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Serrat-Costa M, Serra-Martínez Y, Cabrero-García J, Bertrán-Noguer C, Delclos G, Coll-de-Tuero G, Ramos-Blanes R, Ricart W. A new validated international questionnaire on health professionals’ knowledge of hypertension diagnosis. Hipertensión y Riesgo Vascular 2022; 39:24-33. [DOI: 10.1016/j.hipert.2021.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/13/2021] [Accepted: 12/13/2021] [Indexed: 11/30/2022]
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Bayó J, Dalfó A, Barceló MA, Saez M, Roca C, Pallozzi J, Coll-de-Tuero G. The Role First-Day Readings Play in a 3-Day Schedule of Self-Monitoring Home Blood Pressure Based on Prognostic Data. VAMPAHICA Study. Am J Hypertens 2020; 33:154-160. [PMID: 32086520 DOI: 10.1093/ajh/hpz178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 09/19/2019] [Accepted: 11/05/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The optimal schedule for self-monitoring home BP (SMHBP) readings is enormously important in the diagnosis of different phenotypes related to hypertension. The aim of this study was to determine the prognostic capacity of a 3-day SMHBP schedule when using or suppressing the first-day measurements in compiling the results. METHODS A total of 767 newly diagnosed, nontreated patients with no history of cardiovascular disease (CVD) were followed for 6.2 years. As a baseline, office BP measurements were taken for all the patients who then went on to follow a 3-day SMHBP schedule, taking 2 readings in the morning and 2 in the evening. The prognostic calculation was performed with CVD variables. The prognostic capacity of the 3-day schedule was evaluated with and without the first-day readings (12 and 8 readings). RESULTS A total of 223 normotensive subjects (NT), 271 subjects with sustained hypertension (SHT), and 184 white-coat hypertensive subjects (WCH) were followed. The distribution of 98 (14.4%) nonfatal CV events during the follow-up was as follows: WCH 21 (11.4%), NT 9 (4.0%), and SHT 68 (25.1%). No statistically significant differences were observed in the risk of CV events (OR) for the 2 groups of hypertensives, irrespective of the schedule of readings used (SHT with vs. without first-day readings: 8.81 (4.28-18.15) vs. 8.61 (4.15-17.85) and WCH with vs. without first-day readings: 2.71(1.13-6.47) vs. 3.40 (1.49-7.78)). CONCLUSIONS Our findings show that first-day readings do not need to be discarded in order to calculate the final value of an SMHBP schedule.
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Affiliation(s)
- Joan Bayó
- MEHTARISC Group. Unitat de Suport a la Recerca Girona, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Girona, Spain
- CAP El Clot. SAP Litoral. Institut Català de la Salut. Barcelona. Spain
| | - Antoni Dalfó
- MEHTARISC Group. Unitat de Suport a la Recerca Girona, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Girona, Spain
| | - Maria A Barceló
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- MEHTARISC Group. Unitat de Suport a la Recerca Girona, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Girona, Spain
| | - Marc Saez
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- MEHTARISC Group. Unitat de Suport a la Recerca Girona, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Girona, Spain
| | - Carme Roca
- CAP El Clot. SAP Litoral. Institut Català de la Salut. Barcelona. Spain
| | - Julia Pallozzi
- CAP El Clot. SAP Litoral. Institut Català de la Salut. Barcelona. Spain
| | - Gabriel Coll-de-Tuero
- MEHTARISC Group. Unitat de Suport a la Recerca Girona, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Girona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Medical Sciences, University of Girona, Girona, Spain
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Maynou L, Coll-de-Tuero G, Saez M. The effects of copayment in primary health care: evidence from a natural experiment. Eur J Health Econ 2019; 20:1237-1248. [PMID: 31350623 DOI: 10.1007/s10198-019-01089-4] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 07/12/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Evaluate the effects of the 'euro per prescription' on primary health care services (number of doctor visits), through a retrospective cohort study of health care users in Catalonia (Spain). This policy, implemented in Catalonia on 23 June 2012, only lasted 6 months. This policy was introduced to improve budgetary imbalances in Spain and boost the regional and national governments' budgets. METHODS We used a retrospective cohort, composed of individuals who had had contact with primary healthcare services between January 1, 2005 and December 31, 2012. The econometric specification followed is a hurdle model. RESULTS Our results show that from October 2012 onwards there was a decrease in the average number of overall visits, particularly for individuals aged 65 years or more. However, this decline cannot be entirely attributed to the introduction of the euro per prescription policy as in October of that same year the Spanish government introduced its pharmaceutical copayment for pensioners. CONCLUSIONS The policies appraised in this paper reveal a clear deterrent effect among vulnerable individuals such as those with the highest probability of being unemployed and/or those individuals with chronic conditions.
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Affiliation(s)
- Laia Maynou
- Department of Health Policy, London School of Economics and Political Science (LSE), London, UK.
- Center for Research in Health and Economics (CRES), Universitat Pompeu Fabra, Barcelona, Spain.
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, Spain.
- CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain.
| | - Gabriel Coll-de-Tuero
- CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain
- MEHTARISC Group. Unitat de Suport a la Recerca Girona, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Girona, Spain
- Department of Medical Sciences, University of Girona, Girona, Spain
| | - Marc Saez
- Center for Research in Health and Economics (CRES), Universitat Pompeu Fabra, Barcelona, Spain
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain
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Coll-de-Tuero G, Comas-Cufí M, Rodríguez-Poncelas A, Barrot-de-la Puente J, Blanch J, Figa-Vaello J, Barceló MA, Saez M. Prognostic Value of the Estimated Glomerular Filtration Rate Decline in Hypertensive Patients Without Chronic Kidney Disease. Am J Hypertens 2019; 32:890-899. [PMID: 30794282 DOI: 10.1093/ajh/hpz029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 02/08/2019] [Accepted: 02/20/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Our objective of this study was to determine if rate of estimated glomerular filtration rate (eGFR) decline and its intensity was associated with cardiovascular risk and death in patients with hypertension whose baseline eGFR was higher than 60 ml/minute/1.73 m2. METHODS This study comprised 2,516 patients with hypertension who had had at least 2 serum creatinine measurements over a 4-year period. An eGFR reduction of ≥10% per year has been deemed as high eGFR and a reduction in eGFR of less than 10% per year as a low decline. The end points were coronary artery disease, stroke, transitory ischemic accident, peripheral arterial disease, heart failure, atrial fibrillation, and death from any cause. Cox regression analyses adjusted for potentially confounding factors were conducted. RESULTS A total of 2,354 patients with low rate of eGFR decline and 149 with high rate of eGFR decline were analyzed. The adjusted model shows that a -10% rate of eGFR decline per year is associated with a higher risk of the primary end point (HR 1.9; 95% CI 1.1-3.5; P = 0.02) and arteriosclerotic vascular disease (HR 2.2; 95% CI 1.2-4.2; P < 0.001) in all hypertensive groups. The variables associated to high/low rate of eGFR decline in the logistic regression model were serum creatinine (OR 3.35; P < 0.001), gender, women (OR 15.3; P < 0.001), tobacco user (OR 1.9; P < 0.002), and pulse pressure (OR 0.99; P < 0.05). CONCLUSIONS A rate of eGFR decline equal to or higher than -10% per year is a marker of cardiovascular risk for patients with arterial hypertension without chronic kidney disease at baseline. It may be useful to consider intensifying the global risk approach for these patients.
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Affiliation(s)
- Gabriel Coll-de-Tuero
- MEHTARISC Group, Unitat de Suport a la Recerca Girona, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Girona, Spain
- Department of Medical Sciences, University of Girona, Girona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Marc Comas-Cufí
- MEHTARISC Group, Unitat de Suport a la Recerca Girona, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Girona, Spain
| | - Antonio Rodríguez-Poncelas
- MEHTARISC Group, Unitat de Suport a la Recerca Girona, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Girona, Spain
| | - Joan Barrot-de-la Puente
- MEHTARISC Group, Unitat de Suport a la Recerca Girona, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Girona, Spain
| | - Jordi Blanch
- MEHTARISC Group, Unitat de Suport a la Recerca Girona, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Girona, Spain
| | - Josep Figa-Vaello
- MEHTARISC Group, Unitat de Suport a la Recerca Girona, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Girona, Spain
| | - Maria A Barceló
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, Spain
| | - Marc Saez
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, Spain
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Coll-de-Tuero G, Saez M, Rodriguez-Poncelas A, Bayó-Llibre J, Beltran-Vilella M, Reyes-Negre C, Dalfó-Baqué A, Barceló M. What is the optimal cut-off threshold in self-home blood pressure measurement?: A cohort study according to STROBE statement. Medicine (Baltimore) 2019; 98:e14817. [PMID: 30855506 PMCID: PMC6417491 DOI: 10.1097/md.0000000000014817] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Two aspects arise concerning the use of self-measured blood pressure monitoring to diagnose white-coat hypertension (WCH): the presence of target organ damage (TOD) and the normal cut-off threshold. This study aims to evaluate the cardiovascular risk of WCH according to different self-measured blood pressure normal cut-off thresholds and the influence of TOD at baseline.In all, 678 patients were followed for 6.2 years; 223 normotensive patients, 271 patients with sustained hypertension (HT), and 184 with WCH. TOD was defined as: left ventricular hypertrophy according to ECG, albuminuria, or low estimated glomerular filtration rate. The risk for different cutting points of self-measured blood pressure (<135/85 mm Hg, <130/85 mm Hg, and <130/80 mm Hg) has been determined.The patients with HT experienced an increase in cardiovascular risk and death higher than the normotensive patients (odds ratio [OR] 7.9, 95% confidence interval [CI] 3.8-16.2 for sustained HT; and OR 3.5, 95% CI 1.6-7.4 for WCH). This was observed for all the cut-off thresholds analyzed. In white-coat hypertensive patients (cut-off <135/85 mm Hg) with TOD, the risk was higher than in normotensive patients (OR 4.5; 95% CI 1.9-10.6). Using a self-monitoring blood pressure cut-off threshold of <130/80 mm Hg without TOD at baseline, the WCH cases exhibited no differences in risk to the normotensive patients (OR 2.0, 95% CI 0.5-7.7).The decisions being taken for patients with WCH based on the presence of TOD and a self-administered home monitoring blood pressure measurement cut-off point probably lower than the one that is currently recommended.
