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Inicio Medicina Clínica Perfil de riesgo cardiovascular de los pacientes con hipertensión arterial no c...
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Vol. 128. Núm. 3.
Páginas 86-91 (enero 2007)
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Vol. 128. Núm. 3.
Páginas 86-91 (enero 2007)
Perfil de riesgo cardiovascular de los pacientes con hipertensión arterial no controlada. Estudio Control-Project
Cardiovascular risk profile of uncontrolled hypertensive patients. The Control-Project study
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Emilio Márquez-Contrerasa, Antonio Cocab, Mariano de la Figuera von Wichmannc, Juan Antonio Divisónd, José Luis Llisterrie, Javier Sobrinof, Claudia Filozofg, Miguel Ángel Sánchez-Zamoranog, Lilian Grigorian Shamagianh
a Centro de Salud la Orden. Huelva.
b Unidad de Hipertensión. Instituto de Medicina y Dermatología. Hospital Clínic (IDIBAPS). Universidad de Barcelona. Barcelona.
c CAP La Mina. Barcelona.
d Centro de Salud Casas Ibáñez. Albacete.
e Centro de Salud de Ingeniero Joaquín Benlloch. Valencia.
f Servicio de Medicina Interna. Hospital del Espíritu Santo. Barcelona.
g Departamento Científico. Bristol-Myers Squibb España.
h Servicio de Cardiología. Hospital Clínico. Santiago de Compostela. A Coruña. España.
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Fig. 1. Actitud terapéutica del médico con el paciente hipertenso no controlado.
Fig. 2. Modificación de tratamiento antihipertensivo del paciente hipertenso no controlado.
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Background and objective: To assess absolute cardiovascular risk and co-morbidities in uncontrolled hypertensive patients (blood pressure [BP] >= 140/90 mmHg or >= 130/80 mmHg in diabetics) attending Primary Care Physicians in Spain, and to determine the attitudes of these physicians towards this problem. Patients and method: Cross-sectional, multicenter study involving 356 general practitioners around Spain. Absolute cardiovascular risk was assessed according to ESH-ESC 2003 Guidelines in a sample of 1,710 patients. Results: Two hundred ninety seven patients were excluded by several reasons and a total of 1,413 hypertensive patients were valuable (mean age: 65.3 ± 11.4 years; 56.7% women). Normal BP values (< 140/90 mmHg) were exhibited by 0.2%, high-normal BP (120-139/80-89 mmHg) were exhibited by 2.8%, grade 1 hypertension (140-159/90-99 mmHg) by 49.9%, grade 2 hypertension (160-179/100-109 mmHg) by 39.3%, and grade 3 hypertension (>= 180/110 mmHg) by 7.9%. Associated cardiovascular risk factors were observed in 96.0% of patients (95% CI = 94.7-97.2%), target organ damage in 34.5% (95% CI = 31.6-36.5%), and cardiovascular clinical disease in 36.0% (95% CI = 33.5-38.5%). According to ESH-ESC 2003 Guidelines 34.0% (CI = 31.5-38.2%) were at very-high risk; 29.4% (95% CI = 26.4-32.8%) at high risk; 30.4% (95% CI = 27.2-33.7%) at moderate risk and 5.4% (95% CI= 3.9-7.2%) at low risk of cardiovascular disease. Despite the high absolute risk, physicians did not do any therapeutic change in 30.4% (95% CI = 28.2-33.5%) of uncontrolled hypertensive patients. Most of them (64.26%) considered that bad compliance to life style changes was the reason for inadequate BP control. The most frequent measure introduced was the association of additional drugs. Conclusions: Absolute cardiovascular risk in uncontrolled hypertensive patients attending Primary Care Physicians in Spain is very relevant. Sixty-five percent of these patients are at high or very high risk with a high prevalence of target organ damage or associated cardiovascular clinical disease. Therapeutic attitudes towards these patients are still very conservative although they are improving compared with previous studies.
Keywords:
Cardiovascular risk
Hypertension
Primary Care

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