Българска Лига по Хипертония

ABDOMINAL OBESITY, BLOOD PRESSURE AND DIABETES MELLITUS IN BULGARIAN URBAN POPULATION.

St. Naydenov, Sv. Torbova, F. Nikolov,  Sv. Tsonev , N. Naydenova

The risk for arterial hypertension (AH), diabetes mellitus (DM) and cardiovascular diseases (CVD) increases with the increase of the waist circumferences (WC).

Objective: To assess the blood pressure (BP), abdominal obesity (AO) and blood sugar (BS) and their correlations in Bulgarian urban population.

Design and method: A cross-sectional study, conducted between 17^th of May – World Hypertension Day with motto ”Healthy weight – healthy BP” and 22^th of May 2010 – the first European Obesity Day. Measurements of  BP, WC and BS were organized in 4 large Bulgarian cities by the Bulgarian Hypertension League, Cardiology Department of the Medical University in Plovdiv and  the “Self-control” program. One thousand five hundred and thirty-five volunteers participated – 689 males and 846 females, mean age 58.9±16.4 (14-95) years. A structured questionnaire was completed and BP, WC and BS were measured by trained students in Medicine. According to the WC the participants were divided into 3 groups: 1. Healthy males with WC <94 cm and women <80cm; 2. Increased WC and cardiovascular risk – WC of males 95-101cm and females 81-87cm; 3. High cardiovascular risk – abdominal obesity with WC of males > 102 cm and females >88 cm.

Results: Healthy WC was found in 47.8% of the males and 23.8% of the females. Increased WC was found in 52.2% males and 16.9% females. Abdominal obesity was present in no one of the males but 59.3% of the females. The WC increased with age. The mean age of the groups were as follows: healthy WC males – mean age 52.3 years; increased WC – mean age 60.9 years; abdominal obesity – mean age 63.4 years. The correlation between BP and WC shows that participants with arterial hypertension (AH) have normal WC in 40.6%, increased WC in 45.8% and abdominal obesity in 13.6%. Participants without history of AH have normal WC in 25.7%, increased in 17.5% and abdominal obesity in 56.0%. The WC in participants with diabetes mellitus (n=88) was as follows: normal WC in 18.2% increased in 20.5% and abdominal obesity- 61.4%. The correlation between population’s BP and WC was as follows: the mean BP of the participants with healthy WC was 133/78 mmHg, participants with increased WC – 142/80 mmHg and in participant with abdominal obesity – 144.1/84.5 mm Hg. The mean values of the blood glucose were 5.64±1.94, 5.98±1.32mmol/L and 6.5±1,99 mmol/L for the three groups respectively.

Conclusions: Two thirds of Bulgarian urban population has unhealthy WC and 40% – abdominal obesity. The percent of abdominal obesity in Bulgarian hypertensive population is low- 13.6, but in diabetics and normotensives is high.   These results, as well as the data for increase of the mean population’s BP with the increase of WC, show the insufficient information of the Bulgarian urban population for the abdominal obesity as a cardiovascular risk factor.

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TREATMENT APPROACH OF ARTERIAL HYPERTENSION IN DIFFERENT TYPES BULGARIAN CITIES: IS IT DIFFERENT?

Sv. Tsonev, Sv. Torbova, St. Naydenov, N. Naidenova

The data  from Bulgarian National Health  Insurance  Fund show  a different cost for  the same disease in different  cities :higher cost in the biggest cities.

The aim of the our study was to assess    if the treatment approach, respectively the cost, of the antihypertensive treatment in different type cities is different Methods: A cross- sectional study was performed from July to October 2009 year.1962 hypertensive patients – 866 males and 1090 females, mean ages 63,69  years were included. The cities were as follow :  Gr1.Capital of Bulgaria, Sofia  with 1 200000 residents( 424 patients); Gr.2.Big cities with > 100 000 ressidents( 315 patients );Gr. 3. Midle cities : 50-100000 residents (804 patients); Gr 4. Small cities: 10-50 000 residents(318 patients); and Gr.5. -Villages < 10 000  residents( 90 patients)

Results . The mean blood pressure (BP)  of the patients from the   different types of cities, ( 1-5,) were very close, respectively: 141/86 mmHg, 142/86mmHg, 143/87 mmHg,144/87mmHg,142/84mmHg.The prescribed  antihypertensive drugs were as follow.  The RAAS blockers / ACE inh/ ARB/  were prescribed   in more than 55% of all patients  ( the  Capital in 59%, Gr. 2  in 59%, Gr 3. in  60%, Gr4 in.65% Gr.5. in 57% ). Calcium Channel Blockers were prescribed in very close percent for rhe cities Gr 1 to 5 ( 34%,29%,30% 37%38%). Diuretics were prescribed   in about 50% of the all patients (Gr 1. 50%, Gr 2. 57%, Gr3.49% Gr4.57%, Gr5. 53% ). The   one from 5   Bulgarian hypertensive  patient received Fixed –Dose Combination. In the group was as follow: .Gr .1 28%, Gr. 2. 23%, Gr.3.27% Gr.4 .and Gr.5. -23% . The treatment with statines were from 36% in the Gr 3. to 52% in the Gr1. the Capital Sofia.

Conclusions: The treatment approach of arterial hypertension and the concomitant disly pidemia in Bulgaria is according  the last European  Recommendations independently of the type of the cities  – big or small.  A tendency for higher per cent of the prescription of the FDC as of the statines were  established in the Bulgarian capital Sofia, but differences are not significant.