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Affiliation(s)
- Gabriel Coll-de-Tuero
- METHARISC Group, USR Girona, IdIAP Gol i Gorina
- Department of Medical Sciences, University of Girona
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Marc Saez
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | | | | | | | | | | | - MªAntonia Barceló
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
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Rodríguez-Poncelas A, Barceló MA, Saez M, Coll-de-Tuero G. Duration and dosing of Proton Pump Inhibitors associated with high incidence of chronic kidney disease in population-based cohort. PLoS One 2018; 13:e0204231. [PMID: 30332411 PMCID: PMC6192564 DOI: 10.1371/journal.pone.0204231] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 09/05/2018] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Proton Pump Inhibitors (PPIs) have been associated with chronic kidney disease (CKD). Our objective was to quantify the association between PPI use and incident CKD in a population-based cohort. METHODS AND FINDINGS We used a population-based retrospective cohort, including people aged 15 years or over, between January 1, 2005 and December 31, 2012. PPI use was measured in a follow-up session by recording prescriptions. Incident CKD was defined as an estimated glomerular filtration rate < 60 ml/ min/1.73 m2 and/or urinary albumin level to creatinine level ≥ 30 mg/g, in two or more determinations over a period of at least 3 months of the follow-up. Proton Pump Inhibitor use was associated with incident CKD in analysis adjusted for different clinical variables (Hazard Ratio (HR) 1.18; 95% CI 1.04-1.51) in individuals who used PPI in the basal visit (HR 1.37; 95% CI 1.25-1.50) and in those who started to use PPI during the follow-up. High doses of PPI increased the risk of incident CKD (HR 1.92; 95%CI 1.00-6.19) for any type of exposure to PPIs (HR 2.40; 95%CI 1.65-3.46) and for individuals who used high doses throughout the follow-up. This risk of incident CKD increased after three months' exposure to PPIs, (HR1.78; 95% CI 1.39-2.25) between the third and sixth months and (HR 1.30; 95%CI 1.07-1.72) after the sixth month. CONCLUSIONS PPI use is associated with a higher risk of incident CKD. This association is greater for high doses and becomes apparent after three months' exposure.
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Affiliation(s)
- Antonio Rodríguez-Poncelas
- Research Support Unit, University Institute of Research in Primary Care JordiGol (IdIAPGol), Girona, Spain
| | - Maria A. Barceló
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Marc Saez
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Gabriel Coll-de-Tuero
- Research Support Unit, University Institute of Research in Primary Care JordiGol (IdIAPGol), Girona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Medical Sciences, University of Girona, Girona, Spain
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Rodriguez-Poncelas A, Coll-de-Tuero G, Blanch J, Comas-Cufí M, Saez M, Barceló MA. Prediabetes is associated with glomerular hyperfiltration in a European Mediterranean cohort study. J Nephrol 2018; 31:743-749. [PMID: 30151699 DOI: 10.1007/s40620-018-0524-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 08/12/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Glomerular hyperfiltration is well recognized as an early renal alteration in subjects with diabetes mellitus. However, what is not well-known is whether hyperfiltration also occurs in the early stages of hyperglycaemia, for instance in prediabetes. Identifying subjects with glomerular hyperfiltration from among those with prediabetes might be helpful to implement preventive and therapeutic strategies. This study aimed to investigate the association of prediabetes with glomerular hyperfiltration and its associated variables. METHODS A representative sample of 9238 people aged ≥ 30 years and whose entire clinical and laboratory data were available, were included in this study. Hyperfiltration was defined as an estimated glomerular filtration rate (eGFR) above the age- and gender-specific 95th percentile. The eGFR was assessed using the Chronic Kidney Disease Epidemiology Collaboration equation. RESULTS After adjustment for age, gender, body mass index, systolic blood pressure and diastolic blood pressure, cholesterol, log (triglycerides), high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, serum uric acid, smoking status, hypertension, and use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, fasting plasma glucose (FPG) was found to be independently positively associated with eGFR. The hazard ratios (95% confidence interval) for hyperfiltration were 1.61 (1.28-2.03) and 2.30 (1.89-2.79) for prediabetes and diabetes, respectively, when compared with participants with normoglycemia. CONCLUSION Prediabetes was associated with glomerular hyperfiltration. Longitudinal studies are needed to investigate whether hyperfiltration in prediabetes is associated with a later decline in eGFR.
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Affiliation(s)
| | - Gabriel Coll-de-Tuero
- METHARISC Group, USR Girona, IdIAP Gol i Gorina, Girona, Spain.,Department of Medical Sciences, University of Girona, Girona, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Jordi Blanch
- METHARISC Group, USR Girona, IdIAP Gol i Gorina, Girona, Spain
| | - Marc Comas-Cufí
- METHARISC Group, USR Girona, IdIAP Gol i Gorina, Girona, Spain
| | - Marc Saez
- METHARISC Group, USR Girona, IdIAP Gol i Gorina, Girona, Spain. .,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain. .,Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Carrer de la Universitat de Girona 10, Campus de Montilivi, 17003, Girona, Spain.
