The effects of control of systolic and diastolic hypertension on cardiovascular and all-cause mortality in a community-based population cohort.

The objective of this study (follow-up of 26,113 people) was to investigate differences in the risk of cardiovascular disease (CVD) and all-cause mortality among hypertensive people according to the control of systolic blood pressure (SBP) and diastolic blood pressure (DBP). People with a history of coronary heart disease, heart failure, cancer or incomplete data at baseline (n=1113) were excluded from the study. The participants were classified into six groups according to their blood pressure status. Treated hypertensive individuals with controlled SBP and DBP did not experience an increase in all-cause mortality compared with normotensive people. The increase in all-cause mortality was 1.48-fold (95% confidence interval (CI) 1.09-2.01) among those who were treated with antihypertensive drugs and had only their DBP controlled and 1.45-fold (95% CI 1.04-2.02) among those who were treated and had only their SBP controlled. Treated patients with both SBP and DBP controlled did not have an increased risk of CVD mortality when compared with normotensive people. The risk of CVD mortality was statistically significantly higher in treated hypertensive people with SBP alone, DBP alone or both SBP and DBP uncontrolled. Our study indicates that uncontrolled SBP alone and DBP alone are risk factors of all-cause and CVD mortality.

Glomerular filtration rate and parathyroid hormone are associated with 1,25-dihydroxyvitamin D in men without chronic kidney disease.

BACKGROUND AND AIM: Vitamin D, estimated glomerular filtration rate (eGFR) and parathyroid hormone (PTH) are related to cardiovascular disease risk. We examined the associations between the levels of 25-hydroxyvitamin D (25-D) and 1,25-dihydroxyvitamin D (1,25-D) and both eGFR and PTH. DESIGN AND SETTING: Cross-sectional population-based study in Kuopio, Eastern Finland. SUBJECTS: A total of 909 men without known chronic kidney disease (CKD) and not receiving antidiabetic medication, aged from 45 to 73 years, were included in the study. Main outcome measures. Fasting levels of 25-D, 1,25-D, creatinine and PTH were measured, and an oral glucose tolerance test (OGTT) was performed. RESULTS: High levels of 25-D were associated with low levels of eGFR and PTH (ß = -0.17, P = 9 × 10(-7) and ß = -0.28, P = 6 × 10(-17) , respectively, adjusted for age, body mass index and levels of calcium, phosphorus and glucose in a 2-h OGTT, and also for either eGFR or PTH). By contrast, high 1,25-D levels were associated with high levels of eGFR and PTH (ß = 0.17, P = 2 × 10(-6) and ß = 0.19, P = 5 × 10(-8) , respectively, adjusted as mentioned earlier and additionally for 25-D). Eighteen per cent of men in the highest 25-D quartile were in the lowest 1,25-D quartile and also had a lower eGFR than men with high levels of both 25-D and 1,25-D (P = 4 × 10(-5) ). Finally, 15% of men in the lowest 25-D quartile were in the highest 1,25-D quartile and also had higher PTH levels than men with low levels of both 25-D and 1,25-D (P = 2 × 10(-3) ). CONCLUSION: Our findings suggest that both eGFR and PTH are significantly associated with vitamin D metabolism in men without known CKD.

Diverse associations of 25-hydroxyvitamin D and 1,25-dihydroxy-vitamin D with dyslipidaemias.

