Surveillance des facteurs de risque des maladies cardiovasculaires en Tunisia: Methodologie et principaux resultats

To assess the Cardiovascular risk factors trend in a community based surveys. Method: Two population surveys were conducted in 1996-97 and 2000-01 in the Ariana region among 7608 adults 35-70 years aged. The surveys were based on: I- a questionnary, 2- an anthropometrical and physical examination, 3- a biological investigation, and 4 - an ECG registration for the second cohort. Relative to the first survey, the prevalence of hypertension, diabetes, hypercholesterolemia didn't change significantly while border line cholesterol increased on both genders, tobacco smoking decreased and ex-smokers increased on men. In both genders, hypertension and diabetes prevalence is low before 50 years but it increased after this age. Risk factors association is common: about 35% have more than two risk factors. This association is more common on women and diabetes-hypertension is the most frequent. These two surveys integrated in a global surveillance program has contributed to assess the CVDs burden and to identify priorities and intervention relevant to epidemiological region context

Prevalence des cardiopathies ischemiques: Resultats d'un depistage en population

A cross - sectional population survey was carried out in the Ariana region in 2000-01. The aim of this study is to report the prevalence of CHD as indicated by ECG Minnesota coding. Method: A randomly selected sample included 1837 adults 40-70 years. Data on socio-economic status, demographic, medical history, health behavior, clinical and biological investigations were recorded. Risk factors [hypertension, dyslipedemia, obesity, diabetes] are defined according to WHO criteria's. Standard supine 12 lead ECGs were recorded. All ECGs are red and classified according to the Minnesota codes criteria on CHD probable, CHD possible and on Major abnormalities and minor abnormalities. CHD prevalence was higher on women. Major abnormalities are more common on women [20,6% vs 13%], while minor abnormalities prevalence was higher on men [15,5% vs 7,5%] [p<0,0001]. The prevalence increased with age in both genders. This study tested how feasible is the population approach on CVDs surveillance. It highlighted the burden of cardiovascular diseases and support that women are at risk as men are. The value of ECG findings must be integrated in the cardiovascular diseases surveillance to identify high risk population

Prevalence, connaissance, traitement et controle de l'hypertension arterielle: Resultats d'une enquete populationnelle

The study objective was to assess the prevalence, level of awareness of treatment, and control of hypertension in a general population. We conducted a cross-sectional survey on 1837 adults 40-69 years old. Hypertension and control level are defined according to the WHO/ISH recommendations. HBP is defined as SBP> =140 and or DBP> = 90 mm Hg and the use of blood pressure-lowering medication. Hypertension is controlled by medication if SBP < 140 and DBP < 90 mm Hg. We conduct analysis by socio demographic variable, medical history and CHDs risk factors. 44,3% of adults was hypertensive. The prevalence of hypertension was higher among women [48,2% versus 38,7% on men.] and it increases in both genders with age, body mass index. Only 41,% of the hypertensive were aware of having hypertension, among them, 74,1%declare that they are treated but only 13.2% were controlled. The study highlights the problem of the hypertension in a developing country. It contributes to identify the huge iceberg of this CVDs risk factor. The national strategy must focus on the population life style and drugs management. The question is how much will be the cost of HBP and CVDs control for a country which has a limited resources

Prise en charge de l'hypertension arterielle: Resultats d'une enquete Tunisienne aupres des medicins generalistes

The control of arterial hypertension [HT] is an endlessly hoped objective but usually not reached. Several factors are determinants. The physician role is crucial in the HT prevention. In order to evaluate knowledge's, attitudes and behaviors of Tunisian physicians in HT management, we conducted a cross sectional study in 2002 using a self administered questionnaire addressed to physicians working in private and public sectors. 380 generalists participated to this study. 95,5% of them confirmed that HT constitutes a public health problem. 81,1% saw at least 4 patients with HT a week. 95% insisted on the importance of the primary prevention. 90% took care themselves patients. 71,5% confirmed the importance of a training and an entrainment for the measure of the blood pressure [BP]. 3,7% made diagnosis after a single visit and 10,9% confirmed it only from described symptoms. 20,4% of the generalists chose the old classification as objective level of BP thiazidic Diuretics and 13 blockers were most prescribed medicines in first intention. 9,4% stopped the treatment after stabilization of blood pressure. 60% of generalists had inadequate behavior facing a not stabilized BP Non observance of treatment by patients was indicated by 31% of the generalists, cost and break of the medicines' stock and disappearance of symptoms were the main causes advanced by the generalists. This study shows the existence of gaps in generalists' practical behavior treating this disease. Measures aiming the medical practice improvement turn out necessary in particular the sensitization of the generalists by an adequate university training and a continuous medical training, and a regular evaluation of the national program of hypertension prevention and management