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Resumen Fundamento y objetivo Un gran numero de pacientes con riesgo cardiovascular presentan sindrome metabolico (SM) y son atendidos por distintos especialistas. Se desconoce si existen diferencias en las caracteristicas o en el tratamiento de dichos pacientes en funcion de la especialidad que los atiende. El objetivo del presente trabajo ha sido el de evaluar la existencia de diferencias en las caracteristicas clinicas, el control de la presion arterial y el esfuerzo e inercia terapeuticos entre las distintas especialidades medicas en una cohorte de pacientes hipertensos con SM asociado. Pacientes y metodo Estudio transversal de ambito nacional, realizado en las 17 Comunidades Autonomas, en hipertensos afectos de SM reclutados de forma consecutiva en consultas de cardiologia, medicina interna, endocrinologia y nefrologia. Se determinaron las caracteristicas demograficas y clinicas, asi como el grado de control de la presion arterial. El esfuerzo terapeutico se definio por la presencia de tratamiento con al menos 3 farmacos antihipertensivos. La inercia terapeutica se definio como la falta de modificaciones en el tratamiento antihipertensivo a pesar de un control insuficiente de la presion arterial (cifras ≥ 140 y/o 90 mmHg). Resultados Se incluyeron 2.453 pacientes (40% de mujeres), con una edad media (DE) de 64 (11) anos. Se observaron algunas diferencias entre especialidades en relacion a los componentes del SM, de forma que la dislipidemia aterogenica (elevacion de trigliceridos [97%] y disminucion del colesterol unido a lipoproteinas de alta densidad [colesterol HDL] [61%]) fue mas frecuente entre los pacientes atendidos en consultas de cardiologia. Por lo que respecta al control de la presion arterial, este fue superior en los pacientes atendidos en consultas de nefrologia (16-33% en funcion del criterio utilizado). Estos datos se acompanaban de un mayor esfuerzo terapeutico por parte de dichos especialistas (59%), mientras que el mayor grado de inercia se observaba entre los pacientes atendidos en consultas de endocrinologia (56%). Conclusiones Los pacientes hipertensos con SM atendidos por diferentes especialistas tienen caracteristicas clinicas similares, aunque se observan algunas diferencias, especialmente en la presencia de alteraciones lipidicas, mas frecuentes entre los que son atendidos en consultas de cardiologia. En las consultas de nefrologia se observa un mayor esfuerzo terapeutico y se consigue un mayor control de la presion arterial, mientras que el mayor grado de inercia por lo que respecta al tratamiento antihipertensivo se observa en las consultas de endocrinologia.

Chronic kidney disease (CKD) and type 2 diabetes mellitus (T2DM) are highly prevalent chronic diseases, which represent an important public health problem and require a multidisciplinary management. T2DM is the main cause of CKD and it also causes a significant comorbidity with regard to non-diabetic nephropathy. Patients with diabetes and kidney disease represent a special risk group as they have higher morbi-mortality as well as higher risk of hypoglycemia than diabetic individuals with a normal kidney function. Treatment of T2DM in patients with CKD is controversial because of the scarcity of available evidence. The current consensus report aims to ease the appropriate selection and dosage of antidiabetic treatments as well as the establishment of safety objectives of glycemic control in patients with CKD.

A large number of patients with cardiovascular risk exhibit metabolic syndrome and are attended by several specialists. There is no information about possible differences in the clinical characteristics and management of these patients by these specialists. The aim of the present study was to evaluate possible differences in clinical features, blood pressure control, therapeutic effort, and therapeutic inertia among medical specialities attending hypertensive patients with metabolic syndrome (MS).Cross-sectional study carried out in 17 autonomous communities in Spain, in hypertensive patients with MS consecutively recruited in ambulatory units from departments of cardiology, internal medicine, endocrinology and nephrology. Demographic and clinical data, as well as blood pressure control were assessed. Therapeutic effort was defined as the proportion of patients using 3 or more antihypertensive drugs. Therapeutic inertia was defined as the proportion of patients without any change in antihypertensive treatment despite a lack of blood pressure control (values ≥ 140 and/or 90 mmHg).2,453 patients (40% women) with a mean age of 64 (11) years were included in the study. We observed some differences in the specific MS components among specialities. Atherogenic dyslipidemia, defined as elevated triglycerides (97%) and/or HDL-cholesterol (61%) was more common in patients attended by cardiologists. Blood pressure control was better achieved by nephrologists (16-33%, depending on the criteria used), and it was accompanied by a greater therapeutical effort (59%). Therapeutical inertia in relation to antihypertensive treatment was more common among endocrinologists (56%).Hypertensive patients with MS attended by different specialists have similar clinical features, although some differences are present, especially driven by more frequent lipid alterations among those attending cardiology departments. Nephrologists make a greater therapeutic effort and achieve a better blood pressure control. On the contrary, therapeutical inertia is higher among endocrinologists.

Chronic kidney disease (CKD) and type 2 diabetes mellitus (T2DM) are highly prevalent chronic diseases, which represent an important public health problem and require a multidisciplinary management. T2DM is the main cause of CKD and it also causes a significant comorbidity with regard to non-diabetic nephropathy. Patients with diabetes and kidney disease represent a special risk group as they have higher morbi-mortality as well as higher risk of hypoglycemia than diabetic individuals with a normal kidney function. Treatment of T2DM in patients with CKD is controversial because of the scarcity of available evidence. The current consensus report aims to ease the appropriate selection and dosage of antidiabetic treatments as well as the establishment of safety objectives of glycemic control in patients with CKD.