Aims: In AMANDHA trial, the addition of manidipine, but not amlodipine, in diabetic patients with uncontrolled hypertension, microalbuminuria and preserved renal function resulted in a large decrease of urinary albumin excretion (UAE) despite similar blood pressure (BP) reductions. Factors associated with the reduction of UAE were analyzed. Methods: For this purpose, a multivariable analysis was performed. Results: Although after 6 months of treatment, manidipine and amlodipine decreased BP to a similar extent, reductions of UAE were higher with manidipine. The assigned treatment, changes in mean BP, sympathetic tone and glycemic control were associated with changes in UAE. Conclusion: The assigned treatment, changes in mean BP, sympathetic tone and glycemic control were independently associated with changes in UAE. Compared with amlodipine, manidipine reduced UAE to a higher extent, independently of BP reduction.

Objective: To evaluate lipid profile in patients with no vascular previous disease that were admitted in an emergency room service due to an acute coronary syndrome (ACS). Design and method: We have evaluated retrospectively 817 patients (72.9%men) with a mean age of 65.2(SD:13.1) that were admitted to the emergency room of a general hospital due to an ACS from January 2009 to December 2011. Patients were classified in two groups: A group (373 patients): with known dyslipidemia; B group (443 patients); without dyslipidemia. When admitted a lipid profile was performed to all patients (Total cholesterol (TC), triglycerides (TG), LDL-cholesterol, HDL cholesterol. Results: 51.6% of patients had LDL-cholesterol > 100 mg/dL and 4.7%L LDL-cholesterol was above 160 mg/dL. 44,5% of men had a HDL-cholesterol < 35 mg/dL and 60,9% from women presented a HDL-cholesterol < 45 mg/ dL. A group showed higher CT* levels (173.97 vs. 165.46 mg/dL) and TG* (147 vs. 131.25 mg/dL). On the contrary, LDL-levels (107.5 vs. 102.47 mg/dL) and HDL-cholesterol levels(39.44 vs. 38.67 mg/dL) were similar in both groups. On the A group 55,76% of patients were on statin treatment, 5.63 on fibrates and 1.34% on ezetimibe. (* P < 0,01). Conclusions: More than a half patients with not known previous vascular disease and dyslipidemia presented LDL levels above 100 mg/Dl and 5% presented very hign levels of LDL-cholesterol (>160 mg/dL). HDL-cholesterol levels were similar in patients with and without known dyslipidemia. More than 40% previously known dislipidemic patients were not receiving any hypolipemiant treatment.

BACKGROUND AND OBJECTIVE:In this study, 123 recordings of blood pressure (BP) obtained by ambulatory BP monitoring were analyzed. These recordings were measured in 2011 in patients from a Spanish tertiary university hospital. All participating patients were treated with 2, 3 or 4 anti-hypertensive drugs. The main aim of this study was to determine differences in BP control, if any, depending on the medication schedule. Thus, BP levels were studied at 3 periods of the day: activity hours, rest hours and 24h.PATIENTS AND METHOD:We compared subjects taking all anti-hypertensive agents during the day (n=70, group 1) with those taking at least one at night (n=53, group 2).RESULTS:Significant differences were found on diastolic BP, where group 2 patients had lower levels at activity, 24h periods and sleep-time. Even if it was not statistically significant, lower levels of systolic BP from group 2 were also observed at activity and 24h periods as well as lower levels of systolic, diastolic and mean BP at rest hours periods. There were also significant group differences in relation to the number of prescribed agents (with the mean being higher for group 2) and the type of agent (beta-blockers and calcium antagonists were more prevalent in group 2). Nevertheless, the multivariate regression analysis done taking into account these variables did not change the observed statistical significance.CONCLUSION:The administration of anti-hypertensive drugs at night could be associated with lower BP levels.

