1
|
Gabriel R, Acosta T, Florez K, Anillo L, Navarro E, Boukichou N, Acosta-Reyes J, Barengo NC, Lindström J, Tuomilehto JO, Aschner P. Validation of the Finnish Type 2 Diabetes Risk Score (FINDRISC) with the OGTT in Health Care Practices in Europe. Diabetes Res Clin Pract 2021; 178:108976. [PMID: 34302911 DOI: 10.1016/j.diabres.2021.108976] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/28/2021] [Accepted: 07/19/2021] [Indexed: 10/20/2022]
Abstract
AIMS /hypothesis. To determine the best cut-off threshold value of the Finnish Diabetes Risk Score (FINDRISC) for the detection of diabetes and non-diabetic hyperglycaemia in people 35 years or older at primary health care settings in Europe. METHODS Cross-sectional study in 11,444 adults from primary health care centres using community and opportunistic screening approaches. All participants completed the FINDRISC questionnaire and underwent a 2-hour oral glucose tolerance test (OGTT). The FINDRISC performance was assessed by the area under the curve (AUC) using receiver operating characteristics (ROC) analysis. The sensitivity, specificity, Youdeńs index, positive and negative prediction values for different FINDRISC cut-offs were calculated. RESULTS The optimal FINDRISC value for detecting both diabetes or glucose impairment in the community - screened sample was 14 point with the associated AUC 0.75,5 (95 %CI 0.73,7-0.77,3). The optimal score in the opportunistic screening sample was 16 with the associated AUC only 0.60,4 (95% CI 0.56, 4-0.64, 4). CONCLUSIONS/INTERPRETATION The FINDRISC is a non-invasive tool useful for detecting people with unknown diabetes and glucose impairment in people visiting primary health centres in Europe.
Collapse
Affiliation(s)
- Rafael Gabriel
- Department of International Health, National School of Public Health, Instituto de Salud Carlos III, Madrid, Spain; World Community for Prevention of Diabetes (WCPD) Foundation, Madrid, Spain.
| | - Tania Acosta
- Department of Public Health, Universidad del Norte, Barranquilla, Colombia
| | - Karen Florez
- Departamento de Matemáticas y Estadística, Universidad del Norte, Barranquilla, Colombia
| | - Luis Anillo
- Department of Public Health, Universidad del Norte, Barranquilla, Colombia; Departamento de Matemáticas y Estadística, Universidad del Norte, Barranquilla, Colombia
| | - Edgar Navarro
- Department of Public Health, Universidad del Norte, Barranquilla, Colombia
| | - Nisa Boukichou
- Asociación de Investigación en Prevención de Diabetes y enfermedades Cardiovasculares (PREDICOR). Madrid, Spain
| | - Jorge Acosta-Reyes
- Department of Public Health, Universidad del Norte, Barranquilla, Colombia
| | - Noël C Barengo
- Department of Translational Medicine, Herbert Wertheim College of Medicine Florida International University, Miami, USA; Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Jaana Lindström
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Jaakko O Tuomilehto
- Department of International Health, National School of Public Health, Instituto de Salud Carlos III, Madrid, Spain; World Community for Prevention of Diabetes (WCPD) Foundation, Madrid, Spain; Department of Public Health, University of Helsinki, Helsinki, Finland; Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland; Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Pablo Aschner
- World Community for Prevention of Diabetes (WCPD) Foundation, Madrid, Spain; Javeriana University, Bogota, Colombia; San Ignacio University, Bogota, Colombia
| |
Collapse
|
2
|
Acosta T, Barengo NC, Arrieta A, Ricaurte C, Tuomilehto JO. A demonstration area for type 2 diabetes prevention in Barranquilla and Juan Mina (Colombia): Baseline characteristics of the study participants. Medicine (Baltimore) 2018; 97:e9285. [PMID: 29505512 PMCID: PMC5943102 DOI: 10.1097/md.0000000000009285] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
