ARTERIAL HYPERTENSION: EPIDEMIOLOGICAL SITUATION IN RUSSIA AND OTHER COUNTRIES

Key Facts

• Hypertension , or high blood pressure , is a serious medical condition that significantly increases the risk of developing diseases of the cardiovascular system, brain, kidneys and other diseases.
• An estimated 1.28 billion adults aged 30–79 years worldwide are hypertensive, with the majority (two thirds) living in low- and middle-income countries.
• An estimated 46% of adults with hypertension are unaware they have the disease.
• Less than half (42%) of adults with hypertension are diagnosed and treated.
• About one in five (21%) adults with hypertension have the disease under control.
• Hypertension is one of the leading causes of death worldwide.
• Reducing the prevalence of hypertension by 33% between 2010 and 2030 is among the global targets for the fight against noncommunicable diseases.

More than 700 million people live with untreated hypertension

The number of people with hypertension among adults aged 30–79 years over the past 30 years has been reported in the first comprehensive analysis of global trends in hypertension prevalence, detection, treatment and control, led by Imperial College London and the World Health Organization, published today in The Lancet. increased from 650 million to 1.28 million people. Almost half of these people did not suspect they had hypertension.

Hypertension significantly increases the risk of heart, brain, and kidney disease and is among the leading causes of morbidity and mortality in the world. It is easily detected by measuring blood pressure at home or in a health care facility and often responds well to inexpensive medications.

The study was conducted by a global network of doctors and researchers and covered the period from 1990 to 2021. Recorded blood pressure and treatment data were analyzed covering more than 100 million people aged 30-79 years from 184 countries, which together account for 99% of world population; thus, this is the largest review of the global dynamics of hypertension to date.

After analyzing a huge amount of data, the researchers found that between 1990 and 2021, the overall incidence of hypertension in the world has changed little, but its burden has shifted from rich countries to low- and middle-income countries. While the incidence of hypertension has fallen in rich countries and is now generally at its lowest levels, rates have risen in many low- and middle-income countries.

As a result, the countries with the lowest prevalence of hypertension in 2021 were Canada, Peru and Switzerland, while the highest rates among women were in the Dominican Republic, Jamaica and Paraguay, and among men in Hungary, Paraguay and Poland (data broken down by countries and rankings, see Notes to Editors).

Although the percentage of people with hypertension has changed little since 1990, their number has doubled to 1.28 billion, driven primarily by population growth and aging. In 2021, more than 1 billion people with hypertension lived in low- and middle-income countries (82% of all hypertensive people in the world).

Serious disparities in diagnostic and treatment coverage

Although hypertension can be easily detected and relatively easily treated with inexpensive drugs, the study found significant gaps in diagnostic and treatment coverage. About 580 million hypertensive patients (41% of women and 51% of men) were unaware of their disease because they had never been diagnosed.

The study also found that more than half of people with hypertension (53% of women and 62% of men), or a total of 720 million people, do not receive the treatment they need. Blood pressure was controlled, that is, within normal limits, thanks to the effective use of medications, in fewer than one in four women and one in five men with hypertension.

As Majid Ezzati, one of the study's lead authors and Professor of Global Environmental Health at the Faculty of Public Health at Imperial College London, noted, "The fact that almost half a century after we began to treat hypertension, which is easily diagnosed and treated with inexpensive drugs, so many people with high blood pressure around the world are still not getting the treatment they need is a public health failure.”

Men and women are most likely to be prescribed medications to effectively treat and control hypertension in Canada, Iceland, and the Republic of Korea, where more than 70% of hypertensive patients received treatment in 2021. In comparison, men and women in sub-Saharan Africa, Central, South and South-East Asia and Pacific island countries had the lowest odds of receiving the drugs. In a number of countries in these regions, the proportion receiving treatment was less than 25% among women and 20% among men, demonstrating the enormous inequalities in hypertension treatment that exist worldwide.

It is encouraging that some middle-income countries have been able to scale up treatment and even outpace most high-income countries in treatment and control rates. For example, treatment coverage rates in Costa Rica and Kazakhstan are currently higher than in most upper-middle-income countries.

“Although rates of treatment and control of hypertension have improved in most countries since 1990, there has been no significant change in most sub-Saharan African and Pacific island countries. It is imperative that international donors and national governments take priority action to ensure equity in the treatment of this disease, which poses a serious threat to global health,” said Dr Bin Zhou, Research Fellow at the Department of Public Health at Imperial College London and lead of the analysis.

New WHO recommendations for the treatment of hypertension

Another document released today, WHO Guidelines for the Pharmacological Treatment of Hypertension in Adults, contains new recommendations to help countries provide hypertension care more effectively.

“The new global guidelines for the treatment of hypertension are released for the first time in 20 years and provide the most up-to-date, current and evidence-based recommendations for prescribing antihypertensive drugs in adults,” said Dr Taskeen Khan, spokesperson for the WHO Department of Noncommunicable Diseases.

The recommendations indicate blood pressure parameters at which drug therapy should be started, principles for choosing a drug or combination of drugs, target blood pressure levels, and the frequency of control blood pressure measurements. In addition, the guidelines outline basic mechanisms for the participation of physicians and other health care workers in improving the detection and management of hypertension.

