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Predicted cardiovascular disease risk and prescribing of antihypertensive therapy among patients with hypertension in Australia using MedicineInsight. J Hum Hypertens 2022; 37:370-378. [PMID: 35501358 PMCID: PMC10156591 DOI: 10.1038/s41371-022-00691-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/30/2022] [Accepted: 04/07/2022] [Indexed: 11/09/2022]
Abstract
Hypertension guidelines recommend that absolute cardiovascular disease (CVD) risk guide the management of hypertensive patients. This study aimed to assess the proportion of patients with diagnosed hypertension with sufficient data to calculate absolute CVD risk and determine whether CVD risk is associated with prescribing of antihypertensive therapies. This was a cross-sectional study using a large national database of electronic medical records of patients attending general practice in 2018 (MedicineInsight). Of 571,492 patients aged 45-74 years without a history of CVD, 251,733 [40.6% (95% CI: 39.8-41.2)] had a recorded hypertension diagnosis. The proportion of patients with sufficient recorded data available to calculate CVD risk was higher for patients diagnosed with hypertension [51.0% (95% CI: 48.0-53.9)] than for patients without a diagnosis of hypertension [38.7% (95% CI: 36.5-41.0)]. Of those patients with sufficient data to calculate CVD risk, 29.3% (95% CI: 28.1-30.6) were at high risk clinically, 6.0% (95% CI: 5.8-6.3) were at high risk based on their CVD risk score, 12.8% (95% CI: 12.5-13.2) at moderate risk and 51.8% (95% CI: 50.8-52.9) at low risk. The overall prevalence of antihypertensive therapy was 60.9% (95% CI: 59.3-62.5). Prescribing was slightly lower in patients at high risk based on their CVD risk score [57.4% (95% CI: 55.4-59.4)] compared with those at low [63.3% (95% CI: 61.9-64.8)] or moderate risk [61.8% (95% CI: 60.2-63.4)] or at high risk clinically [64.1% (95% CI: 61.9-66.3)]. Guideline adherence is suboptimal, and many patients miss out on treatments that may prevent future CVD events.
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2
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Al-Karaghouli M, Fuentes S, Davyduke T, Ma M, Abraldes JG. Impact of statin treatment on non-invasive tests based predictions of fibrosis in a referral pathway for NAFLD. BMJ Open Gastroenterol 2022; 9:e000798. [PMID: 34992072 PMCID: PMC8739069 DOI: 10.1136/bmjgast-2021-000798] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 11/28/2021] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE In non-alcoholic fatty liver disease (NAFLD), fibrosis determines the risk of liver complications. Non-invasive tests (NITs) such as FIB-4, NAFLD Fibrosis Score (NFS) and Hepamet, have been proposed as a tool to triage NAFLD patients in primary care (PC). These NITs include AST±ALT in their calculations. Many patients with NAFLD take statins, which can affect AST/ALT, but it is unknown if statin affects NITs fibrosis prediction. METHODS We included 856 patients referred through a standardised pathway from PC with a final diagnosis of NAFLD. 832 had reliable vibration controlled transient elastography (VCTE) measurements. We assessed the effects of statins on the association between NITs and VCTE at different fibrosis thresholds. RESULTS 129 out of 832 patients were taking a statin and 138 additional patients had indication for a statin. For any given FIB-4 value, patients on a statin had higher probabilities of high VCTE than patients not on a statin. Adjusting for body mass index, diabetes and age almost completely abrogated these differences, suggesting that these were related to patient's profile rather to a specific effect of statins. Negative predictive values (NPVs) of FIB-4 <1.3 for VCTE >8, 10, 12 and 16 were, respectively, 89, 94, 96% and 100% in patients on a statin and 92, 95, 98% and 99% in patients not on a statin. Statins had similar impact on Hepamet predictions but did not modify NFS predictions. CONCLUSION In patients with NAFLD referred from PC, those on statins had higher chances of a high VCTE for a given FIB-4 value, but this had a negligible impact on the NPV of the commonly used FIB-4 threshold (<1.3).
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Affiliation(s)
- Mustafa Al-Karaghouli
- Division of Gastroenterology (Liver Unit), University of Alberta, Edmonton, Alberta, Canada
| | - Sonia Fuentes
- Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Tracy Davyduke
- Hepatology Triage Clinic, Alberta Health Services, Edmonton, Alberta, Canada
| | - Mang Ma
- Division of Gastroenterology (Liver Unit), University of Alberta, Edmonton, Alberta, Canada
| | - Juan G Abraldes
- Division of Gastroenterology (Liver Unit), University of Alberta, Edmonton, Alberta, Canada
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Recomendaciones para mejorar el control lipídico. Documento de consenso de la Sociedad Española de Cardiología. Rev Esp Cardiol 2020. [DOI: 10.1016/j.recesp.2019.07.024] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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4
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Escobar C, Anguita M, Arrarte V, Barrios V, Cequier Á, Cosín-Sales J, Egocheaga I, López de Sa E, Masana L, Pallarés V, Pérez de Isla L, Pintó X. Recommendations to improve lipid control. Consensus document of the Spanish Society of Cardiology. ACTA ACUST UNITED AC 2019; 73:161-167. [PMID: 31818706 DOI: 10.1016/j.rec.2019.08.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 08/08/2019] [Indexed: 12/29/2022]
Abstract
T***he current control of low-density lipoprotein cholesterol among patients with atherosclerotic cardiovascular disease is very low and this is associated with an increase of cardiovascular outcomes. In addition, the latter this happens, the risk will be greater. This is mainly due to an insufficient use of the lipid-lowering therapy currently available. In fact, with current treatments (statins, ezetimibe and PCSK9 inhibitors), the majority of patients in secondary prevention should achieve low-density lipoprotein cholesterol goals. For these reasons, in this manuscript promoted by the Spanish Society of Cardiology we propose three simple and feasible decision-making algorithms that include the majority of clinical scenarios among patients with ischemic heart disease, with the double aim of attaining therapeutic goals in the majority of patients as soon as possible; in secondary prevention the magnitude of the benefit is risk- and time-dependent.
