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There is currently a degree of divergence among the main clinical practice guidelines on the management of risk factors for peripheral arterial disease (PAD). This project aims to gain understanding of the management of PAD risk factors in clinical practice and to reach a multidisciplinary consensus on the strategies to be followed in order to optimize its identification, treatment, and follow-up.A multidisciplinary consensus following the Delphi methodology.Professionals (n = 130) with extensive experience in PAD participated in this consultation. The results suggest that in order to optimize the control of risk factors, efforts should be aimed at: (1) promoting the involvement and awareness of all specialists in the identification of and screening for the disease; (2) guaranteeing the possibility of evaluating the ankle-brachial index (ABI) in all the medical specialties involved; (3) promoting strategies for patients to quit smoking through the use of drugs, programs, or referrals to specialized units; (4) promoting an appropriate Mediterranean-based diet and the prescription of daily exercise; (5) raising awareness of the importance of ensuring LDL cholesterol values below 70 mg/dL, especially in symptomatic but also in asymptomatic patients (55 mg/dL following the publication of the ESC/EAS guide); (6) recommending the use of antiplatelet therapy in asymptomatic patients with diabetes mellitus (DM) and/or a pathological ABI; and (7) protocolizing the annual evaluation of ABI in high-risk patients.This document presents the 22 agreed-upon strategies which are intended to help professionals optimize multidisciplinary management of PAD risk factors.

Measurement of blood pressure (BP) by the own patient at home has become a popular procedure. Both a great offer of simple electronic devices and publication of multiple studies supporting its usefulness for the diagnosis and control of hypertension have contributed to this fact. In fact, this technique has various advantages over the conventional clinical measurement such as a higher reproducibility, better representation of the usual BP profile of the patient, greater correlation with target organs damage and greater morbimortality predictive value. Besides, there is a potential benefit on the control of patients under antihypertensives and, maybe, a reduction in health expenses at long-term follow-up. Currently, the main hypertension societies recommend the home measurement of BP in some clinical situations. However, it cannot be considered an alternative to the clinical measurement but rather a complementary technique in the evaluation of the hypertensive patient. Here we review the indications and limitations of this procedure in clinical practice.

ResumenObjetivoEstimar la prevalencia de diabetes mellitus y de glucemia basal alterada en una población adulta de Madrid.MétodosEstudio transversal de base poblacional. Incluyó 1344 adultos (31-70 años de edad), seleccionados aleatoriamente del censo de usuarios de 14 centros de salud de la Comunidad de Madrid. Se realizaron las siguientes determinaciones: cuestionario clínico, exploración física y análisis de sangre basal (glucemia, triglicéridos y colesterol). Se consideraron diabéticos aquellos previamente diagnosticados por su médico, así como los que presentaron una glucemia basal ≥ 126mg/dl en ausencia de un diagnóstico previo de diabetes. Con una glucemia entre 100 y 125mg/dl en ausencia de diabetes se clasificaron como glucemia basal alterada.ResultadosLas prevalencias de diabetes y de glucemia basal alterada, ajustadas por edad y sexo, fueron del 6,6% (intervalo de confianza del 95% [IC95%]: 5,9-8,7) y del 14,1% (IC95%: 12,1-15,8), respectivamente. Un 17,2% [IC95%: 10,9-23,5] de los diabéticos detectados no habían sido diagnosticado previamente de esta enfermedad. Los factores asociados de modo independiente con la diabetes fueron la edad, el sexo masculino, la presencia de obesidad abdominal y la hipertensión arterial.ConclusionesEn nuestra población de Madrid, la prevalencia de diabetes es similar a la de otras regiones españolas. Es destacable el alto porcentaje de sujetos con una glucemia basal alterada, lo cual, asociado a la obesidad, conlleva un alto riesgo de desarrollar diabetes en el futuro.AbstractObjectiveTo estimate the prevalence of diabetes mellitus and impaired fasting glycemia in an adult population living in Madrid (Spain).MethodsIn this cross-sectional, population-based survey, we studied 1,344 adults aged 31-70 years, randomly selected from the population living in 14 primary care districts of the Madrid region. All participants underwent a clinical evaluation that included a clinical interview, physical examination and fasting blood analysis (glycemia, cholesterol and triglyceride levels). The participants were considered to be diabetic if they had been previously diagnosed with diabetes by their general physician or had a fasting glycemia ≥ 126mg/dl without a previous diabetes diagnosis. Impaired fasting glycemia was defined as fasting glycemia between 100mg/dl and 125mg/dl in non-diabetic participants.ResultsThe sex- and age-adjusted prevalence figures for diabetes and impaired fasting glucose were 6.6% (95% CI: 5.9-8.7) and 14.1% (95% CI: 12.1-15.8), respectively. A substantial proportion of diabetic patients [17.2% (95% CI: 10.9-23.5)] had not been previously diagnosed. The variables independently associated with diabetes were age, male gender, abdominal obesity and hypertension.ConclusionsOur prevalence figure for diabetes is similar to those reported in other Spanish regions. The high frequency of impaired fasting glucose is worrisome, particularly when combined with obesity, as this association confers a high risk for developing diabetes mellitus.