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Objective: To analyse the data, according to recruiting place and sex, of the survey May Measure Month in 2018 (MMM18) in Spain, promoted by the International Society of Hypertension., Methods: Subjects more than 18 years old were studied. MMM18 protocol was performed. Volunteers were recruited through the Spanish Society of Community Pharmacy (SEFAC) and the Spanish Society of Hypertension (SEH-LELHA). General linear models of blood pressure (BP) were carried out in subjects with and without treatment, and adjusted by age, sex, tobacco use, obesity and recruitment site., Results: 7 511 individuals (mean age 51.7 ± 19.6 years, 36.8% males) were screened. Systolic and diastolic BP was higher in males (129.0-16.7/119.6-18.2 mmHg) (78.3-11.1/74.8-10.7 mmHg) (p < 0.001). There was a linear relationship between systolic BP, age and sex, with higher values in males (11.2 mmHg in untreated and 4.5 mmHg in treated) (p < 0.001). Diastolic BP was inverted U-shaped, with highest level in males and between 50-55 years. The proportion of individuals with hypertension (pharmacies; public and clinical area) was 47.2% (54.2; 34.1 and 34.8%). Seventy-five percent were aware of their diagnosis (77.5; 61.5 and 69.2%), with 22% of them without pharmacological treatment (20.7; 26.0 and 27.9%). Sixty-four point five percent of those under antihypertensive treatment met targets (62.9; 65.6 and 69.1%) (p < 0.001)., Conclusions: There is big room for improvement in MMM indicators in Spain. Nearly half of subjects are hypertensive. Of those aware of their condition, 1 in 5 did not follow pharmacological treatment and of those treated, 1 in 3 did not meet targets. BP levels were significantly higher in males. Our study suggests that gender differences described should be considered in the BP thresholds established., (Copyright © 2020 SEH-LELHA. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objectives: Unlike the 2018 European Society of Cardiology/European Society of Hypertension (ESC/ESH) guideline, the 2017 American College of Cardiology/American Heart Association (ACC/AHA) guideline has recommended a shift in hypertension definition from blood pressure (BP) 140/90-130/80 mmHg. Further, they proposed somewhat different indications for antihypertensive medication. No data are available on the comprehensive impact of these guidelines in European countries, where physicians do not always follow guidelines from their own continent. We estimated the prevalence of hypertension, recommendations for antihypertensive medication, and cardiometabolic goals achieved in Spain using the ESC/ESH versus ACC/AHA guidelines., Methods: We analyzed data from a national survey on 12074 individuals representative of the population aged at least 18 years in Spain. BP was measured with standardized procedures., Results: According to the ESC/ESH and ACC/AHA guidelines, hypertension prevalence was 33.1% (95% confidence interval: 32.2-33.9%) and 46.9% (46.0-47.8%), respectively, and antihypertensive medication was recommended for 33.5% (32.7-34.3%) and 37.2% (36.3-38.1%) of adults, respectively. This represents 5.3 more million hypertensive patients and 1.4 more million candidates for medication (for a 40-million-adults' country) using the ACC/AHA versus the ESC/ESH guideline. Participants who were hypertensive under the ACC/AHA but not the ESC/ESH guideline achieved less frequently some cardiometabolic goals (e.g. nonsmoking, reduced salt consumption, LDL cholesterol if hypercholesterolemic, lifestyle medical advice, and treatment with renin-angiotensin-system blockers where indicated) than those who were hypertensive under the ESC/ESH guideline., Conclusion: The implementation of the ACC/AHA versus the ESC/ESH guideline would result in a substantial increase in the prevalence of hypertension and the number of adults who should receive medication. There is room for improvement in lifestyles and cardioprotective treatment in individuals with BP of 130-9/80-9 mmHg whether they are called hypertensive (ACC/AHA) or not (ESC/ESH). We suggest that clinical-practice guidelines should consider the public health and costs implications, and not only the evidence on effectiveness and cost-effectiveness, of their recommendations.

Background and Objective: Frailty and disability are associated with cardiovascular risk factors, including hypertension, in older people; however, little is known about their association with ambulatory blood pressure (BP). Thus, we assessed the relationship of frailty and disability with ambulatory BP in older adults., Design, Setting, and Participants: Cross-sectional study of 1047 community-living individuals aged ≥60 years in Spain., Measurements: BP was determined with validated devices under standardized conditions during 24 hours. Frailty was defined as having 3 or more of the following criteria: weight loss, low grip strength, low energy, slow gait speed, and low physical activity. Disability was assessed with the Lawton-Brodýs questionnaire on instrumental activities of daily living. Associations with systolic BP (SBP) and dipping (nocturnal SBP decline) were modeled and adjusted for sociodemographic variables, body mass index, lifestyles, antihypertensive drug treatment, comorbidities, 24-hour heart rate, and conventional or ambulatory SBP as appropriate., Results: Participants' mean age was 71.7 years (50.8% men); 6% were frail and 8.1% had disability. Compared with nonfrail participants, those with frailty had 3.5 mm Hg lower daytime SBP (P = .001), 3.3% less SBP dipping (P = .003), and 3.6 mmHg higher nighttime SBP (P = .016). Compared with participants who are not disabled, those who are disabled had 2.5 mmHg lower daytime SBP (P = .002), 2.5% less SBP dipping (P = .003), and 2.7 mmHg higher nighttime SBP (P = .011)., Conclusions: In community-dwelling older adults, frailty and disability were independently associated with lower diurnal SBP, blunted nocturnal decline of SBP, and higher nocturnal SBP. These findings may help explain the higher mortality associated with low clinic SBP in frail older subjects observed in epidemiologic studies., (Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

Blood pressure (BP) variability and nocturnal decline in blood pressure are associated with cardiovascular outcomes. However, little is known about whether these indexes are associated with white-coat and masked hypertension. We performed a cross-sectional analysis of 1047 community-dwelling individuals aged ⩾60 years in Spain in 2012. Three observer-measured home BPs and 24-h ambulatory blood pressure monitoring (ABPM) were performed under standardized conditions. BP variability was defined as BP s.d. and coefficient of variation. Differences in BP variability and nocturnal BP decrease between groups were adjusted for sociodemographic and clinical covariates using generalized linear models. Of the cohort, 21.7% had white-coat hypertension, 7.0% had masked hypertension, 21.4% had sustained hypertension, and 49.9% were normotensive. Twenty-four hour, daytime and night-time systolic BP s.d. and coefficients of variation were significantly higher in subjects with white-coat hypertension than those with normotension (P<0.05) and were similar to subjects with sustained hypertension. In untreated subjects, 24-h but not daytime or night-time BP variability indexes were significantly higher in subjects with white-coat hypertension than in those with normotension (P<0.05). Percentage decrease in nocturnal systolic and diastolic BP was greatest in the white-coat hypertension group and lowest in the masked hypertension group in all patients and untreated patients (P<0.05). Lack of nocturnal decline in systolic blood pressure was observed in 70.2% of subjects with normotension, 57.8% of subjects with white-coat hypertension, 78.1% of subjects with masked hypertension, and 72.2% of subjects with sustained hypertension (P<0.001). In conclusion, 24-h BP variability was higher in subjects with white-coat hypertension and blunted nocturnal BP decrease was observed more frequently in subjects with masked hypertension. These findings may help to explain the reports of increased cardiovascular risk in patients with white-coat hypertension and poor prognosis in those with masked hypertension, highlighting the importance of ABPM.