Factors associated with blood pressure control in diabetic patients treated in nephrology units. PRESDIAB Study
Factores asociados al control de la presión arterial en pacientes con diabetes tratados en unidades de nefrología. Estudio PRESDIAB
Read
10710
Timeswas read the article
2464
Total PDF
8246
Total HTML
Share statistics
array:21 [ "pii" => "X2013251411051966" "issn" => "20132514" "doi" => "10.3265/Nefrologia.pre2011.Apr.10556" "estado" => "S300" "fechaPublicacion" => "2011-05-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Nefrologia (English Version). 2011;31:313-21" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 6301 "formatos" => array:3 [ "EPUB" => 348 "HTML" => 5231 "PDF" => 722 ] ] "Traduccion" => array:1 [ "es" => array:17 [ "pii" => "X0211699511051969" "issn" => "02116995" "doi" => "10.3265/Nefrologia.pre2011.Apr.10556" "estado" => "S300" "fechaPublicacion" => "2011-05-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Nefrologia. 2011;31:313-21" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 14077 "formatos" => array:3 [ "EPUB" => 279 "HTML" => 13202 "PDF" => 596 ] ] "es" => array:12 [ "idiomaDefecto" => true "titulo" => "Factores asociados al control de la presión arterial en pacientes con diabetes tratados en unidades de nefrología. Estudio PRESDIAB" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "313" "paginaFinal" => "321" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Factors associated with blood pressure control in diabetic patients treated in nephrology units. PRESDIAB Study" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "10556_108_14697_es_10556_t1.jpg" "Alto" => 537 "Ancho" => 600 "Tamanyo" => 242512 ] ] "descripcion" => array:1 [ "es" => "Características clínicas de los pacientes estudiados" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "N. Serra, A. Oliveras, S. Bergoñon, L. Sans, A. Cobos, P. Martínez, R. Artigas, E. Poch" "autores" => array:8 [ 0 => array:2 [ "Iniciales" => "N." "apellidos" => "Serra" ] 1 => array:2 [ "Iniciales" => "A." "apellidos" => "Oliveras" ] 2 => array:2 [ "Iniciales" => "S." "apellidos" => "Bergoñon" ] 3 => array:2 [ "Iniciales" => "L." "apellidos" => "Sans" ] 4 => array:2 [ "Iniciales" => "A." "apellidos" => "Cobos" ] 5 => array:2 [ "Iniciales" => "P." "apellidos" => "Martínez" ] 6 => array:2 [ "Iniciales" => "R." "apellidos" => "Artigas" ] 7 => array:2 [ "Iniciales" => "E." "apellidos" => "Poch" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "X2013251411051966" "doi" => "10.3265/Nefrologia.pre2011.Apr.10556" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251411051966?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699511051969?idApp=UINPBA000064" "url" => "/02116995/0000003100000003/v0_201502091414/X0211699511051969/v0_201502091414/es/main.assets" ] ] "itemSiguiente" => array:17 [ "pii" => "X2013251411051958" "issn" => "20132514" "doi" => "10.3265/Nefrologia.pre2011.Apr.10833" "estado" => "S300" "fechaPublicacion" => "2011-05-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Nefrologia (English Version). 2011;31:322-30" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 5009 "formatos" => array:3 [ "EPUB" => 300 "HTML" => 4152 "PDF" => 557 ] ] "en" => array:12 [ "idiomaDefecto" => true "titulo" => "Impact of an Interdisciplinary Training Course on Counselling and Decision Making Support for Nephrology Department Professionals" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "322" "paginaFinal" => "330" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Impacto de un curso interdisciplinar de formación en Counselling y apoyo en la toma de decisiones a profesionales de un servicio de nefrología" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "10833_16025_17300_en_pages_from_10833i.jpg" "Alto" => 257 "Ancho" => 600 "Tamanyo" => 136300 ] ] "descripcion" => array:1 [ "en" => "Content of the Counselling course for the nephrology department" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Helena García-Llana, H. García-Llana, Javier Barbero, J. Barbero, Eduardo Remor, E. Remor, Laura Díaz-Sayas, L. Díaz-Sayas, Rocío Rodríguez-Rey, R. Rodríguez-Rey, Gloria del Peso, G. del Peso, Rafael Selgas, R. Selgas" "autores" => array:14 [ 0 => array:2 [ "nombre" => "Helena" "apellidos" => "García-Llana" ] 1 => array:2 [ "Iniciales" => "H." "apellidos" => "García-Llana" ] 2 => array:2 [ "nombre" => "Javier" "apellidos" => "Barbero" ] 3 => array:2 [ "Iniciales" => "J." "apellidos" => "Barbero" ] 4 => array:2 [ "nombre" => "Eduardo" "apellidos" => "Remor" ] 5 => array:2 [ "Iniciales" => "E." "apellidos" => "Remor" ] 6 => array:2 [ "nombre" => "Laura" "apellidos" => "Díaz-Sayas" ] 7 => array:2 [ "Iniciales" => "L." "apellidos" => "Díaz-Sayas" ] 8 => array:2 [ "nombre" => "Rocío" "apellidos" => "Rodríguez-Rey" ] 9 => array:2 [ "Iniciales" => "R." "apellidos" => "Rodríguez-Rey" ] 10 => array:2 [ "nombre" => "Gloria" "apellidos" => "del Peso" ] 11 => array:2 [ "Iniciales" => "G." "apellidos" => "del Peso" ] 12 => array:2 [ "nombre" => "Rafael" "apellidos" => "Selgas" ] 13 => array:2 [ "Iniciales" => "R." "apellidos" => "Selgas" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "X0211699511051950" "doi" => "10.3265/Nefrologia.pre2011.Apr.10833" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699511051950?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251411051958?idApp=UINPBA000064" "url" => "/20132514/0000003100000003/v0_201502091638/X2013251411051958/v0_201502091639/en/main.assets" ] "itemAnterior" => array:17 [ "pii" => "X2013251411051974" "issn" => "20132514" "doi" => "10.3265/Nefrologia.pre2011.Feb.10257" "estado" => "S300" "fechaPublicacion" => "2011-05-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Nefrologia (English Version). 2011;31:308-12" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 5055 "formatos" => array:3 [ "EPUB" => 307 "HTML" => 3988 "PDF" => 760 ] ] "en" => array:11 [ "idiomaDefecto" => true "titulo" => "Prophylaxis with gentamicin locking of chronic tunnelled central venous catheters does not cause bacterial resistance" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "308" "paginaFinal" => "312" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "La profilaxis con sellado de gentamicina de las ramas del catéter venoso central crónico tunelizado no causa resistencia bacteriana" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Juan Fdez-Gallego, J. Fernández-Gallego, Mónica Martín, M. Martín, Elena Gutiérrez, E. Gutiérrez, Carmen Cobelo, C. Cobelo, Patricia Frías, P. Frías, Cristina Jironda, C. Jironda, Pilar Hidalgo, P. Hidalgo, Tamara Jiménez, T. Jiménez" "autores" => array:17 [ 0 => null 1 => array:2 [ "nombre" => "Juan" "apellidos" => "Fdez-Gallego" ] 2 => array:2 [ "Iniciales" => "J." "apellidos" => "Fernández-Gallego" ] 3 => array:2 [ "nombre" => "Mónica" "apellidos" => "Martín" ] 4 => array:2 [ "Iniciales" => "M." "apellidos" => "Martín" ] 5 => array:2 [ "nombre" => "Elena" "apellidos" => "Gutiérrez" ] 6 => array:2 [ "Iniciales" => "E." "apellidos" => "Gutiérrez" ] 7 => array:2 [ "nombre" => "Carmen" "apellidos" => "Cobelo" ] 8 => array:2 [ "Iniciales" => "C." "apellidos" => "Cobelo" ] 9 => array:2 [ "nombre" => "Patricia" "apellidos" => "Frías" ] 10 => array:2 [ "Iniciales" => "P." "apellidos" => "Frías" ] 11 => array:2 [ "nombre" => "Cristina" "apellidos" => "Jironda" ] 12 => array:2 [ "Iniciales" => "C." "apellidos" => "Jironda" ] 13 => array:2 [ "nombre" => "Pilar" "apellidos" => "Hidalgo" ] 14 => array:2 [ "Iniciales" => "P." "apellidos" => "Hidalgo" ] 15 => array:2 [ "nombre" => "Tamara" "apellidos" => "Jiménez" ] 16 => array:2 [ "Iniciales" => "T." "apellidos" => "Jiménez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "X0211699511051977" "doi" => "10.3265/Nefrologia.pre2011.Feb.10257" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699511051977?