Jose V. Lozano

Ambulatory blood pressure and microalbuminuria in essential hypertension : role of circadian variability

Objective To assess the relationship of subclinical urinary albumin excretion with ambulatory and circadian variability of blood pressure. Design and methods Patients with essential hypertension (82 males and 59 females, mean + SD age 38.9 ±7.3 years) who had never been previously treated for hypertension were included in the study. Patients with nephropathy or diabetes mellitus, hyperglycemia >120mg/dl, glomerular filtration rate <80ml/min per 1.73 m2, urinary tract infection and positive dipstick for albumin or glucose were excluded. Twenty-four-hour ambulatory blood pressure monitoring on a regular working day using an oscillometric device was performed. Twenty-four-hour urinary albumin excretion was measured on two separate days using an immunonephelometric assay. Results Microalbuminuric patients (urinary albumin excretion 30–300 mg/24 h, n = 31) had significantly higher mean ambulatory systolic blood pressure (SBP) and diastolic blood pressure (DBP) than those with normoalbuminuria (urinary albumin excretion <30 mg/24 h, n = 96) during the 24-h, daytime (0800–2200 h) and night (2400–0600 h) periods, whereas for office blood pressure only DBP was significantly higher. Urinary albumin excretion was positively correlated with the means of SBP and DBP. Multiple regression analysis similarly confirmed that DBP during daytime was positively and day: night ratio of DBP inversely associated with urinary albumin excretion independent of age, sex and other parameters of ambulatory blood pressure. Conclusions In conclusion, the present study indicates that, in middle-aged essential hypertensive patients, the presence of microalbuminuria is a marker for the presence of higher values of blood pressure throughout a 24-h period.

Prevalencia de fibrilación auricular en la población española de 60 o más años de edad. Estudio PREV-ICTUS

Introduction and objectives. The aims of this study were to determine the prevalence of atrial fibrillation in individuals aged 60 years or more in Spain using a random sample of the population and to identify associated factors. Methods. An analysis of the PREV-ICTUS study, a randomized cross-sectional population-based study of individuals aged 60 years or more, was carried out. Data on demographic variables, cardiovascular risk factors, and cardiovascular disease were obtained from medical records. The diagnosis of atrial fibrillation was based on the patient’s medical history and an electrocardiogram performed during the study. Results. In the 7108 individuals studied (mean age, 71.9 [7.1] years, 53.6% female), the prevalence of atrial fibrillation was 8.5% (95% confidence interval [CI], 7.99.2%). It was higher in males (9.3% vs 7.9% in females; P=.036) and increased from 4.2% in individuals aged 6064 years to 16.5% in those aged 85 years or more (χ 2 test for linear trend, P<.001). Multivariate analysis showed that existing cardiovascular disease, hypertension, age, and left ventricular hypertrophy had the strongest associations with atrial fibrillation. Although there was a strong relationship between hypertension and atrial fibrillation (odds ratio, 2.53; 95% CI, 1.60-4.01), no association was found between poor blood pressure control and atrial fibrillation. A weak association with diabetes mellitus was found only when arterial pressure was included in the model, but not when a diagnosis of hypertension was included.

Differences in Blood Pressure Control and Stroke Mortality Across Spain The Prevención de Riesgo de Ictus (PREV-ICTUS) Study

The objective was to assess the stroke risk and prevalence of the cardiovascular risk factors and to analyze their relationship with the specific stroke rates of mortality in each of the autonomic communities of Spain. We conducted a multicenter, cross-sectional study of population >60 years old in Spanish primary care centers. In all of the subjects, clinical, biochemical, and electrocardiographic data were obtained, and the 10-year stroke risk was calculated using the Framingham score. Mortality rates of stroke, age and sex adjusted, were obtained for each of the autonomic communities from the Ministry of Health. A total of 7343 subjects (mean age: 71.6 years, 53.4% women, 34.4% obese, and 27.1% diabetic subjects) were analyzed. A total of 73% were already diagnosed with hypertension. Among hypertensive subjects, 29.1% had blood pressure on therapeutic objective, and, of the total population, 35.7% had blood pressure under control. ECG–left ventricular hypertrophy was present in 12.9% of the subjects. The estimated stroke risk was 19.6%. Stroke mortality rates were significantly related to the estimated 10-year stroke risk (r=0.41; P<0.05) in each autonomic community. Poor hypertension control (P=−0.42; P<0.05) and prevalence of ECG–left ventricular hypertrophy (P=0.52; P<0.05) were the main factors related to the stroke mortality rates after controlling by age, sex, obesity, diabetes, and urban setting. Differences in stroke mortality throughout the autonomic communities of Spain were associated with indexes of worse blood pressure handling, low control rates, and high left-ventricular hypertrophy.