UNLABELLED Type 2 diabetes (T2D) imposes a heavy public health burden in both developed and developing countries. It is necessary to understand the effect of T2D in different settings and population groups. This report aimed to present baseline characteristics of study participants in the demonstration area for the "Type 2 Diabetes Prevention in Barranquilla and Juan Mina" (DEMOJUAN) project after randomization and to compare their fasting and 2-hour glucose levels according to lifestyle and T2D risk factor levels.The DEMOJUAN project is a randomized controlled field trial. Study participants were recruited from study sites using population-wide screening using the Finnish Diabetes Risk Score (FINDRISC) questionnaire. All volunteers with FINDRISC of ≥13 points were invited to undergo an oral glucose tolerance test (OGTT). Participant inclusion criteria for the upcoming field trial were either FINDRISC of ≥13 points and 2-hour post-challenge glucose level of 7.0 to 11.0 mmol/L or FINDRISC of ≥13 points and fasting plasma glucose level of 6.1 to 6.9 mmol/L. Lifestyle habits and risk factors for T2D were assessed by trained interviewers using a validated questionnaire.Among the 14,193 participants who completed the FINDRISC questionnaire, 35% (n = 4915) had a FINDRISC score of ≥13 points and 47% (n = 2306) agreed to undergo the OGTT. Approximately, 33% (n = 772) of participants underwent the OGTT and met the entry criteria; these participants were randomized into 3 groups. There were no statistically significant differences found in anthropometric or lifestyle risk factors, distribution of the glucose metabolism categories, or other diabetes risk factors between the 3 groups (P > .05). Women with a past history of hyperglycaemia had significantly higher fasting glucose levels than those without previous hyperglycaemia (103 vs 99 mg/dL; P < .05).Lifestyle habits and risk factors were evenly distributed among the 3 study groups. No differences were found in fasting or 2-hour glucose levels among different lifestyle or risk factor categories with the exception of body mass index, past history of hyperglycaemia, and age of ≥64 years in women. TRIAL REGISTRATION NCT01296100 (2/12/2011; Clinical trials.gov).
Collapse
Affiliation(s)
- Tania Acosta
- Department of Public Health, Universidad del Norte, Barranquilla, Colombia
| | - Noël C. Barengo
- Department of Medical and Population Health Research, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
| | - Astrid Arrieta
- Centro de Investigation Sanitaria, Barranquilla, Colombia
| | | | - Jaakko O. Tuomilehto
- Dasman Diabetes Institute, Dasman, Kuwait
- Department of Neuroscience and Preventive Medicine, Danube-University Krems, Krems, Austria
- Disease Risk Unit, National Institute for Health and Welfare
- Department of Public Health, University of Helsinki, Helsinki, Finland
- Saudi Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
| |
Collapse
|
3
|
Cos FX, Barengo NC, Costa B, Mundet-Tudurí X, Lindström J, Tuomilehto JO. Screening for people with abnormal glucose metabolism in the European DE-PLAN project. Diabetes Res Clin Pract 2015; 109:149-56. [PMID: 25931281 DOI: 10.1016/j.diabres.2015.04.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 03/09/2015] [Accepted: 04/12/2015] [Indexed: 01/08/2023]
Abstract
AIMS The aim of this report is to describe the application of the FINDRISC in clinical practice within the DE-PLAN project as a step to screen for Type 2 diabetes. METHODS Nine out of 24 possible centers were included. Six centers used opportunistic screening methods for participant recruitment whereas three centers provided study participants of a random population sample. Men (n=1621) and women (n=2483) were evaluated separately. In order to assess the prevalence of abnormal glucose tolerance (AGT) disorders across different risk categories, the FINDRISC was used. Anthropometric measurements included blood pressure, height, weight, and waist circumference. Blood lipids and an oral glucose tolerance test were performed in all participants. The primary outcome was identified risk of AGT and type 2 diabetes. RESULTS There was no difference in the prevalence of smoking between the FINDRISC categories, people with a FINDRISC below 15 points tend to be more physically active and to eat more frequently fruits and vegetables. Men with a FINDRISC from 15 to 19 points had a prevalence of abnormal glucose tolerance of approximately 60% and women 50%. The prevalence for men and women with a FINDRISC >20 points was 80%. 30% of men and 20% of women with a FINDRISC between 15 and 19 points had Type 2 diabetes. Among people with a FINDRISC more than 20 points, 50% had previously undiagnosed Type 2 diabetes. CONCLUSIONS The FINDRISC may be a practical tool to be used in primary health-care systems throughout the European population.