| | - Maria Antònia Barceló
- METHARISC Group, USR Girona, IdIAP Gol i Gorina, Girona, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Carrer de la Universitat de Girona 10, Campus de Montilivi, 17003, Girona, Spain
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Barceló MA, Rodríguez-Poncelas A, Saez M, Coll-de-Tuero G. The dynamic behaviour of metabolic syndrome and its components in an eight-year population-based cohort from the Mediterranean. PLoS One 2017; 12:e0176665. [PMID: 28545089 PMCID: PMC5436648 DOI: 10.1371/journal.pone.0176665] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 04/15/2017] [Indexed: 01/20/2023] Open
Abstract
Background The significant rise in the prevalence of obesity coincides with the considerable increase in the prevalence of metabolic syndrome (MS) currently being observed worldwide. The components of MS are not static and their dynamics, such as the order of their occurrence, or the time of exposure to them are, as yet, unknown but could well be clinically relevant. Our objective was to study the dynamic behaviour of MS and its components in a large population-based cohort from a Mediterranean region. Methods and findings Our study employed a retrospective cohort (between January 1, 2005 and December 31, 2012) made up of individuals from the general population in a region in the northeast of Catalonia, Spain. Given that most of the explicative variables of the risk of having MS were time dependent and, therefore, the risk was not proportional, we used the Andersen-Gill (AG) model to perform a multivariate survival analysis and inferences were performed using a Bayesian framework. Thirty-nine percent of the participants developed MS; 44.6% of them with a single limited episode. Triglycerides and low HDL cholesterol, together with obesity, are components associated with the first occurrence of MS. Components related to the metabolism of glucose are associated with a medium risk of having a first episode of MS, and those related to blood pressure are associated with a lower risk. When the components related to blood pressure and the metabolism of glucose appear first, they determine the appearance of the first episode of MS. The variables concerning the persistence of MS are those that correspond to clinical conditions that do not have well-established drug treatment criteria. Conclusions Our results suggest that the components related to the metabolism of glucose and to high blood pressure appear early on and act as biomarkers for predicting MS, while the components related to obesity and dyslipidaemia, although essential for the development of MS, appear later. Making lifestyle changes reduces the conditions associated with the persistence of MS.
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Affiliation(s)
- Maria A. Barceló
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Antonio Rodríguez-Poncelas
- Research Support Unit. University Institute of Research in Primary Care Jordi Gol (IdIAP Gol), Girona, Spain
| | - Marc Saez
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- * E-mail:
| | - Gabriel Coll-de-Tuero
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Research Support Unit. University Institute of Research in Primary Care Jordi Gol (IdIAP Gol), Girona, Spain
- Department of Medical Sciences, University of Girona, Girona, Spain
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Paz MA, de-La-Sierra A, Sáez M, Barceló MA, Rodríguez JJ, Castro S, Lagarón C, Garrido JM, Vera P, Coll-de-Tuero G. Treatment efficacy of anti-hypertensive drugs in monotherapy or combination: ATOM systematic review and meta-analysis of randomized clinical trials according to PRISMA statement. Medicine (Baltimore) 2016; 95:e4071. [PMID: 27472680 PMCID: PMC5265817 DOI: 10.1097/md.0000000000004071] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The relative efficacy of antihypertensive drugs/combinations is not well known. Identifying the most effective ones and the patients' characteristics associated with best performance of the drugs will improve management of hypertensive patients. OBJECTIVE To assess the blood pressure (BP) reduction attributed to antihypertensive drugs and identify characteristics associated with BP decrease. DATA SOURCES MEDLINE, Cochrane Central Register of Controlled Trials from inception through July 2012 and selected papers. STUDY ELIGIBILITY CRITERIA Double-blind, randomized clinical trials whose main result was the reduction in BP by antihypertensive treatment, with study population ≥50 or ≥25 if the study was a crossover, follow-up of at least 8 weeks, and available required data. STUDY APPRAISAL AND SYNTHESIS METHODS Study data were independently extracted by multiple observers and introduced in an electronic database. Inconsistencies were resolved by discussion and referral back to the original articles. Meta-analysis was performed according to PRISMA statement and using a Bayesian framework. MAIN OUTCOME(S) AND MEASURE(S) Mean decrease in systolic (SBP) and diastolic blood pressure (DBP) achieved by each drug or combination. RESULTS Two hundred eight trials including 94,305 patients were identified. In monotherapy, most drugs achieved 10 to 15 mm Hg SBP and 8 to 10 mm Hg DBP decreases.Olmesartan/amlodipine, olmesartan/hydrochlorothiazide, felodipine/metoprolol, and valsartan/hydrochlorothiazide were the combinations leading to the greatest mean SBP reductions (>20 mm Hg). Female sex and body mass index >25 kg/m were associated with more pronounced SBP and DBP reductions, whereas Afro-American ethnicity was associated with BP reductions smaller than the median. Results were adjusted by study duration, cardiovascular disease, and diabetes mellitus. Still, the estimation was performed using the mean administered doses, which do not exactly match those of the available drug formats. LIMITATIONS Data corresponded to those obtained in each of the included trials; the analysis of the combinations was limited to the most recent ones; estimations were performed using the mean administered doses. CONCLUSIONS AND IMPLICATIONS Certain drug combinations achieve BP reductions ranging from 20 to 25/10 to 15 mm Hg. Sex, ethnicity, and obesity are associated with antihypertensive response. This information can contribute to better selection of the antihypertensive drug, depending on the magnitude of pretreatment BP elevation. Guidelines should be revised.
