Global cardiovascular risk stratification and management of hypertensive adults in primary health care
Abstract
Introduction: High blood pressure is the main risk factor for the occurrence of cardiovascular diseases.
Objective: To identify the influence of treatment adjustment according to risk stratification on high blood pressure control.
Method: A study was carried out including 118 hypertensive patients with moderate or high global cardiovascular risk, who were followed up every four months during one year. The variables studied were age, gender, skin color, comorbidities, obesity, smoking habit, and alcohol consumption. Creatinine, glycemia, cholesterol, triglycerides, uric acid, urinalysis and microalbuminuria were determined. Treatment was adjusted according to risk stratification, and admissions and decompensations in the year prior to the study and during follow-up were recorded.
Results: Mean age was 64±13.4 years old. Females (63.4%) and white skin color (85.59%) predominated. The most frequent comorbidities were ischemic heart disease (18.4%) and heart failure (13.56), diabetes mellitus was present in 27.97%, dyslipidemias in 20.34%, smoking habit in 11.86% and obesity in 10.17% of patients. Blood pressure control improved by 20% and adherence to treatment by 26.2%. Decompensations (82.5%) and decompensated patients (25.2%) were significantly reduced (p<0.01). The drastic reduction in decompensations and better treatment compliance suggest that therapeutic adjustment according to risk stratification was effective.
Conclusions: A history of ischemic heart disease, heart failure and diabetes mellitus were the main causes due to which hypertensive patients classified as high risk. Adjustment of treatment according to risk levels achieved a reduction in the number of decompensations and improved adherence to treatment.
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1. Williams B, Mancia G, Spiering W, Rosei EA, Azizi M, Burnier M, et al. Guía ESC/ESH 2018 sobre el diagnóstico y tratamiento de la hipertensión arterial. Rev Esp Cardiol. 2019;72(2):160.e1-e78. DOI: http://doi.org/10.1016/j.recesp.2018.12.005
2. Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71(6):1269-1324. DOI: https://doi.org/10.1161/hyp.0000000000000066
3. Alcocer LA, Lozada O, Fanghänel G, Sánchez-Reyes L, Campos-Franco E. Global cardiovascular risk stratification: comparison of the Framingham method with the SCORE method in the Mexican population. Cir Cir. 2011;79(2):168-74.
4. Nerenberg KA, Zarnke KB, Leung AA, Dasgupta K, Butalia S, McBrien K, et al. Hypertension Canada's 2018 Guidelines for Diagnosis, Risk Assessment, Prevention, and Treatment of Hypertension in Adults and Children. Can J Cardiol. 2018;34(5):506-25. DOI: https://doi.org/10.1016/j.cjca.2018.02.022
5. Pérez Caballero MD, León Álvarez JL, Dueñas Herrera A, Alfonzo Guerra JP, Navarro Despaigne DA, de la Noval García R, et al. Guía cubana de diagnóstico, evaluación y tratamiento de la hipertensión arterial. Rev Cuban Med [Internet]. 2017 [citado 16 Abr 2020];56(4):242-321. Disponible en: http://scielo.sld.cu/pdf/med/v56n4/med01417.pdf
6. Soler Santana R, Brossard Cisnero M, Vaillant Rodríguez M, Omar Rodríguez Y, Marin Mendez M. Caracterización de pacientes con hipertensión arterial en la provincia de Santiago de Cuba. MEDISAN [Internet]. 2020 [citado 16 Abr 2020];24(2):174-84. Disponible en: http://medisan.sld.cu/index.php/san/article/view/2911/pdf
