Auxiliadora Graciani

Hypertension magnitude and management in the elderly population of Spain.

Objective The present study assessed the prevalence, awareness, treatment and control of hypertension among the elderly population of Spain. Design Based on a nationally representative sample of 4009 individuals aged ⩾ 60 years, two sets of six blood pressure measurements were obtained by trained observers at each subjects home, using standardized methods. In each set, three mercury-based measurements were alternated with three automated measurements. Results The mean systolic blood pressure (SBP)/diastolic blood pressure (DBP) was 143/79 mmHg, and the pulse pressure was 64 mmHg. The prevalence rate of hypertension (SBP ⩾ 140 mmHg, DBP ⩾ 90 mmHg, or current drug treatment) was 68.3%. No result obtained was sensitive to a particular measurement device. Of the hypertensives, 65% were aware of their condition, 55.3% were treated and 16.3% were controlled. Among treated hypertensives, SBP control (32.2%) was much lower than DBP control (82.3%). Control was lower in men than in women, in older than in younger subjects, and in those with lowest than in those with higher educational levels. About 57% of uncontrolled treated hypertensives were on monotherapy. Weight loss was among the least heeded items of advice (39% among overweight hypertensives). Conclusions Hypertension is a major public health problem in elderly Spaniards. Most hypertensives had their hypertension uncontrolled. Greater emphasis should be laid on the most disadvantaged (the older, men, and those with lowest education) in terms of hypertension management, and on reinforcing weight loss and combining drugs for enhanced hypertension control.

Prevalence of general and abdominal obesity in the adult population of Spain, 2008-2010: the ENRICA study.

This is the first study to report the prevalence of general obesity and abdominal obesity (AO) in the adult population of Spain based on measurements of weight, height and waist circumference. The data are taken from the ENRICA study, a cross‐sectional study carried out between June 2008 and October 2010 in 12,883 individuals representative of the non‐institutionalized population on Spain aged 18 years and older. Anthropometry was performed under standardized conditions in the households by trained interviewers. Overweight was considered as body mass index (BMI) 25–29.9 kg m−2, and obesity as BMI ≥ 30 kg m−2. AO was defined as waist circumference >102 cm in men and >88 cm in women. The prevalence of obesity was 22.9% (24.4% in men and 21.4% in women). About 36% of adults had AO (32% of men and 39% of women). The frequency of obesity and of AO increased with age and affected, respectively, 35 and 62% of persons aged 65 and over. The frequency of obesity and AO decreased with increasing educational level. For example, 29% of women with primary education or less had obesity vs. only 11% of those with university studies. The prevalence of obesity was very high in the Canary Islands and in the south of Spain.

Longitudinal association of physical activity and sedentary behavior during leisure time with health-related quality of life in community-dwelling older adults

BackgroundEvidence on the relation between leisure-time physical activity (LTPA) and health-related quality of life (HRQoL) in older adults is based primarily on clinical trials of physical exercise programs in institutionalized persons and on cross-sectional studies of community-dwelling persons. Moreover, there is no evidence on whether leisure-time sedentary behavior (LTSB) is associated with HRQoL independently of LTPA. This study examined the longitudinal association between LTPA, LTSB, and HRQoL in older community-dwelling adults in Spain.MethodsProspective cohort study of 1,097 persons aged 62 and over. In 2003 LTPA in MET-hr/week was measured with a validated questionnaire, and LTSB was estimated by the number of sitting hours per week. In 2009 HRQoL was measured with the SF-36 questionnaire. Analyses were done with linear regression and adjusted for the main confounders.ResultsCompared with those who did no LTPA, subjects in the upper quartile of LTPA had better scores on the SF-36 scales of physical functioning (β 5.65; 95% confidence interval [CI] 1.32-9.98; p linear trend < 0.001), physical role (β 7.38; 95% CI 0.16-14.93; p linear trend < 0.001), bodily pain (β 6.92; 95% CI 1.86-11.98; p linear trend < 0.01), vitality (β 5.09; 95% CI 0.76-9.41; p linear trend < 0.004) social functioning (β 7.83; 95% CI 2.89-12.75; p linear trend < 0.001), emotional role (β 8.59; 95% CI 1.97-15.21; p linear trend < 0.02) and mental health (β 4.20; 95% CI 0.26-8.13; p linear trend < 0.06). As suggested by previous work in this field, these associations were clinically relevant because the β regression coefficients were higher than 3 points. Finally, the number of sitting hours showed a gradual and inverse relation with the scores on most of the SF-36 scales, which was also clinically relevant.ConclusionsGreater LTPA and less LTSB were independently associated with better long-term HRQoL in older adults.