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Affiliation(s)
- Carlos Escobar
- Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain.
| | - Manuel Anguita
- Servicio de Cardiología, Hospital Reina Sofía, Córdoba, Spain
| | - Vicente Arrarte
- Servicio de Cardiología, Hospital General Universitario, Alicante, Spain
| | - Vivencio Barrios
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Ángel Cequier
- Servicio de Cardiología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Juan Cosín-Sales
- Servicio de Cardiología, Hospital Arnau de Vilanova, Valencia, Spain
| | | | | | - Luis Masana
- Unitat de Medicina Vascular i Metabolisme, Hospital Universitari Sant Joan, Reus, Tarragona, Spain
| | - Vicente Pallarés
- Unidad de Vigilancia de la Salud, Unión de Mutuas, Castellón, Spain
| | | | - Xavier Pintó
- Unidad de Riesgo Vascular, Servicio de Medicina Interna, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
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Handschin A, Brighenti-Zogg S, Mundwiler J, Giezendanner S, Gregoriano C, Martina B, Tschudi P, Leuppi JD, Zeller A, Dieterle T. Cardiovascular risk stratification in primary care patients with arterial hypertension: Results from the Swiss Hypertension Cohort Study (HccH). Eur J Prev Cardiol 2019; 26:1843-1851. [DOI: 10.1177/2047487319856732] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Aims Few data are available on cardiovascular risk stratification in primary care patients treated for arterial hypertension. This study aimed at evaluating the cardiovascular risk profile of hypertensive patients included into the Swiss Hypertension Cohort Study according to the 2013 European Society of Hypertension/European Society of Cardiology Guidelines. Methods The Swiss Hypertension Cohort Study is a prospective, observational study conducted by the Centre for Primary Health Care of the University of Basel from 2006 to 2013. Patients with a diagnosis of arterial hypertension (office blood pressure measurement ≥140/90 mmHg) were enrolled. Office blood pressure measurement, cardiovascular risk factors, subclinical organ damage, diabetes mellitus, and established cardiovascular and renal disease were recorded at baseline and at an annual interval during routine consultations by general practitioners in Switzerland. Results In total, 1003 patients were eligible for analysis (55.6% male, mean age: 64.0 ± 13.2 years). At baseline, 78.5% of patients presented with either more than three additional cardiovascular risk factors, diabetes mellitus or subclinical organ damage, while 44.4% of patients had a high or very high overall cardiovascular risk. Cardiovascular risk factors and information about diabetes mellitus, established cardiovascular disease and renal disease were recorded mostly completely, whereas substantial gaps were revealed regarding the assessment of subclinical organ damage. Conclusion The present findings demonstrate that the majority of primary care patients with arterial hypertension bear a substantial number of additional cardiovascular risk factors, subclinical and/or established organ damage. This emphasizes the need for continuous cardiovascular risk stratification and adequate treatment of arterial hypertension in Switzerland.
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Affiliation(s)
- Anja Handschin
- University Clinic of Medicine, Cantonal Hospital Baselland, Liestal, Switzerland
| | | | - Jonas Mundwiler
- University Clinic of Medicine, Cantonal Hospital Baselland, Liestal, Switzerland
| | | | - Claudia Gregoriano
- University Clinic of Medicine, Cantonal Hospital Baselland, Liestal, Switzerland
| | - Benedict Martina
- Centre for Primary Health Care, University of Basel, Switzerland
| | - Peter Tschudi
- Centre for Primary Health Care, University of Basel, Switzerland
| | - Jörg D Leuppi
- University Clinic of Medicine, Cantonal Hospital Baselland, Liestal, Switzerland
- Faculty of Medicine, University of Basel, Switzerland
| | - Andreas Zeller
- Centre for Primary Health Care, University of Basel, Switzerland
- Faculty of Medicine, University of Basel, Switzerland
| | - Thomas Dieterle
- University Clinic of Medicine, Cantonal Hospital Baselland, Liestal, Switzerland
- Faculty of Medicine, University of Basel, Switzerland
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Mancia G, Tsioufis K. Current perspective on the use of calcium channel blockers to treat hypertensive patients: the role of lercanidipine. Future Cardiol 2019; 15:259-266. [PMID: 31180724 DOI: 10.2217/fca-2019-0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The symposium 'Current perspective on the use of calcium channel blockers in the treatment of hypertensive patients', held in Stresa (Italy) on 28th and 29th June 2018 with the participation of the main experts in the field of hypertension from all over the world, reviewed the role of calcium channel blockers in the management of hypertension. Considering the new European Society of Hypertension/European Society of Cardiology (ESH/ESC) guidelines presented at the last European Society of Hypertension meeting in Barcelona in June 2018, a special attention was focused on lercanidipine. In this article, the main highlights of the symposium were summarized.
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Affiliation(s)
- Giuseppe Mancia
- Clinical Medicine Department, University of Milano-Bicocca, Milan, Italy
| | - Kostantinos Tsioufis
- Cardiology Department, First Cardiology Clinic, Medical School, National & Kapodistrian University of Athens, Hippokration Hospital, Greece
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Del Ben M, Baratta F, Polimeni L, Pastori D, Loffredo L, Averna M, Violi F, Angelico F. Under-prescription of statins in patients with non-alcoholic fatty liver disease. Nutr Metab Cardiovasc Dis 2017; 27:161-167. [PMID: 27914698 DOI: 10.1016/j.numecd.2016.09.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 08/09/2016] [Accepted: 09/17/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIM Non-alcoholic fatty liver disease (NAFLD) is a common disease associated with high cardiovascular risk. Management of dyslipidaemia plays a pivotal role in the prevention of CV events and statins have proved to be safe in these patients. However, in everyday clinical practice statin prescription is sometimes limited because of the concern of physicians about side-effects. The aim of the study was to investigate if the presence of NAFLD affects the prescription of lipid-lowering treatment in a large series of patients with cardio-metabolic disorders. METHODS AND RESULTS Cardiovascular risk and LDL-C targets were defined according to ESC/EAS Guidelines in 605 consecutive adult subjects referred for screening of suspected metabolic diseases. Liver steatosis was assessed by ultrasound Hamaguchi criteria. In the whole cohort, 442 patients had indication for cholesterol-lowering treatment. Lack of statin prescription was present in 230 (52.0%) patients. Of these, 77 (33.5%) were very high-risk, 48 (20.8%) high-risk, and 105 (45.6%) moderate risk patients. Only 44% of the NAFLD patients with indication for statin treatment were on therapy. NAFLD patients on statin treatment had significantly lower ALT values as compared to those not on treatment (p < 0.05). CONCLUSIONS Our findings show that about 50% of patients with indication to statin treatment do not receive any cholesterol-lowering medication. Statin under-use was particularly high in subjects with NAFLD. Use of statin treatment should be encouraged in the context of NAFLD, as it may improve lipid profile and reduce the cardiovascular risk in this setting.
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Affiliation(s)
- M Del Ben
- Department of Internal Medicine and Medical Specialties - Sapienza University, Rome, Italy
| | - F Baratta
- Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences - Sapienza University, Rome, Italy
| | - L Polimeni
- Department of Internal Medicine and Medical Specialties - Sapienza University, Rome, Italy
| | - D Pastori
- Department of Internal Medicine and Medical Specialties - Sapienza University, Rome, Italy; Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences - Sapienza University, Rome, Italy
| | - L Loffredo
- Department of Internal Medicine and Medical Specialties - Sapienza University, Rome, Italy
| | - M Averna
- Department of Internal Medicine and Medical Specialties - DIBIMIS, School of Medicine, University of Palermo, Palermo, Italy
| | - F Violi
- Department of Internal Medicine and Medical Specialties - Sapienza University, Rome, Italy
| | - F Angelico
- Department of Public Health and Infectious Diseases - Sapienza University, Rome, Italy.
