Prevalence, awareness, treatment, and control of hypertension in the Czech Republic. Results of two nationwide cross-sectional surveys in 1997/1998 and 2000/2001, Czech Post-MONICA Study.

Hypertension is an easily diagnosed and eminently modifiable risk factor for the development of all clinical manifestations of atherosclerosis. Despite the availability of a simple, non-invasive, and rather accurate method of measuring blood pressure (BP), and overwhelming evidence that reducing BP effectively prevents cardiovascular events, hypertension at the population level is not managed optimally. In 1997/1998 and 2000/2001, two surveys for cardiovascular risk factors were conducted in nine districts of the Czech Republic, involving a 1% population random sample aged 25-64 years in each district. In concordance with the MONICA Project, the present study confirms a high prevalence of hypertension in the Czech population, detecting an increase in prevalence for the male population over a period of 3 years (males from 38.8 in 1997/1998 to 42.3 in 2000/2001; P<0.05). Within the same period, there is also a significant increase in the awareness of hypertension in males (from 57.3 in 1997/1998 to 60.0 in 2000/2001; P<0.05), and an increase in the number of male hypertensives being treated by antihypertensive drugs (from 30.9 to 44.3; P<0.05). Control of hypertension did not change in either sex, being still suboptimal (males 16.4%, females 25.4% in the last survey in 2000/2001).

Evaluation of the effects of fixed combinations of sustained-release verapamil/trandolapril versus captopril/hydrochlorothiazide on metabolic and electrolyte parameters in patients with essential hypertension.

The objective of this randomised open, active controlled, cross-over study was to evaluate the effect of a fixed combination of verapamil SR/trandolapril compared to captopril/hydrochlorothiazide on serum lipids, lipoproteins, and other metabolic and electrolyte parameters in patients with essential hypertension. Another objective was to assess the efficacy and safety of both combinations. One hundred hypertensives with systolic blood pressure 140-209 mm Hg and diastolic blood pressure 90-119 mm Hg were evaluated after 16 weeks receiving a fixed combination of verapamil SR 180 mg/ trandolapril 2 mg (VT) or captopril 50 mg/hydro- chlorothiazide 25 mg (CH) both given once daily. Lipids and lipoproteins were assessed in duplicate on 2 consecutive days. The study was completed by 80 patients. There was no statistically significant difference between the two combined regimens with respect to low-density lipoprotein (LDL)-cholesterol for the 'intention-to-treat' population measured at the end of each treatment period (3.44 +/- 0.87 mmol/L with VT, and 3.46 +/- 0.86 mmol/L with CH). No differences were found for other lipid parameters like total cholesterol, triglycerides, apolipoproteins A1 and B, Lp(a). High-density lipoprotein (HDL)-cholesterol was significantly higher with VT (1.39 +/- 0.01 vs 1.35 +/- 0.01, P < 0. 03). Serum potassium declined while uric acid and glucose increased on CH. In conclusion, no significant differences were found in LDL-cholesterol and in other lipid parameters with the exception of HDL-cholesterol which was significantly higher on VT. Serum potassium declined while uric acid and glucose increased on CH (all significantly). Both fixed combinations were well tolerated. The incidence of adverse events was higher on CH. Both fixed combinations significantly lowered BP. Journal of Human Hypertension (2000) 14, 347-354

[Development of smoking habits in the population of the Czech Republic from 1985 to 1997/98]. / Vývoj kuráckých zvyklostí obyvatelstva Ceské republiky v období 1985-1997/98.

