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Gorostidi M, Gijón-conde T, de la Sierra A, Rodilla E, Rubio E, Vinyoles E, Oliveras A, Santamaría R, Segura J, Molinero A, Pérez-manchón D, Abad M, Abellán J, Armario P, Banegas J, Camafort M, Catalina C, Coca A, Divisón J, Domenech M, Martell N, Martín-rioboó E, Morales-olivas F, Pallarés V, Pérez de Isla L, Prieto M, Redón J, Ruilope L, García-donaire J. Guía práctica sobre el diagnóstico y tratamiento de la hipertensión arterial en España, 2022. Sociedad Española de Hipertensión - Liga Española para la Lucha contra la Hipertensión Arterial (SEH-LELHA). Hipertensión y Riesgo Vascular 2022. [DOI: 10.1016/j.hipert.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/06/2022] [Indexed: 01/08/2023]
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Roa-Chamorro R, González-Bustos P, Torres-Quintero L. Is it necessary to perform cardiovascular screening in migrant patients? Clin Investig Arterioscler 2022; 34:285-290. [PMID: 35840428 DOI: 10.1016/j.arteri.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/08/2022] [Accepted: 06/13/2022] [Indexed: 06/15/2023]
Abstract
Migrant patients arriving in Spain often come from countries where there is no universal access to healthcare. Although the prevalence of arterial hypertension (HTN) is lower in West Africa than in Spain, there is a higher prevalence of masked HT due to the absence of health screening. Furthermore, patients with secondary hypertension may not be diagnosed. We present the case of a 36-year-old Senegalese man, with no known pathological history, resident for a year in Spain, who debuted with a hypertensive emergency. At the time of diagnosis, the patient had severe end-organ damage (hypertensive heart disease, hypertensive retinopathy). After the study, he was diagnosed with arterial hypertension secondary to malformation of the renal artery. After performing angioplasty, blood pressure normalized and, at 18 months, target organ damage had reduced. Migrants who arrive in our country must be incorporated into health screening systems to diagnose and treat possible unknown pathologies. In our case, the clue to secondary hypertension was the development of resistant hypertension with target organ damage in a young subject.
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Affiliation(s)
- Ricardo Roa-Chamorro
- Unidad de Riesgo Vascular, Medicina Interna, Hospital Universitario Virgen de las Nieves, Granada, España.
| | - Pablo González-Bustos
- Unidad de Riesgo Vascular, Medicina Interna, Hospital Universitario Virgen de las Nieves, Granada, España
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Pallares-Carratala V, Carratala-Munuera C, Lopez-Pineda A, Quesada JA, Gil-Guillen V, Orozco-Beltran D, Alfonso-Sanchez JL, Navarro-Perez J, Martin-Moreno JM. Characterizing Diagnostic Inertia in Arterial Hypertension With a Gender Perspective in Primary Care. Front Cardiovasc Med 2022; 9:874764. [PMID: 35783866 PMCID: PMC9246269 DOI: 10.3389/fcvm.2022.874764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 05/24/2022] [Indexed: 11/15/2022] Open
Abstract
Background and Objectives Substantial evidence shows that diagnostic inertia leads to failure to achieve screening and diagnosis objectives for arterial hypertension (AHT). In addition, different studies suggest that the results may differ between men and women. This study aimed to evaluate the differences in diagnostic inertia in women and men attending public primary care centers, to identify potential gender biases in the clinical management of AHT. Study Design/Materials and Methods Cross-sectional descriptive and analytical estimates were obtained nested on an epidemiological ambispective cohort study of patients aged ≥30 years who attended public primary care centers in a Spanish region in the period 2008–2012, belonging to the ESCARVAL-RISK cohort. We applied a consistent operational definition of diagnostic inertia to a registry- reflected population group of 44,221 patients with diagnosed hypertension or meeting the criteria for diagnosis (51.2% women), with a mean age of 63.4 years (62.4 years in men and 64.4 years in women). Results Of the total population, 95.5% had a diagnosis of hypertension registered in their electronic health record. Another 1,968 patients met the inclusion criteria for diagnostic inertia of hypertension, representing 4.5% of the total population (5% of men and 3.9% of women). The factors significantly associated with inertia were younger age, normal body mass index, elevated total cholesterol, coexistence of diabetes and dyslipidemia, and treatment with oral antidiabetic drugs. Lower inertia was associated with age over 50 years, higher body mass index, normal total cholesterol, no diabetes or dyslipidemia, and treatment with lipid-lowering, antiplatelet, and anticoagulant drugs. The only gender difference in the association of factors with diagnostic inertia was found in waist circumference. Conclusion In the ESCARVAL-RISK study population presenting registered AHT or meeting the functional diagnostic criteria for AHT, diagnostic inertia appears to be greater in men than in women.
