Adequacy of the treatment of hypertensive patients with metabolic syndrome

[Resumen] Fundamento y objetivo. El objetivo de este estudio ha sido conocer el tratamiento de los pacientes hipertensos con síndrome metabólico (SM) asistidos en atención primaria y el grado de control de la presión arterial y de los valores de colesterol unido a lipoproteínas de baja densidad (cLDL), y comparar los datos con los de la población hipertensa sin SM. Pacientes y método. Se analizó al subgrupo de pacientes con SM de los incluidos en el etudio PRESCOT (estudio transversal de personas con hipertensión mayores 18 años asistidos en atención primaria). La población PRESCOT fue de 12.954 pacientes (el 49,9% mujeres), con una edad media (desviación estándar [DE]) de 62,1 (10,7) años. Para el diagnóstico de SM se utilizaron los criterios del National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III). Resultados. Cumplían criterios de SM un total de 6.736 (52%) pacientes del estudio PRESCOT, cuya edad media (DE) era de 62,3 (10,5) años; el 43,9% eran varones. El 98,2% de los pacientes con SM tomaba algún fármaco y el 80,5%, al menos 2 fármacos. A pesar de que los hipertensos con SM tomaban más antihipertensivos que aquellos sin SM (un 45,3 frente al 36,6% tomaban más de un fármaco; p < 0,001) y usaban en mayor medida hipolipemiantes (el 43 frente al 39,1%; p < 0,001), el control de la presión arterial (según las guías europeas) y de cLDL (según ATP-III) fue peor en los pacientes con SM (el 17,2 frente al 33,6% y el 17,2 frente al 35,7%, respectivamente; p < 0,0001). Sólo el 4,7% de los pacientes con SM tenía bien controlados ambos factores –presión arterial y cLDL–, frente al 13,5% del grupo sin SM (p < 0,0001). Conclusiones. La presencia de SM en la población hipertensa de atención primaria en España es muy frecuente. A pesar de que a los pacientes hipertensos con SM se les prescriben más fármacos antihipertensivos y más hipolipemiantes, el control de la presión arterial y del cLDL es peor que en los pacientes sin SM.[Abstract] Background and objective. The aim of this study was to know the treatment of hypertensive patients with metabolic syndrome (MetS) attended in primary care setting, as well as the blood pressure and LDL-cholesterol (LDL-c) rates, and to compare these data with those of the hypertensive population without MetS. Patients and method. We analyzed the subset of patients with MetS from those included in the PRESCOT study (a cross-sectional study of hypertensive subjects >18 years attended in primary care). The PRESCOT population was composed by 12,954 patients (49.9% females; 62.1±10.7 years). MetS was diagnosed according to NCEP-ATP-III criteria. Results. 6,736 (52%) patients fulfilled diagnosis criteria of MetS (mean age 62.3±10.5 years; 43.9% males). Almost all MetS patients (98.2%) were on any medication, and 80.5% were at least on two drugs. Despite hypertensive MetS patients were treated with more antihypertensive medications (45.3% vs 36.6% were on two or more drugs, p < 0.001) and used more lipid-lowering agents (43% vs 39.1%, p < 0.001) than patients without MetS, the blood pressure control (according to European guidelines) and LDL-c control (according to NCEP-ATP III) rates were lower in patients with MetS (17.2% vs 33.6% and 17.2% vs 35.7%, p < 0.0001). Only 4.7% of patients with MetS were adequately controlled for both factors, LDL-c and blood pressure, vs 13.5% of patients without MetS, (p < 0.0001). Conclusions. The presence of MetS in the hypertensive population attended in Spanish primary care settings is very common. Even though in hypertensives with MetS more drugs are prescribed, blood pressure and LDL-c control rates are worse in this population than in patients without MetS

Blood pressure and lipid control and coronary risk in the hypertensive population attended in Primary Care setting in Spain. The PRESCOT study