Objective: The aim of this study is to evaluate control of the cardiovascular risk factors in patients with previous cardiovascular disease Design and method: Observational and cross-sectional study. We analyzed 100 patients that presented a cardiovascular event in the previous 24 months. Subjects (18–75years of age) that suffered a stroke in the previous year were included. All patients signed an informed consent. Anamnesis and blood test was performed. 24 h Ambulatory blood pressure monitoring (SpaceLabs® Model90207) was practiced. We evaluated control level of their cardiovascular risk factors attending to recommendations provided by recent international guidelines (2013 ESH/ESC Guidelines for the management of arterial hypertension) Results: We studied 100 patients (70% males; mean age: 59.68 (± 9.5) years). Reason for admission was 48% ischemic heart disease, 47% stroke and 5% peripheral arterial ischemia. At discharge 49% were controlled in primary care and 45% in specialized medicine (25% cardiology, 8% neurology, 8% internal medicine and 4% nephrology). Statistical analysis showed a premature family ischemic heart disease in 34% of patients and 11% of patients had a family history of sudden death. Obesity was found in 33% of patients (BMI> 30 kg / m2); smoking in 14%; sedentary lifestyle in 50% and alcohol drinking in 50%. [Mean alcohol consumption was 10.33 g/day (SD: 14.0) in women and 28.37 g/day (SD: 41.1) in men]. The prevalence of hypertension was 61%, 56% dyslipemia and 27% diabetes. Objective levels (<70 mg/dL) of LDL cholesterol were not achieved in 79.8% of patients and 32.3% had an LDL-cholesterol above 100 mg/dL. 23% of patients had SBP24hr > 130mmHg; 8% DBP24hr> 80mmHg; 37% SBP-night> 120 mmHg and 23% DBP-night> 70mmHg. Patients with diabetes showed HbA1c> 7% in 19.4%. Conclusions: We observed no controlled cardiovascular risk factors in 3/4 of patients. Hypertension and dyslipemia were the most prevalent cardiovascular risk factors. High nocturnal blood pressure was found in 20% of patients. Promoting lifestyle changes (including healthy eating, physical activity and smoking cessation) should be the principal aim for prevention and/or management of cardiovascular disease.

Objective: The aim of this study is to evaluate control of the cardiovascular risk factors in patients with previous cardiovascular disease Design and method: Observational and cross-sectional study. We analyzed 100 patients that presented a cardiovascular event in the previous 24 months. Subjects (18–75years of age) that suffered a stroke in the previous year were included. All patients signed an informed consent. Anamnesis and blood test was performed. 24 h Ambulatory blood pressure monitoring (SpaceLabs® Model90207) was practiced. We evaluated control level of their cardiovascular risk factors attending to recommendations provided by recent international guidelines (2013 ESH/ESC Guidelines for the management of arterial hypertension) Results: We studied 100 patients (70% males; mean age: 59.68 (± 9.5) years). Reason for admission was 48% ischemic heart disease, 47% stroke and 5% peripheral arterial ischemia. At discharge 49% were controlled in primary care and 45% in specialized medicine (25% cardiology, 8% neurology, 8% internal medicine and 4% nephrology). Statistical analysis showed a premature family ischemic heart disease in 34% of patients and 11% of patients had a family history of sudden death. Obesity was found in 33% of patients (BMI> 30 kg / m2); smoking in 14%; sedentary lifestyle in 50% and alcohol drinking in 50%. [Mean alcohol consumption was 10.33 g/day (SD: 14.0) in women and 28.37 g/day (SD: 41.1) in men]. The prevalence of hypertension was 61%, 56% dyslipemia and 27% diabetes. Objective levels (<70 mg/dL) of LDL cholesterol were not achieved in 79.8% of patients and 32.3% had an LDL-cholesterol above 100 mg/dL. 23% of patients had SBP24hr > 130mmHg; 8% DBP24hr> 80mmHg; 37% SBP-night> 120 mmHg and 23% DBP-night> 70mmHg. Patients with diabetes showed HbA1c> 7% in 19.4%. Conclusions: We observed no controlled cardiovascular risk factors in 3/4 of patients. Hypertension and dyslipemia were the most prevalent cardiovascular risk factors. High nocturnal blood pressure was found in 20% of patients. Promoting lifestyle changes (including healthy eating, physical activity and smoking cessation) should be the principal aim for prevention and/or management of cardiovascular disease.