Justificación y métodos del estudio sobre nutrición y riesgo cardiovascular en España (ENRICA)

INTRODUCTION AND OBJECTIVES The ENRICA study aims to assess the frequency and distribution of the main components of the natural history of cardiovascular disease in Spain, including food consumption and other behavioral risk factors, biological risk factors, early damage of target organs, and diagnosed morbidity. METHODS A cross-sectional survey of 11,991 individuals representative of the non-institutionalized population aged 18 years and older in Spain was conducted from June 2008 to October 2010. Data collection comprised 3 sequential stages: a) computer-assisted telephone interview to obtain information on lifestyle, knowledge and attitudes about cardiovascular disease risk factors, and the signs and symptoms of heart attack and stroke, subjective health, and morbidity; b) first home visit, to collect blood and urine samples for analysis by a central laboratory, and c) second home visit, to measure anthropometric variables and blood pressure and to administer a computer-assisted dietary history; data on functional limitations are also collected from participants aged 65 years and older. DISCUSSION The ENRICA study has shown the feasibility of a large home-based health interview and examination survey in Spain. It will provide valuable information to support and evaluate national strategies against cardiovascular disease and other chronic diseases in Spain. Moreover, a 3-year prospective follow-up of the study participants, including a new physical exam, is planned to start in the second semester of 2011 and will update lifestyle information and biological variables. (ClinicalTrials.gov number, NCT01133093).

Waist circumference as a predictor of disability among older adults

Objective: Few studies have addressed the association between abdominal obesity, as measured by waist circumference (WC), and disability in the elderly. Moreover, those studies were cross‐sectional and yielded inconsistent results. The objective of this study was to examine longitudinally the association between WC and self‐reported disability among older adults.

Magnitud y manejo de la hipercolesterolemia en la población adulta de España, 2008-2010, el estudio ENRICA

INTRODUCTION AND OBJECTIVES Only a few studies have reported nationwide population-based data on the magnitude and control of hypercholesterolemia. This work examines the prevalence and management of hypercholesterolemia in Spain. METHODS Cross-sectional study conducted from June 2008 to October 2010 on 11,554 individuals representative of the population aged ≥ 18 years in Spain. Study participants provided 12-h fasting blood samples, which were analyzed in a central laboratory with standardized methods. RESULTS In the whole population, 50.5% had hypercholesterolemia (total cholesterol ≥ 200 mg/dL or drug treatment) and 44.9% high levels of low-density lipoprotein cholesterol (≥ 130 mg/dL or drug treatment), with no substantial sex-related differences. Moreover, 25.5% of men showed high-density lipoprotein cholesterol < 40 mg/dL and 26.4% of women high-density lipoprotein cholesterol <50mg/dL. Also, 23.2% of men and 11.7% of women had triglycerides ≥ 150 mg/dL. Frequency of dyslipidemia increased up to 65 years, except for low high-density lipoprotein cholesterol which did not vary with age. Among those with high low-density lipoprotein cholesterol, 53.6% knew of it and 44.1% of them received lipid-lowering treatment; among the latter, 55.7% had a controlled level (13.2% of all hypercholesterolemics). Control of high low-density lipoprotein cholesterol increased with age and with the number of visits to the specialist physician, but was lower among diabetics (odds ratio=0.38; 95% confidence interval, 0.28-0.53) and patients with cardiovascular disease (odds ratio=0.55; 95% confidence interval, 0.33-0.92). CONCLUSIONS About half of the Spanish population has elevated serum cholesterol; moreover, cholesterol control is poor, particularly among those with highest cardiovascular risk, such as diabetics or patients with cardiovascular disease.

Relationship between obesity, hypertension and diabetes, and health-related quality of life among the elderly.

Background The purpose of this study was to study the cumulative effects of cardiovascular risk factors on all the health-related quality of life dimensions among the elderly in this era of epidemic obesity and diabetes. Design and methods The population-based study covered 3567 participants, representative of the Spanish non-institutionalized population aged 60 years and above. Data were gathered from home-based interviews and from the measurements of blood pressure and other anthropometric variables. Multiple linear regression was used to examine the relationships between health-related quality of life, on each scale of the SF-36 questionnaire, and obesity (waist circumference > 102 cm in men and >88cm in women), hypertension (blood pressure ≥ 140/90 mmHg), and known diabetes, after adjusting for sociodemographic and lifestyle factors. Results Patients with obesity, hypertension, and diabetes, or a combination of these factors were, in general, associated with a worse health-related quality of life, on both the physical and the mental scales, than those without these factors, though statistical significance (P<0.05) was only attained for some relationships. Obesity in women (−2.9 to −6.7 points, according to the scale) and diabetes in men (−6.1 to −16.4 points, according to the scale) were the factors most closely and significantly associated with diminished health-related quality of life. Women who had all three factors showed the maximum decline in health-related quality of life (−10.2 to −17.7 points, according to the scale). Conclusions Obesity in old women and diabetes in old men are the most decisive factors adversely affecting the health-related quality of life. The association with worse health-related quality of life is especially marked (greater than additive) in women with all three factors, thereby rendering them a group that calls for special study and attention.

