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Biomedical subjects

E Vinyoles

Publications and source records attributed to E Vinyoles.

15 recordsLinked to original sources
PubMed2003

Blood pressure measurement in an ambulatory setting: concordance between physician and patient self-measurement.

The aim of this study was to determine concordance between physician and patient blood pressure (BP) measurements in an ambulatory setting. A diagnostic intervention cross-sectional study using a convenience sample was employed. A total of 106 hypertensive patients were included in the study. Patients who were unable to perform their self-measurement or those with cardiac arrhythmia were excluded. BP was determined nine times in each subject in the medical office in a randomised order: BP was taken three times by the physician using a mercury sphygmomanometer (SPH-Hg), three times by the physician using a validated, automated oscillometer (Omron HEM 705 CP), and three times by the patient himself with the same device. The intraclass correlation coefficient was calculated. In all, 59 women and 47 men aged 65.7 (10) years were analysed. Mean BP measurements for the physician using the mercury sphygmomanometer, the physician using the Omron, and the patient using the same device were: 136 (15.8)/80 (11), 137 (17.9)/80 (10), and 139* (17.6)/80 (10) mmHg, respectively. BP control was 48.1, 48.1, and 36.8*% (*P < 0.05), respectively. Intraclass correlation coefficients for systolic/diastolic pressures were: 0.77/0.65 (physician-sphygmomanometer Hg, physician-Omron; P < 0.001), 0.75/0.64 (physician-sphygmomanometer Hg, patient-Omron, P < 0.001), and 0.83/0.83 (physician-Omron, patient-Omron; P < 0.001). In conclusion, the three types of measurement in the medical office were significantly concordant. Patient office self-measurement showed a tendency to increase systolic BP and worsen BP control.

Blood Pressure Determination↗
PubMed2000

[Heart rate and isolated clinical tachycardia in hypertensive patients].

BACKGROUND: There is poor information for isolated clinical tachycardia (ICT), that is to say, office tachycardia but normal ambulatory heart rate (HR). Our objective was to describe it and to know differences between hypertensive subjects with and without ICT. PATIENTS AND METHOD: Comparative study after a diagnostic intervention (ambulatory blood pressure monitoring, ABPM, SpaceLabs 90202-90207), with convenience sampling of non-treated hypertensive patients attended in primary care. We excluded subjects with heart, thyroid or lung disease. ICT were defined on the basis of office and daytime HR percentile 90 of the whole sample. RESULTS: A total of 256 subjects were included, 128 (50%) women, age 49.1 (16.1) years, with mean office blood pressure (BP) 151 (17.1)/92 (11.9) mmHg. The prevalence of ICT was 7.03% (CI 95%, 4.03-11.07) (n = 18). We didn't find any association between isolated clinical hypertension and ICT (p = 0.87). Patients with ICT have lower office and systolic night time BP, lower night time variability, higher night time BP fall, although higher 24 hours-HR and daytime-HR in comparison with non ICT hypertensive patients. In the multivariate analysis only office diastolic BP (OR, 0.93 [CI 95%, 0.87-0.98], for each mmHg increment) and office HR (OR, 1.2 [CI 95%, 1.11-1.28], for each beat for minute increment) were predictive of ICT. CONCLUSIONS: In this study 7.03% of non treated hypertensive patients present ICT, which suggest a profile of more favorable cardiovascular risk than that without ICT. Only office diastolic BP and office HR were predictive variables of ICT.

Adult↗
PubMed2000

[Acute precordial pain: 100 cases in 3 years].

