Abstract
Objetivo
Evaluar las propiedades de medición del cuestionario de calidad de vida en hipertensión arterial (CHAL), en condiciones de práctica clínica habitual, así como la relación existente entre calidad de vida y variables clínicas en pacientes con HTA.
Diseño
Estudio observacional, prospectivo y multicéntrico.
Emplazamiento
Noventa y dos centros de atención primaria de España.
Participantes
Doscientos sesenta y nueve hipertensos de ambos sexos, mayores de 17 años, estratificados según edad (18-44, 45-64 y más de 64 años), sexo y afectación orgánica. Ciento seis individuos normotensos mayores de 17 años, seleccionados de forma aleatoria.
Intervenciones
Intensificación del tratamiento en los pacientes hipertensos.
Mediciones
Administración del CHAL y el EuroQol-5D en todas las visitas (pacientes: basal y al mes; controles: basal). Adicionalmente, se registraron en la visita basal las características sociodemográficas y clínicas, y en la visita al mes las características clínicas y los cambios en el estado de salud.
Resultados principales
El tiempo medio (DE) de administración fue de 28 (23) minutos. Validez: el análisis factorial mostró dos dimensiones: estado de ánimo (EA) y manifestaciones somáticas (MS) que presentaron una correlación máxima con las dimensiones de ansiedad/depresión (0,64) y dolor/malestar (0,55) del EQ-5D, respectivamente. Las puntuaciones del CHAL fueron superiores (peor CV) en pacientes que en controles sin HTA (p < 0,01). Fiabilidad: el coeficiente de correlación intraclase fue de 0,88 en EA y de 0,76 en MS; el alfa de Cronbach de 0,96 y 0,89, respectivamente. Sensibilidad: el «tamaño del efecto» al mes de iniciar el tratamiento antihipertensivo fue de 0,40. La HTA de más de 10 años, mayor afectación orgánica, gravedad y obesidad mórbida se asociaron a una peor calidad de vida, especialmente en la dimensión de EA. La frecuencia cardíaca se correlacionó más con el EA que con las MS.
Conclusiones
El CHAL es el primer cuestionario específico para la HTA desarrollado en España que ha mostrado ser válido, fiable y sensible a los cambios. Sin embargo, debe reducirse el número de ítems para su uso rutinario en la práctica clínica.
Palabras clave: Atención primaria, Calidad vida, Hipertensión arterial, Validación
Abstract
Objective
To evaluate the measurement properties of the Hypertension Quality of Life (HQALY) questionnaire, under normal clinical practice conditions, and the relationship between quality of life and clinical variables in patients with hypertension.
Design
Observational, prospective and multi-centred study.
Setting
92 primary care centres in Spain.
Participants
269 patients, of both sexes and over 17, with hypertension, stratified by age (18-44, 45-64 and over 64), sex and organic complaint. 106 individuals over 17 with normal tension were chosen at random.
Interventions
Intensification of treatment in hypertense patients.
Measurements
Administration of the HQALY and the EuroQol-5D at every attendance (patients, basal and at a month; controls, basal). In addition, at the basal attendance social-demographic and clinical features were recorded, and at the attendance at a month the clinical features and changes in health status.
Main results
Mean time of administration was 28 (23) minutes. Validity: factor analysis showed two dimensions, state of mind and somatic manifestations, which correlated most closely with the dimensions of anxiety/depression (0.64) and pain/discomfort (0.55) on the EQ-5D, respectively. HQALY scores were higher (worse quality of life) in patients than in controls without hypertension (p < 0.01). Reliability: intraclass correlation coefficient was 0.88 in state of mind and 0.76 in somatic manifestations. Cronbach’s alpha was 0.96 and 0.89, respectively. Sensitivity: the «size of the effect» at a month from starting treatment for hypertension was 0.40. Hypertension for over 10 years, more organs affected, gravity and morbid obesity were associated with worse quality of life, especially in the state-of-mind dimension. Cardiac frequency correlated closer with state of mind than somatic manifestations.
Conclusions
The HQALY is the first specific hypertension questionnaire developed in Spain which has been shown valid, reliable and sensitive to changes. However, the number of items on it must be reduced for routine use in clinical practice.
Footnotes
El estudio ha sido posible gracias a la colaboración de Bristol-Myers Squibb.
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