BACKGROUND: Tobacco smoking belongs to high risk factors for the circulation diseases. Aim of the present study is to identify and describe smoking habits of the population in nine districts in Czech republic in years 1997/98 and in six of these districts to analyze smoking trends during the period of 1985-1997/98. METHODS AND RESULTS: Information on the smoking habits were collected in years 1985, 1988, and 1992 in six districts which took part in the international project WHO MONICA. In 1997/98 data collection was extended into three other districts. New randomly selected samples of 1% of the population were explored each time. 5293 males and 5610 females 25-64 years old were questioned during a controlled talk with a health-officer. In 1997/98 in nine districts the prevalence of actual smokers was 38%, that of former smokers was 24% and 38% of non-smokers. The group of females consisted of 27% of actual smokers, 10% of former smokers, and 63% of non-smokers. The average daily consumption was 16.4% (+/- 8.6) cigarettes per day in males and 11.3 (+/- 7.0) cigarettes per day in females. In 1985-1997/98 the smoking prevalence of males aged 25-64 years decreased in six districts from 49% to 37% (p < 0.001). No changes were detected in females of the same age group (28% in 1985, 26% in 1997/98). Decreasing tendency was observed in both males and females up to 45 years old, in males also in the age group 55-64 years. In females older than 45 years the smoking prevalence increased. Significant changes in the smoking prevalence were found when samples were analyzed according to the education level. In males with basic education and among skilled workers the smoking prevalence decreased in years 1985-1997 from 53% to 42% (p < 0.05), among males with secondary education smoking prevalence decreased from 45% to 33% (p < 0.01) and in graduates from 34% to 23% (p < 0.01). In females with basic education the smoking prevalence increased from 25% to 31% (p < 0.05), among females with secondary education it decreased from 34% to 21% (p < 0.001), in graduate females it decreased from 31% to 18% (p < 0.05). CONCLUSIONS: Present situation and 13 years long development of smoking habits differs in males and females. Higher prevalence was found in males as well as the daily consumption of cigarettes. Since 1985 the male smoking prevalence has decreased in age groups 25-64 years and in age and education level subgroups. Only partial decrease of the female smoking prevalence was observed in age group till 45 years and in subgroups with secondary education and graduates. Significant increase in the smoking prevalence among females with basic education as well as the finding that women do not quit smoking with increasing age my become an important information for preventive programmes.

[Longitudinal trends of total and HDL cholesterol in a representative population sample in the Czech Republic]. / Longitudinální trendy celkového a HDL-cholesterolu u reprezentativního vzorku populace Ceské republiky.

Cardiovascular diseases are the main cause of death in the Czech Republic. Since 1984 there is a decline of the total and cardiovascular mortality in the CR which is due to a decline of the mortality from IHD and cerebrovascular disease. Within the framework of the MONICA project in 1985, 1988 and 1992 in six districts of the CR screening examinations of cardiovascular disease risk factors were made. For examination always 1% of the population aged 25-64 years (random sampling) was invited. In 1997 and 1998 a similar cross-sectional surmy was made in nine districts of the CR. A total of 3,209 subjects were examined. In 1985-1997/98 in the representative population samples of six districts of the CR there was a significant decline of total cholesterol (men from 6.21 +/- 1.29 to 5.65 +/- 1.15 mmol/l, p < 0.001, women from 6.18 +/- 1.26 to 5.53 +/- 1.21 mmol/l, p < 0.001 and the total cholesterol/HDL ratio (men from 4.94 +/- 1.83 mmol/l to 4.66 +/- 1.46, p < 0.001, women from 4.14 +/- 1.32 to 3.89 +/- 1.30 mmol/l p < 0.001).

Intima-media thickness of carotid arteries in borderline hypertensives.

