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Rodriguez-Roca G.C.,Primary Care Center La Puebla Of Montalban | Llisterri J.L.,Primary Care Center Ingeniero Joaquin Benlloch | Prieto-Diaz M.A.,Primary Care Center Vallobin La Florida | Alonso-Moreno F.J.,Primary Care Center Silleria | And 6 more authors.
Hypertension Research | Year: 2014

This study aimed to determine the clinical profile, blood pressure (BP) control rates, therapeutic management and physicians' therapeutic behavior regarding very elderly hypertensive patients. A total of 1540 hypertensive patients ≥80 years old on antihypertensive therapy and receiving care in primary care settings in Spain were included in this cross-sectional study. The mean patient age was 83.4±3.1 years, 61.9% of patients were women and 49.3% of patients had cardiovascular disease. Of the patients, 27.7% were on monotherapy and 72.3% were on combined therapy (47.4% on two antihypertensive agents and 24.9% on three or more antihypertensive agents). A total of 40.8% (95% confidence interval (CI): 38.4-43.3%) of patients achieved BP goals (<140/90 mm Hg; <130/80 in patients with diabetes, chronic renal disease or cardiovascular disease). Patients with uncontrolled BP were more likely to have metabolic syndrome, diabetes, obesity, a history of cardiovascular disease, ischemic heart disease, renal disease and stroke and were more frequently smokers. Physicians modified the antihypertensive regimens for 27.4% (95% CI: 23.9-30.8%) of the patients with uncontrolled BP, and the addition of another antihypertensive agent was the most frequent modification. With regard to the physicians' perception of patients' BP control, the BPs of 44.1% of the patients with uncontrolled BP were considered well controlled by the physicians. © 2014 The Japanese Society of Hypertension All rights reserved. Source


Rodriguez-Roca G.C.,Primary Care Center La Puebla Of Montalban | Villarin-Castro A.,Primary Care Multiprofessional Educational Unit | Carrasco-Flores J.,Investigator of RICARTO Project | Artigao-Rodenas L.M.,Primary Care Center Zona | And 6 more authors.
Blood Pressure | Year: 2014

Aim. To evaluate the concordance between automated oscillometric measurement (WatchBP® Office ABI) of the ankle- brachial index (ABI) and the traditional measurement by eco-Doppler in a Spanish population without peripheral artery disease attended in primary care. Methods. The ABI was determined by both methods in a general population aged ≥ 18 years, from the RICARTO study. The intraclass correlation coefficient was calculated to assess the concordance between both techniques and the Bland-Altman plot was determined to analyze the agreement between them. Results. A total of 322 subjects (mean age 47.7 ± 16.0 years; 54.3% women) were included in the study. With regard to cardiovascular risk factors, 70.5% of subjects had dyslipidemia, 26.7% hypertension, 24.8% obesity, 8.4% diabetes and 25.5% were smokers. Mean ABI measured by eco-Doppler and the automated method were 1.17 ± 0.1 and 1.2 ± 0.1, respectively (mean differences - 0.03 ± 0.09; p < 0.001). The Pearson correlation coefficient and the intraclass correlation coefficient were in both cases 0.70. Conclusions. The automated oscillometric measurement of ABI is a reliable and useful alternative to conventional eco-Doppler determination in the general population without peripheral artery disease attended in primary care. © 2014 Scandinavian Foundation for Cardiovascular Research. Source


Llisterri J.L.,Primary Care Center Ingeniero Joaquin Benlloch | Rodriguez-Roca G.C.,Primary Care Center La Puebla Of Montalba N | Escobar C.,Hospital Universitario La Paz | Alonso-Moreno F.J.,Primary Care Center Silleria | And 6 more authors.
Journal of Hypertension | Year: 2012

Objectives: To examine the evolution of hypertension management and blood pressure (BP) control in Spain in the last decade across PRESCAP 2002, 2006 and 2010. Methods: The methodology of the three studies was the same. They were multicenter and cross-sectional surveys aimed to determine BP control rates in hypertensive patients in primary care in Spain during 2002, 2006 and 2010, respectively. In each study, patients at least 18 years, with an established diagnosis of hypertension were included. Adequate BP control was defined as BP less than 140/90 mmHg in the general population (<130/85 mmHg in PRESCAP 2002 and less than 130/80 mmHg in PRESCAP 2006 and PRESCAP 2010 for patients with diabetes, chronic kidney disease and cardiovascular disease). Results: A total of 12 754 patients (mean age 63.3 ± 10.8 years; 57.2% women), 10 520 patients (64.6 ± 11.3 years; 53.7% women) and 12 961 patients (66.3 ± 11.4; 52.0% women) were included in PRESCAP 2002, PRESCAP 2006 and PRESCAP 2010 studies respectively. With regard to BP control rates, 36.1% [95% confidence interval (CI) 35.2-36.9%], 41.4% (95% CI 40.5-42.4%) and 46.3% of patients (95% CI 45.4-47.1%) achieved BP goals in PRESCAP 2002, PRESCAP 2006 and PRESCAP 2010, respectively (P < 0.0001). In PRESCAP 2002, 56% of patients were on monotherapy, 35.6% were taking two drugs and 8.4% at least three drugs. In PRESCAP 2006 these numbers were 44.4, 41.1 and 14.5%, respectively, and in PRESCAP 2010 they were 36.4, 44.1 and 19.5%, respectively (P < 0.0001). Conclusion: BP control rates have improved in Spain from 2002 to 2010. This may be related, at least in part, with the higher use of antihypertensive treatment, particularly combined therapy. © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins. Source