Prevalencia y caracteristicas de la dislipemia en pacientes en prevencion primaria y secundaria tratados con estatinas en Espana. Estudio DYSIS-Espana

INTRODUCTION AND OBJECTIVES Patients at high risk of suffering cardiovascular events require medical treatment to optimize their lipid profile. The present analysis evaluates the lipid profiles among Spanish patients receiving statin therapy in the international DYSIS study. METHODS DYSIS is a multinational cross-sectional study carried out in Canada and Europe (n=22,063). In Spain, 3710 patients treated with statin therapy for at least 3 months were included. We compared data relating to demographic parameters and cardiovascular risk profile. RESULTS Complete lipid profiles of 3617 patients were recorded. Regarding the high cardiovascular risk patients with complete lipid profiles (n=2273), 78.9% had a disorder in at least one of the three main lipid parameters: low-density lipoprotein cholesterol (LDLc), high-density lipoprotein cholesterol (HDLc) and/or triglycerides. LDLc was not within target levels in 61.4% of these high risk patients; HDLc was abnormal in 25.3%, and triglycerides were elevated in 37.8%. Overall, LDLc was outside the target range in 63.1%, and 20.7% (n = 668) of those treated with statins were normal for all parameters. CONCLUSIONS Most patients in this study who received statin therapy, particularly those at high cardiovascular risk, were not at the normal lipid parameter levels according to cardiovascular guidelines. Although it is necessary to wait for the final results of current studies on the use of combined lipid-modifying treatments, the management of lipid levels in Spain still has potential for improvement.

Kidney function and cardiovascular disease in the hypertensive population: the ERIC-HTA study.

Background and objectives Epidemiological data on the incidence and prevalence of cardiovascular disease in chronic renal failure are scant The objective of the present study is to assess the relationship between renal function, measured by the estimated glomerular filtration rate, and the presence of early or established cardiovascular disease, in a population of hypertensives from primary care. Patients and methods Cross-sectional, multicentre study carried out in primary care centres all over Spain. Hypertensive subjects, older than 55 years, were included. In all of them a structured interview including cardiovascular risk factors or disease was performed. Blood pressure was measured following a standard procedure, and serum biochemistry and an electrocardiogram were obtained. Renal function was estimated using the abbreviated MDRD (Modification of Diet in Renal Disease Study Group) equation. For each glomerular filtration rate stratum the odds ratio and 95% confidence interval (CI) of left ventricular hypertrophy or cardiovascular disease were calculated, adjusted by confounding variables. Results A total of 13 687 patients (mean age 68.1 years, women 55.4%, diabetics 30.6%, body mass index 28.6 kg/m2) were included. Of these, 26.4% had established cardiovascular diseases and 20.3% electrocardiographic left ventricular hypertrophy. The average serum creatinine was 1.01 mg/dl, creatinine clearance 70.0 ml/min, and glomerular filtration rate 74.0 ml/min per 1.73 m2. Thirty-three patients (0.24%) had glomerular filtration rate < 5 ml/min per 1.73 m2; 89 (0.65%) from 15 to 29; 3745 (27.36%) from 30 to 59; 7798 (56.97%) from 60 to 89; and 2019 (14.75%) higher than 89 ml/min per 1.73 m2. In a multiple regression analysis, after adjusting by age, sex, body mass index, diabetes, systolic and diastolic blood pressure, and smoking, a lower glomerular filtration rate was associated with a higher prevalence of left ventricular hypertrophy. Likewise, a reduction in the glomerular filtration rate was also associated with a higher prevalence of cardiovascular disease. Conclusions In hypertensive patients from primary care, the prevalence of cardiovascular disease is inversely proportional to the level of renal function. Estimated glomerular filtration is easy to determine and complements evaluation of the hypertensive patient.