Collapse
Affiliation(s)
- Francesc Xavier Cos
- DE-PLAN-CAT Research Group, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona & Reus, Tarragona, Spain
| | - Noël C Barengo
- HJELT Institute, University of Helsinki, Helsinki, Finland; Observatorio de Diabetes de Colombia, Organización para la Excelencia de la Salud, Ibagué, Colombia.
| | - Bernardo Costa
- DE-PLAN-CAT Research Group, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona & Reus, Tarragona, Spain
| | - Xavier Mundet-Tudurí
- DE-PLAN-CAT Research Group, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona & Reus, Tarragona, Spain
| | - Jaana Lindström
- Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Jaakko O Tuomilehto
- Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland; Department of Vascular Prevention, Danube-University Krems, Krems, Austria; Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
| |
Collapse
|
4
|
Barengo NC, Acosta T, Arrieta A, Ricaurte C, Mayor D, Tuomilehto JO. Screening for people with glucose metabolism disorders within the framework of the DEMOJUAN project (DEMOnstration area for primary prevention of type 2 diabetes, JUAN Mina and Barranquilla, Colombia). Diabetes Metab Res Rev 2013. [PMID: 23996584 DOI: 10.1002/dmrr.2462] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2013] [Revised: 08/10/2013] [Accepted: 08/13/2013] [Indexed: 12/20/2022]
Abstract
BACKGROUND Until now, no systematic screening for T2D or prevention activities targeting T2D has been implemented in Colombia. The aims of this study were i) describe the feasibility of implementing the Finnish Diabetes Risk Score (FINDRISC) as a screening tool for glucose metabolism disorders (GMD) in the primary health care system in Barranquilla in Colombia during 2011 and 2012, and ii) to describe the risk factors for T2D in the population screened. METHODS This screening was opportunistic among people aged 34-60 years living in five primary health care catchment areas in Barranquilla, Colombia. People with 13 or more FINDRISC points were invited to an oral glucose tolerance test (OGTT). RESULTS Out of 14193 participants with the FINDRISC completed, 35% (n=4915) had a score of 13 points or higher (men 23%, women 40%). Among those with FINDRISC completed, the percentage of people with BMI<25 kg/m2 was 46% in men and 35% in women. The prevalence of screen-detected T2D was 18% in men and 12% in women, respectively, among those with FINDRISC >12 attending an OGTT. In both sexes the prevalence of isolated IGT, isolated IFG, and IFG and IGT combined were 8%, 11%, and 8%, respectively. CONCLUSIONS In total, 2% of all 14 193 screened participants had undetected T2D and 7% GMD. This figure would potentially be 4.6% (T2D), respectively 15% (GMD) if all with a FINDRISC>12 attend the OGTT. Thus, we found the FINDRISC to be a useful tool to identify people with GMD. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Noël C Barengo
- Centro de Investigación Sanitaria (CIIS LTDA), Barranquilla, Colombia; University of Tolima, Colombia; HJELT institute, University of Helsinki, Finland
| | | | | | | | | | | |
Collapse
|
5
|
Abstract
Hypertension is a very common cardiovascular disease (CVD) risk factor in diabetes, affecting more than half of diabetic patients. Major guidelines on the management of hypertension recommend to start antihypertensive drugs in all diabetic patients with a systolic blood pressure (SBP) 140 mmHg or more and/or a diastolic blood pressure (DBP) 90 mmHg or more, and to adjust the treatment strategy in order to lower their BP below these values. The present body of evidence suggests that in patients with type 2 diabetes mellitus/impaired fasting glucose/impaired glucose tolerance, a SBP treatment goal of 130 to 135 mmHg is acceptable. Aiming at SBP levels of 130 mmHg decreases stroke risk, but the risk of serious adverse events may increase with very low BP levels. The results regarding the attained DBP level is somewhat complex, since middle-aged people with diastolic hypertension and pre-existing CVD may have increased CVD mortality if their DBP is lowered drastically to a very low level. With the currently available very limited trial data on low attained BP level, it is not possible to set a specific treatment target regarding BP levels for diabetic hypertensive patients, but it is important to use a personalized approach in their antihypertensive treatment.