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251411051974?idApp=UINPBA000064" "url" => "/20132514/0000003100000003/v0_201502091638/X2013251411051974/v0_201502091638/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "titulo" => "Factors associated with blood pressure control in diabetic patients treated in nephrology units. PRESDIAB Study" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "313" "paginaFinal" => "321" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "N. Serra, A. Oliveras, S. Bergoñon, L. Sans, A. Cobos, P. Martínez, R. Artigas, E. Poch" "autores" => array:8 [ 0 => array:3 [ "Iniciales" => "N." "apellidos" => "Serra" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 1 => array:3 [ "Iniciales" => "A." "apellidos" => "Oliveras" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] ] 2 => array:3 [ "Iniciales" => "S." "apellidos" => "Bergoñon" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "affc" ] ] ] 3 => array:3 [ "Iniciales" => "L." "apellidos" => "Sans" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] ] 4 => array:3 [ "Iniciales" => "A." "apellidos" => "Cobos" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "affd" ] ] ] 5 => array:3 [ "Iniciales" => "P." "apellidos" => "Martínez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "affe" ] ] ] 6 => array:3 [ "Iniciales" => "R." "apellidos" => "Artigas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "affe" ] ] ] 7 => array:4 [ "Iniciales" => "E." "apellidos" => "Poch" "email" => array:1 [ 0 => "epoch@clinic.ub.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital Clínic de Barcelona, " "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] 1 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital del Mar, Barcelona, " "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] 2 => array:3 [ "entidad" => "Departamento de Farmacología, Universidad de Barcelona, " "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "affc" ] 3 => array:3 [ "entidad" => "Departamento de Salud Pública, Universidad de Barcelona, " "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "affd" ] 4 => array:3 [ "entidad" => "Departamento Médico, Laboratorios Menarini SA, Barcelona, " "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "affe" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Factores asociados al control de la presión arterial en pacientes con diabetes tratados en unidades de nefrología. Estudio PRESDIAB" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "10556_108_17264_en_t110556.jpg" "Alto" => 577 "Ancho" => 600 "Tamanyo" => 186620 ] ] "descripcion" => array:1 [ "en" => "Clinical characteristics of patients studied" ] ] ] "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">INTRODUCTION</span></p><p class="elsevierStylePara">The relationship between arterial hypertension (AHT) and diabetes mellitus type 2 (DM2) is well known. Although the prevalence of AHT in the general population is around 30%, it is between 51% and 93% in DM2 subjects, depending on whether the patient suffers from a related kidney disease.<span class="elsevierStyleSup">1</span> In contrast, it is also known that patients with AHT are 2.4 times more likely to develop DM2 than normotensive subjects.<span class="elsevierStyleSup">2</span> The cardiovascular risk associated with AHT or DM2 is widely recognised, and it is estimated that in general, 68% of coronary events are due to one of the conditions being present.<span class="elsevierStyleSup">3</span> In a classic study, Haffner et al showed that DM2 patients that had not suffered any vascular event had a similar risk to presenting one within 7 years as non-diabetic patients that had already suffered one, be it a coronary, cerebral or peripheral vascular event.<span class="elsevierStyleSup">4</span> As such, in practice, DM2 is considered as a coronary equivalent for assessing the risk of future events, as confirmed by longer-term follow-up studies.<span class="elsevierStyleSup">5</span> Furthermore, it is understood that AHT + DM2 involves an additional increased risk of vascular complications, as shown in a 28-year follow-up study which reported that men with AHT and DM2 have a 66% higher risk of suffering a stroke or heart attack than men who only have AHT.<span class="elsevierStyleSup">6</span></p><p class="elsevierStylePara">There are several studies that have compared the benefits associated with reducing blood pressure (BP) to prevent cardiovascular events in DM2 patients and non-diabetic patients.<span class="elsevierStyleSup">7</span> One of the first studies was the UKPDS38, published in 1998, which revealed that tight BP control in diabetic patients significantly reduced the risk of microvascular complications and stroke during an 8.4-year follow-up.<span class="elsevierStyleSup">8</span> More importance has been given to controlling AHT in DM2 patients since the need to maintain BP control throughout patient follow-up was documented by Holman et al.<span class="elsevierStyleSup">9</span> These authors conducted a 10-year follow-up of the patients that underwent the UKPDS38 study, observing that the differences in BP between the two groups disappeared 2 years after the study was completed, showing that the benefit of lower risk was lost over time.</p><p class="elsevierStylePara">Despite these observations, optimal BP control is achieved in less than 30% of AHT patients, even when more than 60% of these patients are prescribed anti-hypertensive treatment.<span class="elsevierStyleSup">7,10</span> These optimal control percentages are even lower when examining several risk populations. BP control for DM2 patients (130/85mm Hg in studies) is around 13%, both in primary care<span class="elsevierStyleSup">11</span> and hypertension unit.<span class="elsevierStyleSup">12</span> Observational studies and clinical trials have proven that poor systolic BP control (SBP) is the main reason for low AHT control percentages.<span class="elsevierStyleSup">7,13</span> This is especially relevant for the diabetic population, which usually have a high pulse pressure.<span class="elsevierStyleSup">14</span> We are yet to fully understand what causes poor BP control in the hypertensive population. There may in fact be several causes which almost certainly involve patient- (compliance, comorbidities) doctor- (attitude), blood pressure-, and environment- (primary care, hospital) related factors, among others. Furthermore, most studies do not examine all possible aspects that can affect BP control, but only specific aspects.</p><p class="elsevierStylePara">The main objective of this study is to estimate the prevalence of tight BP control (BP<130/80mm Hg) for patients with AHT and DM2, who attended nephrology units in Spanish hospitals. Secondary objectives are to describe the frequency in which tight control is not achieved due to poor systolic or diastolic blood pressure (DBP) control, or a poor control of both. We also aim to investigate the factors associated with good BP control.