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A leading scientist from Prague has announced results showing a forty per cent reduction in cardiovascular mortality overall and a sixty per cent fall in stroke deaths between 1985 and 2007 in the Czech Republic. Renata Cifková explains why improvements in blood pressure control and blood pressure levels are the probable causes of these changes.
Milan, Italy – Better awareness and control of blood pressure in the Czech Republic was named as a likely contributor to a “remarkable decrease in cerebrovascular and coronary heart disease mortality” between the years 1985 and 2007, according to a research team from Prague who reported their findings here at the 2009 European Meeting on Hypertension.
Renata Cifková, PhD, Head of the Department of Preventive Cardiology at the Institute for Clinical And Experimental Medicine in Prague presented results from six surveys in the so-called: POST-MONICA study with 6,818 males and 7,154 females aged 25 to 64 conducted between 1985 to 2007. Mortality from cardiovascular disease was reduced (by 46.3% in men and 44% in women) and also from stroke (63.2% and 63.9%).
“We are one of the few post communist countries with a reduction of cardiovascular mortality,” she said in an interview during the hypertension conference.
Dr Cifková said that changes in patterns of hypertension, dyslpidemia, diabetes and smoking, are all involved in this reduction, but that the fall in average blood pressure levels – as well as better control of blood pressure – may have contributed the most.
The investigators found a decrease in the prevalence of hypertension in females (defined as the mean of two readings ≥ 140/90 mmHg), but no change in males. However there was an improvement in awareness and treatment of hypertension in both genders during the 22 year period with more people being treated and better blood pressure control.
Nutritional changes and a reduction of smoking have also taken place during the same time interval and may have contributed to the decline of mortality, Dr Cifková noted, and she reported that lipid data revealed important changes: a median decrease in total cholesterol of almost one mmol not caused by therapy -since only around 10% of Czech people receive statins.
“There is no doubt that nutritional changes have contributed [to the reductions of cardiovascular disease],” she said. Consumption of foods such as red meat and eggs has gone down during the study period, and there was an increase in the consumption of fruit and vegetables.
Despite the lack of data on exercise among the Czech population, the indirect measure of Body Mass Index shows little change, according to the POST-MONICA study findings. So the improvements in mortality are even more remarkable if exercise has not contributed. Dr Cifková pointed out, however, that men have reduced their smoking from around half of the population to a still excessive 34% today. Women smoke as much as before: around a quarter of all Czech women.
But Dr Cifková is not satisfied yet with the contribution medical therapy is making to improve the overall outlook – since she calculates that hypertension is the cause of around half of all cardiovascular deaths:
“We simply need to have more patients on combination therapy,” she said. And she regrets that 40% of patients diagnosed with hypertension are still treated with only one drug.
“The majority of patients, maybe 80% of them, should be on a combination of drugs,” she insisted. And she has a simple message for clinicians: “Measure blood pressure and – if indicated – initiate treatment and try to achieve the goal values.”