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[Baseline characteristics and clinical management of the first 3,000 patients enrolled in the IBERICAN study (Identification of the Spanish population at cardiovascular and renal risk)]. Semergen 2016; 43:493-500. [PMID: 27567214 DOI: 10.1016/j.semerg.2016.07.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 07/04/2016] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To determine the prevalence and incidence of cardiovascular risk factors in Spain, as well as cardiovascular events, in Spanish adult population attended in primary care. METHODOLOGY IBERICAN is a longitudinal, observational, multicenter study in which patients aged 18 to 85years attended in primary care health center in Spain are being included. The obtained cohort will be followed annually for at least 5years. The estimated final sample is 7,000 patients. The baseline characteristics of the second cut (n=3,042) are presented. RESULTS The mean age of the subjects included is 57.9±14.6 years, and 55.5% are women. 54.9% live in urban habitat, and 57.3% have primary education. 50.3% had dyslipidemia, 47.4% hypertension, 29.7% physical inactivity, 28.2% abdominal obesity and 19% diabetes mellitus. The degree of control of hypertension, dyslipidemia and type2 diabetes was 58.5%, 25.8% and 75.9%. 28.2% have criteria for metabolic syndrome. 15.6% of patients had previous cardiovascular disease. 7.8% have a history of coronary heart disease, a glomerular filtration rate <60ml/min (CKD-EPI) 8.4%, microalbuminuria 9.6%, atrial fibrillation 5.5%, stroke 4.6%, and heart failure 2.9%. CONCLUSIONS Although the population treated in primary care is relatively young, the high prevalence of risk factors, their poor control and the existence of previous cardiovascular disease will determine the impact on the prognosis of the cohort.
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Barrios V, Escobar C. Improving cardiovascular protection: focus on a cardiovascular polypill. Future Cardiol 2016; 12:181-96. [DOI: 10.2217/fca.15.80] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Lack of adherence may explain, at least in part, the poor cardiovascular risk factors control observed in patients with ischemic heart disease, increasing the risk of developing new events. Polypill improves medication adherence, which may actually reduce blood pressure and LDL cholesterol compared with the drugs given separately. The fixed combination of acetylsalicylic acid 100 mg + ramipril 2.5, 5, or 10 mg + either simvastatin 40 mg or atorvastatin 20 mg is the unique cardiovascular polypill that has been registered in 22 countries worldwide. The polypill-containing simvastatin has been specifically tested in a clinical trial including only patients with ischemic heart disease. The FOCUS study showed that patients treated with the polypill showed a higher adherence compared with those receiving separate medications.
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Affiliation(s)
- Vivencio Barrios
- Department of Cardiology, University Hospital Ramon y Cajal, School of Medicine. University of Alcalá, Madrid, Spain
| | - Carlos Escobar
- Cardiology Department, University Hospital La Paz, Madrid, Spain
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Yu EYT, Wan EYF, Chan KHY, Wong CKH, Kwok RLP, Fong DYT, Lam CLK. Evaluation of the quality of care of a multi-disciplinary Risk Factor Assessment and Management Programme for Hypertension (RAMP-HT). BMC FAMILY PRACTICE 2015; 16:71. [PMID: 26088560 PMCID: PMC4471929 DOI: 10.1186/s12875-015-0291-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 06/01/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND There is some evidence to support a risk-stratified, multi-disciplinary approach to manage patients with hypertension in primary care. The aim of this study is to evaluate the quality of care (QOC) of a multi-disciplinary Risk Assessment and Management Programme for Hypertension (RAMP-HT) for hypertensive patients in busy government-funded primary care clinics in Hong Kong. The objectives are to develop an evidence-based, structured and comprehensive evaluation framework on quality of care, to enhance the QOC of the RAMP-HT through an audit spiral of two evaluation cycles and to determine the effectiveness of the programme in reducing cardiovascular disease (CVD) risk. METHOD/DESIGN A longitudinal study is conducted using the Action Learning and Audit Spiral methodologies to measure whether pre-set target standards of care intended by the RAMP-HT are achieved. A structured evaluation framework on the quality of structure, process and outcomes of care has been developed based on the programme objectives and literature review in collaboration with the programme workgroup and health service providers. Each participating clinic is invited to complete a structure of care evaluation questionnaire in each evaluation cycle. The data of all patients who have enrolled into the RAMP-HT in the pre-defined evaluation periods are used for the evaluation of the process and outcomes of care in each evaluation cycle. For evaluation of the effectiveness of RAMP-HT, the primary outcomes including blood pressure (both systolic and diastolic), low-density lipoprotein cholesterol and estimated 10-year CVD risk of RAMP-HT participants are compared to those of hypertensive patients in usual care without RAMP-HT. DISCUSSION The QOC and effectiveness of the RAMP-HT in improving clinical and patient-reported outcomes for patients with hypertension in normal primary care will be determined. Possible areas for quality enhancement and standards of good practice will be established to inform service planning and policy decision making.
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Affiliation(s)
- Esther Yee Tak Yu
- Department of Family Medicine and Primary Care, The University of Hong Kong, Ap Lei Chau, Hong Kong.
| | - Eric Yuk Fai Wan
- Department of Family Medicine and Primary Care, The University of Hong Kong, Ap Lei Chau, Hong Kong.
| | - Karina Hiu Yen Chan
- Department of Family Medicine and Primary Care, The University of Hong Kong, Ap Lei Chau, Hong Kong.
| | - Carlos King Ho Wong
- Department of Family Medicine and Primary Care, The University of Hong Kong, Ap Lei Chau, Hong Kong.
| | - Ruby Lai Ping Kwok
- Primary and Community Services Department, Hospital Authority Head Office, Hong Kong Hospital Authority, Kowloon, Hong Kong.
| | | | - Cindy Lo Kuen Lam
- Department of Family Medicine and Primary Care, The University of Hong Kong, Ap Lei Chau, Hong Kong.
