Awareness and control of hypertension and hypercholesterolaemia in France and Northern Ireland

How effective are strategies for non-communicable disease prevention and control in a high risk population in a developing country? Isfahan Healthy Heart Programme

INTRODUCTION

The Isfahan Healthy Heart Programme (IHHP) is a community-based programme for non-communicable diseases prevention and control using both a population and high risk approach in Iran. This study demonstrated the efficacy of IHHP interventional strategies to improve lifestyle behaviours in a population at risk for developing cardiovascular diseases.

MATERIAL AND METHODS

Healthy Lifestyle for NCDs High Risk Population is one of ten projects of IHHP. High risk individuals were defined as those who have at least one risk factor for developing coronary artery disease (CAD). Changes of behavioural indicators have been compared between two areas with a survey after 5 years of intervention.

RESULTS

Among high risk individuals in the intervention and reference areas, 77.8% and 82.5% had at least one major risk factor for CAD. The prevalence of major risk factors for CAD (except cigarette smoking) was decreased in both intervention and reference areas during 5 years of intervention and the pattern of diet and physical activity was improved.

CONCLUSIONS

Interventional activities in IHHP targeting the high risk population seem to be effective in improving lifestyle behaviour, increasing awareness and control of risk factors of the high risk population.

Application in general practice of treatment guidelines for patients with dyslipidaemia: the RESPECT study

BACKGROUND

Screening for and management of dyslipidaemia are crucial in primary and secondary prevention of cardiovascular disease. The impact on general practitioners (GP) of the 2005 French guidelines for hypercholesterolaemia has not been evaluated.

AIMS

To compare GP's estimation of cardiovascular risk with that from a theoretical calculation; to analyse the consequences of cardiovascular-risk estimation on the threshold of therapeutic intervention and the target low-density lipoprotein cholesterol (LDL-C) concentration; and to analyse patients' awareness of their hypercholesterolaemia.

METHODS

The RESPECT study was a transverse, multicentre, observational survey conducted between March 2006 and February 2007 by 1797 GP in France. Inclusion criteria were adults with primary hypercholesterolaemia who had not taken lipid-lowering drugs within the previous 6 months.

RESULTS

Of the 5627 patients included (60.9% men; mean age+/-standard deviation 58.2+/-11.0 years; body mass index 27.2+/-4.1 kg/m(2); mean total cholesterol 2.68+/-0.37 g/L; LDL-C 1.79+/-0.35 g/L), 1963 (36.2%) had at least three cardiovascular risk factors. GP identified a high cardiovascular risk level in 40.8%, moderate risk in 45.8% and low risk in 13.4% of patients. These compared with calculated rates of 48, 23 and 29%, respectively (kappa concordance 59.4%). For most patients (98.2%), GP defined the therapeutic target based on LDL-C concentration. The target LDL-C was significantly different when cardiovascular risk was estimated by GP versus that calculated theoretically. The higher the estimated risk level, the greater the rate of introduction of lipid-lowering drugs and the shorter the time to the next GP visit. Most patients considered themselves to be well or rather well informed about their cholesterol concentration (91.3%), the causes (64.3%) and consequences of cholesterol-induced diseases (83.7%), and the difference between 'good' and 'bad' cholesterol (57%). Most (81.5%) patients were aware of the benefits of lipid-lowering drugs on cardiovascular disease prevention; 95.8% considered adequate diet and compliance with pharmacological treatment to be very important.

CONCLUSION

Recent French guidelines for hypercholesterolaemia are used widely by GP in practice. They enable correct assessment of overall cardiovascular risk level, have an impact on the therapeutic threshold of intervention by physicians and improve patients' awareness of the relevance of cholesterol concentration.