“The need for better control of hypertension cannot be overemphasized. By following the recommendations in these new guidelines by expanding and facilitating access to blood pressure medications, ensuring that comorbidities such as diabetes and pre-existing heart disease are identified and treated, promoting healthier diets and regular physical activity, and more strictly regulating tobacco products “, countries can save lives and reduce public health costs,” said Dr. Bente Mikkelsen, Director of the WHO Department of Noncommunicable Diseases.

NOTES TO EDITORS

Article 'Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2021: a pooled analysis of 1,201 population-representative studies with 104 million participants' [Worldwide trends in hypertension prevalence and progress in its treatment and control from 1990 to 2021 : a pooled analysis of data from 1201 population-based representative studies involving 104 million people] was prepared by the NCD-RisC Initiative Collaborative and published in The Lancet. DOI: 10.1016/S0140-6736(21)01330-1.

Data were drawn from 1,201 studies involving 104 million people aged 30–79 years in 184 countries and recording blood pressure and treatment data.

Hypertension was defined as: systolic blood pressure ≥140 mmHg. Art., diastolic blood pressure ≥90 mmHg. Art. and/or taking medications for hypertension.

The publication uses the name “South Korea” to refer to the Republic of Korea referred to in this press release.

Imperial College London

Imperial College London is one of the world's leading universities. The activities of the college, which has 20,000 students and 8,000 employees, is aimed at solving the most pressing problems in the fields of science, medicine, technology and business.

According to The Times: Higher Education magazine, Imperial College ranks fifth in the world in terms of international activity, with academic interaction with more than 150 countries. For its exceptional culture of entrepreneurship and connections to the professional environment, Reuters named the college the most innovative university in the United Kingdom.

Imperial College staff, students and alumni are engaged every day in the fight against COVID-19. The college employs almost two thousand representatives of socially important professions and masters the cutting-edge of epidemiology, virology of coronaviruses, development of vaccines and diagnostic tools. More than a thousand Imperial College staff and students volunteer to help the country's National Health Service. https://www.imperial.ac.uk/

World Health Organization

Guided by the well-being of all people and informed by science, the World Health Organization (WHO) guides and supports the global community's efforts to give everyone, everywhere, a fair chance to live a safe and healthy life. WHO is the UN health agency that brings countries, partners and people together to address the most pressing issues in 150 or more places around the world, leading the global response to health emergencies, preventing disease, addressing the root causes of health problems and expanding access to medicines and health care. Our mission is to improve health, keep the world safe, and reach vulnerable populations with services.

Ten countries with the lowest prevalence of hypertension in 2021

WOMEN

MEN

Ten countries with the highest prevalence of hypertension in 2021

WOMEN

MEN

Ten countries with the highest rates of hypertension treatment in 2021

WOMEN

MEN

Ten countries with the lowest rates of hypertension treatment in 2021

WOMEN

MEN

Ten countries that have seen the largest increases in hypertension between 1990 and 2021

WOMEN

MEN

Ten countries that saw the largest declines in hypertension between 1990 and 2021

WOMEN

MEN

Ten countries that saw the largest increases in treatment coverage between 1990 and 2021

WOMEN

MEN

What is hypertension?

Blood pressure is the force that circulating blood exerts on arteries, the most important blood vessels in the body.
Hypertension is characterized by an excessive increase in blood pressure. Blood pressure is described by two indicators. The first indicator (systolic pressure) represents the pressure in the blood vessels at the moment of compression, or contraction, of the heart muscle. The second indicator (diastolic pressure) represents the pressure in the vessels at the moment when the heart is at rest between two contractions.

The diagnosis of “hypertension” is made in cases where, according to pressure measurements taken on two different days, the systolic pressure value on both days is equal to or exceeds 140 mmHg. Art. and/or the diastolic pressure value on both days is equal to or greater than 90 mmHg. Art.

Hypertension in Russia has become an epidemic

Keep it 140/90

— It is in the off-season, in particular at the beginning of autumn, that the frequency of hypertensive crises and angina attacks increases, which is directly related to significant changes in the environment (shortened daylight hours, changes in atmospheric pressure, an abundance of days with cold windy weather, rains). All these factors undoubtedly lead to an exacerbation of chronic cardiovascular diseases,” the deputy explained to MK. Chief physician for the medical unit (outpatient section of work) of the City Clinical Hospital named after. Bakhrushin brothers, candidate of medical sciences, surgeon Alexander GUSEV. “Besides, the autumn weather is not conducive to daily walks in the fresh air. City dwellers, especially older ones, begin to move less, which also negatively affects their cardiovascular system.

But it is during the off-season that it is extremely important to carefully monitor your blood pressure, the expert explains, not to skip taking prescribed medications, and to always have emergency medicine with you (for example, nitroglycerin). And also - visit your doctor in a timely manner. And don't stop moving. Walk in the fresh air in any weather - at least 30 minutes at a comfortable pace. This load is exactly what is necessary for the proper functioning of your heart.