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Evolution of therapy inertia in primary care setting in Spain during 2002–2010. J Hypertens 2014; 32:1138-45; discussion 1145. [DOI: 10.1097/hjh.0000000000000118] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Barrios V, Escobar C, Calderón A, Moreno FJA, Pallarés V, Galgo A. Clinical profile and blood pressure control in patients managed in primary care in Spain: are there any differences between the young and the old? REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2014; 66:824-5. [PMID: 24773867 DOI: 10.1016/j.rec.2013.04.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 04/18/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Vivencio Barrios
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain.
| | - Carlos Escobar
- Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain
| | - Alberto Calderón
- Centro de Salud Rosa de Luxemburgo, San Sebastián de los Reyes, Madrid, Spain
| | | | - Vicente Pallarés
- Unidad de Vigilancia de la Salud, Unión de Mutuas, Castellón, Spain
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Impact of global risk assessment on the evaluation of hypertensive patients treated by primary care physicians in Korea. Hypertens Res 2014; 37:665-71. [DOI: 10.1038/hr.2014.55] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2013] [Revised: 10/24/2013] [Accepted: 11/27/2013] [Indexed: 11/09/2022]
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Derosa G, Bonaventura A, Romano D, Bianchi L, Fogari E, D'Angelo A, Maffioli P. Effects of enalapril/lercanidipine combination on some emerging biomarkers in cardiovascular risk stratification in hypertensive patients. J Clin Pharm Ther 2014; 39:277-85. [DOI: 10.1111/jcpt.12139] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Accepted: 01/14/2014] [Indexed: 01/29/2023]
Affiliation(s)
- G. Derosa
- Department of Internal Medicine and Therapeutics; University of Pavia and Fondazione IRCCS Policlinico S. Matteo; Pavia Italy
- Center for the Study of Endocrine-Metabolic Pathophysiology and Clinical Research; University of Pavia; Pavia Italy
| | - A. Bonaventura
- Department of Internal Medicine and Therapeutics; University of Pavia and Fondazione IRCCS Policlinico S. Matteo; Pavia Italy
| | - D. Romano
- Department of Internal Medicine and Therapeutics; University of Pavia and Fondazione IRCCS Policlinico S. Matteo; Pavia Italy
| | - L. Bianchi
- Department of Internal Medicine and Therapeutics; University of Pavia and Fondazione IRCCS Policlinico S. Matteo; Pavia Italy
| | - E. Fogari
- Department of Internal Medicine and Therapeutics; University of Pavia and Fondazione IRCCS Policlinico S. Matteo; Pavia Italy
| | - A. D'Angelo
- Department of Internal Medicine and Therapeutics; University of Pavia and Fondazione IRCCS Policlinico S. Matteo; Pavia Italy
| | - P. Maffioli
- Department of Internal Medicine and Therapeutics; University of Pavia and Fondazione IRCCS Policlinico S. Matteo; Pavia Italy
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Barrios V, Llisterri JL, Escobar C, Alfaro P, Colado F, Ridocci F, Matali A. Clinical applicability of B-type natriuretic peptide in patients with suspected heart failure in primary care in Spain: the PANAMA study. Expert Rev Cardiovasc Ther 2014; 9:579-85. [DOI: 10.1586/erc.11.28] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Barrios V, Escobar C, Divison JA, Medialdea F. Low-dose fixed combination of perindopril plus indapamide in the diabetic hypertensive population. Expert Rev Cardiovasc Ther 2014; 6:1063-9. [DOI: 10.1586/14779072.6.8.1063] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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González-Juanatey JR, Cordero A. Benefits of delapril in hypertensive patients along the cardiovascular continuum. Expert Rev Cardiovasc Ther 2014; 11:271-81. [DOI: 10.1586/erc.12.188] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Perfil clínico y grado de control de la presión arterial de la población hipertensa asistida en atención primaria en España: ¿hay diferencias entre la población joven y la más mayor? Rev Esp Cardiol 2013. [DOI: 10.1016/j.recesp.2013.04.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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de la Peña A, Roca-Cusachs A, Suárez C, Bonet S. [Vascular risk in outpatient from Internal Medicine departments. MICARE Study]. Med Clin (Barc) 2012. [PMID: 23199827 DOI: 10.1016/j.medcli.2012.05.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND OBJECTIVES The population attended in the Spanish Internal Medicine departments is of increasing age, but the prevalence of vascular risk factors and its degree of control are unknown, as well as the differences by type of hospital or consulting room. PATIENTS AND METHODS Epidemiologic, transversal and metacentric study in patients ≥ 18 years treated in outpatient Internal Medicine hospital. Two-hundred and ninety physicians from 17 Autonomic Communities participated in the study. The type of hospital or consulting room was also recorded. Blood pressure control was defined as <140/90 mm Hg (<130/80 mm Hg in diabetics or patients with vascular disease), LDL-cholesterol control when<130 mg/dl (<100mg/dl in diabetic or vascular disease) and diabetes control if glycated hemoglobin was<7%. RESULTS Data from 2,704 patients was collected (54% men) mean age (SD) 64,1 (14,5) years. Ninety-three percent of them had at least one cardiovascular risk factor: hypertension 73.9%, dyslipidemia 59.5%, abdominal obesity 43.4%, diabetes 39.5%. Fifty percent had some target organ damaged, 46.7% showed vascular disease and 71.2% a high or very high vascular risk. Control over risk factors was: hypertension 33.8%, cholesterol-LDL 40.8% and diabetes 50.7%. There were no differences between type of hospital or type of outpatient consultancy. CONCLUSIONS Over 90% of patients treated in outpatient consultancies of Internal Medicine departments present vascular risk factors, regardless of the type of hospital or type of consulting room. Risk factors control was poor.
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Affiliation(s)
- Andrés de la Peña
- Servicio de Medicina Interna, Hospital Son Llàtzer, Palma de Mallorca, España.
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Vinyoles E, Rodriguez-Blanco T, de la Figuera M, Colomé JM, Tafalla M, Calbet N, Fernández-San Martin MI, García-Alonso J, Murillo C, Agudo J. Variability and concordance of Cornell and Sokolow–Lyon electrocardiographic criteria in hypertensive patients. Blood Press 2012; 21:352-9. [DOI: 10.3109/08037051.2012.686180] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Relevancia de la enfermedad arterial periférica en sujetos de edad avanzada. HIPERTENSION Y RIESGO VASCULAR 2012. [DOI: 10.1016/j.hipert.2011.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Barrios V. Diltiazem in the treatment of hypertension and ischemic heart disease. Expert Rev Cardiovasc Ther 2011; 9:1375-82. [DOI: 10.1586/erc.11.144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Barrios V, Escobar C. Candesartan in the treatment of hypertension: what have we learnt in the last decade? Expert Opin Drug Saf 2011; 10:957-68. [PMID: 21848481 DOI: 10.1517/14740338.2011.608064] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Although all of the first-line antihypertensive drugs effectively reduce blood pressure, there are some conditions that may favor the use of angiotensin receptor blockers over others, such as left ventricular hypertrophy, microalbuminuria, renal dysfunction, diabetes, or metabolic syndrome, among others. AREAS COVERED This manuscript reviewed the data supporting the use of candesartan cilexetil in hypertensive population with a special focus on its efficacy and safety. For this purpose, a search on MEDLINE and EMBASE databases was performed. The MEDLINE and EMBASE search included both medical subject headings (MeSH) and keywords including: candesartan OR angiotensin receptor blockers OR renin angiotensin system AND hypertension treatment. References of the retrieved articles were also screened for additional studies. There were no language restrictions. EXPERT OPINION Candesartan, a long-acting angiotensin receptor antagonist, has been shown to be an effective and well-tolerated therapy in the entire spectrum of hypertensive patients, including those at higher risk, such as those with diabetes, metabolic syndrome, left ventricular hypertrophy, or microalbuminuria.
