Selección del tratamiento farmacológico de la hipertensión arterial en atención primaria
J.R. Laporte
, Grupo de estudio sobre el Abordaje Farmacológico de la Hipertensión en Atención Primaria (AFHAP) *
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jrl@icf.uab.es
Correspondencia: Dr. J.R. Laporte. Fundació Institut Catalá de Farmacologia. Paseo de la Vall d’Hebron, 119-129. 08035 Barcelona.
Correspondencia: Dr. J.R. Laporte. Fundació Institut Catalá de Farmacologia. Paseo de la Vall d’Hebron, 119-129. 08035 Barcelona.
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Laporte" "autores" => array:2 [ 0 => array:4 [ "nombre" => "J.R." "apellidos" => "Laporte" "email" => array:1 [ 0 => "jrl@icf.uab.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "colaborador" => "Grupo de estudio sobre el Abordaje Farmacológico de la Hipertensión en Atención Primaria (AFHAP)" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "fn1" ] ] ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "*" "correspondencia" => "Correspondencia: Dr. J.R. Laporte. Fundació Institut Catalá de Farmacologia. Paseo de la Vall d’Hebron, 119-129. 08035 Barcelona." ] ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "1999-04-06" "fechaAceptado" => "1999-10-21" "PalabrasClave" => array:1 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec220533" "palabras" => array:3 [ 0 => "Hipertensión arterial" 1 => "Tratamiento farmacológico" 2 => "Atención primaria" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "es" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Fundamento</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Examinar si las características clínicas de los pacientes y más específicamente las contraindicacionesa diuréticos tiacídicos y bloqueadores adrenérgicos beta influyen sobre la prescripciónde fármacos antihipertensivos.</p> <span class="elsevierStyleSectionTitle">Pacientes Y Métodos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio transversal con pacientes hipertensos visitados consecutivamente en 28centros de atención primaria de Barcelona entre noviembre de 1997 y febrero de 1998. Se recogió informaciónsobre características clínicas y antihipertensivos prescritos. Se consideraron contraindicacionespara recibir diuréticos tiacídicos la hiperuricemia y un antecedente de efectos adversos o de interacciónfarmacológica. Se consideraron contraindicaciones para recibir bloqueadores adrenérgicosbeta el asma, la enfermedad pulmonar obstructiva crónica, la arteriopatía periférica, la bradicardia, elbloqueo auriculoventricular, la diabetes tipo 1, un antecedente de efectos adversos o la posibilidad deinteracciones farmacológicas.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Participaron en el estudio 83 médicos y 29 enfermeras. Se incluyeron 1.813 pacientes (el 66% mujeres; edad media, 68 años). Setecientos cuarenta y seis (41,1%) presentaban dislipemia,385 (21,2%) diabetes, 251 (13,8%) hiperuricemia, 218 (12%) cardiopatía isquémica y 128 (7,1%)insuficiencia cardíaca. Trescientos cincuenta pacientes (19,3%) presentaron contraindicaciones paralos diuréticos tiacídicos y 537 (29,6%) para los bloqueadores adrenérgicos beta. Ochocientos setenta ynueve pacientes (48,5%) recibieron una prescripción de un inhibidor de la enzima conversiva de la angiotensina,803 (44,3%) de un diurético tiacídico, 521 (28,7%) de un bloqueador de los canales delcalcio y 246 (13,6%) de un bloqueador adrenérgicos beta. El perfil de prescripción fue similar en pacientescon contraindicación para recibir diuréticos tiacídicos o bloqueadores adrenérgicos beta, condiabetes, insuficiencia cardíaca, cardiopatía isquémica o más de 65 años, así como entre los pacientescuyas características clínicas indicaran que sería preferible un diurético tiacídico, un bloqueador adrenérgicobeta o un inhibidor de la enzima conversiva de la angiotensina. La prescripción de diuréticostiacídicos se asoció con la edad y con la contraindicación para recibir bloqueadores adrenérgicos beta,y la de los bloqueadores adrenérgicos beta se asoció a la presencia de cardiopatía isquémica.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Al prescribir un fármaco antihipertensivo no se considera que los diuréticos tiacídicos ylos bloqueadores adrenérgicos beta sean de primera elección, ni las características clínicas ni las contraindicacionesque pueden modificar la primera elección. Los resultados de los ensayos clínicos sobreel tratamiento de la hipertensión se aplican poco a la práctica asistencial y esto comporta que nose ofrezca el beneficio de la prevención cardiovascular a una elevada proporción de pacientes.</p> <span class="elsevierStyleSectionTitle">Background</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To assess whether patients’ clinical characteristics, and more specifically contraindicationsto diuretics or β-blockers have an influence on the prescription patterns of antihypertensive drugs.</p> <span class="elsevierStyleSectionTitle">Patients and Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Cross-sectional descriptive study of consecutive hypertensive patients attending28 Primary Health Care Centres in Barcelona between November 1997 and February 1998. Informationon patients’ clinical characteristics and prescribed antihypertensive and other drugs was recorded.Hyperuricemia, a previous adverse drug reaction and potential drug interactions were consideredas contraindications to diuretics. Asthma, chronic obstructive airways disease, peripheral arteriopathy,bradycardia, atrio-ventricular blockade, type 1 diabetes, a previous adverse drug reaction, and potentialdrug interactions were considered as contraindications to β-blockers.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Eighty-three general practitioners and 29 nurses collected data on 1,813 patients (66% werewomen and mean age was 68 years). Dislipemia was present in 746 patients (41.1%), diabetes in385 (21.2%), hyperuricemia in 251 (13.8%), coronary heart disease in 218 (12%), and heart failurein 128 (7.1%). Diuretics were contraindicated in 350 patients (19.3%) and β-blockers in 537(29.6%). Eight-hundred seventy-nine patients (48.5%) were prescribed an angiotensin-convertingenzyme(ACE) inhibitor, 803 (44.3%) a diuretic, 521 (28.7%) a calcium-channel blocker, and 246(13.6%) a β-blocker. The prescription pattern was similar in both patients with existing contraindicationsto diuretics or β-blockers, or without them, and in those with and without diabetes, heart failureor coronary heart disease and in those whose clinical characteristics would make the prescription of adiuretic, a β-blocker or an ACE-inhibitor a first choice option. Prescription of a diuretic was associatedto age and to existing contraindications to a β-blocker, whereas the prescription of a β-blocker was associatedwith a history of coronary heart disease.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The present study suggests that contraindications to diuretics or β-blockers are not consideredwhen prescribing antihypertensive drugs. The results of clinical trials are not applied to clinicalpractice, and this results in a high proportion of patients not being offered the benefit of cardiovascularrisk prevention.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "nota" => "<p class="elsevierStyleNotepara">Al final del artículo se expone un «Anexo» con el listado de los investigadores participantes.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Referencias Bibliográficas" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:16 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Blood pressure as a cardiovascular risk factor" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "W.B. 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