HELP "MK"

In Russia, for many years, women suffered more from arterial hypertension, now men have actively begun to join their ranks - in terms of heart attacks and strokes, they are catching up with the weaker sex. Although today women are ahead of men in this regard: the incidence of hypertension among women is 41.1%, among men - 39.2%. These include Russians with borderline indicators, approximately 30%. So arterial hypertension is a real scourge of the time: in our country, up to 1.3 million people die annually from cardiovascular diseases alone. Against this background, dangerous coronary heart disease develops almost 4 times more often, and cerebral strokes - 7 times more often!

It would seem that today it is so easy to diagnose blood pressure, you don’t even need to see a doctor. There are various tonometers: automatic, semi-automatic, mechanical. They differ in the type of use (home, professional, children), and in the location of the cuff (tonometers can be installed on the shoulder, on the wrist). But the problem is that at the initial stage there are essentially no disturbing symptoms. Although therapists are already at 140/90 mm Hg. Art. talk about arterial hypertension. But people often turn to doctors only when there are already negative changes in the internal organs - in the heart, in the kidneys, in the brain, in the vessels of the fundus, etc. This means that the risk of complications, including heart attacks and strokes, is already quite high.

“High blood pressure continues to be the main risk factor for myocardial infarction, coronary heart disease, heart and kidney failure,” adds another expert, doctor, Ph.D. Sergey Yakovlev. “And this is connected not only with the atmosphere, heredity, but also with the way of life: poor nutrition, physical inactivity (people move less and less in the technological age), stress. But this disease can be slowed down at the initial stage with even a basic adjustment in diet and thereby reduce the risk of vascular accidents. Research suggests that if the upper pressure (systolic) is reduced by just 3 mm Hg. Art., the risk of death from stroke will decrease by 8%, and heart attack (coronary heart disease) by 5%. And limiting the menu of salt and fatty foods will help reduce it (along with medications).

Unfortunately, the Russians, following the Americans, also began to gain weight sharply. And in our country over the past decades, the number of not only overweight adults has increased, but also children and adolescents who, due to obesity, have an increase in blood pressure. Experts are already talking about a quarter of our population being obese. We seem to be on track to catch up with America in this regard, where already approximately 65% ​​of adults have a body mass index (BMI) of more than 25 kg/g2, which is an indicator of overweight; 30% are obese (BMI >30 kg/g2).

But... Only one decrease in body weight by 5.1 kg leads to a decrease in systolic (upper) and diastolic (lower) blood pressure by 4.4 and 3.6 mm Hg. Art. respectively.

Remove salt and fat from the table

According to our experts, reducing your weight is not difficult: just switch to a low-calorie diet, add as much physical activity as possible and reduce the amount of salt you consume. Many studies have been conducted around the world to evaluate the effect of salt on blood pressure, experts add. It was established: a decrease in salt in the menu by only 0.9 g/day. Helps reduce blood pressure in all patients.

In principle, a small amount of salt should be taken every day. But... small! Experts even set the norm: 1.5 g/day. But today this is difficult to achieve, because... A huge number of semi-finished products are sold and manufacturers do not skimp on adding a lot of salt to them, which allows them to preserve products for a long time. Perhaps this is why the recommendations of experts have changed: now the daily sodium intake is no more than 2.3 g. But groups at risk for hypertension are recommended to switch to foods with a lower salt content or to salt-free diets.

But experts recommend increasing the presence of potassium in foods - it helps lower blood pressure. And the evidence is obtained from experimental, epidemiological and more than 30 clinical studies. It was established: an increase in the concentration of potassium in the urine to 2 g/day. leads to a decrease in systolic and diastolic blood pressure by 4.4 and 2.5 mm Hg. Art. in patients with arterial hypertension and by 1.8 and 1.0 in healthy people. Experts advise: potassium intake per day is 2.9–3.2 g for men and 2.1–3.3 for women.

But all the recommendations of experts fall into thin air: only 10% of men and less than 1% of women follow these tips.

So what foods should you eat to make up for the lack of potassium in the body and thereby not lead yourself to a cardiovascular disaster? It turned out that it’s nothing complicated: just add more vegetables, fruits, cereals, nuts, and legumes to your menu, focusing on foods containing potassium, calcium, and magnesium—and you can see the results in just a couple of weeks. However, such a diet is not suitable for patients with stage 3 chronic renal failure.

And if you add more foods containing calcium to the menu (400 mg/day), this will help reduce upper blood pressure by 0.9–1.4 mm Hg. Art., lower - by 0.2–1.8.

Genes know a lot

Genetic factors also play a role in lowering blood pressure. As the experts explained, “elevated blood pressure levels are “controlled” by six genes, mutations in which lead to increased reabsorption (reabsorption) of sodium in the kidneys.” And the decrease in blood pressure is due to eight genes; mutations in them inhibit renal sodium reabsorption.

And even in this case, you can influence blood pressure with the help of diet, our experts are convinced. Moreover, it is necessary to start already in childhood. This is especially true today due to the growing number of obese children. It’s easier with older patients - their body is able not only to adequately respond to a diet aimed at normalizing blood pressure numbers, but even to maintain the results achieved.

As already mentioned, one of the most important elements that nature gives us to maintain normal blood pressure is potassium. It helps maintain fluid and electrolyte balance in the body, avoid calcium loss, reduce the risk of stroke, and protect blood vessels from oxidative damage.