[Resumen] Objetivo y métodos. El objetivo de este trabajo, de diseño transversal y multicéntrico, fue conocer el perfil de riesgo coronario de los pacientes hipertensos que acuden a la consulta de Atención Primaria, y evaluar si el control de presión arterial y de colesterol LDL podía variar según el grupo de riesgo coronario ATP-III. Se consideró buen control de presión arterial cifras menores a 140/90 mmHg (< 130/80 mmHg en diabéticos) y de colesterol LDL los establecidos para ATP-III para cada grupo de riesgo. Resultados. Se incluyeron 12.954 pacientes (49,9% mujeres, 62,1 ± 10,7 años). El 12,6% pertenecía al grupo de bajo riesgo, el 45% al de riesgo medio y el 42,4% al de riesgo alto. El grado de control fue diferente según el grupo de riesgo (p < 0,0001). Así, para la presión arterial se alcanzó en un 37,5% de los sujetos de riesgo bajo, en un 30,2% de los del grupo de riesgo medio y en un 15,4% de los de riesgo alto, y para el colesterol LDL se consiguió en el 65,6% del grupo de riesgo bajo, el 28% del de riesgo medio y el 12,3% del de riesgo alto. Globalmente, si consideramos el control adecuado de presión arterial y de colesterol LDL, sólo el 25,8% de los de bajo riesgo estaba controlado, el 9,6% de los de riesgo medio y el 2,7% de los de riesgo alto. Conclusiones. La mayoría de los hipertensos asistidos diariamente en Atención Primaria en España son de riesgo medio o alto. Las cifras de control de presión arterial y colesterol LDL en los hipertensos en general son bajas y son muy pocos los pacientes que tienen cifras adecuadas de ambos factores de riesgo. Pero las tasas de control son aún peores según aumenta el riesgo coronario; de hecho, menos del 3% de los pacientes de alto riesgo tienen bien controlados ambos parámetros, con las implicaciones clínicas que ello conlleva.[Abstract] Objectives and methods. The aim of this cross-sectional and multicenter study was to determine the coronary risk of hypertensive patients attended in Spanish Primary Care and to evaluate whether blood pressure and LDL-cholesterol (LDL-c) control rates could change according to the ATP-III risk groups. Good blood pressure control was considered <140/90 mmHg (<130/80 mmHg for diabetics) and LDL-c according to the established by ATP-III for every risk group. Results. A total of 12,954 patients were included in the study (49.9 % women, mean age 62.1±10.7 years). Of these, 12.6% belonged to the group of low risk, 45% to the medium risk group and 42.4% to the high risk group. The control rates were different according to the risk group (p <0.0001). Blood pressure control: 37.5 % in low risk, 30.2 % in medium and 15.4 % in high risk group. LDL-c control: 65.6 % in low risk group, 28 % in medium risk group and 12.3 % in high risk group. Only 25.8 % of the patients of low risk were controlled for both blood pressure and LDL-c, 9.6 % of medium risk group and 2.7 % of high risk group. Conclusions. The majority of hypertensive patients daily attended in Primary Care setting in Spain belongs to the medium or high coronary risk groups. Blood pressure and LDL-c controls rates in hypertensive population are low, and very few patients have both risk factors controlled. The control rates decline when the risk increases. In fact, less than 3% of high-risk patients have both parameters well controlled, what may result in significant clinical implications

Prevalence of the metabolic syndrome in patients with hypertension treated in general practice in Spain: an assessment of blood pressure and low-density lipoprotein cholesterol control and accuracy of diagnosis

[Abstract] This study was designed to evaluate whether primary care physicians in Spain accurately diagnose the metabolic syndrome in hypertensive patients, to define the profile and management of these patients in clinical practice, and to ascertain the level of blood pressure and low-density lipoprotein cholesterol control. Data were analyzed from a cross-sectional survey involving 12,954 patients with hypertension (Prevención Cardiovascular en España en Atención Primaria: Intervención Sobre el Colesterol en Hipertensión [PRESCOT] study), wherein 52% of the cohort fulfilled the National Cholesterol Education Program-Adult Treatment Panel criteria for the metabolic syndrome. The majority of patients (54.6%) had 3 risk factors, 32.4% had 4, and 13% had 5 risk factors. Physician diagnosis of the metabolic syndrome was poor, with 43.7% of physicians missing the diagnosis and 12.9% wrongly diagnosing the metabolic syndrome. Blood pressure and low-density lipoprotein cholesterol control rates were very low, with only 4.7% of metabolic syndrome patients achieving control for both blood pressure and low-density lipoprotein cholesterol vs 13.5% for non-metabolic syndrome patients (P<.0001). These findings demonstrate that the metabolic syndrome is common in patients with hypertension and that it is generally poorly diagnosed and treated by primary care physicians

Consensus document for the detection and management of chronic kidney disease.