Objective: To evaluate lipid profile in patients with no vascular previous disease that were admitted in an emergency room service due to an acute coronary syndrome (ACS). Design and method: We have evaluated retrospectively 817 patients (72.9%men) with a mean age of 65.2(SD:13.1) that were admitted to the emergency room of a general hospital due to an ACS from January 2009 to December 2011. Patients were classified in two groups: A group (373 patients): with known dyslipidemia; B group (443 patients); without dyslipidemia. When admitted a lipid profile was performed to all patients (Total cholesterol (TC), triglycerides (TG), LDL-cholesterol, HDL cholesterol. Results: 51.6% of patients had LDL-cholesterol > 100 mg/dL and 4.7%L LDL-cholesterol was above 160 mg/dL. 44,5% of men had a HDL-cholesterol < 35 mg/dL and 60,9% from women presented a HDL-cholesterol < 45 mg/ dL. A group showed higher CT* levels (173.97 vs. 165.46 mg/dL) and TG* (147 vs. 131.25 mg/dL). On the contrary, LDL-levels (107.5 vs. 102.47 mg/dL) and HDL-cholesterol levels(39.44 vs. 38.67 mg/dL) were similar in both groups. On the A group 55,76% of patients were on statin treatment, 5.63 on fibrates and 1.34% on ezetimibe. (* P < 0,01). Conclusions: More than a half patients with not known previous vascular disease and dyslipidemia presented LDL levels above 100 mg/Dl and 5% presented very hign levels of LDL-cholesterol (>160 mg/dL). HDL-cholesterol levels were similar in patients with and without known dyslipidemia. More than 40% previously known dislipidemic patients were not receiving any hypolipemiant treatment.

Background and objectives: The population attended in the Spanish Internal Medicine departments is of increasing age, but the prevalence of vascular risk factors and its degree of control are unknown, as well as the differences by type of hospital or consulting room.Patients and methods: Epidemiologic, transversal and metacentric study in patients >= 18 years treated in outpatient Internal Medicine hospital. Two-hundred and ninety physicians from 17 Autonomic Communities participated in the study. The type of hospital or consulting room was also recorded. Blood pressure control was defined as <140/90 mmHg (<130/80 mmHg in diabetics or patients with vascular disease), LDL-cholesterol control when < 130 mg/dl (<100 mg/dl in diabetic or vascular disease) and diabetes control if glycated hemoglobin was < 7%.Results: Data from 2,704 patients was collected (54% men) mean age (SD) 64,1 (14,5) years. Ninety-three percent of them had at least one cardiovascular risk factor: hypertension 73.9%, dyslipidemia 59.5%, abdominal obesity 43.4%, diabetes 39.5%. Fifty percent had some target organ damaged, 46.7% showed vascular disease and 71.2% a high or very high vascular risk. Control over risk factors was: hypertension 33.8%, cholesterol-LDL 40.8% and diabetes 50.7%. There were no differences between type of hospital or type of outpatient consultancy.Conclusions: Over 90% of patients treated in outpatient consultancies of Internal Medicine departments present vascular risk factors, regardless of the type of hospital or type of consulting room. Risk factors control was poor. (C) 2012 Elsevier Espana, S.L. All rights reserved.

To analyse the association between Health Related Quality of Life (HRQoL) and age, in hypertensive patients and the correlation between HRQoL reported by patients and evaluated by their doctors. Observational, cross-sectional, multi-centre study, in Primary and Specialised Care. Inclusion of 5,031 hypertensive patients, selected by quotes according to three age groups (<65, 65-79, ≥ 80 years) was planned. Selection criteria were: patients whose age was over 18, diagnosed as having hypertension at least one year before inclusion and attended a follow-up visit. Information related to hypertension, basic socio-demographic and clinical data, the self-administered specific questionnaire MINICHAL for the evaluation of HRQoL (higher scores indicative of lower HRQoL), and a visual analogue scale (VAS) for the general evaluation of HRQoL (higher scores indicative of higher HRQoL) by patients and doctors, were recorded. Data of 4,346 eligible patients were included. HRQoL-age correlation was analysed by Spearman's-rho, differences among age groups by Kruskal-Wallis and patient/doctor agreement by the intraclass correlation coefficient (ICC). Mean age (SD) was 68.35(12.60). 38.1% of patients were under 65, 36.9% between 65 and 80 and 25.0% were over 80 years old. 54.5% were men. Mean time since diagnosis was 10.33(7.68) years. 34.2% had a family history of high blood pressure. Mean scores in MINICHAL were: State of Mind dimension 8.07(5.83), Somatic Manifestations dimension 3.24(3.06). Worsening of both dimensions was found when comparing groups of higher age (p<0.001) as well as significant moderate correlations of both dimensions with age (0.335, p<0.001; 0.397 p<0.001). Mean(SD) VAS score for doctors' evaluation was 66.84(15.82) and 63.93(18.46) that of patients; ICC for agreement was 0.697 (0.672, 0.687 and 0.663 by age groups). An impact of age on HRQoL worsening is evidenced. Patient/doctor agreement in the evaluation of HRQoL is adequate; however doctors trend to overestimate the HRQoL of patients.