Achievement of Cardiometabolic Goals in Aware Hypertensive Patients in Spain: A Nationwide Population-Based Study

Despite the importance of achieving cardiometabolic goals beyond blood pressure, in the health of hypertensives, no comprehensive assessment of these characteristics has been performed in whole countries. We studied in 2008–2010 a total of 11 957 individuals representative of the Spanish population aged ≥18 years. Information on cardiometabolic characteristics was collected at the participants’ homes, through structured questionnaires, physical examination, and fasting blood samples. A total of 3983 individuals (33.3%) had hypertension (≥140/90 mm Hg or current antihypertensive drug treatment), 59.4% were aware of their condition, 78.8% treated among those aware, and 48.5% controlled among those aware and treated (22.7% of all hypertensives). Of the aware hypertensives, 13.8% had a body mass index <25 kg/m2, 38.6% consumed <2.4 g/d of sodium, 19.3% were diabetic with 61% attaining goal hemoglobin A1c <6.5%, whereas 42.3% had hypercholesterolemia, with 38.1% reaching goal low-density lipoprotein <115 mg/dL. Only 30.7% of overweight patients received a prescription of specific method for weight loss, 17.4% of daily smokers were offered a smoking cessation strategy, and 15.8% of older patients were given a flu shot. Aware and unaware hypertensives showed a similar frequency of some lifestyle, such as adequate physical activity. In conclusion, in a European country with a well-developed, free-access healthcare system, achievement of many cardiometabolic goals among hypertensives is poor. Moreover, a serious deficiency in hypertension awareness and in the effectiveness of some lifestyle interventions among aware hypertensives is present. Greater effort is needed in the management of coexisting risk factors and on lifestyle medical advice to improve the cardiometabolic health of hypertensives

Usual sleep duration and cognitive function in older adults in Spain

The few studies that have examined the association between usual sleep duration and cognitive function have shown conflicting results. This cross‐sectional study examined the association between sleep duration and cognitive function among 3212 people, representative of the non‐institutionalized population aged 60 years and over in Spain. Sleep duration was self‐reported, and cognitive function was measured with the Mini‐Examen Cognoscitivo (MEC), a version of the Mini‐Mental State Examination that has been validated in Spain. Linear regression, with adjustment for the main confounders, was used to obtain mean differences in the MEC between the categories of sleep duration (≤5, 6, 7, 8, 9, 10, ≥11 h day−1). The MEC score decreased progressively (became worse) across sleep categories from 7 to ≥11 h (P for linear trend <0.001). People who slept for ≥11 h had a significantly lower MEC score than those who slept for 7 h (mean difference −1.48; 95% confidence interval −2.12 to −0.85). This difference in the MEC was similar to that observed for a 10‐year increase in age. The results did not vary significantly by sex (P for interaction >0.05). No association was observed between short sleep duration (<7 h) and cognitive function. We conclude that long sleep duration is associated with poorer cognitive function in older adults from the general population.

Achievement of Cardiometabolic Goals in Aware Hypertensive Patients in SpainNovelty and Significance: A Nationwide Population-Based Study

Despite the importance of achieving cardiometabolic goals beyond blood pressure, in the health of hypertensives, no comprehensive assessment of these characteristics has been performed in whole countries. We studied in 2008–2010 a total of 11 957 individuals representative of the Spanish population aged ≥18 years. Information on cardiometabolic characteristics was collected at the participants’ homes, through structured questionnaires, physical examination, and fasting blood samples. A total of 3983 individuals (33.3%) had hypertension (≥140/90 mm Hg or current antihypertensive drug treatment), 59.4% were aware of their condition, 78.8% treated among those aware, and 48.5% controlled among those aware and treated (22.7% of all hypertensives). Of the aware hypertensives, 13.8% had a body mass index <25 kg/m2, 38.6% consumed <2.4 g/d of sodium, 19.3% were diabetic with 61% attaining goal hemoglobin A1c <6.5%, whereas 42.3% had hypercholesterolemia, with 38.1% reaching goal low-density lipoprotein <115 mg/dL. Only 30.7% of overweight patients received a prescription of specific method for weight loss, 17.4% of daily smokers were offered a smoking cessation strategy, and 15.8% of older patients were given a flu shot. Aware and unaware hypertensives showed a similar frequency of some lifestyle, such as adequate physical activity. In conclusion, in a European country with a well-developed, free-access healthcare system, achievement of many cardiometabolic goals among hypertensives is poor. Moreover, a serious deficiency in hypertension awareness and in the effectiveness of some lifestyle interventions among aware hypertensives is present. Greater effort is needed in the management of coexisting risk factors and on lifestyle medical advice to improve the cardiometabolic health of hypertensives