Chronic kidney disease (CKD) is a major public health problem that, in its different stages, may affect up to 10% of the Spanish population and results in high morbidity and mortality, as well as high consumption of National Health System resources. Ten scientific societies involved in the management of kidney patients agreed to update the 2007 CKD consensus document. The current version is an abridged edition of the detailed general document, which can be consulted on the webpages of each signatory society. It includes the following aspects: CKD definition, epidemiology and risk factors and criteria on diagnosis, assessment and staging of CKD, albuminuria and glomerular filtration estimation. Progression factors and concept. Criteria for referral to Nephrology. Patient follow-up, attitudes and objectives by specialty. Prevention of nephrotoxicity. Detection of cardiovascular damage. Attitudes, lifestyle and treatment: management of high blood pressure, dyslipidaemia, hyperglycaemia, smoking, obesity, hyperuricaemia, anaemia and mineral and bone metabolism disorders. Coordinated follow-up by Primary Care - other specialties - Nephrology. Management of renal replacement therapy, haemodialysis, peritoneal dialysis and renal transplantation patients. Palliative treatment of terminal uraemia. We hope that this document will be very useful in the multidisciplinary management of CKD patients, in view of the updated recommendations

Prevalence and factors associated with circadian blood pressure patterns in hypertensive patients.

Comment in Timing of antihypertensive therapy and circadian blood pressure pattern. [Hypertension. 2009] Timing of antihypertensive therapy and circadian blood pressure pattern. Almirall J, Martínez-Ocaña JC, Comas L. Hypertension. 2009 Jun; 53(6):e41; author reply e42. Epub 2009 May 4. Dipping comes of age: the importance of nocturnal blood pressure. [Hypertension. 2009]. Dipping comes of age: the importance of nocturnal blood pressure. O'Brien E. Hypertension. 2009 Mar; 53(3):446-7. Epub 2009 Jan 26.Nondipping in patients with hypertension. [Hypertension. 2009]Ambulatory blood pressure (BP) monitoring has become useful in the diagnosis and management of hypertensive individuals. In addition to 24-hour values, the circadian variation of BP adds prognostic significance in predicting cardiovascular outcome. However, the magnitude of circadian BP patterns in large studies has hardly been noticed. Our aims were to determine the prevalence of circadian BP patterns and to assess clinical conditions associated with the nondipping status in groups of both treated and untreated hypertensive subjects, studied separately. Clinical data and 24-hour ambulatory BP monitoring were obtained from 42,947 hypertensive patients included in the Spanish Society of Hypertension Ambulatory Blood Pressure Monitoring Registry. They were 8384 previously untreated and 34,563 treated hypertensives. Twenty-four-hour ambulatory BP monitoring was performed with an oscillometric device (SpaceLabs 90207). A nondipping pattern was defined when nocturnal systolic BP dip was <10% of daytime systolic BP. The prevalence of nondipping was 41% in the untreated group and 53% in treated patients. In both groups, advanced age, obesity, diabetes mellitus, and overt cardiovascular or renal disease were associated with a blunted nocturnal BP decline (P<0.001). In treated patients, nondipping was associated with the use of a higher number of antihypertensive drugs but not with the time of the day at which antihypertensive drugs were administered. In conclusion, a blunted nocturnal BP dip (the nondipping pattern) is common in hypertensive patients. A clinical pattern of high cardiovascular risk is associated with nondipping, suggesting that the blunted nocturnal BP dip may be merely a marker of high cardiovascular risk.The main funding for the study was obtained from Lacer Spain, SA, through an unrestricted educational grant.Ye