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Introduction and Objectives: Hypertension is one of the main cardiovascular risk factors. An educational intervention, aimed at increasing or reinforcing the patient's knowledge, can contribute to better control of their blood pressure. Our goal was to evaluate the efficacy of a continuing therapeutic education versus an initial intervention in hypertensive patients., Methods: Experimental study of multicenter community intervention, through the application of a therapeutic education program in hypertension., Results: 980 patients on antihypertensive treatment were included, 490 in each group, with a mean age of 65 years, and 50% women, baseline mean SBP in both groups was136 mmHg. Regarding knowledge about hypertension, although a similar initial improvement was observed in both groups, at the end of the study, in the continuous intervention group (CIG) an average of 23.06 correct answers was observed, while in the Initial intervention group (IIG) the mean was 20.91, being the difference statistically significant (p < 0.001). At the end of the study, the mean SBP was 127.5 mmHg in the CIG and 136.57 mmHg in the IIG group. Likewise, a lower percentage of patients with a BMI ≥25 was observed in the CIG (78.2%) than in the IIG 82.6%, this difference being statistically significant (p < 0.001). This same effect was observed on the abdominal perimeter, observing an increased abdominal perimeter in 46.3% of the CIG compared to 68.8% in the IIG (p < 0.001). CONCLUSIóN: A continuous educational intervention increases the degree of knowledge about hypertension compared to an initial intervention. Likewise, this intervention is associated with an improvement in blood pressure, weight, body mass index and abdominal girth figures., (Copyright © 2021 Elsevier España, S.L.U. All rights reserved.)

Introduction: Resistant hypertension(RH) has been defined as failure to control office blood pressure (BP) despite the use of≥3 different antihypertensive agents at optimal doses, including, ideally, a diuretic. Apparent RH, defines patients with an incorrect diagnosis of RH due to different causes. The objective was to determine whether most patients with RH in fact have apparent but not true RH., Patients and Methods: Observational study involving 93 patients with suspected RH, being 60 patients finally included. Screening for secondary causes of hypertension was perfomed. True RH was defined as office BP>140/90mmHg despite full doses of 3 antihypertensive drugs including a diuretic., Results: Mean age 63.7±9.8years, 68.3%were male. Office BP 154.3±14.4/84.4±13.7mmHg. Of the 60 patients, 23.3% had white coat effect, 3.3% didn't have a diuretic and 8.3% were non-adherent-to-treatment. Accordingly, 58.3% were classified as true RH. Spironolactone was added in 62.5% of patients of whom 78.4% achieved ambulatory BP control., Discussion: Almost half of the patients with suspected RH were not really true RH. We provide more evidence of excess of fluid retention as an underlying cause of lack of BP control in patients with RH, reinforce the relevant paper of spironolactone for the management in those patients., (Copyright © 2017 Elsevier España, S.L.U. All rights reserved.)

Background and Objetives: The prevalence of non-valvular atrial fibrillation (NVAF) increases with the patient's age and is associated with high morbi-mortality rates. The main goal of this study was to describe the characteristics of hospitalized elderly patients with NVAF and to identify the clinical and functional factors which determine the use of different antithrombotic strategies., Patients and Methods: Observational, prospective, multicentre study carried out on patients with NVAF over the age of 75, who had been admitted for any medical condition to Internal Medicine departments., Results: We evaluated 804 patients with a mean age of 85 years (range 75-101), of which 53.9% were females. The prevalence of risk factors and cardiovascular disease was high: hypertension (87.6%), heart failure (65.4%), ischemic cardiomyopathy (24.4%), cerebrovascular disease (22.4%) and chronic kidney disease (45%). Among those cases with previous diagnoses of NVAF, antithrombotic treatment was prescribed in 86.2% of patients: anticoagulants (59.7%), antiplatelet medication (17.8%) and double therapy (8.7%). The factors associated with the use of antithrombotic treatment were history of acute coronary syndrome and atrial fibrillation progression longer than one year. Older age, atrial fibrillation for less than one year, higher HAS-BLED scores and severe cognitive impairment were associated with the use of anti-platelet drugs. Permanent atrial fibrillation favoured the use of anticoagulants., Conclusions: Hospitalized patients older than 75 years old with NVAF showed numerous comorbidities. The percentage of anticoagulation was small and 18% received only anti-platelet therapy. The patient's age, atrial fibrillation's progression time and the severity of the cognitive impairment influenced this therapy choice., (Copyright © 2016 Elsevier España, S.L.U. All rights reserved.)