“Thanks to the microelement potassium, muscle contraction, including the myocardium, is controlled,” adds nutritionist and gastroenterologist Ksenia SELEZNEVA. “That’s why potassium is so good for the cardiovascular system. It also regulates water exchange and maintains the pH balance of the internal environment of the body. When the pH shifts to the acidic side, potassium helps to equalize the acid-base balance.

There is a lot of potassium in greens, the expert adds. Don't forget about the beneficial fiber they contain.

Photo: Gennady Cherkasov

10 foods that contain the most potassium : dried apricots, prunes, avocados, salmon, spinach, pumpkin, oranges, potatoes, sun-dried tomatoes, beans. There is potassium in legumes, as well as in animal meat (lamb, broilers, beef - approximately 300 mg of potassium and 200 mg of phosphorus per 100 g of product). Bananas also contain a lot of potassium.

...Arterial hypertension must be treated, even if its characteristic symptoms have not yet appeared, but only a persistent increase in blood pressure has been recorded - all our experts agree on this. It has now been reliably proven that a significant reduction in the risk of myocardial infarction and stroke (by 40% and 16%, respectively) occurs even with a decrease in blood pressure by 13/6 mmHg.

With effective treatment of hypertension, it would theoretically be possible to save about a third of the lives of men and women - this is data from the State Research Center for Preventive Medicine. Men and women with a systolic (upper) blood pressure of 180 mm Hg. Art. and more, live 10 years less compared to those who have 120 mm Hg. Art.

But, alas, hypertension, which has been studied quite well today, is still the cause of severe complications and many deaths. The results of sample studies indicate that only less than half of Russians know that they have arterial hypertension, and just over a third take treatment at all.

AND NOW - ATTENTION!

Most risk factors for arterial hypertension can be prevented by a person himself. You just need:

reduce the amount of fatty foods in your menu, focusing on lean beef, skinless poultry, fish, vegetables, fruits, and nuts. This is especially true for those who already have abdominal obesity (fat is mainly deposited on the stomach). The waist circumference for men should not be more than 94 cm, for women - more than 80 cm);

give your muscles at least some physical activity: run in the park, swim in the pool, spin a bicycle at home;

eat under-salted food (or better yet, remove the salt shaker from the table);

do not drink alcohol, especially strong alcohol, or reduce its consumption to a minimum (100 g of vodka contains 220–240 kcal, a 0.5 liter bottle contains 1175 kcal);

give up cigarettes (when smoking, food is not completely digested, and the person becomes fat).

By the way, 80% of Russians have at least one of these risk factors. And it is enough to get rid of at least one of them for death to slow down its steps.

As easy as pie.

What are the risk factors for hypertension?

Controllable risk factors include unhealthy diets (excessive salt intake, high levels of saturated fat and wasteful foods, insufficient consumption of fruits and vegetables), lack of physical activity, tobacco and alcohol use, and overweight and obesity.

Uncontrollable risk factors include a family history of hypertension, age over 65, and underlying medical conditions such as diabetes or kidney disease.

What are the typical symptoms of hypertension?

Hypertension is called the “silent killer”. Most patients with hypertension are not even aware of the problem, since hypertension often does not give warning signs and is asymptomatic. This is why it is so important to measure your blood pressure regularly.

When symptoms occur, they may include early morning headaches, nosebleeds, irregular heart rhythms, blurred vision and ringing in the ears. Severe hypertension can cause weakness, nausea, vomiting, confusion, internal tension, chest pain and muscle tremors.

The only way to detect hypertension is to have your blood pressure measured by a medical professional. Blood pressure measurement is quick and painless. Although it is possible to measure your blood pressure yourself using automatic devices, a medical professional must conduct the assessment to assess the risk and associated disorders.

Hypertension, according to statistics, is diagnosed in 40% of the Russian population

First of all, it is necessary to measure the patient’s pressure on both arms and write down the readings. Photo by RIA Novosti

One of the most common reasons for calling an ambulance is a hypertensive crisis. Most often it occurs in older people, but recently it often occurs in young people, even twenty-year-olds. In what cases does this pathological condition occur? How does it manifest itself? What is first aid? These questions are of interest to many people, especially those who suffer from hypertension, which, according to statistics, is diagnosed in approximately 40% of the Russian population.

According to the dictionary of medical terms, a hypertensive crisis is a sharp exacerbation of hypertension over a short period of time. This condition can be provoked by both exogenous (external) and endogenous (internal) factors.

The former include, in particular, stress, sudden changes in weather, excessive consumption of salt and water, and alcohol intake. Among the endogenous factors, it is worth noting disturbances in the functioning of the kidneys, hormonal disorders, and unauthorized withdrawal of medications prescribed by a doctor that lower blood pressure. In addition, a hypertensive crisis can occur against the background of progression of coronary heart disease (CHD).

Diagnosis of a hypertensive crisis is based on the following signs: the sudden onset of an attack (and before this the person may feel well), a sharp increase in blood pressure for a particular patient (taking into account the values ​​​​that are familiar to him), as well as his individual complaints. So, if a hypertensive crisis is mild, the patient, for example, complains of a severe headache and a feeling of uncertainty when walking. In more severe forms of the crisis, nausea and vomiting are observed, and the patient may faint.

