Luis Cea-Calvo

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.

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.

Clinical inertia in diagnosis and treatment of hypertension in primary care: Quantification and associated factors

Abstract Objectives. The objective of the present study was to quantify both diagnostic and therapeutic inertia in hypertension and to identify patient-associated variables. Patients and methods. Cross-sectional, multicenter study of 35 424 subjects carried out in 428 health centers and/or primary care clinics in the Valencian Community, Spain, in a preventive activity conducted during 2003 and 2004. Diagnostic inertia was identified when a patient without known hypertension had high blood pressure (BP) but was labeled “normal” by the medical staff, and therapeutic inertia when treatment was not modified for a hypertensive patient on the presence of high BP values. Bivariate and multivariate statistical analyses were performed to identify patients characteristics associated with inertia. Results. Diagnostic inertia was present in 32.5% (95% CI 31.4–33.6) and therapeutic inertia in 37.0% (95% CI 35.6–38.5) of the cases. Both were more frequent in cases of isolated systolic or diastolic high BP. In the multivariate models, the factors associated with diagnostic inertia were type-2 diabetes (p=0.041), non-smoking (p=0.004), previous coronary heart disease (p=0.001), BP values (p<0.001) and body mass index (p=0.031), whereas for therapeutic inertia they were type-2 diabetes (p=0.003), previous coronary heart disease (p=0.016) or stroke (p<0.001) and BP values (p<0.001). Conclusions.Clinical inertia, either diagnostic or therapeutic, was present in one of every three cases of high BP. The most frequent factors associated with clinical inertia were the presence of associated conditions, which requires lower BP goals and the BP values.

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.

Target organ damage and cardiovascular complications in patients with hypertension and type 2 diabetes in Spain: a cross-sectional study

BackgroundTarget organ damage (mainly cardiac and renal damage) is easy to evaluate in outpatient clinics and offers valuable information about patients cardiovascular risk. The purpose of this study was to evaluate, using simple methods, the prevalence of cardiac and renal damage and its relationship to the presence of established cardiovascular disease (CVD), in patients with hypertension (HT) and type 2 diabetes mellitus (DM).MethodsThe RICARHD study is a multicentre, cross-sectional study made by 293 investigators in Nephrology and Internal Medicine Spanish outpatient clinics, and included patients aged 55 years or more with HT and type 2 DM with more than six months of diagnosis. Demographic, clinical and biochemical data, and CVD were collected from the clinical records. Cardiac damage was defined by the presence of electrocardiographic left ventricular hypertrophy (ECG-LVH), and renal damage by a calculated glomerular filtration rate (GFR) of <60 ml/min/1.73 m2, and/or the presence of an albumin/creatinine ratio ≥ 30 mg/g; or an urinary albumin excretion (UAE) ≥ 30 mg/24 hours.Results2339 patients (mean age 68.9 years, 48.2% females, 51.3% with established CVD) were included. ECG-LVH was present in 22.9% of the sample, GFR <60 ml/min/1.73 m2 in 45.1%, and abnormal UAE in 58.7%. Compared with the reference patients (those without neither cardiac nor renal damage), patients with ECG-LVH alone (OR 2.20, [95%CI 1.43–3.38]), or kidney damage alone (OR 1.41, [1.13–1.75]) showed an increased prevalence of CVD. The presence of both ECG-LVH and renal damage was associated with the higher prevalence (OR 3.12, [2.33–4.19]). After stratifying by gender, this relationship was present for both, men and women.ConclusionIn patients with HT and type 2 DM, ECG-LVH or renal damage, evaluated using simple methods, are associated with an increased prevalence of established CVD. The simultaneous presence of both cardiac and renal damage was associated to the higher prevalence of CVD, affording complementary information. A systematic assessment of cardiac and renal damage complements the risk assessment of these patients with HT and type 2 DM.

Concordancia de las escalas REGICOR y SCORE para la identificación del riesgo cardiovascular alto en la población española

Introduction. The aims of this study were to evaluate the consistency between the SCORE (Systematic Coronary Risk Evaluation) and REGICOR (Registre Gironi del Cor) scales in identifying high cardiovascular risk and to describe the characteristics of those individuals for whom scale results were discrepant. Methods. This cross-sectional study involved 8942 subjects aged 40-65 years who had an indication for a complete lipid profile. The agreement between SCORE (for low-risk countries) and Framingham-REGICOR (with a high risk threshold of 10%) scales in classifying patients as high risk was evaluated using the kappa statistic. Subjects for whom there was a discrepancy between classifications were identified and variables associated with this discrepancy were determined by multivariate analysis involving binary logistic regression. Results. The REGICOR scale classified 6.7% of subjects (95% confidence interval [CI], 6.2-7.3) as highrisk, while SCORE classified 12.5% (95% CI 11.8-13.2) as high-risk. Discrepant findings were observed in 10.2% of the total population (8% had a high risk on SCORE but not REGICOR, and 2.2% had a high risk on REGICOR but not SCORE; κ=0.420; P<.001). The best agreement was observed between SCORE and REGICOR with a high-risk threshold of 8% (κ=0.463). Multivariate analysis showed that a high risk on SCORE but not REGICOR was associated with lower age, female sex, a high fasting glucose level, and raised diastolic blood pressure, and a high risk on REGICOR but not SCORE, with male sex,

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.

Criterios electrocardiográficos de hipertrofia ventricular izquierda y perfil de riesgo cardiovascular en hipertensos. Estudio VIIDA

Introduccion y objetivos Evaluar si los criterios de Cornell y Sokolow-Lyon permiten identificar a los pacientes con hipertrofia ventricular izquierda (HVI) de distinto perfil y si hay asociacion entre la severidad de la hipertrofia y la prevalencia de enfermedad cardiovascular. Metodos Estudio transversal y multicentrico, en consultas de cardiologia, en pacientes hipertensos con HVI por Cornell o Sokolow-Lyon. Se recogieron los valores de la presion arterial (PA), asi como los datos clinicos y analiticos. Se dividio a la poblacion en cuartiles segun los complejos electrocardiograficos para valorar la asociacion con la enfermedad cardiovascular. Resultados En total fueron analizables 3.074 pacientes con HVI; 978 pacientes (31,8%) cumplieron ambos criterios, 1.244 (40,5%) cumplieron solo los criterios de Cornell y 852 (27,7%), solo los de Sokolow-Lyon. La positividad por Sokolow-Lyon se asocio con el sexo masculine y un menor indice de masa corporal (IMC), asi como con una menor prevalencia de diabetes y mayor de infarto de miocardio. La positividad por Cornell se asocio con el sexo femenino, un mayor IMC y una mayor prevalencia de diabetes. La positividad por ambos se asocio con un peor control de la PA y una mayor prevalencia de insuficiencia cardiaca. Se observo asociacion entre la mayor severidad de la HVI y la prevalencia de enfermedad cardiovascular (odds ratio ajustada [ORa] para el cuartil superior respecto al inferior = 1,65; p = 0,011, para Sokolow-Lyon; ORa = 1,59; p = 0,014, para Cornell, y ORa =2,03; p = 0,001, para la suma). Conclusiones Los criterios de HVI de Sokolow-Lyon y Cornell identifican a pacientes de distinto perfil y elevado riesgo cardiovascular, por lo que es recomendable utilizar ambos para aumentar la deteccion de la HVI electrocardiografica. Ademas, hay relacion entre severidad de la HVI electrocardiografica y la prevalencia de enfermedad cardiovascular establecida.