Collapse
Affiliation(s)
- Noël C Barengo
- Institute of Clinical Medicine/Internal Medicine, University of Oulu, Oulu, Finland.
| | | |
Collapse
|
6
|
Mager U, Kolehmainen M, Lindström J, Eriksson JG, Valle TT, Hämäläinen H, Ilanne-Parikka P, Keinänen-Kiukaanniemi S, Tuomilehto JO, Pulkkinen L, Uusitupa MI. Association between ghrelin gene variations and blood pressure in subjects with impaired glucose tolerance. Am J Hypertens 2006; 19:920-6. [PMID: 16942934 DOI: 10.1016/j.amjhyper.2006.02.017] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2005] [Revised: 02/09/2006] [Accepted: 02/15/2006] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Ghrelin is a gut-brain hormone, which stimulates food intake and controls energy balance. Recently, it has been shown that ghrelin may also play a role in the regulation of blood pressure (BP) by acting at the sympathetic nervous system. In the present study we genotyped six variants of the ghrelin gene and its promoter, and tested whether these single nucleotide polymorphisms (SNPs) were associated with BP levels in participants of the Finnish Diabetes Prevention Study. METHODS The Finnish Diabetes Prevention Study was a longitudinal study where 522 subjects with impaired glucose tolerance were randomized into either an intervention or control group. DNA was available from 507 subjects (mean body mass index [BMI] 31.2+/-4.5 kg/m2, age 55+/-7 years). All six SNPs were screened by the restriction fragment length polymorphism method. RESULTS Subjects with the most common genotype combination of the following four SNPs, -604G/A, -501A/C, Leu72Met, and Gln90Leu, had the lowest systolic (131+/-11 v 137+/-13 mm Hg, P=.003) and diastolic BP levels (79+/-7 v 83+/-7 mm Hg, P=.004) at the baseline of the study and during 3 years of follow-up compared to all other genotypes. Adjustments for age, gender, antihypertensive medication, BMI, waist circumference, and alcohol intake did not change this association. CONCLUSIONS Several ghrelin gene variations were associated with BP levels in subjects with impaired glucose tolerance.
Collapse
Affiliation(s)
- Ursula Mager
- Department of Public Health and Clinical Nutrition and Food and Health Research Centre, University of Kuopio, Kuopio, Finland.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Antikainen RL, Moltchanov VA, Chukwuma C, Kuulasmaa KA, Marques-Vidal PM, Sans S, Wilhelmsen L, Tuomilehto JO. Trends in the prevalence, awareness, treatment and control of hypertension: the WHO MONICA Project. ACTA ACUST UNITED AC 2006; 13:13-29. [PMID: 16449860 DOI: 10.1097/00149831-200602000-00004] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To describe the secular changes in the prevalence, awareness, treatment and control of hypertension. DESIGN Two independent cross-sectional population surveys using standardized methods conducted between the early 1980s and mid-1990s. SETTING Twenty-four geographically defined populations of the WHO MONICA Project. PARTICIPANTS Randomly selected men and women aged 35-64 years. The total number of participants was 69 907. MAIN OUTCOME MEASURES Two definitions of hypertension were used: 160/95 mmHg or above and 140/90 mmHg or above for systolic or diastolic blood pressure. Subjects on antihypertensive drug treatment were considered to be hypertensive regardless of their blood pressure. Treated subjects whose measured blood pressure level was less than 160/95 or 140/90 mmHg according to the two definitions, respectively, were considered to be adequately treated. RESULTS The age-adjusted prevalence of hypertension decreased in most and increased in only a few populations. For both definitions of hypertension, the proportion of hypertensive subjects who were aware of their condition increased in three-quarters of the male populations and in two-thirds of the female populations. Furthermore, the proportion of hypertensive individuals on antihypertensive drug treatment increased in three-quarters of the populations. In the final survey, hypertension tended to be better treated and controlled in women than in men. Nevertheless, a large proportion of patients receiving antihypertensive drug therapy still had inadequately controlled blood pressure levels. CONCLUSION Although awareness and treatment of hypertension according to the data obtained during the late 1980s to the mid-1990s increased in several populations, the effectiveness of antihypertensive treatment showed the continuing need for improvements.
