Cribado precoz e intervención breve en el consumo perjudicial de alcohol para mejorar el tratamiento de la hipertensión arterial en atención primaria

Gmel²,

Sierra

et al. 2016

Adicciones

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Through a simulation study, we estimated the potential effects of better detection of hypertension and improved screening for alcohol problems with subsequent interventions. Results showed that if 50% of Spanish males between 40 and 64 years of age who are currently unaware of their hypertension become aware of their condition and receive the usual treatment, and 50% of these males with hypertension are screened for alcohol and are treated for hazardous drinking or alcohol use disorders, then the percentage of uncontrolled hypertension among men with hypertension decreases from 61.2% to 55.9%, i.e. by 8.6%, with about 1/3 of the effect due to the alcohol intervention. For women, likewise, these interventions would decrease the percentage of women in the same age group with uncontrolled hypertension by 7.4% (about 40% due to the alcohol intervention). The reduction of blood pressure in the population would avoid 412 premature CVD deaths (346 in men, 66 in women) within one year. Therefore, better detection of hypertension and screening for alcohol with subsequent interventions would result in marked reductions of uncontrolled hypertension and CVD mortality.

Section: Discussionunclassified

Reducción de la mortalidad mediante una mejor detección de la hipertensión y los problemas con el alcohol en atención primaria de salud en España

Gmel²,

Sierra

et al. 2016

Adicciones

Self Cite

“…In preparation for the conference, a number of national meetings on its topic were held in Belgium [ 10 ], Finland [ 11 ], Germany [ 12 ], Spain [ 13 ], and the UK [ 14 ], where presentations of systematic reviews and meta-analyses on causality and the relationship between drinking and BP (see below for a summary) and of systematic reviews on the effects of alcohol intervention on BP (see below for a summary) were held. Further, modelling of the potential impact of primary care interventions on alcohol (technical details on the modelling are listed in Appendix 2, following the stipulations of the GATHER statement [ 15 ]) was performed and the results from a survey among primary care physicians on practices concerning alcohol screening and interventions in the management of hypertension [ 16 ] were presented.…”

Section: Methodsmentioning

confidence: 99%

Towards new recommendations to reduce the burden of alcohol-induced hypertension in the European Union

Anderson

Prieto

et al. 2017

BMC Med

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BackgroundHazardous and harmful alcohol use and high blood pressure are central risk factors related to premature non-communicable disease (NCD) mortality worldwide. A reduction in the prevalence of both risk factors has been suggested as a route to reach the global NCD targets. This study aims to highlight that screening and interventions for hypertension and hazardous and harmful alcohol use in primary healthcare can contribute substantially to achieving the NCD targets.MethodsA consensus conference based on systematic reviews, meta-analyses, clinical guidelines, experimental studies, and statistical modelling which had been presented and discussed in five preparatory meetings, was undertaken. Specifically, we modelled changes in blood pressure distributions and potential lives saved for the five largest European countries if screening and appropriate intervention rates in primary healthcare settings were increased. Recommendations to handle alcohol-induced hypertension in primary healthcare settings were derived at the conference, and their degree of evidence was graded.ResultsScreening and appropriate interventions for hazardous alcohol use and use disorders could lower blood pressure levels, but there is a lack in implementing these measures in European primary healthcare. Recommendations included (1) an increase in screening for hypertension (evidence grade: high), (2) an increase in screening and brief advice on hazardous and harmful drinking for people with newly detected hypertension by physicians, nurses, and other healthcare professionals (evidence grade: high), (3) the conduct of clinical management of less severe alcohol use disorders for incident people with hypertension in primary healthcare (evidence grade: moderate), and (4) screening for alcohol use in hypertension that is not well controlled (evidence grade: moderate). The first three measures were estimated to result in a decreased hypertension prevalence and hundreds of saved lives annually in the examined countries.ConclusionsThe implementation of the outlined recommendations could contribute to reducing the burden associated with hypertension and hazardous and harmful alcohol use and thus to achievement of the NCD targets. Implementation should be conducted in controlled settings with evaluation, including, but not limited to, economic evaluation.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-017-0934-1) contains supplementary material, which is available to authorized users.

“…Of all lifestyle factors, alcohol seems to be the least intervened in the management of HTN [10–13], which is no surprise given the low screening and intervention rates for hazardous drinking and alcohol use disorder in primary health care [14, 15]. Interventions for hazardous drinking are scarce [15–17]; and alcohol use disorders have the lowest treatment rate of all mental disorders [18–20], despite evidence that there are effective interventions available for both hazardous drinking and for alcohol use disorders [21, 22], which could be implemented at the primary care level [23, 24].…”

Section: Introductionmentioning

confidence: 99%

“…However, the mortality and disease burden attributable to HTN has increased globally since 1990 [ 1 ] and large European surveys still show a large proportion of adults with uncontrolled HTN ( http://apps.who.int/gho/data/?theme=home ), indicating the need for further action. Of all lifestyle factors, alcohol seems to be the least intervened in the management of HTN [ 10 – 13 ], which is no surprise given the low screening and intervention rates for hazardous drinking and alcohol use disorder in primary health care [ 14 , 15 ]. Interventions for hazardous drinking are scarce [ 15 – 17 ]; and alcohol use disorders have the lowest treatment rate of all mental disorders [ 18 – 20 ], despite evidence that there are effective interventions available for both hazardous drinking and for alcohol use disorders [ 21 , 22 ], which could be implemented at the primary care level [ 23 , 24 ].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The role of alcohol in the management of hypertension in patients in European primary health care practices – a survey in the largest European Union countries

Prieto

Beier³

et al. 2016

BMC Fam Pract

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BackgroundEven though addressing lifestyle problems is a major recommendation in most guidelines for the treatment of hypertension (HTN), alcohol problems are not routinely addressed in the management of hypertension in primary health care.MethodsInternet based survey of 3081 primary care physicians, recruited via the mailing lists of associations for general practitioners (GPs) in France, Germany, Italy, Spain and the UK. Clinical practice, attitudes, knowledge, education and training were assessed. Logistic regression to predict screening, brief intervention and treatment for alcohol dependence in the management of hypertension were assessed.ResultsOverall, about one third of the interviewed GPs reported sufficient screening in cases with HTN (34.0 %, 95 % confidence interval (CI):32.1–35.8 %). One out of five GPs screened and delivered brief interventions in HTN patients with hazardous consumption (22.2 %, 95 % CI: 20.6–23.8 %) and about one in 13 GPs provided treatment for HTN patients with alcohol dependence other than advice or brief intervention (7.8 %, 95 % CI: 6.8–8.9 %). Post-graduate training and belief in their effectiveness predicted interventions. There were marked differences between countries.ConclusionsWhile current interventions were overall low, marked differences between countries indicate that current practices could be improved. Education and post-graduate training seems to be key in improving clinical practice of including interventions for problematic alcohol consumption and alcohol dependence in primary health care.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-016-0529-5) contains supplementary material, which is available to authorized users.