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Affiliation(s)
- Marco A. Paz
- Hospital de Santa Caterina, Girona
- Department of Medical Sciences, University of Girona
- Correspondence: Marco A. Paz, Hospital de Santa Caterina, Girona, Spain, C/ Dr. Castany s/n, 17190, Salt, Girona, Spain (e-mail: )
| | | | - Marc Sáez
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona
- CIBER of Epidemiology and Public Health (CIBERESP)
| | - María Antonia Barceló
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona
- CIBER of Epidemiology and Public Health (CIBERESP)
| | | | | | | | | | | | - Gabriel Coll-de-Tuero
- CIBER of Epidemiology and Public Health (CIBERESP)
- Department of Medical Sciences, University of Girona
- Research Unit, USR Girona, IdIAP Gol i Gorina, ICS, Spain
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Ruiz-Tamayo I, Franch-Nadal J, Mata-Cases M, Mauricio D, Cos X, Rodriguez-Poncelas A, Barrot J, Coll-de-Tuero G, Mundet-Tudurí X. Noninsulin Antidiabetic Drugs for Patients with Type 2 Diabetes Mellitus: Are We Respecting Their Contraindications? J Diabetes Res 2016; 2016:7502489. [PMID: 26881258 PMCID: PMC4736814 DOI: 10.1155/2016/7502489] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 12/16/2015] [Indexed: 11/25/2022] Open
Abstract
AIM To assess prescribing practices of noninsulin antidiabetic drugs (NIADs) in T2DM with several major contraindications according to prescribing information or clinical guidelines: renal failure, heart failure, liver dysfunction, or history of bladder cancer. METHODS Cross-sectional, descriptive, multicenter study. Electronic medical records were retrieved from all T2DM subjects who attended primary care centers pertaining to the Catalan Health Institute in Catalonia in 2013 and were pharmacologically treated with any NIAD alone or in combination. RESULTS Records were retrieved from a total of 255,499 pharmacologically treated patients. 78% of patients with some degree of renal impairment (glomerular filtration rate (GFR) < 60 mL/min) were treated with metformin and 31.2% with sulfonylureas. Even in the event of severe renal failure (GFR < 30 mL/min), 35.3% and 22.5% of patients were on metformin or sulfonylureas, respectively. Moreover, metformin was prescribed to more than 60% of patients with moderate or severe heart failure. CONCLUSION Some NIADs, and in particular metformin, were frequently used in patients at high risk of complications when they were contraindicated. There is a need to increase awareness of potential inappropriate prescribing and to monitor the quality of prescribing patterns in order to help physicians and policymakers to yield better clinical outcomes in T2DM.
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Affiliation(s)
- Irene Ruiz-Tamayo
- Primary Health Care Center La Torrassa, Consorci Sanitari Integral, Ronda Torrassa 151-153, 08903 L'Hospitalet de Llobregat, Spain
- DAP-Cat Group, Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Sardenya 375, 08006 Barcelona, Spain
| | - Josep Franch-Nadal
- DAP-Cat Group, Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Sardenya 375, 08006 Barcelona, Spain
- Primary Health Care Center Raval Sud, Gerència d'Àmbit d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Avinguda Drassanes 17-21, 08001 Barcelona, Spain
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Monforte de Lemos 3-5, 28029 Madrid, Spain
- *Josep Franch-Nadal:
| | - Manel Mata-Cases
- DAP-Cat Group, Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Sardenya 375, 08006 Barcelona, Spain
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Monforte de Lemos 3-5, 28029 Madrid, Spain
- Primary Health Care Center La Mina, Gerència d'Àmbit d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Mar S/N, 08930 Sant Adrià de Besòs, Spain
| | - Dídac Mauricio
- DAP-Cat Group, Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Sardenya 375, 08006 Barcelona, Spain
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Monforte de Lemos 3-5, 28029 Madrid, Spain
- Department of Endocrinology & Nutrition, Health Sciences Research Institute and Hospital Universitari Germans Trias i Pujol, Carretera Canyet S/N, 08916 Badalona, Spain
| | - Xavier Cos
- DAP-Cat Group, Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Sardenya 375, 08006 Barcelona, Spain
- Primary Health Care Center Sant Martí de Provençals, Gerència d'Àmbit d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Fluvià 211, 08020 Barcelona, Spain
| | - Antonio Rodriguez-Poncelas
- DAP-Cat Group, Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Sardenya 375, 08006 Barcelona, Spain
- Primary Health Care Center Anglès, Gerència d'Àmbit d'Atenció Primària Girona, Institut Català de la Salut, Carretera de Girona S/N, 17160 Anglès, Spain
| | - Joan Barrot
- DAP-Cat Group, Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Sardenya 375, 08006 Barcelona, Spain
- Primary Health Care Center Salt, Gerència d'Àmbit d'Atenció Primària Girona, Institut Català de la Salut, Manel de Falla 35, 17190 Salt, Spain
| | - Gabriel Coll-de-Tuero
- DAP-Cat Group, Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Sardenya 375, 08006 Barcelona, Spain
- Primary Health Care Center Anglès, Gerència d'Àmbit d'Atenció Primària Girona, Institut Català de la Salut, Carretera de Girona S/N, 17160 Anglès, Spain
| | - Xavier Mundet-Tudurí
- DAP-Cat Group, Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Sardenya 375, 08006 Barcelona, Spain
- Primary Health Care Center El Carmel, Gerència d'Àmbit d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Murtra 130, 08032 Barcelona, Spain
- Autonomous University of Barcelona, Campus de Bellaterra, 08193 Bellaterra, Spain
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Rodriguez-Poncelas A, Coll-de-Tuero G, Saez M, Garrido-Martín JM, Millaruelo-Trillo JM, Barrot de-la-Puente J, Franch-Nadal J. Comparison of different vascular risk engines in the identification of type 2 diabetes patients with high cardiovascular risk. BMC Cardiovasc Disord 2015; 15:121. [PMID: 26464076 PMCID: PMC4605091 DOI: 10.1186/s12872-015-0120-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 10/01/2015] [Indexed: 12/27/2022] Open
Abstract
Background Some authors consider that secondary prevention should be conducted for all DM2 patients, while others suggest that the drug preventive treatment should start or be increased depending on each patient’s individual CVR, estimated using cardiovascular or coronary risk functions to identify the patients with a higher CVR. The principal objective of this study was to assess three different cardiovascular risk prediction models in type 2 diabetes patients. Methods Multicentre, cross-sectional descriptive study of 3,041 patients with type 2 diabetes and no history of cardiovascular disease. The demographic, clinical, analytical, and cardiovascular risk factor variables associated with type 2 diabetes were analysed. The risk function and probability that a cardiovascular disease could occur were estimated using three risk engines: REGICOR, UKPDS and ADVANCE. A patient was considered to have a high cardiovascular risk when REGICOR ≥ 10 % or UKPDS ≥ 15 % in 10 years or when ADVANCE ≥ 8 % in 4 years. Results The ADVANCE and UKPDS risk engines identified a higher number of diabetic patients with a high cardiovascular risk (24.2 % and 22.7 %, respectively) compared to the REGICOR risk engine (10.2 %). The correlation using the REGICOR risk engine was low compared to UKPDS and ADVANCE (r = 0.288 and r = 0.153, respectively; p < 0.0001). The agreement values in the allocation of a particular patient to the high risk group was low between the REGICOR engine and the UKPDS and ADVANCE engines (k = 0.205 and k = 0.123, respectively; p < 0.0001) and acceptable between the ADVANCE and UKPDS risk engines (k = 0.608). Conclusions There are discrepancies between the general population and the type 2 diabetic patient-specific risk engines. The results of this study indicate the need for a prospective study which validates specific equations for diabetic patients in the Spanish population, as well as research on new models for cardiovascular risk prediction in these patients.
