Eftyhia Helis

Time trends in cardiovascular and all-cause mortality in the ‘old’ and ‘new’ European Union countries

Aims: There are large differences in all-cause and cardiovascular disease (CVD) mortality between eastern and western countries in Europe. We reviewed the development of these mortality trends in countries of the European Union (EU) over the past 40 years and evaluated available data regarding possible determinants of these differences. Methods and results: We summarized all-cause mortality and specific cardiovascular mortality for two country groups – 10 countries that joined the European Union (EU) after 2004 (East), and 15 countries that joined before 2004 (West). Standardized mortality rates were retrieved from the World Health Organization “European Health for All” database for each country between 1970 and 2007. Currently (in the 2000s), mortality due to circulatory system disease, ischemic heart disease (IHD), cerebrovascular disease (CBVD), and all-causes in the ‘new’ EU countries (East) is approximately twice that in the ‘old’ EU countries (West). These differences were much smaller in the 1970s. The increasing gap in mortality between West and East is primarily the result of a continuous and rapid improvement in the West. Conclusion: Differences in lifestyle (i.e. diet, alcohol consumption, physical activity, and smoking) provide insufficient explanation for the observed mortality gap in these two groups of EU countries. Higher expenditures on health, better access to invasive and acute cardiac care, and better pharmacological control of hypertension and hypercholesterolemia in the West are well documented. Socioeconomic and psychosocial factors may also contribute to the changes in mortality trends.

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.

What is the feasibility of implementing effective sodium reduction strategies to treat hypertension in primary care settings? A systematic review.

Objective: To evaluate whether efficacious counseling methods on sodium restriction can be successfully incorporated into primary care models for the management of hypertension. Methods: We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effects and Health Technology Assessment to identify randomized controlled trials of dietary counseling for salt intake reduction that reported significant reduction in 24-h urinary sodium and blood pressure levels among adults with untreated hypertension. Data extraction and assessment of reproducibility and feasibility were done in duplicate and any disagreements were resolved by consensus. Results: Six trials were included for assessment of methods as they were efficacious in reducing sodium intake (24-h urinary sodium excretion) by 73 to 93 mmol/day (intervention) vs. 3.2 to 12.5 mmol/day (control). This was paralleled with a reduction in blood pressure (−4 to −27 mmHg) between groups. In four of the six trials, the methods were described in sufficient detail to be reproducible, but in none of these trials were the ‘counseling methods’ feasible for application in primary care settings. Apart from multiple sessions of counseling, the reported interventions were supplemented with provision of prepared food, community cooking classes, and intensive inpatient training sessions. Conclusion: Despite the availability of efficacious counseling methods for the reduction of sodium intake among newly diagnosed hypertensive patients (feasible within a clinical trial setting), none of these methods, in their present form, are suitable for incorporation into existing primary care settings in countries such as Canada, United States, and UK.

A cross-national comparative study of blood pressure levels and hypertension prevalence in Canada and Hungary

Purpose: Hungary has one of the highest cardiovascular (CV) mortality and stroke rates compared to other countries in Europe and North America. Data from two recent blood pressure (BP) screening projects in Hungary and Canada provided us with the opportunity to compare potential differences in the prevalence of hypertension between these countries. Methods: From the Ontario Blood Pressure Survey, 880 white Canadians between 20 and 62 years old with white-collar occupation were selected and compared with a total of 1000 Hungarian bank employees in the same age range. Identical methods were employed for CV risk factor screening and BP measurements using the BpTRU instrument. Hypertension was defined by elevated BP measurement (SBP ≥140 mmHg and/or DBP ≥90 mmHg) or current intake of antihypertensive medication. Results: Canadian participants were on average 10 years older with a higher rate of obesity, diabetes and high cholesterol. Smoking was more prevalent among Hungarians (29.4 vs. 22.5%, P < 0.001). Despite being younger, Hungarians exhibited significantly higher SBP (121.3 ± 4.3 vs. 111.6 ± 14.1, P < 0.001) and DBP (78.5 ± 10.5 vs. 70.8 ± 9.5, P < 0.001), which remained significant after adjustment for age and use of antihypertensive medication as well as sex and CV risk factors. Age-adjusted prevalence of hypertension was significantly higher and poorly controlled among Hungarians (P < 0.001). Conclusion: The increased prevalence of hypertension among young and middle-aged Hungarians compared with Canadians could represent an essential contributor to the high CV mortality and stroke rates in Hungary. BP awareness, treatment and control require improved medical attention and should be addressed early among young Hungarians.

