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      Impacto del control de la tensión arterial sobre la morbimortalidad en pacientes hipertensos mayores de 65 años, en el ámbito comunitario Translated title: Impact of blood pressure monitoring on morbidity and mortality in hypertensive patients aged 65 years and over in the community setting

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          Abstract

          RESUMEN Objetivo: evaluar el impacto del control de la tensión arterial (TA) sobre la morbimortalidad en >65 años, sin patología cardiovascular previa, en el ámbito comunitario. Métodos: estudio de cohortes retrospectivas. Se incluyeron todos los pacientes (≥ 65 años) con diagnóstico de hipertensión arterial (HTA) (01/01/2007-31/12/2008), sin eventos cardiovasculares previos de los centros de salud de la Comunidad de Madrid, con al menos dos registros de TA el primer año de seguimiento (n = 17.150). Se evaluaron la aparición de eventos cardiovasculares (incluida mortalidad cardiovascular) y la mortalidad total, mediante regresión de Cox. Resultados: la mediana de seguimiento para mortalidad fue de 129,58 meses (rango intercuartil [RIC]: 120,41-136,94 meses). Se produjeron 8.641 eventos cardiovasculares y 4.073 muertes por cualquier causa. Ajustado por género, grado de hipertensión, tabaquismo, diabetes e hipercolesterolemia, el buen control (TA < 140/90 mmHg) no se asociaba con una disminución de eventos cardiovasculares, pero sí con una disminución de mortalidad del 14,41% (hazard ratio [HR] 0,8559; intervalo de confianza [IC] 95%: 0,7776-0,9421%) entre 75 y 84 años. Cuando se utilizan las cifras de 130/80 mmHg para definir el buen control, este se asociaba con un exceso de mortalidad del 43,58% (IC 95%: 19,60-72,36%) entre 65 y 74 años y del 61,22% (IC 95%: 22,99-111,35%) en sujetos de 85 y más años. Conclusión: el control de la TA en sujetos >65 años se asocia con una disminución ligera de la mortalidad entre 75 y 84 años. Cifras de control más estrictas se relacionan con mayor ocurrencia de evento cardiovascular y de mortalidad, especialmente en el grupo de mayor edad.

          Translated abstract

          ABSTRACT Objective: to assess the impact of blood pressure (BP) control on morbidity and mortality in over 65-year-olds, without previous cardiovascular pathology, in a community setting. Methods: retrospective cohort study. All patients (≥65 years) with a diagnosis of HT (01/01/2007-31/12/2008), without previous cardiovascular events (CVD), with at least two BP recordings in the first year of follow-up) from every health centres in the Community of Madrid were included (n = 17,150). The occurrence of CVD (including CV mortality) and total mortality were assessed using Cox regression. Results: the median follow-up for mortality was 129.58 months (IQR: 120.41-136.94 months). There were 8,641 CVDs and 4,073 deaths from any cause. Adjusted for gender, hypertension severity, smoking, diabetes, and hypercholesterolemia, good control (BP < 140/90 mmHg) was not associated with a decrease in CVD, but was associated with a 14.41% decrease in mortality (HR 0.8559, 95% CI: 0.7776- 0.9421) between 75 and 84 years. When threshold of 130/80 mmHg is used to define good control, this was associated with an excess mortality of 43.58% (95% CI 19.60-72.36%) between 65 and 74 years and 61.22% (95% CI 22.99-111.35%) in subjects aged 85 and over. Conclusion: BP control in people over 65 years of age is associated with a slight decrease in mortality between 75 and 84 years of age. Tighter control figures are associated with a higher incidence of CVD and mortality, especially in the older age group.

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          Most cited references40

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          2018 ESC/ESH Guidelines for the management of arterial hypertension

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            A Randomized Trial of Intensive versus Standard Blood-Pressure Control

            New England Journal of Medicine, 373(22), 2103-2116
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              Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants

              Summary Background Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. Methods We used data from 1990 to 2019 on people aged 30–79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. Findings The number of people aged 30–79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306–359) million women and 317 (292–344) million men in 1990 to 626 (584–668) million women and 652 (604–698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55–62) of women and 49% (46–52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43–51) of women and 38% (35–41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20–27) for women and 18% (16–21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. Interpretation Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings. Funding WHO.
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                Author and article information

                Journal
                albacete
                Revista Clínica de Medicina de Familia
                Rev Clin Med Fam
                Sociedad Española de Medicina de Familia y Comunitaria (Barcelona, Cataluña, Spain )
                1699-695X
                2386-8201
                2023
                : 16
                : 1
                : 17-23
                Affiliations
                [4] Madrid orgnameServicio Madrileño de Salud orgdiv1Gerencia Asistencial Atención Primaria orgdiv2Unidad Docente Multiprofesional de Atención Familiar y Comunitaria Oeste España
                [1] Madrid Madrid orgnameUniversidad Rey Juan Carlos orgdiv1Facultad de Ciencias de la Salud orgdiv2Departamento de Especialidades Médicas y Salud Pública Spain
                [6] Madrid orgnameISCIII orgdiv1Red de Investigación en Servicios de Salud en Enfermedades Crónicas. REDISSEC España
                [2] Madrid orgnameServicio Madrileño de Salud orgdiv1Gerencia Asistencial de Atención Primaria orgdiv2Dirección Técnica de Sistemas de Información España
                [7] Madrid orgnameISCIII orgdiv1Red de Investigación en Cronicidad. Atención Primaria y Promoción de la Salud-RICAPPS (RICORS) España
                [3] Madrid Madrid orgnameUniversidad Rey Juan Carlos orgdiv1Programa de Ciencias de la Salud Spain
                [5] Madrid orgnameInstituto de Investigación Sanitaria Gregorio Marañón España
                Article
                S1699-695X2023000100004 S1699-695X(23)01600100004
                10.55783/rcmf.160104
                11cfa143-7287-491b-9c45-f676dfdf1f4b

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                : 05 February 2023
                : 07 February 2023
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 41, Pages: 7
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                SciELO Spain

                Categories
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                Health of the Elderly,indicadores de morbimortalidad,Atención Primaria de Salud,salud de la persona anciana,Hypertension,Indicators of Morbidity and Mortality,Primary Health Care,hipertensión

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