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Despite the importance of achieving cardiometabolic goals beyond blood pressure, in the health of hypertensives, no comprehensive assessment of these characteristics has been performed in whole countries. We studied in 2008-2010 a total of 11 957 individuals representative of the Spanish population aged≥18 years. Information on cardiometabolic characteristics was collected at the participants' homes, through structured questionnaires, physical examination, and fasting blood samples. A total of 3983 individuals (33.3%) had hypertension (≥140/90 mm Hg or current antihypertensive drug treatment), 59.4% were aware of their condition, 78.8% treated among those aware, and 48.5% controlled among those aware and treated (22.7% of all hypertensives). Of the aware hypertensives, 13.8% had a body mass index<25 kg/m2, 38.6% consumed <2.4 g/d of sodium, 19.3% were diabetic with 61% attaining goal hemoglobin A1c<6.5%, whereas 42.3% had hypercholesterolemia, with 38.1% reaching goal low-density lipoprotein<115 mg/dL. Only 30.7% of overweight patients received a prescription of specific method for weight loss, 17.4% of daily smokers were offered a smoking cessation strategy, and 15.8% of older patients were given a flu shot. Aware and unaware hypertensives showed a similar frequency of some lifestyle, such as adequate physical activity. In conclusion, in a European country with a well-developed, free-access healthcare system, achievement of many cardiometabolic goals among hypertensives is poor. Moreover, a serious deficiency in hypertension awareness and in the effectiveness of some lifestyle interventions among aware hypertensives is present. Greater effort is needed in the management of coexisting risk factors and on lifestyle medical advice to improve the cardiometabolic health of hypertensives. [ABSTRACT FROM AUTHOR]

Background: The major cardiovascular risk factors and existing cardiovascular disease have been linked to increased risk of the frailty syndrome. However, the association between ideal cardiovascular health and the risk of frailty in older adults is uncertain., Methods and Results: Prospective cohort study of 1745 individuals (≥60 years and free of cardiovascular disease) recruited during 2008 to 2010. Cardiovascular health was defined as having 7 ideal metrics: never smoking, physically active, healthy diet, body mass index <25 kg/m(2), untreated serum cholesterol <200 mg/dL, untreated blood pressure <140/90 mm Hg, and untreated fasting serum glucose <100 mg/dL. Participants were followed-up through 2012 to assess incident frailty, defined as ≥3 of the 5 Fried criteria. Statistical analyses were performed with Cox regression and adjusted for main confounders. During a mean follow-up of 3.5 years, 117 cases of incident frailty were identified. Compared with meeting 0 to 1 ideal metrics, the hazard ratio (95% confidence interval) of frailty was 0.51 (0.30-0.84) for 2 metrics and 0.630 (0.39-0.99) for ≥3 metrics. Results were similar after excluding incident cases of cardiovascular disease. The number of ideal metrics showed a tendency to a reduced risk of all frailty criteria. The cardiovascular metrics associated with the greatest reduction of frailty risk were being physically active and ideal body mass index., Conclusions: Reaching old age in ideal cardiovascular health is associated with a reduced risk of frailty. This highlights the importance of a life-course approach for frailty prevention., (© 2016 American Heart Association, Inc.)

Introduction: High cardiorespiratory fitness (CRF) is strongly associated with longer life among older adults. CRF can be assessed by exercise-based methods, which are not feasible in most clinical settings. Thus, nonexercise algorithms to estimate CRF have been developed, but whether they predict mortality in older adults is uncertain., Methods: A cohort of 1470 men and 1460 women, representative of the Spanish population age ≥60 yr, was established in 2000/2001 and followed up prospectively through 2011. At baseline, nonexercise CRF was estimated with the sex-specific algorithms developed by Jackson et al. Analyses were performed with Cox regression and adjusted for the main confounders., Results: During an average follow-up of 9.4 yr, 570 (38.8%) deaths occurred in men and 295 (20.2%) in women. Among men, no association was observed between nonexercise CRF and all-cause mortality. Compared with women in the lowest quartile of CRF, the hazard ratio (95% confidence interval) for all-cause death was 0.81 (0.62-1.06) in the second quartile, 0.68 (0.48-0.95) in the third quartile, and 0.56 (0.36-0.87) in the highest quartile (P for trend = 0.004). Results held regardless of age, body mass index, waist circumference, HR, subjective health, functional limitations, and disease status., Conclusions: Higher nonexercise CRF was related to lower risk of death in older women but not in men. Because previous research does not support clear sex-specific association, further research is required to assess whether nonexercise CRF predicts mortality in older adults or new algorithms should be developed for this population, with special attention to older men.

