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Gijón-Conde T, Rubio E, Gorostidi M, Vinyoles E, Armario P, Rodilla E, Segura J, Divisón-Garrote JA, García-Donaire JA, Molinero A, Ruilope LM. 2021 Spanish Society of Hypertension position statement about telemedicine. Hipertens Riesgo Vasc 2021; 38:186-196. [PMID: 33888438 PMCID: PMC8054212 DOI: 10.1016/j.hipert.2021.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 03/29/2021] [Indexed: 12/01/2022]
Abstract
The pandemic caused by coronavirus SARS-CoV-2 (COVID-19) has forced, in many cases, to replace face-to-face consultation with the telematic consultation, in order to reduce the risk of contagion associated with the presence of patients in health centres. This change may represent an opportunity for a different and more effective communication between professionals and patients, allowing better accessibility to medical care and more systematic and comprehensive approach to patients with hypertension and cardiovascular risk. However, organisational tools are needed to facilitate communication between patients and professionals, specifically with the exchange of clinical data by remote monitoring of variables associated with hypertension and cardiovascular risk (blood pressure, weight, height, blood tests…), and allow monitoring of adherence to treatments, lifestyles and risk factors. It would be desirable for this to be carried out by multidisciplinary teams, both from primary care, hospital and community pharmacy, with an adequate coordination of care. This document of the Spanish Society of Hypertension (SEH-LELHA) tries to give the keys to improve the quality of care of telematic consultations of patients with hypertension and cardiovascular risk, provide basic criteria of telematic or face to face attention and systematise their content. Likewise, the follow-up criteria are proposed by the different professionals.
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Affiliation(s)
- T Gijón-Conde
- Centro de Salud Cerro del Aire, Departamento de Medicina, Universidad Autónoma Madrid/IdiPAZ y CIBERESP, Majadahonda, Madrid, Spain.
| | - E Rubio
- Servicio de Nefrología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
| | - M Gorostidi
- Servicio de Nefrología, Hospital Universitario Central de Asturias, RedinRen, Universidad de Oviedo, Oviedo, Spain
| | - E Vinyoles
- Centre d'Atenció Primària La Mina, Departamento de Medicina, Universidad de Barcelona, Barcelona, Spain
| | - P Armario
- Área Atención Integrada de Riesgo Vascular, Departamento de Medicina Interna, Hospital Moisès Broggi Sant Joan Despi, Universidad de Barcelona, Sant Joan Despí, Barcelona, Spain
| | - E Rodilla
- Servicio de Medicina Interna, Hospital Universitario de Sagunto, Universidad Cardenal Herrera-CEU, Sagunto, Valencia, Spain
| | - J Segura
- Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, Spain; Unidad de Hipertensión, Servicio de Nefrología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - J A Divisón-Garrote
- Centro de Salud de Casas Ibáñez, Universidad Católica San Antonio, Casas Ibáñez, Albacete, Spain
| | | | - A Molinero
- Sociedad Española de Farmacia Comunitaria (SEFAC), Spain
| | - L M Ruilope
- Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, Spain; Unidad de Hipertensión, Servicio de Nefrología, Hospital Universitario 12 de Octubre, Madrid, Spain; Escuela de Estudios de Doctorado e Investigación, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
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Núñez-Gil IJ, García-Donaire JA, Vedia O, Abad-Cardiel M, Martell-Claros N, Fernández-Ortiz A. [Initial experience with a multi-electrode catheter in renal denervation. A technique that has come back to stay?]. Hipertens Riesgo Vasc 2019; 36:166-168. [PMID: 31160234 DOI: 10.1016/j.hipert.2019.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 04/12/2019] [Accepted: 04/12/2019] [Indexed: 11/18/2022]
Affiliation(s)
- I J Núñez-Gil
- Cardiología Intervencionista, Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, España.
