J. A. Divisón Garrote

Facultad de Medicina, Madrid, Madrid, Spain

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Publications (34)8.64 Total impact

  • J A Divisón Garrote, M Seguí Díaz, C Escobar Cervantes
    Semergen / Sociedad Espanola de Medicina Rural y Generalista. 08/2014;
  • J A Divisón Garrote, M Seguí Díaz, C Escobar Cervantes
    SEMERGEN - Medicina de Familia 05/2014;
  • J.A. Divisón Garrote, M. Seguí Díaz, C. Escobar Cervantes
    SEMERGEN - Medicina de Familia 01/2014;
  • J.A. Divisón Garrote, M. Seguí Díaz, C. Escobar Cervantes
    SEMERGEN - Medicina de Familia 01/2014;
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    ABSTRACT: La automedición de la presión arterial domiciliaria con aparatos semiautomáticos validados es una técnica cada vez más utilizada en la práctica clínica habitual. En el presente artículo se revisan las ventajas que su uso tiene sobre otras técnicas de medición, tanto para el establecimiento del diagnóstico de hipertensión arterial como para la evaluación de la potencial repercusión orgánica y el seguimiento terapéutico de los pacientes, así como los inconvenientes que su uso generalizado puede tener (criterios de normalidad no establecidos, relación con morbimortalidad, técnica de medición más indicada), y que creemos que en la actualidad más que desventajas son preguntas no respondidas en su totalidad. Continúa por tanto existiendo la necesidad de seguir desarrollando estudios bien diseñados en este tema que traten de responder a estas cuestiones.
    Hipertensión y Riesgo Vascular. 07/2013; 17(2):53–61.
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    ABSTRACT: The aim of this study is to compare the efficiency of different fixed-dose combinations of renin-angiotensin-aldosterone system (RAAS) blockers and calcium channel blockers, to use it as a guide to assist the rational prescribing in antihypertensive therapy. The efficacy of each drug was obtained from intervention studies randomized, double-blind, made with these combinations and a utility-cost modeling from the model proposed and used by NICE. The perspective of our analysis is the National Health System and the time horizon is long enough to achieve therapeutic goals. Cost per mmHg reduction in BP, percentage of reduction necessary to achieve the therapeutic goals for hypertension control and cost, and finally quantity and quality of life gained with these treatments in patients with hypertension, diabetes. We studied three fixed-dose combinations: amlodipine/olmesartán, amlodipine/valsartan and manidipine/delapril. The cost per mmHg systolic BP ranged from 24.93 to 12.34 €/mmHg, and diastolic BP ranged from 34.24 to 18.76 €/mmHg, depending on the drug used. For an initial value of 165mmHg systolic BP the most efficient treatment to achieve the therapeutic goal of hypertension control (<140mmHg) is manidipine/delapril with a cost of 67.76 €. The use of these drugs to control diabetic and hypertensive patients resulted in all cases being cost-effective (more effective and lower cost compared to "no treatment"). Manidipine/delapril showed the best relation cost-utility (1,970 €/QALY (quality-adjusted life year)) followed by amlodipine/olmesartan and amlodipine/valsartan (2,087 and 2,237 €/QALY, respectively).
    SEMERGEN - Medicina de Familia 03/2013; 39(2):77-84.
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    ABSTRACT: Objective The aim of this study is to compare the efficiency of different fixed-dose combinations of renin-angiotensin-aldosterone system (RAAS) blockers and calcium channel blockers, to use it as a guide to assist the rational prescribing in antihypertensive therapy.Methods The efficacy of each drug was obtained from intervention studies randomized, double-blind, made with these combinations and a utility-cost modeling from the model proposed and used by NICE.The perspective of our analysis is the National Health System and the time horizon is long enough to achieve therapeutic goals.Main outcome measuresCost per mmHg reduction in BP, percentage of reduction necessary to achieve the therapeutic goals for hypertension control and cost, and finally quantity and quality of life gained with these treatments in patients with hypertension, diabetes.ResultsWe studied three fixed-dose combinations: amlodipine/olmesartán, amlodipine/valsartan and manidipine/delapril. The cost per mmHg systolic BP ranged from 24.93 to 12.34 €/mmHg, and diastolic BP ranged from 34.24 to 18.76 €/mmHg, depending on the drug used.For an initial value of 165 mmHg systolic BP the most efficient treatment to achieve the therapeutic goal of hypertension control (<140 mmHg) is manidipine/delapril with a cost of 67.76 €.The use of these drugs to control diabetic and hypertensive patients resulted in all cases being cost-effective (more effective and lower cost compared to “no treatment”). Manidipine/delapril showed the best relation cost-utility (1,970 €/QALY (quality-adjusted life year)) followed by amlodipine/olmesartan and amlodipine/valsartan (2,087 and 2,237 €/QALY, respectively).