The diagnostic criterion for a hypertensive crisis is an increase in pressure above 180/120 mm Hg. Art. Sometimes one of the indicators, for example, upper (systolic) pressure, reaches high numbers. But there are cases when symptoms of a hypertensive crisis are observed at lower values ​​than the above values. Let us note that the severity of the patient’s condition in most cases is determined by the rate of increase in blood pressure, and not by its absolute indicators.

Depending on the clinical manifestations, hypertensive crisis is divided into two types: hyperkinetic and hypokinetic.

The first is characterized by a sudden onset, redness of the face, rapid heartbeat, and sweating. Frequent urination, the appearance of chest pain typical of angina pectoris, and heart rhythm disturbances are possible. The duration of the attack is from 2 to 4 hours.

Symptoms of a hypokinetic crisis increase gradually. Thus, there is a significant increase in lower (diastolic) pressure, pale skin, drowsiness, lethargy, pain in the heart and headache. In addition, the patient experiences confusion, short-term deterioration in vision and hearing, and difficulty speaking. Hypokinetic crisis usually occurs in the late stages of hypertension.

What should relatives or colleagues do if a person has an attack at home or at work? First of all, measure the pressure in both arms and write down the results, since the emergency doctor will need them to assess the patient’s condition. As for medications, the patient should be given the drug that he usually takes for high blood pressure, and call an ambulance as quickly as possible. And before the doctors arrive, provide first aid.

The patient must be placed comfortably in a chair or placed in bed so that the head (with the help of pillows) is necessarily raised. He needs to unbutton his collar and, if possible, remove any tight clothing. It is also necessary to open a window or vent to provide fresh air. In addition, before the ambulance arrives, it is advisable to give the patient a hot foot bath or simply put a heating pad (a couple of bottles of hot water) on his feet. And if you have mustard plasters in your first aid kit, you can put them on the back of his head. It is also a good idea to give the patient a sedative.

The emergency doctor, having assessed his condition, will inject him with a drug to relieve the attack. In severe cases, hospitalization is necessary. A hypertensive crisis is dangerous due to its consequences, for example, the development of acute cerebrovascular accident, coma (profound depression of the functions of the central nervous system) and other serious complications. Therefore, a person suffering from hypertension should not voluntarily stop taking medications prescribed by a doctor.

What is prevention? First of all, avoid stress and monitor your blood pressure levels on a daily basis. Follow the work and rest schedule, as well as the diet recommended by your doctor. In particular, avoid spicy and fatty foods, salt, smoked sausage, and pickled foods. Remember that the daily volume of fluid consumed should not exceed one liter.

What are the complications of uncontrolled hypertension?

Among other complications, hypertension can cause serious harm to the heart. Excessive pressure can cause artery walls to lose their elasticity and reduce the flow of blood and oxygen to the heart muscle. This increased blood pressure and decreased blood flow can cause:

• chest pain, also called angina;
• a heart attack that occurs when blood flow to the heart is blocked, causing heart muscle cells to die from oxygen starvation; the longer blood flow is blocked, the more serious the damage to the heart;
• heart failure, in which the pumping function of the heart muscle cannot fully supply other important organs with blood and oxygen;
• cardiac arrhythmia, which can lead to sudden death.

Hypertension can also cause stroke, causing the arteries that supply blood and oxygen to the brain to rupture or become blocked. In addition, hypertension can cause kidney failure caused by kidney damage.

Why is hypertension an issue in low- and middle-income countries?

The prevalence of hypertension varies across regions and countries of different income categories. Hypertension is most prevalent in the WHO African Region (27%) and lowest in the Region of the Americas (18%).

The number of adults with hypertension increased from 594 million in 1975 to 1.13 billion in 2015, primarily in low- and middle-income countries. This increase is mainly due to increased risk factors for hypertension among the populations of these countries.

How does WHO respond to the problem of hypertension?

The World Health Organization (WHO) is supporting countries to reduce the prevalence of hypertension as a public health problem.

In 2021, WHO released new guidelines for the pharmacological treatment of hypertension in adults. The publication provides evidence-based recommendations on when to begin treatment for hypertension, as well as recommended follow-up intervals for the patient. The document also identifies blood pressure targets that must be achieved to control hypertension and provides information on health care actors who can initiate treatment.

In September 2021, to help governments improve the prevention and treatment of cardiovascular disease, WHO and the United States Centers for Disease Control and Prevention (CDC) launched the Global Hearts Initiative, which developed the HEARTS technical intervention package. The six modules of the HEARTS technical package (healthy lifestyle counselling, evidence-based treatment protocols, access to essential medicines and technologies, risk-based case management, team-based care and monitoring systems) provide a strategic approach to promoting cardiovascular health. -vascular system in various countries of the world.

In September 2021, WHO launched a partnership with Vital Strategies' Resolve to Save Lives initiative to support governments in implementing the Global Hearts initiative. Other partners involved in the Global Hearts Initiative include: US CDC Foundation, Global Health Advocacy Incubator, Johns Hopkins Bloomberg School of Public Health, Pan American Health Organization (PAHO) and US CDC. Since the program began in 2021, 3 million people in 18 low- and middle-income countries have received hypertension treatment protocols through patient-centered care models. These programs provide clear evidence of the feasibility and effectiveness of standardized hypertension control programs.

