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array:23 [ "pii" => "S0025775301717733" "issn" => "00257753" "doi" => "10.1016/S0025-7753(01)71773-3" "estado" => "S300" "fechaPublicacion" => "2001-01-01" "aid" => "71773" "copyright" => "Elsevier España, S.L.. Todos los derechos reservados" "copyrightAnyo" => "2001" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Med Clin. 2001;116:209-13" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1390 "formatos" => array:3 [ "EPUB" => 7 "HTML" => 1204 "PDF" => 179 ] ] "itemSiguiente" => array:18 [ "pii" => "S0025775301717745" "issn" => "00257753" "doi" => "10.1016/S0025-7753(01)71774-5" "estado" => "S300" "fechaPublicacion" => "2001-01-01" "aid" => "71774" "copyright" => "Elsevier España, S.L." "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Med Clin. 2001;116:214-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2600 "formatos" => array:3 [ "EPUB" => 7 "HTML" => 2081 "PDF" => 512 ] ] "es" => array:10 [ "idiomaDefecto" => true "titulo" => "Conversión a esclerosis múltiple clínicamente definida tras un síndrome medular aislado: valor de la resonancia magnética craneal y medular" "tienePdf" => "es" "tieneTextoCompleto" => 0 "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "214" "paginaFinal" => "216" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Conversion to clinically definite multiple sclerosis after isolated spinal cord syndrome: value of brain and spinal MRI" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:2 [ 0 => array:2 [ "autoresLista" => "Imma Pericot, Mar Tintoré, Luis Brieva, Xavier Montalbán" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Imma" "apellidos" => "Pericot" ] 1 => array:2 [ "nombre" => "Mar" "apellidos" => "Tintoré" ] 2 => array:2 [ "nombre" => "Luis" "apellidos" => "Brieva" ] 3 => array:2 [ "nombre" => "Xavier" "apellidos" => "Montalbán" ] ] ] 1 => array:2 [ "autoresLista" => "Elisenda Grivé, Alex Rovira" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Elisenda" "apellidos" => "Grivé" ] 1 => array:2 [ "nombre" => "Alex" "apellidos" => "Rovira" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775301717745?idApp=UINPBA00004N" "url" => "/00257753/0000011600000006/v1_201307291450/S0025775301717745/v1_201307291450/es/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S0025775301717721" "issn" => "00257753" "doi" => "10.1016/S0025-7753(01)71772-1" "estado" => "S300" "fechaPublicacion" => "2001-01-01" "aid" => "71772" "copyright" => "Elsevier España, S.L." "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Med Clin. 2001;116:206-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1802 "formatos" => array:3 [ "EPUB" => 4 "HTML" => 1427 "PDF" => 371 ] ] "es" => array:10 [ "idiomaDefecto" => true "titulo" => "Influencia de la menopausia en la concentración plasmática de homocisteína" "tienePdf" => "es" "tieneTextoCompleto" => 0 "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "206" "paginaFinal" => "208" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Influence of menopausal status in homocysteine plasma levels" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Consuelo Fernández-Miranda, María de la Calle, José Manuel Bris, Mercedes Muelas, Pilar Gómez, Pilar Díaz-Rubio" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Consuelo" "apellidos" => "Fernández-Miranda" ] 1 => array:2 [ "nombre" => "María" "apellidos" => "de la Calle" ] 2 => array:2 [ "nombre" => "José" "apellidos" => "Manuel Bris" ] 3 => array:2 [ "nombre" => "Mercedes" "apellidos" => "Muelas" ] 4 => array:2 [ "nombre" => "Pilar" "apellidos" => "Gómez" ] 5 => array:2 [ "nombre" => "Pilar" "apellidos" => "Díaz-Rubio" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775301717721?idApp=UINPBA00004N" "url" => "/00257753/0000011600000006/v1_201307291450/S0025775301717721/v1_201307291450/es/main.assets" ] "es" => array:14 [ "idiomaDefecto" => true "titulo" => "Análisis poblacional de la necesidad de cambios y tasas de continuidad de los diferentes fármacos antihipertensivos" "tieneTextoCompleto" => 0 "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "209" "paginaFinal" => "213" ] ] "autores" => array:2 [ 0 => array:4 [ "autoresLista" => "Francisco Javier Sierra Alonso, Carlos Lagarejos Tricas, Francisco Cirujano Pita, Natalia Villalba Guijorro, M.<span class="elsevierStyleSup">a</span> Jesús Muñoz Sanz" "autores" => array:5 [ 0 => array:3 [ "nombre" => "Francisco" "apellidos" => "Javier Sierra Alonso" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Carlos" "apellidos" => "Lagarejos Tricas" ] 2 => array:2 [ "nombre" => "Francisco" "apellidos" => "Cirujano Pita" ] 3 => array:2 [ "nombre" => "Natalia" "apellidos" => "Villalba Guijorro" ] 4 => array:2 [ "nombre" => "M.<span class="elsevierStyleSup">a</span>" "apellidos" => "Jesús Muñoz Sanz" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Centro de Salud Prosperidad. Hospital La Princesa. Área II. Madrid." ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "*" "correspondencia" => "Correspondencia: Dr. F.J. Sierra Alonso. Centro de Salud Castelló. Castelló, 63. 