To establish the relationship between cardiovascular risk (CVR) and health-related quality of life (HRQoL), as well as the presence or absence of comorbidities, in a Spanish hypertensive population. Epidemiological, cross-sectional, multicenter study conducted in adult patients with essential hypertension of ≥1 year of evolution. Patients were stratified in 5 categories according to the CVR within 10 years (ESH/ESC, 2007): average, low added, moderate added, high added and very high added CVR. HRQoL was measured by MINICHAL questionnaire. It comprises 2 domains (mental status and somatic manifestations) referred to the past week. Overall scores range from 0 to 48, with higher scores representing worse HRQoL. Presence of kidney and cardiovascular disease was evaluated. A total of 6,654 patients (55.2% male) were assessed; median age (Q1, Q3) 63.0 (55.0, 72.0) years and time since hypertension diagnosis 6.5 (2.9, 10.7) years. Average CVR was presented in 3.5%, low added in 13.6%, moderate added in 12.8%, high added in 39.0% and very high added in 31.0% of patients. Overall MINICHAL scores ranged from 4.0 (2.0, 8.0) in patients with average CVR to 11.0 (5.0, 18.0) in patients with very high added CVR (p<0.0001). Mental status and somatic manifestations domains scores ranged from 4.0 (1.0, 6.0) for average CVR to 8.0 (4.0, 13.0) for very high added CVR, and from 0.0 (0.0, 2.0) for average CVR to 3.0 (1.0, 6.0) for very high added CVR, respectively (p<0.0001, in both cases). Overall MINICHAL scores related to comorbidities (presence vs. absence) were: kidney disease 13.0 (7.0, 20.0) vs. 7.0 (3.0, 12.0) and cardiovascular disease 10.0 (5.0, 17.0) vs. 6.0 (3.0, 12.0), [p<0.0001, in both cases]. Hypertensive patients with increased CVR show significant worse HRQoL, in both mental status and somatic manifestations domains. The presence of comorbidities is associated with a worse HRQoL.

ResumenObjetivo: Realizar un análisis de impacto presupuestario (AIP) de la introducción

Objective: To carry out a budget impact analysis (BIA) of olmesartan/amlodipine (20/5, 40/5 and 40/10 mg) marketed as a fixed combination (FC) in its approved indication for the National Health System (NHS).Desig: We developed a decision tree model in order to estimate usual hypertension treatment algorithm in Spanish clinical practice.Settings: The BIA has been developed from the perspective of the NHS for a period of 3 years (years 2010-2012).Participants: Spanish hypertensive population >= 35 years old. Interventions: Introduction into the market of a fixed combination (FC) olmesartan/amlodipine in Spain.Primary measures: Expected costs to be assumed by the Spanish NHS (RRP-VAT) for hypertensive population able to be treated with the FC versus currently assumed costs by the NHS with free combination olmesartan and amlodipine.Results: Estimated pharmaceutical costs in hypertensive population treated with olmesartan and amlodipine (2 pills) would be (sic)25.2 M (1(st) year), (sic)26.4 M (2011), (sic)27.6 M (2012), with a total 3-year period of (sic)79.2 M. According to patient tree model, the population able to be treated with FC would be 71,283 patients (2010), with a growth rate of 4.8% in the successive years, which supposes an annual cost of (sic)21.2 M (2010), (sic)21.8M (2011) and (sic)22.4 M (2012), with a total 3-year period of (sic)65.4 M. The MA shows savings of (sic)13.8 M in a total 3-year period. Conclusion: The BIA of FC olmesartan/amlodipine could generate net savings of (sic)13.8 M for the NHS in the period ranging from years 2010 to 2012. (C) 2010 Elsevier Espana, S.L. All rights reserved.

