Cascade of care for hypertension among apparently healthy and unhealthy individuals of 25-64 years in the Czech Republic.

BACKGROUND: Despite accessible diagnostics and treatment of hypertension, a high proportion of patients worldwide remain unaware of their diagnosis, and even more remain untreated. Several studies suggest that absence of comorbidities is a predictive factor for unawareness and consequently non-treatment of hypertension. There are only a few studies that have assessed the hypertension prevalence and management among apparently healthy individuals. OBJECTIVE: The aim of the study was to assess and compare hypertension prevalence, awareness, treatment and control among apparently healthy individuals, patients with internal diseases, and patients with non-internal diseases. METHODS: Data from standardised blood pressure measurements conducted during the Czech European Health Examination Survey 2014 and information on health status and health care use collected during the Czech European Health Interview Survey 2014 were analyzed. We focused on participants aged 25-64. Data were weighted on sex and age to ensure an appropriate sex and age structure of the population. The χ2-test and binary logistic regression analyses were used to compare distribution of cascade of care for hypertension between the health-status groups of respondents. RESULTS: The final eligible sample consisted of 1121 participants. The prevalence of hypertension was 32.8% in the healthy group, 29.8% in the non-internal disease group and 52.4% in the internal disease group, (p < 0.001). Awareness was 54.1%, 59.1% and 85.2% respectively, (p < 0.001). Treatment was 44.2%, 52.6% and 86.4%, respectively, (p < 0.001). Among apparently healthy respondents 62.6% had their blood pressure measured by a medical professional in the last year, compared to 71.1% in the non-internal disease group and 91.7% in the internal disease group, (p < 0.001). Differences in hypertension control were not statistically significant. CONCLUSIONS: Generally, our data show a discordance in hypertension management within the Czech population. Apparently healthy individuals are the least aware of their diagnosis and the highest proportion of them remain untreated.

Outcomes of Alcohol Septal Ablation in Patients With Severe Left Ventricular Outflow Tract Obstruction: A Propensity Score Matching Analysis.

BACKGROUND: The current ACC/AHA guidelines on hypertrophic cardiomyopathy (HCM) caution that alcohol septal ablation (ASA) might be less effective in patients with left ventricular outflow tract obstruction (LVOTO) ≥ 100 mm Hg. METHODS: We used a multinational registry to evaluate the outcome of ASA patients according to baseline LVOTO. RESULTS: A total of 1346 ASA patients were enrolled and followed for 5.8 ± 4.7 years (7764 patient-years). The patients with baseline LVOTO ≥ 100 mm Hg were significantly older (61 ± 14 years vs 57 ± 13 years; P < 0.01), more often women (60% vs 45%; P < 0.01), and had a more pronounced HCM phenotype than those with baseline LVOTO < 100 mm Hg. There were no significant differences in the occurrences of 30-day major cardiovascular adverse events in the 2 groups. After propensity score matching (2 groups, 257 pairs of patients), the long-term survival was similar in both groups (P = 0.10), the relative reduction of LVOTO was higher in the group with baseline LVOTO ≥ 100 mm Hg (82 ± 21% vs 73 ± 26%; P < 0.01), but the residual resting LVOTO remained higher in this group (23 ± 29 mm Hg vs 13 ± 13 mm Hg; P < 0.01). Dyspnoea (NYHA functional class) at the most recent clinical check-up was similar in the 2 groups (1.7 ± 0.7 vs 1.7 ± 0.7; P = 0.85), and patients with baseline LVOTO ≥ 100 mm Hg underwent more reinterventions (P = 0.02). CONCLUSIONS: After propensity matching, ASA patients with baseline LVOTO ≥ 100 mm Hg had similar survival and dyspnoea as patients with baseline LVOTO < 100 mm Hg, but their residual LVOTO and risk of repeated procedures were higher.

Importance and efficiency of blood pressure control not only in type 2 diabetes patients.

Arterial hypertension is one of the most frequent comorbidities of patients with type 2 diabetes, the rates are approximately three times higher among diabetics than in general population. The presence of both diseases increases the cardiovascular risk of the patients two to three times. Therefore, it is essential to control the blood pressure values vigorously down to 130/80 mmHg as recommended in guidelines of the Czech Hypertension Society. According to EHES Study data, the blood pressure control is not sufficient in Czech diabetic population. The target values are reached in only 29 % of diabetics. A well organized system of care, intensive antihypertensive treatment, self-monitoring of patients or appointment reminder system can be used to improve blood pressure control.

Risk of cardiovascular complications related to blood glucose concentration: from diabetes to prediabetes.

Diabetes is an established risk factor of cardiovascular disease including the coronary heart disease (CHD) and elevates the risk of cardiovascular death 2 times. Based on current evidence the risk of acquiring the CHD increases accordingly to the level of fasting blood glucose even in the prediabetic range. In the range of 5.6-6.0mmol/l the risk is 1.11, in the range of 6.1-6.9mmol/l the risk is 1.17. In the range of HbA1c of 42-47mmol/l the risk of the CHD is 1.28. The probability of the CHD occurrence therefore does indeed increase in conjunction with the fasting blood glucose levels but the dependence is not linear.

Prevalence of diabetes and prediabetes and its risk factors in adults aged 25-64 in the Czech Republic: A cross-sectional study.

AIMS: The aim of this study is to establish the prevalence of diabetes (DM) and prediabetes in the Czech population aged 25-64 years and to evaluate the relationships with various cardiometabolic, sociodemographic, and lifestyle risk factors. METHODS: This was an epidemiological study with a stratified, crosssectional, random sampling design. Sociodemographic, lifestyle, and anamnestic data were collected through interviewer-administered questionnaires, medical examination, and biochemical assays. RESULTS: Among the 1189 participants, 114 were diagnosed with DM (9.6%), 330 with prediabetes (27.8%) and 745 were non-diabetes/non-prediabetes individuals (62.7%). Logistic regression analysis showed that overweight, general and abdominal obesity, hypertension, and lower level of HDL (increased risk) significantly increased the risk of both prediabetes and DM, while living in the cities diminished risk of DM. Among lifestyle variables the significant increased risk of prediabetes and DM was found for smokers and ex-smokers. In other lifestyle variables (marijuana lifetime prevalence, physical activity and frequency of alcohol drinking) the significantly higher or lower risk for prediabetes or DM was not found. CONCLUSIONS: The study shows a high prevalence of DM and prediabetes in the Czech population of age between 25 and 64, providing data on their association with several risk factors.