Effective control of hypertension: a project of the Hungarian society of hypertension, baseline data

High prevalence of prehypertension and hypertension in a working population in Hungary

BACKGROUND

Hungary has one of the highest mortality rates due to strokes among the European Union countries. As elevated blood pressure (BP) is the principal risk factor for strokes, we assessed BP levels, as well as awareness and treatment status of hypertension and prehypertension in a working population sample in Hungary.

METHODS

Worksite employees in Budapest and Szeged were screened for their BP using an automated BP measuring instrument (BpTRU). BpTRU readings of heart rate (HR) were also recorded. Respondents were classified as normotensives (NT), prehypertensives (PHTN) and hypertensives (HTN) according to their BP levels, as defined by the JNC 7 guidelines. Body height and body weight were measured and body mass index (BMI) was calculated. Self-reported information regarding smoking was collected.

RESULTS

In total, 2,012 respondents were recruited (1,000 white collar; 1,012 blue-collar workers), with a mean (±s.d.) age of 34.8 (±9.9) years. Of all respondents, 22.6% were identified as HTN and 39.8% as PHTN. Among HTN, 40% were unaware of their condition and only 18.5% were adequately treated. PHTN were similar in age as NT, but showed significantly higher HR.

CONCLUSIONS

A high proportion of relatively young and apparently healthy Hungarian employees were diagnosed with prehypertension and hypertension. Only a small proportion of HTN had their BP controlled. BMI and HR were significantly higher among individuals with prehypertension compared to NT. Whether the high rates of hypertension, prehypertension, and low levels of control explain the high stroke mortality and unfavorable cardiovascular disease (CVD) profile of Hungary needs further study.

Primary care research in Hungary. Results and experiences in comparison with Europe

A közlemény a magyar alapellátási rendszerben korábban körzeti, ma háziorvosok által végzett tudományos kutatások történetét, eredményeit és a jelenlegi helyzetet tekinti át, előremutató javaslatokkal a jövőre nézve. Beavatja az olvasót ennek a területnek sajátosságaiba, vizsgálómódszereibe, céljaiba. Áttekinti és összehasonlítja az Európában és Magyarországon vizsgált kutatási témákat, eredményeket, infrastrukturális különbségeket és perspektívákat, információt ad a téma iránt érdeklődő olvasónak a további tájékozódás forrásaihoz.

Cardiovascular care of high-risk subjects and cardiovascular patients in a general medical practice

The aim of this investigation was to study, how high-risk subjects and cardiovascular (CV) patients are receiving care in a general medical (GP) practice. There are 1296 individuals belonging to this GP outpatient ward. Taking into consideration of available data, it was considered that because of high-risk level or some CV diseases, 883 subjects (68%) should have been taken care. The number of definitely cared subjects was 831 (94%), which means that just 6% of the whole group remained out of proper CV care activity. High risk subjects were as follows: 56.2% overweight, 26.0% obese, and 19.4% were active smokers. Every fourth of patients with angiological disease (24.2%) were actively smoking. The majority of high-risk subjects (83.5%) have had a physically inactive life. In the very high-risk group, just 31.5% of subjects, in the high-risk group 23.0% could reach the lipid target values, fixed by the III. Hungarian Consensus Conference. These target values were, however, achieved by 61.1% of patients treated because of arterial hypertension, and 64.6% of diabetics. According to these data, in this very GP practice two third of all individuals do need CV care. Majority of these subjects were properly drawn into this activity. At present, the possibilities of GP care are not enough for properly influencing lifestyle, shown by the high ratio of smokers, people with overweight and those who are living without regular physical exercise. In the same time, the ratio of optimal care of patients with diabetes and hypertension was significantly higher than those in the data published in the literature. The results of treating hyperlipidaemia were similar to other studies published in the medical literature.

Compliance with hypertension guidelines in general practice in Slovenia

INTRODUCTION

Compliance with hypertension guidelines in clinical practice is generally poor, but there was no data about compliance with any guidelines in general practice in Slovenia.

OBJECTIVE

Our aim was to find out whether general practitioners in Slovenia managed their hypertensive patients according to the national guidelines, based on 1999 WHO/ISH guideline recommendations.

METHOD

42 family physicians registered all patients with the diagnosis of arterial hypertension among 300 consecutive regular office visits. We used data about blood pressure management from paper medical records.

RESULTS

We collected data from 2752 patients with hypertension; the mean age was 64.1 years (SD = 12.4 years, from 21 to 97 years). All elements of the minimal diagnostic program in the last five years were performed in 23.8% of the patients. In 1809 (65.7%) patients, whose cardiovascular risk was estimated, the minimal diagnostic program was performed more frequently (p < 0.001). Non-pharmacological measures were performed in 1210 (47.0%) patients. 2649 (97.6%) patients had drug therapy in accordance with the guidelines. Follow-up in accordance with the guidelines was performed in 1492 (55.3%) patients. Only 256 (9.3%) patients were managed completely according to the guidelines and only 347 (15.5%) of study population reached the target values of blood pressure.

CONCLUSION

The impact of hypertension guidelines on patients' management in everyday primary care appears marginal. More emphasis should be placed on the efficient implementation of the guidelines.

Detection and treatment of hypertension in general health-care practice: a patient-based study

The aim of this study was to describe the pattern of blood pressure (BP) distribution in a multiethnic primary care practice in relation to sociodemographic characteristics, lifestyle and risk factors. Another aim was to analyse the quality of diagnosis and effectiveness of hypertension (HT) treatment. In all, 470 adult patients (> or =16 years old) who visited the Jordbro Health Centre (JHC), Haninge Municipality, participated in this study. A general questionnaire with questions about sociodemographic characteristics, lifestyle, health status and chronic disease was used. Medical records: information on consultations with the general practitioner and prescriptions were collected from the medical records for the year 2001. Furthermore, a medical examination was performed: this consisted of weight, height, systolic (SBP) and diastolic (DBP) blood pressure, and laboratory analyses including fasting blood glucose, serum cholesterol, serum triglycerides, electrocardiogram and spirometry. Out of 464 patients, 114 (24.6%) reported HT. Among the HT patients, 93 (81.6%) had SBP > or =140 mmHg and 52 (45.6%) DBP > or =90 mmHg. Among the nonhypertensive patients (n=350), 120 (34.3%) had SBP > or =140 mmHg and 50 (14.3%) DBP > or =90 mmHg. Furthermore, there are some patients with high BP who are unknown or undetected. HT treatment among this population is unsatisfactory and greater efforts are required to identify people with high BP and to ensure that they are managed according to the best available evidence.