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Multicenter Study
. 2001 Oct 15;28(6):373-80.
doi: 10.1016/s0212-6567(01)70397-6.

[Control of blood pressure in a population of patients with hypertension and in a subgroup with hypertension and diabetes: relationship with characteristics of the health care center and the community]

[Article in Spanish]
M Benítez, N Codina, A Dalfó, M A Vila, J M Escribà, E Senar, M Miracle, F J Tovillas
Multicenter Study

[Control of blood pressure in a population of patients with hypertension and in a subgroup with hypertension and diabetes: relationship with characteristics of the health care center and the community]

[Article in Spanish]
M Benítez et al. Aten Primaria. .

Abstract
in English, Spanish

Aims: To evaluate how well blood pressure (BP) is controlled in the population of persons with hypertension alone and with diabetes, and to evaluate the influence of characteristics of the health care center on the degree of control of BP. Design. Descriptive, cross-sectional, multicenter, retrospective study.

Setting: 31 health centers in Catalonia (Northeastern Spain). Participants. Random sample of 2240 clinical records of patients with hypertension who were seen at 31 different primary care centers in Catalonia between January and December 1996.

Main outcome measures: Audit of clinical records. We recorded the two most recent BP measurements, and annotations regarding screening for and diagnosis of other cardiovascular risk factors. We also recorded health center and physician characteristics.

Results: 495 patients (22.1%) had diabetes in addition to hypertension. 61.2% were women. Mean age was 64.9 years (95% CI, 64.4-65.4 years). In 25.7% of the patients, BP was below 140/90 mmHg (95% CI, 23.9-27.5%), but among patients with diabetes only 6.7% had BP below 130/85 mmHg (95% CI, 4.5-8.9%). Mean systolic and diastolic BP at the end of the study period were higher at teaching centers. Diastolic BP was significantly higher at urban centers and in patients younger than 65 years. Diastolic BP was also higher in patients with at least one associated cardiovascular risk factor, and at centers less than 6 years old, although these differences were not statistically significant. We found no differences according to physician characteristics.

Conclusions: Blood pressure was adequately controlled in few patients with hypertension and diabetes in Catalonia. Associated cardiovascular risk factors, age less than 65 years, and being a patient at a teaching center or an urban center, were associated with a worse degree of BP control.

Objetivo: Valorar el grado de control de la presión arterial (PA) en la población hipertensa e hipertensa y diabética, así como la influencia de las características del centro en este control.

Diseño: Estudio descriptivo, transversal, multicéntrico, retrospectivo.

Emplazamiento: Un total de 31 centros de salud de Cataluña.

Participantes: Muestra aleatoria de 2.240 historias clínicas de pacientes hipertensos de 31 centros de atención primaria de Cataluña, atendidos entre enero y diciembre de 1996.

Mediciones principales: Auditoría de historias clínicas. Se recogieron los dos últimos valores de PA y el registro de cribado y diagnóstico de otros factores de riesgo cardiovascular. También se recogieron las características del centro de salud y del médico.

Resultados: Cuatrocientos noventa y cinco pacientes (22,1%) eran además diabéticos. Un 61,2% era de sexo femenino. La media de edad es de 64,9 años (IC del 95%, 64,4–65,4).

El 25,7% de los pacientes presentaba cifras de PA por debajo de 140/90 mmHg (IC del 95%, 23,9–27,5%), pero solamente en un 6,7% de diabéticos eran menores de 130/85 mmHg (IC del 95%, 4,5–8,9%).

Las cifras de PA sistólica (PAS) y diastólica (PAD) medias al final del período de estudio fueron mayores en los centros docentes. Se observaron PAD significativamente superiores en los centros urbanos y en los pacientes menores de 65 años. También fueron mayores en aquellos pacientes que tenían algún factor de riesgo cardiovascular asociado y en los centros con menos de 6 años de funcionamiento, aunque las diferencias no fueron estadísticamente significativas. No se observaron diferencias según las características del médico. Conclusiones. Existe un bajo grado de reducción de las cifras de PA entre la población hipertensa y diabética de Cataluña. Presentar otros factores de riesgo cardiovascular asociados, tener menos de 65 años y ser atendido en un centro docente y urbano se asocian a peor control tensional.

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Comment in

  • [Teaching: risk factor?].
    Iglesias Bonilla P, Lapetra Peralta J. Iglesias Bonilla P, et al. Aten Primaria. 2002 Feb 28;29(3):197; author reply 197-8. doi: 10.1016/s0212-6567(02)70538-6. Aten Primaria. 2002. PMID: 11879612 Free PMC article. Spanish. No abstract available.

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