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Biomedical subjects

M de la Figuera

Publications and source records attributed to M de la Figuera.

At least 19 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↗
PubMed1999

The impact of different echocardiographic diagnostic criteria on the prevalence of left ventricular hypertrophy in essential hypertension: the VITAE study. Ventriculo Izquierdo Tension Arterial España.

BACKGROUND: The prevalence of echocardiographic left ventricular hypertrophy in essential hypertension ranges from 12 to 96% depending on the threshold values used to define it, and on the selection bias. OBJECTIVE: To estimate the prevalence of echocardiographic left ventricular hypertrophy by different criteria in essential hypertensives seen in primary care centres. METHODS: Cross-sectional study in a population-based sample of 946 essential hypertensives randomly selected in 39 primary care centres across Spain. Echocardiographic studies were performed in reference hospitals by trained observers (concordance Cohen kappa index > 0.7) and analysed by a single observer. RESULTS: Prevalence of left ventricular hypertrophy ranged from 59.2% [95% confidence interval (CI) 56.1 -62.3] by Framingham criteria to 72.7% (95% CI 69.9-75.6) using the criteria of De Simone et al. (J Am Coll Cardiol 1995; 25: 1056-1062). Prevalence was higher in males by the Cornell-Penn criteria, but higher in females when using Framingham or De Simone et al. criteria. Eccentric hypertrophy was more frequent (51.3-54.1%) independently of the criteria used, particularly when adjusting wall-thickness-ratio for age (56.2-58.9%). Concentric remodelling was present in 6.5-11.4% and only 20.8-29.7% of patients had no evidence of left ventricular structural alterations. Factors independently associated with left ventricular hypertrophy in the logistic regression analysis were age, gender, systolic blood pressure, pulse pressure and body mass index. CONCLUSION: Prevalence of echo left ventricular structural alterations among essential hypertensives seen in primary care centres in Spain ranged from 70.3 to 79.2% depending on the threshold values used. Left ventricular hypertrophy ranged from 59.2 to 72.7% and age-adjusted concentric remodelling ranged from 6.5 to 11.4% depending on the criteria used. Only one-quarter of hypertensive patients were free from morphological alterations.

Aged↗
PubMed1999

Prospective comparison of therapeutical attitudes in hypertensive type 2 diabetic patients uncontrolled on monotherapy. A randomized trial: the EDICTA study.

OBJECTIVE: To compare the anti-hypertensive effect of combination therapy versus a single drug regimen schedule (dose-titration or switching to a different drug class) in type 2 diabetic hypertensive patients with inadequate blood pressure (BP) control on monotherapy. DESIGN: Prospective, randomized, open-fashion, parallel study of two therapeutic strategies during an 8-week period. SETTING: Primary care centers in Spain. PARTICIPANTS: A total of 898 men and women with type 2 diabetes mellitus and hypertension, receiving antihypertensive treatment with one single drug and whose BP was > 140 and/or 90 mmHg. INTERVENTION: Patients were randomized to a fixed combination therapy (verapamil 180 mg plus trandolapril 2 mg; Knoll AG, Ludwigshafen, Germany) or continued on a single drug regimen, either increasing the dose of the current drug or switching to a different drug class. MAIN OUTCOME MEASURE: Absolute BP reduction in the two groups of treatment, and the percentage of normalized patients (< 140/90 mmHg) in each group. RESULTS: The diastolic BP (DBP) decrease (5.6 mmHg) was significantly greater in patients treated with combination therapy, compared to patients on monotherapy (2.9 mmHg). The decrease in systolic BP (SBP) was not significantly different (11.1 versus 10.0 mmHg). In addition, a significantly higher number of patients treated with combination therapy (82% versus 74%) reached diastolic BP normalization (< 90 mmHg). CONCLUSIONS: In type 2 hypertensive patients with uncontrolled BP despite anti-hypertensive monotherapy, the change to combination therapy was more effective in attaining DBP control than any monotherapy schedule (either increasing the dose or switching to another different drug class).

Aged↗
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↗
PubMed1995

Do changes in dietary salt influence blood pressure of hypertensive patients pharmacologically controlled with verapamil? The Salt-Switching-Study (SSS).