Independent impact of obesity and fat distribution in hypertension prevalence and control in the elderly

Background Studies on the impact of weight excess and fat distribution on blood pressure are usually limited to young and middle-aged population, and data on the elderly are scarce. Methods and results We performed an analysis of the Prevencion de Riesgo de Ictus, a population-based study on individuals aged 60 years or more in Spain, to assess the impact of weight excess, stratified by body mass index (normal <25; overweight 25–29.9; obesity ≥30 kg/m2), and waist circumference [increased if ≥88 cm (women) or ≥102 (men)] on the prevalence on hypertension and lack of blood pressure control. In 6263 individuals (mean age 71.9 years old, 53.3% women; 73.0% with diagnosed hypertension), prevalence of obesity was 35.0%, and 65.6% showed an increased waist circumference. Body mass index and waist circumference showed an independent impact on the prevalence and absence of hypertension control. In a multivariate model including age, sex, body mass index, and waist circumference, prevalence of hypertension was higher in the overweight and obesity groups (odds ratio 1.41 and 1.96, respectively, compared to normal weight), and in those with increased waist circumference (odds ratio 1.25) compared with normal waist circumference. After further adjustment for antihypertensive therapy, overweight, and obesity (odds ratio 1.40 and 1.59, respectively) as well as increased waist circumference (odds ratio 1.39) were independently related to absence of blood pressure control. The impact of waist circumference on hypertension and blood pressure control was shown in each category of body mass index. Conclusion In this cross-sectional study in an elderly population, body mass index and waist circumference showed an independent and direct impact on the prevalence of hypertension and on the absence of blood pressure control.

Hipertrofia ventricular izquierda en la población hipertensa española. Estudio ERIC-HTA☆

Introduccion y objetivos El objetivo del presente estudio es evaluar la prevalencia de hipertrofia del ventriculo izquierdo (HVI) en el electrocardiograma y el perfil epidemiologico en pacientes hipertensos atendidos en atencion primaria. Pacientes y metodo Estudio transversal, multicentrico, realizado en 15.798 pacientes hipertensos ≥ 55 anos de centros de atencion primaria. Se midio la presion arterial y se recogieron los antecedentes cardiovasculares de la historia clinica de los pacientes. La HVI se evaluo segun los criterios de Cornell. Resultados Se evaluo a 15.798 pacientes (edad media, 68,0 anos; 55,3% mujeres; 30,4% diabeticos). El 20,3% presento HVI en el electrocardiograma. La prevalencia fue mayor en varones, diabeticos, fumadores, pacientes con presion arterial no controlada y pacientes con enfermedad renal o con cualquier antecedente de enfermedad cardiovascular. Respecto a los pacientes sin HVI, los pacientes con HVI eran de edad mas avanzada, habia un mayor porcentaje de varones, y mas prevalencia de diabetes mellitus (el 40,5 frente al 27,8%), enfermedad renal (el 34,2 frente al 26,9%) y enfermedad cardiovascular (el 52,1 frente al 20,2%). En el analisis multivariante, la HVI se asocio, de forma independiente, con una edad mas avanzada, el sexo masculino, la diabetes, el tabaquismo, la ausencia de control de la presion arterial, y la presencia de enfermedad cardiovascular y renal. El porcentaje de pacientes que cumplian objetivos de control de presion arterial fue menor entre los pacientes con HVI respecto a aquellos sin HVI. Conclusiones La prevalencia de HVI en el electrocardiograma es elevada y se asocia con una mayor prevalencia de diabetes, y enfermedad renal y cardiovascular, ademas de un control de la presion arterial deficiente.

Blood Pressure and Estimated Risk of Stroke in the Elderly Population of Spain The PREV-ICTUS Study

Background and Purpose— The objective of this study was to estimate the high blood pressure values and the 10-year risk of stroke in the Spanish general population aged 60 years or older using the Framingham scale. Methods— This was a multicenter, population-based, cross-sectional study performed in Spanish primary care centers. A randomized selection of centers and recruitment population was used. We collected clinical, biochemical, and electrocardiographic data. Results— We analyzed 7343 subjects (mean age, 71.6 years; standard deviation, 7.0; 53.4% females, 34.4% obese subjects, and 27.1% diabetic subjects). Electrocardiographic–left ventricle hypertrophy was present in 12.9% of the subjects, atrial fibrillation in 8.4%, and established cardiovascular disease in 28.9%; 73.0% already had hypertension diagnosed, and 12.8% showed high blood pressure without a prior diagnosis of hypertension. Among hypertensive subjects, 29.1% had high blood pressure on therapeutic objective, and of the total population 35.7% had high blood pressure under control. Those with hypertension already diagnosed showed a higher prevalence of other stroke risk factors (left ventricle hypertrophy, atrial fibrillation, diabetes, or established cardiovascular disease). The estimated 10-year stroke risk was 19.6% (standard deviation, 17.3%), and was greater in hypertensive patients (23.7%; standard deviation, 18.5) than in patients with high blood pressure without known hypertension (12.4%; standard deviation, 9.2), or in normotensive subjects (5.3%; standard deviation, 0.2; P<0.001). Conclusion— The 10-year estimated stroke risk was 19.6%, and it was greater in hypertensive patients as compared with the remainder people at any blood pressure range. The concomitant stroke risk factors are more prevalent in patients with hypertension already diagnosed, which implies an important additional estimated risk of stroke.