    SEMERGEN - Medicina de Familia 03/2013; 39(2):77–84.
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    ABSTRACT: Introduction Inflammation is present in every stage of the atherosclerosis process, therefore, inflammation hallmarks such as the fibrinogen can be related to the complications in which it intervenes, mortality is one of them. The objective of this study is to assess the association of the fibrinogen with all-cause mortality in men from general population sample obtained by random sampling in the Spanish region of Albacete. Methods A total of 506 men without cardiovascular events with 10.6 years (SD = 2.3) of follow-up, volunteered to participate in a prospective cohort study. The assessment of the fibrinogen as a predictor variable has been calculated after adjusting it by age, hypertension, diabetes mellitus, obesity, total cholesterol, HDL-cholesterol/triglycerides ratio, and smoking habit applying a Cox regression model. The adjustment has been made by adding the fibrinogen to the model, as a qualitative variable (< 400 and ≥ 400 mg/dl). Results The average age of the participants was 46.6 years old (DE = 16.8). After the adjustment, the hyperfibrinogenemia (≥ 400 mg/dl) showed a hazard ratio (HR) for all-cause mortality of 1.85 (95%CI: 1.05-3.26) and for cardiovascular mortality HR = 2.69 (95%CI: 1.09-6.63). Conclusions In men without cardiovascular events of our study, fibrinogen was showed as an independent predictor of all-cause mortality and cardiovascular mortality.
    Clínica e Investigación en Arteriosclerosis. 01/2013; 25(2):56–62.
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    ABSTRACT: There is a need for more information on therapeutic inertia in blood pressure (BP) treatment. The purpose of this study was to determine the therapeutic behaviour and associated factors of Primary Care (PC) physicians on uncontrolled hypertensive patients. Cross-sectional multicentre study of patients with hypertension attending Spanish PC centres. Data was collected from patients (social-demographics, clinical status and treatment), as well as data from physicians (medical practice, background and therapeutic behaviour) were collected. Uncontrolled BP was considered when average BP values where ≥140/90mmHg. A total of 12,961 patients (52.0% women) were included. The mean age was 66.3 (SD 11.4) years, and mean number of years from diagnosis of hypertension was 9.1 (6.7) years. Almost two-thirds (62.4%) of the patients were taking a combined blood pressure treatment, (44.2% with two drugs and 18.2% with three drugs, or more). An uncontrolled BP was observed in 38.9% (95% CI: 38.1-39.7) of patients. Treatment was changed by physicians in 41.8% (95% CI: 40.4-43.2) out of 5,036 uncontrolled patients. Adding another drug was the most frequent behaviour (55.6%). The physician's perception of good BP control in uncontrolled patients, together with the presence of combined blood pressure treatment, were the two variables most strongly associated with therapeutic inertia. The Spanish PC Physician modified antihypertensive treatment in only 4 out of 10 uncontrolled patients. The physician's perception of good BP control was the variable most strongly associated with therapeutic inertia.
    SEMERGEN - Medicina de Familia 01/2013; 39(1):3-11.
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    ABSTRACT: Background and Objective Insulin resistance (IR) has been directly related to obesity, particularly central obesity, and to other cardiovascular risk factors (CVRFs). Direct IR quantification is difficult in clinical practice, and indirect methods such as HOMA (homeostasis model assessment) have therefore been developed. The aim of this study was to assess the association of IR, as measured by HOMA, with different anthropometric measures and some CVRFs.
