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Prevention of hypertension, the most frequent cardiovascular disease .

Prevention of hypertension, the most frequent cardiovascular disease. prof. dr hab. med. Kalina Kawecka-Jaszcz, dr med. Piotr Jankowski I Department of Cardiology IK CMUJ Kraków. 14.10.2005 r. The most important causes of death in the world. tys. Ezzatti M. Lancet 2002; 360: 1347.

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Prevention of hypertension, the most frequent cardiovascular disease .

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  1. Prevention of hypertension, the most frequent cardiovascular disease. prof. dr hab. med. Kalina Kawecka-Jaszcz, dr med. Piotr Jankowski I Department of Cardiology IK CMUJ Kraków 14.10.2005 r.

  2. The most important causes of death in the world tys. Ezzatti M. Lancet 2002; 360: 1347

  3. The risk of cardiovascular event according to the presence of hypertension. Kannel WB: JAMA 1996, 275, 1571.

  4. 2002 Hypertension in Poland 29 M 8.7 M 8.4 M Optimal BP Normal BP High normal BP Hypertension T.Zdrojewski NATPOL III PLUS 2002

  5. Hypertension in Czech Republic Cifkova R et al. J Hypertens 2004, 22, 1479

  6. Prevention of hypertension • Smoking. • Obesity. • Physical activity. • Diet: • salt intake, • alcohol intake, • fat intake, • fruits and vegetables.

  7. Men Women Prevention of HT - obesity BMI – BP relationship mmHg Systolic BP Diastolic BP * NS NS * * * NS * BMI BMI Sharabi Y i wsp. Am J Hypertens 2004; 17: 404

  8. Prevention of HT - obesity The influence of weight reduction on the frequency of drug prescription tygodnie Whelton PK: JAMA 1998;279:839

  9. Prevention of HT - obesity BMI < 25 kg/m2 Waist < 88 cm (W) < 102 cm (M) AHA 2004

  10. Prevention of HT – physical activity 13/10mmHgFentern, Br Med. Bull 1992, 48, 630. 5-7/5-7 mmHgArroll, J Clin Epidemiol 1992, 45, 439. 6/7 mmHg (HT borderline) Fagard, J Cardiovasc Pharmacol 1995, 25-I, S20. 10/8 mmHg (HT moderate) Fagard, J Cardiovasc Pharmacol 1995, 25-I, S20. 4 – 9 mmHgESH/ESC 2003, JNC VII. The influence of regular physical activity on BP:

  11. Prevention of HT – physical activity The influence of regular physical activity on BPMeta-analysis of randomized trials 54 trials 2419 participants Mean reduction in systolic blood pressure: 4,94 mmHg diastolic blood pressure: 3,73 mmHg Reduction of BP [mmHg] Whelton SP et al.: Ann Intern Med. 2002; 136:493.

  12. Prevention of HT – physical activity Aerobic physical 30 – 45 min 4-7/week activity* Vigorous-intensity ** 20-40 min 3-5/week Moderate-intensity ** 30 min 4-7/week * - JNC VII, PTNT 2003 ** - AHA 2002

  13. Prevention of HT– salt intake Reduction in salt intake by 6 g daily (100 mmol Na+) BP reduction by about 4 - 6 mmHg ESH/ESC 2003

  14. Prevention of HT– salt intake The influence of salt intake reduction (by 40 mmol/d) on the risk of hypertension development by 14 % Observation: 36-48 months Kumanyika et al. J Hum hypertens 2005, 19, 33.

  15. EPOGH Prevention of HT– salt intake 24-hour urinary sodium excretion mmol/24h Stolarz K i wsp. Hypertension 2004;44:156.

  16. Prevention of HT– salt intake The influence of salt intake reduction on the frequency of drug prescription weeks Whelton PK: JAMA 1998;279:839

  17. Prevention of HT– salt intake Sodium intake should be perceived as the significant environmental factor, which influences not only blood pressure, but also: • left ventricular mass • arterial stiffness • sympathetic nervous activity Sodium intake was observed to be a strong modulator of the impact of the genetic factors on many of the cardiovascular phenotypes.

  18. EPOGH Ambulatory blood pressure (ABPM) and β-adducin (ADD2) C1797T polymorphism NS P=0.03 P=0.01 24-h systolic BP, mmHg 24-h Na, mmol/d P=0.01 CC T CC T CC T CC T Slavic Italian Slavic Italian β-adducinC1797T polymorphism influences urinary sodium excretion (decreased in the presence of T allele). It is also related to systolic blood pressure, but only in the populations with high sodium intake. Tikhonoff et al. Am J Hypertens. 2003;16:840.

  19. Prevention of HT– alcohol intake Pressure threshold: men: 20-30 g ethanol/d women: 10-20 g ethanol/d Consumption ≥ 3 drinks daily BP increase of 3-4/1-2 mmHg

  20. Relationship of alcohol drinking pattern to risk of hypertension N = 2609 Stranges et al. Hypertension 2004;44:813

  21. Prevention of HT– alcohol intake The influence of small amounts of alcohol on the effectiveness of the DASH diet. BP reduction [mmHg] Ann Intern Med. 1999;159:225

  22. Prevention of HT– alcohol intake In 2002: The average ethanol intake in Poland: 5.87 l/year About 4 M intemperates About 600-900 thousands dependents About 25 %increase in alcohol intake fromthe time of excise reduction in 2002. PARPA i SPBS

  23. Prevention of hypertension The influence of non-pharmacological interventions – randomized trials Kastarinen MJ. Hypertens 2002;20:2505 Mattila R. J Hum Hypertens 2003;17:199 Jankowski P, Kawecka-Jaszcz K. Nadciś Tęt 2001;8 (supl. D): 25.

  24. Prevention of HT– real life The proportions of patients advised about lifestyle in Slovenia Accetto R: Blood Press 2005; 14 (suppl 2): 22.

  25. Prevention of HT– real life The proportions of hypertensives advised about lifestyle in Poland NATPOLPLUS 2002

  26. Contraceptives pills and BP Pills Controls N = 94 BP > 140/90 mmHg in 5 % of users after 5 years Narkiewicz K i wsp. Am J Hypertens 1995, 8: 249

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