910 ASSOCIATION OF SMOKING AND HYPERTENSION IN TWO HUNGARIAN POPULATIONS

Background: There are contradictory reports concerning the relation of smoking to hypertension (HTN). Some studies observed increased risk of developing HTN while other findings consistently indicate lower blood pressure (BP) in smokers.1,2 We investigated the association of smoking and HTN in two groups of employees in Hungary. Design and Methods: We recruited “blue collar” emploees (BC) in a salami factory (n = 1011) and “white collar” (WC) employees in a bank (n = 1000) for BP screening. BP and pulse rate were measured with an automated BPTRu instrument.. The smoking habits were ascertained by completing a structured questionaire administered by an interviewer. HTN was defined as SBP ≥140 and /or DBP≥90 mm Hg and/or use of antihypertensive medications. Statistical analysis was performed by chi-squared tests, multinomial logsitic regression model, and analysis of covariance. Results: The smoking prevalence was significantly higher in BC (43 %) compared with the WC employees (29 %; p < 0.0001). The prevalence of smokers in WC normotensives was 26% and 33.7% in WC hypertensives (ns). The coresponding figures in BC employees were 45% in normotensives and 39% in HTN(ns). Conclusion: Smoking status has no significant effect on prevalence of HTN in WC and BC employees. However, BP values were higher in each age category in smoking WC female workers. ReferencesBowman TS, Gaziano JM, Buring JE, Sesso HD. Am Coll Cardiol. 2007;50(21):2085.Mikkelsen KL, Wiinberg N, Høegholm A, et al. Am J Hypertens. 1997;10(5 Pt 1):483.

HEART RATE IN PREHYPERTENSIVE AND HYPERTENSIVE YOUNG AND MIDDLE-AGED BANK EMPLOYEES IN HUNGARY: PP.19.243

Approximately one third of prehypertensives (PH) develop hypertension (HTN) within four years (1). We investigated the association of PH and HTN with heart rate (HR) speculating that increased HR may have a prognostic significance. Method: 1000 bank employees (mean age = 32.6) were screened for their blood pressure (BP), HR and other cardiovascular risk factors at their worksite. The respondents included 304 males (mean age = 30.8) and 696 females (mean age = 33.2). Respondents were classified as normotensives (NT), prehypertensives (PH) and hypertensives (HTN) according to their BP levels. The BP and HR were measured using an automated instrument (BpTRU®) which is performing 6 measurements of BP and HR, discards the first value and displays the average of the remaining 5 measurements. Results: A progressive and significant increase in HR was ascertained as BP levels increased (Table). Considering 75 beats per min (bpm) or higher as a threshold for high HR, increased HR was found in 7.6% of male and 35.0% of female NT. In the PH group, 14.8 % of males and 48.0% of females belonged to this category. The corresponding values for the HTN group were 27.7% and 49.7% for males and females, respectively. In this sample, a significantly higher proportion of women compared to men in the NT (p < 0.05) and PH groups (p < 0.0001) had high HR. Conclusion: Respondents with PH and HTN have significantly higher HR than NT. The prevalence of high HR progressively increased from 42.6% in NT to 62.7% in PH and 77.4% in HTN. Further studies are planned to evaluate the prognostic significance of elevated HR. Figure 1. No caption available.