Mortality in hypertensive patients in Hospitalet de Llobregat, Barcelona (Spain)

A retrospective cohort study was carried out on 729 hypertensive patients (male and female 40 years and older) in Hospitalet de Llobregat (Barcelona, Spain) to assess possible differences between the mortality of this group of hypertensives and the general population of the same area matched by age and sex. Patient mortality was assessed during a six year period, resulting in a mean follow-up of 2.6 years at the end of the study. The results reflect an increased risk of dying among hypertensives compared with the general population, with standardised mortality ratio by age and sex of 1.88 (95% confidence interval 1.21-2.44). Cardiovascular mortality was significantly higher for males, while noncardiovascular mortality was significantly higher for females. The study also shows that the presence of smoking habit, diabetes or hyperglycaemia, uncontrolled hypertension and age > or = 60 years can increase the risk of dying among hypertensive patients. Although a higher level of BP control is achieved in hypertension hospital clinics than in the primary health care system, the study shows that hypertensives have an excess of mortality than expected considering their own general population by age and sex.

Cardiovascular mortality trends in Spain and Catalonia. Comparisons with Europe

Cardiovascular mortality trends in Spain during the last 15 years have been reviewed and compared with those observed in other European countries. Future coronary heart disease (CHD) mortality trends in Catalonia have been estimated, and its expected evolution with intervention programmes on the prevalence of hypercholesterolaemia is discussed. The main conclusions are: (a) a reduction in stroke and no changes in CHD mortality in Spain and Catalonia has been observed during recent years; (b) this evolution was similar to that observed in other European countries; (c) Spain, like other Mediterranean countries, shows a peculiar cardiovascular mortality pattern with predominance of stroke over CHD; (d) no spectacular changes in CHD mortality trends during the next few years can be expected in Catalonia, but reductions in the prevalence of hypercholesterolaemia may contribute to modify the stable CHD mortality trends.

Epidemiology of cardiovascular disease risk factors in Catalonia (Spain)

Cardiovascular disease is one of the most important public health problems in developed countries. We have studied the epidemiology of the following cardiovascular disease risk factors in a random sample (n = 704) of the adult population of Catalonia (Spain): hypercholesterolemia (> or = 6.1) mmol/l or 240 mg/dl), hypertension (SBP > or = 160 and/or DBP > or = 95 mmHg), low HDL-cholesterol concentrations (< 0.9 mmol/l or 35 mg/dl), hypertriglyceridemia (> 2.8 mmol/l or 250 mg/dl), obesity (BMI > 30), smoking and history of diabetes and coronary heart disease. Two percent of participants had hypertriglyceridemia, 3% had a history of coronary heart disease, 4% a history of diabetes, 6% low HDL-cholesterol concentrations, 12% were obese, 20% had hypertension, 24% had hypercholesterolemia and 36% were smokers. 58% of hypertensive individuals had been previously detected, 46% were currently on treatment, and 21% had their blood pressure controlled (SBP < 160 and DBP < 95 mmHg). Correlation and multiple regression analyses were used to investigate the association between cardiovascular risk factors. Multiple linear regression analysis showed independent correlations between risk factors. Prevalence of hypercholesterolemia, obesity and diabetes was higher and prevalence of smoking was lower in hypertensives than normotensives. The odds ratio was 3.68 (95% CI = 2.07-6.54) for hypercholesterolemia, 3.26 (95% CI = 1.52-7.02) for obesity, 3.81 (95% CI = 1.09-7.02) for diabetes and 0.40 (95% CI = 0.22-0.70) for smoking. The adjusted odds ratio was statistically significant for hypercholesterolemia (OR = 2.74, 95% CI = 1.01-3.75). The prevalence of cardiovascular risk factors was similar to that observed in other Mediterranean communities.(ABSTRACT TRUNCATED AT 250 WORDS)

[Lipid distribution in the adult population of Catalonia]

BACKGROUND

High concentrations of total and LDL-cholesterol and low concentrations of HDL-cholesterol are related to morbidity and mortality due to cardiovascular diseases. In this study, lipid concentration, prevalence of hypercholesterolemia and the association between hypercholesterolemia and other cardiovascular risk factors was investigated in a random sample of adult population of Catalonia (Spain).

METHODS

A random sample of adult population of Catalonia aged 16 or more years was obtained. The sample was of 314 individuals, 156 men and 158 women. Serum total cholesterol, LDL-cholesterol, HDL-cholesterol and triglyceride concentrations were determined. Other cardiovascular risk factors were investigated: hypertension, smoking, body mass index, history of diabetes, and history of coronary heart disease.