OBJECTIVE: To find the effectiveness of diagnoses of acute precordial pain seen as an emergency at our centre. DESIGN: Observational, descriptive and retrospective study. SETTING: Urban primary care centre. PATIENTS: The 100 most recent patients who attended as an emergency with their first episode of acute precordial pain were included. STUDY PERIOD: December 1994 to March 1998. Home visits, patients without medical records and those seen on repeated attendance for precordialgia were excluded. MEASUREMENTS AND MAIN RESULTS: The emergency diagnosis and the diagnosis recorded afterwards in the clinical history of 100 people with acute precordialgia, aged 54.9 (16.7 years; 56% [n = 56] women), were gathered. Ischaemic cardiopathy (41%, n = 41) and mechanical precordialgia (36%, n = 36) were the most common initial diagnoses. We found 66.6% sensitivity and 81.4% specificity in the detection of ischaemic cardiopathy. The proportion of diagnostic errors was not linked to the pathological history of anxiety, ischaemic cardiopathy or oesophageal disease. CONCLUSIONS: 41% of precordialgias are diagnosed as presumably ischaemic and are potentially serious, although only 50% of them are confirmed as such. Our sensitivity in their diagnosis is comparable to that of other studies.

Acute Disease↗
PubMed1996

[Hypertensive patients with poor blood pressure control in clinic. Study using ambulatory blood pressure monitoring].

OBJECTIVE: To describe the characteristics of hypertensive patients with poor clinical control of their blood pressure (BP > 140/90 mmHg), by examining the level of control indicated by out-patient monitoring of BP (OMBP). DESIGN: An observational study with diagnostic intervention. SETTING: Urban health centre. PATIENTS: Hypertensive patients > 15 years old, with poor control of their BP and on the lists of 11 family doctor practices. INTERVENTIONS: Hypertensive patients with their BP > 140/90 mmHg, measured in base conditions with a mercury Sphygmomanometer, were studied through a 24-hour OMBP (SpaceLabs 90202-90207). Good pressure using OMBP was defined as: BP mean in the monitoring period < 140/90 mmHg. RESULTS: The study included 247 hypertensive patients (53.8% women, age 53); 39.3% treated with drugs. Patients with BP appearing well-controlled through OMBP (51%) were mainly women, with less damage to target organs, less evolution, less variability and less day and night pressure loads, when compared with the hypertensive patients with BP showing poor control in OMBP. No significant differences were detected between the two groups for the consumption of medicine. CONCLUSIONS: In our survey half the hypertensive patients who recorded high BP in the clinic showed their pressure well-controlled when using OMBP. A more conservative therapeutic approach is suggested for these cases.

Blood Pressure Monitoring, Ambulatory↗
PubMed1995

[Clinical characteristics of the white coat hypertension].

BACKGROUND: White coat hypertension (WCH) is a relatively prevalent clinical situation (around 20% of the hypertense population). The aim of this study was to analyze the clinical characteristics of these patients. METHODS: A descriptive transversal study was carried out in general medicine consultations in a unrandomized sample of hypertensive patients receiving pharmacologic treatment. Twenty-four hour ambulatory blood pressure monitorization (ABPM) (SpaceLabs 90202-90207) was performed following three resting blood pressure (BP) determinations carried out during the visit at 5-minute intervals by mercury sphigmomanometer. WCH was defined as: BP during the consultation > 140 mmHg (systolic) or > 90 mmHg (diastolic) with a mean daily blood pressure by ABPM < 140/< 90 mmHg. RESULTS: One hundred sixty-four patients (53% males) with a mean age of 48 years (SD 15.8) and a mean time of high blood pressure of 36 months (SD 51.4) were studied. Seventy-one patients (43%) fulfilled WCH criteria. WCH was significantly associated with females (p < 0.01), hypercholesterolemia (p < 0.05), lower involvement of target organs (p < 0.05), greater nocturnal tolerance to ABPM (p < 0.05) and lower mean nocturnal blood pressure (p < 0.001). CONCLUSIONS: The prevalence of white coat hypertension is elevated. Most of these patients are females, have fewer target organ lesions that the remaining hypertensive patients although dyslipemia is more frequently observed in these cases.

Adult↗
PubMed1993

[The recommendable frequency for performing electrocardiograms in the hypertension patient].