    Clinica Chimica Acta - CLIN CHIM ACTA. 11/2011;
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    ABSTRACT: Insulin resistance (IR) has been directly related to obesity, particularly central obesity, and to other cardiovascular risk factors (CVRFs). Direct IR quantification is difficult in clinical practice, and indirect methods such as HOMA (homeostasis model assessment) have therefore been developed. The aim of this study was to assess the association of IR, as measured by HOMA, with different anthropometric measures and some CVRFs. A cross-sectional, observational study was carried out in a general population sample older than 18 years in the province of Albacete, Spain. Sample size was 678 subjects. Participants completed a survey and underwent physical examinations and laboratory tests. Obesity measures included body mass index, waist perimeter, and sagittal abdominal diameter. Data analysis was performed using SPSS 15.0 software. Mean values of obesity measures were higher in males as compared to females and increased with age. IR prevalence was 39.8%. All assessed anthropometric measures, decreased HDL (high density lipoprotein) cholesterol and increased non-HDL cholesterol were independently associated to the risk of IR. A clear association exists between different anthropometrical measures and IR in the general population. There is also an association between lipid profile cahnges and the risk of experiencing IR.
    Endocrinología y Nutrición 09/2011; 58(9):464-71.
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    ABSTRACT: To establish strategies for prevention of cardiovascular disease implies to know its epidemiology and evolution in time. The objective of this study is to know the prevalence of risk factors and cardiovascular risk in two moments during the following of a grownup general population. Study of cohorts, followed at random selected general population during 12 years (1992-94 to 2204-06). Two transversal studies were made, one at the beginning and the other one at the end of this follow-up. The population in this study was 18 years and older registered in the province of Albacete. Random sampling, stratified and two-stage. The sample size for the first cut was 2121 subjects and for second one 1577. One specific anamnesis was made, physical examination, measurement of blood pressure, electrocardiogram and extraction of venous blood. The studied variables were: age, sex, personal and familiar antecedents, risk factors and global cardiovascular risk. 1322 subjects went to the appointment for the first examination (mean age 48.2 years. 53.6% women) and 997 for the second (mean age 52.8 years. 56.7% women). Has Increased the prevalence of hypertension (32.7% to 41,2%), diabetes (9,8 to 11,4%), obesity (27,8 to 34,3%) and hypercolesterolemia (47,5 to 53,5%), whereas smokers have decreased (32,6 to 23,7%) and have handicapped the average values of arterial pressure (132/81 to 129/73 mmHg), glycaemia (100,8 to 92,8 mg/dl) and LDL-cholesterol (128,7 to 116,7 mg/dl) and also a lowering of cardiovascular risk with Framingham (10,8% to 8,2%) and Score (2,3% to 1,6%). In the last years an increasing prevalence of risk factors has been seen (hypertension, diabetes and hypercolesterolemia), a better control of them, and lower prevalence of smoking and cardiovascular risk in the population has also be seen.
    Revista Española de Salud Pública 06/2011; 85(3):275-84. · 0.71 Impact Factor
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    ABSTRACT: IntroductionThe aim of this study was to investigate the predictive value of the ankle-brachial index (ABI) in all-cause mortality and composite end-point all-cause mortality and cardiovascular morbidity in a sample of a general population.
    Seminars in Hematology - SEMIN HEMATOL. 01/2011; 23(1):21-28.
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    ABSTRACT: Objectives Discuss the evolution of blood pressure (BP) control grade in a large sample of Spanish hypertensive patients in the period of 2002–2006.