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">PATIENTS AND METHOD</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Study design</span></p><p class="elsevierStylePara">We invited 60 nephrologists throughout Spain to participate in our multi-centre, observational, cross-sectional study. We informed them of the objectives and the study justification, and how they could register and participate in the study (via the especially designed web site). We asked doctors to choose the first 10 patients that met the selection criteria (see “Participants”) and visited their unit consecutively, and who agreed to participate in the study. Being a cross-sectional study, the most recent patient data were collected, and we did not perform any type of prospective follow-up. The study was monitored online to ensure that the correct data was included.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Participants</span></p><p class="elsevierStylePara">We included patients with AHT<span class="elsevierStyleSup">15</span> and DM2<span class="elsevierStyleSup">16</span> clinically diagnosed in accordance with the current guidelines, at least 18 years old and who had consented to inclusion in writing. We did not include patients who were not physically or mentally capable of giving consent or those who were already participating in other clinical investigations that could interfere with our study. The study was approved by the research ethics committee in the Clínic Hospital, Barcelona.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Recorded variables</span></p><p class="elsevierStylePara">We recorded the following data for each of the patients: demographic data were age, sex, body mass index (BMI), waist circumference, mid-upper arm circumference, smoking habit, alcohol use, history of cardiovascular disease (CVD), serum creatinine level, estimated glomerular filtration rate (eGFR), urinary albumin:creatinine ratio (ACR<span class="elsevierStyleInf">or</span>), total cholesterol, HDL cholesterol and LDL cholesterol, triglycerides, baseline glycaemia, glycated haemoglobin (HbA<span class="elsevierStyleInf">1</span>c), ambulatory blood pressure monitoring (ABPM) over the past year, self-monitoring of blood pressure at home during the past 6 months, time since diagnosed with AHT, DM and hypercholesterolemia, number of drugs administered for AHT treatment, use of angiotensin-converting enzyme inhibitors (ACEi) and/or angiotensin II receptor blockers (ARB), AHT treatment compliance, adherence to dietary advice for AHT, DM2 or hypercholesterolemia, usual physical exercise, concomitant treatment with psychoactive drugs, non-steroidal anti-inflammatory drugs (NSAID), sympathomimetic drugs, antiplatelet drugs, number of BP measurements, and number of hours since AHT treatment was last taken. Clinical parameters were: hypercholesterolemia, diabetes, cardiovascular disease or clinical BP, and were defined in accordance with guidelines from the European Society of Hypertension and the American Diabetes Association.<span class="elsevierStyleSup">15,16</span> BP was measured in accordance with the standard techniques described in the medical literature.<span class="elsevierStyleSup">15,17</span> Tight BP control was defined as SBP<130mm Hg and DBP<80mm Hg, in accordance with the AHT guidelines that were valid when the study was being conducted.<span class="elsevierStyleSup">18</span> Furthermore, given the recent critical review on the recommendations established,<span class="elsevierStyleSup">19</span> we calculated the percentage for a less tight BP control (<140/85mm Hg). Using the serum creatinine level, we estimated the GFR using the MDRD equation, and defined kidney failure as GFR<60ml/min/1.73m<span class="elsevierStyleSup">2</span>.</p><p class="elsevierStylePara">We also asked all doctors to complete a detailed questionnaire on their usual medical practice, with special reference to measuring BP, evaluating lifestyle and hygienic/dietary measures, recommendations given to patients and their adherence to them.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Statistical analysis</span></p><p class="elsevierStylePara">We used a sample size of 600 patients to ensure that the estimation of the prevalence for good BP control was accurate by ±3.5% (95% confidence interval [CI] of 7% amplitude) supposing that this prevalence were 25%. The study was finished after the three month inclusion period was complete. We had 526 patients and considered that the number was adequate to enable us to make precise estimations. All analyses were performed on eligible patients i.e. those that complied with selection criteria and were able to provide the data needed for examining the main objective. We used the data available, and did not need to use replacement techniques for missing data. The prevalence for good BP control was estimated by calculating the 95% CI, using the normal calculations. Prevalence for successful tight BP control (SBP<130mm Hg and DBP<80mm Hg), for good SBP control and good DBP control was estimated in accordance with the clinical BP measurements.</p><p class="elsevierStylePara">We performed a logistic regression analysis to identify the factors associated with BP control. Firstly, we analysed the relationship using univariate models. Secondly, we adjusted a multivariate model which included all statistically significant variables (<span class="elsevierStyleItalic">P</span><.25) in the corresponding univariate model. Then, using this model, we performed a stepwise selection, with entry and exit levels set at 0.05.</p><p class="elsevierStylePara">We initially considered the following factors: age, sex, BMI, waist circumference, mid-upper arm circumference, smoking habit, alcohol use, history of CVD, serum creatinine level, eGFR, urinary albumin-creatinine ratio (ACR<span class="elsevierStyleInf">or</span>), total cholesterol, HDL-cholesterol and LDL-cholesterol, triglycerides, baseline glycaemia, glycated haemoglobin (HbA<span class="elsevierStyleInf">1</span>c), time since diagnosed with AHT, DM and hypercholesterolemia, number of drugs administered for AHT treatment, use of ACEi and/or ARB, AHT treatment compliance, adherence to dietary advice for AHT, DM2 or hypercholesterolemia, usual physical exercise, concomitant treatment with psychoactive drugs, NSAID, sympathomimetic drugs, antiplatelet drugs, number of BP measurements, and number of hours since AHT treatment was last taken. The overall adjustment of the models was considered based on the Hosmer-Lemeshow test, and the (bilateral) significance of the terms using the Wald statistic. All statistical analyses were performed using the SAS<span class="elsevierStyleSup">®</span> statistical<span class="elsevierStyleSup"> </span>package for Windows (version 9.1).</p><p class="elsevierStylePara"><span class="elsevierStyleBold">RESULTS</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Patient characteristics</span></p><p class="elsevierStylePara">Fifty-five doctors included a total of 526 patients from April until July 2008. Six patients were not considered as eligible as they did not comply with some of the selection criteria. As such, 520 (98.9%) were included in the analysis.