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Appendice 1
Sturkenboom MC, Dieleman JP, Picelli G, Mazzaglia G, Mozaffari E, Filippi A, Cricelli C, van der Lei J. Prevalence and
treatment of hypertensive patients with multiple concomitant cardiovascular risk factors in The Netherlands
and Italy.
J Hum Hypertens. 2008
ABSTRACT. The Anglo-Scandinavian Cardiac Outcomes Trial-Lipid-Lowering Arm (ASCOT-LLA) trial demonstrated the
benefits of combined antihypertensive/lipid-lowering treatment over antihypertensive treatment alone in hypertensive
patients with >/=3 additional cardiovascular (CV) risk factors. We assessed the prevalence and treatment of patients with
hypertension and >/=3 additional CV risk factors in The Netherlands and Italy in a retrospective cohort study using the
Integrated Primary Care Information (IPCI) database in The Netherlands and the Health Search/Thales Database (HSD) in
Italy. Patients aged >/=16 years, with 1 year of valid database history, diagnosed and/or treated for hypertension (>140/90
mmHg) during 2000-2002 were included in the study. The IPCI and HSD populations consisted of approximately 175
000 and approximately 325 000 patients, respectively. The prevalence of hypertension increased from 20.3 to 22.3%
in the IPCI, and from 19.0 to 21.8% in the HSD during 2000-2002. The prevalence of >/=3 concomitant risk factors
among hypertensive patients increased from 31.2 and 31.1% in 2000 to 34.2 and 39.3% in 2002 in the IPCI and HSD,
respectively. From 2000 to 2002, among hypertensive patients with >/=3 CV risk factors and no prior symptomatic
CV disease (CVD) approximately 54-57% in the IPCI and 80-83% in the HSD received antihypertensive treatment. In
these patients, the use of combined antihypertensive and lipid-lowering treatment increased from 14.2 to 17.6% in
the IPCI and from 15.5 to 17.4% in the HSD from 2000 to 2002. This study shows that primary prevention of CVD in
hypertensive patients in The Netherlands and Italy could be improved.
Minutolo R, De Nicola L, Mazzaglia G, Postorino M Cricelli C, Mantovani LG, Conte G, Cianciaruso B. Detection and
Awareness of Moderate to Advanced CKD by Primary Care Practitioners: A Cross-sectional Study From Italy.
Am J Kidney Dis 2008;52(3):444-53
ABSTRACT. BACKGROUND: Chronic kidney disease (CKD) is a strong independent predictor of cardiovascular disease.
Although general practitioners (GPs) represent the first line for identification of these high-risk patients, their diagnostic
approach to CKD is ill defined. STUDY DESIGN: Cross-sectional evaluation of database of Italian GPs. SETTING &
PARTICIPANTS: Representative sample of adult Italian population regularly followed up by GPs in 2003. OUTCOMES:
Frequency of serum creatinine testing, prevalence of CKD (estimated glomerular filtration rate [eGFR] < 60 mL/
min/1.73 m(2)), awareness of CKD assessed from use of diagnostic codes (Classification of Diseases, Ninth Revision,
Clinical Modification [ICD-9-CM]) for CKD, and referral to nephrologists. RESULTS: Of 451,548 individuals in the entire
practice population, only 77,630 (17.2%) underwent serum creatinine testing. Female sex (odds ratio [OR], 1.09; 95%
confidence interval [CI], 1.06 to 1.12), advanced age (OR, 2.70; 95% CI, 2.63 to 2.78), diabetes (OR, 1.31; 95% CI,
1.20 to 1.42), hypertension (OR, 1.10; 95% CI, 1.02 to 1.19), autoimmune diseases (OR, 1.42; 95% CI, 1.11 to 1.82),
and recurrent urinary tract infections (OR, 1.63; 95% CI, 1.10 to 2.42) were all associated with serum creatinine testing.
Conversely, use of either nonsteroidal anti-inflammatory drugs (OR, 1.03; 95% CI, 0.89 to 1.21) or aminoglycosides or
contrast media (OR, 0.78; 95% CI, 0.54 to 1.14) was not associated with serum creatinine testing. In the subgroup with
serum creatinine data, the age-adjusted prevalence of CKD was 9.33% (11.93% in women, 6.49% in men). However,
in patients with eGFR less than 60 mL/min/1.73 m(2), serum creatinine values were apparently normal (<1.2 mg/dL in
women, <1.4 mg/dL in men) in 54%, and GPs used ICD-9-CM codes for CKD in only 15.2%. Referral to nephrologists
ranged from 4.9% for patients with eGFR of 59 to 30 mL/min/1.73 m(2) to 55.7% for those with eGFR less than 30 mL/
min/1.73 m(2). LIMITATIONS: The prevalence of decreased kidney function may be overestimated because of the more
frequent serum creatinine testing in sicker individuals and lack of creatinine calibration. CONCLUSIONS: In primary care,
CKD stages 3 to 5 are frequent, but its awareness is scarce because of limited rates of serum creatinine testing and
difficulty recognizing decreased eGFR in the absence of increased serum creatinine testing.
Mazzaglia G, Yurgin N, Boye KS, Trifirņ G, Cottrell S, Allen E, Filippi A, Medea G, Cricelli C. Prevalence and
antihyperglycemic prescribing trends for patients with type 2 diabetes in Italy: A 4-year retrospective study
from national primary care data.
Pharmacol Res 2008. 57(5):358-63
ABSTRACT. To estimate the prevalence of type 2 diabetes in Italy and to investigate patient-related variables associated
with the use of different antihyperglycemic therapies. This study was conducted between the years 2000-2003 from
a source population comprising a cumulative sample of 394,719 patients from 320 General Practitioners across Italy,
who provide information to the Health Search/Thales Database (HSD). A total sample of 23,729 of patients with type 2