| | - J A García-Donaire
- Unidad de Hipertensión Arterial, Hospital Clínico San Carlos, Madrid, España
| | - O Vedia
- Cardiología Intervencionista, Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, España
| | - M Abad-Cardiel
- Unidad de Hipertensión Arterial, Hospital Clínico San Carlos, Madrid, España
| | - N Martell-Claros
- Unidad de Hipertensión Arterial, Hospital Clínico San Carlos, Madrid, España
| | - A Fernández-Ortiz
- Cardiología Intervencionista, Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, España
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García-Donaire JA, Franch-Nadal J, Rodríguez-Fortúnez P, Labrador-Barba E, Orera-Peña ML, Rodríguez de Miguel M. Epidemiological multicentre study on the education provided to patients with type 2 diabetes mellitus in the Spanish Health Care System. The Forma2 study. Semergen 2017; 44:5-12. [PMID: 28511878 DOI: 10.1016/j.semerg.2017.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 09/23/2016] [Revised: 12/30/2016] [Accepted: 01/03/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE The purpose of the present study was to characterize the education that patients with type 2 diabetes mellitus receive, and to identify differences as regards the presence of insulin therapy or not. METHODS This crossover, multicentre and descriptive study involved 1066 Spanish physicians who completed a questionnaire on Internet. RESULTS The physicians that responded had a mean of 26.0 years of experience in healthcare, and mainly worked in a walk-in clinic in an urban area. Physicians rated the level of patient knowledge about their disease on a 5.0 point-scale. Fifty percent of them indicated that they spent between 15 and 30min in educating patients at the time of diagnosis. Previous control with HbA1c>9%, presence of microvascular complications, and a low socio-cultural level, were factors associated with spending more time in education. CONCLUSION This is the first study designed to evaluate the education provided to patients with type 2 diabetes mellitus from Spain. The time spent and the individualization of the education are important factors associated with better long-term control of the disease, and thus with the effectiveness of the clinical management.
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Affiliation(s)
| | - J 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), Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Primary Health Care Center Raval Sud, Gerència d'Àmbit d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain
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Alvarez-Alvarez B, Martell-Claros N, Abad-Cardiel M, García-Donaire JA. [Hypertensive disorders during pregnancy: Cardiovascular long-term outcomes]. Hipertens Riesgo Vasc 2016; 34:85-92. [PMID: 27394656 DOI: 10.1016/j.hipert.2016.06.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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: 06/07/2016] [Accepted: 06/07/2016] [Indexed: 11/29/2022]
Abstract
Pregnancy-induced hypertension (PIH) induces maternal and fetal damage, but it can also be the beginning of future metabolic and vascular disorders. The relative risk of chronic hypertension after PIH is between 2.3 and 11, and the likelihood of subsequent development of type 2 diabetes is multiplied by 1.8. Women with prior preeclampsia/eclampsia have a twofold risk of stroke and a higher frequency of arrhythmias and hospitalization due to heart failure. Furthermore, a tenfold greater risk for long-term chronic kidney disease is observed as well. The relative risk of cardiovascular death is 2.1 times higher compared to the group without pregnancy-induced hypertension problems, although the risk is between 4 and 7 times higher in preterm birth associated with gestational hypertension or pre-existing hypertension The postpartum period is a great opportunity to intervene on lifestyle, obesity, make an early diagnosis of chronic hypertension and DM and provide the necessary treatments to prevent cardiovascular complications in women.
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Affiliation(s)
| | - N Martell-Claros
- Unidad de Hipertensión, Servicio de Medicina Interna, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, España.
| | - M Abad-Cardiel
- Unidad de Hipertensión, Servicio de Medicina Interna, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, España
| | - J A García-Donaire
- Unidad de Hipertensión, Servicio de Medicina Interna, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, España
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Maroun-Eid C, Ortega-Hernández A, Abad M, García-Donaire JA, Barbero A, Reinares L, Martell-Claros N, Gómez-Garre D. [Circulating endothelial progenitor cell levels in treated hypertensive patients]. Hipertens Riesgo Vasc 2015; 32:142-50. [PMID: 26486462 DOI: 10.1016/j.hipert.2015.07.002] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 07/02/2015] [Accepted: 07/13/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Most optimally treated hypertensive patients still have an around 50% increased risk of any cardiovascular event, suggesting the possible existence of unidentified risk factors. In the last years there has been evidence of the essential role of circulating endothelial progenitor cells (EPCs) in the maintenance of endothelial integrity and function, increasing the interest in their involvement in cardiovascular disease. In this study, the circulating levels of EPCs and vascular endothelial growth factor (VEGF) are investigated in treated hypertensive patients with adequate control of blood pressure (BP). MATERIAL AND METHODS Blood samples were collected from treated hypertensive patients with controlled BP. Plasma levels of EPCs CD34+/KDR+ and CD34+/VE-cadherin+ were quantified by flow cytometry. Plasma concentration of VEGF was determined by ELISA. A group of healthy subjects without cardiovascular risk factors was included as controls. RESULTS A total of 108 hypertensive patients were included (61±12 years, 47.2% men) of which 82.4% showed BP<140/90 mmHg, 91.7% and 81.5% controlled diabetes (HbA1c <7%) and cLDL (<130 or 100 mg/dL), respectively, and 85.2% were non-smokers. Around 45% of them were obese. Although patients had cardiovascular parameters within normal ranges, they showed significantly lower levels of CD34+/KDR+ and CD34+/VE-cadherin+ compared with healthy control group, although plasma VEGF concentration was higher in patients than in controls. CONCLUSIONS Despite an optimal treatment, hypertensive patients show a decreased number of circulating EPCs that could be, at least in part, responsible for their residual cardiovascular risk, suggesting that these cells could be a therapeutic target.