7. Noval García R, Armas Rojas NB, De la Noval González I, Fernández González Y, Pupo Rodríguez HB, Dueñas Herrera A, et al. Estimación del Riesgo Cardiovascular Global en una población del Área de Salud Mártires del Corynthia. La Habana, Cuba. Rev Cuban Cardiol [Internet]. 2011 [citado 18 Abr 2020];17(1):62-8. Disponible en: http://www.revcardiologia.sld.cu/index.php/revcardiologia/article/view/20/18
8. Hajjar I, Kotchen JM, Kotchen TA. Hypertension: trends in prevalence, incidence, and control. Annu Rev Public Health. 2006;27:465-90. https://doi.org/10.1146/annurev.publhealth.27.021405.102132
9. Valdés Ramos E, Bencosme Rodríguez N. Frecuencia de la hipertensión arterial y su relación con algunas variables clínicas en pacientes con diabetes mellitus tipo 2. Rev Cuba Endocrinol [Internet]. 2009 [citado 18 Abr 2020];20(3):77-88. Disponible en: http://scielo.sld.cu/pdf/end/v20n3/end02309.pdf
10. Paramio Rodríguez A, Cala Solozábal JC. Comportamiento de la tensión arterial en un barrio del municipio Cárdenas. Estado Táchira. Venezuela. Rev Habanera Cienc Méd [Internet]. 2010 [citado 18 Abr 2020];9(3):395-402. Disponible en: http://www.revhabanera.sld.cu/index.php/rhab/article/view/1696/1464
11. Boulton AJ, Vileikyte L, Ragnarson-Tennvall G, Apelqvist J. The global burden of diabetic foot disease. Lancet. 2005;366(9498):1719-24. DOI: https://doi.org/10.1016/s0140-6736(05)67698-2
12. Vilches Izquierdo E, Ochoa Montes LA, Pernas Sánchez Y, González Lugo M, Ramos Marrero L, Tamayo Vicente ND, et al. Tabaquismo, consumo de alcohol y de café en el espectro de los factores de riesgo para la muerte cardíaca súbita. Rev Cuban Med [Internet]. 2014 [citado 19 Abr 2020];53(3):325-36. Disponible en: http://scielo.sld.cu/pdf/med/v53n3/med09314.pdf
13. Arias Capote JC, Molerio Pérez O, Pérez Inerárity M. Validación del instrumento de recogida de información para evaluar la percepción de riesgo en hipertensos. Medicentro [Internet]. 2020 [citado 19 Abr 2020];24(1):68-84. Disponible en: http://www.medicentro.sld.cu/index.php/medicentro/article/view/2953/2505
14. Rodríguez-Abt JC, Solís-Visscher RJ, Rogic-Valencia SJ, Román Y, Reyes Rocha M. Asociación entre conocimiento de hipertensión arterial y adherencia al tratamiento en pacientes hipertensos del Hospital Nacional Edgardo Rebagliati Martins de Lima, Perú. 2015. Rev Fac Med. 2017;65(1):55-60. DOI: https://doi.org/10.15446/revfacmed.v65n1.56773
15. Arredondo Bruce AE, Navarro Pirez DO, Porto Franco L. Estudio del descontrol de la tensión arterial de los adultos menores de 60 años. Rev Méd Electrón [Internet]. 2019 [citado 21 Abr 2020];41(6). Disponible en: http://www.revmedicaelectronica.sld.cu/index.php/rme/article/view/3279/_1
16. Guedes Ramallo P, Morillas Blasco P, Gómez Martínez MJ, Núñez Martínez L, Romero Valero A, Peris Castelló F, et al. Utilidad pronóstica del electrocardiograma en pacientes hipertensos mayores de 65 años. Estudio FAPRES. Rev Clin Esp. 2020;220(2):100-8. DOI: https://doi.org/10.1016/j.rce.2019.05.007
17. Herrera Calderón Y, Menéndez Villa ML, Serra Valdés MA. Microalbuminuria como marcador de daño renal en pacientes con hipertensión arterial. Rev Habanera Cienc Méd [Internet]. 2019 [citado 21 Abr 2020];18(2):217-30. Disponible en: http://www.revhabanera.sld.cu/index.php/rhab/article/view/2585/2218
18. Gómez-Sánchez M, Patino-Alonso C, Gómez-Sánchez L, Recio-Rodríguez JI, Rodríguez-Sánchez E, Maderuelo-Fernández JA, et al. Valores de referencia de parámetros de rigidez arterial y su relación con los factores de riesgo cardiovascular en población española. Estudio EVA. Rev Esp Cardiol. 2020;73(1):43-52. DOI: https://doi.org/10.1016/j.recesp.2019.04.006
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