Roca-Cusachs, A.1; Abellán, J.2; Font, B.3; Lahoz, R.3; Salazar, J.3 Author Information

1Centro De Salud De San Andrés, San Andrés-Spain, 2Hospital De la Santa Creu i Sant Pau, Barcelona-Spain, 3Novartis Farmacéutica S.A., Barcelona-Spain

Objective: To assess the influence of hypercholesterolemia on 24-h blood pressure (BP) and vascular risk in hypertensive patients. Methods: We analyzed data from the Spanish Society of Hypertension ABPM Registry. Hypercholesterolemia was defined as a serum LDL-cholesterol ≥165 mg/dl or current treatment with statins. Definitions for other variables and risk stratification followed 2007 ESH-ESC guidelines. ABPM was performed under standardized conditions and conventional thresholds for ambulatory BP and definition of a non dipping BP were applied. Results: We identified 9,805 subjects with hypercholesterolemia. Mean age (SD) was 64.1 (11.0) and 53.7% were men. Control rates of ambulatory BP were 49.6% (24-h), 57.3% (daytime), and 41.7% (nighttime) despite a widespread use (71.3%) of antihypertensive combinations. A non-dipper pattern of BP was present in 61.5% of subjects. Among those treated with statins, the proportion of patients showing a serum LDL-cholesterol <100 mg/dl was 11.8%. Prevalences of concomitant risk factors and organ damage were smoking 13.2%, diabetes 35.2%, obesity 40.7%, left ventricular hypertrophy 14.0%, radiological evidence of atherosclerosis 9.1%, microalbuminuria 11.8%, coronary heart disease 16.0%, cerebrovascular disease 9.3%, congestive heart failure 3.1%, and chronic kidney disease 4.5%. Consequently, prevalence of patients stratified as having high or very high added risk was 74.4%. Conclusions: Hypercholesterolemia identified hypertensive patients with a 75% likelihood of being at high or very high added cardiovascular risk. More than 50% of hypercholesterolemic hypertensives had their ambulatory BP undercontrolled. Only 53.6% of these patients were receiving statins, being very low (11.8%) the control rate of LDL-cholesterol. Additional efforts should be done for control of global cardiovascular risk in hypertensive patients with hypercholesterolemia.

Objective: To examine the concordance of blood pressure (BP) control by means of both office measurements and ambulatory BP monitoring (ABPM), in a large cohort of treated hypertensives from the Spanish Society of Hypertension ABPM Registry. Methods: A total of 43,499 hypertensives were analyzed. Office BP control was defined when BP <140/90 mmHg. Ambulatory BP control was considered by means of 3 different criteria: daytime BP <135/85 mmHg, 24-h BP <130/80 mmHg, and nightime BP <120/70 mmHg. Clinical characteristics were compared between patients with daytime BP below or above 135/85 mmHg. Results: Office BP control was 22.7%, daytime BP control was 52.0%, 24-h BP control was 44.8%, and nighttime BP control was 39.7%. Concordant control of BP was present in 17.4%, 15.7%, and 12.9%, by the 3 different criteria. The main source of difference between office and ABPM was the proportion of patients with isolated office resistance, the proportion of which, using the 3 aforementioned criteria was 34.5%, 29.1%, and 26.8%, respectively. When compared to patients with normal ABPM values, the presence of elevated daytime BP (higher than 135/85 mmHg) was associated (p < 0.001 for all comparisons) with male gender (57.5% vs 47.7%), diabetes (25.1% vs 20.9%), smoking (17.5% vs 12.5%), left ventricular hypertrophy on EKG (11.1 vs 9.1), and chronic kidney disease (3.0% vs 2.0%). Conclusions: BP control in the treated hypertensive population by using ABPM is twice as observed by office measurements. The proportion of patients with isolated office resistance (white coat) is relatively large. Normal values of ABPM in treated patients are more frequent in women, nondiabetic, and nonsmokers subjects, as well as in those without organ damage.