Collapse
Affiliation(s)
- Riitta L Antikainen
- Department of Internal Medicine, University of Oulu and Oulu City Hospital, Oulu, Finland
| | | | | | | | | | | | | | | |
Collapse
|
8
|
Kastarinen MJ, Antikainen RL, Laatikainen TK, Salomaa VV, Tuomilehto JO, Nissinen AM, Vartiainen EA. Trends in hypertension care in eastern and south-western Finland during 1982–2002. J Hypertens 2006; 24:829-36. [PMID: 16612243 DOI: 10.1097/01.hjh.0000222751.90443.0a] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the trends in blood pressure (BP) levels and the control of hypertension in eastern and south-western Finland during 1982-2002. DESIGN Five independent cross-sectional population surveys conducted in 1982, 1987, 1992, 1997 and 2002. SETTING The provinces of North Karelia and Kuopio in eastern Finland and the region of Turku-Loimaa in south-western Finland. PARTICIPANTS Stratified random samples of men and women aged 25-64 years were selected from the national population register. The total number of participants was 29 127. MAIN OUTCOME MEASURES Mean systolic blood pressure (SBP) and diastolic blood pressure (DBP), the prevalence and control of hypertension. The distribution of all subjects with no antihypertensive drug treatment in 2002 according to the modified risk stratification scheme introduced in 2003 European Society of Hypertension-European Society of Cardiology guidelines. RESULTS Mean SBP and DBP and the prevalence of hypertension decreased significantly in all areas. The proportion of treated hypertensive subjects with adequately controlled BP (SBP < 140 mmHg and DBP < 90 mmHg) increased from 13.7 to 33.3% in men (P < 0.001) and from 11.4 to 32.0% in women (P < 0.001). The unsatisfactory treatment of hypertension was mainly a result of the lack of control of high SBP. According to the 2003 guidelines, 35.9% of the entire population currently not on antihypertensive drug treatment should have been prescribed such treatment within a year. CONCLUSIONS Hypertension care has improved significantly in Finland during 1982-2002. However, the difference between the actual situation at the population level and the treatment goals presented by the hypertension guidelines remains vast.
Collapse
Affiliation(s)
- Mika J Kastarinen
- Department of Internal Medicine, Kuopio University Hospital, Kuopio, Finland.
| | | | | | | | | | | | | |
Collapse
|
9
|
Abstract
The objective of this study was to determine the site-specific cancer incidence of hypertensive patients and examine the effect of blood pressure-related variables on the risk of cancers with elevated incidence among the hypertensive patients. A record linkage study of Hypertension Register of the North Karelia Project and the Finnish Cancer Registry was conducted. The mean follow-up time was 16 years. A total of 20 529 hypertensive patients were studied. Main outcome measures were standardised incidence ratios and hazard ratios. The overall cancer incidence was close to that of the general population for both men and women. The incidence rate for the kidney cancer was significantly increased in hypertensive patients (standardised incidence ratio 1.34, 95% confidence interval (CI) 1.11-1.60), as well as incidence rates for cancers of pancreas (1.26, 1.02-1.54), and endometrium (1.22, 1.01-1.44) in hypertensive women. The incidence of lung cancer was significantly decreased (0.86, 0.77-0.95). The incidence of liver cancer was elevated with borderline significance (1.36, 0.99-1.82). In Cox regression models, the use of antihypertensive drugs at baseline was a significant predictor of kidney (hazard ratio for use of antihypertensive drugs 1.89, 95% CI 0.96-3.75) and pancreatic cancer (1.78, 0.99-3.22) in women but not in men. The incidence of endometrial cancer or liver cancer was not related to blood pressure levels or the use of antihypertensive drugs. In women, obesity was a significant predictor of cancers of the endometrium, kidney and liver. In conclusion, increased occurrence of some cancer types among hypertensive patients seem to be partly explained by obesity and the use of antihypertensive drugs.
Collapse
Affiliation(s)
- A M Lindgren
- Department of Public Health and General Practice, University of Kuopio, Finland.
| | | | | | | |
Collapse
|
10
|
Kastarinen MJ, Puska PM, Korhonen MH, Mustonen JN, Salomaa VV, Sundvall JE, Tuomilehto JO, Uusitupa MI, Nissinen AM. Non-pharmacological treatment of hypertension in primary health care: a 2-year open randomized controlled trial of lifestyle intervention against hypertension in eastern Finland. J Hypertens 2002; 20:2505-12. [PMID: 12473876 DOI: 10.1097/00004872-200212000-00031] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess whether lifestyle counselling is effective in non-pharmacological treatment of hypertension in primary health care. DESIGN Open randomized controlled trial. SETTING Ten municipal primary health care centres in eastern Finland. PATIENTS Seven hundred and fifteen subjects aged 25-74 years with systolic blood pressure 140-179 mmHg and/or diastolic blood pressure 90-109 mmHg or antihypertensive drug treatment. INTERVENTIONS Systematic health counselling given by local public health nurses for 2 years. MAIN OUTCOME MEASURES Blood pressure, lipids and lifestyle data were collected annually. RESULTS Among participants with no antihypertensive drug treatment, the net reductions after 1 year both in systolic blood pressure [-2.6 mmHg; 95% confidence interval (CI), -4.7 to -0.5 mmHg] and in diastolic blood pressure (-2.7 mmHg; 95% CI, -4.0 to -1.4 mmHg) were significant in favour of the intervention group. This difference in blood pressure change was maintained during the second year. In participants with antihypertensive drug treatment, no significant difference in blood pressure reduction was seen between the groups during the study. CONCLUSIONS A relatively modest, but systematic counselling in primary health care can, at least among untreated hypertensive subjects, produce reductions in blood pressure levels that are modest for the individual, but very important from the public health point of view.
