Cardiology Letters 2021, 30(3):148-158

Screening for Arterial Hypertension in Primary Healthcare Facilities in Slovakia - the "Charter 70/2023" Initiative

Charta 70/2023

¹ Klinika kardiológie a angiológie NÚSCH, a. s. a Lekárská fakulta Slovenskej zdravotníckej univerzity v Bratislave

² Katedry štatistiky, Fakulta hospodárskej informatiky Ekonomickej univerzita v Bratislave

³ Benmedika s. r. o., všeobecná ambulancia pre dospelých, Veľký Biel, Slovenská republika

Arterial hypertension (AH) is the most prevalent modifiable risk factor for cardiovascular morbidity and mortality and in about half of the cases it is the determining factor for stroke and coronary heart disease. In addition, significant burdens of atrial fibrillation and heart failure are attributable to AH. At population level, appropriate management of AH is crucial for cardiovascular health. The "Charter 70/2023" is an initiative to improve BP control so that at least 70% of hypertensive patients in Slovakia achieve target BP values by the year 2023. Study aim: To assess the prevalence of AH in Slovak adult population and to evaluate the level of achieved blood pressure (BP) control in hypertensive subjects by screening BP using guideline recommended method for BP measurement. Population and methods: Screening of BP in adult population during visits to 36 general physicians located in all regions of Slovakia. All persons ≥18 years of age, who visited during 1-2 days offices of participating general physicians for any purpose except fever and willing to undergo a short survey and a BP measurement were included. The guideline recommended method for BP measurements consists of 3 consecutive measurements within 5 minutes time after resting in sitting position for 5 minutes. The measured BP value corresponded to the calculated mean value from the last 2 measurements.

Results: The screened population included 1260 persons (797 women, 63%) with a mean age of 49.6 ± 18.9 years, 75% were younger than 65 years. AH was treated in 40% of the population, overweight / obesity was present in 52% of women and 71% of men, 27% were smokers or quitted smoking. AH defined as calculated systolic BP ≥140 mm Hg and /or diastolic BP ≥ 90 mm Hg was found in 431 persons, corresponding to a prevalence of 34.2%. AH was found in 231 women (29%) and 200 men (43%). Optimal BP values (≤120/80 mm Hg) were found in 34% of women and in 13% of men. Comparing BP values from measurement #1 with the mean of the measurements # 2 and # 3 a mean reduction of systolic BP of 6.3 ± 8.3 mm Hg (p < 0.01) and of diastolic BP of 2.6 ± 6.3 mm Hg were found. These findings suggest that performing just a single BP measurement may overestimate the prevalence of hypertension - in our cohort this would be the case in 163 persons (13%). Among 509 patients with AH (40.4% of the cohort) acceptable BP values of <140/90 mm Hg were found in 232 patients (45.6%). Detection of hypertension during screening in persons not treated for AH identified 144 patients (11.4%) in whom diagnosis of AH will possibly be confirmed with new measurements after variable time delay.

Conclusion: BP should be measured with the standardised guideline recommended oscillometric method with 3 consecutive measurements with final value calculated as mean of the 2 last measurements. First measurement incorrectly increases the value of systolic BP by 6.3 ± 8.3 mmHg (p < 0.01) and that of diastolic BP by 2.6 ± 6.3 mmHg. This would falsely increase the relative proportion of hypertensives in the studied population by 13%. With the correct technique of BP measurement 34.2% prevalence of AH was calculated for our population. Insufficient, above target BP values were found in 54.4% of treated hypertensives. Thus, an unmet need for improving BP control in the general population in Slovakia is evident and should be addressed.

Keywords: blood pressure; arterial hypertension; primary healthcare

Published: March 1, 2021  Show citation