OBJECTIVE: To obtain information on how often electrocardiograms (ECG) should be carried out during hypertense patients' follow-up. DESIGN: A retrospective, descriptive study. SETTING: La Mina Primary Care Centre. PATIENTS: Out of 1780 hypertense patients over 14 years old monitored at our Health Centre, 352 were selected by random sampling. MEASUREMENTS AND MAIN RESULTS: Their first ECG after the AHT diagnosis was analysed. Those patients with a normal initial ECG, a minimum of one year's monitoring, and absence of a chronic limitation of air flow, diabetes mellitus or cardiopathy were included in the study. The ECGs following the first ECG were analysed sequentially until an anomalous ECG was detected. Final sample: 98 patients (average age 53, SD 12.8; 33 men and 65 women). 89 (91.8%) had light-to-moderate AHT. The average interval between the initial normal ECG and the first pathological ECG was 36 months (SD 16.9). The most common electrocardiographic irregularities were the T minor wave (34.5%), the greater unevenness of the ST (17.2%) and left ventricular hypertrophy (13.8%). A total of 29 patients presented a pathological ECG during an average monitoring period of 61 months (C.I. 95%; 50-72). These were only significantly different from the remaining 69 as regards age. Those patients over 54 (n = 51) had significantly more irregularities (21) than those under 55 (n = 47) (8 irregularities) (p = 0.006), the main increase being between the ages of 55 and 60. CONCLUSIONS: The recommendation to carry out an ECG every 2 or 3 years when monitoring a hypertense patient with a normal initial ECG and without additional pathologies, could be extrapolated from our study. The time interval could be shortened for older patients.

Adult↗
PubMed1992

[Major and minor changes in the electrocardiogram of the hypertensive patient].

OBJECTIVE: To determine the prevalence and characteristics of electrocardiograph deviation in such hypertensive patients. DESIGN: Retrospective descriptive study of a representative sample of patients with high blood pressure. SITE. Primary attention centre. PATIENTS: The sample consists of 352 patients, systematically random selected from a pool of 1780 patients suffering from hypertension, aged over 14 years, attending the centre (119 males (34%) and 233 females (66%). Average age 59.4 +/- 13.5 years). MAIN MEASUREMENTS AND RESULTS: The first ECG reading after diagnosis of hypertension was analysed and codified according to the pooling project criteria. 38.9% present electrocardiograph deviations, the most frequent being minor wave 1 (12%), significant breaking up of the ST (9%) and left ventricular hypertrophy (5.1%), the latter more frequent in women (p = 0.03). Age, systolic arterial blood pressure and the time the condition had been in existence, certain associated chronic diseases, and use of pharmaceutical drugs acting cardiovascularly, are positively related to the deviation in ECG (p < 0.05). CONCLUSIONS: The value of ECG in the treatment of high blood pressure sufferers is indicated.

Age Factors↗
PubMed1992

[Study of diffuse chronic hepatopathy in the outpatient context].

OBJECTIVE: Description of the general characteristics of patients with Diffuse Chronic Hepatopathy (DCH) in an ABS. DESIGN: Empirical study of a prospective and retrospective type. Site. Primary Care. ABS La Mina. Sant Adrià de Besòs. PATIENTS AND OTHER PARTICIPANTS: All patients diagnosed as suffering DCH since 1984, in line with histological or clinical--morphological criteria accepted in the literature. MAIN MEASUREMENTS AND RESULTS: Using a data base of the centre's morbidity and mortality register, 287 reports of patients over 14 years old defined as having DCH were examined. 222 cases met the established criteria. Most of these were males (68%), and to an even higher proportion in the group with alcoholic etiology (84%), which was the most common cause of DCH (64.4%). There was a lower number of complications and deaths attributable to DCH than in published hospital series. CONCLUSIONS: Among the characteristics of DCH in a natural population using the health services, it is important to note the predominance of compensated forms having a rate of complications and deaths attributable to DCH significantly lower than what was observed in hospital series. This information may be of use in planning activities at the ABS level.

Adolescent↗