To study how changes in dietary salt influence the blood pressure (BP) of pharmacologically controlled hypertensive patients, we have selected from a large multicenter trial two subgroups of 14 and 16 patients who attained BP control (office DBP < 90 mm Hg) after a 4-week treatment with verapamil SR 240 mg once daily, either under an unrestricted salt diet (high-salt; 14 patients) or under a moderately restricted salt diet (low-salt; 16 patients). All of them were switched to the opposite dietary salt regimen and continued on verapamil for 4 more weeks (Salt-Switching-Period). Office BP and ambulatory blood pressure monitoring (ABPM) were registered before and after the Salt-Switching-Period. Salt intake was checked by urinary sodium excretion (UNa). Patients switching from high- to low-salt reduced UNa from 180.9 +/- 22.9 to 89 +/- 28 mM Na/24h (P < 0.001) and patients switching from low- to high-salt increased UNa from 85 +/- 38.4 to 175.8 +/- 57.5 mM Na/24h (P < 0.001). No significant changes in BP were found by ABPM either in the group switching from high- to low-salt or in the group switching from low- to high-salt. In the latter group, a significant increase was observed in office DPB but not in SBP. Short-term changes in salt intake seem to have little influence on the BP of patients pharmacologically controlled with verapamil.

Adult↗
PubMed1994

[Control of arterial hypertension: analysis of visit and time factors].

OBJECTIVE: To analyse the frequency of attendance and the time elapsed between the diagnosis of Arterial Hypertension (AHT) and the control of Arterial Pressure (AP); and to analyse the different ways of presenting the level of control of AHT. DESIGN: Retrospective study. SETTING: Teaching Health Centre. PATIENTS: 103 hypertense patients diagnosed since 1986: 44 men (42.7%) and 59 women (57.3%), with an average age of 52.6 +/- 1. Their initial AP was 164.4 +/- 17.1/102.1 +/- 7.4 mmHg. The criterion of AHT control was Diastolic Arterial Pressure (DAP) < 90 mmHg. MEASUREMENTS AND MAIN RESULTS: AP at the end of the first year was 150.1 +/- 20.6/90.7 +/- 9.6 mmHg (p < 0.001 in comparison with the initial AP). The average attendances for AHT and per patient in the first year was 8.7 +/- 5 (1-26). Patients with more severe forms of AHT and/or with associated risk factors visited more often (p < 0.05). During the first year 76 patients (73.7%) presented on at least one attendance a controlled DAP. At the end of the first year 46 patients (44.6%) were under control. The average time per patient until AP was controlled was 28.6 +/- 31.6 weeks (1-168). Males and under-65s took more time to control their AP (p < 0.05). CONCLUSIONS: There are gender and age differences in the time required to bring AP under control. Frequency of attendance is related to the severity of AHT and the presence of other pathologies and risk factors. The level of control of AHT, expressed in different ways, is not constant.

Adult↗
PubMed1994

[Analysis of direct costs of controlling arterial hypertension].

OBJECTIVE: To analyse the number of attendances and the direct cost of pharmaceutical prescription arising from a year-long monitoring of hypertense patients. SETTING: Health Centre. DESIGN: A prospective observation study. PATIENTS: 220 hypertense patients, undergoing arterial pressure (AP) monitoring, were chosen by means of systematic random sampling. MEASUREMENTS AND MAIN RESULTS: The variables of age, gender, cardiovascular risk factors, AP, monitoring level (criterion AP < 160-90 mmHg), attendances and treatment used were analysed. The pharmaceutical cost was calculated in line with the dosages and according to the 1990 Vademecum. The monitoring level was 43.6%. The total number of attendances per patient were 12.8 +/- 6.43 and those for hypertension, 7.9 +/- 3.5. Diabetics attended more for hypertension (8.8 vs 7.5, p < 0.05). Pharmaceutical treatment was prescribed for 183 people (83.2%). The number of drugs was correlated with the severity of the hypertension and the number of attendances. Overall drug cost was 429,571 pesetas per month. Average monthly cost per patient was 2,348.69 +/- 2,318.92 pesetas (range 90.5-12,856.5). Angiotensin enzyme conversion inhibitors (AECI) made for the greatest monthly mean cost per patient (4,352.9 pesetas) and diuretics, the least (322.2 pesetas). CONCLUSION: Frequency of attendance is related to the presence of diabetes and the number of drugs prescribed. The introduction of AECI and Calcium antagonists into first-line treatment represents an important increase in the cost of controlling Hypertension.

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↗