ARTERIJSKA HIPERTENZIJA U HRVATSKOJ
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1 ARTERIJSKA HIPERTENZIJA PREVALENCIJA, SVJESNOST, LIJEČENJE, KONTROLA U HRVATSKOJ
2 ... one of the major issues of modern medicine is how to increase disease-free and incapacity-free life expectancy. Benetos, 2005 f Hypertension 22,4 1,8 1,3 3,9 High normal BP 27,6 1,4 1,4 2,9 Normal BP 29,5 1 0,9 2,8 m Hypertension 17,3 3,2 1,4 2,8 High normal BP 21,3 3,2 0,9 2,7 Normal BP 24,5 0,9 2,1 2, age Franco, 2005 LE free of CVD LE with MI LE with Stroke LE with other CVD 50-year-old normotensives - survived 7.2 years longer without CV disease than HT, - lived 5 years longer!
3 UZROCI SMANJENJE KVALITETE ŽIVOTA I PRERANE SMRTI tjelesna inaktivnost premalo voća i povrća 1,9 3,3 3,9 debljina 2,7 7,4 alkohol 6,2 9,2 hiprlipidemija 1,9 2,1 7,6 pušenje ,2 HIPERTENZIJA 2,5 5 10,9 Yach, JAMA 2004 RAZVIJENE U RAZVOJU NERAZVIJENE
4 Ukupna smrtnost i učinak faktora rizika Global Burden of Disease Study Murray, Lopez najčešćih čimbenika rizika za godine izgubljenog života zbog preranog mortaliteta ili poremećene kvalitete života (DALY) u razvijenim zapadnim zemljama i zemljama bivših socijalističkih ekonomija % DALY malnutricija voda,sanitarije pušenje alkohol profesionalno HIPERTENZIJA tjelesna inakt. nedozvoljeni lijekovi 3
5
6 Lancet, 2005;365: 217 The number of adults with hypertension in 2025 was predicted to increase by about 60% to a total of 1.56 billion.
7 EUROPA SJEVERNA AMERIKA prosječni RR 136/83 127/77 prevalencija AH 44% 28% Wolf-Maier et al, JAMA 2003
8 number of HT rose 30%!!! population grew 13.2 %
9 Lancet, 2005;365: 217 NITI JEDNA STUDIJA IZ ZEMALJA S BIVŠOM SOCIJALISTIČKOM EKONOMJOM nije ispunila kriterije za uključenje! Cifkova et al. Czech Republik, J Hum Hypertens 2004
10 HRVATSKA 1. Visoka stopa KV smrtnosti (oko 53%) 2. Pripada FSE, ALI NIJE BILA dio ISTOČNOG BLOKA 3. Smještena u DVIJE REGIJE: Mediteran i Srednja Europa 4. Nema nacionalne studije o prevalenciji, svjesnosti, liječenju i kontroli hipertenzije 5. EHUH studija - pilot
11 EPIDEMIOLOGIJA HIPERTENZIJE U HRVATSKOJ EH-UH studija ispitanika starijih od 18 godina ispunilo sve kriterije potrebne za analizu -80 liječnika opće medicine -randomizirane listu (registar osiguranika) -živin tlakomjer + 2 veličine orukvica -kućna posjeta + 2 pregleda u ambulanti (različita vremena dana) -RR je mjeren 2 puta u 3 položaja (sjedeći, stojeći, ležeći) -tjelesna masa i visina su određene i izračunat je ITM Jelaković, project Min.science Rep of Cro Šmuc, project Min.science Rep of Cro
12 Karakteristike nacionalnih studija Zemlja Broj ispitanika % populacije Dob Metoda Kanada , registar osiguranika SAD , >80 populacijski registar Engleska , >80 adrese Finska , populacijski registar Njemačka , populacijski registar Italija , populacijski registar Španjolska , nacionalni registar Švedska , populacijski registar EHUH , >80 registar osiguranika sponzorstvo i suradnja Abbott Laboratories Wolf-Maier, 2003 B. Jelaković, projekt Min.znanosti T.Šmuc, projekt Min.znanosti