</p><p class="elsevierStylePara">Table 1 summarises the clinical characteristics of patients included in the study. The mean age was over 65 years old and there were more males than females. Mean time between DM2 and AHT diagnosis and inclusion in the study was more than 10 years. Three-hundred and thirty patients (63.4%) had been advised to follow a low-salt diet, 55 (10.5%) a low-fat diet due to dyslipidemia (DLP), and 455 (87.5%) had been given dietary advice for DM2.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Prevalence of good BP control</span></p><p class="elsevierStylePara">Tight clinical BP control (<130/80mm Hg) was observed in 91/520 cases (17.5% of the sample; 95% CI:14.3-21.0). Tight clinical SBP control was observed in 110/520 cases (21.2% of the sample; 95% CI:17.7-24.9), and tight DBP control was observed in 281/520 cases (54.0% of the sample; 95% CI: 49.6-58.4).</p><p class="elsevierStylePara">Table 2 compares the clinical characteristics of the patients with tight BP control and those that did not reach tight BP control.</p><p class="elsevierStylePara">Experts have recently started to question whether tight BP control is beneficial for DM2 patients, given the lack of clear evidence.<span class="elsevierStyleSup">19</span> Although the study objective was to analyse the variables related to lack of tight BP control, we also examined less-tight BP control. Less-tight clinical BP control (<140/85mm Hg) was therefore observed in 180/520 cases, (36.92% of the sample; 95% CI:32.76-41.23). SBP control was observed in 211/520 cases (40.58% of the sample; 95% CI:36.32-44.94), and DBP control was observed in 365/520 cases (70.19% of the sample; 95% CI:66.06-74.1).</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Relationship between tight BP control and predictive factors</span></p><p class="elsevierStylePara">Table 3 shows the main results from the logistic regression analysis. This table only includes the variables that had a significance of <span class="elsevierStyleItalic">P</span><.25 in the univariate models. The following variables showed a statistically significant relationship (<span class="elsevierStyleItalic">P</span><.05) with BP control (Table 3, univariate models): history of CVD (<span class="elsevierStyleItalic">P</span><.001), GFR (<span class="elsevierStyleItalic">P</span>=<span class="elsevierStyleItalic">.</span>019), LDL-cholesterol (<span class="elsevierStyleItalic">P</span><.001), treatment with ACEi and/or ARB (<span class="elsevierStyleItalic">P</span>=.003), and total cholesterol (not shown on the table). Given that the dependent variable was successful tight BP control, OR>1 showed that BP control was more frequent and OR<1 showed that BP control was less frequent. As a result, the OR of the variables mentioned above indicate that history of CVD (OR=2.19) is associated with a more frequent good BP control. On the other hand, GFR values (OR=.74 for one standard deviation increase) or LDL-cholesterol (OR=.52 for one standard deviation increase) and ACEi and/or ARB (OR=.39) are associated with less frequent BP control.</p><p class="elsevierStylePara">We included all of these variables in a multivariate logistic regression model and achieved a good overall adjustment (Hosmer-Lemeshow c<span class="elsevierStyleSup">2</span>=9.81; degrees of freedom [df]=8; <span class="elsevierStyleItalic">P</span>=.279). According to the results of this adjustment (Table 3, multivariate model), the GFR and LDL-cholesterol have a statistically significant relationship (<span class="elsevierStyleItalic">P</span><.05). Using a stepwise selection, LDL-cholesterol and GFR remained statistically significant (<span class="elsevierStyleItalic">P</span><.001). OR for one standard deviation increase in LDL-cholesterol is 0.55 (0.41-0.75). This implies that when the LDL-cholesterol or GFR are higher, the patient is less likely to control BP. Mean SBP and DBP are higher in patients with LDL>100mg/dl than in patients with LDL<100mg/dl (Student’s t-test, <span class="elsevierStyleItalic">P</span><.001) (data not shown). Furthermore, no statistically significant differences were found in the SBP and DBP averages for patients with LDL>100mg/dl, considering whether statins were used or not (data not shown). Lastly, 84.8% of patients with history of CVD had GFR values less than 60ml/min/1.73m<span class="elsevierStyleSup">2</span>, while this occurred for 68.1% of patients that did not have CVD (OR=.38; 95% CI:0.24-0.60).</p><p class="elsevierStylePara"><span class="elsevierStyleBold">DISCUSSION</span></p><p class="elsevierStylePara">In this study we have checked a sample of patients suffering from AHT and DM2 who were cared for in nephrology units of Spanish hospitals. We found that the percentage of tight BP control (<130/80mm Hg) was 17.5%. In the univariate analysis, various factors are associated with unsuccessful BP control, such as presence of CVD, GFR, treatment with renin-angiotensin-inhibitors, hypercholesterolemia, and concomitant treatment with NSAID. However, in the multivariate analysis, only LDL-cholesterol and GFR were related to poor BP control. The prevalence of good BP control in this study is somewhat higher than that found in previous Spanish studies: in primary care<span class="elsevierStyleSup">11</span> and hypertension units,<span class="elsevierStyleSup">12</span> (12.2% and 13%, respectively). This is even more important considering that the BP criteria was <130/85mm Hg in these cases. In contrast, a recent study examining compliance of overall DM2 treatment guidelines in nephrology units in Catalonia<span class="elsevierStyleSup">20</span> observed a BP control rate of 21.8%. However, their criterion for BP control was ≤30/80mm Hg. When observing the control rate in other countries, we have noted that some observational epidemiological studies found higher BP control rates in diabetic patients. A study conducted in the United States showed that 31.4% had a BP control of <130/80mm Hg.<span class="elsevierStyleSup">21</span> In prospective intervention studies on diabetic patients, the SBP control (target <130mm Hg) was not achieved by any of the patients, while the DBP objective (<80mm Hg) was achieved by half of them. Therefore, the percentage of diabetic patients with DBP control <80mm Hg in our study (54%) is similar to those clinical trials. There is little evidence showing that reducing SBP to below 130mm Hg represents a clear benefit for the DM2 patient group. Furthermore, in no clinical trial hypertensive patients with DM2 have reached this SBP level.<span class="elsevierStyleSup">22</span> These facts have encouraged the European hypertension guidelines to be reviewed, questioning this target until there is evidence in its favour.