BACKGROUND AND AIM: Previous studies have suggested a link between circulating levels of 25-hydroxyvitamin D (25-D) and dyslipidaemias. However, it is not known whether 25-D and the active hormone 1,25-dihydroxyvitamin D (1,25-D) have similar associations with dyslipidaemias. Therefore, we studied the associations between both 25-D and 1,25-D and total cholesterol (total-C), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and triglycerides in a population-based study. DESIGN: Cross-sectional population-based study. SETTING: Kuopio, Eastern Finland. SUBJECTS: A total of 909 men, aged from 45 to 70 years, who were not receiving antidiabetic medication were enrolled. MAIN OUTCOME MEASURES: Fasting serum samples were obtained for measurement of 25-D, 1,25-D and lipid levels. An oral glucose tolerance test was performed, and insulin sensitivity was evaluated using the Matsuda insulin sensitivity index (Matsuda ISI). RESULTS: We found a significant inverse association between 25-D and total-C, LDL-C and triglycerides (ß = -0.15, -0.13 and -0.17, respectively, P < 0.001), but no association between 25-D and HDL-C was observed. By contrast, 1,25-D was associated with HDL-C (ß = 0.18, P < 0.001), whereas no relationship was found between 1,25-D and LDL-C or triglycerides. The associations remained significant after the exclusion of subjects receiving statin treatment and after adjustment for age, waist circumference, body mass index, alcohol consumption, smoking, renal function, glucose tolerance and Matsuda ISI. CONCLUSION: Low levels of active vitamin D (1,25-D) are associated with low HDL-C levels, whereas low levels of the storage form 25-D are associated with high levels of total-C, LDL-C and triglycerides. Our findings may provide new insights into the understanding of the link between vitamin D deficiency and cardiovascular disease.

Risk factors for end-stage renal disease in a community-based population: 26-year follow-up of 25,821 men and women in eastern Finland.

BACKGROUND AND OBJECTIVE: There are very few European cohort studies assessing the risk factors of end-stage renal disease (ESRD) in a community-based population. This study investigated the predictors of ESRD in Finland. DESIGN: Prospective cohort study. SETTING: Eastern Finland. SUBJECTS: A random sample of 25,821 men and women aged 25-64 years from the national population register participating in three independent cross-sectional population surveys in 1972, 1977 and 1982. Only the subjects without diagnosis of ESRD or chronic kidney disease based on the national register data were included in the study. MAIN OUTCOME MEASURE: Initiation of renal replacement therapy (dialysis or kidney transplantation) identified from the Finnish Registry for Kidney Diseases through December 31, 2006. RESULTS: A total of 94 cases with ESRD were identified during a mean follow-up period of 26.5 years. In a multivariate proportional subdistribution hazard regression analysis, taking into account death as a competing risk event, diabetes (hazard ratio [HR] 4.76, 95% confidence interval [CI] 2.32-9.79), hypertension (HR 2.21, 95% CI 1.19-4.12), obesity defined as body mass index > or =30 kg m(-2) (HR 2.02, 95 %CI 1.10-3.71) and male gender (HR 1.68, 95% CI 1.19-4.12) were independent risk factors for ESRD. CONCLUSION: The findings of the present study confirm that modifiable risk factors play a major role in the development of ESRD in the North-European population. People with diabetes, hypertension or obesity should be considered as the target groups when planning preventive measures to control the future epidemic of ESRD.

Despite evidence-based guidelines, systolic blood pressure remains inadequately controlled in older hypertensive adults.

We aimed to assess the trends in the prevalence, awareness, treatment and control of hypertension in Finnish men and women aged 60-74 years. Three independent cross-sectional population surveys were conducted in 1997, 2002 and 2007 in the province of North Karelia and the region of Helsinki-Vantaa. Random samples were selected from the national population register. The total number of participants was 3282. In 2007, the prevalence of hypertension was 79% in men and 78% in women. The mean systolic blood pressure (SBP) (in men, 151 mm Hg in 1997, 148 mm Hg in 2002 and 149 mm Hg in 2007; in women 150, 149 and 149 mm Hg, respectively) and prevalence of hypertension (77% in 1997, 74% in 2002 and 79% in 2007 in men; 75, 75 and 78% in women, respectively) remained stable. The mean diastolic blood pressure (BP) decreased in both genders. Awareness of hypertension increased from 60 to 71% in men (P<0.001 for trend) and from 66 to 76% (P=0.012) in women. The prevalence of antihypertensive drug treatment among hypertensive people increased from 35 to 56% in both genders (P<0.001). The proportion of treated hypertensive patients with adequately controlled BP increased from 16 to 32% in men (P<0.001) and from 16 to 30% in women (P=0.003). Hypertension care in older adults has improved in Finland during 1997 to 2007. The situation is not optimal: the main problem in this age group is high SBP.

The effects of awareness, treatment and control of hypertension on cardiovascular and all-cause mortality in a community-based population.