The purpose of this study was to assess the effect of the main risk factors for cardiovascular disease on the process of subclinical atherosclerosis in originally borderline hypertensives. The relation of far wall common carotid artery intima-media thickness (IMT CCA) measured by B-mode ultrasound to smoking, body mass index (BMI), blood pressure, lipids, and angiotensin-converting enzyme (ACE) gene polymorphism was analyzed. In 48 subjects examined (mean age, 61.9 +/- 2.54 years), median IMT CCA was 0.708 mm. Statistically significant differences in BMI (26.5 vs. 29.2 kg/m2, p < 0.025) and HDL-cholesterol level (1.42 vs. 1.1 mmol/l, p < 0.025) between the first and third tertile of IMT CCA were found. No differences were observed between "controls" and "cases" in blood pressure, total cholesterol, and triacylglycerols. No significant differences in IMT CCA were found between smokers and nonsmokers and among different alleles of the ACE gene. These data reflect the importance of HDL-cholesterol and BMI on the process of atherosclerosis within an otherwise homogeneous group of patients.

Coronary events in the population of six districts of the Czech Socialist Republic.

In 1984, 640 coronary events were registered in six districts of the Czech Socialist Republic in a population of 164, 185 men aged 25 to 64 years; in a population of 166, 651 women of the same age-group there occurred 162 coronary events. 695 coronary events were according to criteria of the MONICA project (Monitoring of Cardiovascular Diseases and their Risk Factors) confirmed as definite or possible myocardial infarction (MI). The incidence of MI per 100,000 inhabitants amounted in 1984 to 347.7 in men and to 74.4 in women aged 25 to 64 years. The death-rate up to the 28th day of the disease is in men and women the same: one third of patients with a coronary event die within 4 weeks after the onset of symptoms. Death occurs in 75.8% of men and in 69.2% of women during the first 24 hours. Of all subjects with fatal MI, 35.4% of men and 56.1% of women died in hospital.

Myocardial Infarction Register in MONICA-Czechoslovakia Centre.

In 1984, 802 coronary events (age 25-64) were registered in six MONICA areas in Czechoslovakia. According to the MONICA study criteria, 63% of these coronary events in males and 51% in females were confirmed as definite myocardial infarction (MI), 26% of events in both males and females as possible MI, 5% of events in males and females were fetal cases with insufficient data, and 6% of events in males and 18% in females were not confirmed as MI (MONICA diagnostic category = 4). Age-standardized annual attack rates of MI per 100,000 population (age 35-64) were 510.4 for males and 99.3 for females. Age-standardized annual incidence rates (first ever MI) per 100,000 population (age 35-64) were 387.4 for males and 89.7 for females. 28-day case fatality was 33.3% in males and 31.5% in females. Of all deaths occurring within 28 days, 75.8% in males and 69.2% in females occurred during the first 24 hours. Of all coronary deaths, 38.5% of males and 64.1% of females died in hospital or other institution.

Left ventricular morphology and function in mild to moderate essential hypertension.

150 males with mild to moderate essential hypertension [EH] were examined echocardiographically and the findings in the left ventricle [LV] were compared with those in 20 normotensive men. Increased LV wall thickness and LV mass was found in 81% and 67% of hypertensives respectively in contrast with a complete absence of LV hypertrophy in normotensives. The former showed also a tendency to the concentric type hypertrophy, which can be considered a characteristic feature of the 2nd stage [WHO] EH. There was an almost uniform incidence of asymmetric septal hypertrophy in the two groups [12 vs. 10%]. Decreased LV end-systolic wall stress in EH was a sign of compensatory myocardial hypertrophy without LV dilatation. The hypertensives exhibited a normal or slightly elevated systolic LV function. On the other hand, some indirect indices of LV properties [peak rate of LV relaxation and left atrial dimension] were indicative of diastolic function impairment. A slight but significant correlation between the degree of LV hypertrophy and systemic blood pressure at rest was found in a part of hypertensive patients. The study indicates that mild to moderate EH leads to some changes in LV morphology and function, which can be easily recognized by echocardiography.

Distribution of blood pressure in children and adolescents.