ARTERIAL HYPERTENSION: EPIDEMIOLOGICAL SITUATION IN RUSSIA AND OTHER COUNTRIES

prevalence of arterial hypertension, risk factors, prognosis. Drawings and diagrams

The article is devoted to studying the prevalence of arterial hypertension (AH) among the population of some cities in Russia and other countries. It has been established that the frequency of hypertension among men and women living in some cities of Russia is significantly higher than the average for most countries of the world. Based on the material of prospective studies, risk factors that most significantly influence the prevalence of hypertension were identified. According to the study, hypertension is the main risk factor for death from cardiovascular diseases for the Russian population.

The work was carried out using unified, strictly standardized epidemiological research methods and unified criteria for measuring blood pressure and assessing other risk factors.

The paper covers the studies into the prevalence of arterial hypertension (AH) in the populations from some cities and towns of Russia and other countries. The incidence of AH among the males and females who live in some cities and towns of Russia is much higher than the mean rates in most countries of the world. Risk factors that make the most significant contribution to the prevalence of AH are defined on the basis of prospective studies. The latter show that AH is a major risk factor of cardiovascular diseases of Russia's population. The present study has been performed by using the common, strictly standardized epidemiological surveys and the unified criteria for measurement of blood pressure and assessment of other risk factors.

G.S. Zhukovsky, V.V. Konstantinov, T.A. Varlamova, A.V. Kapustina.

State Center for Preventive Medicine of the Ministry of Health of the Russian Federation, Moscow.

GS Zhukovsky, VV Konstantinov, TA Varlamova, AV Kapustina

State Center of Preventive Medicine, Ministry of Health, Russian Federation, Moscow

Prevalence of hypertension among the population of the Russian Federation

In Russia, as in most economically developed countries, arterial hypertension (AH) is one of the most common cardiovascular diseases. Summary results of an epidemiological study conducted in Russia in 1984 - 1986. among the male population 20 - 54 years old in 7 cities located in different regions of the country are presented in table. 1. The prevalence of hypertension among this population ranges from 11 to 29%, varying by region by 2-3 times and averaging 18.6%. In other words, in Russia every 5th man of working age suffers from hypertension. A more detailed analysis of the prevalence of hypertension in individual age groups of men shows that in Russia, on average, every 14th man (7.1%) aged 20 - 29 years has hypertension, and at the age of 30 - 39 years - every 6th (16 ,3%), 40 - 49 years old - every 4th (26.9%), and at the age of 50 - 54 years, every 3rd man suffers from this disease (34.4%). The prevalence of hypertension in Russia among women is also high. This is evidenced by data from a one-time epidemiological study conducted in Moscow (Krasnopresnensky district) in 1979 - 1981. among the male and female population 20 - 69 years old. In Fig. 1 shows that in general, among the male and female population 20 - 69 years old, the prevalence of hypertension is the same: every 5th man and every 5th woman suffer from it (22.3 and 21.8%, respectively). However, there are significant gender-related differences in the age dynamics of the prevalence of this pathology: if in the age range of 20 - 49 years in men and women the prevalence of hypertension increases equally with age, then in the age range of 40 - 69 years the indicator in men changes little (32 ,8 - 41.1%), while in women it continues to increase rapidly compared to the age group 40 - 49 years: twice in 50 - 59 years (34.7%) and three times in 60 - 69 years ( 57.6%). Of course, the fact that every 14th woman aged 30–39 years old suffers from hypertension, which often leads to an unfavorable outcome of pregnancy and childbirth, cannot but cause concern.

Table 1. Age-standardized prevalence of hypertension per 100 men 20 - 54 years old living in cities of various regions of Russia

*Age standardized indicator.

Prevalence of hypertension in other countries

A huge amount of data from epidemiological studies conducted in different countries could be cited for comparison. But such comparisons are more legitimate if the results of one international study are compared, carried out in a number of countries using a single protocol, which presupposes a unified strategy for selecting the population for examination, a sufficient response (the percentage of those actually examined from the number of those subject to examination), a unified methodology for measuring blood pressure (BP) and unified criteria for evaluating measurement results, a system of external and internal data quality control, a computer program for data rejection and mathematical and statistical analysis. The international MONICA study satisfies the above requirements. Survey results in 1984 - 1985. random samples of the male and female population aged 35 - 64 years in Russia and other countries participating in this study are presented in Fig. 2 and 3. From these data it follows that the prevalence of hypertension in Moscow (Oktyabrsky district) is significantly higher than the average for other countries (36.6 and 27.5% among men and 37.7 and 24.3% among women, respectively).

