Level of blood pressure control in a hypertensive population when measurements are performed outside the clinical setting

Background: To determine whether the number of optimally controlled hypertensive patients is higher using self-measurement of blood pressure at home and ambulatory monitoring, compared to using conventional blood pressure measurements at the doctor&#8217;s office. Method: An observational, cross-sectional, multicentre, descriptive study of a random sample of 237 primary health care patients, known to be hypertensive, from Badajoz (Spain). Blood pressure was measured at the doctor&#8217;s office and by self-measurement at home. Those patients showing good control by self-measurement were subjected to 24-hour ambulatory monitoring. Optimal control was understood as blood pressure < 140/90 mm Hg when measured at the doctor&#8217;s office, and < 135/85 mm Hg when self-measured at home and by daytime ambulatory monitoring. Results: Mean systolic/diastolic measurements at the doctor&#8217;s office and by self-measurement were 145.6/83.9 and 134.0/78.7 mm Hg, respectively (p < 0.000). In the population optimally controlled by self-measurement and who subsequently received ambulatory monitoring, the mean blood pressure was 121.8/73.4 and 125.6/76.2 mm Hg, respectively (p = 0.002; p < 0.000). When measured at the doctor&#8217;s office blood pressure was controlled in about 29.5% (95% CI 23.7-35.3%) of patients, in 38% when self-measured (95% CI 31.4-44.2%; p < 0.000), and in 24.5% when it was confirmed through ambulatory monitoring (95% CI 15.4-33.6%). Sensitivity and positive predictive values of the office measurements for the detection of patients who were well-controlled by self-measurement were 50% and 64.3%, respectively, and 53.4% and 73.8% as regards ambulatory monitoring. Conclusions: A higher level of control is achieved with self-measurement at home not confirmed by ambulatory monitoring. Therefore, the white coat effect does not seem to influence the percentage of well-controlled patients detected at the doctor&#8217;s office. Office blood pressure does not appear to be useful in distinguishing which individual patients are optimally controlled

Prevalencia de síndrome metabólico según las nuevas recomendaciones de la OMS: Estudio HERMEX Prevalence of metabolic syndrome estimated with the new World Health Organization recommendations: The HERMEX study

Objetivos: La unificación de criterios para el diagnóstico del síndrome metabólico, junto con la propuesta de la Organización Mundial de la Salud de eliminar de ellos a los pacientes con diabetes o con enfermedades cardiovasculares, cambiará la estimación de su prevalencia. Nuestro objetivo fue determinar la prevalencia del síndrome metabólico en un área de salud extremeña siguiendo ambas recomendaciones. Métodos: Estudio transversal, poblacional, con selección aleatoria de individuos entre 25 y 79 años de edad, en un Área de Salud de Badajoz. Se recogieron los antecedentes de factores de riesgo cardiovascular, la presión arterial y el perímetro abdominal, y una muestra de sangre en ayunas. Se comparó la prevalencia del síndrome metabólico siguiendo los recientes criterios, por sexo y edad. Resultados: Se reclutaron 2.833 personas, el 46,5% eran hombres, y la edad media 51,2 años. La prevalencia del síndrome metabólico fue del 33,6%, significativamente mayor en los hombres (36,7% frente a 30,9%; pObjectives: The unification of criteria for the diagnosis of metabolic syndrome, together with the subsequent World Health Organization (WHO) proposal to eliminate diabetes and cardiovascular diseases from the diagnostic criteria, will change estimates of the known prevalence of this syndrome. The aim of this study was to determine the prevalence of metabolic syndrome in a health area of Badajoz (Spain) using the latest consensus criteria and eliminating diabetes and cardiovascular disease. Methods: We performed a cross-sectional population-wide study of randomly selected individuals aged between 25 and 79 years old in a health area of Badajoz. In all patients, data on their history of cardiovascular risk factors were gathered, waist circumference and blood pressure were measured and a fasting blood sample was collected. The prevalence of metabolic syndrome, following recent criteria, was compared by age and gender. Results: We recruited 2,833 individuals (46.5% men). The mean age was 51.2 years The prevalence of metabolic syndrome was 33.6% and was significantly higher in men (36.7% vs 30.9%; p<0.001). The prevalence of metabolic syndrome fell significantly after exclusion of patients with diabetes or cardiovascular disease (20.8%; p<0.001). The difference in prevalence between the distinct criteria was significant for the whole population and by sex (p<0.000). A significant difference in prevalence between genders was observed from the age of 45-54 years in men and 55-64 years in women. Conclusions: The prevalence of metabolic syndrome in a health area of Badajoz is among the highest reported in population-based studies in Spain. Although estimates of the prevalence are decreased by the new international recommendations, a considerable proportion of the young population requires preventive measures