Impacto de la diabetes en las enfermedades cardíacas en España. Estudio CARDIOTENS 1999

Fundamento Estudio transversal de ambito estatal que pretende conocer el impacto de los diferentes factores de riesgo en las cardiopatias, llevado a cabo sobre 32.051 pacientes atendidos en consultas de cardiologia y de atencion primaria. Pacientes y metodo Se registraron, de forma prospectiva, en un cuestionario uniformizado, las principales caracteristicas demograficas, clinicas y terapeuticas de todos los pacientes atendidos en un mismo dia por 1.159 medicos (un 21% cardiologos y un 79% de atencion primaria). Resultados El 19% de la muestra (6.194 pacientes) de 32.051 pacientes tenia antecedentes de cardiopatia, de los cuales 1.275 (el 20,6% del total de pacientes con cardiopatias) eran diabeticos, el 74% de ellos eran hipertensos. El 45% de los diabeticos con insuficiencia cardiaca presentaba tambien cardiopatia isquemica (angina o infarto previo). Menos del 30% de los diabeticos con cardiopatia tenia un adecuado control tensional (presion arterial menor de 130/85 mmHg), sin diferencias entre el porcentaje de controlados entre los atendidos por cardiologos o medicos de atencion primaria. Tan solo el 12% de los diabeticos con cardiopatia isquemica tenia unas cifras de colesterol unido a lipoproteinas de baja densidad menor de 100 mg/dl; la media del colesterol total y colesterol unido a lipoproteinas de baja densidad de los vistos por cardiologos eran significativamente menores (p Conclusiones La diabetes es una enfermedad asociada a mas del 20% de los pacientes con cardiopatia. Tan solo una escasa proporcion de diabeticos con cardiopatia cumple los objetivos recomendados de presion arterial y lipidos plasmaticos. El empleo de farmacos de beneficio pronostico probado en diabeticos con cardiopatia es muy limitado.

Control de la presión arterial de los pacientes diabéticos en el ámbito de atención primaria. Estudio DIAPA

Fundamento y objetivo Conocer el control de la presion arterial (PA) en pacientes con diabetesmellitus (DM) visitados en atencion primaria (AP), y determinar los factores asociados a uncontrol suboptimo de la PA. Pacientes y metodo Estudio transversal y multicentrico. Noventa investigadores incluyeron a875 pacientes con DM (57,8% mujeres), con edad media (DE) de 64 (11,8) anos. La PA semidio segun las recomendaciones del Sexto Informe del Joint National Committee (JNC-VI) yde la Organizacion Mundial de la Salud/Sociedad Internacional de Hipertension (OMS/ISH),calculandose la media aritmetica de tres tomas sucesivas. Se considero hipertensos a los pacientescon diagnostico previo establecido, y control optimo a los valores de PA inferiores a130/85 mmHg. Resultados El 66,7% (n = 583) de los pacientes con DM estaban previamente diagnosticadosde hipertension arterial (HTA); de estos, el 86,3% (intervalo de confianza [IC] del 95%, 83,0–89,1) de los pacientes con DM tipo 2 y el 87,8% (IC del 95%, 70,9–96,0) de los pacientescon DM tipo 1 no tenian un control optimo de la PA en la visita (PA mayor o igual de 130 y/o85 mmHg). El 56,8% (IC del 95%, 50,1–63,3) de los enfermos con DM tipo 2 y el 23,8% (ICdel 95%, 12,6–39,8) de los enfermos con DM tipo 1 sin HTA conocida tenian una PA igual osuperior a 130 y/o 85 mmHg en la visita. La mediana de farmacos antihipertensivos utilizadosfue de 1 (1–2). En el analisis multivariante, la edad, un mayor indice de masa corporal y los valoresde colesterol y acido urico se asociaron a un peor control de la PA (p Conclusiones En nuestro estudio, el 66,7% de los pacientes con DM atendidos en AP eran hipertensosconocidos y solo el 13,6% tenia un control optimo de la PA. Los pacientes diabeticoscon HTA estaban infratratados, con una mediana de un farmaco antihipertensivo.