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Affiliation(s)
- Vicente Pallares-Carratala
- Health Surveillance Unit, Castellon Mutual Insurance Union, Castellón, Spain
- Department of Medicine, Jaume I University, Castellón, Spain
| | | | | | | | | | | | - Jose L. Alfonso-Sanchez
- Department of Preventive Medicine and Public Health, School of Medicine, University of Valencia, Valencia, Spain
- Preventive Medicine Department, General Hospital of Valencia, Valencia, Spain
| | - Jorge Navarro-Perez
- Biomedical Research Institute INCLIVA, Clinic University Hospital of Valencia, University of Valencia, Valencia, Spain
| | - Jose M. Martin-Moreno
- Department of Preventive Medicine and Public Health, School of Medicine, University of Valencia, Valencia, Spain
- Biomedical Research Institute INCLIVA, Clinic University Hospital of Valencia, University of Valencia, Valencia, Spain
- *Correspondence: Jose M. Martin-Moreno
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Armario P, Brotons C, Elosua R, Alonso de Leciñana M, Castro A, Clarà A, Cortés O, Díaz Rodriguez Á, Herranz M, Justo S, Lahoz C, Pedro-Botet J, Pérez Pérez A, Santamaria R, Tresserras R, Aznar Lain S, Royo-Bordonada MÁ. Statement of the Spanish Interdisciplinary Vascular Prevention Committee on the updated European Cardiovascular Prevention Guidelines. Clin Investig Arterioscler 2021; 33:85-107. [PMID: 33495044 DOI: 10.1016/j.arteri.2020.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 11/16/2020] [Indexed: 11/24/2022]
Abstract
We present the adaptation for Spain of the updated European Cardiovascular Prevention Guidelines. In this update, greater stress is laid on the population approach, and especially on the promotion of physical activity and healthy diet through dietary, leisure and active transport policies in Spain. To estimate vascular risk, note should be made of the importance of recalibrating the tables used, by adapting them to population shifts in the prevalence of risk factors and incidence of vascular diseases, with particular attention to the role of chronic kidney disease. At an individual level, the key element is personalised support for changes in behaviour, adherence to medication in high-risk individuals and patients with vascular disease, the fostering of physical activity, and cessation of smoking habit. Furthermore, recent clinical trials with PCSK9 inhibitors are reviewed, along with the need to simplify pharmacological treatment of arterial hypertension to improve control and adherence to treatment. In the case of patients with type 2 diabetes mellitus and vascular disease or high vascular disease risk, when lifestyle changes and metformin are inadequate, the use of drugs with proven vascular benefit should be prioritised. Lastly, guidelines on peripheral arterial disease and other specific diseases are included, as is a recommendation against prescribing antiaggregants in primary prevention.
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Armario P, Brotons C, Elosua R, Alonso de Leciñana M, Castro A, Clarà A, Cortés O, Díaz Rodriguez Á, Herranz M, Justo S, Lahoz C, Pedro-Botet J, Pérez Pérez A, Santamaria R, Tresserras R, Aznar Lain S, Royo-Bordonada MÁ. [Statement of the Spanish Interdisciplinary Vascular Prevention Committee on the updated European Cardiovascular Prevention Guidelines]. Hipertens Riesgo Vasc 2020; 38:21-43. [PMID: 33069629 DOI: 10.1016/j.hipert.2020.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 07/29/2020] [Indexed: 12/23/2022]
Abstract
We present the adaptation for Spain of the updated European Cardiovascular Prevention Guidelines. In this update, greater stress is laid on the population approach, and especially on the promotion of physical activity and healthy diet through dietary, leisure and active transport policies in Spain. To estimate vascular risk, note should be made of the importance of recalibrating the tables used, by adapting them to population shifts in the prevalence of risk factors and incidence of vascular diseases, with particular attention to the role of chronic kidney disease. At an individual level, the key element is personalised support for changes in behaviour, adherence to medication in high-risk individuals and patients with vascular disease, the fostering of physical activity, and cessation of smoking habit. Furthermore, recent clinical trials with PCSK9 inhibitors are reviewed, along with the need to simplify pharmacological treatment of arterial hypertension to improve control and adherence to treatment. In the case of patients with type 2 diabetes mellitus and vascular disease or high vascular disease risk, when lifestyle changes and metformin are inadequate, the use of drugs with proven vascular benefit should be prioritised. Lastly, guidelines on peripheral arterial disease and other specific diseases are included, as is a recommendation against prescribing antiaggregants in primary prevention.
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Affiliation(s)
- Pedro Armario
- Sociedad Española-Liga Española para la Lucha contra la Hipertensión Arterial, Madrid, España.
| | - Carlos Brotons
- Sociedad Española de Medicina de Familia y Comunitaria, Barcelona, España
| | | | | | - Almudena Castro
- Sociedad Española de Cardiología-Coordinadora Nacional Sección de Prevención, Madrid, España
| | - Albert Clarà
- Sociedad Española de Angiología y Cirugía Vascular, Madrid, España
| | - Olga Cortés
- Asociación Española Pediatría de Atención Primaria, Madrid, España
| | | | - María Herranz
- Federación de Asociaciones de Enfermería Comunitaria y Atención Primaria-FAECAP, Madrid, España
| | | | - Carlos Lahoz
- Sociedad Española de Medicina Interna, Madrid, España
| | | | | | | | - Ricard Tresserras
- Sociedad Española de Salud Pública y Administración Sanitaria-SESPAS, Barcelona, España
| | - Susana Aznar Lain
- Facultad de Ciencias del Deporte, Universidad Castilla La Mancha, Toledo, España
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Coca A. Reflexiones acerca del posicionamiento de SEMERGEN sobre las más recientes guías de hipertensión arterial de Estados Unidos y Europa. Semergen 2019; 45:213-214. [DOI: 10.1016/j.semerg.2019.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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