28001 Madrid." ] ] ] 1 => array:3 [ "autoresLista" => "Francisco Rodríguez Salvanés" "autores" => array:1 [ 0 => array:3 [ "nombre" => "Francisco" "apellidos" => "Rodríguez Salvanés" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:3 [ "entidad" => "Unidad de Epidemiología Clínica. Hospital La Princesa. Área II. Madrid." "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "A population-based study of need for changes and continuing rates of antihypertensive drugs" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2000-08-23" "fechaAceptado" => "2001-01-09" "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec221349" "palabras" => array:3 [ 0 => "Fármacos antihipertensivos" 1 => "Cambio de tratamiento" 2 => "Práctica clínica" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec221348" "palabras" => array:3 [ 0 => "Antihipertensive agents" 1 => "Clinical practice" 2 => "Discontinuing of therapy" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Fundamento</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">El tratamiento farmacológico de la hipertensión arterial precisa ser modificado frecuentemente por ineficacia o intolerancia. El objetivo del presente trabajo es comparar la incidencia de cambios de los nuevos fármacos antihipertensivos frente a los clásicos bloqueadores beta y diuréticos, además de definir en el tiempo la probabilidad de continuidad de cada grupo.</p> <span class="elsevierStyleSectionTitle">Material y método</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Se revisaron las historias clínicas de los hipertensos de un centro de salud y se registraron los cambios y sus causas en el período de octubre de 1997 a septiembre de 1999. Se calculó la incidencia de cambio por efecto adverso, ineficacia y global de cada grupo, así como los riesgos relativos de cambio de todos frente a bloqueadores beta, diuréticos, inhibidores de la enzima conversiva de la angiotensina (IECA) y antagonistas de los receptores de la angiotensina-II (ARA-II). Mediante tablas de vida se describe la probabilidad acumulada de continuidad.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">El 27,6% de los 786 tratamientos evaluados tuvieron que ser cambiados, el 51,4% de ellos por efectos adversos y el 29,8% por ineficacia. La probabilidad de continuidad era del 88% a los 3 meses, del 81% a los 6 meses, del 71% al año y del 54% a los 2 años. Los cambios por intolerancia ocurrieron en el 51% en los primeros 3 meses, y el riesgo persistió después en el tiempo. La incidencia de cambios globales por 1.000 meses de prescripción fue la siguiente: ARA-II, 17,1; bloqueadores beta, 18,4; combinación IECA-diurético, 22,7; IECA, 23,7; diuréticos, 35,4; antagonistas del calcio, 37,4, y bloqueadores alfa, 42,2. El análisis de cambios por efectos adversos dio resultados muy similares. Los antagonistas del calcio tuvieron, respecto al resto, un riesgo significativamente superior de cambio por este motivo. Las tasas de continuidad fueron superiores para bloqueadores beta y ARA-II, seguidos de IECA y la combinación IECA-diurético</p> <span class="elsevierStyleSectionTitle">Conclusión</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Los fármacos antihipertensivos se cambian con más frecuencia de lo deseable y tienen unas bajas tasas de continuidad. Las diferencias observadas en la incidencia de cambios y tasas de continuidad entre los diferentes grupos farmacológicos no justifican, en sí mismas, la necesidad de modificar la recomendación general de utilizar los bloqueadores beta y diuréticos como primera elección en el tratamiento inicial de la hipertensión arterial.</p>" ] "en" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Background</span><p id="spar00025" class="elsevierStyleSimplePara elsevierViewall">Antihypertensive drugs are frequently changed because of inefficacy and adverse effects. The aim of this study was to compare the incidence of changes of the new classes of drugs from the classical ß-blockers and diuretics. We also have calculated the probability of continuing with each class of drug.</p> <span class="elsevierStyleSectionTitle">Material and method</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Clinical reports of hypertensive patients of a general practice centre were examined. All changes of treatment and their causes were registered between october 1997 and september 1999. The incidences for global changes and also for intolerance and ineficacy changes were calculated for each drug. Relative risks for ß-blockers, diuretics, ACE inhibitors of anhidride carbonic enzyme and angiotensine II-receptor-antagonists were analized. The cumulated probability for continuing therapy was also studied.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">27.6% out of 786 courses of treatment were changed, 51.4% due to intolerance and 29,8% due to inefficacy. The probability for continuing was 88% after 3 months, 81% after 6 months, 71% after one year and 54% after 2 years. The probability for discontinuing because of intolerance was higher in the first 3 months (51%), but afterwards it remained stable along the time.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Anthypertensive drugs are discontinued more frequently than what it would be desirable and their continuing rates are low. Differences observed among each class of drugs are not argument enough for changing the general recommendation of using ß-blockers and diuretics as first choice drugs for initial treatment of hypertension.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Referencias Bibliográficas" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:26 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." 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