13 Karakteristike nacionalnih studija Zemlja Uređaj Mjerenje AT Broj orukvica Br.mjerenja Kanada RR med.sestra 3 4 SAD RR liječnik 4 6 Engleska Dinamap med.sestra 4 3 Finska RR med.sestra 3 2 Njemačka RR obučena osoba 3 3 Italija RR med.sestra 2 2 Španjolska RR liječnik 2 3 Švedska RR med.sestra 3 2 EHUH RR liječnik 2 18 (6) sponzorstvo i suradnja Abbott Laboratories Wolf-Maier, 2003 B. Jelaković, projekt Min.znanosti T.Šmuc, projekt Min.znanosti
14 Karakteristike EHUH ispitanika Muškarci Žene Total p m vs. ž Dob 52.0 (16.0) 53.5 (15.8) 52.9 (15.9) NS ITM 27.0 (3.9) 27.3 (5.3) 27.2 (4.8) < ITM > 30 (%) Obrazovanje (%) < 8 godina < Prihod (%) < 1500 kn/m < Pušači (%) < Tjelesna aktivnost (%) Nikada < 0.001
15 VRIJEDNOSTI ARTERIJSKOG TLAKA U 41 POPULACIJI MONICA WHO Project Wolf,, 1997 Država muškarci žene... Poljska 143/90 142/85 Italija 142/87 138/84 Njemačka 140/84 138/82 Madžarska 139/88 138/86 Rusija 139/89 140/87 Jugoslavija 135/86 135/84 Češka 132/84 126/79 Cifkova 2004 EH-UH 137/84 134/83 sponzorstvo i suradnja Abbott Laboratories B. Jelaković, projekt Min.znanosti T.Šmuc, projekt Min.znanosti
16 EH-UH Prevalencija hipertenzije u Hrvatskoj Ukupno muškarci žene age-adjusted sponsorship and collaboration Abbott Laboratories Jelaković, project Min.science Rep of Cro Šmuc, project Min.science Rep of Cro
17 RASPODJELA KATEGORIJA ARTERIJSKOG TLAKA U NORMOTONIČARA 37,1 OPTIMALAN 47,1 24,5 p = NORMALAN 27,8 36,3 38,5 NT svi NT ž NT m VISOKO NORMALAN 25 30,1 39,1 p = age-adjusted
18 EH UH Prevalencija hipertenzije Država svi muškarci žene Canada United States England Finland Germany Italy Spain Sweden Czech Rep Slowakia EHUH sponsorship and collaboration Abbott Laboratories Wolf-Maier, 2004 Cifkova, 2004 Rieckansky, 1991 Jelaković, project Min.science Rep of Cro Šmuc, project Min.science Rep of Cro
19 PREVALENCIJA HIPERTENZIJE OVISNO O DOBI 90,0 80,0 83,4 90,0 80,0 70,0 67,3 73,4 70,0 60,0 60,0 50,0 51,6 50,0 40,0 40,0 30,0 20,0 25,0 30,0 20,0 10,0 10,1 DEKADA 10,0 0,0 0,2 0, ,0 M F TOTAL sponsorship and collaboration Abbott Laboratories Jelaković, project Min.science Rep of Cro Šmuc, project Min.science Rep of Cro
20 PREVALENCIJA HIPERTENZIJE U RAZLIČITIM REGIJAMA 43.5 p = KONTINENT 34.8 MEDITERAN 37.4 age-adjusted
21 RASPODJELA KATEGORIJA ARTERIJSKOG TLAKA U NELIJEČENIH (%) HIPERTNIČARA STADIJ 1 46,1 49,1 STADIJ 2 STADIJ 3 0,0 6,5 12,3 19,6 neliječene Ž neliječeni M ISH 41,5 40,9 age-adjusted sponsorship and collaboration Abbott Laboratories Jelaković, project Min.science Rep of Cro Šmuc, project Min.science Rep of Cro
22 PRETILOST I HIPERTNEZIJA PP Rubens, 1624, Three Graces, Prado Madri
23 PREVALENCIJA HIPERTENZIJE OVISNO O INDEKSU TJELESNE MASE % H 80,0 70,0 60,0 50,0 40,0 30,0 20,0 10,0 0,0 73,2 65,1 47,2 45,7 29,0 25,2 < > 30 BMI M F 50,0 46,6 cijela skupina ITM < % % > % 40,0 30,0 20,0 10,0 0,0 36,3 36,3 31,7 27,3 21,6 < > 30 m f age-adjusted
24 Distribucija kategorija hipertenzije prema spolu i ITM JNC - Male Hip-2 Hip-1 % per BMI interval 100% 80% 60% 40% 20% 0% < >32 BMI PreHip Norm 100% % per BMI interval 80% 60% 40% 20% JNC-Female Hip-2 Hip-1 PreHip Norm 0% < >32 BMI sponsorship and collaboration Abbott Laboratories Jelaković, project Min.science Rep of Cro Šmuc, project Min.science Rep of Cro