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Affiliation(s)
- Vivencio Barrios
- Hospital Ramon y Cajal, Department of Cardiology, Madrid, Spain.
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Bruckert E, Bonnelye G, Thomas-Delecourt F, André L, Delaage PH. Assessment of cardiovascular risk in primary care patients in France. Arch Cardiovasc Dis 2011; 104:381-7. [PMID: 21798470 DOI: 10.1016/j.acvd.2011.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Revised: 04/19/2011] [Accepted: 04/21/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Current guidelines for the prevention of cardiovascular disease emphasize the importance of assessing global cardiovascular risk, but there is evidence that risk is often assessed inaccurately. AIMS To compare general practitioner-reported global cardiovascular risk in French primary care patients with estimates based on established risk-scoring systems, and to identify factors accounting for any mismatch between the analyses. METHODS Data on patients, aged 50 years or older, seen during two 3-day periods were provided by 619 general practitioners. Physicians rated each patient's cardiovascular risk as low, moderate or high, according to their perception; in addition, risk was assessed using the Framingham and Systematic coronary risk evaluation (SCORE) risk-scoring systems. RESULTS A total of 13,446 patients aged greater or equal to 50 years were included. Of 11,241 patients with no previous history of cardiovascular disease, 47% were considered by their physicians to be at low risk of cardiovascular disease and 14% to be at high risk. In that population, 72% of patients rated as high risk according to the Framingham system and 77% rated as high risk according to SCORE system were incorrectly assessed by their physicians; similar results were observed in patient cohorts based on whether or not patients had received treatment for dyslipidaemia. Weighted kappa analysis showed poor agreement between physician risk assessment and both the Framingham and SCORE risk-scoring systems. CONCLUSION This study underlines the mismatch between GP-estimated cardiovascular risk and the risk assessed using scoring systems, especially for high-risk patients.
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Affiliation(s)
- Eric Bruckert
- Service d'endocrinologie métabolisme, hôpital Pitié-Salpêtrière, pavillon Delessert, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 1, France.
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Szyndler A, Kucharska WA, Dubiela-D Browska AE, Olszanecka A, Widecka J, B Czkiewicz MA, Widecka K, Galas GY, Chlebi Ska I, Sakiewicz W, Gaciong Z, Widecka K, Januszewicz A, Kawecka-Jaszcz K, Narkiewicz K. SCORE model underestimates cardiovascular risk in hypertensive patients: results of the Polish Hypertension Registry. Blood Press 2011; 20:342-7. [PMID: 21675828 DOI: 10.3109/08037051.2011.587267] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE. The aim of the present study was to compare the effectiveness of Systemic COronary Risk Evaluation (SCORE) charts and European Society of Hypertension/European Society of Cardiology (ESH/ESC) hypertension guidelines for identifying high-risk hypertensive patients. METHODS. The data on hypertensive patients was collected using the Polish Hypertension Registry. We enrolled 636 patients (357 females and 279 males, mean age 54.4 (+/-) 7.9 years) from hypertension centres in Poland. RESULTS. Only 3.5% of the subjects had no additional risk factors. Thirty-six per cent of the patients had three or more risk factors. Metabolic syndrome was found in 40.1% of the patients. According to the SCORE charts, 9.0% of females and 27.2% of males had high to very high cardiovascular risk (p < 0.001). Taking into account risk factors and the metabolic syndrome, 55.7% of females and 56.3% of males (p = NS) had high or very high additional cardiovascular risk according to the 2007 ESH/ESC guidelines. For both females and males, the prevalence of high to very high risk was greater (p < 0.001) from the calculation based on the 2007 ESH/ESC guidelines than from the SCORE charts. Fifty-two per cent of patients classified as low to moderate risk according to the SCORE system, had high or very high risk according to the 2007 ESH/ESC guidelines. CONCLUSIONS. The SCORE charts seem to underestimate the burden of the cardiovascular risk among hypertensive patients. The cardiovascular risk, especially in the hypertensive female population, seems to be much higher when estimated according to the 2007 ESH/ESC guidelines.
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Affiliation(s)
- Anna Szyndler
- Hypertension Unit, Dept. Hypertension and Diabetology, Medical University of Gdansk, Poland.
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[Computerized interpretation of the electrocardiogram in the diagnosis of left ventricular hypertrophy. The ELECTROPRES project]. Rev Clin Esp 2011; 211:391-9. [PMID: 21571266 DOI: 10.1016/j.rce.2011.03.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2011] [Revised: 03/14/2011] [Accepted: 03/19/2011] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Despite its low sensitivity, the electrocardiogram (ECG) is the tool used the most in the daily practice for detection of left ventricular hypertrophy (LVH). This study has aimed to assess the impact of the computerized interpretation of the ECG on the diagnosis of LVH in the practical clinical setting. METHODS ELECTROPRES is a project based on a free access computer platform that permits an online interpretation of the electrocardiogram. It includes 19 different left LVH criteria previously validated by echocardiography in a substudy. We analyzed the data from the first 669 patients with essential arterial hypertension (ATH) included in the ELECTROPRES platform from 21 primary care centers in 9 of the 17 Spanish autonomous communities. RESULTS Up to April 2010, a cohort of 669 hypertensive patients (51.7% women), with a mean age of 66.3±11.89 years, was analyzed. The mean evolution of the disease was 8 years, and the patients had been receiving an average of 2.4 antihypertensive agents. Systolic blood pressure was 139±17 mmHg and diastolic blood pressure 76±11. The ECG-known frequency of LVH was 3%. The prevalence of LVH increased up to 33.3% (P<0.001) with the ELECTROPRES platform. When all the criteria were independently examined, the Lewis index (R-I+S-III) and the Cornell product [(R-aVL+S-V3 (+6 for women)] were those in which the most cases of left ventricular hypertrophy were detected (24.8% and 13.3%, respectively). The Lewis index and the Cornell product were the criteria that detected more cases of left ventricular hypertrophy, regardless of the AHT stage and of the presence of cardiovascular complications. CONCLUSIONS The ECG computerized reading (ELECTROPRES platform) significantly increases detection of left ventricular hypertrophy in a population of essential hypertense subjects compared to conventional detection with the ECG by the physician in the usual clinical practice setting.