Patients with resistant hypertension (RH) exhibit a higher cardiovascular risk than those with well-controlled hypertension. Around 30% have indeed isolated-office resistant hypertension (IO-RH). 24h-ABPM is a useful tool to classify patients in true RH (T-RH) or IO-RH. Aim: To determine clinical, laboratory and echocardiographic variables which help the clinician to identify subjects with T-RH. Patients and Methods: Patients with suspected RH were consecutively recruited from Spanish Hypertension Units. Inclusion criteria: age>18yr, office-RH diagnosis (BP≥140 and/or 90mmHg despite treatment with ≥3 drugs, diuretic included), secondary hypertension ruled-out, glomerular filtration rate (GFR) >30 mL/min/1,73m2. Demographic and anthropometric characteristics, cardiovascular risk factors and clinical associated conditions were recorded. All subjects underwent complete laboratory evaluation, 2D-echocardiography and 24h-ABPM. We defined IO-RH if office-BP was ≥140 and/or 90mmHg and 24h-ABPM <130/80mmHg. Urinary albumin excretion (UAE) resulted from average of three first-morning-void urine samples determinations of the urinary albumin/creatinine ratio. Microalbuminuria (MA) was defined according to the proposed sex-specific cutoff values: ≥22 mg/g (males) and ≥31 mg/g (females). Left ventricular hypertrophy (LVH) was diagnosed if left ventricular mass index ≥125 g/m2 (males) and ≥110 g/m2 (females). Results: 529 patients included, 47% were women, age(mean ± DE): 64 ± 11yr; 38,2% with diabetes mellitus, 11,6% smokers. Target organ damage: LVH in 57.3%; MA in 45.9% and renal insufficiency (GFR <60 mL/min/1,73m2) in 26.5%. T-RH accounted for 74.3% (25.7% had IO-RH). Variables associated with T-RH: office-SBP: 160.7 ± 16mmHg vs. 153.6 ± 13.0; p < 0.0001; ABMP patterns no-dipper/riser for both SBP (73.2% vs. 63.6%; p = 0.038) and DBP (60.6% vs. 48.8%; p = 0.020), and night/day SBP ratio (0.95 ± 0.09 vs. 0.90 ± 0.25;p = 0.0004); MA (51.7% vs. 28.2%;p = 0.0002) and BMI >25Kg/m2 (93.3% vs. 85.2%;p = 0.025). UAE was higher in subjects with T-RH after adjustment for age, sex, office-SBP, diabetes, GFR, BMI and waist circumference (p = 0.0023). In a logistic regression analysis, only office-SBP [OR (95%CI): 1.043 (1.020–1.065),p = 0.0002] and UAE [OR (95%CI): 1.290 (1.106–1.503),p = 0.012] were independently associated with T-RH. Conclusion: Urinary albumin excretion is independently associated with true RH with respect to IO-RH, which can be useful to identify these patients.

Objective The use of diagnostic criteria based on 24-h ambulatory blood pressure (BP) values could improve prognostic value by incorporating night BP, minimize biases and improve the diagnostic reproducibility of isolated clinic hypertension (ICH). We estimate the 24-h BP cut-off points that best discriminate and predict the two diagnostic thresholds of mean daytime BP for ICH (135/85 and 130/80 mmHg). Methods Cross-sectional, comparative, multicentre study in 6176 untreated hypertensive patients, whose BP was measured by ambulatory BP monitoring. ICH was defined with an office BP of ≥140/≥90 mmHg and a daytime BP of <135/<85 mmHg (ICH1) or <130/80 mmHg (ICH2). Sensitivity, specificity, positive likelihood ratio (LR+), odds ratio (OR), error rate, predictive values, κ values and 95% confidence interval were calculated for each possible cut-off point for ICH1 and ICH2. Results One thousand eight hundred and seven patients (29.2%) and 960 patients (15.5%) met ICH1 and ICH2 criteria, respectively. The 24-h BP cut-off points that best predict ICH1 and ICH2 are less than 132/82 mmHg (sensitivity: 93.6%, specificity: 94.3%, LR+: 16.6, OR: 1367.1, error rate: 5.9, κ 0.86) and less than 127/77 mmHg (sensitivity: 90.8%, specificity: 97.4%, LR+: 34.6, OR: 1041.5, error rate: 3.6,κ 0.86), respectively. These values achieved the best balance of sensitivity and specificity, together with the highest values of LR+ and OR and the lowest error rate. Conclusion The 24-h BP cut-off point that best predicts the daytime criterion of less than 135/85 and less than 130/80 mmHg are 132/82 and 127/77 mmHg, respectively. These 24-h cut-off points may add value to ambulatory blood pressure monitoring for both diagnostic and management future decisions.

