Abstract
Objetivo
Determinar la actitud terapéutica de los profesionales de atención primaria ante la falta de reducción de la presión arterial. Describir los tratamientos antihipertensivos más utilizados.
Diseño
Estudio descriptivo, longitudinal y retrospectivo llevado a cabo durante el año 2001.
Emplazamiento
Atención primaria.
Participantes
Se incluyó a 990 pacientes hipertensos pertenecientes a 12 centros de salud, escogidos entre los 31 participantes en el estudio DISEHTAC-1996.
Métodos
Se analizaron: edad, sexo, peso y talla; valores de presión arterial recogidos durante todo el año 2001; actitud terapéutica (aumento/sustitución/combinación) ante el mal control (más de 2 visitas consecutivas con presión arterial > 139 y/o 89 mmHg); cribado y prevalencia de factores de riesgo cardiovascular (FRCV), y fármacos utilizados.
Resultados
El 58,9% de los pacientes incluidos eran mujeres, con una edad media de 65,4 ± 13,01 años. El 43,8% recibía 2 o más antihipertensivos. Los más prescritos fueron los diuréticos (47,6%) y la combinación más usada fue la de un inhibidor de la enzima conversiva de la angiotensina (IECA) más un diurético (22,1%). Ante cifras de mal control, en el 76,8% de los casos (intervalo de confianza [IC] del 95%, 73,6-80) se realizó algún cambio en el tratamiento, con frecuencia, se utilizó la combinación de fármacos (49,6%). La actitud expectante fue más frecuente en los pacientes con edades ≥ 65 años y con hipertensión arterial (HTA) de grado I (presión arterial sistólica [PAS] comprendida entre 140 y 150 mmHg y presión arterial diastólica [PAD] comprendida entre 90 y 99 mmHg (p < 0,001).
Conclusiones
La terapia combinada se utiliza en casi la mitad de los pacientes hipertensos. Es destacable la actitud activa de los médicos ante la detección de reiterados controles de presión arterial elevados, y la actitud más frecuente es la combinación de fármacos.
Palabras clave: Hipertensión, Control inadecuado, Actitud terapéutica
Abstract
Objective
To determine the attitude to therapy of primary care staff in view of the lack of reduction in blood pressure. To describe the most commonly used antihypertensives.
Design
Descriptive, longitudinal, retrospective study during the year 2001.
Setting
Primary care, Spain.
Participants
We analysed 990 hypertensive patients from 12 health centres picked from the 31 participants in the DISEHTAC-1996 study.
Methods
Age, sex, weight, and height were analysed, along with blood pressure values throughout the year 2001, therapeutic attitude (increase/replacement/combination) with poor control (more than 2 consecutive visits with blood pressure >139 and/or 89 mm Hg), screening and prevalence of cardiovascular risk factors (CVRF), and drugs used.
Results
There were 58.9% females; mean age: 65.4 (13.01) years, and 43.8% received 2 or more antihypertensives. The most common antihypertensives prescribed were diuretics (47.6%), and angiotensin-converting enzyme (ACE) inhibitors plus diuretics was the most used combination (22.1%).When there was poor control, some change in treatment was made in 76.8% (95% confidence interval [CI], 73.6-80) of cases. The most common was a combination of drugs (49.6%). The expected action was more frequent in those over 65 years and with a grade I of arterial hypertension (systolic blood pressure [SBP] between 140-150 and diastolic blood pressure [DBP] between 90-99 mm Hg (P<.001).
Conclusions
Combined therapy is used in almost half of hypertensive patients, with the most common action being a drug combination.
Key words: Hypertension, Inadequate control, Therapeutic attitude
Footnotes
Equipo de Trabajo en HTA.
El trabajo contó con la esponsorización, para la realización del trabajo de campo, del grupo Vita.
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