The objective of this prospective follow-up study (median follow-up time 20 years) was to investigate whether there are differences in cardiovascular disease (CVD) and all-cause mortality among hypertensive men and women by awareness, treatment and blood pressure (BP) control status. The study was carried out among 20,358 men and 21,537 women aged 25-64 years living in Eastern and south-western Finland within the framework of the North Karelia Project and the Finrisk studies. Risk factors of CVD and life-style habits were assessed by a self-administered questionnaire, BP and laboratory measurements. The participants were classified into five groups according to their BP status: (i) normotensive, (ii) patients treated with antihypertensive drugs and controlled for HT, (iii) patients treated with antihypertensive drugs but uncontrolled for HT, (iv) hypertensive people aware of their HT but untreated, (v) hypertensive people unaware of their hypertension (HT). In men, all-cause and CVD mortality was significantly higher in all HT subgroups compared with the normotensive group. The risk increase for CVD mortality was 49-125% and 27-79% for all-cause mortality, respectively. Treated and controlled hypertensive women at baseline did not have any increase in CVD (hazard ratio (HR) 1.14; 95% CI 0.89-1.46) or all-cause mortality (HR 1.09; 95% CI 0.72-1.67) compared with normotensive women. In men, however, the corresponding HR were 1.58 (95% CI 1.28-1.96) for CVD and 2.25 (95% CI 1.70-2.99) for all-cause mortality. Treated hypertensive women seem to benefit from achieving normal BP.

Community control of hypertension- experiences from Finland.

The improvement in the hypertension control in Finland started in the 1970s by the activities of the North Karelia Project, a comprehensive programme for the control of cardiovascular diseases. The blood pressure level of the population has had a continuous downward trend according to the population surveys conducted every fifth year since 1972 and the rule of halves has changed to the rule of two-thirds. The serum cholesterol level has decreased among hypertensives, even though it is still higher than among normotensives; the patients with antihypertensive drug treatment smoke less than the rest of the population. However, the situation is far from optimal; BP levels are high and body mass index is continuously increasing among the patients. The need for intensifying both pharmacological and nonpharmacological treatment among the hypertensives on a large scale is obvious.

Effectiveness of multidisciplinary lifestyle intervention for hypertension: a randomised controlled trial.

Lifestyle factors like weight, alcohol consumption, salt intake and physical activity have shown to be important in treating hypertension. There have been made some randomised trials about the effects of lifestyle interventions, but the numbers of patients have been relatively small and the durations of follow-ups have been short. No controlled trials assessing the effects of lifestyle intervention in a rehabilitation setting have been reported. In this study, the effects of multidisciplinary lifestyle intervention in rehabilitation centres among middle-aged hypertensive employees were described. A total of 731 hypertensives from 45 worksites were randomised to lifestyle intervention in a rehabilitation centre or to usual care in an occupational or primary health-care centre for 12 months. Standard measurements were conducted before the intervention and 1-year later. Blood pressure (BP) levels were clearly reduced in the intervention group, while only minor changes were observed in the control group. The net changes between the two groups both for systolic and diastolic BPs were -2.1 mmHg (95% confidence intervals (CI) -4.0 to -0.1) and -1.5 mmHg (95% CI -2.6 to -0.4), respectively. The net changes were greater among men than women. The multidisciplinary lifestyle intervention in a rehabilitation centre setting produced significant reductions in BP among middle-aged employees with hypertension.

Smoking trends in hypertensive and normotensive Finns during 1982-1997.

Despite the evidence that smoking is one of the main predictors of the cardiovascular disease risk among hypertensive subjects, there are very few data available of the smoking trends of these subjects at public health level. This study assesses the trends in smoking and in smoking cessation advice given by physicians in the hypertensive and normotensive population in Finland during 1982-1997. The data were derived from four independent cross-sectional standardised population surveys conducted in 1982, 1987, 1992 and 1997 in the provinces of North Karelia and Kuopio in eastern Finland and the region of Turku-Loimaa in south-western Finland. Men and women aged 25-64 years, selected randomly from the national population register, were classified to four groups according to their blood pressure level and antihypertensive treatment status: normotensive, unaware hypertensive, aware but not treated hypertensive and treated hypertensive. The total number of participants was 24 083. In men, the prevalence of smoking decreased significantly in both treated hypertensive patients and normotensive subjects during 1982-1997, whereas it increased significantly in treated hypertensive women. The proportion of current smokers who had been advised to stop smoking by their physician was significantly higher in treated hypertensive men compared to the other subgroups of men (P < 0.001). The observed decreasing trend in smoking in men is encouraging, but the increase in smoking among hypertensive women taking antihypertensive medication warrants concern. In the future, the methods used for smoking cessation advice given by health care personnel should be intensified to make this effort more effective.