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Martell-Claros N, Galgo-Nafria A. Cardiovascular risk profile of young hypertensive patients: the OPENJOVEN study. Eur J Prev Cardiol 2011; 19:534-40. [DOI: 10.1177/1741826711406202] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background: Knowledge of the hypertensive patient’s characteristics is an important aspect to improve its clinical handling. Because of the burden that the patients of advanced age suppose in primary care, few data exist about the youngest patient's cardiovascular profile. Objective: To describe the cardiovascular profile of the young hypertensive patient (<55 years) in primary care in Spain. Design and methods: Cross-sectional multicentre study that was carried out in centres of primary care of the whole Spanish territory. At total of 2108 doctors participated and 6815 patients diagnosed with high blood pressure were included. We used a survey of risk factors, subclinical organ damage, and cardiovascular or renal established disease according to the European Society of Hypertension and the European Society of Cardiology 2007 guidelines to evaluate the cardiovascular risk. Results: Of the hypertensive patients, 5.8% did have not another cardiovascular risk factor (CVRF), 23.2% had one risk factor associated with high blood pressure, 32.8% two, 24.7% three, 11.3% four, and 2.3% had five risk factors. The most prevalent cardiovascular risk factor was dyslipidaemia, found in 80.4% (37.9% with treatment), followed by abdominal obesity, in 45.9% of the hypertensive patients. The prevalence of metabolic syndrome was 44.4%. The cardiovascular risk was average in 0.2% of the sample, low in 5%, moderate in 26.1%, high in 47.3%, and very high in 21.4%. Conclusions: Our study demonstrates that newly diagnosed young hypertensive patients have an intense association of CVRF and a high cardiovascular risk.
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Barrios V, Escobar C. Valsartan-amlodipine-hydrochlorothiazide: the definitive fixed combination? Expert Rev Cardiovasc Ther 2011; 8:1609-18. [PMID: 21090936 DOI: 10.1586/erc.10.115] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
A significant proportion of patients with hypertension will need three or more antihypertensive agents to achieve blood pressure goals, particularly those at higher risk. On the other hand, fixed combinations provide an extra beneficial effect, as they improve medication adherence and, secondarily, the attainment of blood pressure goals during follow-up. Triple therapy is recommended in the treatment of hypertension in those patients not adequately controlled with two antihypertensive drugs. In this context, guidelines recommend the combination of a renin-angiotensin system inhibitor, a calcium channel blocker and a diuretic. The triple fixed combination of valsartan-amlodipine-hydrochlorothiazide has been shown to be an effective and safe therapy for treating hypertension and seems a logical approach for those patients uncontrolled with two antihypertensive agents as well as in those patients already treated with three drugs to improve treatment compliance. In this article, available evidence about the efficacy and tolerability of the triple fixed combined therapy valsartan-amlodipine-hydrochlorothiazide for the treatment of hypertension is updated.
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Affiliation(s)
- Vivencio Barrios
- Department of Cardiology, Hospital Ramón y Cajal, Carretera de Colmenar Viejo, Km 9.100, 28034 Madrid, Spain.
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Abstract
Angiotensin-converting enzyme inhibitors and angiotensin II type 1 receptor antagonists (angiotensin receptor blockers) have been shown to be effective drugs in the management of hypertension and to have beneficial effects along the cardiovascular continuum. However, due to compensatory mechanisms, both of these types of agent increase plasma renin activity, which has been reported to have deleterious effects on patient outcomes. Aliskiren is the first nonpeptide orally administered direct renin inhibitor available on the market. Reported data have shown that aliskiren effectively reduces BP alone or in combination with other antihypertensive agents, and has a good tolerability profile. Moreover, this agent reduces plasma renin activity, which in theory could have additional clinical benefits. However, clinical trials analyzing the effects of aliskiren on mortality are still ongoing.
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Windak A, Gryglewska B, Tomasik T, Narkiewicz K, Yaphe J, Grodzicki T. The competence of primary care doctors in the investigation of patients with elevated blood pressure: results of a cross-sectional study using clinical vignettes. J Eval Clin Pract 2010; 16:784-9. [PMID: 20557416 DOI: 10.1111/j.1365-2753.2009.01194.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Specific laboratory tests are required to ensure adequate management of patients with hypertension, according to internationally accepted guidelines. There is wide variation in doctor test ordering behaviour. Many factors are known to affect this. Little is known about the interaction between doctor, patient and practice characteristics. The current study was designed to explore this. METHODS A series of eight case vignettes was designed to examine test ordering behaviour among primary care doctors in Poland. The cases differed with regard to the level of blood pressure and the presence or absence of other cardiovascular risk factors, including diabetes. Doctors stated their choices of laboratory investigations needed in these cases. Their responses were compared with recommendations in the 2003 European Society of Hypertension/European Society of Cardiology hypertension guidelines. Associations between the correct responses and patient, doctor and practice characteristics were tested. RESULTS One hundred and twenty-five out of 192 invited doctors (65%) participated in the study. They ordered a mean of 4.9 laboratory tests per case. This represents 47.9% of the tests recommended by current guidelines. Older doctors working in smaller practices and private settings ordered fewer laboratory tests. Specialization in family medicine was associated with greater compliance with guidelines. Grade 2 hypertension and the presence of other risk factors of cardiovascular disease were associated with ordering more tests but the presence of diabetes did not improve compliance with guidelines. CONCLUSIONS Further educational efforts are needed to promote rational test ordering for hypertensive patients by Polish primary health care doctors.
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Affiliation(s)
- Adam Windak
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Cracow, Poland.
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Calderón A, Barrios V, Escobar C, Ferrer E, Barrios S, González-Pedel V, Montoro P, Navarro-Cid J. Detection of Left Ventricular Hypertrophy by Different Electrocardiographic Criteria in Clinical Practice. Findings From the Sara Study. Clin Exp Hypertens 2010; 32:145-53. [DOI: 10.3109/10641960903254455] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Barrios V, Escobar C. Complementary mechanisms of action and rationale for the fixed combination of perindopril and indapamide in treating hypertension - update on clinical utility. Integr Blood Press Control 2010; 3:11-9. [PMID: 21949617 PMCID: PMC3172067 DOI: 10.2147/ibpc.s6636] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Indexed: 01/13/2023] Open
Abstract
Although reducing blood pressure is the most important approach to reduce cardiovascular outcomes in the hypertensive population, the majority of patients fail to attain the targets. Most patients with hypertension need at least 2 antihypertensive agents to achieve blood pressure goals. The 2007 European hypertension guidelines state that combined therapy is needed when monotherapy does not attain blood pressure objectives and as a first-line treatment in high-risk patients. This point has been reinforced in the 2009 update of the European guidelines. The advantages of combination therapy are well documented with the potential for increased antihypertensive efficacy as a result of different mechanisms of action, and a lower incidence of adverse effects because of the lower doses used and the possible compensatory responses. Moreover, the use of fixed dose combinations are specially recommended as they facilitate treatment compliance. The inhibition of the renin-angiotensin system appears to be very beneficial in the treatment of patients with hypertension along the cardiovascular continuum and the combination of a renin-angiotensin system inhibitor and a diuretic is particularly recommended. Many clinical trials have demonstrated the benefits of the fixed combination perindopril/indapamide in the treatment of hypertension. The aim of this manuscript is to update the published data on the efficacy and safety of this fixed combination.