Association between administration of IL-6 antagonists and mortality among patients hospitalized for COVID-19 : a meta-analysis

IMPORTANCE Clinical trials assessing the efficacy of IL-6 antagonists in patients hospitalized for COVID-19 have variously reported benefit, no effect, and harm. OBJECTIVE To estimate the association between administration of IL-6 antagonists compared with usual care or placebo and 28-day all-cause mortality and other outcomes. DATA SOURCES Trials were identified through systematic searches of electronic databases between October 2020 and January 2021. Searches were not restricted by trial status or language. Additional trials were identified through contact with experts. STUDY SELECTION Eligible trials randomly assigned patients hospitalized for COVID-19 to a group in whom IL-6 antagonists were administered and to a group in whom neither IL-6 antagonists nor any other immunomodulators except corticosteroids were administered. Among 72 potentially eligible trials, 27 (37.5%) met study selection criteria. DATA EXTRACTION AND SYNTHESIS In this prospectivemeta-analysis, risk of biaswas assessed using the Cochrane Risk of Bias Assessment Tool. Inconsistency among trial results was assessed using the I-2 statistic. The primary analysis was an inverse variance-weighted fixed-effects meta-analysis of odds ratios (ORs) for 28-day all-cause mortality. MAIN OUTCOMES AND MEASURES The primary outcome measurewas all-cause mortality at 28 days after randomization. There were 9 secondary outcomes including progression to invasive mechanical ventilation or death and risk of secondary infection by 28 days. RESULTS A total of 10 930 patients (median age, 61 years [range of medians, 52-68 years]; 3560 [33%] were women) participating in 27 trials were included. By 28 days, there were 1407 deaths among 6449 patients randomized to IL-6 antagonists and 1158 deaths among 4481 patients randomized to usual care or placebo (summary OR, 0.86 [95% CI, 0.79-0.95]; P =.003 based on a fixed-effects meta-analysis). This corresponds to an absolute mortality risk of 22% for IL-6 antagonists compared with an assumed mortality risk of 25% for usual care or placebo. The corresponding summary ORs were 0.83 (95% CI, 0.74-0.92; P <.001) for tocilizumab and 1.08 (95% CI, 0.86-1.36; P =.52) for sarilumab. The summary ORs for the association with mortality compared with usual care or placebo in those receiving corticosteroids were 0.77 (95% CI, 0.68-0.87) for tocilizumab and 0.92 (95% CI, 0.61-1.38) for sarilumab. The ORs for the association with progression to invasive mechanical ventilation or death, compared with usual care or placebo, were 0.77 (95% CI, 0.70-0.85) for all IL-6 antagonists, 0.74 (95% CI, 0.66-0.82) for tocilizumab, and 1.00 (95% CI, 0.74-1.34) for sarilumab. Secondary infections by 28 days occurred in 21.9% of patients treated with IL-6 antagonists vs 17.6% of patients treated with usual care or placebo (OR accounting for trial sample sizes, 0.99; 95% CI, 0.85-1.16). CONCLUSIONS AND RELEVANCE In this prospectivemeta-analysis of clinical trials of patients hospitalized for COVID-19, administration of IL-6 antagonists, compared with usual care or placebo, was associated with lower 28-day all-cause mortality