Blood pressure, antihypertensive treatment and factors associated with good blood pressure control in hypertensive diabetics: the Tarmidas study

Numerous population studies confirm the high prevalence of hypertension in type II diabetic (DM2) subjects and that intensive antihypertensive treatment is more beneficial to diabetic than to nondiabetic hypertensive subjects, yet not many of these are specific to Spain. To assess the degree of blood pressure (BP) control and the effects of antihypertensive drugs in the medical management of hypertension in diabetic patients in specialist care centres throughout Spain, we studied the socio-demographic, clinical and relevant laboratory parameters of 796 hypertensive patients with DM2 (mean age 66.09 (95% confidence interval (CI): 64.08-68.10). The percentage of diabetic patients responding positively to BP control measures was lower when compared to the nondiabetic population in both Spain and Europe. The degree of control was poorer for systolic than for diastolic BP, yet 40.6% of the patients were only on monotherapy. The fact that antihypertensive treatment was modified in only 40% of the poorly controlled patients was also highly significant and could be attributed to a nonstringent use of clinical guidelines. Among the other differences between well-controlled and poorly controlled patients, we found that well-controlled patients presented with lower levels of cholesterol and triglycerides, a lower prevalence of excess weight/obesity, and a greater prevalence of cardiovascular and/or cerebrovascular disease despite having a greater percentage of patients on antiplatelet therapy. Better application of therapeutic guidelines and the prevention and treatment of compounding factors could improve the response rate to BP control measures in poorly controlled patients.

The factor II G20210A gene polymorphism, but not factor V Arg506Gln, is associated with peripheral arterial disease: results of a case-control study

BACKGROUND

The FIIG20210A polymorphism has been associated with arterial wall thickness and atherothrombotic diseases in selected subgroups. The FVArg506Gln polymorphism does not seem to be associated with arterial diseases. Few data are available on these polymorphisms and the risk of peripheral arterial disease (PAD).

OBJECTIVES

To study the association between the FIIG20210A and FVArg506Gln polymorphisms and PAD and its clinical severity. To examine the potential interactions with traditional vascular risk factors.

PATIENTS AND METHODS

We studied 184 consecutive male patients under 70 years of age with symptomatic PAD and 330 age-matched male controls free of symptomatic PAD and with no cardiovascular history. We evaluated the FIIG20210A and FVArg506Gln polymorphisms in all subjects.

RESULTS

Mean age was 57.1 +/- 7.2 years (cases) and 56.7 +/- 7.6 years (controls). The FII20210A allele was more frequent in PAD patients with odds ratios (OR) of 3.77 (1.39-10.2) in univariate analysis and 4.30 (1.3-14.7) after adjustment for diabetes, smoking, hypertension and hypercholesterolemia. In smokers or past smokers the magnitude of the association was markedly increased but there was no evidence of an interaction between tobacco exposure and FIIG20210A. In case subjects, the FII20210A allele was also associated with critical ischemia [OR = 4.1 (1.1-15.7), P = 0.039 in multivariate analysis]. FVArg506Gln was not associated with PAD [OR = 0.65 (0.27-1.54) and 0.77 (0.28-2.1) in univariate and multivariate analyses, respectively].

CONCLUSIONS

The FIIG20210A gene polymorphism may be a risk factor for PAD and its severity. In contrast, the FVArg506Gln polymorphism is not associated with PAD.

Prevalence, awareness, treatment and control of hypertension in a Canarian population. Relationship with glucose tolerance categories. The Guía Study

OBJECTIVE

To estimate the prevalence, awareness, treatment and control of hypertension in a Canarian population; and their relationship with the glucose tolerance categories.

DESIGN

From a population of 6355 subjects over 29 years old, 690 were chosen in a random sampling. Blood pressure measurements, a standard oral glucose tolerance test (excluding known diabetic patients), and a questionnaire on diabetes and hypertension history and medication use was performed.

