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Prevalence of Arterial Hypertension in the Italian Population

Simona Giampaoli1, Maria Fenicia Vescio1, Andrea Gaggioli1, and Diego Vanuzzo2 on behalf of the Research Group of the Observatory for Cardiovascular Epidemiology3

1Istituto Superiore di Sanità, Laboratorio di Epidemiologia e Biostatistica, Roma

2Agenzia dei Servizi del Friuli Venezia Giulia, Udine

3Members listed in reference 4

 

Although mortality from arteriosclerotic heart disease has declined over the past 30 years in Italy, coronary artery disease and stroke are still common conditions and remain among the most frequent causes of disability.

A number of epidemiologic studies have demonstrated the excess risk of heart disease, especially coronary artery disease and stroke that is attributable to hypertension, (1). Controlled clinical trials on the modification of dietary habits and on the use of antihypertensive drugs have shown the substantial benefit resulting from these preventive measures, both in middle-aged and older persons (2,3). The purpose of this article is to communicate information obtained from a study conducted of the general population in Italy regarding the prevalence of arterial hypertension.

 

The study was conducted by members of the Observatory for Cardiovascular Epidemiology, which represents a collaboration between the Istituto Superiore di Sanità and ANMCO (Association of Hospital Cardiologists). Between 1998 and 2000, 4437 men and 4397 women between 35 and 74 years of age from the general population were enrolled and examined in 46 cardiology centres (cardiology divisions or services) throughout the country. A detailed description of the methodology can be found elsewhere (4). The persons examined underwent measurement of blood pressure twice, with the measurements taken 5 minutes apart and performed according to the standardized methods used in the World Health Organization’s Monitoring of Cardiovascular Disease (MONICA) project. Additional information was collected on prior history of hypertension and drug therapy. For purposes of this analysis, the mean value of the two measured blood pressures were used.

 

Values corresponding to the median, the 25th percentile, and the 75th percentile of systolic and diastolic pressure for the study population, stratified by sex and geographic area were determined. The prevalence of borderline hypertension was calculated by determining the number of persons who had systolic pressures between 140 and 160 mm Hg or who had diastolic pressures between 90 and 95 mm Hg. Persons were considered hypertensive if they had systolic pressures greater than or equal to 160 mm Hg or diastolic pressures of 95 or greater mm Hg or were on antihypertensive treatment. The population of hypertensives on treatment was further stratified by level of control; a person was considered to be adequately treated if they had pressures less than 160 and 95 mm Hg, while those whose values exceeded these levels were consider to not be under adequate treatment.

Blood pressure values and the prevalence of hypertension among men and women by region are reported in Figure 1 and 2. Overall, 31% of the Italian population in the study population of persons 35-74 years of age was hypertensive and an additional 17% were borderline. In men, hypertension levels were highest in the Northeast (37%) and Northwest (32%); among women, the highest values were seen in the South (34%). As reported in the literature, the prevalence of hypertension increased with increasing age; in women, the change was particularly marked after menopause.

 

Overall, the proportion of treated hypertensives was greatest in the South (63%) and lowest in the Northwest (49%) and Northeast (51%). The proportion of hypertensive men under adequate treatment ranged from 24% in the Northeast and Northwest to 33% in the Center and 29% in the South; the situation was slightly better among women; the proportion adequately treated was 36% in the Northwest, 40% in the Northeast, 46% in the Center, and 37% in the South. The proportion of hypertensives not under treatment was high among men in all areas of the country, with values ranging from 56% in the Northwest, to 55% in the Northeast, 47% in the Center, and 45% in the South; the corresponding proportions in women were 40%, 40%, 31% and 27%. It is interesting to note that a high percentage of the hypertensives were unaware that they had hypertension (overall 27%, ranging from 32% in the Northeast, 30% in the Northwest, 19% in the Center, and 24% in the South; most had not had their pressure evaluated during the previous year.

 

The high prevalence of hypertension among both men and women, the differences in prevalence between the North, the Center, and the South, and the high proportion of persons with hypertension who were not receiving adeguate treatment are of concern. It is interesting to note that women appear to be under better management that the men, perhaps because they pay more attention to health issues. What is surprising is the high percentage of hypertensives who are not under treatment; the majority of whom were unaware they were hypertensive and had not been tested in the past year. The measurement of blood pressure is a simple, inexpensive, rapid, and non-invasive procedure, and if it is performed in a standardized way, can be of great importance in the evaluation of cardiovascular disease risk.

 

Measures that are effective in preventing or treating hypertension include eating a diet that contains fruits and vegetables, low quantities of saturated fats, and limited amounts of salt, increasing levels of physical activity, which helps decrease excess weight, and adequate drug treatment. A number of drugs are available that are safe and that produce excellent blood pressure control when used appropriately.

Cardiovascular and cerebrovascular diseases are among the most important health problems in Italy in terms of preventable deaths, disability, quality of life, and financial and human resources. Routine medical visits represent an excellent opportunity for measuring blood pressure.

 

Bibliografia

1. Mac Mahon S, Peto R, Cutler J, et al: Blood pressure, stroke and coronary heart disease: Part 1. Prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias. Lancet 1990; 335: 765–774.

2. Sacks FM, Svetkey LP, Vollmer WM, Appel LJ, Bray GA, Harsha D et al. Effects on Blood Pressure of Reduced Dietary Sodium and the Dietary Approaches to stop Hypertension (Dash) Diet. New England Jour Med 2001; 344: 3-10.

3. Insua JT, Sacks HS, Lau T, Lau J, Reitman D, Pagano D et al. Drug Treatment of Hypertension in the Elderly: A Meta-Analysis. Ann Intern Med. 1994; 121: 355-62.

4. Giampaoli S, Vanuzzo D. I fattori di rischio cardiovascolare in Italia: una lettura in riferimento al Piano Sanitario Nazionale 1998-2000. Giornale Italiano di Cardiologia 1999; 29 (12): 1463-1471.