25 Povezanost ITM i sistoličkog RR je izrazitija u žena WHO MONICA 1997 Wolf, % per BMI interval JNC - Male 100% 80% 60% 40% 20% 0% < >32 BMI Hip-2 Hip-1 PreHip Norm 100% % per BMI interval 80% 60% 40% 20% JNC-Female Hip-2 Hip-1 PreHip Norm 0% < >32 BMI
26 PREVALENCIJA HIPERTENZIJE I PRETILOSTI U RAZLIČITIM REGIJAMA p = % p = H % ITM age-adjusted
27 SOCIOEKONOMSKI STATUS I HIPERTENZIJA Millet , L Angelus, Musee d' Orsay, Paris
28 PREVALENCIJA HIPERTENZIJE OVISNO O MJESEČNOM PRIHODU 60,0 50,0 48,6 49,2 47,3 40,0 30,0 33,3 27,9 32,3 20,0 14,5 16,6 10,0 0,0 < >5000 M F KN / MONTHLY 50,0 47,3 MJESEČNI PRIHOD < % 45,0 40,0 35,0 30,0 25,0 20,0 15,0 10,0 5,0 0,0 41,8 33,0 28,5 22,0 14,5 6,7 0,2 < >5000 m ž age-adjusted
29 EH-UH Prevalencija Svjesnost Liječenje Kontrola m ž age-adjusted sponsorship and collaboration Abbott Laboratories Jelaković, project Min.science Rep of Cro Šmuc, project Min.science Rep of Cro
30 Karakteristike nacionalnih studija Svjesnost Liječenje Kontrola Kontrola svih HT liječenih HT Država Canada United States England Germany Italy Spain Sweden Czech Rep EHUH sponsorship and collaboration Abbott Laboratories Wolf-Maier, 2004 Cifkova, 2004 Jelaković, project Min.science Rep of Cro Šmuc, project Min.science Rep of Cro
31 Broj korištenih lijekova ,3 33,3 > 85% niske doze 23,3 1 lijek 2 lijeka 3 i više 1 drug 34% 45% 2 drugs 32% 34% 3 drugs 27% 21% ¾ physicians didn't increase dose despite inadequate BP control Berlowitz, 1998 Mallion, 2001 sponsorship and collaboration Abbott Laboratories Jelaković, project Min.science Rep of Cro Šmuc, project Min.science Rep of Cro
32 KARAKTERISTIKE NEKONTROLIRANIH HIPERTONIČARA 60 < 8 godina 50 < 1500 kn/mj ITM > 25 Nikada income education BMI Physical act 1 21,1 15,2 17,6 19,2 2 36,4 31,7 42,3 34,7 3 42,3 52,9 44,7 46,1 sponsorship and collaboration Abbott Laboratories Jelaković, project Min.science Rep of Cro Šmuc, project Min.science Rep of Cro
33 PROMJENE ŽIVOTNIH NAVIKA ,1 57,3 3 Smanjiti ITM 72,8 70,9 4,4 Smanjiti NaCl 36,9 19,1 2,8 Prestati pušti 44,7 34,9 4,5 Smanjiti alkohol 59,5 33,1 2,4 Povećati tjelesnu aktivnost Savjet liječnika Odgovor liječniku Anonimna anketa sponsorship and collaboration Abbott Laboratories Jelaković, project Min.science Rep of Cro Šmuc, project Min.science Rep of Cro
34 Jadranska obala, ljeto 2005
35 EH-UH zaključak 1. Prevalencija, svjesnost, liječenje i kontrola hipertenzije u Hrvatskoj je u skladu s drugim europskim državama. 2. Uočena je razlika između mediteranske i kontinentalne regije. 3. Pretilost i socioekonomski čimbenici utječu na prevalenciju i kontrolu hipertenzije. ---> ključno je inaprijediti primarnu prevenciju (globalna edukacija) 4. Uočena je razlika između muškaraca i žena --- > različit pristup 5. Medikamentno liječenje je nedostatno --> mnogi liječnici još ne teže ciljnim vrijednostima, suboptimalne doze monoterapija sponsorship and collaboration Abbott Laboratories Jelaković, project Min.science Rep of Cro Šmuc, project Min.science Rep of Cro
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