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Affiliation(s)
- Antonio Rodriguez-Poncelas
- Primary Healtcare Center (PHC) Anglès, Girona, Spain. .,Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.
| | - Gabriel Coll-de-Tuero
- Primary Healtcare Center (PHC) Anglès, Girona, Spain. .,Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain. .,Department of Medical Sciences, University of Girona, Girona, Spain. .,Research Unit, IdIAP, Maluquer Salvador,11, 17002, Girona, Spain.
| | - Marc Saez
- Research Group in Statistic,Applied economy and Health. (GRECS), University of Girona, Girona, Spain.
| | - José M Garrido-Martín
- Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.
| | | | - Joan Barrot de-la-Puente
- Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain. .,PHC Salt, ICS, Salt, Girona, Spain.
| | - Josep Franch-Nadal
- Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain. .,PHC Raval Sud, ICS, Barcelona, Spain.
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12
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Affiliation(s)
| | - Gabriel Coll-de-Tuero
- Department of Medical Sciences, University of Girona, Girona, Spain.,Research Unit, IdIAP Gol i Gorina, Catalan Healthcare Institute (ICS), Girona, Spain
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13
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Franch-Nadal J, Roura-Olmeda P, Benito-Badorrey B, Rodriguez-Poncelas A, Coll-de-Tuero G, Mata-Cases M. Metabolic control and cardiovascular risk factors in type 2 diabetes mellitus patients according to diabetes duration. Fam Pract 2015; 32:27-34. [PMID: 25194144 DOI: 10.1093/fampra/cmu048] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Control of glycaemic levels as well as cardiovascular risk factors (CVRF) is essential to prevent the onset of complications associated with type 2 diabetes mellitus (T2DM). AIM To describe the degree of glycaemic control and CVRF in relation to diabetes duration. PATIENTS AND METHODS Multicentre cross-sectional study in T2DM patients seen in primary care centres during 2007. VARIABLES Demographical and clinical characteristics, antidiabetic treatments and development of disease complications. Diabetes duration classification: 0-5, 6-10, 11-20 and >20 years. Logistic regression models were used in the analysis. RESULTS A total of 3130 patients; 51.5% males; mean age: 68±11.7 years; mean diabetes duration:7.0 (±5.6) years, median: 5 (interquartile range:3-9) years; mean HbA1c: 6.84 (±1.5), were analyzed. There has been a progressive decline in HbA1c levels (HbA1c > 7% in 25.8% of patients during the first 5 years and 51.8% after 20 years). Blood pressure values remained relatively stable throughout disease duration. The mean value of low density lipoprotein (LDL) experienced a slight decline with the progression of the disease, but due to the significant increase of cardiovascular disease (CVD) after 20 years of duration, less patients reached the recommended target (LDL < 100mg/dl) in secondary prevention. Logistic regression model controlling for age, sex and CVD showed that diabetes duration was related to glycaemic control (odds ratio: 1.066, 95% confidence interval: 1.050-1.082 per year) but not to blood pressure or LDL control. CONCLUSIONS The degree of glycaemic control and the risk factors in relation to the duration of T2DM followed different patterns. Diabetes duration was associated with a poorer glycaemic control but in general had a limited role in blood pressure control or lipid profile.