    01/2009;
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    ABSTRACT: There is little information available on Therapeutic Inertia in Primary Care (PC). This study aimed to know the therapeutic behavior of the physician for uncontrolled hypertensive patients. Cross-sectional, multicenter study that included hypertensive patients of both genders, under pharmacological treatment who were recruited consecutively in the PC out-patient clinic in all of Spain. Social-demographic, clinical and treatment data were recorded, as well as the motives for eventual therapeutic modification. Adequate BP control was considered when BP values were below 140/90 mmHg in general, and below 130/80 mmHg in diabetes, renal insufficiency or cardiovascular disease. A total of 10,520 patients (53.7% women) were included with average age of 64.6 (11.3 years). Of these, 44.4% the patients were receiving monotherapy and 55.6% were treated with combined therapy (two drugs 41.2%, three drugs 11.7%, and more than three 2.8%). Uncontrolled hypertension was found in 58.6% (95% CI. 57.6-59.5) of the patients. Treatment was modified by physicians in 30.4% (95% CI. 29.2-31.6) of the uncontrolled patients, combination with another drug being the most frequent behavior (46.3%), followed by dose increase (26.1%), and antihypertensive drug switch (22.8%). The perception of the physician of good BP control was the factor most associated with not modifying the treatment in uncontrolled patients. Study results showed that the PC physician modified antihypertensive treatment in only 3 out of 10 uncontrolled patients. When treatment modification was made, association of drugs was the most frequent behavior.
    Revista Clínica Española 10/2008; 208(8):393-9. · 2.01 Impact Factor
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    ABSTRACT: Introduction There is little information available on Therapeutic Inertia in Primary Care (PC). This study aimed to know the therapeutic behavior of the physician for uncontrolled hypertensive patients. Patients and methods Cross-sectional, multicenter study that included hypertensive patients of both genders, under pharmacological treatment who were recruited consecutively in the PC out-patient clinic in all of Spain. Social-demographic, clinical and treatment data were recorded, as well as the motives for eventual therapeutic modification. Adequate BP control was considered when BP values were below 140/90 mmHg in general, and below 130/80 mmHg in diabetes, renal insufficiency or cardiovascular disease. Results A total of 10,520 patients (53.7% women) were included with average age of 64.6 (11.3 years). Of these, 44.4% the patients were receiving monotherapy and 55.6% were treated with combined therapy (two drugs 41.2%, three drugs 11.7%, and more than three 2.8%). Uncontrolled hypertension was found in 58.6% (95% CI. 57.6-59.5) of the patients. Treatment was modified by physicians in 30.4% (95% CI. 29.2-31.6) of the uncontrolled patients, combination with another drug being the most frequent behavior (46.3%), followed by dose increase (26.1%), and antihypertensive drug switch (22.8%). The perception of the physician of good BP control was the factor most associated with not modifying the treatment in uncontrolled patients. Conclusions Study results showed that the PC physician modified antihypertensive treatment in only 3 out of 10 uncontrolled patients. When treatment modification was made, association of drugs was the most frequent behavior.
    Revista Clinica Espanola - REV CLIN ESPAN. 01/2008; 208(8):393-399.
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    ABSTRACT: Hypertensive crises are a frequent motive for consultation in the emergency services. Approximately 1-2% of hypertensive patients develop a hypertensive crisis at some time of their lives. The present work aims to review the most recent clinical manuals for management of this condition, in order to propose some clinical recommendations. The subject of this study is usually treated in the consensus documents published on the management of arterial hypertension. The clinical manuals evaluated have very similar contents and recommendations, almost all of them including an introduction section, classification, definitions and general management. Differences appear, however, in hypertensive urgencies and emergencies depending on the absence or presence of acute lesion of target organs of the arterial hypertension. There are few published randomised clinical trials that have compared different drugs or management strategies for hypertensive crises. Manuals have been found on the management of AHT that base their recommendations on evidence, but similar manuals for hypertensive crises do not exist, except for the management of pre-eclampsia/eclampsia.
    Revista Clínica de Medicina de Familia. 01/2008; 2(5):236-243.