RESULTS

The total prevalence of hypertension was 50.3%; 62.0% of the hypertensive subjects were aware of their condition; 60.6% had their diastolic and 11.0% their systolic blood pressure controlled and 8.6% had both. For diabetic, glucose intolerant and normoglycemic subjects, the respective prevalences of hypertension were 79.4, 60.2 and 43.1% (higher in diabetic subjects, P < 0.001); the awareness of hypertension was 66.7, 61.8 and 59.5% (differences not significant); systolic blood pressure control was 4.8, 14.7 and 13.7% (lower in diabetic subjects, P = 0.017 versus glucose intolerant and P = 0.011 versus normoglycemic subjects); diastolic blood pressure control was 50.4, 72.1 and 63.2% (lower in diabetic subjects, P = 0.004 versus glucose intolerant and P = 0.025 versus normoglycemic subjects). There were no differences in the number and type of antihypertensive drugs among the different glucose tolerance categories.

CONCLUSIONS

Blood pressure was comparable in our population and in other European populations. The prevalence of hypertension was higher, the awareness was similar, and control was worse in diabetic than in non-diabetic subjects; the drug treatment pattern was not different.

Trends in hypertension prevalence and management in Southwestern France, 1985-1996

The changes occurring in Southwestern France between 1985 and 1996 in hypertension prevalence, awareness and control were assessed in 622 men and 626 women for 1985 and in 614 men and 569 women for 1996. In women, prevalence of hypertension (defined as systolic blood pressure >/=160 mmHg and/or diastolic blood pressure >/=95 mmHg and/or presence of antihypertensive treatment) was 19% and 19% (NS), awareness was 67% and 87% (P < 0.001), treatment was 85% and 87% (NS) and control was 44% and 68% (P < 0.01) in the first and the second surveys, respectively. In men, prevalence of hypertension was 28% and 21% (P < 0.01), awareness was 47% and 71% (P < 0.001), treatment was 81% and 80% (NS) and control was 41% and 58% (NS). After stratifying on survey, women received significantly more beta-blockers and significantly less calcium channel blockers and ACE inhibitors than men, but those differences became nonsignificant after adjusting for other cardiovascular risk factors. We conclude that in Southwestern France, screening and management of hypertension have improved significantly, but more than one-third of treated hypertensive subjects still lacks adequate control.

Can we afford to treat hyperlipidaemia as we should? Strategies for rational treatment

There is no debate about whether patients with established coronary heart disease (CHD) should receive cholesterol-lowering drug therapy: the great majority should. certainly those whose serum cholesterol exceeds 5 mmol/l. In primary CHD prevention the indication for lipid-lowering drug therapy is largely determined by the absolute risk of CHD. There is considerable disagreement about the level of absolute risk at which such treatment should be commenced. The relative absence of side-effects of the statin drugs and their relatively high cost means that issues of cost-effectiveness are of more concern for state health services than the balance between benefits of therapy and adverse events. Thus, the degree of risk at which they are recommended appears to be largely determined by the type of healthcare system a nation has and the frequency of high risk individuals in that nation. In Britain, which has both state healthcare and numerous high risk patients, the cost of primary prevention with statins except at extreme risk is viewed as prohibitive, whereas the CHD risk at which lipid-lowering drugs are recommended is lower in the USA, where healthcare costs are borne more directly by the patient, and in European countries with lower rates of CHD. Whatever level of risk is recommended for the use of lipid-lowering drugs in primary CHD prevention, the clinician should be in a position to assess CHD risk in an individual with a reasonable degree of accuracy. When recommended algorithms and charts were compared with calculations of risk using the equations derived from the Framingham Study, on which they are based, they were shown to be inaccurate. High density lipoprotein cholesterol emerged as a particularly important risk factor, which when omitted led to underestimation of risk in women and people with multiple risk factors. It is concluded that guidelines should be evaluated in the type of patient for whom they are intended. It is important to redress the balance between the numerous publications on the interpretation of clinical trials and the virtual absence of rigorous assessments of methods for determining CHD risk in clinical practice.