<span class="elsevierStyleSup">19</span> Until more evidence is made available, general BP control <140/85mm Hg is recommended for all hypertensive patients. The ACCORD study,<span class="elsevierStyleSup">23</span> examining more than 4000 patients, showed that a target SBP control <120mm Hg as compared with <140mm Hg did not reduce the rate of fatal and non-fatal cardiovascular events. This outcome has confirmed that the tight BP control levels recommended to date (which are difficult to achieve) are probably unnecessary. More studies are certainly needed to clarify this important clinical matter. The objective of our study was to analyse the factors associated with a tight BP control, in accordance with a recommendation that was in practice at the time the study was designed and performed. However, given that the experts changed their opinion on the matter, we also analysed the less-tight control rate in our sample. As such, 36.9% of patients had a <140/85mm Hg control, while 40% had SBP control and 70% DBP control. These control rates are very close to those of the general hypertensive population,<span class="elsevierStyleSup">12</span> suggesting that the poor historic control attributed to DM2 is partly due to therapeutic objectives being too tight and probably unjustified.</p><p class="elsevierStylePara">The UKPDS38 study established a target BP control of <150/85mm Hg, and observed that 29% of the patients were being treated with three or more anti-hypertensive drugs.<span class="elsevierStyleSup">8</span> Our study’s target was <130/80mm Hg and only 35% of patients were treated with three or more drugs, which to some extent suggests that this poor control may be due to undertreatment. Even though in most clinical trials diabetic patients use three or more drugs to reach the BP target, (3.2 drugs according to Bakris et al<span class="elsevierStyleSup">24</span>) the implementation of intense treatment in clinical practice does not seem to be achieved, according to the results that we present here.</p><p class="elsevierStylePara">Although the univariate analysis showed a worse control rate for patients treated with ACEi or ARB, we believe that this finding should be interpreted with caution. Firstly, this is because more than 90% of the patients were treated with these drugs. Secondly, we do not know the dosage that was taken, making interpretation difficult. Furthermore, this correlation was not observed in the multivariate model.</p><p class="elsevierStylePara">The correlation that we have observed between the GFR and BP control is in the opposite direction than was expected. Although this was analysed in a different way, the CLUE study reported a lower BP control (12%) in patients with kidney failure (defined as creatinine >1.4-1.5mg/dl, depending on sex), compared with the general sample (42%).<span class="elsevierStyleSup">12</span> In this respect, we must take into consideration that the control limits were tight (<130/80mm Hg) when considering kidney failure. The COPARENAL study,<span class="elsevierStyleSup">25</span> which is the most important study that has been conducted in Spain on BP control of kidney failure patients, showed a (<130/80mm Hg) BP control rate of only 17%. However, no difference was shown between serum creatinine and creatinine clearance between groups with and without optimal BP control. In our study, although we observed a statistically significant correlation with GFR, we believe that the difference of 7ml/min has little clinical importance to be able to consider it the cause of good or bad control. In our sample, there was a correlation between the GFR <60ml/min and cardiovascular disease. However, the correlation between GFR and BP control was no longer significant when we examined each CVD category. We could also believe that patients with lower GFR (as well as those that have more serious cardiovascular disease) could cause the doctor to pay more attention to improving BP control, although this is merely speculative. Meanwhile, a correlation between poor BP control and the proteinuria level was found in the COPARENAL study. We did not find this correlation in our study, partly because the proteinuria level in our patients was low (ACR median: 36mg/g, mean: 200mg/g). This was probably because were more patients with nephrosclerosis than with diabetic nephropathy, and they were undergoing anti-hypertensive treatment.</p><p class="elsevierStylePara">Furthermore, results from the multivariate logistic regression analysis show and that independent BP control was lower when LDL-cholesterol values were higher. This correlation matches with that observed in other studies on BP control in Spain: such as the one conducted in a primary care setting (PRESCAP)<span class="elsevierStyleSup">26</span> or in the COPARENAL study, mentioned above.<span class="elsevierStyleSup">25</span> The correlation between dyslipidemia and AHT is well known. Hypercholesterolemia is related to endothelial dysfunction, both in human and animal models<span class="elsevierStyleSup">27</span> and it seems that a deficiency of the nitric oxide vasodilator,<span class="elsevierStyleSup">28</span> which is involved in its mechanism, is partly produced by the oxidative effect of atherogenic lipoproteins.<span class="elsevierStyleSup">29</span> The mean LDL-cholesterol values for patients in our study were above 110mg/dl (Table 1), being higher than the figure recommended in current dyslipidemia guidelines for DM2 patients.<span class="elsevierStyleSup">16</span> However, it matches the figure found by other authors in a recent analysis of overall DM2 treatment guide compliance,<span class="elsevierStyleSup">20</span> in which only 39% of patients achieved the LDL-cholesterol target (<100mg/dl).</p><p class="elsevierStylePara">One limitation of our study was that we were not able to assess the doctor’s attitude when their patient did not achieve BP control, given that it was a single cross-sectional study. Another limitation found in observational and cross-sectional studies is that convenience samples are used, although this is not greatly relevant to our study as our results are similar to those found in other studies on BP control.</p><p class="elsevierStylePara">In summary, tight AHT control for patients with DM2 who attended nephrology units is low, while the less-tight control is similar to the general hypertensive population. Among the factors analysed, the LDL-cholesterol and GFR have an impact on the degree of BP control. Likewise, despite the vast range of drugs available, data suggest that they are underused in these patients, given that the percentage of patients treated with three or more drugs was relatively low despite poor BP control. This warns us that we need to emphasise on the number of drug used to improve BP control in diabetic patients. Similarly, the percentage of patients treated with statins may seem inappropriate, which would indicate that doctors are placing less emphasis on controlling lipids, as well as the BP. We therefore believe that understanding the factors that influence BP control could help when implementing strategies for fulfilling tight therapeutic targets in this risk population.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">ACKNOWLEDGEMENTS</span></p><p class="elsevierStylePara">This study has been financed by an unconditional grant from Laboratorios Menarini, S.A.