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Resumen: Objetivo: Identificar el patrón de medición de la automonitorización de la presión arterial (AMPA) más eficiente para el seguimiento del hipertenso en atención primaria. Diseño: Estudio validación de prueba diagnóstica. Emplazamiento: Equipo de atención primaria en Murcia. Población: Ciento cincuenta y tres hipertensos menores de 80 años que cumplieran con los criterios de inclusión; y con AMPA y monitorización ambulatoria de su presión arterial válidos. Mediciones principales: Realización de monitorización ambulatoria de presión arterial durante 24 h (MAPA). El protocolo de AMPA consistió en registrar 2 mediciones en la mañana y 2 en la noche durante 7 días. Con los registros obtenidos se establecieron los diferentes patrones de AMPA (7, 6, 5, 4, 3 días). Para el análisis utilizamos las curvas COR, el coeficiente de correlación intraclase y el diagrama de Bland-Altman. Resultados: Las mejores áreas bajo la curva para la presión sistólica de los diferentes patrones de la AMPA correspondieron al patrón de 4 días: 0,837 (0,77-0,90); y al de 3 días: 0,834 (0,77-0,90). En cuanto a la diastólica, el patrón de 7 días presentó un área bajo la curva de 0,889 (0,84-0,94); y en segundo lugar, coincidiendo con la misma cifra, los patrones de 3 y 4 días: 0,834 (0,83-0,94). No hubo diferencias significativas entre los coeficientes de correlación intraclase para las presiones arteriales sistólicas y diastólicas. El patrón de 3 días mostró en conjunto una menor dispersión en el diagrama de Bland-Altman. Conclusión: Proponemos el patrón de AMPA de 3 días para el seguimiento del paciente hipertenso, ya que no presenta una eficiencia inferior a los demás patrones. Abstract: Objective: To identify the most efficient measurement pattern of home blood pressure monitoring (HBPM) for the follow-up of hypertensive patients in primary care. Design: Validation study of a diagnostic test. Setting: Primary care team in Murcia, Spain. Population: One hundred and fifty three hypertensive patients younger than 80 years who met the inclusion criteria, who used HBPM and ambulatory blood pressure monitoring. Main measurements: Performing HBPM for 24 hours. The HBPM protocol consisted of recording 2 measurements in the morning and 2 in the evening for 7 days. With the records obtained, the different HBPM patterns were established (7, 6, 5, 4, 3 days). The ROC curves were used for the analysis, together with the correlation coefficients and the Bland-Altman plots. Results: The best areas under the curve for the systolic pressure of the different HBPM patterns corresponded to the 4-day pattern: 0.837 (0.77-0.90); and the 3 day one: 0.834 (0.77-0.90). As for diastolic pressure, the 7-day pattern had an area under the curve of 0.889 (0.84-0.94); followed by the 3 and 4 days patterns, which had the same statistical result both: 0.834 (0.83-0.94). There were no significant differences between correlation coefficients for systolic and diastolic blood pressures. The 3-day pattern showed a lower dispersion in the Bland-Altman plots. Conclusion: The 3 days HBPM pattern is proposed for the follow-up of the hypertensive patient, since it does not have an inferior efficiency to the other patterns. : Automonitorización presión arterial, Atención primaria, Riesgo cardiovascular, Keywords: Home blood pressure monitoring, Primary care, Cardiovascular risk

Background: Physicians’ failure to change/adjust treatments after learning of poor follow-up control in hypertensive patients can be defined as clinical inertia, a frequent and serious problem that affects health care activity at the international level. Method: A total of 153 hypertensive patients under 80 years of age who met the inclusion and exclusion criteria and had received ambulatory blood pressure monitoring (ABPM) for 24 hours as the follow-up method to evaluate their level of blood pressure (BP) control. One year after data collection, the included patients were studied retrospectively, and the changes introduced by their physicians were checked based on their results. Results: Sixty-five hypertensive patients (42.5%) out of the total sample (153) were classified as poorly controlled; of these, 36 were subject to therapeutic inertia (55%). Of the 29 hypertensive patients who did undergo treatment adjustment (45%), 15 (52%) underwent adjustment before the month of notification. Conclusion: Therapeutic inertia in the care of hypertensive patients continues to be a common problem in primary care. Young hypertensive patients of male sex, smokers and nondiabetic patients were the most affected groups. Test record: Registered retrospectively by the Clinical Ethics Committee of the José María Morales Meseguer University Hospital with the code EST: 62/17

Background Improving clinical practice aimed at controlling hypertension is a pending issue in health systems. One of the methods currently used for this purpose is self blood pressure measurement (SBPM) whose use increases every day. The aims of this study are to establish the optimal cut-off point for the 3-day SMBP protocol and to identify factors that could affect the precision of the 3-day SMBP protocol using 24-h ambulatory blood pressure monitoring (ABPM) as a reference. Method This is a cross-sectional descriptive study to validate a diagnostic test performed by a primary care team in Murcia, Spain. A total of 153 hypertensive patients under 80 years of age who met the inclusion criteria were evaluated. ABPM was performed for 24 h. The SBPM protocol consisted of recording 2 measurements in the morning and 2 at night for 3 days. Results The cut-off point for SBP was set at 135 mmHg (sensitivity: 80.39%, specificity: 74.19%), and for DBP, it was set at 83 mmHg (sensitivity: 76.48%, specificity: 84.89%), which yielded the highest combined sensitivity and specificity. After carrying out the validation study with the new figures, we proceeded to establish which socio-demographic factors prevented a correct classification of patients. These errors were more common in male patients for the assessments of both DBP (OR = 2.4) and SBP (OR = 2.5); hypertensive patients with age