Blood pressure levels and obesity trends in hypertensive and normotensive Finnish population from 1982 to 1997.

OBJECTIVE: To assess the trends in blood pressure (BP) and in body mass index (BMI) in the hypertensive and normotensive population in Finland during 1982-1997. DESIGN: Four independent cross-sectional standardized population surveys were conducted in 1982, 1987, 1992 and 1997. SETTING: The provinces of North Karelia and Kuopio in eastern Finland and the region of Turku-Loimaa in southwestern Finland. PARTICIPANTS: Men and women aged 25-64 years were selected randomly from the national population register. The participants were classified into four groups according to their BP level and treatment status: normotensive, unaware hypertensive, aware but untreated hypertensive and treated hypertensive. The total number of participants was 24,083. MAIN OUTCOME MEASURES: The means of systolic BP (SBP), diastolic BP (DBP) and BMI, as well as the distribution of BMI among the four study groups were measured. RESULTS: Mean SBP decreased significantly in all groups. The fall in DBP was significant only in drug-treated hypertensive men and women (P< 0.001). Mean BMI increased significantly in all groups except in aware hypertensive women receiving no antihypertensive drug treatment The proportion of obese subjects (BMI > 30 kg/ m2) increased most in aware hypertensive men and in drug-treated hypertensive women. CONCLUSIONS: The prevalence of obesity has increased significantly in normotensive and particularly in hypertensive Finns during the past 15 years. There is an urgent need for more effective measures for weight reduction in obese hypertensive patients in primary healthcare, and for the prevention and control of obesity in the whole population.

Trends in lipid levels and hypercholesterolemia in hypertensive and normotensive finnish adults from 1982 to 1997.

OBJECTIVES: To assess the trends in lipid levels and awareness of hypercholesterolemia in hypertensive and normotensive population in Finland from 1982 to 97. DESIGN: Four independent cross-sectional population surveys conducted in 1982, 1987, 1992 and 1997. SETTING: The provinces of North Karelia and Kuopio in eastern Finland and the region of Turku-Loimaa in south-western Finland. SUBJECTS: Men and women aged 25-64 years, selected randomly from the national population register. The subjects were classified to four groups according to their blood pressure level and treatment status: normotensive, unaware hypertensive, aware but not treated hypertensive and treated hypertensive. The total number of participants was 24 083. MAIN OUTCOME MEASURES: We assessed the mean serum total cholesterol and HDL cholesterol concentrations, the prevalence of hypercholesterolemia (total cholesterol >/=6.5 mmol L-1 or the use of lipid-lowering drugs), the prevalence of a high ratio of total cholesterol to HDL cholesterol (ratio >/=5) and the awareness of hypercholesterolemia amongst the four study groups. RESULTS: Mean total cholesterol, the prevalence of hypercholesterolemia and the prevalence of a high ratio of total to HDL cholesterol decreased, whereas the awareness of hypercholesterolemia increased significantly in all study groups. The decline in mean total cholesterol was largest in treated hypertensive subjects of both sexes (13% in men, 14% in women). Mean HDL cholesterol increased significantly in all study groups except in the unaware hypertensive men, but it remained significantly lower in treated hypertensive patients in both sexes compared with the other groups (P < 0.001). CONCLUSIONS: The lipid profile of both the hypertensive and normotensive population has significantly improved in both the hypertensive and normotensive population in Finland from 1982-97. The introduction of newer antihypertensive drugs has not had any effect on the HDL cholesterol level amongst treated hypertensive patients at the population level.

Trends in blood pressure levels and control of hypertension in Finland from 1982 to 1997.

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.