RESULTS

Total and LDL-cholesterol levels were similar in both sexes, with a mean of 211 mg/dl for the first 140 mg/dl for the latter. In contrast, triglyceride levels were higher in men (95 mg/dl) than in women (70 mg/dl), and HDL-cholesterol levels were higher in women (60 mg/dl) than in men (51 mg/dl) (p < 0.001). Total cholesterol, LDL-cholesterol and triglycerides concentration increased with age in both sexes. Total cholesterol values were > or = 240 mg/dl in 25% of men and 24% of women. Individuals with hypercholesterolemia had a higher prevalence of hypertension, obesity and diabetes was than normocholesterolemic individuals. The odds ratio was 3.68 for hypertension, 1.89 for obesity and 1.99 for diabetes. The adjusted odds ratio was statistically significant for hypertension (OR adj. = 2.77).

CONCLUSION

The distribution of lipid values observed in the adult population of Catalonia was similar to that observed in other Mediterranean populations.

[The cost of arterial hypertension in Spain]

BACKGROUND

High blood pressure has a high incidence and produces a high morbidity and mortality due to associated diseases: cerebrovascular disease, ischemic cardiopathy, and cardiac failure. The socioeconomic impact of high blood pressure in Spain was estimated during 1985 in primary, hospitalary and pharmaceutical health care, to provide a framework for decision making and to determine strategies for reducing the costs of this entity.

METHODS

The methodology of analysis of the cost of the disease was followed with the aim of quantifying the socioeconomic consequences of an entity, disease or risk factor with prevalence being the focus of the study.

RESULTS

The socioeconomic impact estimated was situated between 95,000 and 124,000 millions of pesetas according to the different hypothesis adopted in the analysis of sensitivity. The direct health care costs represented between 2.6 and 3.9% of the global health care costs for Spain in 1985. Health care funding consumed by high blood pressure in primary health care was higher (between 4.5 and 6.7%) than hospital attendance (between 1.0 and 1.5%) and pharmaceutical care (between 2.3 and 3.5%), with respect to the total costs of each category.

CONCLUSIONS

The reduction of the costs related with high blood pressure in Spain must be obtained from improvement of efficacy of interventions carried out in health care education and primary health care. The economic evaluation of the primary and secondary prevention programs may aid in determining more cost-effective strategies.

[Epidemiology of obesity among the adult population of Catalonia]

Several epidemiological studies have shown that obesity is related to the mortality from cardiovascular disease. In this study, the epidemiology of obesity and the correlation between body mass index and other cardiovascular risk factors was studied in a representative sample of the adult population of Catalonia. It was obtained a random sample (n = 704) of the adult population of Catalonia aged 15 or more years. Height and weight were measured and body mass index (BMI) was calculated (height in Kg/weight2 in m2). Obesity was defined as a BMI greater than 30, and overweight as a BMI from 25 to 30. In the first 314 participants, it was determined the concentration of total cholesterol, cholesterol-HDL and triglyceride, and it was measured the blood pressure. The correlation between BMI and other cardiovascular risk factors was analysed. The study was carried out in 1989. The mean of BMI increased with age in both sexes. BMI was significantly higher in men (26 kg/m2) than women (25 kg/m2). The prevalence of obesity was of 12% in both men and women, and the prevalence of overweight was of 48.5% in men and 38% in women. The prevalence of arterial hypertension, hypercholesterolemia and diabetes was greater individuals with obesity, with differences statistically significant for hypertension (odds ratio of 3.26). The multiple logistic regression analysis showed that the association between obesity and hypertension was not statistically significant (OR adj. = 2.09), when the effect of the other risk factors, the age and sex were controlled.(ABSTRACT TRUNCATED AT 250 WORDS)

[Epidemiology of arterial hypertension in the adult population of Cataluña]

BACKGROUND

The arterial hypertension is one of the most prevalent cardiovascular diseases. In this study the epidemiology of hypertension was investigated in a random sample of the adult population of Catalonia (Spain).

METHODS

It was obtained a random sample (n = 704) of the adult population of Catalonia aged 15 or more years. The blood pressure was measured and hypertension was defined as a systolic blood pressure (SBP) equal or greater to 160 and/or a diastolic blood pressure (DBP) equal or greater to 95 mmHg. The borderline hypertension was defined as a SBP of 140-159 and/or a DBP of 90-95 mmHg. It was studied the association between hypertension and the following cardiovascular risk factors: hypercholesterolemia, obesity, diabetes and smoking. The study was carried out in 1989.