</p><p class="elsevierStylePara"><a href="grande/10556_108_17264_en_t110556.jpg" class="elsevierStyleCrossRefs"><img src="10556_108_17264_en_t110556.jpg" alt="Clinical characteristics of patients studied"></img></a></p><p class="elsevierStylePara">Table 1. Clinical characteristics of patients studied</p><p class="elsevierStylePara"><a href="grande/10556_108_17265_en_t210556.jpg" class="elsevierStyleCrossRefs"><img src="10556_108_17265_en_t210556.jpg" alt="Clinical characteristics of the patients in accordance with degree of blood pressure control"></img></a></p><p class="elsevierStylePara">Table 2. Clinical characteristics of the patients in accordance with degree of blood pressure control</p><p class="elsevierStylePara"><a href="grande/10556_108_17266_en_t310556.jpg" class="elsevierStyleCrossRefs"><img src="10556_108_17266_en_t310556.jpg" alt="Variables that affect good control of blood pressure according to the logistic regression analysis"></img></a></p><p class="elsevierStylePara">Table 3. Variables that affect good control of blood pressure according to the logistic regression analysis</p>" "pdfFichero" => "P1-E521-S2948-A10556-EN.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "es" => array:5 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec441109" "palabras" => array:1 [ 0 => "Control de la hipertensión arterial" ] ] 1 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec441111" "palabras" => array:1 [ 0 => "Tratamiento" ] ] 2 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec441113" "palabras" => array:1 [ 0 => "Presión arterial" ] ] 3 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec441115" "palabras" => array:1 [ 0 => "Diabetes mellitus tipo 2" ] ] 4 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec441117" "palabras" => array:1 [ 0 => "Hipertensión arterial" ] ] ] "en" => array:5 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec441110" "palabras" => array:1 [ 0 => "Blood pressure control" ] ] 1 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec441112" "palabras" => array:1 [ 0 => "Treatment" ] ] 2 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec441114" "palabras" => array:1 [ 0 => "Blood pressure" ] ] 3 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec441116" "palabras" => array:1 [ 0 => "Type 2 diabetes mellitus" ] ] 4 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec441118" "palabras" => array:1 [ 0 => "Arterial hypertension" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:1 [ "resumen" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Background and objective:</span> Most hypertensive patients do not reach target blood pressure (BP), especially if they are diabetic. The objective of the study is to assess the percentage of tight BP control, defined as BP<130/80mm Hg and identify factors associated with it in diabetic type 2 (DM2) patients treated in nephrology units. <span class="elsevierStyleBold">Patients and methods:</span><span class="elsevierStyleBold"> </span>Observational and cross-sectional study; we included 526 patients with DM2 and arterial hypertension (AHT). We collected data on: demographics, anthropometrics, harmful habits, history of cardiovascular disease (CVD), blood pressure, kidney function, glycaemic control, lipid profile, and drug treatment, among others. <span class="elsevierStyleBold">Results:</span> The mean age (SD) was 66 (10.6) years, 61% were male, 12.8% were smokers, 39.4% had a history of CVD, 72% had hypercholesterolemia, and 44% were obese. Seventeen point five percent of patients had tight BP control (<130/80mm Hg) (95% confidence interval [CI]:14.3-21.0), while 36.9% had BP below 140/85mm Hg. Seventy-one percent of patients were prescribed two or more anti-hypertensive treatments. Several factors are associated with tight BP control not being achieved, and the logistic regression analysis revealed that LDL cholesterol levels were significantly associated (odds ratio [OR] 0.55; 95% CI:0.41-0.75 for one standard deviation increase). <span class="elsevierStyleBold">Conclusions:</span> Of the DM2 patients that attended the nephrology units, less than 20% achieved a tight BP control. Cholesterol levels seem to be the main factor associated with unsatisfactory BP control within our study population.</p>" ] "es" => array:1 [ "resumen" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Fundamento y objetivo:</span> La mayoría de pacientes hipaertensos no alcanza los objetivos de control de la presión arterial (PA), especialmente si son diabéticos. El objetivo del estudio fue evaluar el porcentaje de control estricto de la PA definida como PA <130/80 mmHg e identificar factores asociados al mismo en pacientes diabéticos tipo 2 (DM2) tratados en unidades de nefrología. <span class="elsevierStyleBold">Pacientes y método: </span>Estudio observacional y transversal, en el que se incluyeron 526 pacientes con DM2 e hipertensión arterial (HTA). Se recogieron datos demográficos, antropométricos, hábitos tóxicos, antecedentes de enfermedad cardiovascular (ECV), medidas de PA, función renal, control glicémico, perfil lipídico y tratamiento farmacológico, entre otros. <span class="elsevierStyleBold">Resultados:</span> La edad media (DE) fue de 66 (10,6) años, con un 61% de hombres, un 12,8% de fumadores, un 39,4% con antecedentes de ECV, un 72% con hipercolesterolemia, y 44% con obesidad. El porcentaje de control estricto de la PA (<130/80 mmHg) fue del 17,5% (intervalo de confianza [IC] 95%: 14,3-21,0), mientras que un 36,9% tenían la PA por debajo de 140/85 mmHg. Un 71,1% de pacientes recibía dos o más tratamientos antihipertensivos. Diversos factores se asociaron con falta de control estricto de la PA, de los cuales, tras análisis de regresión logística, destacaban los valores de colesterol LDL (<span class="elsevierStyleItalic">odds ratio</span> [OR] 0,55; IC 95%: 0,41-0,75 para un aumento de 1 DE). <span class="elsevierStyleBold">Conclusiones:</span> En pacientes con DM2 atendidos en unidades de nefrología, el porcentaje del control estricto de la PA es inferior al 20% en la clínica. Los niveles de colesterol parece el principal factor asociado con el control insuficiente de PA en la población estudiada.</p>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig1" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "10556_108_17264_en_t110556.jpg" "Alto" => 577 "Ancho" => 600 "Tamanyo" => 186620 ] ] "descripcion" => array:1 [ "en" => "Clinical characteristics of patients studied" ] ] 1 => array:8 [ "identificador" => "fig2" "etiqueta" => "Tab. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "10556_108_17265_en_t210556.jpg" "Alto" => 436 "Ancho" => 600 "Tamanyo" => 181519 ] ] "descripcion" => array:1 [ "en" => "Clinical characteristics of the patients in accordance with degree of blood pressure control" ] ] 2 => array:8 [ "identificador" => "fig3" "etiqueta" => "Tab. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "10556_108_17266_en_t310556.jpg" "Alto" => 248 "Ancho" => 600 "Tamanyo" => 133578 ] ] "descripcion" => array:1 [ "en" => "Variables that affect good control of blood pressure according to the logistic regression analysis" ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:29 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Tarnow L, Rossing P, Gall MA, Nielsen FS, Parving HH. Prevalence of arterial hypertension in diabetic patients before and after the JNC-V. Diabetes Care 1994;17:1247-51. <a href="http://www.ncbi.nlm.nih.gov/pubmed/7821162" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Gress TW, Nieto FJ, Shahar E, Wofford MR, Brancati FL. Hypertension and antihypertensive therapy as risk factors for type 2 diabetes mellitus. Atherosclerosis Risk in Communities Study. N Engl J Med 2000;342:905-12. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10738048" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Danaei G, Lawes CM, Vander Hoorn S, Murray CJ, Ezzati M. Global and regional mortality from ischaemic heart disease and stroke attributable to higher-than-optimum blood glucose concentration: comparative risk assessment. Lancet 2006;368:1651-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17098083" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Haffner SM, Lehto S, Ronnemaa T, Pyörälä K, Laakso M. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med 1998;339:229-34. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9673301" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 4 => array:3 [ "identificador" => "bib5" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Whiteley L, Padmanabhan S, Hole D, Isles C. Should diabetes be considered a coronary heart disease risk equivalent?: results from 25 years of follow-up in the Renfrew and Paisley survey. Diabetes Care 2005;28:1588-93. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15983305" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 5 => array:3 [ "identificador" => "bib6" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Almgren T, Wilhelmsen L, Samuelsson O, Himmelmann A, Rosengren A, Andersson OK. Diabetes in treated hypertension is common and carries a high cardiovascular risk: results from a 28-year follow-up. J Hypertens 2007;25:1311-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17563546" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 6 => array:3 [ "identificador" => "bib7" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, Jr., et al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension 2003;42:1206-52." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:1 [ "itemHostRev" => array:3 [ "pii" => "S002191501200860X" "estado" => "S300" "issn" => "00219150" ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib8" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38.\u{A0}BMJ 1998;317:703-13." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 8 => array:3 [ "identificador" => "bib9" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Holman RR, Paul SK, Bethel MA, Neil HA, Matthews DR. Long-term follow-up after tight control of blood pressure in type 2 diabetes. N Engl J Med 2008;359:1565-76. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18784091" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:1 [ "itemHostRev" => array:3 [ "pii" => "S0167527313021372" "estado" => "S300" "issn" => "01675273" ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib10" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Banegas JR, Rodríguez-Artalejo F, De la Cruz Troca JJ, Guallar-Castillón P, Del Rey Calero J. Blood pressure in Spain: distribution, awareness, control, and benefits of a reduction in average pressure. Hypertension 1998;32:998-1002. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9856963" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 10 => array:3 [ "identificador" => "bib11" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "García Vallejo O, Vicente Lozano J, Vegazo O, Jiménez Jiménez FJ, Llisterri Caro JL, Redón J, et al. Control of blood pressure in diabetic patients in primary care setting. DIAPA study. Med Clin (Barc) 2003;120:529-34." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 11 => array:3 [ "identificador" => "bib12" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Banegas JR, Segura J, Ruilope LM, Luque M, García-Robles R, Campo C, et al. Blood pressure control and physician management of hypertension in hospital hypertension units in Spain. Hypertension 2004;43:1338-44. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15117908" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 12 => array:3 [ "identificador" => "bib13" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Lloyd-Jones DM, Evans JC, Larson MG, O'Donnell CJ, Roccella EJ, Levy D. Differential control of systolic and diastolic blood pressure: factors associated with lack of blood pressure control in the community. Hypertension 2000;36:594-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11040241" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 13 => array:3 [ "identificador" => "bib14" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Rodríguez Roca GC, Alonso Moreno FJ, García Jiménez A, Llisterri Caro JL. Factors conditioning pulse pressure in type-2 diabetics in a primary care population suffering from hypertension. Aten Primaria 2003;31:486-92. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12765586" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 14 => array:3 [ "identificador" => "bib15" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, et al. 2007 ESH-ESC Practice Guidelines for the Management of Arterial Hypertension: ESH-ESC Task Force on the Management of Arterial Hypertension. J Hypertens 2007;25:1751-62. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17762635" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 15 => array:3 [ "identificador" => "bib16" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "American Diabetes Association. Standards of medical care in diabetes-2007. Diabetes Care 2007;30(Suppl 1):S4-S41. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17192377" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 16 => array:3 [ "identificador" => "bib17" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "O'Brien E, Asmar R, Beilin L, Imai Y, Mallion JM, Mancia G, et al. European Society of Hypertension recommendations for conventional, ambulatory and home blood pressure measurement. J Hypertens 2003;21:821-48. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12714851" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 17 => array:3 [ "identificador" => "bib18" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "2003 European Society of Hypertension-European Society of Cardiology guidelines for the management of arterial hypertension. J Hypertens 2003;21:1011-53. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12777938" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 18 => array:3 [ "identificador" => "bib19" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Mancia G, Laurent S, Agabiti-Rosei E, Ambrosioni E, Burnier M, Caulfield MJ, et al. Reappraisal of European guidelines on hypertension management: a European Society of Hypertension Task Force document. J Hypertens 2009;27:2121-58. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19838131" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 19 => array:3 [ "identificador" => "bib20" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Fontsere N, Bonal J, Torres F, De las Cuevas X, Fort J. Compliance with the 2002 consensus document of the Spanish Society of Nephrology for the control of diabetic nephropathy in Catalonia (ECCODIAB). Nefrologia 2006;26:679-87. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17227245" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 20 => array:3 [ "identificador" => "bib21" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Andros V, Egger A, Dua U. Blood pressure goal attainment according to JNC 7 guidelines and utilization of antihypertensive drug therapy in MCO patients with type 1 or type 2 diabetes. J Manag Care Pharm 2006;12:303-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16792436" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 21 => array:3 [ "identificador" => "bib22" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Zanchetti A, Grassi G, Mancia G. When should antihypertensive drug treatment be initiated and to what levels should systolic blood pressure be lowered? A critical reappraisal. J Hypertens 2009;27:923-34. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19381107" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 22 => array:3 [ "identificador" => "bib23" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Cushman WC, Evans GW, Byington RP, Goff DC Jr, Grimm RH Jr, Cutler JA, et al. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med 2010;362:1575-85. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20228401" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 23 => array:3 [ "identificador" => "bib24" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Bakris GL, Williams M, Dworkin L, Elliott WJ, Epstein M, Toto R, et al. Preserving renal function in adults with hypertension and diabetes: a consensus approach. National Kidney Foundation Hypertension and Diabetes Executive Committees Working Group. Am J Kidney Dis 2000;36:646-61." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 24 => array:3 [ "identificador" => "bib25" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Marín R, Fernández-Vega F, Gorostidi M, Ruilope LM, Díez J, Praga M, et al. Blood pressure control in patients with chronic renal insufficiency in Spain: a cross-sectional study. J Hypertens 2006;24:395-402. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16508589" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 25 => array:3 [ "identificador" => "bib26" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Alonso-Moreno FJ, Llisterri Caro JL, Rodríguez-Roca GC, Ferreiro Madueño M, González-Segura Alsina D, Divisón Garrote JA, et al. Primary care physicians behaviour on hypertensive patients with poor blood pressure control. The PRESCAP 2006 study. Rev Clin Esp 2008;208:393-9." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 26 => array:3 [ "identificador" => "bib27" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Stokes KY. Microvascular responses to hypercholesterolemia: the interactions between innate and adaptive immune responses. Antioxid Redox Signal 2006;8:1141-51. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16910762" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 27 => array:3 [ "identificador" => "bib28" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Creager MA, Gallagher SJ, Girerd XJ, Coleman SM, Dzau VJ, Cooke JP. L-arginine improves endothelium-dependent vasodilation in hypercholesterolemic humans. J Clin Invest 1992;90:1248-53. <a href="http://www.ncbi.nlm.nih.gov/pubmed/1401062" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 28 => array:3 [ "identificador" => "bib29" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Engler MM, Engler MB, Malloy MJ, Chiu EY, Schloetter MC, Paul SM, et al. Antioxidant vitamins C and E improve endothelial function in children with hyperlipidemia: Endothelial Assessment of Risk from Lipids in Youth (EARLY) Trial. Circulation 2003;108:1059-63." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000003100000003/v0_201502091638/X2013251411051966/v0_201502091638/en/main.assets" "Apartado" => array:4 [ "identificador" => "35441" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Originals" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003100000003/v0_201502091638/X2013251411051966/v0_201502091638/en/P1-E521-S2948-A10556-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251411051966?idApp=UINPBA000064" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 8 | 12 |
| 2024 October | 64 | 27 | 91 |
| 2024 September | 68 | 26 | 94 |
| 2024 August | 69 | 53 | 122 |
| 2024 July | 72 | 26 | 98 |
| 2024 June | 65 | 39 | 104 |
| 2024 May | 69 | 28 | 97 |
| 2024 April | 73 | 29 | 102 |
| 2024 March | 81 | 24 | 105 |
| 2024 February | 40 | 40 | 80 |
| 2024 January | 44 | 23 | 67 |
| 2023 December | 45 | 26 | 71 |
| 2023 November | 52 | 30 | 82 |
| 2023 October | 45 | 31 | 76 |
| 2023 September | 55 | 43 | 98 |
| 2023 August | 44 | 24 | 68 |
| 2023 July | 54 | 34 | 88 |
| 2023 June | 47 | 27 | 74 |
| 2023 May | 63 | 34 | 97 |
| 2023 April | 25 | 19 | 44 |
| 2023 March | 39 | 26 | 65 |
| 2023 February | 29 | 18 | 47 |
| 2023 January | 36 | 23 | 59 |
| 2022 December | 60 | 25 | 85 |
| 2022 November | 60 | 32 | 92 |
| 2022 October | 41 | 37 | 78 |
| 2022 September | 58 | 29 | 87 |
| 2022 August | 72 | 46 | 118 |
| 2022 July | 44 | 43 | 87 |
| 2022 June | 44 | 42 | 86 |
| 2022 May | 43 | 30 | 73 |
| 2022 April | 56 | 58 | 114 |
| 2022 March | 56 | 50 | 106 |
| 2022 February | 46 | 34 | 80 |
| 2022 January | 48 | 23 | 71 |
| 2021 December | 45 | 38 | 83 |
| 2021 November | 41 | 44 | 85 |
| 2021 October | 31 | 29 | 60 |
| 2021 September | 52 | 32 | 84 |
| 2021 August | 68 | 37 | 105 |
| 2021 July | 62 | 29 | 91 |
| 2021 June | 42 | 27 | 69 |
| 2021 May | 61 | 35 | 96 |
| 2021 April | 116 | 80 | 196 |
| 2021 March | 68 | 31 | 99 |
| 2021 February | 59 | 20 | 79 |
| 2021 January | 52 | 25 | 77 |
| 2020 December | 43 | 13 | 56 |
| 2020 November | 31 | 21 | 52 |
| 2020 October | 35 | 16 | 51 |
| 2020 September | 39 | 13 | 52 |
| 2020 August | 46 | 17 | 63 |
| 2020 July | 58 | 13 | 71 |
| 2020 June | 53 | 20 | 73 |
| 2020 May | 50 | 40 | 90 |
| 2020 April | 70 | 18 | 88 |
| 2020 March | 58 | 27 | 85 |
| 2020 February | 63 | 17 | 80 |
| 2020 January | 83 | 25 | 108 |
| 2019 December | 115 | 24 | 139 |
| 2019 November | 100 | 26 | 126 |
| 2019 October | 63 | 9 | 72 |
| 2019 September | 110 | 21 | 131 |
| 2019 August | 123 | 11 | 134 |
| 2019 July | 147 | 29 | 176 |
| 2019 June | 127 | 32 | 159 |
| 2019 May | 106 | 21 | 127 |
| 2019 April | 133 | 41 | 174 |
| 2019 March | 99 | 26 | 125 |
| 2019 February | 47 | 16 | 63 |
| 2019 January | 45 | 23 | 68 |
| 2018 December | 116 | 38 | 154 |
| 2018 November | 164 | 21 | 185 |
| 2018 October | 116 | 20 | 136 |
| 2018 September | 114 | 21 | 135 |
| 2018 August | 75 | 21 | 96 |
| 2018 July | 75 | 24 | 99 |
| 2018 June | 58 | 13 | 71 |
| 2018 May | 68 | 17 | 85 |
| 2018 April | 54 | 10 | 64 |
| 2018 March | 63 | 7 | 70 |
| 2018 February | 61 | 9 | 70 |
| 2018 January | 56 | 5 | 61 |
| 2017 December | 63 | 13 | 76 |
| 2017 November | 71 | 10 | 81 |
| 2017 October | 49 | 12 | 61 |
| 2017 September | 66 | 17 | 83 |
| 2017 August | 46 | 11 | 57 |
| 2017 July | 58 | 9 | 67 |
| 2017 June | 58 | 15 | 73 |
| 2017 May | 47 | 13 | 60 |
| 2017 April | 59 | 19 | 78 |
| 2017 March | 46 | 14 | 60 |
| 2017 February | 109 | 14 | 123 |
| 2017 January | 41 | 12 | 53 |
| 2016 December | 67 | 10 | 77 |
| 2016 November | 76 | 19 | 95 |
| 2016 October | 140 | 4 | 144 |
| 2016 September | 193 | 4 | 197 |
| 2016 August | 232 | 5 | 237 |
| 2016 July | 186 | 4 | 190 |
| 2016 June | 116 | 0 | 116 |
| 2016 May | 135 | 0 | 135 |
| 2016 April | 121 | 0 | 121 |
| 2016 March | 88 | 0 | 88 |
| 2016 February | 88 | 0 | 88 |
| 2016 January | 100 | 0 | 100 |
| 2015 December | 122 | 0 | 122 |
| 2015 November | 79 | 0 | 79 |
| 2015 October | 94 | 0 | 94 |
| 2015 September | 85 | 0 | 85 |
| 2015 August | 80 | 0 | 80 |
| 2015 July | 68 | 0 | 68 |
| 2015 June | 31 | 0 | 31 |
| 2015 May | 55 | 0 | 55 |
| 2015 April | 5 | 0 | 5 |
Show all