Background and Objective: To evaluate the adequacy of atrial fibrillation (AF) management 6 years after the establishment of a coordinated AF Unit., Patients and Methods: Patients with AF attended during 14 consecutive days in the Emergency Room, Internal Medicine, Neurology and Arrhythmia departments of a tertiary hospital, and 3 primary health care centers of the same urban health care area were included. Treatment for AF and its adequacy to current clinical guidelines, tests performed and knowledge about the arrhythmia were evaluated. Results were compared with a population of 239 patients treated 6 years earlier., Results: One hundred and sixty-eight patients were included. Knowledge of the arrhythmia improved. The adequacy of treatment (rate control, rhythm control and antithrombotic prophylaxis) remained at the same level as in the previous period in all areas. The adequacy of thromboprophylaxis was negatively associated with advanced age (P < .001) and positively associated with knowledge of arrhythmia (P = .026)., Conclusion: Treatment of AF in a coordinated health area remains appropriate 6 years after the establishment of a coordinated AF unit. Elderly patients are still poorly anticoagulated. Health education may improve this deficit., (Copyright © 2013 Elsevier España, S.L.U. All rights reserved.)

The number of patients older than 80 years is steadily increasing and it represents the main basis for increasing population figures in developed countries. Cardiovascular diseases are the leading causes of mortality and disability causes result in a huge burden of disease in elderly people. However, available scientific evidence to support decision-making on cardiovascular prevention in elderly patients is scarce. Currently available risk assessment scales cannot be applied to elderly people. They are focused on cardiovascular mortality risk and do not provide information on factors with a proven prognostic value in the very old (functioning disability, dementia). Elderly people are a highly heterogeneous population, with a variety of co-morbidities, as well as several functional and cognitive impairment degrees. Furthermore, aging-associated physiological changes and common use of multiple drugs result in an increased risk of adverse drug reactions. Thus, drug use should always be based on a risk/benefit assessment in the elderly. Therefore, therapeutic decision-making in the very old must be an individually tailored and based on an appropriate clinical judgement and a comprehensive geriatric assessment. The current consensus report aims to present a proposal for clinical practices in the primary and secondary cardiovascular prevention in the very old and to provide a number of recommendations on lifestyle changes and drug therapy for the management of major cardiovascular risk factors., (Copyright © 2014 Elsevier España, S.L. All rights reserved.)

Introduction and Objective: In recent years the evidence that masked hypertension is associated with a highest cardiovascular risk is well established. Knowing the prevalence of masked hypertension in our country will allow a better cardiovascular risk stratification and management of hypertensive patients, although the information is scant and heterogeneous. For this reason, the working group for the study of masked hypertension (ESTHEN) in Spain developed the present study with the objective to know the prevalence of masked hypertension in a cohort of hypertensive patients follows in several Hypertension Units in Spain., Patients and Methods: Prospective study of a cohort of hypertensive patients followed in 75 Hypertension Units in Spain. Eligible patients were hypertensive cases aged ≥ 18 years receiving antihypertensive drug treatment and showing an adequate BP control at the clinic (BP < 140/90 mmHg). Masked hypertension was defined when mean daytime BP ≥ 135/85 mmHg., Results: We analyzed data from 302 patients. Mean age was 56.2 years and 56% were male. Prevalence of masked hypertension was 48% (95%CI 42-53). The most prevalent accompanying risk factors were abdominal obesity (39.7%), smoking (24.2%), family with premature cardiovascular disease (22.5%), and diabetes (11.6%). Prevalence of left ventricular hypertrophy was 23.8%, and 22.2% of patients had established cardiovascular disease, and 6.3% had renal disease. Masked hypertension was related to the absence of established cardiovascular disease (OR 0.306, 95%CI 0.139-0.676) and to the proximity of the clinic BP levels to the control thresholds (0.901, 95%CI 0.842-0.963). The OR of masked hypertension diminished 10% for each mmHg below the threshold of control., Conclusions: The prevalence of masked hypertension was approximately 50% in treated hypertensive patients. ABPM constitutes a basic tool for detection of this abnormality., (Copyright © 2010 Elsevier España, S.L. All rights reserved.)