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Affiliation(s)
| | - Carlos Escobar
- Department of Cardiology, Hospital Infanta Sofia, Madrid, Spain
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Barrios V, Escobar C. Beating the clock: reducing cardiovascular risk by rapid blood pressure reduction with olmesartan. Expert Opin Pharmacother 2010; 11:1549-58. [DOI: 10.1517/14656566.2010.484020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Barrios Alonso V, Escobar Cervantes C. Utilidad de la terapia combinada en la prevención y tratamiento de la enfermedad cardiovascular. Rev Clin Esp 2010; 210:230-6. [DOI: 10.1016/j.rce.2009.09.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2009] [Revised: 09/17/2009] [Accepted: 09/28/2009] [Indexed: 10/19/2022]
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Hagège AA, Demil N, Errieau G, Aupetit JF, Dievart F, Mourad JJ. First evaluation using a validated scale of the risk of congestive heart failure among hypertensive patients treated by general practitioners (O-PREDICT survey). Arch Cardiovasc Dis 2010; 103:176-83. [PMID: 20417449 DOI: 10.1016/j.acvd.2010.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2009] [Revised: 01/17/2010] [Accepted: 01/19/2010] [Indexed: 11/16/2022]
Abstract
BACKGROUND Routine management of hypertensive adults is based on assessment of risk factors for coronary artery disease; risk factors for heart failure (HF) remain poorly investigated despite the key role of hypertension in HF development. AIM To assess the components of HF risk in hypertensive adults in primary care, compare physicians' estimations of HF and global cardiovascular risks with established calculation algorithms, and assess the concordance of these algorithms. METHODS O-PREDICT was a transverse, observational, multicentre French survey conducted in 2006 among general practitioners who included the first hypertensive, non-HF patient seen in each of three age classes (<60, 60-70, >70 years). Estimations of HF and global cardiovascular risks (at 4 and 10 years, respectively) were performed subjectively during the consultation and calculated a posteriori according to algorithms from the Framingham cohort and the European SCORE database, respectively. For each of these methods, patients were stratified into four risk categories (i.e., no, low, moderate, high). RESULTS One thousand five hundred and thirty seven physicians recruited 4523 patients (61% men; 64.5+/-10.9 years; systolic blood pressure 149.9+/-15.4 mmHg); most (67.2%) patients had one or two cardiovascular/HF risk factors (dyslipidaemia 48.8%, left ventricular hypertrophy 25.3%, diabetes 18.8%, coronary artery disease 8.8%, valvulopathy 6.1%); the number increased with advancing age and in men versus women. According to the Framingham algorithm, the risk of HF (mean 5.4+/-8.5%; 13.4% of patients at high risk) increased with advancing age (p<0.001), nearly doubling for each decade increase. According to the European SCORE system, global cardiovascular risk (mean 5.4+/-4.3%) was moderate or elevated in 48.1% of patients. Concordance between physicians' estimations and theoretical calculations for HF and global risks was poor, as was concordance between algorithms (kappa(w)=0.28, 0.12, 0.11, respectively). CONCLUSION More than one in 10 hypertensive patients seen in primary care is at high risk of HF at 4 years according to the Framingham model; this algorithm appears to offer additional information to that provided by the SCORE system. Physicians' estimations of risks correlated poorly with algorithm calculations, suggesting that the use of these tools in general practice should be encouraged.
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Affiliation(s)
- Albert Alain Hagège
- hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, université Paris Descartes, 75015 Paris, France.
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De Rivas B, Barrios V, Redón J, Calderón A. Effectiveness of an Interventional Program to Improve Blood Pressure Control in Hypertensive Patients at High Risk for Developing Heart Failure: HEROIC Study. J Clin Hypertens (Greenwich) 2010; 12:335-44. [DOI: 10.1111/j.1751-7176.2010.00271.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Abstract
Current epidemiologic predictions show that the world is heading for a vascular tsunami of pandemic proportions. The number of people at high risk from cardiovascular disease is increasing; recent cohort studies suggest that only 2%-7% of the general population have no risk factors at all, and >70% of at-risk individuals have multiple risk factors. The recently published Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial (ONTARGET) study, which showed that telmisartan was as effective as ramipril in the prevention of a range of cardiovascular outcomes, enrolled a broad cross section of high-risk patients. This population was chosen to reflect the type of patients encountered in general practice, and because the proportion of high-risk individuals is increasing worldwide, the ONTARGET results will be relevant for most at-risk patients. Further analysis of the ONTARGET results may also aid in the development of risk estimation scores populated with real-life data and could also determine the impact of treatment on the long-term reduction of total cardiovascular burden (ie, absolute risk reduction). This may be a particularly useful exercise because current risk estimation charts have limitations in their scope, sensitivity, and the ability to reflect changes in risk.
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Rodriguez-Roca GC, Llisterri-Caro JL, Barrios-Alonso V, Alonso-Moreno FJ, Lou-Arnal S, Prieto-Diaz MA, Sanchez-Ruiz T, Dura-Belinchon R, Santos-Rodriguez JA, Divison-Garrote JA, Gonzalez-Segura D, Banegas-Banegas JR. Cardiovascular risk and blood pressure control in a Spanish hypertensive population attended in a Primary Care setting. Data from the PRESCAP 2006 study. Blood Press 2009; 18:117-25. [DOI: 10.1080/08037050902982292] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Barrios V, Escobar C, Calderón A, Ribas L, MartÍ D, AsÍn E. Prevalence of left ventricular hypertrophy detected by Cornell voltage‐duration product in a hypertensive population. Blood Press 2009; 17:110-5. [DOI: 10.1080/08037050802059092] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
| | - Carlos Escobar
- Department of Cardiology, Hospital Ramón y Cajal, Madrid
| | | | - Leandre Ribas
- Boehringer‐Ingelheim Medical Department, Barcelona, Spain
| | - David MartÍ
- Department of Cardiology, Hospital Ramón y Cajal, Madrid
| | - Enrique AsÍn
- Department of Cardiology, Hospital Ramón y Cajal, Madrid
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Barrios V, Brommer P, Haag U, Calderón A, Escobar C. Olmesartan Medoxomil plus Amlodipine Increases Efficacy in Patients with Moderate-to-Severe Hypertension after Monotherapy. Clin Drug Investig 2009; 29:427-439. [PMID: 19499960 DOI: 10.2165/00044011-200929070-00001] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Vivencio Barrios
- Department of Cardiology, Hospital Ramón y Cajal, Ctra., De Colmenar km 9, 100, 28034, Madrid, Spain.