Background: The use of antihypertensive medication and hypertension control has significantly increased during recent decades in some developed countries, but the impact of improved drug treatment on blood pressure (BP) control in the population is unknown., Methods and Results: Data were taken from 2 surveys representative of the population aged ≥ 60 years in Spain conducted with the same methodology in 2000 to 2001 and in 2008 to 2010. BP was measured 6×. The first BP reading was discarded, and the average of the remaining 3 to 5 BP readings was taken for analysis. Hypertension prevalence was 68.7% in 2000 to 2001 and 66.0% in 2008 to 2010. Between both time periods there was an improvement in hypertension awareness (63.6%-67.7%), drug treatment among those aware (84.5%-87.5%), and BP control among treated hypertensives (30.3%-42.9%). Overall, BP control among all hypertensives increased from 16.3% to 25.4%. After adjustment for age, sex, education, hypertension duration, smoking, alcohol consumption, body mass index, sedentary behavior, diabetes mellitus, cardiovascular disease, and visits to the physician through logistic regression, ≈ 7% of the improvement in BP control among all hypertensives was explained by higher hypertension awareness, and 36.2% was explained by a higher treatment rate. Among the treated hypertensives, 22.6% of the progress in BP control was because of the increase in the number of BP medications used in each patient., Conclusions: BP control among the older hypertensive population in Spain has improved from 2000 to 2001 to 2008 to 2010 because of a higher treatment rate and more intense antihypertensive drug treatment., (© 2015 American Heart Association, Inc.)

Purpose: Prolonged sitting time (ST) is associated with higher mortality. However, previous studies used only a single measure of ST at baseline, so they could not directly assess the effect of continued exposure to high ST, or of changes in ST, on mortality. We prospectively assessed the association of continued sedentariness and of changes in ST for 2 yr with subsequent long-term all-cause mortality., Methods: This study was based on a prospective cohort of 2635 persons representative of the Spanish population 60 yr and older. ST was self-reported in 2001 and 2003. The median of ST was used as the cutoff to define excessive ST. Individuals were classified as consistently sedentary (> median in 2001 and 2003), newly sedentary (≤ median in 2001 and > median in 2003), formerly sedentary (> median in 2001 and ≤ median in 2003), and consistently nonsedentary (≤ median in 2001 and 2003). The association of ST in the period 2001-2003 with all-cause mortality from 2003 through 2011 was assessed with Cox regression and adjusted for the main confounders, including physical activity., Results: Among the study participants, 846 died between 2003 and 2011. Compared with persons who were consistently sedentary, the hazard ratios (95% confidence interval) for mortality were 0.91 (0.76-1.10) in those who were newly sedentary, 0.86 (0.70-1.05) in formerly sedentary individuals, and 0.75 (0.62-0.90) in those who remained consistently nonsedentary. The results were similar across strata defined according to obesity, morbidity, functional limitations, or meeting recommendations for physical activity., Conclusion: Compared with older adults who were consistently sedentary during 2 yr, consistently nonsedentary individuals showed reduced all-cause mortality. Individuals who changed ST experienced an intermediate reduction in mortality.

This study assessed a training programme attended by 25 observers, intentionally chosen for their lay status, who were invited to participate in a prevalence of hypertension study. The results highlight the fact that the 14 trainee observers finally selected were comparable to professionals in terms of both the estimated validity of the blood pressure measurement [the mean difference (standard deviation) compared with the expert being -0.4 (1.8) mmHg for systolic blood pressure and 0.0 (1.8) mmHg for diastolic blood pressure] and estimated inter-observer variability (100% of the observers complying with the criteria recommended for professional health-care workers), even though the training given to the former was in no way more comprehensive than or distinct from that recommended for professional health-care workers in community studies.

Background and Purpose: This study examines the changes in provincial distribution of cerebrovascular disease (CVD) mortality and its socioeconomic and lifestyle risk factors to identify those factors that have most greatly contributed to the decline in CVD mortality in Spain during the period 1975-1993., Methods: We performed a study using data aggregated at a provincial level. Mortality data were taken from official vital statistics, while data on risk factors were obtained from surveys of representative large Spanish population samples. Correlation and multiple linear regression analyses were performed on percent changes in age-standardized CVD mortality from 1975-1979 to 1989-1993 and its potential determinants during the period 1964-1980., Results: CVD mortality was higher in the southern and eastern (Mediterranean coast) provinces in 1975-1979 and again in 1989-1993. Between these periods there was a 55% decline in CVD mortality, which affected all provinces but was greater in those with a lower CVD mortality (r = -0.31, P = 0.03). The 1964-1980 period witnessed an increase in the intake of most foodstuffs and all types of fats. However, there was a decrease in the consumption of vegetables and legumes and in the proportion of illiteracy among the population older than 45 years. The greatest increase in fruit and fish consumption and the greatest decrease in illiteracy were registered by Spain's northernmost provinces, the same provinces that recorded the greatest decline in CVD mortality. Changes in fruit, wine, and fish intake accounted for 22% of the variation in the decline in CVD mortality. The increase in fruit consumption and decrease in wine consumption showed a statistically significant relationship (P < or = 0.04) with the decline in CVD mortality., Conclusions: The increase in fruit and decrease in wine consumption from 1964-1980 may have contributed to the decline in CVD mortality in Spain during 1975-1993.