Objective: To examine changes in hypertension control reported by physicians participating in a web-based project for management of patients with high BP. Methods: We selected physicians participating in the Spanish Society of Hypertension ABPM Registry, each one recruiting >20 subjects both in 2005 (group 1 or G1) and 2007 (group 2 or G2) (n = 71). Data between both groups were compared. Cases with repeated ABPM were discarded. Office BP was considered as controlled when <140/90 mmHg and ambulatory BP was considered as controlled when 24-h BP <130/80 mmHg. Results: G1 and G2 included 4,158 and 3,253 patients respectively. Age (62.3 vs 62.7 years), duration of hypertension (8.3 vs 8.1 years), body mass index (29.5 vs 29.3 kg/m2), presence of at least one additional cardiovascular risk factor (91.1% vs 90.3%), prevalence of diabetes (21.9% vs 20.7%), and prevalence of established cardiovascular disease (16.8 vs 15.6%) were similar in both groups. Male sex was 49.0% in G1 and 51.6% in G2, p = 0.03. Office BP was 151.2/86.6 mmHg in G1 and 146.8/84.2 mmHg in G2 (p < 0.001), and control rates were 22.8% and 27.9% respectively (p < 0.001). Mean 24-h BP was 130.4/75.4 mmHg in G1 and 129.2/74.7 mmHg in G2 (p < 0.01), and ambulatory control rates 45.1% and 48.0% respectively (p = 0.022). Combination antihypertensive therapy was more frequently used in 2007 (68.5%) than in 2005 (63.3%), p < 0.001. Conclusions: A modest improvement in 2-year hypertension control rate was observed in patients attended by participant physicians in this web-based ABPM registry. Programs designed to help physicians in daily management of hypertensive patients may be useful for ameliorating hypertension control.

Objective: To estimate the prevalence of masked hypertension in subjects with high normal blood pressure (BP). Methods: We analyzed data from untreated individuals included in the Spanish Society of Hypertension ABPM Registry (whole sample number 68,045). High normal BP was defined following current guidelines when office systolic BP was 130–139 mmHg and diastolic BP was 85–89 mmHg. A series of demographic and clinical variables were collected. Definitions and risk stratification followed 2007 ESH-ESC guidelines. ABPM was performed under standardized conditions. Masked hypertension was diagnosed when mean 24-h systolic BP = or > 130 mmHg and/or 24-h diastolic BP = or >80 mmHg. Results: We identified 3,199 untreated subjects with high normal BP. Mean (SD) age was 51.2 (15.1) years, 53.6% were men, and 26.4% were obese (body mass index ≥30 kg/m2). Mean (SD) office BP was 132.5 (5.2)/81.5 (6.3) mmHg and mean (SD) 24-h ambulatory BP was 123.9 (10,4)/75.8 (8,2) mmHg. Prevalence (95%CI) of masked hypertension was 39.5% (37.8–41.2). Subjects with masked hypertension showed a 24.5 % prevalence of high cardiovascular risk. With respect to individuals with ambulatory normotension, subjects with masked hypertension were overweighted, more frequently smokers, and showed a higher prevalence of a riser profile of nocturnal BP (p < 0.05 for all comparisons). Prevalence of documented target organ damage and established cardiovascular disease was similar in patients with masked hypertension and subjects with ambulatory normotension. Conclusions: Masked hypertension was present in 4 of 10 subjects with high-normal BP. This proportion and the potential high-risk profile of these individuals should encourage the detection of masked hypertension in subjects with high-normal BP.