Applicability to primary care of national clinical guidelines on blood pressure lowering for people with stroke: cross sectional study

BackgroundPrimary aldosteronism (PA) is the most frequent cause of secondary hypertension. Reported prevalences of PA vary considerably because of a large heterogeneity in study methodology.AimTo examine the proportion of patients with PA among patients with newly diagnosed, never treated hypertension.Design and settingA cross-sectional study set in primary care.MethodGPs measured aldosterone and renin in adult patients with newly diagnosed, never treated hypertension. Patients with elevated aldosterone-to-renin ratio and increased plasma aldosterone concentration underwent a saline infusion test to confirm or exclude PA. The source population was meticulously assessed to detect possible selection bias.ResultsOf 3748 patients with newly diagnosed hypertension, 343 patients were screened for PA. In nine out of 74 patients with an elevated aldosterone-to-renin ratio and increased plasma aldosterone concentration the diagnosis of PA was confirmed by a saline infusion test, resulting in a prevalence of 2.6% (95% confidence interval = 1.4 to 4.9). All patients with PA were normokalaemic and 8 out of 9 patients had sustained blood pressure >150/100 mmHg. Screened patients were younger (P<0.001) or showed higher blood pressure (P<0.001) than non-screened patients.ConclusionIn this study a prevalence of PA of 2.6% in a primary care setting was established, which is lower than estimates reported from other primary care studies so far. This study supports the screening strategy as recommended by the Endocrine Society Clinical Practice Guideline. The low proportion of screened patients (9.2%), of the large cohort of eligible patients, reflects the difficulty of conducting prevalence studies in primary care clinical practice.

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Fatores Associados a Tensão Arterial Não Controlada em Pessoas com Diabetes Tipo 2 Seguidas nos Cuidados de Saúde Primários em Portugal

Acta Médica Portuguesa ◽

10.20344/amp.8321 ◽

2017 ◽

Vol 30 (3) ◽

pp. 197 ◽

Cited By ~ 2

Author(s):

Inês Rosendo ◽

Luiz Miguel Santiago ◽

Margarida Marques

Keyword(s):

Physical Activity ◽

Blood Pressure ◽

Type 2 Diabetes ◽

Primary Care ◽

Regression Analysis ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Primary Care Patients

Introduction: Determine whether socio-demographic, habits and risk factors are associated with a better tensional control in type 2 diabetes in primary care patients in order to identify a specific target population for compensatory interventions improving diabetes control and reducing its morbi-mortality.Material and Methods: Cross-sectional study in primary care. Randomized type 2 diabetes patient data collection by their volunteer family doctors, proportionally stratified from the 5 Portuguese continental regions. Variables: blood pressure, age, gender, education, diabetes duration, HbA1c, smoking habits, weight, waist circumference, physical activity and adherence to medication. Bivariate and logistic regression analysis to evaluate each measured variable’s independent association with uncontrolled blood pressure (≥ 140/90).Results: 709 patients were included in the study, 60.2% men, mean age 66.12 ± 10.47 years. In logistic regression analysis, the factors independently associated to uncontrolled BP were lower education (p = 0.014), shorter diabetes duration (p = 0.002), higher waist circumference (p < 0.001), higher pulse pressure (p < 0.001), higher physical activity level (p = 0.043) and being a smoker (p < 0.001).Discussion: The main limitations are the fact that the sample was not totaly random and included only primary care patients, a possible inter-observer bias and being a cross-sectional study, thus not providing information on temporal relation or causality.Conclusion: The sub-group of people with diabetes identified to have worse tensional control should have a different and more intensive approach in primary care. We recommend further longitudinal and population based confirmatory research.

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Correction: Predictors of Medication Adherence and Blood Pressure Control among Saudi Hypertensive Patients Attending Primary Care Clinics: A Cross-Sectional Study

PLoS ONE ◽

10.1371/journal.pone.0187614 ◽

2017 ◽

Vol 12 (10) ◽

pp. e0187614 ◽

Cited By ~ 1

Author(s):

Keyword(s):

Blood Pressure ◽

Primary Care ◽

Medication Adherence ◽

Blood Pressure Control ◽

Pressure Control ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Hypertensive Patients ◽

Primary Care Clinics

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Predictors of Medication Adherence and Blood Pressure Control among Saudi Hypertensive Patients Attending Primary Care Clinics: A Cross-Sectional Study

PLoS ONE ◽

10.1371/journal.pone.0171255 ◽

2017 ◽

Vol 12 (1) ◽

pp. e0171255 ◽

Cited By ~ 21

Author(s):

Sarah M. Khayyat ◽

Salwa M. Saeed Khayyat ◽

Raghda S. Hyat Alhazmi ◽

Mahmoud M. A. Mohamed ◽

Muhammad Abdul Hadi

Keyword(s):

Blood Pressure ◽

Primary Care ◽

Medication Adherence ◽

Blood Pressure Control ◽

Pressure Control ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Hypertensive Patients ◽

Primary Care Clinics

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Association of Blood Pressure and Hypertension with Alcohol Consumption in HIV-Infected White and Nonwhite Patients

The Scientific World JOURNAL ◽

10.1155/2013/169825 ◽

2013 ◽

Vol 2013 ◽

pp. 1-8 ◽

Cited By ~ 2

Author(s):

Maria Leticia R. Ikeda ◽

Nêmora T. Barcellos ◽

Paulo R. Alencastro ◽

Fernando H. Wolff ◽

Ajácio B. M. Brandão ◽

...

Keyword(s):

Blood Pressure ◽

Alcohol Abuse ◽

Skin Color ◽

Cross Sectional Study ◽

Blood Pressure Lowering ◽

Alcohol Abusers ◽

Cross Sectional ◽

Pressure Lowering ◽

Blood Pressures ◽

Independent Association

Introduction.Although alcohol abuse is associated with hypertension in whites and nonwhites, it has been scarcely investigated in HIV-infected patients.Objective.To investigate whether the association of alcohol abuse with hypertension is influenced by skin color in HIV-infected individuals.Methods.Cross-sectional study in HIV-infected individuals aged 18 years or older. Demographic characteristics, lifestyle, and HIV infection were investigated. Alcohol abuse was defined as ≥15 (women) and ≥30 g/alcohol/day (men), and binge drinking by the intake of ≥5 drinks on a single occasion. Hypertension was defined by blood pressure ≥140/90 mmHg or use of blood pressure-lowering agents.Results.We studied 1,240 individuals, with39.1±10years, 51% males and 57% whites. Age and body mass index were associated with blood pressure, and there was an independent association of alcohol abuse with hypertension in whites (RR = 1.9, 95% CI 1.1–3.3) and nonwhites (RR = 2.4, 95% CI 1.4 to 4.0). Among nonwhite individuals who were alcohol abusers, systolic (9.3±3.2;P=0.001) and diastolic blood pressures (6.4±2.1;P=0.008) were higher than in nonabusers.Conclusion.Alcohol abuse is a risk factor for hypertension in white and nonwhite HIV-infected individuals. The association of ethanol consumption with blood pressure is not explained by AIDS-related conditions.

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