RESULTS

The prevalence of hypertension observed was of 20%. The prevalence increased to 28% when the individuals with borderline hypertension were included. 87 of 144 detected hypertensives (58%) were known hypertensives, 67 (46.5%) received antihypertensive medication, and 30 (21%) were treated and had their blood pressures under control. Individuals with hypertension or borderline hypertension had a greater prevalence of hypercholesterolemia, obesity and diabetes, and a lower prevalence of smoking than normotensive persons. The odds ratio (hypertensive vs. normotensive persons) was of 3.68 for hypercholesterolemia, 3.26 for obesity, 3.81 for diabetes, and 0.40 for smoking. Nevertheless, the adjusted odds ratio was only statistically significant for the hypercholesterolemia (OR adj = 2.74).

CONCLUSIONS

Arterial hypertension is one of the most important public health problems in Catalonia. The percentage of detected, treated and controlled hypertensives should be increased in the following years.

Ecological association between hypertension and stroke in Catalonia (Spain): development and use of an ecological regression model

The objectives of this paper were to study the association between the prevalence of uncontrolled hypertension (PUHT) and stroke mortality at the ecological level, in nine geographical areas of Catalonia (Spain); to develop an ecological regression model and to assess its ability to predict crude stroke mortality rate (CMR) from the PUHT. The regression equation obtained for the population older than 25 yrs was CSMR x 10(3) = 0.67035 + 4.94752 PUTH x 10(-2). The ecological risk ratio was 8.38 and the ecological attributable proportion 71.1%. The CSMR estimation obtained by applying the model in a concrete case was close to that observed. The results support an ecological association between the studied variables. The ecological model can be useful in the assessment of observed changes in health problems and risk factor levels in the community. It could also be used in the evaluation of intervention programmes.

Detection, treatment and control of hypertension in Spain

Attitudes and practices with regard to hypertension were the subject of a survey conducted in 1987 among 2,500 Spanish general practitioners. Their responses showed almost complete use of diagnostic criteria adhering to WHO recommendations and guidelines, the wide prescription of diuretics as first-step medication and beta-blockers as the drug of choice in second-step treatment, and a non-compliance rate of 25% attributed to inadequate information and bureaucracy, similar to other countries.

Antihypertensive strategy: a current and prospective review

The efficacy of antihypertensive therapy in reducing cardiovascular complications has been clearly demonstrated in the last 20 years. Antihypertensives are particularly useful in the reduction of cerebrovascular complications which decrease by 60% on average in clinical trials on the treatment of mild and severe hypertension. After the first clinical trials, the 1978 World Health Organization Experts Committee recommended the classic stepped-care (SC) approach with diuretics and beta blockers as first-step agents. Other antihypertensive drugs, such as reserpine, centrally acting agents and vasodilators could be used in the next steps if blood pressure control was not achieved. Both diuretics and beta blockers have been widely used and the SC regimen has contributed to the better control of arterial hypertension in the community. The SC regimen has given general practitioners easy guidelines with which to treat hypertensive patients. There are many reasons for modifying the classic SC approach. Prescription of antihypertensive drugs at high doses should be avoided and the use of new agents, such as calcium antagonists and angiotensin-converting enzyme inhibitors, is recommended. Demographic trends have brought about an increase in the aged population and, consequently, an increase in the proportion of elderly hypertensives. These patients present particular problems in long-term management, among which are a high frequency of other associated diseases and an important number of adverse effects caused by the classic antihypertensive drugs. Nevertheless, diuretics are still useful in the treatment of hypertension, either as a monotherapy regimen or in association with other drugs. New diuretics, such as indapamide, have a very interesting pharmacologic profile with considerably fewer metabolic side effects on plasma cholesterol and glucose levels.

[Multicenter study of atenolol, combined with hydralazine and bendroflumethiazide in the treatment of essential, mild, and severe, arterial hypertension]

The aim of the present study was to determine both the effectiveness and tolerance of a preparation constituted by the combination at fixed doses of a betablocker (atenolol, 100 mg), a diuretic (bendroflumethiazide, 5 mg) and a vasodilator (hydralazine, 50 mg). The study was carried out on a sample formed by 46 patients with moderate or severe essential hypertension who received this preparation as a single antihypertensive therapy during 2 months. As for the hypotensive effectiveness of the product, obtained results demonstrate that arterial blood pressure (BP) levels were normalized in 89% of the patients with moderate essential hypertension and in 9/10 patients with severe hypertension. Tolerance was excellent in most of the cases. Although new studies should be performed in order to enlarge the number of available case-studies, the above presented data allow us to conclude with a positive opinion about the studied combination.