. CONCLUSIONS: The information provided by ABPM probably entails a more conservative approach at the beginning of pharmacologic treatment.

Antihypertensive activity of verapamil: impact of dietary sodium. The VERSAL Study Group.

OBJECTIVE: To define the influence of dietary salt intake on the antihypertensive effect of slow-release verapamil 240 mg once a day in a population with mild-to-moderate essential hypertension. DESIGN: Parallel, randomized, multicentre study. METHODS: Patients were advised to follow a moderately low salt diet (Low-salt group). After a 2-week run-in period, those patients with 24-h urinary sodium excretion (UNa) < or = 120 mmol/day and a diastolic blood pressure (DBP) between 90 and 114 mmHg were randomly assigned to verapamil + Low-salt or verapamil + unrestricted-salt diet (High-salt group) for 28 days. Compliance with diets was defined as Low-salt UNa < or = 120 mmol/day and High-salt UNa > 120 mmol/day with UNa increased by > or = 60 mmol/day over the level attained at the end of the run-in period. RESULTS: Significant reductions in mean systolic blood pressure (SBP) and DBP were found in both the Low-salt (n = 235) and High-salt (n = 183) groups. The therapeutic goal (DBP < 90 mmHg) was achieved in 38.3% of patients in the Low-salt and 44.8% of patients in the High-salt group. Office blood pressure results were confirmed by ambulatory 24-h blood pressure monitoring in a subsample of patients. Verapamil reduced mean blood pressure throughout the nycthemeral cycle without any significant difference between the two groups. CONCLUSION: The restriction in sodium intake does not have an additive effect on the antihypertensive effect of the slow-channel calcium antagonist verapamil.