| | | | - Uwe Haag
- HaaPACS GmbH, Schriesheim, Germany
| | - Alberto Calderón
- CS Rosa de Luxemburgo, San Sebastian de los Reyes (Madrid), Spain
| | - Carlos Escobar
- Department of Cardiology, Hospital Infanta Sofia, San Sebastian de los Reyes (Madrid), Spain
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Barrios V, Escobar C, Bertomeu V, Murga N, de Pablo C, Calderón A. Sex differences in the hypertensive population with chronic ischemic heart disease. J Clin Hypertens (Greenwich) 2009; 10:779-86. [PMID: 19090879 DOI: 10.1111/j.1751-7176.2008.00020.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Cardiopatía Isquémica Crónica e Hipertensión Arterial en la Práctica Clínica en España (CINHTIA) was a survey designed to assess the clinical management of hypertensive outpatients with chronic ischemic heart disease. Sex differences were examined. Blood pressures (BP) was considered controlled at levels of <140/90 or <130/80 mm Hg in diabetics (European Society of Hypertension/European Society of Cardiology 2003); low-density lipoprotein cholesterol (LDL-C) was considered controlled at levels <100 mg/dL (National Cholesterol Education Program Adult Treatment Panel III). In total, 2024 patients were included in the study. Women were older, with a higher body mass index and an increased prevalence of atrial fibrillation. Dyslipidemia, smoking, sedentary lifestyle, and peripheral arterial disease were more frequent in men. In contrast, diabetes, left ventricular hypertrophy, and heart failure were more common in women. BP and LDL-C control rates, although poor in both groups, were better in men (44.9% vs 30.5%, P<.001 and 33.0% vs 25.0%, P<.001, respectively). Stress testing and coronary angiography were more frequently performed in men.
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Affiliation(s)
- Vivencio Barrios
- Department of Cardiology, Hospital Ramón y Cajal, Madrid, Spain.
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Barrios V, Escobar C, Echarri R. Fixed combinations in the management of hypertension: perspectives on lercanidipine-enalapril. Vasc Health Risk Manag 2009; 4:847-53. [PMID: 19066001 PMCID: PMC2597757 DOI: 10.2147/vhrm.s3421] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Although achieving blood pressure (BP) control is critical to improve cardiovascular prognosis in hypertensive patients, many of them fail to achieve BP goals. The majority of hypertensive patients need more than one antihypertensive agent to attain BP targets. Combination therapy is required when monotherapy fails to attain BP objectives and as a first-line treatment in certain situations, such as markedly elevated BP values, when lower targets are required in high or very high cardiovascular risk patients. The advantages of combination therapy are well documented, with an increased antihypertensive efficacy as a result of the simultaneous inhibition of different mechanisms of action and with a lesser incidence of adverse events, because of the possible compensatory responses and the lower doses used. Calcium channel blockers are effective drugs in the treatment of hypertension. The efficacy of lercanidipine has been evaluated in several noncomparative and in comparative studies showing a great efficacy with a good tolerability. On the other hand, the inhibition of the renin-angiotensin system appears to be very beneficial in the treatment of patients with hypertension. Enalapril is an effective and well tolerated angiotensin converting enzyme inhibitor. Although there are several fixed-combination drugs, the combination lercanidipine plus enalapril appears to be one of the most promising therapies in the treatment of hypertension. The aim of this manuscript is to update the published data about the efficacy and safety of this fixed combination.
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Affiliation(s)
- Vivencio Barrios
- Department of Cardiology, Hospital Ramón y Cajal, Madrid, Spain.
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Clinical profile and management of hypertensive patients with chronic ischemic heart disease and renal dysfunction attended by cardiologists in daily clinical practice. J Hypertens 2008; 26:2230-5. [DOI: 10.1097/hjh.0b013e328311cdee] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Llisterri Caro JL, Barrios Alonso V. [Role of new drug combinations at fixed doses for the management of arterial hypertension]. Med Clin (Barc) 2008; 130:342-4. [PMID: 18373913 DOI: 10.1157/13117357] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Barrios Alonso V, Escobar Cervantes C, Calderón Montero A, Llisterri Caro JL, Echarri Carrillo R, Matalí A. [Impact of the presence of cardiovascular disease on blood pressure and lipid control in the hypertense population attended in primary care]. Aten Primaria 2008; 40:21-7. [PMID: 18190764 DOI: 10.1157/13114336] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES To determine the impact of cardiovascular disease (CVD) (heart failure, ischaemic heart disease, stroke, renal insufficiency, and peripheral arterial disease) on blood pressure (BP) and LDL-cholesterol (LDL-C) control in hypertense patients. DESIGN We analysed the subset of patients with CVD from those included in the PRESCOT study (a cross-sectional study of hypertense patients attended in primary care). SETTING A total of 2000 primary care physicians participated in the study. PARTICIPANTS In an analysis of 12 954 patients (50.1% males; aged 62.1 [10.7]), good BP control was defined as <140/90 mm Hg (<130/80 mm Hg for diabetics) and good LDL-C control, according to the ATP-III stipulations for every risk group. RESULTS Overall, 3294 (25.43%) patients had established CVD (mean age, 66.0 [10.2] years; 56.3% males). Of these, 82.2% had dyslipidaemia and 45.6% were diabetics (vs 72.3% and 23.9%, respectively, in non-CVD group; P< .0001). Patients with CVD were treated with more anti-hypertensives (55.7% vs 30.4% were on é2 drugs; P< .001) and more lipid-lowering drugs (67.6% vs 55.4%, P< .001) than patients without CVD. BP was controlled in 25.3% of patients with CVD versus 26.7% (P=.095); and LDL-C in 13.3% versus 40.2% (P< .001). Only 7.0% of patients with CVD were well controlled for both parameters versus 18.7% of those without CVD (P< .001). The main predictive factors of poor BP control were Diabetes (OR, 1.20; 95% CI, 1.10-1.30), sedentary lifestyle (OR, 1.19; 95% CI, 1.11-1.29) and female gender (OR, 1.12; 95% CI, 1.02-1.23), among others; whilst the main factors for poor LDL-C control were a family history of CVD (OR, 1.34; 95% CI, 1.24-1.46), sedentary lifestyle (OR, 1.28; 95% CI, 1.18-1.39), and diabetes (OR, 1.15; 95% CI, 1.06-1.26). CONCLUSIONS BP and LDL-C control in the hypertense population with CVD is very poor. In fact, only 7% of these patients have both parameters well controlled.
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Cardiovascular protection for all individuals at high risk: evidence-based best practice. Clin Res Cardiol 2008; 97:713-25. [DOI: 10.1007/s00392-008-0713-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2008] [Accepted: 08/08/2008] [Indexed: 10/21/2022]
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Escobar C, Barrios V. Calcium channel blocker-based combination therapy. The best approach in the treatment of high-risk hypertension? Int J Clin Pract 2008; 62:670-2. [PMID: 18412928 DOI: 10.1111/j.1742-1241.2008.01728.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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