Hypertension and other risk factors

Based on the data from the above-mentioned study in 7 cities of Russia, a multivariate regression analysis was carried out to determine the magnitude of the relationship between the prevalence of hypertension and other factors taken into account in the program: overweight (BMI), alcohol abuse, smoking, hypercholesterolemia (HCS), hypertriglyceridemia (HTG) , level of education (Table 2). With an increase in the level of each of the mentioned factors, except education, the prevalence of hypertension increases, and only with an increase in the level of education does this indicator decrease. Obviously, this indicates that a lifestyle associated with a low level of education (below average) contributes to an increase in the prevalence of hypertension, while the lifestyle of people with higher education helps to reduce the prevalence of this pathology. According to the strength of influence on the prevalence of hypertension, the above-mentioned factors were distributed as follows: BMI (the strongest factor), then TG, education, hypercholesterolemia, smoking, alcohol consumption. The question arises: to what extent do the established and measured determinants of the prevalence of hypertension determine changes in this indicator in space (inter-territorial differences) and in time (dynamics of the indicator over the studied period of time)? The materials of a cooperative study carried out in the indicated 7 cities of Russia (Table 3) indicate that in Novosibirsk, where the prevalence of hypertension was 2-3 times higher than in St. Petersburg and Yakutsk, in cities with a minimum level of this indicator (28.6 and 14.5%, respectively), the prevalence of BMI is significantly higher (12% in Novosibirsk and 10% each in two other cities), and the prevalence of smoking was significantly higher in Novosibirsk (62 and 56%, respectively). At the same time, the prevalence of severe hypercholesterolemia (the concentration of total cholesterol in the blood more than 249 mg/dl) was almost the same in cities with the maximum and minimum prevalence of hypertension (15 and 16%, respectively; p > 0.05). Unfortunately, it was not possible to compare objective data on alcohol consumption in cities with the maximum and minimum prevalence of hypertension due to the absence of an anonymous questionnaire in the study.

Dynamics of hypertension prevalence

To assess the dynamics of the prevalence of hypertension, we used data from the above-mentioned MONICA study in Moscow (Oktyabrsky district), obtained in screening surveys of random independent samples of the population in 1984 - 1985, 1988 - 1989 and 1992 - 1994. (Table 4). For the period from 1984 - 1985 to 1992 - 1994. There is a steady, pronounced decrease in the prevalence of hypertension both among men (from 37 to 26%; p < 0.001) and among women (from 38 to 26%; p < 0.001). A decrease in the prevalence of hypertension both among men and women is associated with a rapid decrease in the frequency of BMI (from 28 to 17% in men; p < 0.001; from 46 to 30% in women; p < 0.01), hypercholesterolemia (from 21 to 10% in men; p < 0.01; from 20 to 15% in women; p < 0.05) with virtually no changes in the prevalence of smoking among women (14 and 13%, respectively) and men (41 and 48%, respectively; p > 0.05). Consequently, the decrease in the prevalence of hypertension over the period from 1989 - 1990 to 1992 - 1994. both men and women contributed to a significant reduction in the prevalence of BMI and hypercholesterolemia. The decrease in the prevalence of BMI and hypercholesterolemia is most likely due to a sharp reduction, according to the Research Institute of Nutrition of the Russian Academy of Medical Sciences, in the average daily consumption of total fats by the population (from 96.7 g in 1989 to 79.1 g in 1992), carbohydrates (from 346. 2 to 323.4 g) and animal proteins (from 45 to 34.2 g). The observed intensive decrease in the prevalence of hypertension occurred against the background of a rapid increase during this period in the proportion of the population with psychological stress (pronounced psycho-emotional stress). The relevant data from the MONICA study are presented in Table. 5. Thus, the percentage of people who assessed their relationships with close relatives as good during the specified period decreased from 34.9 to 28.6% (p < 0.05); at the same time, the proportion of people who assessed their relationships with loved ones as tense and conflicting almost doubled (from 7.9 to 13.2; p < 0.05). The percentage of people satisfied with their income decreased threefold (from 40.6 to 14.1%; p < 0.05) while the proportion of the population dissatisfied with their income doubled (from 34.1 to 65.1%; p < 0. 05). Finally, during this period, there was a doubling of the proportion of the population that is generally dissatisfied with the last year of their life (from 15.6 to 27.1%; p < 0.05). At first glance, these data do not agree with the observed dynamics of the prevalence of hypertension, since it is well known that psychological stress plays a significant role in the pathogenesis of hypertension. However, there are examples where severe psychological stress in the population does not lead to an immediate increase in the prevalence of cardiovascular pathology. The latter is observed some time after exposure to a psychotraumatic factor (an example in this regard could be the population of besieged Leningrad during the Second World War).

Table 2. Multivariate regression model of factors making an integral contribution to the prevalence of hypertension in men 20 - 54 years old living in cities of different regions