Casual blood pressures were evaluated in 13 475 children and adolescents of elementary and secondary schools in the district of Prague 4. Measurements in an unselected children population determined mean systolic and diastolic pressures and standard deviations in different age groups. Children with elevated blood pressure were selected according to arbitrarily chosen criteria. Blood pressure greater than or equal to 130/80 mmHg (17.3/10.6 kPa) occurred in 0.6% of children aged 6-10 years, greater than 135/80 mmHg (17.9/10 kPa) in 2.0% of children aged between 11-15 years, and greater than 145/85 mmHg (19.2/11.3 kPa) in 0.4% of adolescents under 19 years.

Education and the risk factors of ischaemic heart disease.

Screening for the risk factors of ischaemic heart disease among the male residents of the district of Prague 4 aged 40--49 years was undertaken under the "National multifactorial primary preventive study of myocardial infarction and stroke". Of the 11 091 men invited, 5395 met the defined criteria and were admitted to the study. 58% of them were included in the risk group. The level of attained school education was ascertained at the initial examination. The lowest percentage of persons with hypercholesterolaemia, overweight, elevated blood pressure and smokers was found among university graduates. The results are compared with data of other studies and possible causes of the findings are discussed.

Angina pectoris and middle-aged man.

The incidence of some risk factors of ischaemic heart disease in men aged 40-55 years is compared with the presence and absence of angina pectoris (AP). Patients with positive AP had significantly higher values of the blood pressure, serum cholesterol level, and ponderal index. The frequency of probably pathological and possibly ischaemic changes was likewise significantly higher in the group with AP. Intermittent claudication was more frequent in this group as well. No significant difference in consumption of cigarettes was found between the two groups.

Population study of the early phase of acute myocardial infarction and sudden coronary death.

A two-year population study in the district of Prague 4 (population 190 000) showed that patients with acute myocardial infarction [AMI] came to the hospital with a considerable delay (median 10.25 hours), whose substantial part was caused by the patient's lingering in calling for medical aid (a half of them called as late as within 3 hours since the appearance of symptoms). On the other hand, out of 226 cases of sudden death caused by ischaemic heart disease (IHD), 92% of the victims died as early as within the first hour. Within the first hour, 27% of all patients with coronary attacks in the community died, and as a few as 2% only were hospitalized within this period. No prevention of sudden coronary death is possible for the time being. Nevertheless, an attempt can be made at least to reduce the risk of early death in the following two ways. The public shoudl be avised of the gravity of characteristic symptoms of AMI, danger in the case of delay, and necessity of prompt medical aid. Because a majority of victims of sudden death have positive histories of IHD, and most deaths occur in the patients' homes in the presence of their family members, these next relatives of patients with manifest IHD should be trained in the performance of cardiopulmonary resuscitation.

[Experiences of 15 years in the screening of ischaemic heart diseases and arterial hypertension]. / 15jährige Erfahrungen mit dem Screening der ischämischen Herzkrankheit und der arteriellen Hypertension

A survey concerning 15 years' experiences with the screening of the ischaemic heart disease and the arterial hypertension in selected male age groups in Prague is given. Here the authors entered an international study, in which the possibilities of the primary prevention of the ischaemic heart disease and its complications were investigated by means of clofibrate. As a preliminary result a reduction of serum cholesterol, which was increased over 279 mg/100 ml, by 13% and in values between 279 and 260 mg/100 ml by 8.8% could be established. With the help of screenings not only the incidence and the prevalence of the examined disease in the population, respectively, were established, but at the same time factors of risk were found, the elimination of which may shift the beginning of the disease or fully prevent its development.

Some risk factors of ischaemic heart disease in the Prague male population.

In a representative sample of men aged 50-54 years (N = 400), the frequency and distribution of individual risk factors of ischaemic heart disease were established. In 10.3% (41 persons) no risk factor was present, whereas 36.9% (147 persons) exhibited 3-7 risk factors each. With the number of risk factors, the prevalence of ischaemic heart disease and the incidence of exercise coronary insufficiency rose statistically significantly during a 3-year follow-up period. The most frequent risk factors appear to be low physical activity, excess cigarette consumption, and body overwieght.