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Affiliation(s)
- Josep Franch-Nadal
- Primary Care Center Raval Sud, Barcelona, Spain; Barcelona Ciutat Research Support Unit - IDIAP Jordi Gol, Barcelona, Spain;
| | | | | | | | - Gabriel Coll-de-Tuero
- PCC Anglés, Girona, Spain; Research Unit, Healthcare Institute, Girona, Spain; Translab. Departament of Medical Sciences, University of Girona, Girona, Spain and
| | - Manel Mata-Cases
- Barcelona Ciutat Research Support Unit - IDIAP Jordi Gol, Barcelona, Spain; PCC La Mina, Sant Adrià de Besòs, Barcelona, Spain
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14
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Ferriol C, Tremols S, Jimenez C, Tura A, Sanmartín M, Pagès N, Rodríguez-Poncelas A, Paz-Bermejo M, Saez M, Coll-de-Tuero G. Are There Height-Dependent Differences in Subclinical Vascular Disease in Hypertensive Patients? J Clin Hypertens (Greenwich) 2014; 16:70-6. [DOI: 10.1111/jch.12222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 09/20/2013] [Accepted: 09/27/2013] [Indexed: 11/30/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | - Marc Saez
- Research Group on Statistics; Applied Economics and Health (GRECS); University of Girona; Girona Spain
| | - Gabriel Coll-de-Tuero
- PCC Anglès; IAS; Girona Spain
- Research Unit; IAS; Salt Girona Spain
- Department of Medical Science; University of Girona; Girona Spain
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Coll-de-Tuero G, González-Vázquez S, Rodríguez-Poncelas A, Barceló MA, Barrot-de-la Puente J, Penedo MG, Pose-Reino A, Pena-Seijo M, Saez M. Retinal arteriole-to-venule ratio changes and target organ disease evolution in newly diagnosed hypertensive patients at 1-year follow-up. ACTA ACUST UNITED AC 2013; 8:83-93. [PMID: 24239162 DOI: 10.1016/j.jash.2013.10.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 09/20/2013] [Accepted: 10/02/2013] [Indexed: 11/16/2022]
Abstract
There is no agreement on the systematic exploration of the fundus oculi (FO) in hypertensive patients, and it is unknown whether the evolution of retinal microcirculatory alterations has prognostic value or not. The aim of this study was to investigate whether the evolution of the arteriole-to-venule ratio (AVR) in newly-diagnosed hypertensive patients is associated with better or worse evolution of target organ damage (TOD) during 1 year. A cohort of 133 patients with newly-diagnosed untreated hypertension was followed for 1 year. At baseline and follow-up, all patients underwent a physical examination, self-blood pressure measurement, ambulatory blood pressure monitoring, blood and urine analysis, electrocardiogram, and retinography. The endpoint was the favourable evolution of TOD and the total amount of TOD, according to the baseline AVR and the baseline and final difference of the AVR. A total of 133 patients were analyzed (mean age, 57 ± 10.7 years; 59% men). No differences were found in the decrease in blood pressure or antihypertensive treatment between quartiles of baseline AVR or baseline-final AVR difference. Patients with a difference between baseline and final AVR in the highest quartile (>0.0817) had a favorable evolution of left ventricular hypertrophy (odds ratio, 14.9; 95% confidence interval, 1.08-206.8) and the amount of TOD (odds ratio, 2.22; 95% confidence interval, 1.03-6.05). No favorable evolution was found of glomerular filtration rate. There is an association between the evolution of the AVR and the favorable evolution of TOD. Patients with greater increase of AVR have significantly better evolution of left ventricular hypertrophy and amount of TOD.
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Affiliation(s)
- Gabriel Coll-de-Tuero
- Research Unit, Institut d'Assistència Sanitària, IAS, Girona, Spain; CIBER of Epidemiology and Public Health, CIBERESP, Spain; Department of Medical Sciences, University of Girona, Girona, Spain
| | - Sonia González-Vázquez
- Artificial Vision and Pattern Recognition Group, VARPA, Department of Computing, University of A Coruña, Spain
| | | | - María Antònia Barceló
- CIBER of Epidemiology and Public Health, CIBERESP, Spain; Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Spain
| | | | - Manuel G Penedo
- Artificial Vision and Pattern Recognition Group, VARPA, Department of Computing, University of A Coruña, Spain
| | - Antonio Pose-Reino
- Internal Medicine Service, Hospital de Conxo, Santiago de Compostela, Spain
| | - Marta Pena-Seijo
- Internal Medicine Service, Hospital de Conxo, Santiago de Compostela, Spain
| | - Marc Saez
- CIBER of Epidemiology and Public Health, CIBERESP, Spain; Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Spain.
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16
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Mata-Cases M, Benito-Badorrey B, Roura-Olmeda P, Franch-Nadal J, Pepió-Vilaubí JM, Saez M, Coll-de-Tuero G. Clinical inertia in the treatment of hyperglycemia in type 2 diabetes patients in primary care. Curr Med Res Opin 2013; 29:1495-502. [PMID: 23944631 DOI: 10.1185/03007995.2013.833089] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To assess clinical inertia, defined as failure to intensify antidiabetic treatment of patients who have not achieved the HbA1c therapeutic goal (≤7%). RESEARCH DESIGN AND METHODS Multicenter cross-sectional study. Clinical inertia was assessed in a random sample of type 2 diabetes mellitus (T2DM) patients seen in primary care centers. RESULTS A total of 2783 patients (51.3% males; mean age: 68 [±11.5] years; diabetes duration: 7.1 [±5.6] years; mean HbA1c: 6.8 [±1.5]) were analyzed. Of those, 997 (35.8%) had HbA1c >7%. Treatment was intensified in 66.8% and consisted of: dose increase (40.5%); addition of oral antidiabetic (45.8%); or insulin treatment initiation (3.7%). Mean HbA1c values in patients for whom treatment was intensified vs. non-intensified were 8.4% (±1.2) vs. 8.2% (±1.2), p < 0.05. Clinical inertia was detected in 33.2% of patients and diminished along with treatment complexity: lifestyle changes only (38.8%), oral monotherapy (40.3%), combined oral antidiabetics (34.5%), insulin monotherapy (26.1%) and combination of insulin and oral antidiabetics (21.4%). Clinical inertia decreased as HbA1c increased: 37.3% for HbA1c values ranging between 7.1%-8%; 29.4% for the 8.1%-9% HbA1c range and 27.1% for HbA1c ≥9%. Multivariate analysis confirmed that diabetes duration, step of treatment and HbA1c were related to inertia. For each unit of HbA1c increase clinical inertia decreased 47% (OR: 0.53). LIMITATIONS The retrospective design of the study precluded an accurate investigation about reasons for lack of intensification that could actually be justified by some patient conditions, especially patients' lack of adherence. CONCLUSIONS Clinical inertia affected one third of T2DM patients with poor glycemic control and was greater in patients treated with only lifestyle changes or oral monotherapy. Treatment changes were performed when mean HbA1c values were 1.4 points above therapeutic goals.