Note. Hypo-a-CS - hypoalphacholesterolemia

Prognostic value of hypertension

Hypertension causes enormous harm to public health, being the strongest risk factor for morbidity and mortality from cardiovascular diseases. Data on the effect of hypertension on mortality from coronary artery disease and cerebral strokes, taking into account a number of other main risk factors, are presented in Fig. 4. In the group of men with hypertension, over 10 years of observation, mortality from ischemic heart disease and cerebral strokes increases more than twice (from 2 to 4.6 per 1000 men; p < 0.05), and when hypertension is combined with dyslipoproteinemia and/or smoking - almost 7 times (from 2 to 13.2 per 1000 men; p < 0.05) compared with the group of men who do not have these three main risk factors. A generalized characteristic of damage to public health caused by hypertension is a reduction in average life expectancy (ALL) in that part of the population that has high blood pressure. The corresponding data is presented in Fig. 5 using the example of men aged 40 years; The life table was constructed based on the results of the aforementioned long-term prospective study in Moscow (Oktyabrsky district). Data in Fig. 5 show that in men 40 years old who had hypertension, the life span was 6 years less than in men of the same age who did not have this pathology. Moreover, if at a level of diastolic blood pressure corresponding to mild hypertension (90 - 104 mm Hg), the life span decreases by 1.7 years, then at a diastolic blood pressure of 115 mm Hg. Art. and more - almost 9 years (p < 0.05). Threshold values ​​of systolic and diastolic blood pressure that have an unfavorable prognostic value are presented in table. 6. With an increase in systolic blood pressure to 140 mm Hg. Art. changes in mortality from cerebral stroke were not of a regular nature, varying within the statistical error. However, when systolic blood pressure is above 140 mm Hg. Art. There is a marked increase in mortality from cerebral stroke. Systolic blood pressure is above 160 mm Hg. Art. combined with a sharp increase in mortality from cerebral stroke (12 per 1000 men over 13 years of observation).

Table 3. Age-standardized prevalence rates (in %) of a number of risk factors for hypertension among men 20 - 54 years old living in cities of various regions of Russia (1984 - 1986)

Table 4. Standardized prevalence rates (in %) of risk factors among men (M) and women (F) 35 - 64 years old, identified during screenings conducted between 1984 and 1994.

* p < 0.05. ** p < 0.01. *** p < 0.001 (for indicators identified among individuals of the same sex).

Table 5. Dynamics of the prevalence of psycho-emotional tension (stress) among the population for the period from 1989 - 1990 to 1992 - 1994. according to the MONICA program, Moscow

Table 6. Mortality from cerebral stroke depending on blood pressure per 1000 men 40-59 years old over 13 years of prospective observation

D.ecili blood pressure (X + s), Mortality from cerebral strokes per 1000 mmHg person-years

Systolic

Diastolic

Diastolic blood pressure level is 95 mm Hg. Art. and higher is associated with a unidirectional increase in mortality from cerebral stroke. At the same time, an increase in diastolic blood pressure for every 5 mm Hg. Art. is accompanied by a doubling of the mortality rate from cerebral stroke: if diastolic blood pressure is 95 - 99 mm Hg. Art. Mortality from cerebral stroke was 2.7 per 1000 men, then in the range of 100 - 105 mm Hg. Art. mortality increased to 4.5 per 1000 men, and with diastolic blood pressure values ​​of 106 mm Hg. Art. and higher mortality from cerebral stroke during the specified observation period was 10.6 per 1000 men. Therefore, systolic blood pressure is above 140 mmHg. Art. and diastolic blood pressure 95 mm Hg. Art. and higher have an unfavorable prognostic value and require correction.

Literature:

1. Zhukovsky G.S., Shalnova S.A., Deev A.D. The prevalence of arterial hypertension and its relationship with the main risk factors in women 20 - 69 years old (according to a cross-sectional epidemiological study). Bull. VKSC AMS USSR. - 1983. - No. 1. — P. 16-26. 2. Zhukovsky G.S., Varlamova T.A., Konstantinov V.V. and others. Patterns of formation of dynamics and territorial differences in the epidemiological situation in relation to coronary heart disease. Cardiology. - 1996. - No. 3. — P. 8-18. 3. Konstantinov V.V., Zhukovsky G.S., Konstantinova O.S. etc. Comparative characteristics of the prevalence of arterial hypertension in connection with the main risk factors for coronary artery disease in men and women aged 20 - 69 years (epidemiological study). Ter. arch. - 1988. - No. 1. — P. 7-14. 4. Konstantinov V.V., Zhukovsky G.S., Oganov R.G. and others. Epidemiology of systolic and diastolic arterial hypertension in connection with risk factors and education among the male population in some cities of Russia, the CIS countries and the Baltic states (cooperative study). Ter. arch. - 1994. - No. 1. — P. 54-57. 5. Kopina O.S. Approach to the study of psychosomatic conditions in preventive cardiology // Prevention, clinical examination, diagnosis and treatment of cardiovascular diseases. - Riga, 1985. - pp. 167-169. 6. Kapustina A.V., Zhukovsky G.S., Barsov D.A., Deev A.D. Average life expectancy (ALE) for men over 40 years of age, depending on the values ​​of various risk factors. Scientific and practical conf. “Current problems of prevention of non-communicable diseases”: Abstracts of reports. - M., 1995. - P. 68-69. 7. Oganov R.G. Preventive cardiology in the USSR. Ter. arch. - 1985. - No. 11. — P. 3-6. 8. Chazov E.I., Wichert A.M., Oganov R.G. Epidemiology of major cardiovascular diseases in the USSR. Proceedings of the Academy of Medicine. Sciences of the USSR. - T. 1. - M., 1985. - P. 36-52. 9. Towards a healthy Russia. GNITS PM MZ and MP RF. - M., 1994. - P. 32-35. 10. The Lipid Research Clinics Program: Protocol of the Lipid Research Clinics Program Prevalence Study. Chapel Hill, North Carolina, Central Patient Registry and Coordinating Center, Department of Biostatistics, University of North Carolina, 1974. 11. WHO MONICA Project: Risk Factors. Intern J of Epidemiol 1989;18:(Suppl 1):S46-S55.