Blood pressure. Supplement最新文献

The authors review the present situation in epidemiology and prevention of arterial hypertension in Poland. In 2002, the NATPOL PLUS survey on representative sample of adults (n=3051, age range 18-93) was conducted. Prevalence of hypertension, diagnosed on basis of three separate visits, was 29%, awareness 67% and efficacy of treatment 12.5%. Thus, in Poland, one-third of 8.6 million hypertensives are unaware of their disease. A comparison with data from other countries should be careful due to the different methods (age range, number of readings and visits) used in the studies. The data, in concert with a decrease in awareness of one's own blood pressure (from 71% in 1994 to 59% in 2002), called for urgent preventive measures. Two large interventions were implemented under the National Programme POLKARD in 2003: the Polish 400 Cities Project aimed to increase detection and knowledge of hypertension and other risk factors among small-town and village communities, and the educational project, A Chance for the Young Heart targeted at children aged 11-14 years and using traditional teaching methods and an interactive Internet website. Also, an educational and marketing programme targeted at public opinion leaders and decision makers (trade unions, local governments, healthcare financing authorities, print media and radio, the Polish Parliament) started in 1999 and is still in process.

Hypertension increases the risk of coronary heart disease, stroke, peripheral arterial disease and heart failure. Five independent cross-sectional surveys for cardiovascular risk factors have been conducted in the Czech Republic (1985, 1988, 1992, 1997/98 and 2000/01), always involving a representative population sample aged 25-64 years. Over a period of 15-16 years, there was a statistically significant downward trend in population mean systolic (from 133.6 +/- 20.2 to 128.8 +/- 18.1 mmHg; p < 0.001) and diastolic (from 84.1 +/- 11.3 to 81.4 +/- 10.0 mmHg; p < 0.001) blood pressure (BP). There was also a significant decrease in the prevalence of hypertension in both sexes (from 51.9% to 45.6% in men; p < 0.001; from 42.5% to 33.0% in women; p < 0.001). Awareness of hypertension increased in both sexes, showing higher rates for females (men from 41.4% to 62.1%; p < 0.001; women from 58.9% to 73.8%; p < 0.001). Hypertension control improved significantly over the period of 15/16 years (from 3.9% to 17.9%; p < 0.001), consistently showing more effective control in women. The significant decrease in population mean BP seems to have contributed to the decrease in total and cardiovascular mortality in the Czech Republic observed since 1985.

The incidence of resistant hypertension remains to be clarified. In this article, three categories of resistance are distinguished: resistant patient, resistant clinician and refractory hypertension. Inadequate compliance, which in case of antihypertensive treatment means taking fewer doses of medications than prescribed, remains a significant cause of poor blood pressure control. Among most frequent physician-related causes of resistant hypertension, there are measurement errors, pseudohypertension, white coat hypertension and therapy errors. Careful elimination of patient- and physician-related reasons of inadequate blood pressure control should lead to the diagnosis of truly resistant hypertension. One of the causes of refractory hypertension may be concomitant use of other medications that are known to reduce antihypertensive effect of main drugs. Resistance may be associated with increased intravascular volume or fluid overload or with sympathetic activation. Modifiable contributing factors responsible for resistant hypertension include obesity often coexisting with insulin resistance and metabolic syndrome as well as excessive alcohol use and cigarette smoking. Another potential cause of refractory hypertension is the presence of secondary hypertension. Certain therapeutic modifications are essential in resistant hypertension.

The goal of the paper is to summarize the current status of blood pressure management in patients with ischaemic heart disease. Recently published results from Europe and North America showed that about half of ischaemic heart disease patients have their blood pressure over 140/90 mmHg. Moreover, these data provide further evidence that poor hypertension management is common in a variety of healthcare settings. Although most ischaemic heart disease patients receive blood pressure-lowering drugs, still a large proportion of them does not reach the recommended treatment goals. During recent years, several attempts were made to improve the control of risk factors (among them blood pressure) in patients with ischaemic heart disease; however, none of them was definitively successful.