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Affiliation(s)
- Manel Mata-Cases
- Primary Care Center (PCC) La Mina, Sant Adrià de Besòs , Barcelona , Spain
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Coll-de-Tuero G, Mata-Cases M, Rodriguez-Poncelas A, Pepió JMA, Roura P, Benito B, Franch-Nadal J, Saez M. Chronic kidney disease in the type 2 diabetic patients: prevalence and associated variables in a random sample of 2642 patients of a Mediterranean area. BMC Nephrol 2012; 13:87. [PMID: 22905926 PMCID: PMC3537582 DOI: 10.1186/1471-2369-13-87] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Accepted: 07/27/2012] [Indexed: 12/22/2022] Open
Abstract
Background Kidney disease is associated with an increased total mortality and cardiovascular morbimortality in the general population and in patients with Type 2 diabetes. The aim of this study is to determine the prevalence of kidney disease and different types of renal disease in patients with type 2 diabetes (T2DM). Methods Cross-sectional study in a random sample of 2,642 T2DM patients cared for in primary care during 2007. Studied variables: demographic and clinical characteristics, pharmacological treatments and T2DM complications (diabetic foot, retinopathy, coronary heart disease and stroke). Variables of renal function were defined as follows: 1) Microalbuminuria: albumin excretion rate & 30 mg/g or 3.5 mg/mmol, 2) Macroalbuminuria: albumin excretion rate & 300 mg/g or 35 mg/mmol, 3) Kidney disease (KD): glomerular filtration rate according to Modification of Diet in Renal Disease < 60 ml/min/1.73 m2 and/or the presence of albuminuria, 4) Renal impairment (RI): glomerular filtration rate < 60 ml/min/1.73 m2, 5) Nonalbuminuric RI: glomerular filtration rate < 60 ml/min/1.73 m2 without albuminuria and, 5) Diabetic nephropathy (DN): macroalbuminuria or microalbuminuria plus diabetic retinopathy. Results The prevalence of different types of renal disease in patients was: 34.1% KD, 22.9% RI, 19.5% albuminuria and 16.4% diabetic nephropathy (DN). The prevalence of albuminuria without RI (13.5%) and nonalbuminuric RI (14.7%) was similar. After adjusting per age, BMI, cholesterol, blood pressure and macrovascular disease, RI was significantly associated with the female gender (OR 2.20; CI 95% 1.86–2.59), microvascular disease (OR 2.14; CI 95% 1.8–2.54) and insulin treatment (OR 1.82; CI 95% 1.39–2.38), and inversely associated with HbA1c (OR 0.85 for every 1% increase; CI 95% 0.80–0.91). Albuminuria without RI was inversely associated with the female gender (OR 0.27; CI 95% 0.21–0.35), duration of diabetes (OR 0.94 per year; CI 95% 0.91–0.97) and directly associated with HbA1c (OR 1.19 for every 1% increase; CI 95% 1.09–1.3). Conclusions One-third of the sample population in this study has KD. The presence or absence of albuminuria identifies two subgroups with different characteristics related to gender, the duration of diabetes and metabolic status of the patient. It is important to determine both albuminuria and GFR estimation to diagnose KD.
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Affiliation(s)
- Gabriel Coll-de-Tuero
- Primary Healthcare Center Anglès, Department of Medical Sciences, University of Girona, Girona, Spain
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Coll-de-Tuero G, López-Pousa S, Vilalta-Franch J. ¿Cuándo suspender el tratamiento farmacológico específico en el Alzheimer? Aten Primaria 2011; 43:565-7. [DOI: 10.1016/j.aprim.2011.09.001] [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] [Received: 08/30/2011] [Accepted: 09/02/2011] [Indexed: 10/16/2022] Open
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Coll-de-Tuero G, Rodríguez-Poncelas A, Vargas-Vila S, Roig-Buscató C, Alsina-Carreras N, Comalada-Daniel C, Beltran-Vilella M, Roman-Pomares M, Planas-Pujol X, Garre-Olmo J. Ejercicio físico y calidad de vida autopercibida en el anciano hipertenso. Hipertensión y Riesgo Vascular 2009. [DOI: 10.1016/j.hipert.2009.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Coll-de-Tuero G, Foguet-Boreu Q, Rodriguez-Poncelas A, Creus-Bosch R, Sanmartín-Albertos M, Saez-Zafra M, Antònia Barceló-Radó M, Salleras-Marcó N. Valores de normalidad de la automedida de la presión arterial en relación con la presencia de lesión en los órganos diana. Datos del estudio VAMPAHICA. Med Clin (Barc) 2008; 130:321-6. [DOI: 10.1157/13117348] [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: 11/21/2022]
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