Barrios V.,Hospital Ramon y Cajal | Escobar C.,Hospital Universitario La Paz | Alonso-Moreno F.J.,Primary Care Center Silleria | Prieto M.A.,Primary Care Center Vallobin La Florida | And 4 more authors.
Journal of Hypertension | Year: 2015

Objectives: To examine the evolution of clinical profile, management of hypertension, and blood pressure (BP) control according to sex in the past decade in Spain. Methods: Data were taken from three surveys (PRESión arterial en la población española en los Centros de Atención Primaria studies) aimed to determine BP control rates in treated hypertensive patients, who attended the primary care in Spain during 2002, 2006, and 2010, respectively. Adequate BP control was defined as BP lower than 140/90 mmHg for the general hypertensive population in the three surveys. In patients with diabetes, chronic kidney disease, or cardiovascular disease, BP control was established as lower than 130/85 mmHg in the 2002 survey and lower than 130/80 mmHg in the 2006 and 2010 surveys. Results: A total of 12 754 (57.2% women), 10 520 (53.7% women), and 12 961 (51.7% women) patients were included. The proportion of patients with cardiovascular disease increased from 27.1% in men and 21.9% in women in 2002, to 33.0 and 23.9%, respectively, in 2010 (P < 0.0001 in men and women, respectively). In 2002, 36.3% of men and 35.9% of women achieved BP goals (P = NS); 39.7 and 42.9% in 2006 (P < 0.001); and 44.7 and 47.9% in 2010 (P < 0.0001). The proportion of men on combined therapy increased from 44.2% in 2002 to 63.9% in 2010 (P for trend < 0.0001), and in women it increased from 43.9 and 63.2%, respectively (P for trend <0.0001). Conclusion: Despite the fact that clinical profile of treated hypertensive patients has worsened in the past years in Spain, BP control rates have improved, particularly in women. This improvement was related with a higher use of combined therapy, regardless of sex. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. Source


Escobar C.,Hospital Universitario La Paz | Barrios V.,Hospital Ramon y Cajal | Alonso-Moreno F.J.,Primary Care Center Silleria | Prieto M.A.,Primary Care Center Vallobin La Florida | And 3 more authors.
Journal of Hypertension | Year: 2014

OBJECTIVE: To determine the therapeutic behavior of primary care physicians in uncontrolled hypertensive patients in Spain during the last decade. METHODS: Data were taken from three cross-sectional surveys aimed to determine the blood pressure (BP) control rates in treated hypertensive patients followed in a setting of primary care in Spain during 2002, 2006, and 2010, respectively. Adequate BP control was globally defined as BP lower than 140/90mmHg for the hypertensive population in the three studies. In patients with diabetes, chronic kidney disease, or cardiovascular disease, BP control was established as lower than 130/85mmHg in PRESión arterial en la población Española en los Centros de Atención Primaria (PRESCAP) 2002 and lower than 130/80mmHg in PRESCAP 2006 and 2010. RESULTS: A total of 12754, 10520, and 12961 patients were included in PRESCAP 2002, 2006, and 2010 studies. Of them, 36.1, 41.4, and 46.3%, respectively, achieved BP targets. In those patients with uncontrolled BP, physicians modified the treatment in 18.3, 30.4, and 41.4% of the cases, respectively (P=0.0001). The most frequent action taken was the change to another drug in PRESCAP 2002 (47.0%), and the addition of other antihypertensive agent in PRESCAP 2006 and 2010 (46.3 and 55.6%, respectively). Predictors of therapeutic inertia were the physicians' perception of BP control, being on treatment with combined therapy, and the absence of risk factors or cardiovascular disease. CONCLUSION: Although therapeutic inertia has decreased in the last years in primary care setting in Spain, nowadays in nearly 60% of patients with uncontrolled BP, no therapeutic action is actually taken. Therefore, despite a significant improvement, therapeutic inertia still remains a relevant clinical problem in hypertension general practice. © 2014 Wolters Kluwer Health / Lippincott Williams & Wilkins. Source

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