Hypertension affects nearly one-third of total Polish adult population. Poor control of hypertension largely contributes to high cardiovascular disease (CVD) mortality in Poland. However, satisfactory hypertension control at the national level could be beyond economical conditions. Prevention of hypertension by lifestyle modification may be one of the ways to decrease CVD population risk attributed to hypertension. The goal was to assess the relation between the chance of having hypertension and lifestyle characteristics, i.e. education, smoking, physical activity, salt consumption, ethanol consumption and body mass index (BMI) in the middle-aged population of the urban population of Kraków. A cross-sectional study of a random sample of 1157 women and 1153 men, permanent inhabitants of Kraków at age 45-64 years, was carried out by home interview followed by a visit in the clinic. There were 66% men and 56% women who had hypertension. After adjustment for age, BMI over 27.5 kg/m2 in men and over 25.0 kg/m2 in women was strongly related to hypertension. In men, odds ratio (OR) increased from 1.96 in the group with overweight (27.5 kg/m2 < or = BMI < 30.0 kg/m2) to 5.33 in the group with obesity (BMI > or = 35.0 kg/m2). In women, OR increased from 1.6 in the group with overweight (25.0 kg/m2 < or = BMI < 27.5 kg/m2) to 13.42 in the group with obesity (BMI > or = 35.0 kg/m2). In men, after adjustment for age and BMI, a higher chance of hypertension was found for binge drinkers but the result was of borderline significance (p = 0.057). In women, moderate alcohol consumption was related to lower chance of hypertension (OR = 0.72). Women who were current smokers had lower chance of hypertension (OR = 0.67). No significant relation between smoking and hypertension was found in men. After adjustment for age and BMI, there was no significant relation between hypertension and physical activity. However, both in men and in women, there was a dose effect of leisure time physical activity on the average estimate of the chance of hypertension. Education, estimate of sodium consumption and blood total cholesterol (TC) were not related to hypertension. The findings confirmed that weight control may be a strong tool for preventing hypertension and increasing physical activity and refraining from binge drinking may have a protective effect.

The aim of our study was to investigate blood pressure (BP) control and different factors with possible influence on BP control in Croatian hypertensive patients. In this cross-sectional investigation, a representative sample of target populations (primary care physicians and patients) from different parts of Croatia was included according to the study protocol. During December 2003 and January 2004, we included, according to correctly completed questionnaires, 141 physicians and 814 hypertensive patients. A controlled BP (BP < 140/90 mmHg) in this hypertensive population treated with antihypertensive drugs was in 23% of patients. The analysis of BP control according to risk factors showed that significantly related with higher levels of systolic or diastolic BP were the age (poorer systolic BP control in patients older than 60 years), left ventricular hypertrophy, changes of the eye retina, smoking and diabetes mellitus. Furthermore, patients from towns closer to the hospital, from urban centers, with higher education and employed had significantly lower average BP. According to our results of hypertension control in Croatia, there is a need and a possibility for the improvement of the quality of hypertension care. The relationship between demographic and cardiovascular risk factors with poor BP control should be taken into account when treating patients.

The pathophysiological role of endothelial cells is important in the mechanism of progression of atherosclerosis and improvement of endothelial function may be important for cardiovascular morbidity. Calcium antagonists are reported to have protective effects on the endothelium in vitro and in vivo. In this clinical study, we investigated the effect of calcium antagonist, benidipine, on endothelial function in the patients with essential hypertension, which causes endothelial dysfunction. Twenty-five patients with hypertension without other risk factors for atherosclerosis were treated with monotherapy (8 mg benidipine, n=25) for 8 weeks. Blood pressure was reduced significantly. Endothelial function was evaluated using forearm blood flow by strain-gauge plethysmography after 8 weeks of treatment. Changes in vasodilator response to reactive hyperemia were significantly improved (p<0.01), while the response to nitroglycerin was not changed, suggesting the improvement of endothelial function. Moreover, we focused on hepatocyte growth factor (HGF), which is a novel angiogenic growth factor with an anti-apoptotic action on endothelial cells, and evaluated involvement of HGF in improvement of endothelial function. Serum HGF concentration in subjects treated with benidipine was significantly elevated at 8 weeks (p<0.05). Overall, these results demonstrated that benidipine improved endothelial dysfunction in patients with hypertension. Interestingly, an increase in serum HGF concentration by benidipine might contribute to the improvement of endothelial dysfunction.