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    ABSTRACT: The HICAP study assessed the cardiovascular (CV) global risk and the CV risk factors control in hypertensive patients managed in Primary Care (PC) in Spain. Cross-sectional and multilocated study in which each investigator included data from 5 consecutives hypertensive patients. A routine laboratory test and a ECG from the previous 6 months had to be available for each patients CV global risk evaluation, blood pressure (BP) and diabetes control was based on ESH-ESC 2003; lipid profile evaluation was based on NCEP 2001 (ATP III) RESULTS: 1288 PC physicians included 6719 hypertensive patients, and data from 6375 patients were analyzed.64.5% (CI95%: 63.3-65.7) of the hypertensive patients managed in Primary Care showed a high or very high CV global risk.BP was controlled in 39.3% (CI95%: 38.1-40.5) of patients, 10.5% (CI95%: 9.1-11.9)among diabetics. 37.3% (CI95%: 35-38.7) of diabetics showed HbA1c < 6.5% and 18.8% (CI95%: 17.6-20) of dyslipidemic subjects had their LDL-c controlled. The control was lower among the patients at higher CV global risk. These results demostrate the high proportion of hypertensive patients that present a high CV global risk. The cardiovascular risk factors control, specially among patients at higher CV global risk, is insufficient.
    Anales de medicina interna (Madrid, Spain: 1984) 07/2007; 24(7):312-6.
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    ABSTRACT: Introduction Scarce information is available on the clinical characteristics and risk factors of patients with chronic heart failure (CHF) attended in Primary Care (PC) setting. The aim of this study was to analyze the clinical characteristics of this population in PC. Patients and methods Multicenter, cross-sectional study in patients with CHF, consecutively recruited by 232 physicians in PC. The collected data included sociodemographic, etiologic, clinical and therapeutic variables. Results Eight hundred forty seven (847) patients were included (age 73.0 ± 9.6 years; 50.5% men). Of these, 84.3% had arterial hypertension (AHT), 59.2% hypercholesterolemia and 34.9% diabetes mellitus. The most frequent associated clinical disorders were ischemic heart disease (40.1%) and peripheral artery disease (28.6%). In 69.6% of the patients the physicians knew the type of dysfunction (32.4% systolic, 37.2% diastolic). The main etiologies of CHF were the hypertensive cardiomyopathy (75.0%) and ischemic heart disease (40.1%); the most frequent trigger factor was atrial fibrillation (43.9%). Loop diuretics (72.3%) and angiotensin-converting enzyme inhibitors (60.9%) were the treatments used most and 6.7% of the patients were receiving treatment with beta blockers. Conclusions AHT appears to be primary cause of CHF in PC. Diastolic dysfunction is more frequent than the systolic one, and the PC physicians do not know the cause of the ventricular dysfunction in one third of the cases. Loop diuretics and angiotensin-converting enzyme inhibitors were the most frequently used in these patients; the use of beta blockers in CHF is very scarce in PC.
    Revista Clínica Española 07/2007; 207(7):337–340. · 2.01 Impact Factor
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    ABSTRACT: Scarce information is available on the clinical characteristics and risk factors of patients with chronic heart failure (CHF) attended in Primary Care (PC) setting. The aim of this study was to analyze the clinical characteristics of this population in PC. Multicenter, cross-sectional study in patients with CHF, consecutively recruited by 232 physicians in PC. The collected data included sociodemographic, etiologic, clinical and therapeutic variables. Eight hundred forty seven (847) patients were included (age 73.0 +/- 9.6 years; 50.5% men). Of these, 84.3% had arterial hypertension (AHT), 59.2% hypercholesterolemia and 34.9% diabetes mellitus. The most frequent associated clinical disorders were ischemic heart disease (40.1%) and peripheral artery disease (28.6%). In 69.6% of the patients the physicians knew the type of dysfunction (32.4% systolic, 37.2% diastolic). The main etiologies of CHF were the hypertensive cardiomyopathy (75.0%) and ischemic heart disease (40.1%); the most frequent trigger factor was atrial fibrillation (43.9%). Loop diuretics (72.3%) and angiotensin-converting enzyme inhibitors (60.9%) were the treatments used most and 6.7% of the patients were receiving treatment with beta blockers. AHT appears to be primary cause of CHF in PC. Diastolic dysfunction is more frequent than the systolic one, and the PC physicians do not know the cause of the ventricular dysfunction in one third of the cases. Loop diuretics and angiotensin-converting enzyme inhibitors were the most frequently used in these patients; the use of beta blockers in CHF is very scarce in PC.
    Revista Clínica Española 01/2007; 207(7):337-40. · 2.01 Impact Factor