RESUMEN
This study sought to assess blood pressure (BP) control rates by determining the factors associated with poor BP control, therapeutic management and physicians' therapeutic behavior among elderly Spanish hypertensive patients in a primary care setting. This cross-sectional multicenter study included hypertensive patients at least 80 years of age in primary care settings throughout Spain who were on pharmacologic treatment. BP was considered well controlled at <140/90 mm Hg (<130/80 in patients with diabetes, chronic renal disease or cardiovascular disease). A total of 923 patients were included (83.3+/-3.5 years; 62.9% women). Almost two-thirds (64.0%) of the patients were taking a combined therapy (68.7%; 2 drugs) and approximately one-third (35.6%; 95% CI 32.6-38.7) of the patients attained BP goals. Physicians modified the antihypertensive treatment in 26.1% (95% CI 22.3-29.9) of patients with uncontrolled BP, which most frequently involved the addition of another drug (47.6%). Predictive factors for no BP control and no therapeutic modification in patients with uncontrolled BP included diabetes (OR 2.8 (95% CI 2.0-3.9); P<0.0001) and mistaken physician perceptions about BP control (OR 108.1 (95% CI 40.5-288.6); P<0.0001), respectively. Only three out of 10 hypertensive patients 80 years or older in Spain achieved the BP goals. Physicians only modified the treatment in one out of four patients with uncontrolled BP. Diabetes was associated with a threefold increase in the likelihood of uncontrolled BP, and the mistaken physician perceptions about BP control were associated with a 100-fold rise in the probability of not modifying antihypertensive therapy.
Asunto(s)
Anciano de 80 o más Años/estadística & datos numéricos , Presión Sanguínea/efectos de los fármacos , Hipertensión/terapia , Relaciones Médico-Paciente , Antihipertensivos/uso terapéutico , Estudios Transversales , Utilización de Medicamentos , Femenino , Encuestas de Atención de la Salud , Humanos , Hipertensión/tratamiento farmacológico , Hipertensión/epidemiología , Estilo de Vida , Masculino , Educación del Paciente como Asunto , España/epidemiología , Resultado del TratamientoRESUMEN
Two consecutive experiments determined whether disruption of the endothelial nitric oxide synthases (NOS) gene (Nos3) affects ovulation, fertilization, implantation, and embryo development. In the first trial, Nos3-knockout mice (groups Nos3(-/-)) and wild-type mice (groups Nos3(+/+)) showed significant differences in mean number of corpora lutea (9.7+/-1.2 in Nos3(-/-) versus 14.2+/-1.2 in Nos3(+/+); P<0.01), rate of anovulation (48.3+/-7.3% in Nos3(-/-) versus 29.7+/-6.3 in Nos3(+/+); P<0.05), total mean number of recovered oocytes/zygotes (4.0+/-1.1 in Nos3(-/-) versus 10.4+/-1.6 in Nos3(+/+); P<0.01), and non-fertilization rate (50.7 in Nos3(-/-) versus 3.3% in Nos3(+/+); P<0.001). In the second trial, implantation and early pregnancy losses in Nos3-knockout and wild-type dams were detected by real-time ultrasound imaging. The number of embryos reaching implantation was higher in Nos3(+/+) than in Nos3(-/-) mice (7.5+/-0.4 vs 4.0+/-0.4; P<0.005); thereafter, embryo losses were detected between days 8.5 and 13.5, in 62.5% of the Nos3-knockout dams and, at days 10.5 and 11.5, in 16.7% of the control females (P<0.005). Thus, NO and NOS3 deficiencies affect reproductive and developmental features in the Nos3-knockout mouse model.