Collapse
Affiliation(s)
- Mika J Kastarinen
- Department of Public Health and General Practice, University of Kuopio, Finland.
| | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Kastarinen MJ, Salomaa VV, Vartiainen EA, Jousilahti PJ, Tuomilehto JO, Puska PM, Nissinen AM. Trends in blood pressure levels and control of hypertension in Finland from 1982 to 1997. J Hypertens 1998; 16:1379-87. [PMID: 9746125 DOI: 10.1097/00004872-199816090-00019] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess the trends in blood pressure levels and hypertension control in Finland from 1982 to 1997. DESIGN Four independent cross-sectional population surveys conducted in 1982, 1987, 1992 and 1997. SETTING From 1982 to 1997, the provinces of North Karelia and Kuopio in eastern Finland and the region of Turku-Loimaa in southwestern Finland were surveyed. From 1992 to 1997, the Helsinki-Vantaa region in southern Finland was surveyed. PARTICIPANTS Men and women aged 25-64 years were selected randomly from the national population register. The total number of participants was 27 623. MAIN OUTCOME MEASURES We assessed mean systolic and diastolic blood pressure, prevalence of hypertension (subjects with systolic blood pressure > or = 160 mmHg or diastolic blood pressure > or = 95 mmHg or current use of antihypertensive drug treatment) and antihypertensive drug treatment and quality of hypertension care among hypertensive persons. RESULTS Mean systolic blood pressure and the prevalence of hypertension decreased significantly in all areas except among men in the Helsinki-Vantaa region. The fall in mean diastolic pressure was significant only in eastern Finland. The proportion of hypertensives who were unaware of their condition fell from 45.5 to 24.1% in men and from 27.2 to 15.7% in women. At the same time, the proportion of hypertensives with adequately controlled blood pressure (systolic pressure < 160 mmHg and diastolic pressure < 95 mmHg) increased from 9.4 to 23.5% in men and from 16.0 to 36.7% in women. CONCLUSION Hypertension care in Finland has improved significantly during the last 15 years. However, the situation is still far from optimal. It is obvious that the biggest problem in hypertension care has shifted from detection to adequate treatment of high blood pressure.
Collapse
Affiliation(s)
- M J Kastarinen
- Department of Public Health and General Practice, University of Kuopio, Finland
| | | | | | | | | | | | | |
Collapse
|
12
|
Dobson AJ, Evans A, Ferrario M, Kuulasmaa KA, Moltchanov VA, Sans S, Tunstall-Pedoe H, Tuomilehto JO, Wedel H, Yarnell J. Changes in estimated coronary risk in the 1980s: data from 38 populations in the WHO MONICA Project. World Health Organization. Monitoring trends and determinants in cardiovascular diseases. Ann Med 1998; 30:199-205. [PMID: 9667799 DOI: 10.3109/07853899808999404] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The World Health Organization (WHO) MONICA Project is a 10-year study monitoring trends and determinants of cardiovascular disease in geographically defined populations. Data were collected from over 100,000 randomly selected participants in two risk factor surveys conducted approximately 5 years apart in 38 populations using standardized protocols. The net effects of changes in the risk factor levels were estimated using risk scores derived from longitudinal studies in the Nordic countries. The prevalence of cigarette smoking decreased among men in most populations, but the trends for women varied. The prevalence of hypertension declined in two-thirds of the populations. Changes in the prevalence of raised total cholesterol were small but highly correlated between the genders (r = 0.8). The prevalence of obesity increased in three-quarters of the populations for men and in more than half of the populations for women. In almost half of the populations there were statistically significant declines in the estimated coronary risk for both men and women, although for Beijing the risk score increased significantly for both genders. The net effect of the changes in the risk factor levels in the 1980s in most of the study populations of the WHO MONICA Project is that the rates of coronary disease are predicted to decline in the 1990s.
Collapse
|