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Affiliation(s)
- C Maroun-Eid
- Unidad de Hipertensión, Hospital Clínico San Carlos-Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, España
| | - A Ortega-Hernández
- Laboratorio de Biología Vascular, Hospital Clínico San Carlos-IdISSC, Madrid, España
| | - M Abad
- Unidad de Hipertensión, Hospital Clínico San Carlos-Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, España
| | - J A García-Donaire
- Unidad de Hipertensión, Hospital Clínico San Carlos-Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, España
| | - A Barbero
- Unidad de Hipertensión, Hospital Clínico San Carlos-Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, España
| | - L Reinares
- Unidad de Lípidos, Hospital Clínico San Carlos-IdISSC, Madrid, España
| | - N Martell-Claros
- Unidad de Hipertensión, Hospital Clínico San Carlos-Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, España
| | - D Gómez-Garre
- Laboratorio de Biología Vascular, Hospital Clínico San Carlos-IdISSC, Madrid, España.
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García-Donaire JA, Segura J, Cerezo C, Ruilope LM. A review of renal, cardiovascular and mortality endpoints in antihypertensive trials in diabetic patients. Blood Press 2011; 20:322-34. [DOI: 10.3109/08037051.2011.602878] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Gutiérrez MJ, Acebedo-Ribó M, García-Donaire JA, Manzanera MJ, Molina A, González E, Nungaray N, Andrés A, Morales JM. Pregnancy in Renal Transplant Recipients. Transplant Proc 2005; 37:3721-2. [PMID: 16386517 DOI: 10.1016/j.transproceed.2005.09.175] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Fertility is restored after renal transplantation when good function is achieved. Our aim was to describe the gestations of our transplanted patients, analyzing outcomes and complications as well as long-term evolution of renal function. From 1976 to 2004, 43 gestations occurred in 35 renal transplanted women: their mean age was 31.7 +/- 4.06 years, with a mean time from the transplant to pregnancy of 4.32 years (0.4-13). At conception, all showed normal renal function (SCr 1.05 +/- 0.2 mg/dL). There were 19 abortions (43.8%), 9 of them spontaneous (21%) and 10 therapeutic (six cases for noncompliance with described criteria of European Best Practice Guidelines for Renal Transplantation, especially pregnancy less than 6 months after transplantation). Excluding these six cases of therapeutic abortions, 24 successful pregnancies occurred in 37 women (65.7%), although eight (29.1%) had premature delivery with live fetuses. Arterial hypertension was the most frequently complication (64%). Preeclampsia occurred in nine (37.5%) pregnancies, with proteinuria in five and only two with mild renal function deterioration. The majority of patients received cyclosporine (n = 20) or tacrolimus (n = 19). Since 1996, mycophenolate mofetil and sirolimus were stopped before conception. Birth weight was lower than 2500 g in 33.3% of pregnancies. Every newborn baby was healthy. Afterward, of the 24 patients with successfully pregnancy, 21 (87.5%) have functioning renal transplants at 53.2 months. After delivery, all currently show good renal function (SCr 1.16 +/- 0.35 mg/dL, CrCl 91 +/- 28.45 mL/m). In conclusion, pregnancy in our renal transplant women shows a success rate of 65.6%. However, complications related to arterial hypertension such as preeclampsia are frequent. The incidence of spontaneous abortions was similar to other series (21%). Long-term graft survival does not seem to be negatively affected by pregnancy.
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Affiliation(s)
- M J Gutiérrez
- Renal Transplant Unit, Nephrology Department, Hospital 12 Octubre, Madrid, Spain.
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